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- This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Michael Hassel Berg,
chief Digital Health Officer at URMC.
Michael, it's a pleasure to have you on the podcast today.
- Thank you, Laura. Excited to be here.
- Now, I know we've got a lot to talk about.
There's so much happening in healthcare technology,
and particularly when you think about digital health,
just such an emerging and fast growing field.
But before we dive into my questions,
can you tell us a little bit more
about yourself and your background?
- Sure. Um, Michael Hasselbeck, as you said,
I'm the Chief Digital Health Officer at the University
of Rochester Medical Center.
Um, those of you who are not familiar with URMC,
we are a large academic health system in upstate New York.
Actually, the, probably the largest health system in the
state of New York, outside of the city of Rochester
or outside of New York City.
Um, background, I am a nurse by clinical training.
I went on to become a psychiatric nurse practitioner.
I started my career in rural New York state
where I was the only psychiatric, uh, provider
for about six counties.
So became really passionate about rural healthcare
and how we could increase access
to care out into those communities,
which led me into the path of technology.
Um, and I've been working pretty much exclusively in
that kind of intersection of clinical care
and, uh, technology
for about the last 15 years of my career.
- Well, that's amazing to hear.
And you know, I'm wondering at what point did you
find yourself really gearing more towards looking at,
you know, how can I, um,
really dive into the digital health space,
the technology space, and use that interest
and, um, knowledge that I have in order to improve care
for patients in the community?
I can imagine obviously having the, um, clinical background
that that's really valuable.
And then, you know, what other things that you do in order
to make sure that you had the technology background as well?
- Well, interesting. When I finished my doctorate degree
and I ended up joining faculty, uh, at the university,
I actually had a very forward-thinking chair of psychiatry,
um, who about 15 years ago knew that
as our health system grew its geographic reach,
there was gonna be a huge need
for getting behavioral health out into, again,
the communities that surround us.
So, um, it was my chair actually who said, if, um,
I bring you on as faculty, I want you
to develop a telemedicine, uh, program for our department.
And this was well before telemedicine was a cool thing
or even reimbursed in the state of New York.
And I was a really good grant writer,
and I was able to get several grants to allow me
to start building a statewide, um, telepsychiatry program.
Um, and, you know, quickly learned
that this technology was able to allow my
clinical providers to continue to, to deliver
that high quality care in these regions of the states
that did not have psychiatric providers.
I ended up going back on to get further education,
um, uh, ended up going on to get a business background
because I became really anxious
around my telemedicine program
because essentially I was chasing grant
after grant to pay for those services.
And, um, when I went back to school, I, I really started
to understand the business of healthcare.
What did it really mean when the a CA started
to get rolled out when people were talking about this move
from volume to value?
Um, and that background was a game changer for me
because I started measuring my telemedicine,
um, programs that I was developing no longer
through the lens of a clinician or a researcher,
but I started measuring 'em through the lens of a payer,
which allowed me to really develop some early
risk-based contracts, uh, with our insurers in our state to
pay for our telemedicine programs that we developed.
Um, after that, you know, I had,
I had successfully had figured out reimbursement
for telemedicine early
and figured out the regulations for telemedicine,
but could not grow my programs any further
because I couldn't graduate psychiatrist
or psych mps fast enough
to take on more patients on the other end of that video.
So, ended up moving into innovation, um,
started thinking about technologies that didn't require the,
the need for a clinician on the other end.
So moved into the, the, the world of mobile apps partnered
with our engineering, uh, school to start developing, um,
cognitive behavioral therapy mobile apps
that we could prescribe out of our electronic health record
to patients moved on from mobile apps, uh,
into the world of virtual reality.
Um, started, you know, again, working with engineers
and our computer scientists at our university
to start developing mindfulness
and meditation applications within VR headsets
that we could deploy out into our communities.
And then about six years ago,
I really got heavily involved in data science
and machine learning and really became interested
and could you use data
and, uh, machine learning methods
to essentially risk stratify patients,
match the the right patients, uh, with the,
the right provider at the right time and in the right place.
And again, over time developed this leadership role
and innovation for my health system.
And then when covid hits, um, you know, we needed a digital
strategy, like every health system in the, in the country.
And that's when I got put into my current role
of Chief Digital health officer to really lead
that digital transformation strategy for our system.
- That's amazing to hear. And what a great career journey.
