Bill Russell: 00:07 Welcome to influence, a production of this week in health it where we discussed the influence of technology on health with people who are making it happen. This is our first episode of this new show. My name is Bill Russell recovering healthcare 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 today Ed Marx Cio for the Cleveland Clinic and I discussed the newly released book voices of innovation, fulfilling the promise of information technology and healthcare. This podcast is brought to you by health lyrics, helping you build agile, efficient, and effective health it. Let’s talk visit healthlyrics.com to schedule your free consultation. Well, good morning Ed welcome to the show.
Ed Marx: 00:45 Good morning, Bill. Thank you for having me.
Bill Russell: 00:47 Wow, this is a, this is exciting. Thank you for coming on our inaugural episode of the show, uh, when we did our, our feedback session with our listeners, we heard a lot of do more of this and more of that and uh, and condense it down to 30 minutes. So they want to hear more from you. More from our guests and they want us to really cover the news a little bit more so we’re segmenting our shows a little bit. So this is primarily just an interview type show, so we’re going to be hearing from you about, uh, about this, this new book which was released just last week. So a voices of innovation is a collaborative book which you pulled together as an editor. So give us a little background on the book.
Ed Marx: 01:30 Yeah, I am so psyched and I can’t wait to get my hands on it. Actually have a lot of my friends and family will have a copy of the book now, but I have yet to receive mine, but I think it’s happening today. So otherwise I would show you the book. I’m so pumped because really four reasons. One is there is a gap right between how far along healthcare it is in healthcare compared to other industries. And I know that we have a lot of good reasons for why there is a gap, but they’re not good enough to substantiate such a large gap. It’s really up to us, right? Cios and working with our organizations. And other team members to really change that but how you do it. So I really thought a lot about that. At the same time I was cleaning out my garage so you know, the annual episode, clean out the garage and I was going through.
Ed Marx: 02:16 I have a file folder or a file cabinet full of all my army stuff. So I used to be a Army combat medic than Army combat engineer officer. And as I opened it up, I found FM dash 35. It’s a field manual. That’s what the FM stands for. It’s a field manual for engineer officers. And when I became an engineer officer, I was a non engineer major. I was a psych major for my bachelor’s and I was in this class learning how to be an engineer officer with all these engineers from west point. And I was clueless. But what saved me and helped make me be a pretty decent officer was this field manual because you could open it up and find out how to do anything. So I remember one time I had a platoon, we were horizontal up engineering platoon and we had mission to create an airport.
Ed Marx: 03:00 How do you make an airport and land C-130s. So you grab your field manual, you go to the chapter on airport and you do it and you could do the same with innovation, but no one’s done it. So credit to himss, they came up with some pathways, right? And that’s highlight in the book. So the book is centered around the pathways but there’s like eight key steps and so now you have practical examples from organizations around the world. So this book has 40 different contributors and their academics, some academic mostly providers like you and myself, a lot of suppliers. So you have the Ciscos of the world and the microsofts of the world and you have big hospitals and small hospitals all who have done it. So you not only learn the framework but you get three or four examples from around the world. Again, all different types of health systems and small hospitals who’ve actually put this in practice and have innovated. So it’s a field manual. So it’s something that didn’t exist, so if you’re wondering, Gee, innovation sounds good, it’s a great buzzword, right? You so many books on it, but this is actual practical book that you can actually do something with it and learn from others’ experience. So those are two reasons, many more reasons, but those are two.
Bill Russell: 04:09 Yeah, I love the pathways form the framework for the discussion, but I love the fact that you went out and solicited just a large group of people and said, do you have something to write on this topic? A case study or something to share? So give us an idea of just some of the authors and some of the different collaborators. I mean you mentioned Microsoft, Cisco and some providers, but just some of the. Some of the other essays that were written for this book.
Ed Marx: 04:36 I went back in preparing for today and I was reading back through a lot of the drafts. I don’t, like I said, I don’t have the actual book yet, but I have all the drafts. Of course we went through with the publisher going back and forth in the editing process and all the contributors and I got really excited again because it’s like, Dang, those are some great ideas. I’ve never thought of it. Now I can apply them as well, so I loved. I loved one from Spain, so there’s a big health public health system in Madrid and the biggest of them all the academic health center here was the cio and one of the physicians talking about this is how you use people with it, but don’t just think about it, but incorporate others in your ecosystem to help create innovation. And so here were these two leaders, the organization, they get together.
