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Developing the next generation of Health IT leaders. My name is Bill Russell Healthcare, CIO Coach, creator of this week in health. it a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. In this episode, we're gonna talk about technology, clinical decision support, ai, and how all those things are coming together to address clinical variation and how we are doing that as an industry with a special guest.

Diana. CEO of Walters Clore, uh, health. Good afternoon, Diana, and welcome to the show. Thank you. It's great to be here. Well, I, I appreciate you, uh, making the time. We were gonna do this from the showroom floor, but, uh, this, you know, this is a, a sign of the times and, and things that are going on. So tell us a little bit about Walters Clore and, and, uh, you know, just, uh, about the company, about, you know, the kind of things you guys focus in on.

Yeah, sure. So, um, you know, we're really focused on ways that we can make sure every patient gets the opportunity to benefit from the best knowledge and and evidence. And that really starts from when clinical, uh, individuals are educated. So we have a very big focus on education. Then once they leave education and actually go into practice, we have a suite of different kinds of clinical decision support tools and also just lifelong learning.

Uh, so we have continued to evolve those to get to best practices in today's world of education, practice research, and look forward to talking to you a little bit about that today. Yeah. That's awesome. I, you know, this is, uh, this clinical variation conversation's interesting because it crosses, it crosses every aspect.

I've, I've talked to physicians about the topic. I've talked to CFOs about the topic. I've talked to, uh, operations people about the topic. It is, uh, an area where. Uh, we can improve quality. It's an area where we can reduce costs. It's an area where we can do a lot of things. Uh, but this, this whole conversation might be obvious, but let's go ahead and set the stage.

Why, why is clinical variation so important and, you know, why is there a sense of urgency in the industry around this right now? From my perspective, I do think that there is definite recognition that we're spending tremendous amounts of money on healthcare. And so we're always looking for ways that we can reduce cost, but we don't wanna do it at the, um, element of sacrificing quality.

And so we really focus in on why, if there is strong evidence to say that if you follow these treatment pathways. And you can get a great outcome, which is, you know, that evidence is there. Why would we deviate from that? And that's a really deep question as to, well, why do people deviate from it? And I don't think any clinical person is trying to deviate from best practices, but oftentimes they just don't know what the best practice is.

And that's why the tools have to really work. In their environment, in their workflow, and in the point of time when they're making that decision. And then it has to really be carried out by the entire team. You can have the best, you know, doctor that gives the best treatment, and yet, you know, maybe the patient doesn't follow it, right?

So I think there's so much focus also on how to better engage patients in their own healthcare. Uh, so a little bit of, you know, kind of why I think it's so important is obviously really anchored towards the fact that we have very rising costs and we don't have the improvements in quality that we really should be getting.

Yeah. So how, how are health systems addressing clinical variation and what kind of tools are they, uh, tools and methods are they using to really, uh, progress it forward? Yeah. You know, so from my perspective, again, kind of starting with where we think about it, we first start with how do people get educated?

And you know, we oftentimes within our own, um, organization talk about the fact that people don't get educated in a lecture hall by a professor. They really are in the education. Doing things with advanced technology, uh, virtual simulation, uh, we now have suites of offerings that include adaptive testing.

And you might think, well, what does that really get at? And that really tries to put the clinical person, the clinical student in a situation where they can. Think about it from a true clinical judgment so that they're actually better prepared when they get to practice. I think the other aspect then, and one which really rings true to us is that, um, a doctor himself said, as soon as I got out of school, I felt like I was getting behind.

And that's what caused him. To personally start what is now, um, called up to date, and it was, I don't have the ability or the time to be able to wade through all of the journals with all of the evidence for the specific patient that is sitting here in front of me. And so that's what kind of bore out, up to date.

Now, I think taking it the next step is the clinical tools that really work. People have high expectations. So up to date, really the next generation of that is needing to sit within the EHR in the workflow. It needs to start to take in more and more the context of the patient and rely even less on the clinical person to know the questions, to ask up to date.

So that's how you sort of see the evolution of where we're trying to go. Now what's really interesting in all of that is I think the clinician still feels a great . Ownership over making the decision and needs to really understand how that decision kind of came to be. And so being able to trust the evidence and really know that it's from somebody that's carefully curated, it is really important.

Yeah, it's, it's, it's almost like GPS, you know, I, I don't follow GPS to the letter. There's sometimes where I look at it and I go, you know. Living in Southern California, I know that the traffic is gonna be worse there than what they're indicating right now. I'm gonna go in a different direction and, and it almost, it, it doesn't act as autopilot.

It asked, it acts as sort of a, a, a, an assist to the physicians, right? It's like, Hey, here's what it potentially is. Here's what it potentially could be. Uh, maybe look at these things and that, I mean, part of this challenge is getting people to. Um, understand and feel comfortable with the technology, looking at the data, and providing some feedback in terms of care decisions or care potential care pathways.

Right. Uh, bill, I think that we referred to sort of, instead of artificial intelligence, augmented intelligence, I think there's been a lot of hype about, you know, a robot being able to treat patients and we don't think that's the case. And, and yet when we built Pathways, um, you know, you could obviously see from a technology perspective, we could have automatically just, you know, kind of populated the pathway and just come to a decision and spit it out.

