Keynote: Digital Transformation, AI, and the Future of Pediatric Care with Shakeeb Akhter
Episode 713rd May 2024 • This Week Health: Conference • This Week Health
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Today on Keynote

(Intro)  in many health systems, the clinician is providing care, doing quality improvement.

And doing clinical research. I mean, these people wear multiple hats. So our thought process was, how can you create a catalog that allows them to do all their work seamlessly

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week.

Today's episode is sponsored by Quantum Health, Gordian, Doctor First, Gozio Health, Artisight, Zscaler, Nuance, CDW, and Airwaves

Now, let's jump right into the episode.

. All right, here we are for keynote. And today we're joined by Shakeeb Akhter, the CIO, SVP at Children's Hospital of Philadelphia. Shakeeb, welcome to the show.

Thanks, Bill. Thanks for having me. Looking forward to the conversation.

You attended one of our 229 events and shared some really interesting stuff around around data, digital transformation and whatnot.

And we're going to get into some of those topics, but let's start by setting the stage. Tell us about Children's Hospital of Philadelphia it's mission and the work there in Philadelphia.

Sure, absolutely. So, Children's Hospital of Philadelphia is the oldest pediatric institution in the country.

It has been on the cusp of clinical innovation for a very long time. The polio vaccine was invented here. The COVID vaccine in terms of the new mRNA. Capabilities was also a lot of that work was driven through CHOP. And so our mission really is to impact and improve the lives of children across the world.

And so not limited to Philadelphia, we have two hospitals inpatient settings here. We're over 20, 000 employees and We run four billion dollars in revenue not for profit large children's hospital. We have a strong presence in the Tri State area, so we're based out of Philadelphia, but we also have sites in New Jersey and Delaware.

And we have a large global medicine program for international patients that come to CHOP. And so, I think what you'll find at CHOP is we take care of the sickest children in the world, We have a tripartite mission, it's research, education and the best quality outcomes in clinical care.

It's interesting, I've seen your CEO present at the JP Morgan conference and every time she comes in, she shares a really inspirational story. that weaves in the research, the technology, and and the experience in the presentation itself. it's amazing how CHOP has led the way on the on the advancement of utilizing.

Technology and data and other things to really drive outcomes. it really is inspiring. I'm not sure there's a question there. I just wanted to, yeah,

think we do try to do a lot of those things. I think one of the things that we have a concept here called breakthrough, breakthrough makers, and so really driving breakthroughs every single day.

And that may look like it's coming in the form of research, may look like it's coming in the form of technology. or other aspects of innovation, operational innovation. We're trying to build all those things together, particularly through the digital transformation strategy. So I've got some great stories I could tell you in terms of how our digital work is pulling all that together.

We shared some great stories around how quality of care is improving through digital, what we're calling care model innovation.

Let's just go there. How technology is transforming pediatric health care.

Yeah. So I think what we've looked at from a digital perspective, we have three components of our digital transformation strategy.

One is AI and automation. And our focus there is really to reduce clinician burden, in terms of documentation. The second one is digitally enabled care models. And our goals there are improve the quality of the care for the patient, improve the accessibility to care. And really just capacity in our inpatient facilities.

And the last one is digital experience and access. So how do we improve the access to care, as well as the experience that our patients and our families have when they're trying to access care at a CHOP? Those are three. In terms of how digital is transforming, Clinical care particularly. we embarked on a part of the strategy for digitally enabled care models.

And one of the first things we worked on is remote patient monitoring programs. we started this work last year, probably 12 months ago. And our goal was to launch a handful of programs. with, maybe a few thousand patients enrolled in these programs. In 12 months or so, in partnership with our chief medical officer, chief medical informatics officer, we've launched 11 programs with close to 8, 000 kids enrolled in these programs.

