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 Welcome to this Weekend in Health, it influence where we discuss the influence of technology on health with the people who are making it happen today. Darren Din, CIO for Cedar-Sinai joins me and I love having conversations with Darren. We touch on everything we talk about Telehealth, data innovation, you name it, we touch on it.

It's one of the reasons I love talking to Darren. My name is Bill Russell, former healthcare, C-I-O-C-I-O, coach, consultant, and creator of this week in health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. I wanna thank Sirius Healthcare for supporting the mission of our show.

We have three shows on that channel. We have Newsday, we have solution showcases, and we have Influence E episodes where we talk to industry influencers. Uh, the only change you're gonna see on that channel next year. Is that the Newsday episodes are now gonna be duets. We're gonna have a series of about six guests that come through and talk, talk about the news with me.

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Welcome to the show. Yeah, I, I'm looking forward to this, this conversation every time I get you on, I think I'm gonna do a deep dive into something, but there's so many things I wanna talk to you about that I always end up asking you questions that are all over the board. But one of the comments I got on one of the shows that we did before.

One of my listeners said, Hey, you, you're not asking these people about their health system. Can you get more information? So I, I'd love to have you just share a little bit about Cedars, what you guys are up to. Just a little, little background. You guys are expanding in that LA market. Sure. Well, thanks again for having me.

And listen, what a great question. I love talking about Cedar-Sinai great, great organization here in LA County. L Cedars Sinaii is built around the flagship hospital of Cedars Sinai Medical Center, which in itself is different in many ways. It is a almost thousand bed academic medical center that has all of the stereotypical things you would expect in an academic, tertiary, quaternary organization.

But we also act as the community hospital for a large part of our region. So it makes up for, uh, a lot of diversity and a lot of, uh, different types of care settings built in and around the organization, largely around the main medical center has been like many organizations across the country. Just a tremendous amount of growth in the ambulatory space.

And maybe what, uh, makes us a little bit different, which is unique to LA is that while we have many, many locations, they're geographically pretty close to each other as the bird flies. But of course, long to get through when traffic come into play, who knows what the new realities will bring in a post covid world.

But we just have a lot of ambulatory locations surrounding, and then again, like many organizations, we've been expanding fairly rapidly by bringing in new hospitals and new ambulatory and geographic markets under the fold, which has largely been around . Plans to expand and build scale and to ensure that we're making the right investments, uh, in our future.

But to me, I joined almost 15 years ago and I just think of it as such a special and unique place. Consider it such a big privilege to have come here and still be here. And it's really been a lot of fun to watch the organization continue to find and grow its place in the region. Yeah. Well, we're gonna talk a little bit about that growth later because I wanna talk to you about the, the Huntington Hospital, um, affiliation as well as some other things.

But, but I, I, I do wanna go back, 'cause we talked in, gosh, what was it, March, April, which, you know, was really the, the peak of Covid in New York City. Your market was experiencing some of that. We're, we're still in, in the throes of it at this moment. I guess we're right around Thanksgiving. And, uh, for those who are gonna listen to it later, these podcasts have a, have a lifespan.

So we're talking around Thanksgiving, obviously, we're talking about masking up and those kind of things. So let's talk, let's talk, carry a distance real quick. We're looking at things like reducing touch points, minimizing unnecessary contact. Creating new avenues for care to be received, how, how's that going for your health system?

What are some of the things that you guys are doing? I, I, I think it, it depends, and it's becoming an increasingly complex answer. I, I think that when we first spoke, we were in, uh, crisis mode of jumping in and doing whatever we had to do to get ourselves ready and to deliver care in what felt like a new and emergent way.

I think we then went into what we started to think of as an next phase, which is how we start to deal with sort of this, this sprint that we had to get through. And of course at that time we couldn't see the forest through the trees. It turned out that sprint was really a marathon, and now we're in that much longer period.

And I think the reality is that we're seeing. Lots of different things we need to do for different parts of our care setting much in the same way. We wouldn't refer to the idea of we're planning for doctor visits. I don't think we can, um, equally say we're planning for telehealth. The initial things we did for telehealth were broad, but now they're becoming a lot more focused.

So we're quickly starting to think of these touchless. Telehealth, the sort of the, the digital pieces we're overlaying onto the health system, not as one broad layer, but really as enabling technologies for the different types of care that we provide and the different settings that we provided. So I'll give you a couple of quick examples.

