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 Thanks for joining us on this week in Health It Influence. My name is Bill Russell, former Healthcare, CIO for 16 hospital system and creator of this week in health. It. A channel dedicated to keeping health IT staff current and engaged today, Nasser, NAMI joins us and we have a phenomenal conversation.

He's the CIO for Jefferson Health. It's very quick. I caught him in between meetings. We got about out a half hour together, but we talk a lot of things. We talk priorities. We talk about the impact of covid on health it, the impact of Covid on the community that they serve. We talk health disparities, A lot of great topics.

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You could also go to today in health it.com. And now on to today's show. Alright, today we are joined by a friend of the show, Nasser Nazami, who's CIO for Jefferson Health. Good afternoon, naer. Welcome back to the show. Good afternoon, bill. It's always a pleasure. Thank you for inviting me again. Yeah, I'm, I'm looking forward to the conversation.

With 14 hospitals, a long-term care facility, and a robust outpatient network. We serve communities in Philadelphia and metro area and southern New Jersey. We have about 35,000 employees as a health system. We have been exponentially growing for several years now. And as a reference to your audience, Jefferson was a three hospital, one and billion organization in, have tripled in matter of six or seven.

Both growing organically and through a series of mergers, acquisitions, and partnerships. Yeah. So this, this is one of those things that happens when you, you do the podcast towards the end of the day and we record. I, I get kind of like, oh, so you, you haven't been busy since then, right? So not much it work as a result of growing that fast.

It's a privilege to be working for an ISTs like Dr. Klasko, and it's hard to match in his imagination. But I'll share a few things, like some of the things that are futuristic. But I think are not that too far in future. For instance, we know that last year Amazon got FAE approval to operate in, uh, its fleet of prime drones, and last year CVS partnered with UPS deliver medication to senior students living in, in the villages in Florida.

Right. Some of the things, like you mentioned in Dr. Klas, you mentioned virtual work. You know the limit the. We already experienced that. We, Jefferson, like many other organizations, successfully moved thousands of users and thousands of students to work and, uh, study remotely in a matter of days. It's, it's a combination of things.

I think, you know, when we discuss and we think about future, you know, uh, my team's job is to understand the business we are in, understand the role of technology, uh, understand Dr. Vision like Dr. Klas vision in general to stay a few steps ahead of where the industry is going to be so we can move Jefferson, uh, accordingly.

Right. You know, and, and you really have a choice. You can work for someone like that, Dr. Klasko, who is a, you know, a visionary and out there, or you can work for somebody that you're, you have to bring along and the As, as ACIO and it, it is, it is really a privilege to work with somebody who's, who's really pulling you a little bit and saying, Hey, uh, this is where we're going in this city.

Let, let, let's go there together. So it's. He, he shared some numbers at Jefferson, you guys had zero transmission to non covid patients and less than, uh, 1% infection, uh, uh, 1% in employee infection rate. And those are fantastic numbers. How, how did, how did technology play a role, uh, in your covid response at Jefferson?

Look, first of all, you know, we, I'm very proud to be part of Jefferson and proud of what team has achieved. I must say that everything starts with a focus and mission. Things like. Covid happens once in a lifetime, and if, uh, you're not clear about the mission, then it's very difficult to come up with any plans.

And early on when Covid hit us, uh, we looked at our mission and says, the Covid mission is to improve lives. We need to do the right thing. And from a technology perspective, that enabled myself and my team to focus on our. Core competency, which is ability, uh, our ability to execute. We had all the right ingredients.

We had the trust by our operational colleagues. We had the technical expertise of clear communication channels and the ability for even a junior person in our team to make the right decision. So our motto was, Hey, decide, communicate and execute. Even if you're an analyst and you have to deliver a laptop to someone who decides that they're gonna be working virtually.

So, and look, a few things that we did quickly that result in the numbers you mentioned. We pivoted to work from home very quickly, right? This is partly because we were in the cloud for some of the key applications used by back office workforce. We had collaboration tools already, like email, et cetera, budgeting systems already in the cloud.

Secondly, we were very quickly able to, uh, stop things that were not critical for Covid and very quick decision, again, making played a key role. 'cause early on, if you think about February and early March, it was very unclear was how things were gonna unfold. We were able to stay, uh, stand up sites bring up.