And, some of them, I'll give you an example, like the NICU Catch program is a program dedicated to catching Kids that are very sick, leaving the NICU, but allowing them to get their care at home and have access to a digital care team. So when they leave, they get digital tools, like a digital stethoscope, and other tools, weight scale, etc.

The ability to contact the care team directly, report out, telehealth. capabilities when the family's at home. We're even training these families on how to insert tubes, take care of their very sick children while they're at home. And so we've got a couple of stories where, we had two very sick children.

That both of which would have passed away if they didn't have access to the digital care and the digital teams that are supporting these families. that's why we're doing the work and I think we're grounded and we're doing this work to improve the quality of the care that kids are receiving.

And it's great to see this, in some cases resulting in life saving treatment for them.

so talk about digital workflows a little bit. Are you. Looking at existing workflows and changing them, or are you introducing all new workflows?

Both. So, we've been on EPIC for 25 years.

So we may be one of EPIC's oldest customers. Wow. And back then EPIC did not have much pediatric content. So we actually have an interesting challenge to pediatric hospital. Aside from most recently EPIC was built largely for adult. system workflows. And so we now are on, I think we're on 14 or 15 of the pediatric advising steering committees.

We advise Epic on how to build the Epic content, but we've been on Epic for 20, 25 years. And we have customized Epic to a very large extent, which has You know, for pediatrics, pediatric care, which is really important, but now there's a technical debt that we have to pay off in terms of the workloads, we can't adopt new features, things like that.

So two years ago, we recognized this and we launched an EPIC Refuel. I don't know if you're familiar with this, but this EPIC Refuel program is really getting back on the foundation and redesigning. It's two parts. One is Going back to foundation, redesigning workflows to be closer to standard.

And then two, is introducing new workflows. And so with that program, we have gone from a two gold stars organization to a seven gold stars organization. But we're not doing it for the gold stars. We're doing it because it's the right thing to do for our patients. It creates efficiency for our clinicians.

It automates a lot of the things that we were doing previously that we're doing now. I think we've saved something like 90, 000 hours in terms of labor efficiency. We've generated over 10 million of financial stewardship that we measure for the organization by introducing these new workflows and optimizing existing workflows.

A good example is nursing flow sheets. We got so many complaints with the nurses, we have to duplicate, chart entry, duplicate flow sheets, lots of time and documentation. How can we shave a lot of that time off? And we've essentially redesigned all of that flow sheet build. So it's something that existed.

But we've taken the approach to say, what is the optimal workflow for nurses redesigned to save them hundreds or thousands of hours, tens of thousands across the labor force?

you identify the workflows you're going to work on? And then how does that project start? is it CMIO?

Is it CMO driven? How do you identify it and then how do you get it off the ground?

This is something that I spoke about at HIMSS and a couple other places in terms of our digital work impact of it is based on existing metrics.

We have not created new metrics to measure the impact of digital. So we measure the success of digital based on, is it moving the needle in terms of access, in terms of EMR satisfaction by clinicians, in terms of, Things that we've already had. That's really an important point, and so, with that, these projects come from multiple ways.

One, where are the sources of frustration and challenges? for people that are here at CHOP and our patients and families, and then how do we start solving some of those problems using digital tools. So that's where it starts. It's patient centric, it's employee centric, and then from there, it may turn into, there's new technologies that could help us with some of our issues, and how do we start implementing some of those.

So I think we take a Dual lens approach, right? What are the problems we're trying to solve? What are new technologies that can help solve those problems? Bring that together and get CMO, CNO, COO level sponsorship to bring some of those products into the organization.

It's interesting. So when those challenges come up and it's not hard to find the challenges, they typically find you in the hallway or on rounds or that kind of thing.

You end up with a list of those challenges. Is there a governance group? Is there a group that looks at that and says, Yeah, you know what? This represents something that would materially change access or materially change the physician experience of those physicians?

Yes. So we have One of the things we've been working on here is really revising our governance structure for IT.