It's been very clear to us that telehealth measured against follow up visits in surgical care is something completely different. Then on demand video visits as perhaps a substitute to going to see your primary care physician or urgent care. They're really at opposite ends of the spectrum. Similarly, some of the video visit work that we've done or the telehealth visit platforms that we've stood up to enable some of our subspecialty care.

Very, very different than what you need to do in an ambulatory setting in and around internal medicine. And so really starting to understand the differences between that. Making sure that we're building the right types of enabling technologies for each one is becoming more and more important. And I think the reality is that quickly dissipating is a give back or the luxury that we've had of, well, it was quick, it was temporary.

We'll give 'em a little bit of a break. I think consumer expectation is really rising around. Some of the things that we thought we were standing up super quick and folks should be appreciative as the months are going on, you really have to harden them. Yeah. E everything you said there really made sense to me except for the primary care one.

So, Le let's unpack that one a little bit. So, te telehealth visits for primary care. I, I, is that, I mean, is that not working for the physician, not working for the expectation of the patient? Where's, where's it maybe not working as as we want it to? No, it's, it's, it's interesting. I, I think the honest answer is, I'm not sure we know yet, but I will say that our observations around primary care telehealth has probably been similar to everybody else's.

It was hovering at a low level covid hits, and it goes really, really high since new records everywhere we thought it would set. Then it slowly comes down to this equilibrium that's not at the peak and not at the low, and it's somewhere in between. And we're, I think, in the early stages of trying to unpack what that means.

And I think that there will be more than one answer. Some of it will be physician preference and practice preference. Some of it will be patient preference, some of it will be family preference, some of it will be . What was the visit really about and . Maybe what were the, the, some of the underlying sort of nuances in and around it?

Heck, we're starting to discover some simple things that we never would've thought of. We rolled out some technology support so that you could wait in your car and we would notify you and you can fill out some forms on your phone and wonderful stuff. Then we realized that hey, some of the parking lots and some of the ambulatory offices don't have cell coverage.

That's not gonna work. And so it's little things that are hurting the experience for patients that are perhaps drawing them to maybe think differently around it. And we're starting to trying to find sort of what the, what the right answers are. But I do think at the end of the day, what we have all underestimated, when we got super excited about that peak.

Was that patient preference is ultimately going to be the driver and a lot of our patients want to come and see our physicians. Yes. It's interesting. At the peak, my mom was, was saying, I want to go see my doctor. I'm like, it's the covid iss at its peak. Are you, are you sure you wanna do this? She goes, I want to see my

I was like, she was just adamant. It's, it's not like there was a, a solid argument for it. It was just. This is what I want. This is my preference. And so that, that really resonates with me. Uh, I'll tell you what the, the, the other thing that we worry about, and, and again, it'll be interesting to see how it plays out.

We have, we need to be careful about staying true to ourselves about what technology has done with healthcare. And what I mean by that is that we have many examples where the technology has been both great and wonderful. But it's also been an and and I, I think that it's gonna be interesting to see whether folks will really use as much of the telehealth as an or and not just as an and, because we're starting to see people will start with a video visit and then expect an in-person visit and then keep going.

And so I, I just think it's something that we want to, uh, keep an eye on. I. Well, and the, the, the follow-up visits in a location like yours, which has to be in the top 10 hardest to get to from if you're outside a certain boundary. It makes, makes perfect sense. And we see that in New York City. We'll see that in, uh, marks like yourself, Chicago, and others, where it's hard to get.

And so those follow-up surgical visits. Where a lot of times it's just a conversation with the doctor. It makes sense. I, I wanna talk to you about telehealth. One, one of the disservices we do to telehealth is we lump all this technology into one bucket. Telehealth is, it's, it's the virtual visits. It's also the remote patient monitoring.

It's also this whole classification, and this is the one I wanna talk to. Which is the internal video use of video and, and use of technologies to, uh, do consults, collaborate to maybe have multiple doctors see a patient at the same time. Are, are, are you guys, are, are you guys finding in the midst of covid you're doing more like video rounds and, and those kinds of things, the internal telehealth kind of solutions?

Yes and no. I, I, I, I'm not sure. I'm not, we are, I'm not sure exactly how you characterized it. So, on the inpatient side, we found that the use of video could play a couple of interesting roles. So the first was when we had very restrictive visitation policies. We discovered that video visitation. Enabling video for our patients to be able to connect to their families was really a precious gift that we could add to the care system.