Ed Marx: 05:21 The CEO gets together. They had a serious safety event and they were determined to innovate and fix it and they did by bringing together sort of this team of 10 concepts and how it wasn’t just focused on the it. Although maybe you could blame it, but they didn’t, but they thought, how do we innovate? And so by getting together as a team of team type concept, they were able to come up with a very creative solution to their specific situation and then they’ve taken that same model now and applied it elsewhere in their health system. So it became this catalyst for innovation thinking. And that is by bringing people together, in this case, they solved an issue in their blood bank and I don’t want to go into specific as you can read the book on the specifics, but, uh, it was a very key thing for them to solve and they did it through his innovative approach.
Ed Marx: 06:04 So that’s, that’s one example I love. Um, again, I can give you examples from Johns Hopkins, Stanford, Nyp, Inner Mountain, a lot of the lot of the big areas. But what I like is also some of the public health systems. So there’s a public health system here actually in Cleveland and they really focused on this cocreation concept of solutions. And so they cost scrappy innovation because you know, what, not all hospitals, some hospitals, like Cleveland Clinic, we’re blessed that we actually have an innovation center. And same with probably Johns Hopkins and some of the bigger ones I mentioned, but not everyone has that luxury. That’s why I loved including all types of hospitals. So here’s a hospital, they don’t necessarily have an innovation center, so they call it scrappy innovation. And so what they did is they worked with, with others outside of their ecosystem. So working with partners and they tackled the whole dilemma around what we call social determinants of health, right?
Ed Marx: 07:00 They, they knew they couldn’t be innovative on their own because that’s a big thing to tackle because that’s a community that’s a city. So they brought in people from the community, people from the city and they cocreated solutions to address social determinants of health and how it impacts their patients. And it’s made a substantial difference in the care that they deliver. So that’s, that’s another example. I could go on. Like I said, I have 40 examples were so cool. So again, it’s just practical. So if you’re thinking about, wow, how do I innovate my healthcare organization, you look at the innovation pathways and you say, man, I’m kind of struggling with creating a roadmap. Well guess what, there’s three or four examples in their organizations who created a roadmap. So that’s how practical it is.
Bill Russell: 07:40 Yeah, absolutely. So in the, um, in the excerpt, that you sent to all the potential authors, you essentially said there’s a set of questions we hope to answer in this book. So interestingly enough, I’m just going to, for this interview, I’m just going to throw those questions back at you to see how we did the, where were you able to answer these and just see, you know, what, what we found out as we, as we went through this book, now I’ve read less of it than you have. I got to write an essay which I appreciate you giving me the opportunity. I got to read a Glen Tullman’s essay and a couple others that were in, in the section that, uh, the editor sent me. And it really is fascinating. Just the, the breadth of experience and the concepts. So let’s go through these questions real quick here. So, um, got about 20 minutes. We’ll just, we’ll just fire through these. So where do you begin with innovation and make it real and practical in a profession and organization?
Ed Marx: 08:42 Yeah. So the first thing is adopt a framework. It doesn’t have to be the framework we speak about in the book frameworks a framework but have something because people sometimes think well to do innovation you can’t have structure and that they’re mutually but they’re not in fact structure. It helps bring balance to innovation, helps bring success. So adopt something. So that’s the first thing. So we give you the himss and the himss pretty well thought through and it’s been out there for four or five years. So I think it’s a pretty good model that people could hold onto. So one is adopt a framework and then you got to talk about it. So that’s how you start innovation and create, you know, adoptive framework and start evangelizing and start talking about. And then the most important thing to start doing things. It doesn’t have to be a huge thing, it doesn’t have to be solving world hunger or even something as big as social determinants.
Ed Marx: 09:28 Start small, start with something easy and it doesn’t have to be formalized. You can have the framework, but it doesn’t have to, you know, don’t kill it with bureaucracy. That’s a. that’s another issue that happens in many organizations. You put so much bureaucracy on it that you never innovate, but it’s good to have this sort of framework and then start and then start small. I think about a time when I was at cooter valley hospital in the very beginning of my career, we had five percent adoption of our it systems and just by doing some innovative things and again doesn’t sometimes innovation is not inventing something new technology, it’s applying it in a new way, so we just figured out better ways of marketing the technology. We didn’t actually change the technology, but how we market it, we went from five percent to 95 percent adoption in under a year.