We've been changing the name, it used to be Information Services, we're now Digital and Technology Services, just to show that we're moving towards digital and technology implementation and thought leadership. We have, through the governance structure, we have a Digital Transformation Steering Committee.

We have a digital and technology planning committee. And that's a steering committee underneath the digital information steering committee. And it's cross functional. So it's, VPs from facilities, access, operations, ancillary, core clinical care network. And we bring these folks together and we now have a new process we implemented last year, which is actually going really well, that all projects.

need to be submitted. They all need to be weighed against a score. We use REACH a portion of that score, and then ROI and some other components associated with it. And then there needs to be a vetting through these committees around what will be the highest ROI to the organization. And we measure ROI both in terms of clinical value and kind of financial value.

And so, this year is the first year, really, we've gone through that process. I tell you, we got 300 project submissions. So, typically, on a given year, my team works on something like 150 large capital projects. I mean, it's an incredible amount of work. This year, we received 300 submissions. Only 30 of them, 31 of them, made it to the DTPC.

Wow. Small sub planning committees. So, you know, we introduced nine sub planning committees across domains. that are staffed by clinical operational leaders, along with my team, who are partners in this, and then it goes up to the DTPC, who then refine it further, and then it goes to DTSC for review and finalization.

So, we're excited to see like a tenfold drop in our project submissions

or approvals. One of the things I've heard in the discussion so far is the earmarks of a data driven organization. It sounds like you guys measure things. You're constantly going back to those numbers.

You're not relying a lot on anecdotes. You're saying no, let's. Let's see the numbers. Let's see. Prove it out. So let's start at, the groundwork for that. What does it take to be a data-driven company, and what does your data journey look like? You've been there for a little while.

What does that data journey look like?

Yeah, so in my first role at CHOP started five years ago I was the VP of, the first VP of data analytics, essentially was now the chief data analytics officer role. And so, our data driven approach started there. First of all, it's baked into the quality improvement framework.

That's one. CHOP has historically had a very strong quality improvement organization that is essentially part, completely embedded in the culture. That work was done in the past. prior to my time and led by our chief medical officer. But it set the stage for this idea that data is extremely important to making decisions and that we'd have very robust analytics capabilities in order to be able to do that.

So when I came on board, we created a data enterprise data analytics strategy. And this is going backwards, but essentially the pillars of that strategy are we need an enterprise wide data platform strategy. We need to be able to have very standard data sets across the organization. We need to have, we think about that as the enterprise data model.

We need to serve up data in a self serve way, right? In terms of people need to be able to get their fingers on this data and analyze it for themselves and not rely on a centralized team. Four, and that's something that we're very proud of is we have a very strong data literacy program. So that has been the investment.

In training people in all the tools, technology, self service and even going beyond that, we have a DNA University that we started two, three years ago, to train people on how do you analyze data? How do you find it at CHOP? How do you analyze it? How do you tell a story with it? What are the pitfalls when you're analyzing data?

And then how do you use it to make better decisions? So we have trained something like 3, 000 people across the organization. We have multiple tracks for clinicians, non clinicians, and now we're building a track for executives. And the last part of that strategy, as you can imagine, is advanced analytics.

This is where our AI and machine learning Right. Really robust capabilities in terms of data science come into play. And so all those things, I think, really came together during the pandemic. The pandemic, I started six months before the pandemic as the first VP of Data Analytics. It's a great time to start because, it's very hectic, but the one thing that folks grounded on is what is the data you're using to make this decision?

How many patients do we have with COVID in the system? How many masks do we have? How many N95s do we have? How many kits do we have? How many lab tests do we have? where are the patients with the highest rates of diagnoses for COVID? And can we use that as a canary in a coal mine, right?

All of these were data driven decisions. And so, as I came on board, I essentially told the team, every crisis is an opportunity, this is the one for us. This is the silver lining, is that we build a data driven organization to come out of this. So, we used an opportunity to build an enterprise operating dashboard that's used by executives every single day in terms of what's the state of the health system, and educating people on all the things I just talked about in our data strategy.