Partnership with, uh, the City of Philadelphia, et cetera, and third party organization. We immediately very quickly enabled remote monitoring for patients who were in our hospitals in the bed. Uh, so the exposure of our clinical staff was limited to the patients. So a number of steps, uh, and technologies ability, especially collaboration tools.

Telehealth played a role our.

You know, play the key role. But at the core of it really was, you know, everyone's, you know, understanding of what our mission is and how we are gonna be making decision, whether it's a small decision or. It's, it's, it's interesting the inter several interviews we've done with you and even with you and, and Dr.

Klasko, you guys talked a lot about, you know, the healthcare without, without an address or, I forget the terminology, but it was essentially, you guys have really been preparing for this for a long time. It's not like, it's not like covid hit and you're like, oh gosh, we've, we've, we've gotta implement all this technology so that we can work remotely.

I mean, this has been a, a, a, a path that you were on and probably just like a lot of others.

You are absolutely right. Like so Jefferson and Dr. Klasko, myself, we are big believers in healthcare. We use, we call healthcare without address. Jefferson and home is another term that we use. We invested in telehealth several years ago when there were a few health systems that were investing in telehealth in a big way, in a, in a significant way, which, uh, frankly paid off dividends.

We invested some in some of the technologies. When it was difficult to, you know, uh, make a case for an ROI, right? Even simple things that, you know, seems to reasonable. Now, our investment in cloud, for example, you know, uh, decisions that we were able to make because of the right leadership, because of clarity, regardless of Covid home.

Hospital without at risk is the feature that we believe in. You know, and you, you probably have heard Dr. K talk about versus health assurance. You know, this, this has been part of the mantra before Covid, so you are absolutely right. We were already on, on a, on a journey and Covid just accelerated it probably by, I don't know, 10 times.

Yeah.

The clinicians and, and, and, and to be honest, I mean, they pulled us in some directions because from an IT perspective, I'm not sure any of us anticipated sending the, I don't know, the finance team home to work from home. That's, that, that's, that's not a team or supply chain and whatnot. Those have traditionally been in the office kind of teams, but.

I mean, one of the proud moments, uh, for me was when we all went home, we were not sure about the productivity, et cetera, but I think two months or three months into covid, like this is Jan, June or May or June timeframe, our CFO basically said, look, we have been remote and I have not seen any loss of productivity.

And this is a person who is not a believer in in, in remote work and. Now he's a believer. I mean, I almost 12 months after we went work from home, our productivity levels are still very high working, uh, working remotely. Yeah. I, you know, it's, uh, you're sort of at a disadvantage here because I got to hear your CEO and I'm like, okay, your CEO said this.

What do you do? I'm kind of doing that. I know , you know.

Strongly on the topic. And I, I think the, the quote I picked up was, of all the forms of inequality in healthcare is the most shocking and, uh, inhumane. And, and you know, I guess the question around this is how, how can technology play a role in addressing health disparities in. Look, I think there is an opportunity for technology to play a significant role.

So at the same time, I worry about digital Divide as well, right? Uh, I'll, I'll give you one example, uh, that the need for access to broadband services became clearing obvious during code. Right. We saw exponential increase in the use of telehealth services, and it's something to be celebrated and health systems across the nation.

You saw an increase and it's just amazing, amazing thing to happen. But in order to have a successful telehealth visit, you need a, at least a mobile phone or desktop, right? In a working broadband connection and.

Not everyone have a robust broadband connection. Not everyone have a working device at home. It's very difficult to eCheck in. Uh, if your computer is broken, have virus or is just slow processing wise. If you don't have proper broadband connection and your reliance and connection, that often fails 20% of our telehealth as an, as a, as a point of, um, reference fail because of some issue at the end point.

Okay. So to me it, it highlighted the need of robust broadband connection, but generally speaking, you don't think as related to healthcare. It's just a internet connection, but it is and has become a very key way, and especially when we think about hospital at home and care at home and Jefferson without address, this is just significantly important without a robust connection and without access to digital tools.

There are will continue to be divide. And frankly, I think that there's a part of where I think that government ha can play a role in regulating, uh, broadband connection. And in my mind, frankly, we have to start feeding broadband as a utility. Power water is no longer luxury. And similarly access to the access to digital devices.

