March 26, 2021: The year is 2030. How would a leader of a healthcare system address the pandemic? Dr. Stephen Klasko, CEO for Jefferson Health presented exactly how at the JP Morgan conference. 3D printers printing PPE, drones delivering medication, bots IDing illness and wearables testing for cases. WOW! Today we are joined by their CIO Nassar Nizami for further technology insights. In 2020 Jefferson Health had zero transmission to non COVID patients and less than a 1% employee infection rate. How did technology play a role in their COVID response? How can technology address health disparities in a community like Philadelphia, keeping in mind the digital divide? What are Jefferson’s priorities going into 2021? And what valuable lessons has Nassar learned as a health system CIO?
The Future of Health with Jefferson Health CIO Nassar Nizami
Episode 382: Transcript – March 26, 2021
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[00:00:00] Bill Russell: [00:00:00] Thanks for joining us on This Week in Health IT influence. My name is Bill Russell, former healthcare CIO for 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged.
[00:00:17]Today, Nassar Nizami joins us. And we have a phenomenal conversation. He’s the CIO for Jefferson Health. It’s very quick. I caught him in between meetings. We had about a half hour together. But we talk a lot of things. We talk [00:00:30] priorities. We talk about the impact of COVID on health IT, the impact of COVID on the community that they serve, we talk health disparities, a lot of great topics. He’s a great guest.
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[00:01:56] All right. Today, we are joined by a friend of the show Nassar [00:02:00] Nizami who’s CIO for Jefferson Health. Good afternoon Nassar. Welcome back to the show.
[00:02:06] Nassar Nizami: [00:02:06] Good afternoon Bill. It’s always a pleasure. Thank you for inviting me again.
[00:02:10] Bill Russell: [00:02:10] I’m looking forward to the conversation. There’s so much going on. I really appreciate your time, but this is the first time we’re talking in 2021.
[00:02:17] So give us a little background on Jefferson Health, where, what markets you guys serve and some of the things you guys are doing.
[00:02:26] Nassar Nizami: [00:02:26] Sure. Sure. So Jefferson Health is about five and a half billion dollar [00:02:30] Academy and community health system with 14 hospitals, a longterm care facility and a robust outpatient.
[00:02:36] We serve communities in Philadelphia, Metro area in Southern New Jersey. We have about 35,000 employees. As a health system, we have been exponentially growing for several years now. And as a reference to your audience, Jefferson was at three hospitals. One and a half billion dollar organization in 2014. We have more than tripled in a matter of six or seven [00:03:00] years. Both growing organically and through a series of mergers, acquisitions and partnerships.
[00:03:08] Bill Russell: [00:03:08] Yeah. So this is one of those things that happens when you do the podcast towards the end of the day. And we record, I get kind of like, oh, so you haven’t been busy since then. Right? So not much it work as a result of growing that fast.
[00:03:21] Nassar Nizami: [00:03:21] A few things. Just a few things.
[00:03:23] Bill Russell: [00:03:23] Yeah, I would imagine. Well, hey I got the opportunity to hear Dr. Klasko. He presented at the JP [00:03:30] Morgan conference and he was, you know, electric as always just electrifying and his presentation. He presented a vision of how Jefferson would address this pandemic in 2030.
[00:03:41] And I love how he does that. He sort of fast forwards and he says, okay, it’s 2030 and here’s what we have. And it. He talks about 3D printers printing PPE talked about bots and he talks about bots ID and the illness, wearables that tests for cases, drones that deliver [00:04:00] medications, virtual work that limits the spread.
[00:04:03] You know, when, when these things get developed, how do they, you know, when he develops these kinds of visions, and I assume he does it with a group, how do they inform the work that you’re going to be doing at Jefferson?
[00:04:16] Nassar Nizami: [00:04:16] It’s a privilege to be working for an officious person like Klaskow in his fight to Mac in his imagination. But I’ll share a few things. Like some of the things that are futuristic but I think are not that too far in future. For instance, [00:04:30] we know that last year Amazon got FDA approval to operate in its fleet of primary drones. And last year, CVS partnered with UPS to deliver medication, the senior citizens living in the villages in Florida, right? Some of the things like you mentioned an upper-class, you mentioned virtual work, you know, the limit, the spread of virus. We already experienced that. We Jefferson like many other organizations successfully move thousands of users and thousands of students to work and study remotely [00:05:00] in a matter of days.
