This Week Health

April 19: Today on TownHall Jake Lancaster, Chief Medical Information Officer at Baptist Memorial Health Care interviews Mark Zhang, Associate CMIO at Brigham and Women's Hospital and Medical Director at Brigham Digital Innovation Hub. Launched in 2013, the Hub matchmakes market solutions with internal challenges, accelerates the development, use and commercialization of Brigham-developed solutions, and fosters a culture of digital innovation and collaboration. What does it take to build successful programs and products within an academic medical center? What challenges come up with building things internally? How do you get funding?

Transcript

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Today on This Week Health.

What's the easy button? What could we try that we can get the process and buy in for? What if there was a button in the bathrooms when they were dirty to press and it would send an email and a SMS to the appropriate parties to let them know that the bathroom needs to be cleaned. Like most projects it's the 80 20, right? Most of it was just getting the people and processes aligned and then the technology was fairly straight forward.

Welcome to This Week Health Community. This is TownHall a show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels designed to amplify great thinking to propel healthcare forward. We want to thank our show sponsors Olive, Rubrik, Trellix, Hillrom, Medigate and F5 in partnership with Sirius Healthcare for investing in our mission to develop the next generation of health leaders. Now onto our show.

Hello, I'm Jake Lancaster. I'm an internal medicine physician and the chief medical information officer for Baptist Memorial healthcare based out of Memphis, Tennessee. And today I'm very excited to be with Mark Zhang, the Medical Director for the digital innovation hub and the Associate CMIO for Brigham and Women's. Mark. Welcome to the podcast.

Thanks, Jake. It's a, it's a pleasure to be here and I'm thrilled to be invited to this podcast. So,

And I'm very excited to have Mark on. We we've known each other for, for many years. We met each other when we were both in clinical informatics fellowship. But for the rest of the audience, can you just give them a little bit of your background and tell me what.

Sure. Sure. So I am an internist by training then specialized in palliative care and then specialized again in clinical informatics and my current role as the medical director of the digital innovation hub at Brigham and women's and ACM IO at Brigham and women's for digital innovation, I run a team embedded in IIS within our IAS infrastructure that really focuses on anything digital innovation within the hospital, we do like kind of four buckets of work. The first is we're a solutions delivery group within the organization. So we're able to build custom developed solutions based on requirements within the hospital or our larger. National Brigham umbrella. We also implement innovation projects that are vendor based.

So if there's like a vendor that we're looking at that doesn't have a natural home, or we're kind of scoping a pilot, our team is a team that can do. We do what we call innovation consults, which really helps support internal staff members at the Brigham who have ideas, any stage either back of the napkin to like ready to spit out, we help them get to the next step.

And then we also are a true hub for external companies who want to engage with Brigham and women's in the digital space. They can reach out to us and If there's a good connection, or if it makes sense, we make those connections with researchers, scientists, and clinicians at the Brigham. And hopefully we see a really great collaborations come from that.

And then finally, we're a lighthouse within the organization for digital. So we host events across typically one, a quarter where we'll partner with a community-based group, like mass challenge or a more national group, like Y Combinator or other vendors to host events kind of highlighting our, our engagement with the digital community. So that's kind of the work work we do at, at the iHub and my role.

Very nice. And if I remember correctly, even in fellowship, you were doing some work with the innovation. Can you tell us just a little bit about that past experience and how it prepared you and led you to this role?

Sure. Sure. So I actually didn't even know what informatics was until I was a palliative care fellow. I did my residency. It was like a lot of this, like most things is about timing and luck. And, and like maybe a little bit of skill. And I think for me it was good timing and great luck. I did my residency in Pittsburgh at Allegheny general. Right around the time the iPhone had been announced a couple of years before, and the app store was coming out like right when I was an intern.

And I remember when I was like a fourth year medical students seeing the first iPhone for me I think one of the interns had one. And I remember looking at like my old Palm trio and thinking, man, like the game has changed. Like that's the future. So when I was an intern and the app store came out, I'm don't have a technical background, but I knew that knowing that that's where things were going, I wanted to do something with digital and healthcare.