Ed Marx: 10:09 Shortly thereafter at Park U fiscal medical center. Again, another organization that I, that I had the opportunity to serve with, we wanted to change market share, but everything that we tried in traditional ways, we couldn’t change market share, so we actually developed technology, some working with partners, some that we developed ourselves and we implemented it and again, within a year we have changed, we’ve shifted the market share and we are up against kind of like a David Goliath situation. So it’s something starting small, getting some key success and then just building upon it. And so that’s one way of, of uh, helping create it. Then you as you market it. So again, your question is how do we create and how do you sort of sustain this, what are some of the ideas? And then then you market it and you get other people involved. And so there’s many different ways and one of the chapters we talk about that, how do you get other people involved?
Ed Marx: 10:58 And it’s very easy. It could be a sharepoint site, you could have votes, people could vote there. Everyone gets 10 votes and people post their favorite innovation. Another thing to do, and we we did at Texas health resources, is do a Tedx so everyone knows Ted.com. We did TEDX thr for several years and a part of that was a whole pitch session. So before that tedx event, which was huge and people wanted to be a part of it, we did these pitches so anyone in the health system could bring an idea forward and it went through a process where we had judges and things like that and we said whoever wins, we will fund. So we created a fund and it could be modest fund, doesn’t have to be big funds, a modest fund and so we ended up, not only did we find someone who came up with a very clever mobile application, but I actually hired her.
Ed Marx: 11:44 She was so good. She didn’t come from technology backgrounds. She was on the clinical side and she was so passionate and her ideas are so good that we hired her to actually develop that. So those are some examples. And then the final thing I would say, I mean so much to say at all these topics. The final thing I would say is celebrate both victory and failure, so it’s okay that something didn’t go well and just and you know, acknowledge it and say, look, but here’s what we learned and my favorite example I think we talk about in the book as well is we were really big into a Microsoft surface. Not the surface. You know, today that’s a tablet, but Microsoft surface started out as a coffee table and so we were gung Ho. We started working on this coffee table and we had developers and we developed a really cool technology, but guess what? By the time we were ready to launch, the world had changed and so no longer were people ever going to use something like that. Although now we see those sort of screens up on the wall, but we changed that same development to a, to a more of a surface, a small type ipad type unit and took the same principles and develop something. We actually took the market to help with Alzheimer’s early detection, so we took a failure or celebrate it, but we were able to turn it and make a success out of it.
Bill Russell: 12:57 Absolutely. So you answered the second question, which is have you created a sustainable culture of innovation and uh, and, and that’s so key in your last example. It just reminds me of the reason that agile was adopted within silicon valley and within many health systems now is to constantly get that feedback so that we don’t end up developing something and taking a year to do it. By the time we get there, the world has changed. So you’re seeing a lot of health systems adopt a natural framework. Um, the, the next question is how do you ensure that innovation, once it’s introduced, is, is widely accepted? I mean, you clearly, you can do it within it and you can do it within a, maybe even some clinical practices, but how do you make sure, like the, the entire culture gets around it?
Ed Marx: 13:41 Yeah, and I know my answer to the questions are kind of blending them because they all, they’re not so neatly packaged, you know, that will blend and work together. But yeah, the culture is the important part. You know, everyone who studied change theory, organizational change management, Kotter, eight principles, things like that. Know, that really at the end of the day, culture is King and Queen and you’ve got to make sure that you hit the culture and it becomes innovative, innovative. So I think there’s a lot of great organizations that we do give some examples of the book of organizations, how they’ve embedded that culture. I think intermountain health is, is one of those I could speak about and we do something very similar at the clinic and that is these daily huddles. So we start early in the morning, we have five, six different tiers of daily huddles.