[00:05:01] It’s a combination of things. I think, you know, when we discuss and we think about future. You know, my job is to understand the business. We are in understand the role of technology, understand leaders vision, like Dr. Klasko’s vision in general to stay a few steps ahead of where the industry is going to be. So we can move Jefferson accordingly.
[00:05:23] Bill Russell: [00:05:23] Right. You know and you really have a choice. You could work for someone like that. Dr. Klasko who is a, in [00:05:30] a visionary and out there, or you can work for somebody that you’re you have to bring along. And the as a CIO it is really a privilege to work with somebody who’s, who’s really pulling you a little bit and saying, Hey, this is where we’re going in this city. Let go there together. So it’s kind of fun. He shared some numbers at Jefferson, you guys had zero transmission to non COVID patients and less than a 1% infection, 1% [00:06:00] employee infection rate. And those are fantastic numbers. How did technology play a role in your COVID response at Jefferson?
[00:06:09] Nassar Nizami: [00:06:09] First of all, you know, we, I’m very proud to be part of Jefferson and product team as a team. I must say that everything is starts with a focus and mission. Things like Go With happens once in a lifetime. And if you’re not clear about the mission then it’s very difficult to come up with any plans.
[00:06:28] Early on when COVID hit [00:06:30] us, we looked at our mission and said the COVID mission is to improve lives. We need to do the right thing. And from a technology perspective that enabled myself and my team to focus on our core competency, which is ability or ability to execute. We have all the right ingredients.
[00:06:52] We have the trust by our operational colleagues. We have the technical expertise. All pure communication channels and the ability for [00:07:00] even a junior person in our team to make the right decision. So our motto was, Hey, decipher, communicate and execute. I mean, if you’re an analyst and you have to deliver a laptop to someone who decides that they’re going to be working. So a few things that we did quickly that in resulting the numbers you mentioned, we figured it to work from home very quickly, right? This is partly because we were in the cloud for some of the key applications use by back office or force. We have collaboration tools already, [00:07:30] like email, et cetera, budgeting systems already in the cloud.
[00:07:33] Secondly, we were very quickly able to stop things that were not critical. Very quick decision again making played a key role because early on, if you think about February and early March, it was very unclear how things are going to unfold. We were able to stand up sites, bring up equipment and partnership with city of Philadelphia, et cetera. And for party organization, we immediately very quickly enabled remote monitoring for patients who work in our [00:08:00] hospitals, in the bed. So the exposure of our clinical staff was limited to the patient. So a number of steps and technologies, abilities collaboration tools our ability to pivot, to work from home very quickly.
[00:08:16] I mentioned the presence of cloud. You know, played a key role but at the core of it really was, you know, everyone’s you know understanding of what our mission is and how we are going to be making decision, whether it’s a small [00:08:30] decision or what decision.
[00:08:32] Bill Russell: [00:08:32] It’s interesting. The several interviews we’ve done with you and even with you and Dr. Klasko, you guys talk a lot about you know, the healthcare without without an address, or I forget the terminology, but it was essentially, you guys have really been preparing for this for a long time. It’s not like COVID hit and you’re like, Oh gosh, we’ve got to implement all this technology so that we can work remotely.
[00:08:54] I mean, this has been a path that you were on and probably just like a lot of [00:09:00] others. COVID just accelerated the use and adoption of a lot of those technologies. I would imagine.
[00:09:07] Nassar Nizami: [00:09:07] You’re absolutely right. Like, so Jefferson and opera class for myself, we are big believers in healthcare. You’ve got healthcare without address. Jefferson and home is another firm that we used. We invested in telehealth several years ago.
[00:09:22] And there were a few health systems that were investing in telehealth in a big way, in a significant way, which frankly paid off dividends. We invested [00:09:30] some in some of the technologies. When it was difficult to, you know make a case for an ROI, right? Even simple things that, you know seems reasonable now our investment in cloud, for example, you know, decisions that we were able to make because of the right leadership because of clarity, regardless of COVID or no COVID hospital at home.
[00:09:55] Hospital without an at-risk is the future that we believe in, you know, and you probably [00:10:00] have heard the upperclass we talk about secure, which is a health assurance. You know, this has been part of the mantra there before COVID so you actually, right. We were already on, on a, on a journey and COVID just accelerating it probably by, I dunno, 10 times.