And really learned a lot during my residency finding interdisciplinary teams of programmers and and others to build kind of clinical applications for iOS and then eventually Android. And then when I found my clinical niche, which is palliative care, I also knew I wanted to go to a place where there would be more opportunities, the community and the environment was just a little bit more, I would say, connected than Pittsburgh, which again is an incredible city.

e all the pieces, but back in:

In fact, like during, for holidays, we all got Christmas, like holiday mugs. With like something personalized and mindset. This mug is an app, which, which I think was like, chef's kiss. So I was on, service with one of my, attendings who now is a, is a good friend. And he saw a flyer for this new fellowship that was coming out at the Brigham called clinical informatics and he gave it to me and he went, Hey, mark. this is something that, it seems like you would be really interested. Like the, undertone was, you're like a big nerd. You should like, look at this.

And I did it. And I was like, you know what, actually, I do want to do this. So I reached out to the program director and to see if I could do an elective, we got to talking and he was like, you should just apply. And I did. And I became the first clinical robotics fellow in the program with really the goal was to try and figure out how to build these digital tools within an AMC. A lot of the work I did prior to that was really resulting in me not being able to figure out how to get it done in the confines of like a an AMC or with a hospital system. It's just, I just kept on running into kind of walls. So like, well, how I solved that was just going out of the hospital system, finding others and other groups just doing it outside of my normal day to day.

So fellowship was a lot, was it was a lot of learning how to build these kinds of solutions and do kind of become an intrepreneur of sorts. And, and to that end after my fellowship, I stayed on at the Brigham to effectively do that, to build apps and help with innovation. And then when this w this gig came up, I was really fortunate to be able to take it on.

Yeah. That's really great. Particularly when you're talking about how to build it within the confines of an academic medical center or hospital. I know we still struggle with us. I'm sure everybody still struggles with it. Can you tell us just a little bit about how y'all have addressed some of those challenges with building things internally and maintaining it particularly as is some of the challenges.

Maintaining is thats yup. Yup. Yup. so I think like one of the things that we do at the iHub is as I said, we were a solutions delivery. But we're also kind of a support structure and almost like a mentor for anyone at the Brigham who has an idea in digital health and for the solutions delivery, it's pretty straightforward. It's a top-down approach. So really we don't build the thing unless leadership sees the problem and asks. To build the thing. And typically when we do that we'll use a fairly standard kind of processes to help ideally figure out like, okay, Who's going to do what, right? Like who's going to maintain this thing for how long and dah, dah, dah, dah. Is this a build or a buy?

We kind of come either that's already pre-decided before it comes to us. Or that's like, the first part of work is like creating eventually the charter for, for this type of work. And then hopefully we maintain it. So during COVID like, I think most groups because everything was so aligned, everyone was so aligned.

We were able to do a lot of really incredible kind of system level interventions very quickly. So one of the things that my team kind of created and continued to maintain is our daily symptom at the station. At Brigham and women's, but also at mass general, Brigham Dana Farber. And actually I think other sites use it outside of our system called COVID pass.

And that was something that is a perfect example of a custom developed application that, you know, because we had that alignment from the beginning, we were able to rapidly create the solution, may develop it, iterate on it. And then also as part of that, have a maintenance plan moving forward.

Maintenance plan was my team and other teams who played a role in substantial role in building the thing. We continue to maintain it in an agile format. We have like bi-weekly sprints and it's been, it's been a blast. On the other end of that is when we support kind of Brigham innovators who have like really early stage ideas. A lot of the work we do is really making sure that they it's a lot of education, right? Like folks are typically incredibly talented, incredibly smart folks who might not have as much experience or in, in digital or doing anything in digital.

So a lot of what we do at the initial stages is just understand what they're trying to solve. Talk about some kind of base concepts, like what is an MVP. And then we also have a framework at the iHub, which we call the COFT team model, which is really something that we do. Particularly when it comes to like a digital intervention that like the researcher or clinician wants to ultimately try and pilot or implement within the hospital system.

And we run through it to kind of get a sense of like how ready they are. It's like a readiness scale to actually do the thing. So C is like, who's the clinical champion. And if you don't identify, if you're not the clinical champion or maybe if you are, how much time and effort do they have dedicated to do this thing.