And three years later I think we have an organization that's still moving towards being more and more data driven. I think it's a journey. It never ends. I wouldn't say we're there, but most decisions here are made using data. We want to know the impact of what people might do, and then measure the impact of those projects with very specific metrics.

That is just in our culture at this point, and we built the tools to make that possible. Easily that the easy thing to do rather than the more difficult thing to do.

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  📍 So talk about your literacy program. I don't think it's unique, but it is really advanced for what I've heard in the industry.

Is there like a certain certification people need to have in order to get certain access to certain data. And so they're sort of an incentive to go through the program so that they can get more and more. And you guys are an academic research facility as well. So You have different entities trying to get at that data as well.

Yes, exactly. So we are a very large academic medical center. We have a very strong research presence here in the Research Institute. And so we've got stakeholders, on the research side, on the clinical side, on the operations side. And so all three have to be served the same way.

I can talk a little about data literacy. One thing I forgot to mention, Bill, was part of that strategy, the strategic pillars, was data trust, having trusted data. And so you mentioned, like, this, when I came on board, it was there was a lot of discussions around what data are you looking at?

What does that mean? How do you think about that? So we built what I call the data trust office. And in it are all the governance structures in terms of defining data, defining metrics, having data stewards for every single metric. And we actually launched an enterprise data cloud catalog last year called Gene.

It's a product, Elation, I'm sure you've heard of it, in the market. And we've created that. That and in line with your comments when we were at the medical center, was the first time where we have all research data sets and all clinical and operational and financial data sets all available through one data catalog defined by the FDA.

Governed with data stewards. I can't think of many AMCs that have that, and I just like the strong partnership between our research institute and the data analytics group to really bring that together. And so, in many health systems, the clinician is providing care, doing quality improvement.

And doing clinical research. I mean, these people wear multiple hats. So our thought process was, how can you create a catalog that allows them to do all their work seamlessly? So that's what the Data Trust Office and the Enterprise Data Catalog journeys look like. In terms of data literacy, we do have, you're right, we have three levels.

You're essentially a novice in terms of, you're being introduced to it, and I'm forgetting the exact term, and you're a novice, which is a data fellow, try to follow the clinical realms, like graduating as a resident fellow, and then you're a data professional.

And each of those three fields. Levels have very clear training requirements, certification requirements, and then follow up in terms of you're not at one and done. You have to retrain, continuously on new tools, new things that we release. So that's part of the culture. We also created an analytics champion program through this.

So we're actually trained for our clinicians, which is led by. So, when we created this program, we have various flavors of this. We have offerings that are, hey, you only have an hour. Let's get you into a lunch and learn. You want to be part of the community of practice, which we call Nucleus. You can be part of that.

You can know what's the latest and greatest things that are happening in terms of data analytics across the organization. You can keep a, pulse on what's happening there. You want to be a data professional? Great. We have an eight week course that will require five hours a week of training and your manager has to sign off on all things related to data analytics.

So there's different levels to this and then through all this we also created a clinician analytics program, which is You have 30 minutes and you need you need to know how to use analytics, which is led by a clinician that's been really successful. I think it was inspired. I was inspired by Airbnb's Data Science University when I first started this like three, four years ago, and it's built into this great program that I think people find very valuable in getting trained, people trained on analytics.

The data becomes the foundation for a lot of other things. Obviously I'm going to skip to the end, which is. We're seeing AI permeate the conversation. In fact, I heard a CIO yesterday give me the term AI fatigue because he's tired of the number of times it comes up. But I, and I told him, I'm like, I don't think it's going to go down in number.

I think it's only going to continue to go up. guess is, like many healthcare institutions, you've been using AI for quite some time at CHOP. But now we have this whole concept of who's going to lead AI. But it's been around for a decade, if not longer, in most institutions. Is there a conversation of It's seeing the momentum of AI, like how are we going to bring it in?