Uh, for underserved population. With these things, I think we can really cut through the big issues of access and affordability. We dig with the health of digital, right? We, we really have an opportunity to, to reach a population which otherwise don't have access to facilities, healthcare facilities, right?

And we can help them in their homes wherever they are. And in a very affordable way. I mean, telehealth makes everything very affordable. But on the other side of things, like look, I mean there is a lot of promise for technologies like AI and machine learning because discussing with our chair of radiology, the ability for AI to read through x-rays in, in perhaps, you know, underprivileged communities in some developing countries, the ability for.

AI to flag things like x-rays or cts and, and help in an area where there are just not specialists, there are not radiologists available. Right. So, so, so I think that there are, there is, there's enormous potential and technology can certainly play a role in addressing health disparities in a community like Philadelphia and beyond.

Trying to go and they don't have, I mean, how silly this is remotely, they have broadband, let alone a computer device. Not like those computer devices are all that expensive these days, and their next door neighbor has, has broadband. So it's, it's like, you know, we've, we've gotta, this is not, this is not rocket science.

This is probably one of those things. This

Toand a significant barrier.

Don't, if I can't get on the internet, if I can't go to a public

things.

Well said. Look, I mean, you, you, you hit it on the head. The issues you mentioned around education. Absolutely. I mean, this is something I experienced with my kids as well. Like you, you spoke about we are fortunate to have broadband, but in areas, uh, I enough areas where my team members have only one broadband carrier.

Right. So, no, no choice. And during pandemic, the, the, the service was just, you know, very poor. And there was no choice, right? So it just highlighted the need to rethink about our nation's investment in broadband infrastructure. You're absolutely right. Yeah. Well, let, let's talk about priorities and then I, I wanna come back to, you know, what are the lessons learned?

Uh, so this, at this point in the pandemic, but let's talk about priorities. What are.

We are, hopefully we are towards the end of pandemic. You know, our numbers are decreasing, so it's, we, I would say we are still very focused on covid. Okay. I think our focus now has changed from. You know, inpatient and more patients coming to the hospital to now how do we vaccinate? So we are spending weekends, evenings on mass vaccination, right?

So, and the needs are different. So we are focused immediate future, uh, on how do we register our patient in a reasonable way, in a safe way. How do we reach the. You know, electronically, so obviously you think you, again, this goes back to our discussion of Digital Divide because you think about, you know, the best way to register and then vaccinate.

You know, if we have a access to portal, sign up on the portal, pick a date, and we'll, we'll schedule in next two weeks from now. This is fantastic. In ideal way, fortunately we have technology to make that happen. But not everyone has technology at, at their homes and not everyone have access to it. So our priority immediately from a technology perspective is to make sure that we help not only Jefferson, but also City of Philadelphia, Southern Jersey, public vaccination.

I think a big, uh, you know, area of investment, hopefully in the later part of 21 for us is be technologies. We, we forced. To work from home and rely on, uh, lot of virtual services. I think a year, almost a year into it, we are thinking that this is going to be really permanent. I mean, uh, at, at, at, uh, it, it's quite possible that we are staying some sort of a hybrid format.

I'm, I'm very certain and it's gonna be, we are not going back to our old base. That, that I can, I can share with certain, so some of our work is going to be just around that. How do we cement. You know, work from home. Some of the for instance, technologies that are not cloud-based, that require things like VPN access that, you know, works if you work like one or two days AW week from home.

But if you are doing your job and you're relying on, you know, services and old systems that are still hosted in our data center, it becomes problematic. So continued move to cloud, continued investment in digital. We, we, I think that there is a huge opportunity in improving, at least at Jefferson, and I think in general healthcare, the, what I think the common word I think is probably overused is digital front door.

So there is going to be a big push already is, but I think even more significantly, we are gonna be pushing, pushing more towards, uh, digital automation is, is kicked. We slowed down because of Covid. I think that that's going to be a big push in later part of 21. We are still, so we're still end of our implementation of EHR in some of our hospitals.

So one EHR we are fortunate we will have one EHR possible health system. That's, that's something that, that, that will, that's ongoing and looking forward to completed. So a number of initiatives, but. If I were to sum it up in one word, I would say digital. Yeah, digital a absolutely. That, that would make sense.