Ed Marx: 14:21 We have them in it as well as on the clinical side and business side and eventually these merged at the, about the tier four, tier five level. So I, I sit in our organization to tier six level of these huddles and, and what happens is people bring up ideas or issues that are taking place and it starts making everyone think about what’s the solution. So that’s an example of how it’s embedded in the culture now and again, intermountain gets some good examples how they’re just thinking about not only how do we deal with this particular challenge today, but how do we keep it happening in the future. I’ll give you one really good example, I’m trying to steal, steer clear of clinic examples because this is not about the clinic. It’s, it’s, it’s a for all of healthcare globally, but it’s pretty exciting. So we would hear everyday these huddles about, you know, issues where people may not feel safe, right?
Ed Marx: 15:07 In healthcare, you hear about all these things that happen, you know, Chicago most recently where some employees were, were killed outside of their hospital and, and you know, it can be a dangerous environment just because the nature of what we do and society in general is getting more dangerous. So as we listen to this, we thought, well why don’t we just create an app where with a push of the button, the APP on your phone knows exactly where you are and brings the appropriate code, whatever code it is, brings the appropriate personnel to help you. We did it. I think it took less than a week using agile. So again, just embedding this sort of culture where everyone starts thinking, Hey, what about innovation? How can we solve this? And then encouraging it and supporting it. So that’s how the. That’s how it gets the stickiness and the culture is that people bring up ideas and you ignore them. No one’s going to bring up ideas, but if people bring up ideas, you listen, you take note, you acknowledge and you actually do something with some of them. It creates this whole culture. So that’s the. That’s the thing. It’s really about adoption of all this thought around innovation that will spur more innovation. It’s weird how it happens. Is it like spins faster and faster? The more that people understand it, accept it and embrace it?
Bill Russell: 16:20 Yeah. You sort of create a velocity. You identify a handful of problems, you solve them and then people go, wow, they’re starting to solve those problems. I want to bring this problem to bear. And sometimes we get caught in trying to solve these massive problems like we’re gonna, we’re gonna solve a patient experience or patient experience is huge, but you know, if you break that down into the core problems of what the patient are and prioritized, those things, we’re seeing some great examples of innovation even from small health systems where they go, I can’t solve patient experience from one end to the other, but I’m going to solve their, the, uh, you know, the scheduling, I’m going to solve the intake process, I’m going to solve a messaging. Uh, you know, it’s, it’s breaking them down into smaller solutions and as you solve each one of those, it’s sort of sort of builds on itself.
Ed Marx: 17:10 Yeah. And there’s examples in here as well as let’s take telemedicine. So telemedicine, it’s a huge thing and if you’re a small hospital, you might think oh that’s too big for us. Well you know what, just start with video conferencing like you and I are doing. Just start embracing some of facetime just start doing something because then it, it does lead to more thinking. It’s a catalyst about, wow, if this works pretty well, you and I talking, exchanging ideas, maybe I can have this sort of relationship with a patient in a secure manner and just leads to more and more thinking. And that’s part of getting innovation in your culture. If you don’t do anything, if you don’t take those small steps that you’re talking about. And again, there’s examples in the book of organizations, small and large that have done this. You take these small steps, they lead to bigger steps and so absolutely, you know, that’s how you sort of embed that culture is by again doing something and building on that success and eventually you’ll be doing big things.
Bill Russell: 18:04 Yeah. And some of the things I find interesting is, you know, some of the solutions start outside of there. They’re already going on and you just have to unearth them. So, you know, the, the beginning of our telestroke program was essentially people using video conference just like this and you know, and it, it was, it was kind of Clunky, right? So you had the, you had the Ehr up over here and you had a, you had the vitals up over here and you had a, you know, telemetry and whatnot, and then you had the video going and when they, when they finally brought it and it was just, hey, can you, can you make this better? I mean, this is essentially all the components that we want. We just, we just, we just want it to be a better experience. Yeah, absolutely. Um, so, uh, you know, what’s an example of potential outcomes for robust healthcare transformation? That as we say, there’s, there’s a lot of velocity building. Do you find health systems, this is gonna be a great avenue for health systems to learn from other health systems, but do you find some of these innovation centers are starting to share across across the board and we’re going to see a really a, a, an increase or you know, or an increase in velocity of healthcare transformation as a result of all this innovation going across the entire industry?