Who is going to lead these efforts? Who's going to introduce us to the new concepts or how it's being used or keep an eye on the industry, keep an eye on the horizon with regard to AI.

Yeah, absolutely. So, I mean, everybody knows that meeting isn't complete without, bringing up AI at this point.

And so, in my role as the CDIO, the Chief Digital Information Officer, that that's my purview in terms of what is happening with AI. What is our AI strategy? How will we utilize AI to meet our, strategic goals and really use it as an accelerator for us. That's how we've been thinking about it.

I think in terms of, we've done a couple of things. We want an enterprise. AI strategy. So we have brought in our chief data analytics officer, our chief research information officer, and some other very adept people with AI who've been working with AI for a very long time in our research institute together to build an AI work group.

And so we've launched with that, this is the brain trust, this is a small one to figure out how we use AI safely, effectively, ethically, and to meet our goals. And then we also have an AI governance committee now established, which is, we're all getting peppered with the next latest AI tool.

It's like, well, how do we vet? If it's safe to use, if it's not just a data grab, if it's feasible, if the company's going to be around in the next couple of years, because I'm sure digital health funding has decreased so much in the economic environment. So all of these things are things we need to factor into our decision making.

And so we're being very thoughtful with this AI Governance Steering Committee that includes legal, compliance, or Chief Data Analytics Officer and others. To vet, our chief information security officer as well, to vet these new products both in terms of what's the problem we're trying to solve here, and is this product the one that can help solve it, or do we already have something existing in our inventory that we can use because as this is, I call it like the AI arms race, we may have A ton of products that are being released as point solutions right now.

But the big players of what I call platform plays are all also embedding AI in all their workflows. ServiceNow, Workday, Epic, Salesforce, right? They're all Microsoft. They're all doing it. So, I think there's a decision to be made in terms of how are you going to take what's on their roadmaps and what they're evolving versus what's being newly released in the industry and where's this balance point for that.

So that's what we're trying to figure out.

Yeah. It's been interesting to have these conversations. And one of the things. That I hear people being concerned about. And I'm sure you guys are looking at this. It's just the they start to embed AI and then all of a sudden there's a fee for AI.

And now all of a sudden it's like, wow, all of our platforms just went up by 20 percent or 15 or 30%. And it's like, how are we going to fund AI? It seems like it's being treated as. a new technology and not a technology that's replacing other technology or replacing existing, work that needs to be done.

And as such, it just drives up the overall cost of IT. I mean, that's going to continue to be a challenge, I would imagine.

Yeah, that's really interesting. I'm glad you brought it up because we just had a discussion a couple of days ago and we are expecting that AI will actually increase the productivity of these companies that are building the technology solutions that we use and like price increases, we'd expect those productivity increases To show up in terms of reduced prices in our contracts.

And that's like, our ideal state, not sure it's going to happen. But that's like the expectation we're trying to set with folks is we know that this is going to make us all more productive. How will this be passed down to us? In terms of customers. And so I think there's definitely a discussion that needs to happen there.

It's very early innings in terms of how it

works. Yeah, I love that point of view. As we're closing up here, I want to ask you personal questions, about your leadership philosophy, your approach. , healthcare uniquely demanding. Right. So, what's your your leadership philosophy, and how has it guided your approach to leading CHOP's IT and digital strategy?

Yeah, I mean, I think number one, and one of my mentors told me this as well, health IT is all about people. And so, I think that is my leadership philosophy is that we're here to help our patients, our providers, who happen to be our customers, and how can we do that in the best way? And that's my leadership philosophy.

I switched careers a number of years ago from financial services consulting to come to healthcare for that particular reason. And so my leadership philosophy really has been. Let's solve problems for the folks that are having them, improve the care of the patients that are being, that's being received here, as well as the providers, and use technology to do that.

