David Bensema on Consumerism at the Scottsdale Institute

David Bensema This Week in Health IT
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David Bensema, M.D. and I hit the links for a discussion on the concepts of consumerism that we picked up at the Scottsdale Institute. Hope you enjoy.

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Bill Russell:                   00:07                welcome to this week in health it where we discuss the news information and emerging thought with leaders from across the health care industry. My name is Bill Russell recovering health care CIO and creator of this week in health it a set of Podcasts and videos dedicated to training the next generation of health it leaders. This podcast is brought to you by health lyrics looking for someone to be your personal coach in healthcare technology. Let’s talk, was it health to schedule your free consultation. Okay, so this recording’s going to be just a little different. David Bensema and I just finished attending the Scottsdale Institute conference here in Phoenix, Arizona and we decided to go out on the golf course this afternoon and uh, just record a few of our thoughts from the conference. We also talked about his latest article in health system CIO and just about anything else that comes to our mind, including the traps and bunkers and things that we happen to end up in. We had a great time recording this. I, uh, apologize ahead of time. We, uh, you know, we’re always pushing the envelope here, learning some new things. And, uh, one of the things we’ve learned is not to drive the cart while we’re talking and generates too much wind. We also learned to be cognizant of airplanes as they were going by and trucks as they’re going by. Uh, but that’s, uh, that’s part of what we’re learning here and a will continue to strive to be better as we move forward.

Bill Russell:                   01:27                All right, so here we are, our first, uh, onsite podcast from a golf course with Dr. David, Bensema. And, uh, well, welcome. Welcome to Phoenix. Thank you. I can’t think of a better way to do this. Oh, me neither. Actually this is going to have to become the normal format from now on. I’m just going to call CIO is and ask them to, uh, to meet me on the golf course and we’ll do this. Uh, so yeah, so we’re at the Phoenician actually just finished up at the Scottsdale Institute, which was a great conference. And, uh, we’re looking forward to giving you guys some, a little bit of, of the insights. We’re not going to go in depth into a lot of things, but just some things that they got us thinking about and talking about. You were on a panel. I was on a panel. Yeah. So, uh, looking forward to doing that. But right now we’re going to go hit a shot and then we’ll come back.

Bill Russell:                   02:13                We’re not going to give you a play by play on the call shots, but we are both pretty close to that green, so I feel pretty good about that. Um, so let’s start with, uh, the, the whole conference was about consumerization and a digital health and those kinds of topics. Let’s talk, let’s talk first about your panel discussion. So, uh, just give us a little rundown of what you guys talked about.

David Bensema:            02:35                So we, uh, we’re tasked with discussing how computer aid, health healthcare in the future was going to look, what we thought would be some of the most useful, uh, interventions and inventions that could be applied and, uh, had some terrific panelists. Um, it was great to be up there with David and, um, get a chance to hear his take from the quality safety standpoint and then have Andrew have his take as a intensivists as well as a CIO. And then mine is a former CIO, um, who has time to think about things.

Bill Russell:                   03:12                Yeah. Uh, it’s so moderated by Jonathan Maness. Uh, Andrew Rosenberg who’s been a guest on the show before and then, um, David David’s last name Best David Best, uh, was there from partners I believe. Right? Correct. And uh, yeah, I thought it was good. Good. One of the things I want you to talk about it cause you, you shared, you know, sometimes this stuff is just an incremental, we think it’s, you know, digital health is this massive thing and you shared about your discharge process and it’s something that really struck me as something a lot of health systems struggle with and you guys saw a significant benefits actually got written up. So yeah. Talk a little about that.

David Bensema:            03:50                Uh, we instituted a physician builder program as we went live with epic. And in the two years since we completed the go lives, they’ve been working on enhancements and one of them was directed by our hospitalists home builder and she saw an opportunity to automate a lot of the data aggregation for discharge and for discharge preparedness. What it did was it saved the nurses from having to go through screens and pull it, um, and the physician from having to go through screens to see what was still missing. It presents it in a single format and they’re able to see what still needs to be done, whether it’s med rec or a scheduling, a followup. And it cuts time. We, uh, in the study that they did at Baptist, um, they found that it cut 40 minutes of nursing time per discharge, um, in the initial, and it continues to have those kinds of numbers. Plus it reduces the time from declared ready for discharge to out the door by 15 minutes for the patient because of the, including the transportation folks. So it’s a patient satisfier as well as a timesaver for clinicians.