Right. And would they people person that would also maintain the pilot or maintain this thing? Oh, is who's the operational champion. So that could be. Does your superior, your chair? Is there buy-in? Is this a problem for you or is this a problem for your department? To actually implement the thing, do you need assistance?

Like, do you need actual implementers to do it F. Obviously it's funding. Right. Is there any funding for this? If not, that's okay. Then it, clearly, the next step is like, we need to refine the proposal in a way where we can get you set up for funding or try and do as much as we can without the funding to kind of get you to like some kind of either functional or at least conceptual MPP.

And then I think the other really important piece, which really only works because we're aligned with our ISDN. We're part of the ISDN group at Brigham is the T, which is what does the technology alignment with our current stack, right? Like our group and our job, I feel strongly as not to be the, not to be like the tech cops and just say no to things.

It's more to make people aware. When they wanna do a solution that could, that already exists within our EHR kind of functionality or already exists in an enterprise, like software package that we already use. We want to show them like, look, this already exists. Maybe you should use it.

And maybe if they still want to do it for research or what happens. It's about making sure they're a guard rails. So the expectations are set at the beginning that, look, you can do this for research, but because this exists, there really isn't a pathway to like move this into enterprise. So like, let's understand that from the get-go. So we we're all on the same page.

That's great. Now that that's really helpful to understand kind of y'all's processes. And you talked a little bit about the intake about some things they'll come to you as we've decided we're going to build this instead of buy it and turn it over to your team. But tell us a little bit more about the governance about how projects come to your group. Yeah, once you're done with them, do you spend them off? Do you keep them internally to maintain? How does, how does that work?

Yeah. Yeah. So I tend to think about, specifically at the iHub, we have essentially two bosses, right? The first boss is the Brigham and MGB. So those are like the top-down requests where there's a, there's an ask to do X, Y, Z, and it's coming from executive leadership. And we have to do it. We have to figure out a way to do it or accommodated. Our second boss are all staff, anyone that works at the Brigham through that innovation console perspective.

Right. And typically it's that request is I have an idea or I have a project and I wanted to get to the next step or I need some assistance. Or my project is like going great or it's stuck. How can you help? the governance from the top down is pretty straight forward, right? Like if it's coming from the top down we'll work through the existing committees and pathways depending on the project in working with kind of our leadership as well. And it's coming from the bottom up. A lot of this is about supporting whatever the idea or the project is to get to the next step. And sometimes the next step is that, Hey, you know what, maybe this is ready to be scaled at larger than just a pilot. And then from there, we work with our colleagues in, kind of our central MGB innovation group to there's a mechanism we use to help kind of scale these projects. So that's kind of the governance set for the things that come from the bottom up.

Nice. You talked a little bit about COVID pass, but tell me about some other projects that you're proud of. I remember hearing you give a talk about a button that you would put in a bathroom that patients could to clean the bathroom. I thought that was really good.

Yeah. Yeah. Yeah. So this, so this was like maybe three or four years ago. This is a perfect example, actually. It's funny, we're actually doing like version two of this now. So that was actually an example of an innovation console, like an internal innovator who already had a relationship and was interested in doing Dr. Peter chai toxicologists, and just like just an incredible innovator. Already was interested in doing work with these IOT buttons and had a relationship with a company that that kind of created some software to help make them more of an enterprise solution.

And this was actually, if you remember the Amazon dash buttons. Yeah, yeah, yeah. This was like three or four years ago. And we were looking for kind of use cases for them in the hostile. And the use case that we saw was what's the easy button. what could we try that we can get the process and buy in for, and we ended up doing it for kind of things like to flag when like a bathroom needs to be clean or when wheelchairs need to be refilled.

Kind of like the use case that the dash buttons were originally intended for as the consumer to like refill your tide? Well, we don't share bank needs to be refilled. What if there was an easy buy-in that we could program to alert the transport group to refill the wheelchairs or what if there was a button in the bathrooms when they were dirty to press, and it would send an email and a SMS to the appropriate parties to let them know that the bathroom needs to be cleaned, like most projects. Most of the work it's the 80 20, right? Most of it was just getting the people. And processes aligned. and then the technology was fairly straight forward.