[00:10:14] Bill Russell: [00:10:14] Yeah. Yeah. It’s amazing. The adoption rates, both in the community. Honestly clinicians and to be honest, I mean, they pulled us in some directions because from an IT perspective I’m not sure any of us anticipated [00:10:30] sending the, I dunno, the finance team home to work from home.
[00:10:34] That’s not a team or supply chain or whatnot. Those have traditionally been in the office kinds of teams, but when COVID first hit it was, it was you know, just a different model.
[00:10:46] Nassar Nizami: [00:10:46] No. I mean, one of the proud moments for me was when we all went home, we were not sure about the productivity, et cetera. But I think two months or three months into COVID like this is June or May or June [00:11:00] timeframe our CFO basically said, I have not seen any loss of productivity. And this is a person who was not a believer in remote working now he’s a believer. I mean, almost 12 months after we went work from home, our productivity levels are still very high working remotely.
[00:11:22] Bill Russell: [00:11:22] Yeah. I, you know, it’s, you’re sort of at a disadvantage here cause I got to hear your CEO and I’m like, okay, your CEO said this, what do you do? [00:11:30] I’m kind of doing that now. But there was a lot of talk about health disparities at the JP Morgan conference. And Jefferson was one of those systems that talks pretty strongly on the topic.
[00:11:42] And I think that the quote I picked up was of all the forms of inequality, injustice, and healthcare is the most shocking and inhumane. And you know, I guess the question around this is how can technology play a role in addressing health disparities [00:12:00] in a community like Philadelphia?
[00:12:02] Nassar Nizami: [00:12:02] Look, I think there is an opportunity for technology to play a significant role. So at the same time, I worry about digital divide as well. Right. I’ll give you one example that the need for access to broadband services became glaringly obvious during COVID. Right. These sites mentioned increase in the use of telehealth services and it’s something to be celebrated. And health systems across the nation in a [00:12:30] sudden is just amazing, amazing thing to happen. But in order to have a successful kind of health visit, you need at least a mobile phone or a desktop, you know, and a working broadband connection and not everyone has ia robust broadband connection, not everyone have a working device at home.
[00:12:51] It’s very difficult to each check in if your computer is broken, have virus, or is just slow processing wise. [00:13:00] If you don’t have proper broadband connection, any of alignments and connection that often feels 20% of our work. How as a point of reference failed because of some issue at the end point.
[00:13:14] Okay. So to me it highlighted the need of robust broadband connection but generally speaking, you don’t think of it as related to healthcare, it just, hey, indirect connection, but it is, yeah. And has become a very key way and especially [00:13:30] when we think about hospital at home and secure at home and Jefferson without address, this is just significantly important. Without a robust connection and without access to digital tools there will continue to be divided in, frankly, I think that. There a part off where I think that government can play a role in regulating a broadband connection in nine months, frankly, we have to start treating broadband as a utility like water. It Is no longer a luxury [00:14:00] and similarly access to digital devices for underserved populations. With these things. I think we can really get to the big issues of access and affordability with did with the help of digital, right. We really had an opportunity to reach a population which otherwise don’t have access to facilities, healthcare facilities, right.
[00:14:26] And we can help them in their homes, wherever they [00:14:30] are. In a very affordable way. I mean damn I helped makes everything very affordable. On the other side of things like recommend, there is a lot of promise for technologies like AI and machine learning was discussing or trigger for radiology the ability for AI to read through x-rays in perhaps, you know, under privileged communities in some developing countries. The ability for AI [00:15:00] to flight things like x-rays or CTs and how in an area they’re just not specialists, they’re not radiologist available. Right. So I think there is enormous potential.
[00:15:15] And technology can certainly play a role in addressing health disparities in a community like Phildelphia but there are some very important and difficult questions that need to answer in terms of access and affordability around [00:15:30] digital technologies, broadband access.
[00:15:34] Bill Russell: [00:15:34] You know, that was actually one of my predictions for 2021 coming into this year is around the digital divide. And I think it got so accentuated, I guess, is the right word last year because it wasn’t only healthcare. It was education. You have kids trying to go to school and they don’t have broadband, I mean, think how silly this is. They’re trying to go school remotely and they don’t have [00:16:00] broadband let alone a computer device.
[00:16:01] And it’s not like those computer devices are all that expensive these days and their next door neighbor has broadband. So it’s like you know, we’ve got to, this is not rocket science. This is probably one of those things that you know, this year, I think assumptions before and you know, to not have broadband in 2021 is a significant barrier. I don’t know how I [00:16:30] even look for a job if I don’t, if I can’t get on the internet. If I can’t go to a public place to get on the computer and the public place as a computer is closed down because I can’t go sit inside. I mean, just all those things, but we just didn’t anticipate them. And I think they’re all front and center now.