It really was a tragedy, tragic story over tragic story of folks isolated in hospital rooms not being able to be with their family. And so that that was a new piece of video platform technology that we hadn't previously thought of. Another variation of that is maybe closer to what you've described, which is when we had concerns around restrictions of PPE, and we were heavily trying to conserve as much as we could, not knowing what supply chains would look like, and not knowing

What our own supply capacity was going to be. We were limiting number of folks that needed to, uh, use the PPE by having one caregiver in the room and multiple people video consult, uh, consult in. And that I think has been interesting and probably the closest thing we came to of video rounding. Part of the question that I love and I think that continues to be under leveraged is physician to physician consult, and especially constructed around perhaps multiple specialists, working with a patient around the same time and collaborating things that are often restrictive in terms of the normal sort of ambulatory models, constructs that exist.

That when you rethink things in a digital world, perhaps can be done. And while we have a few examples of that, we're in the super, super early stages of really trying to reimagine what that would look like. Interesting. I know academic medical centers, you guys compete fiercely, but collaborate liberally essentially.

Uh.

Collaboration look like during Covid,

maybe more specifically. Let's focus in on the health IT side. What did it look like for you to collaborate with your, your peers around the country? Well, first just the, the framing of that question. I, I would say that I think there's some markets where there is fierce competition. I will say that we're fortunate in the LA market that is very much characterized by collaboration.

I think that there are, at any given time, faculty that are working together between different academic medical centers on countless, countless projects and initiatives. We're constantly doing joint funded NIH research with not just our colleagues in and around town here in la, but really across the country and frankly across the world.

And I think that maybe a different topic for a different day. It's the awkwardness of cybersecurity when you have academic medical centers that their DNA is around, how do I open up and share everything? And so I think that that's the base that you're working on within it. I will say that I consider myself super, super fortunate to just pre covid, but long before have established some great, uh, relationships with colleagues across the country.

That. I think people often say, Hey, if you ever get stuck, give me a call, drop me a note. But I think that there was just this wonderful ability to collaborate with colleagues around the country, especially as Covid was popping up in different hotspots. I remember being on some email streams and being on some calls with some colleagues in New York, so useful to hear what they were thinking about the.

The steps they went through, Hey, we forgot about this technology. We forgot about extra licenses for that. We forgot about shoring up this infrastructure. It was really invaluable and I think the nature of medicine generally, I. Is to always understand, Hey, let's do a root cause analysis and figure out what we could have done even better next time.

And I think that culture is pervasive through AMCs and the willingness of people to share not just what went great, but what went wrong really has, uh, been super helpful. Yeah, no, that's fantastic. Uh, true to what I said earlier, I'm gonna bounce around how, how has the pandemic impacted the accelerators?

So you guys. Obviously have the, uh, accelerator there at Cedars, uh, around innovation. And did you have a class this year or did you postpone a class? So with, with some irony, just as Covid hit, we were wrapping up our first ever international week. We had started off a, uh, very specialized class to bring in companies from, uh, all over the world.

And obviously as, uh, covid was, uh, beginning to rage, we could quickly wanted to get everybody home safely, and so that got wrapped up. It finished, but, uh, a little bit of a, of an abrupt end From there, the accelerator took a really interesting pivot and I would say that if you think of our. Cedar Sinai Accelerator as the front door of the center of sort of innovation at Cedar-Sinai.

We certainly can put a big old tick mark into the accelerator. Pivoting to jump into the DIY business. Again, I alluded to it before of we all got a, a really big scare around our supply chains, or and particular around PPE and the accelerator quickly stood up and mobilized itself as being the engine or a center place by which we were making.

Gallons of, of, uh, Purell like substances and masks and shields and other difficult, uh, to acquire pieces of equipment. And so the accelerator and its team, were really focused around that as our supply chain started to catch up a little bit. We've pivoted to having the accelerator now work in a remote and a more sort of virtual model, and we're still trying to figure out exactly what that will be.

We're actually getting ready to, uh, launch a full fledged virtual class. And so we figured, uh, no better way to try it than to jump in with both feet. And it will be interesting because I think that the most positive feedback we get from companies who came through the accelerator. Was there chance to have boots on the ground inside our hospital?

And so it's gonna be a challenge for us to figure out how we create that virtually. But we're hoping that we think since the magic is all around the people anyway, if we can connect the teams and the people, we might be able to recreate that sort of core piece that's, that's gonna be, that's gonna be interesting to watch.