Ed Marx: 19:20 Yeah, I think there’s several catalysts that are going to help sort of push things. One is we have to realize that healthcare is flat. We’re no longer bound by geography. In the past was like, okay, we have the city or we have this state or this part of the state and no one can really intrude because they’re not going to build a hospital in our territory. Well guess what? There’s no walls anymore. They’re gone. So you have to understand healthcare flat and you have to do something because if you don’t, someone’s going to do it for you, and if someone else does it for you, it could not be that. It may not be the best interest of your organization or your community, so it’s really beholden up to you as a leader to try to make things happen. So healthcare being flat is a huge catalyst people have to get ahold of and really embrace and look at that as an advantage.
Ed Marx: 20:06 The second thing is sharing. So recently I got together with some of my colleagues at Stanford all credit to them. They’re the ones who were the catalyst to get this going. I was helping them on a steering committee where we convened who we thought might be the top 25 innovators in healthcare and we had a one day session where everyone shared their one best practice. And so out of that, if you attended, you got to hear what 24 other leading organizations are doing in order to help transform healthcare. And so that’s another thing is the sharing we have to share. I think it’s a, it’s a duty that we, we do it obviously, you know, we have, we’re in competitive environments in some, uh, and we have to be very prudent, but I think it’s our duty as leaders to share best practices that are gonna help people because that’s why we do this is because we care about people and the quality of their life, so it’s really important to share it. And then I think the book again, being that field manual, a catalyst that anyone could buy this book or get this book and then actually do something with it and you’re learning from global examples and again, big hospitals, small hospitals, academic, nonacademic. It’s a really a profound mix that you’ll find in there of examples and just sharing. So it’s really important. I think we have a duty that once we discover something that we have to share because it’s best for our society.
Bill Russell: 21:27 Yeah. So what, what have innovators accomplished that is now just standard practice or generally accepted approaches to healthcare delivery?
Ed Marx: 21:35 Yeah, I think it’s still, it’s, it’s a, it’s small, but growing is the whole concept of virtual care. Right? We were talking about that earlier and so at first it may have started with a remote monitoring of maybe for one disease for hypertension, but because we saw success with it now we are doing remote monitoring for multiple diseases and in fact I believe that the hospital as we know it today will become increasingly extinct. It’ll be only for those, for the sickest of the sick and I think we’re going to end up in a situation where the home becomes our primary area to convalesce and our cars become the medium where we’ll have a lot more digitization of the car in terms of Iot devices that are monitoring our health because you touched so many components of the car. But I want to be practical.
Ed Marx: 22:27 So the example of remote monitoring is a really good one. So now we’re seeing more and more hospitals adopt remote monitoring. And then I think we’ve shared before I’ve shared with you or your audience, you know, how that’s personally impacted me for the betterment of, of leveraging that sort of technology where I was getting real time medication updates based on the feedback they were receiving from some of these remote capabilities. So it doesn’t matter where I was in the world or where our patients are, we can help take care of them. So, so the book has several examples around virtual medicine, uh, and that’s a practical example, I think everything remotes, you think 10 years ago, you know, the things that we did today and there wasn’t anything really going on from virtual, from a virtual capability, uh, in terms of the mainstream. And now today it’s pretty much mainstream. So that’s another example, but I think you’re going to see some examples in the book and also that are leading to this whole concept of disinter mediating the hospital as the center and even ambulatory facilities as a center, but really the home becoming the center. So lots of.
Bill Russell: 23:35 Let’s go off script a little bit here. So when you would, when you describe that, and I think of Inner Mountain and their digital hospital and some of the other systems out there, they’re doing a similar. A mercy health system also has a digital, uh, and, and what they’re doing is they’re essentially setting up a building that is not a hospital you wouldn’t walk through the front door, but it’s loaded with clinicians. So it is nurse practitioners all the way up to physicians who are monitoring all these devices, not only the beds in the ICU and, and, and those kinds of things, but also monitoring, uh, just the daily devices, the Iot devices that people are walking around with the, you know, just anything that happens to that record or any input that they can get digitally. They’re now responding to. Or do you think we’re going to see like those kinds of services pop up or do you think every health system is gonna, gonna create those kinds of going to need to create those kinds of capabilities, of more clinicians behind screens looking at vitals as they’re coming in?