[00:16:49] Nassar Nizami: [00:16:49] Well said, look, I mean, you hit on the head the issues you mentioned around education. Absolutely. And this is something that I experienced with my kids as well. [00:17:00] You spoke about we are fortunate to have broadband. But in areas I know enough areas where my team members have only one broadband carrier, right?
[00:17:09] So no choice. And during the pandemic the service was just, you know, very poor. And there was no choice. Right? So it just highlighted the need to rethink about our nation’s investment in broadband infrastructure. You’re absolutely right.
[00:17:28] Bill Russell: [00:17:28] Well let’s talk about [00:17:30] priorities and then I want to come back to, you know, what are the lessons learned? So this, at this point in the pandemic, but let’s talk about priorities. What are the technology priorities going into 2021?
[00:17:42] Nassar Nizami: [00:17:42] Look, I think we are hopefully we are the end of the pandemic, you know, our numbers are decreasing. Well, I would say be very focused on COVID. Okay. I think our focus now has changed turned from [00:18:00] inpatient and more patients coming to the hospital to now how do we vaccinate? So we are spending weekends, evenings on mass vaccination, right? And the needs are different. So you’re focused, immediate future on how do we register a patient in a reasonable way? In a safe way. How do reach the populations electronically? So obviously, you know, this goes back to where discussion of the digital divide, because you think about, you know, the best way to [00:18:30] register in the vaccinate.
[00:18:31] If you have access to the portal, you sign up on the portal pick a date and we will schedule the next two weeks from now. This is fantastic and ideal way. Fortunately we have technology to make that happen. But not everyone has technology at their homes and not everyone has access to it. So our priority immediately from a technology perspective is to make sure that we help not only Jefferson, but also city of Philadelphia.
[00:18:56] So then inner city public vaccination. I [00:19:00] think a big you know, area of investment, hopefully in the later part of 21 for us as we need to be on digital technologies. We we were forced innovate to work from home and rely on a lot of virtual services. I think a year, almost a year into it we are thinking that this is going to be really permanent.
[00:19:24] I mean, it is quite possible that we are staying in some sort of a hybrid [00:19:30] format. I’m very certain that we are not going back to old ways, that I can, I can share with. Certainly some of our work is going to be just around that. How do we cement work from home. Some of the, for instance, technologies that are not cloud based, that require things like VPN access that, works if you work like one or two days a week from home, but if you are doing your job and you’re relying on, services and own systems that are [00:20:00] still hosted in our data center it becomes problematic. So continued move to cloud continued investment in digital. We I think that there is a huge opportunity in improving at least at Jefferson. And I think in general healthcare the, what I think the common word is probably overused is digital front door. So there’s going to be a big push already is, but I think even more significantly, we are going to be pushing more towards a digital front [00:20:30] door.
[00:20:30] Automation is a huge priority. We just kicked it off last year. We slowed down because of COVID. I think that that’s going to be a big push in later part of 21. We still sort of, we still enough in our implementation of EHR in some of our hospitals. So one EHR, we are fortunate that we’ll have one EHR possible health system. That’s something that’s [00:21:00] ongoing and looking forward to completing it. So a number of initiatives but if I were to sum it up in one word, I would say digital.
[00:21:08] Bill Russell: [00:21:08] Yeah, digital, absolutely. That would make sense. The but the, you did touch on this a little bit, that the major systems that EHR PACS, ERP CRM you have you have a one EHR initiative cause you guys grew through several acquisitions and whatnot. So you’re still in the midst of that one. EHR. What about the other major systems?
[00:21:28] Nassar Nizami: [00:21:28] So we are [00:21:30] fortunate that in the last few years we as an organization made a decision that not, you know, as a health system we have one operating model and it’s going to be a centralized operating model.
[00:21:42] We are not going to operate as a holding or which basically educated us in informed decision to say, like, if you’re having to operate as one company really need centralized systems and ERP HCM, payroll, we’re on the first systems that we started as standardizing and [00:22:00] centralizing on EMR standardization came a little bit later.
[00:22:04] Which I’m glad that in a few months we will be done with it seamless and fastest as of one version of facts across the health systems. And this is a result of our philosophy that we are going to, there is value in economies of scale there’s value in standardization of care, especially in the areas that are tried and trusted people.