Bill Russell:                   05:00                Yeah. And the amazing thing to me was, you know, consumerization really is about convenience, choice. Um, it’s, uh, it’s about, uh, it’s about the consumer and that was a huge consumer benefit from a perception standpoint. Um, but we also talked about the consumer on both ends, right? So the consumer, the consumer of our services as CIO is the clinician and the consumer being the patient. So that was a win in both directions.

David Bensema:            05:26                Correct. Yeah. And from the patient’s standpoint, the fact that the nurses were spending less time on it, the doctor had the information, it also allowed for earlier discharges in the day and then that 15 minutes saving, um, for transport. So it really is about a 45 to 50 minute savings for the patient.

Bill Russell:                   05:43                Yeah. And that’s huge. And great shot by your wife. She’s on the green and we will, uh, come back and a couple of minutes. So David, one of the things I found interesting was there was an awful lot, um, disagreement, which actually made this conference. We’re pretty, cause there was a lot of conversations, um, different ways of approaching budget, different ways of approaching digital in general, different concepts of digital. Um, people thinking we’re spending too much time on the consumer and not enough time on the clinician in our core business. Um, but so let’s, let’s break some of those down. One of the things, uh, you know, some organizations have decided the future of healthcare is consumer. And so I, I did a panel, we’ll see if we can drive and do this at the same time. Um, I did a panel that was a chief digital officers, chief consumer officer, a CEO, a former Disney employee who’s now working for a health system.

Bill Russell:                   06:40                And those systems are essentially saying, hey, we’re all in on consumer. The consumer experience is going to be king. We want to make sure we hold onto our customers. Um, but there were others who were like, you know what? We hired these kinds of people and then our DNA doesn’t allow them to be successful. It shuts them down. Um, I mean, did you get, get a feel for, is our, do you think it’s going to head in one direction or another? I mean, are you feeling a consensus building or just we’re going to see what works

David Bensema:            07:09                eventually. We’ll all adopted. I think we’re going to see, um, you know, we heard the comment about two major companies not in healthcare and the one saying I want to be a fast second. Yeah. I think there’s a lot of systems that want to be a fast second because the investment in consumer, uh, orientation and the digitization is significant. The change in workflow is demanding and they want to see some success and Roi before they jump in because everyone’s experiencing the tightening margins. The other reason is I think there’s generally a lack of creativity within healthcare. We are not, um, artistic individuals and so we don’t have the ability to do the imagineering that a Disney employee can do. And our boards are highly conservative and particularly our legal counsels and digitization and consumer orientation puts you out there a bit.

Bill Russell:                   08:02                Yeah. Too much risk. Um, I also, uh, you know, I found it found it interesting as we were talking to, as I was talking to the chief digital officers, uh, just the, a bunch of them coming from outside of healthcare and the learning curve and they even said the learning curve is very significant. Working with, uh, these health systems. And you know, they are a hundred year old companies that are, you know, their DNA is designed to, to mitigate risk and reduce risk. So,

David Bensema:            08:31                and they are the sense that a lot of the folks in those organizations are working very hard to have them fail. Yeah. Because they don’t want to be proven wrong about the way they used to do it. Yeah. It’s a struggle.

Bill Russell:                   08:42                Hole Number five. Okay. Well, you know, it was, uh, this is going to sound like a choppy podcasts I’m sure. Cause it’s like, but you know, we, we record something and then we had like three or four shots, then we get some drinks, then get back on the, uh, thing. Um, uh, I, I love the Scottsdale Institute because first of all, they pick such a great topics and there’s great people in that room. Um, one of the things that struck me, and we’re not going to do justice to the, to the agenda, and what not? But one of the things that struck me was a, Jerry Lewis was their CIO for acsention, um, as was Marcus Shipley, a CIO for trinity. And both of them talked about, uh, the fact that their budgets, um, that they’ve given away a lot of their budget control. And now when I was CIO, I don’t know if this was the same with you, I was like the Bank of Saint Joe’s absolutely.

Bill Russell:                   09:36                I had a massive budget. So every time somebody wanted money for a project or whatnot, they were coming to me. And Marcus made the point of saying, you want to get out of that business as fast as possible and essentially the budgets, yeah, we got to applaud phenomenal shot there. Um, but they made the point of saying, you want to get out of that business as soon as possible. You want, uh, the governance committees, the executive cause you really want your strategy to drive where your dollars are, not the CIO holding onto the money. It’s a bad place to be. I mean I actually, I assume you picked up on that.