The but, but the, you, you did touch on this a little bit, the, the major systems, the ER pacs, eerp C rmm, you have, you have a one EHR initiative because you guys grew through, uh, several acquisitions and whatnot, so you're still, still in the midst of that one EHR. What about the, the other major systems? So we are fortunate that in, in the last few years, we as an organization made a decision that, uh, you know, as a health system, uh, we have one operating model and it's going to be a centralized operating model.

We are not going to operate as a holding company and therefore, which basically. Educated us and informed our decision to say, look, if we are going to operate as one company, really need centralized systems and E-R-P-H-C-M payroll were one of the first systems that we started standardizing. And on EMR standardization came a little bit later.

Which I'm glad that, you know, in a few months we'll be done with it. Same is with Standard, as of one version of facts across the health systems. And this is, this is, uh, uh, all result of, uh, our philosophy that we are going to. There is there, there is value in economies of scale. There is value in standardization of care, especially in the areas that are tried and trusted people.

Now there is, innovation happens in all forms, but. Today. Mostly I would say that, you know, it doesn't matter what EMR you're using, any organization you're using, it doesn't matter what pack you're using as long, it's like, you know, one of the scalable ones, I wouldn't name any names, uh, but I think it's more important to have one standard system and processes and protocols that go, uh, along with that then a mishmash of systems.

And I have lived both lives and my colleagues in operations have lived that life and we all agree that. Standardized align. A way of work is way better than working in, believe it or not, nine different EMRs that we lived through that. Well, I, I have, you know, two closing questions. I, I appreciate your time.

We, we squeezed it in here. You've got a lot of, lot of stuff going on. I, I want. Looking back and, and once gonna be looking forward. And, you know, the, the one looking back is, you know, we're, we're sort of hopefully beyond the midway point of the pandemic. What lessons have you learned as a health system? CI look, uh, I think the, the most important lesson I think for me is.

The nimbleness and ability to make good decisions was just amazing. Countless times our teams faced an issue without calling themselves Tiger teams or any other fancy names. Individuals got together, discussed the issue, came up with a solution and implemented it. It was just a amazing process, right?

Which basically, and, and then, and, and this happened at all levels of organization. It happened at leadership level, it happened at a mid leadership level. It happened at analyst level right in, which told me that our. Prior to Covid, you know, if you had asked me, I would say, you know, yeah. You know, health systems tend to be bureaucratic, especially if you're in the Catholic Medical Center.

It takes months and months, sometimes years to, for us to make decisions, simple decisions like the standardizations or a product, et cetera. And frankly, what, what lesson learned from me, one of the biggest lessons learned. You know that, look, we can do, we can operate in a very nimble way, almost like a startup.

And how, a question for us frankly is how do we preserve that? Because we were forced into the situation where we had to act a certain way, we acted, and I think we were incredibly successful. How do we preserve that nimbleness? The trust that we have created among each other, the whole mantra of the site, communicate and execute.

We just need to move it forward. And that's, you know, it's interesting 'cause that's one of the hardest things as a leader is to get that, uh, momentum going. And the, the silver lining of the crisis was, it was the impetus, it was the momentum and it, it did prove we could do things we never thought, uh, possible, which was pretty amazing.

I.

Is gonna be on health it specifically. Look, I think, uh, it's going to be cultural, uh, in, uh, the change in thinking around technology, right? I mean, the changes that would have happened anyway over next 5, 7, 8, 10 years that happened within, let's say.

The acceptance of technology as a key, uh, enabler of healthcare, especially in realm of digital telehealth. Just accept the cultural change where it is very accepted now to work from home. Our ability to. Hire people in remotely and allow them to work, uh, remotely, I think is going to be big. And generally the trust that patients, uh, experienced using digital technologies in certain populations where we.

Historically we thought of a not as technology savvy or won't trust technology as much, and, uh, some of the segments of population that, uh, trusted technology and use technology and have, I think forever change is just amazing. And I think that will be the lasting impact on covid, that the on the culture change within IT teams.

Jefferson and I think across the nation and then the population that, uh, we serve both our colleagues in operations and how they use NC technology and equally important, the students and the patients that we serve, their acceptance and use of technology, I think have radically changed. And, uh, I think the, we are not going back, as I said earlier in, we're thank.

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