[00:22:27] Now there is innovation happens in all [00:22:30] forms, but today, mostly I would say that, you know, it doesn’t matter what EMR you’re using, any organization is using. It doesn’t matter what you’re using as long as like, you know, one of the scale the ones, won’t name any names, but I think it’s more important to have one standard system and processes and protocols that go along with than a mish-mosh of systems. And I lived both lives. And my colleagues in operations I’ve lived that life. [00:23:00] And we all agreed that standardized align we have worked is day better than working in, believe it or not nine different EMR, but we live through that.
[00:23:12] Bill Russell: [00:23:12] Well, I have you know, two closing questions. I appreciate your time. We squeezed it in here. You’ve got a lot of stuff going on. I, I want one, one question is going to be sort of looking back and wants to be looking forward. And the one looking back is we’re sorta, [00:23:30] hopefully beyond the midway point of the pandemic. What lessons have you learned as a health system CIO?
[00:23:39] Nassar Nizami: [00:23:39] I think the most important lesson I think for me is the nimbleness and the ability to make good decisions was just amazing. Complex times, or teams faced an issue without calling themselves tiger teams on or any other fancy names. Individuals got [00:24:00] together, discuss the issue, came up with a solution and implemented it right. It was just amazing process. Right. Which basically, and this happened at all levels of organization, it happened at leadership level. It happened at the mid leadership level. It happened at an analyst level, right. In which told me that prior to COVID, you know if you had asked me, I would say, you know, yeah, health systems tend to be bureaucracy, especially if you’re in a Catholic medical [00:24:30] center. It takes months and months, sometimes years for us to make decisions, simple decisions like the standardizations or a product, et cetera.
[00:24:38] And frankly, what lessons learned for me, one of the biggest lessons learned for me is you know, look do we can operate in a very nimble way. Almost like a startup. And how a question for us frankly, is how do we preserve that? Because we were forced into the situation where we had to act a certain way. We acted. And I think we were [00:25:00] very successful. How do we preserve that nimbleness that trust that we have created among each other the whole monitor of the site, communicate and execute. We just need to move it forward.
[00:25:11] Bill Russell: [00:25:11] Yeah. And that’s, it’s interesting because that’s one of the hardest things as a leader is to get that momentum going. And the silver lining of the crisis was, it was the impetus. It was the momentum and it did prove we could do things we never thought possible, which [00:25:30] was pretty amazing.
[00:25:33] And I guess the closing question is what do you think the lasting impact of COVID is going to be on health IT specifically?
[00:25:42] Nassar Nizami: [00:25:42] Okay. I think it’s going to be cultural, the change in thinking around technology, right. In changes that would have happened anywhere or over the next five seven, eight, 10 years that happened within let’s [00:26:00] say 10, 12 months.
[00:26:01] So the acceptance of technology as a key enabler of healthcare especially in around the digital health just accept the cultural change here is very accepted now to work from home, or we looking to hire people in the world really. And a lot of them to work remotely I think is going to be big. And the trust that [00:26:30] patients experienced using vision technologies in certain populations where we historically, we thought of as not as technology savvy or won’t trust technology as much in some of the segments of population that custard technology and use technology. And have, I think forever change is just amazing. And I think that will be the lasting impact of COVID. On the culture change within IT teams that work at Jefferson and I think across the nation. [00:27:00] And then the population that we serve both our colleagues in operations and how they use see technology and equally important the students and the patients that we serve, their acceptance and use of technology, I think has radically changed. And I think we’re, we are not going back. As I said earlier in the interview, you’re not going back.
[00:27:19] Bill Russell: [00:27:19] We’re not going back. Nassar thank you for your time. I really appreciate it. Always a pleasure to sit down with you.
[00:27:25] Nassar Nizami: [00:27:25] It’s my pleasure. Thanks for having me.
[00:27:28]Bill Russell: [00:27:28] What a great discussion. If you know [00:27:30] someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to this show. It’s conference level value every week. They can subscribe on our website thisweekhealth.com or they can go wherever you listen to podcasts, Apple, Google, overcast, which is what I use, spotify, Stitcher. You name it. We’re out there. They can find us. Go ahead. Subscribe today. Send a note to someone and have them subscribe as [00:28:00] well. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders. Those are VMware Hill-Rom, StarBridge Advisers, Aruba and McAfee. Thanks for listening. That’s all for now.