David Bensema:            10:10                Absolutely. When you’re not in the full implementation of the integrated Ehr, we were, um, I can understand that to a degree my only concern is no one in operations, no one else in the c-suite has an appreciation for the complexity and nuances of an it implementation, so they all under budget and over commit. In terms of financing both projects. I think the CIO has got to at least be able to be in the room and have a very strong voice to control the overgrowth of the projects.

Bill Russell:                   10:44                But that didn’t concede control is an interesting word because what I was hearing from them was a lot of um, giving up control and being more the uh, guidance, uh, educator. Um,

David Bensema:            10:58                yeah. And so yeah, you’re right. I, my word of control is kind of a misuse. It is guide the conversation to make sure all the aspects are considered, all unnecessary aspects are considered. That’s not controlling. That is simply guiding and educating.

Bill Russell:                   11:14                Absolutely. Well, let’s go hit some shots. David. It’s Kinda, it’s kind of a cliche to talk about the role of the CIO, but one of the things that struck me about that panel, you had, uh, uh, are also Eric, uh, Blonsky your landscape from Stanford, Stanford and, uh, used to be Chicago. One of the things that just struck me was when, when they got done, you hadn’t heard that heard the word Ehr. You hadn’t really heard them talk about technology. They were talking about business and influence and leadership and um, and leading out in, in different areas like, uh, partnerships like driving new partnerships and new business models and those kinds of things. And somebody made the comment of uh, you know, they almost sounded more like CEOs to a certain extent. And I think that’s the evolution we’ve all been talking about of this CIO is now the CEO of technology within the organization.

David Bensema:            12:11                Absolutely. Yeah. And having a much stronger role in developing the system strategy and having to think in terms of a more holistic model. Um, I liked when Eric was talking about convening some of the clinicians and some of the department directors and was slightly surprised that others had thought about doing that. And I think that’s where it has the opportunity because they see who the end users are, they understand who’s gaining value from the systems and you can bring them together to help evolve them and improve them and other executives may not have that insight.

Bill Russell:                   12:50                Okay. So we’re going to talk a little bit about your article, but before we do that, what do you think of the Phoenician so far? You’ve played nearby love the course. Loved the course. I don’t like the way I’m playing it, but I love the course. It’s actually fair. So I’m awful. This is my first time out for the year, so I’m not too hard on myself. Plus playing the course of the first time, sometimes you find water that you didn’t know. Was there a couple of other things? So, uh, feeling pretty good about that. So you wrote an article and the health system CIO was that last week or two weeks came out Monday. On Mondays. Monday. Okay. And, uh, we pulled a couple of pictures from it, a great article and it reminds me, I think this was your quote from this morning of, you know, you can spend time up front talking to the clinicians, listening to them, um, getting their feedback, incorporating it or you can spend a ton of time later trying to earn their trust back because you, you violated their trust. Yeah.

David Bensema:            13:44                Recovery takes a whole lot longer than being proactive about it and just involving them. And you know, my other take on it is because I’ve seen it and I saw it so beautifully illustrated by the 216 physicians who participated in our build process. Um, and that is when you engage them, they are so positively contributory that executives are amazed, their productivity levels high cause they don’t have time to waste. But they’ll come in there and they’re going to give your best because they don’t want anything shotty going out with their name on it.

Bill Russell:                   14:16                Right. So how do you, so it’s interesting. Uh, one of the CEOs was sharing their process and they, they took 150 people, they’d put him, they locked him in a room is what he said. I doubt they locked them in a room, but I guess they secluded them a little bit, gave them some time and they said, design what health care’s going to look like in 10 years. And uh, and they came back with their concepts and their ideas. I think somewhat sometimes people are afraid that if we put physicians in a room, they’re going to come back and design something that’s iterative as opposed to something that’s transformative, if you will. I mean, something that’s going to look totally different, but that’s

David Bensema:            14:52                not really the case. It’s not the case. When you look at some of the surgical techniques that they’ve pioneered and some of the thought process to get through those surgical techniques, they’re thinking so outside the box. So, um, extravagantly audaciously risk, um, avid that they come up with things that you just wouldn’t do if you were to being cautionary and trying to do an iterative or incremental process and they’ll bring the same to healthcare.

Bill Russell:                   15:21                Yeah. But where, so where’s the physician’s head at with regard to digital? I mean, one of the things I always think is we did really such a bad job with the Ehr just as an industry, let’s just say that because some systems that did a really good job, um, but as an industry we sort of, you know, sort of pushed it on people and it wasn’t really a shovel ready project and we had all those issues and it almost, uh, I tell people, I think that put a bad taste in physician’s mouth.