It's gonna be, as you say, I mean, the magic is in the collaboration. Between the, between the clinicians, between the people in the hospital and the, the really smart startups and the, the, uh, the innovators that you bring in. But it, that's, that'll be a conversation for later, but I'm sure it it'll be, uh, an interesting.

Just like everything else in Covid, we're learning as we go. It's, it'll be, uh, be interesting. Uh, what's funny is that early on when we told the founders that you had to come to LA for 90 days, they're like, oh, I love the program, but I don't think I can do that now. Of course, now that we're not having people, people are asking, can I come to LA for 90 days?

Hey, I, I read in Becker's and, and if I read it, if I misread it, let me know. But. You guys are hiring during the pandemic, and I, I, I know that every it shop has openings at any given time, but it, it seemed like you're strategically hiring into certain areas in, in certain capabilities. Uh, did I read that and, and what, what would those areas be that you're looking at as either trying to shore up or, or try to expand your capabilities?

Yeah, no, I, I think you read that correctly. Listen, at least half of that is we are always looking for unique skill sets to bring onto our teams. I think that one of the things that we've done really, really well within the Cedar-Sinai tech teams is to combine. Sort of diverse backgrounds together so that we have team members that really understand the nuance and the context of what they're working on.

So that, what that translates to is, uh, about 25% of our team have a clinical background of some sort. I. Physicians, nurses, and in a variety of sort of other backgrounds. And I think that's just really important if you're working to implement a complex pathology system. Having spent time, uh, in pathology, working in the labs makes the world of difference if you can speak both languages.

And so we're always, um, looking for great experienced talent to help push the envelope of what we can do from a technology and digital. And just general tech enablement point of view. That being said, there's a few areas that we're continuing to grow in. We're continuing to make, uh, investments in analytics in particular around data science and to, uh, really build out those skillsets.

I. I'd use that as an example of one that we're excited and it's a part of a, of a, a larger strategy. We're also, uh, expanding in cybersecurity. One that I, I wish we lived in a safer world and we didn't have to expand, but, you know, I think that it's a, it's a reality that we just have to accept. And so we're looking to grow those teams and, and build up where we are.

And then there's a bunch of others in particular, they tend to follow. Some of our large academic areas of interest around heart cancer, neuro, but we're, we're, we're an ever expanding team, and candidly, feel very privileged, uh, to be in that position. Yeah. It's, yeah. That's interesting. Uh, man, I'd love to go into analytics.

I'd love to go into the cyberspace. I'm, I'm not gonna, I'm not gonna do any in, in detail given that we're.

An agreement to affiliate with Cedars. What, what does that partnership look like and, and how will you approach that as the CIO? I think one of the things that I, one of the many things I love about Cedars-Sinai is that it truly is an organization that's built around a philosophy of creating great partnerships.

I think that there's lots of rivalries folks can talk about between payers and providers and between institutions and all sorts of other things that I think are inherent in a fragmented ecosystem of healthcare delivery. But Cedars has always, uh, prided itself on being able to build great partnerships, and I think Huntington is just another example of that, of just a wonderful institution on its own.

Serving the Pasadena marketplace and community in really a phenomenal way with just a wonderful high quality reputation. And I think, uh, uh, a realization that, I don't wanna say that bigger is better, but that the idea that combining the resources to achieve some scale to frankly bring down the cost of delivery is sort of what is in our new reality, our new, uh, world order ahead of us.

That by working together more closely, we can achieve some of that. From an IT perspective, I think that, I don't know, I, I, I'll pick on cyber again. Maybe I keep doing it 'cause it's on the forefront of my mind, but I think about the investments we need to make. I. The investments we need to make for one large hospital versus two, three, or four, they're not that incrementally different.

And so I think it's a good example where you could spread some of our unbelievably high fixed costs that we have to deliver or that we need to invest in to deliver the best that we can over, uh. Larger, uh, sort of footprint, I think, is there something that just makes a ton of sense in it, by the way? It makes a ton of sense in supply chain.

It makes a ton of sense in most of the back office functions. And so I just think it's a, it's a reality that you're gonna see more, more and more of. And the last thought I'll interject on that is that. E even even with Covid and what it's done to the economy and, and the job market, it, it's tough to get great tech talent.

And so when we're able to partner with another tech team and spread, uh, talent across a same or a combined sort of set of problems we wanna work on together, it's only additive. And so I think that it just represents a lot of opportunity. I'm kind of excited for it. Yeah. And it's interesting that cyber bubble has to keep getting bigger and bigger as you do partners.