And let's go into the spaces that are causing the most frustration. And try to solve those really difficult problems. So that's what I try to focus on every day that I come in.

me an idea, so you're sitting in this role, and this role is a future leaning role, obviously it's one foot firmly planted in today, and One foot firmly planted.

I used to say five years from now, but five years from now, who knows what's going on, but at least three years from now. Give me an idea of you envision the future of pediatric health care at CHOP maybe three years from now. How is it going to evolve and in what areas do see it really leading out or pushing out?

Yeah, I think technology's already been at the center of what we do, but it's going to become even more critical in driving some of the changes. I don't think, not just pediatric care, but generally the healthcare industry is asking for in terms of financial pressures we're facing, in terms of workforce shortages, pressures we're facing as an industry.

And so we really need to use technology To help solve some of these very large problems. So I think a couple of ways it'll look different. One, the CIO role has now morphed into this, in many places, the CDIO role, and I think what that really means to me is that You're actually in charge of figuring out how to transform clinical operations and business through the use of technology.

That's got to be the value add, not the, here's a piece of technology and let's figure out what it can do. But it's, here's a piece of technology and here's what I think it can do and the value that it could create. for the institution, let's go, give that a shot. So I think that's the change, and I think it'll become even more and more business clinical facing as we move forward.

In terms of how it'll change healthcare, it will allow us to meet our patients where they are. Telehealth, remote patient monitoring, care at home programs, virtual rounding, virtual ICUs, virtual nursing, all of those things are going to change the workforce and it's going to allow us to change and drive care closer to where our patients are, which I think is a win.

I think it will make operations much more efficient in healthcare. In terms of, there's a lot of manual work that's done in healthcare today. I think the technology can really take a lot of that burden off of people to help us focus on top of licensed work, areas like ambient intelligence, right, voice recognition transcribing notes, chart review, robotic process automation.

That's where we're looking in terms of how can the employee experience. How can the jobs be more fulfilling with tech? And the last piece is, I think, one of the things that I say is that we have always thought about AI as an automation to impact blue collar jobs, for the lack of a better term, but I don't think that's going to be the case.

I think it's going to disrupt clinical work in terms of, if you look at radiology, pathology, lab, the ability to diagnose, the ability to write a report. Those are things that AI is going to get very good at in the next three to five years. And we just need to figure out, I think you mentioned this earlier, it's not about replacing the human.

It's about augmenting the abilities that we currently have, making us more productive through the use of the AI, while always keeping a human in the loop for making sure it's making the right calls and the right judgment. So, I think I said this to a group of physicians, you know, will not replace physicians.

The physicians that use AI replace physicians that don't. And that's going to be, I think, true for every role within healthcare. Actually,

that's going to be true for everyone in every industry. Correct. Exactly. That's what it feels like right now. Alright, so closing question. We have a lot of I get notes.

from our listeners who are aspiring to either be in healthcare leadership or aspiring to be in the healthcare technology space. Think of the college graduate. I guess we're coming up on another year of graduates coming out. And they're looking at healthcare and saying, I think I can make a difference there.

What do you say to those people? And what would guide them in terms of their first steps into healthcare or healthcare technology?

first thing is that healthcare needs you, healthcare needs your talents, healthcare needs your expertise. And then we're in a transformational point in healthcare where I think the, the healthcare industry is waking up to the fact that there's so many advances and how do we leverage them?

And there's an acceptance of that in ways that there maybe hasn't been in the past. And so I would say it's a very exciting time to get in the industry because it is transforming in a major way. And I would say as first steps, it's really figuring out how you can combine, whether you're a technologist, how you can combine those technology skills with operational skills.

How can you learn more about healthcare, the challenges healthcare is facing, and then figure out how you can align your skills to contribute to solving some of those challenges.

Right, absolutely. Shaquem, I want to thank you for your time and really appreciate your time.

You sharing your wisdom with the community. Thank you.

Thanks for the opportunity. Appreciate it, Bill.  

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