Ed Marx: 24:40 Yeah, I think we’ve had that here at the clinic for about 10 years. Uh, I do think that you’ll see more and more of that and it’s not going to be limited, I don’t think in the future to just, again, healthcare is flat to a, your own geographic region, but you might provide that sort of care for a health system that you’re affiliated with in China or, or perhaps just a community that needs help. Someone needs help, you know, they’re having heart issues. They want to be connected to world leaders and heart, so it doesn’t matter where they are across the globe. Again, healthcare is flat. So yeah, I think there’s going to be a lot more. And of course, you know, the whole ai piece of that machine learning piece of that. So you’re seeing the early adopters now going out there and doing things and I think that’s going to become more and more prolific.
Ed Marx: 25:25 So again, the way we’re attacking it and I’m really trying hard to stay away from Cleveland Clinic examples because the book is not about the Cleveland Clinic. Uh, although great innovation happens here. Um, you know, we’re seeing more and more of the push to discharge patients to their home because they’ll convalesce better the it, the patient care is equal to or better the patient experience is better at home obviously versus being in a hospital no matter how great your hospital is and the cost is about half. So these, these great drivers and of course we’re seeing the, not only the technology is already there, but we’re seeing the, the payment structure is starting to change as well. We’ve seen some good progress with cms recently on payments and and of course it with value based care, that payment structure is not as big of a deal. So he really incentivized to, to allow patients convalesced at home earlier instead of waiting in the hospital for someone to check on him once every 24 hours when they could do it remotely. So, so many people, organizations going that way. I do believe that’s the future.
Bill Russell: 26:32 Yeah. This is really excited. I appreciate you writing this book or editing this book. I mean you’ve said multiple times, it’s a team effort, 40 different contributors. This is an exciting time to be in healthcare. I think the patient experience is going to change the clinic, the clinician’s experience is going to change and we’re going to see new care models that are going to benefit, um, you know, the aging as well as people that suffer with chronic conditions all the way through. It really runs the gambit. I mean, it could be the healthy as well. So this is, this is a great time to be in there and you’ve provided a field manual, hopefully the first of many field manuals for innovation. Uh, so I guess the final question will be, you know, where can people go to buy this book?
Ed Marx: 27:17 So Amazon’s probably the easiest shopping place. So I think,
Bill Russell: 27:21 which, which sort of highlights the whole innovation thing. But go ahead, sorry.
Ed Marx: 27:26 The book on Amazon. I’m sure there’s a multiple places that are going to pop up to where you can try and get the best price that you can. So that’s a good place. My final word is, and it’s saved for the very last page of the book, but it is that if you want to be innovative, you have to be innovative, so I always encourage people to not just talk about innovation or help create innovation in your organization, which is really important and good, but if you don’t practice innovation yourself, you’re going to have a hard time sort of leading innovation and this is just personal things that you can do. It’s nothing that’s going to change the world necessarily, but you’ve got to continuously make over yourself. If you hope to be part of the solution to make over health care the way we know it today for the betterment of the people that we care for.
Bill Russell: 28:17 I took a real risk at one point I presented to a CEO and they were constantly saying, we need to innovate, innovate, innovate. Except for in one area. They just said, you can innovate but just don’t get rid of my mainframe. And so I had. I had a cartoonist who work for me and I drew a cartoon of essentially what he just said. You know, it had a picture of him hugging the mainframe saying go ahead and innovate everywhere but here and uh, and I put it up on there and he looked at it and he laughed and he said, Yep. And that’s the hardest thing about innovation. You’ve got to be willing to let go of some of those things that you were proud to create maybe even a year ago. Uh, there’s, there’s new things out there and new ways to go. And thanks again. I know you’re so busy. Thanks for coming on the show. I really appreciate it.
Ed Marx: 29:07 Yeah, and thank you again for having me and thank you to all my contributors. They’re really the magic sauce behind the book. It’s not, I was just the weaver of a lot of different stories, just putting it up in a framework. They are the true innovators out there, so thank you to them.
Bill Russell: 29:19 Yeah, and I can’t wait to read the book. It’ll give me an idea of, of what some other people to have on the show. It will be great. You’ll find some great leaders. So, uh, you know, the show’s production to this week in health it for more great content, you can check out our website @www.thisweekinhealthit.com or the youtube channel at thisweekinhealthit.com slash video. Thanks for listening. That’s all for now.
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