Bill Russell:                   15:49                So when we come in and talk about digital, they sort of go, whoa, Whoa, slow down, take a breath. Let’s, let’s think this one through before, we go running down the running down the path. I just that, I mean, how are they thinking about,

David Bensema:            16:02                I think there’s some of that, but when I talked to them, I’m, their concern is that if it’s coming from the same people, they don’t want it. But if you bring in a chief digital officer and you’re bringing in some different players to work through the process, um, I think you’ve got a much better chance of engaging them because they love their Ios, they love their droid and they love their apps and they love things that work intuitively and things that work well, whether it’s for themselves or for their patients. So I think you’ve got to change the faces You know, as I said, when I left my role, I was the face of the painful part of epic. There’s now folks who get to be the face of the evolving, improving part of that epic. And I thought that was important. I thought that was valuable to the organization.

Bill Russell:                   16:44                There was an awful lot of talk about organizational change management, right? So that’s one of the things that we did not do well. And it came up in my panel, my digital panel a couple of times where they said, hey, we’ve got these new initiatives, but we are really struggling with uh, getting it implemented at scale across the board. And uh, and people just kept driving home that the old skills, the skills we learned in doing the EHR, at least towards the end. Yeah, we may have screwed up in the beginning and we learned out. We got to bring people along, we’ve got to include them in the conversation, we’ve got to cocreate the solution as we go. Um, all those things we learned, those are going to be critical moving forward. Absolutely. And that becomes changed facilitation instead of management. Physicians hate to be managed. They liked to be helped,

Bill Russell:                   17:29                liked to be helped. And I like to be a part of the process. Our wives are going forward without us. We’ve, we might want to hit it, hit our drive. Sir.

Bill Russell:                   17:38                So Cedars Sinai ended the, the accelerator and it was really interesting and it gets me to thinking, um, how should we be thinking about innovation? Um, cause we have a lot of different models out there. We have some pcs, we have the accelerator model in detail, which is very interesting. And uh, there’s just, there’s so many different models. But you came from a a $2 billion health system. How did you think about innovation?

David Bensema:            18:08                We thought of innovation as organic efforts that, um, responded creatively and uniquely to a need that we saw within the system that could be done, uh, with the personnel that we had and the systems that we had really more innovative of what we already had. Um, and then hopefully be able to share it. So that discharge process for the record, it’s shared out that’s available in the library is then share it out to several of our friends around the country. But the thing that I’d liked about cedars idea is it could look at a wide variety rapidly and truly accelerate things plus they are thinking about bringing in other groups that represent different demos, different needs than cedar’s going to experience.

Bill Russell:                   19:02                Right. But you know, I think there were one of the few that has an accelerator like that. Um, but you were, you were chatting with them. And I mean that’s, that’s sort of the conversation of how many of those should we have across the country.

David Bensema:            19:15                Yeah. And so, Ann, and I had a nice chance to chat about it and my concern was you could spend a whole lot of money across the country if every one of us chase this. And she agreed and we kind of settled on the idea that their thought was, and I agree that 20 across the country, um, doing different approaches to innovation but still having the openness that cedars does to bring in other participants, other partners to at least look at the op opportunities and to bring new understanding is a good model that way. Not everyone has to have that infrastructure. There’s other things that each of us can do in our sites that can contribute to the care of the patients across the country without having to have an innovation center.

Bill Russell:                   19:58                The thing that struck me was it w it doesn’t, here’s the thing that’s expensive. It’s not the money. It’s not the cash. That’s the expensive part. The expense part is the pilots. And the people and the resources that you have to dedicate to it. And that’s where, that’s where it really burns. Um, it’s burns cycles and you know, so you’re not going to have a lot of them, but there’s been a lot of talk about sharing, um, you know, what, what kind of sharing models so you think are going to work and where, where have you seen sharing models where obviously through, you know, through epic you share some of the things

David Bensema:            20:32                yeah. Through, through the epic library in the Ugm and XGM certainly share there. But, um, within, um, the state of Kentucky, there’s a CMIO collaborative and uh, Dave, Danhower from Owensboro health is convener of that group and there’s six to eight cm Nios who participate at various times from Kentucky and Southern Indiana. And they’re sharing ideas. They’re sharing ideas that they have found to be beneficial to the physicians, beneficial to the patient is beneficial to the nursing and physician relationships because none of us want to have to invent the wheel by ourselves. Right.