That was actually, so we published a couple of pieces on that, that our proposal and then our initial results. And afterwards it was a QA stuff. Afterwards, actually, it was so successful that like groups just wanted to use it moving forward and they kept on using it until the batteries actually died. And the company that supported the whole solution, like no longer supported the solution. So actually more recently we're doing this really interesting, very early pilot where. One of the things that we saw with COVID is that people just as a whole are way more used to using QR codes. There was always like this tension using QR codes in the past about do people actually know how I think technology technologically savvy people of course know how to use QR code, but like, is that the case for everyone else?

And it was unclear. Well now I think we're all pretty familiar with QR codes just with our day-to-day life. So we actually are replicating the IOT button work. We have this other project that the iHub built. It's another solution called Brigham at its best. And it was actually a project I started when I was a fellow fix it, which was kind of a similar, I like 95% of my career so far Jake has been, how do I like work with environmental services to give them more work.

To be coming up with names for your projects?

Well, that's how I know when things actually are super successful. I lose, I lose naming rights when things are successful and then someone else gets the name I'm. So, so fix it was was what I initially called it, but then when it, when it actually got good the name came to bring meds best, which is which is a fine name.

But it was basically, it was basically a digital version of the E the easy buy-in. So now we're actually creating a new version. Using QR codes that are linked. So, so these are hard-coded fix it requests to a QR code. So you can just put up a, we put up a pilot on one of our floors where we have a sign that anyone can just scan the QR code.

And it automatically brings you to a pre-filled web form that like says environment and central transport needed to clear this hallway. And there's a whole to fill in more details as needed. And we've actually created a really nice way to close a loop for central transport using the same QR code. And what we're seeing is that the engagement there is pretty incredible. And people really like it. In fact, they've they're requesting another good sign when these things are going forward. Is who are your stakeholders holders requesting? That these things get scaled further. And this one so far, we've seen that, which is great.So.

No, I mean, I can definitely think of a lot of applications for that if your computer's broken or something's broken on a computer instead of having them call the help desk and go through that, you could have the QR code that just straight to them.

QR code. And actually, I think it's the QR code. But importantly it's the platform we had already build to like ingest these, fix it requests and the process like this is like all this is stuff it's all iterative. Right. We built this initial thing back when I was a second year fellow, which was a really straightforward web form that we linked to email and SMS, and we got the stakeholders in our environmental services to like, kind of look at and respond to. And that's kind of expanded to become this whole platform called Brigham at its best, which not only enables you to do fix it, send out, fix it requests, but also is like an employee hub. For your real-time shuttle tracking. What's the menu at the cafeteria resources. Bundled into a progressive web application kind of as a tool. So these are kind of some of the things that I would say are part of our solutions delivery arm of the iHub.

Cool. Well, mark, it's been great talking with you and catching up for the audience. Can you give them just one or two things that you're optimistic about in the next few years with the innovation hub?

t a decade now. We started in:

And also how do you, how do you do it within the confines of academic medical? And I think what we're trying to do and we continue to do is create processes and frameworks to make this reproducible. And also ideally to make it something that isn't just innovation theater, but really has like really as connected with the true kind of operations and needs.

Both our customers, so Brigham and also Brigham MGB, and also the staff. So I'm really excited actually to see how this continues to move forward and how we kind of build this out. So. One of the things. This is probably more than a couple minutes, but just one last thing one of the things we're really moving towards is how do digital innovation centers like the iHub really become subject matter experts in like these new fields that are emerging.

So things like web three or VR AR things like that digital prescribed prescription therapies. How do we become a true SME and how do we, and there's value there's clear value to that within our organization? How do we attract that? We are the SME and how do we. Keep track of that and support that within the organization. And still also importantly, be the light house. So that outside parties know that there's, this stuff is happening within the hospitals and, and we're here to support that. So that's the stuff that I'm super excited to work on moving forward.

Well, thanks. That, that sounds amazing. And I would love to hear more in the future and thank you everybody for listening. Have a great day. Yeah. Thanks so much.

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