You know, it's really important that the clinician feels like they understand every decision point in that decision tree. They understand it and can still kind of reflect on the situation at hand with the patient at hand. Um, so you're right, they're, you know, they're still just like GPS. There are probably, in any case, with the, you know, information constantly coming at you, there's always ways to get to the route that will

Still get you to the place that you're trying to go. Um, so, uh, so I, I I like your analogy for sure. Yeah. So, so here's my question. It, it's, so up to date right now is, is sort of sits off to the side and I have to ask a questions, but you see a future where it's actually taking in. Data, either, uh, either the historical data or the real-time clinical data, it's processing through, I mean, as you say, from the minute a physician graduates, until they're potentially seeing this patients, you could have 20 years of journals and advancements, and that's what you bring to bear.

You bring the ability for that, either real-time, clinical data, or even the historical clinical data to go through that filter. And to pop that out, how hard is it going to be to get to that point where we're, we're actually sifting through the, uh, the, the, as much of the longitudinal patient record and even some of the consumer data that might be coming down to provide, I don't know, maybe a more fine tuned diagnosis at the point of care.

Yeah, so we already have started, and where our team focused was, they focused on a subset of situations out there, clinical situations that had probably the widest variety of variation. And, uh, so the, and was, and the. Um, you know, the richest evidence that if you follow this decision tree in the order that it's presented, you will actually produce a good outcome.

So we're already there and we're working tightly with the EHR companies on being able to, on the front end, you know, with things like smart on Fire, pass the data. Into the pathway. So the way it works is you're in the patient, um, you see the, the UpToDate information, and it will potentially say that there's a pathway available.

It can then auto-populate it on the front end. Now, I think where we're still working through, and you'll, you'll know that there's some recent information that was published this week on interoperability. I think the other aspect is then once the clinician kind of walks themself through the pathway as it's presented.

They obviously want to place an order or decide on the treatment and document that and have it go back into the EHR, and that is the pathway that we're on. And we're starting, you know, we have made advancements. We were going to have some joint things, uh, uh, promoted at himss, you know, with, with the folks like Cerner in terms of the advancements that we're starting down that, so it's in the works, it's already out there.

It's really focused initially. Those ones again, that are probably the most structured in sense of data and evidence that kind of is matched. But you bring up an excellent point that this is gonna continue to evolve to the more complex cases and the more complex cases may involve additional data. So this aspect of having interoperability is gonna be critical as we continue to evolve as an industry.

So give us a little more background. What, what, what else were you gonna do at him? So what were you gonna talk about and what were you gonna focus in on? Well, I think a lot of this is focused on exactly the clinician, but the other aspect that we were heavily focused on the aspects of engaging with the patients.

And again, for those areas that are the, you know, might be most costly, but if you can just get the patient to sort of adhere to the treatment pathway for them. You can probably understand, like diabetes is one that comes up, but there are others. And how do you really then take the digital health record out into the patient?

And so we were going to be speaking on a number of things around patient engagement. I. Really the proven facts that if you do actually engage patients, educate them on how important it is to follow these treatments. They do. We have proven data that they will actually have a better outcome. So that's a bigger piece.

Are you gonna integrate with like existing engagement tools and provide them? Are you gonna be the. The information and the CDS behind the scenes, or are you actually introducing some tools? Well, this, uh, from an Emmy suite, it's really integrated, again, into the provider's workflow. So it's integrated into, again, the EHR and then data is kind of set up within that.

So it really appears as though it's coming out from the provider. And then there's data that's kind of, you know, sent out to the patient, please watch this information. And then also from a transition. Kind of once they're at home, how do you collect that data and then the data gets fed back into, again, the EHR.

It might highlight something to the caregiver, the nurse, the doctor, to take action. Uh, so I think those are the systems that you're starting to see how, you know, from all various . Points you can get to this. Reduction in clinical variation. You know, some things that we don't even do, but just the fact that I was speaking with a customer and she said, you know, now we know if a patient has not picked up their prescription.

'cause we get that feedback. And that is something where you know, the provider, again, can reach out to the patient and understand was it a matter of cost? You know, what is it? Because, you know, those are still some of the breakdowns that occur in the whole clinical care, uh, provider setting. Yeah. And you identify those social determinants, which is, you know, we've always said that there, they're outside of the healthcare environment much more than they're inside the healthcare environment.

And if we can impact those times between visits, that's really gonna have a significant impact on health. And I guess that's the area, that consumer area where you're really. Uh, looking to make, uh, make, make some progress? Yeah. I think that, that, that is harder because you're talking about the entire population that's out there and changing behavior, and you get at the same elements of trust and the, and you know, again, affordability.

Um, but it's, um, it's an area that, uh, you know, I, I certainly think that myself and my entire organization share a lot of passion around, because. It's, you know, every patient wants to get healthy. So determining why they chose to take the path that wasn't recommended for them is really, I think, an important step in us moving forward on this.

Fantastic. Thanks. Thanks for taking the time, uh, Diane. I really appreciate it. Uh, how can people get more information on, on, uh, what you guys are doing and, and what you're, uh, how you're progressing? Well, some of the best ways is we're, we're very active on social media, so we have our Walters Klu Health, and then we have some of our individual areas such as UpToDate.

Um, so that would be the same, you know, one of the best ways to learn more about us, our websites, et cetera. Uh, so hopefully that helps. Fantastic. I appreciate it. Um, awesome. So, uh, don't forget to check back this week. We're gonna do multiple interviews, uh, from our himss, uh, our, our HIMSS coverage. We're gonna be dropping several more interviews, uh, this week, and then next week we'll go back to our normal production.

This shows the production this week in Health It from More great content. Check out the website this week, health.com or the YouTube channel. Thanks for listening. That's all for now.