Even if somebody is just a community Connect partner, you still have to be cognizant of their practices, their procedures, 'cause you're opening up that VPN tunnel. So I'd imagine that there's just a lot of complexity, uh, around that. Just in and of itself. The other thing obviously is, is the EHR, I mean, one of the benefits of partnering with, with the CS is you guys have a phenomenal epic build and you have, you have so many great elements that are built into that, that are just part of your, your care protocols and your guidelines and those kind of things.

But I think it maybe it, if I were partnering with, with an academic medical center, that's the value. I would, I would, I think partnership. So do, do you expect to, to, to come together around certain technologies and, and approaches? Yeah, there's no question. And I think it's interesting, uh, the way you phrased that, 'cause by the way, I, I completely agree, is that as little as 10 years ago, the innovation was the EMR itself.

Heck, 10 years ago we celebrated the Go Live, which when I step back and I think about it, what a silly thing to celebrate. We celebrated that we bought something and we turned it on. But anyway, that, that was the big celebration. Uh, deservedly so by the way, it was really hard. Oh, no. I know. I, I remember the.

The, the timeline that that was happening in and all the stuff that was being said, that was a, that was a big deal. That go line it, it was, but moving past all that, I, I mean, to your, to your very correct point, the EMR is, you know, quickly becoming the table stakes and so the content. Of what's in the EMR is where, uh, we think it starts to get really different, really interesting, and the, the protocols and the decision support and the, the layers of content that we've built up over the years that really represent, uh, sort of the pathways to enabling how we deliver care.

I think that over time is gonna become the secret sauce and being able to share that with partners is gonna be really interesting to me. There's lots written and lots pushed around that the Holy Grail is to move information between organizations and I think with all due respect, when uh, people figure that out, they're gonna realize that was just step one.

What you really wanna do is you really wanna be able to share and enable . Care and how you deliver care between settings so that from a patient perspective, uh, we can say it doesn't matter what door you enter in and at what facility, you can count on the same quality research driven, academic driven protocols that have been developed that are available to you.

Well, well, Darren, you don't disappoint I these conversations. I.

Big, take it wherever direction you want to go, which is, what do you think the lasting impact on health it is gonna be as a result of the pandemic? I'll tell you what I hope it is, and what I hope it is, is that we've been talking about real time dashboards and predictive analytics for the longest of times, and I wanna say this carefully.

I think that part of our challenge has been that while the dashboards have been phenomenal. The leadership teams haven't always needed them because their experience and their knowledge has been equally as phenomenal. What Covid showed us was that those same phenomenal operational leaders, so COOs and CMOs across the country, who were still brilliant and still had unbelievable intuition and knowledge of their institutions, they didn't have the same visibility because everything had been thrown on.

Its on its side. So they began to look at the dashboards that were put in front of them. I'm hoping that the lasting effect is a little bit of a aha or a click, and they're gonna become addicted to those, and they're gonna want them in more scenario planning, in more, uh, real time ways. I think the, the idea of telehealth growing was inevitable.

There's no question that digital got a kick in the butt, and that was super helpful. But for me, what I'm really, really hoping, uh, is that executives across the country and their use of dashboards and especially the predictive analytics that are built in these dashboards, becomes an elixir that they don't wanna let go of.

Yeah, absolutely. It's, it, it's been fascinating to see how many of those dashboards have been created. Obviously you guys had a.

Creating them. In fact, somebody was almost not happy with the fact that their team spent about 400 man hours to build a dashboard and then Epic released it two weeks later or three weeks later. Uh, you have to appreciate that about Epic, but they had already invested the couple hundred hours to get that done.

So Darren has always great conversation. Thanks. Thanks again for your time. You bet. Thank you, bill. What a great conversation. That's all for this week. Don't forget to sign up for clip notes. It's a great way to support the show. It's also a great way for you to stay current If you're not familiar, CliffNotes is an email that we send out immediately following the shows, actually 24 hours after the show airs, and it'll have an summary of the show bullet points.

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Uh, please check back every, well you wanna check back. We, we publish three shows a week. We have the Newsday episode on Tuesday. We usually have solution showcase every Wednesday, and then an influencer. Show on Friday, but right now we don't have any solution showcases, so we are doing multiple, we're dropping multiple influence episodes, so a lot of content being dropped between now and the end of the year.

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