Bill Russell:                   21:08                You know, it’s interesting to me. I listened to somebody, somebody set up at a Mic and said, don’t we don’t have a lot of good examples of machine learning or AI. And I thought, well, I really wish you’d listened to the podcast because we’ve had about a dozen of them that people come on. And I was thinking of Halamka’s thing of routing other faxes through Amazon web services, having the machine learning, look at it, identifying the consent forms, and then just using fire to check the box. We got the consent form for this person and now you’ve taken a process that is whether it was very manual and very whatever. It’s just doing simple NLP on a form and using fire to check back in. And I thought, you know, that’s the kind of thing that would not be that hard to implement across many systems. Um, so I don’t know, it’s probably something we should all be spending some mind time on of uh, how do we facilitate more sharing of those kinds of things? Because most of us don’t view each other as competitors. Obviously in a market you do. But outside of,

David Bensema:            22:02                yeah. How do we more intentionally share on a regular basis to make sure that we’re not missing opportunities?

Bill Russell:                   22:08                Yeah, absolutely. All right, well I talked about your shot into the bunker. I got to talk about your shot here and I, I strive and thank you and good luck on the next one. Thank you.

Bill Russell:                   22:22                All right. So we’re going to close this up. This will probably be one of the most disjointed podcast. Yeah, absolutely. And we clearly didn’t cover everything. There was a great CEO panel. Um, and there was, I mean there was just a bunch of great conversations outside of it, but what I wanted to do is catch up with you on. So last time we talked, you were working on a wood project for your grandson and it was the titanic. How far along are we on the wood wooden replica?

David Bensema:            22:51                I have the steerage, um, deck below decks. I have the crew quarters below decks and I’ve got the main deck in place. Now I have to build the three levels above main deck and then the captain’s area and the stern area with the lifeboats. So a lot to go, but I’m getting told by a five and a half year old that I messed up cause I don’t have an engine. I don’t have a, a propeller shaft and my bill is not right.

Bill Russell:                   23:18                At some point he’s going to get older and you’re going to tell that story and he’s going to go, I can’t believe I did that to you. That’s, that is so funny.

David Bensema:            23:26                Oh, day. In the meantime, we were building to, uh, Airbus three eighties out of walnut and I have all the wings and tail, uh, components, just have to do the landing trucks. And then I, uh, built a, B two stealth bomber because the fourth grandson just really didn’t want to be like the others.

Bill Russell:                   23:44                Got It. And uh, our, our, uh, I assume you’re like, you’re like widdling those things, right?

David Bensema:            23:50                Yeah. That’s easily using, um, graspers and surforms and sometimes Grindr.

Bill Russell:                   23:56                Golly, it does amaze me as we sit around with the CIOS, the different hobbies that people have and what not. Not all of them are golfers. A couple of them are golfers. But yeah, the boys all got their own surf forms and so they’re learning how to shape wood with a surf form. Know, Gosh, it’s fun. Well, that’s great. That’s amazing. Any, anything else you would add at this point?

David Bensema:            24:16                You know, I, I just so appreciate the opportunity to be in the presence of the CEO, Cio CMIOs and Cnio is and get the wisdom from that many people in a short period of time, but in such a relaxed and condensed setting. And I just encourage anyone when you have an opportunity to get in that kind of a gathering, don’t pass it up.Don’t think you’re too busy. You’re going to really regret it. Your organization’s going to be harmed by you not doing it.

Bill Russell:                   24:45                Yeah. These, um, I, I agree with you 1000% when, when these, when these settings, the smaller they are, I mean, when you look at who’s going and the smaller they are, that’s the value just increases. Even if it’s only 10 CIO’s, you know, you’re going to have one on one conversations. You’re going to talk a very tactically and get to talk about it

David Bensema:            25:05                and I watched three of the CIO is find new partners to work with. So six people got linked up in meaningful ways that will benefit their organizations.

Bill Russell:                   25:13                Absolutely. We’re going to sign off on number 10 so we don’t have any excuses for our back nine. But uh, thanks again for coming on the show. Appreciate it. As always.

Speaker 2:                    25:21                Thank you again for listening and uh, I once again just sorry for some of the production challenges that we had. Hope you get some good content out of this. I really enjoyed it. Recording the show with David. It’s always fun to get together with him and take a look at the industry and what the, the things that are going on. This show is a production of this week in healthit for more great content. You could check out the website at this week in health or the youtube channel slash video. Thanks for listening. That’s all for now

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