Um, you know, in, in such, um, such a,
a great place you put yourself in, especially
as you mentioned, when the pandemic hit, um,
and really needing to have the digital strategy up
and quickly running.
Um, this is fascinating.
And now here too, we're a few years removed from that.
What are the headwinds that you're seeing
and have your eye on right now?
What are you spending your, uh, time and attention on?
- Yeah, you know, I think a free health system in the
country right now is struggling with margin pressures
and, you know, labor costs,
and we're seeing big shifts, uh,
from our payers into government pools.
Um, which for a health system where primarily
we get our reimbursement still through fee for service,
that ends up putting even further pressure on us.
The other things that, you know, we're seeing is, um, a
clinician burnout and clinician stress
and, you know, that is causing labor shortages for us,
which we're struggling with,
and we're really seeing it in on our post-acute side in our,
in our skilled nursing facilities that,
that are part of our health system.
You know, we're, we're seeing staffing mandates, uh,
coming out from the regulators.
Again, we have those shortages.
So it's, it's very difficult for us to, uh,
discharge patients from our acute hospitals into post-acute
settings because, you know, they are beds closed
because we don't have staff to, to serve 'em.
So, you know, all of that combined is, is, you know,
really causing significant stress on,
on the healthcare ecosystem.
You know, I think the last headwinds
that we've seen over the last couple of years,
which in some ways is exciting.
Um, but at at the same time, um, you know,
I think push pushes further stress on incumbents like the
University of Rochester is the significant investment
that we're seeing from industry and retail into healthcare.
You know, what we're, we're, we're, we're, we're seeing, um,
you know, almost, uh, commoditizing, um, healthcare services
through, you know, by these big retailers
that are moving in, which is really driving, you know,
consumerism for, for our patients.
And so, you know, those are other headwinds that, you know,
i I and my health system has to keep an eye on.
- Absolutely. I think all of those things you mentioned are
just so crucial and critical
to a health system's ability to provide care.
As you were talking through some of the clinician burnout,
obviously staff shortages,
and then trying to figure out how
to do things on the post-acute care side in,
in all the while, while the disruptors are coming in from
other industries and trying to, you know, carve out a space
for themselves in healthcare too.
I can imagine there's a lot, um, of pressure in thinking
through all of these different things
and dynamics happening in the market.
So, you know, when you look at your position
as a chief digital health officer,
what does that look like for you?
How are you kind of meeting some of these challenges,
helping this guide system through it,
and then really looking at growth as well overall?
- Yeah, you know, a, a lot of, a lot
of my role from a strategy standpoint is helping
identify not only opportunities for my health systems,
but new partnerships, uh, for, for my health systems.
So where I see the potential for growth, uh, for us,
um, is gonna be through working with, you know,
other verticals that, that we have traditionally not worked
with, uh, before as a health system incumbent.
So, you know, trying to talk with these industry partners
and retailers and seeing, you know, where,
where we bring value to them
and, you know, where they bring value to us.
And so a lot of my role is, you know, you know,
traveling the country and getting to meet
with leaders in these other verticals
and truly trying to understand their business models and,
and where there is overlap with, with my health systems
strategy and priorities.
And then, then I think at the same time,
is incumbents coming together and forming new partnerships.
There's probably never been a better time for health systems
to start really partnering up,
especially on the virtual care side
and the digital health side and,
and us starting to pool our resources to together to,
to grow and be successful.
So, you know, I think to me, you know,
that's the really exciting part.
Healthcare is gonna look really different
five years from now.
It's gonna look really different six
months to a year from now.
And, and I think it's, it's gonna be these partnerships
that's gonna allow us to, to really be successful in scale.
- That's so interesting to hear.
And certainly being able to have those types
of partnerships, um, you know, I I can imagine
we will reinvent and redesign healthcare
in ways we couldn't imagine.
- Oh, it a, a abs. Absolutely.
Um, you know, I, I think, you know, the other opportunity
that, that we have to, to, to push care towards is
outside of our hospital walls
and moving them into the homes of our patients,
the communities that, that our patients live in.
And when you think about that, you know,
you really start thinking about the daily lives that
our patients, um, have, you know, what myself, you know,
what is, what is my daily journey in in, in my communities,
you know, the grocery stores, I go to the banks that,
you know, I, I stop in, um, you know, the gas stations, the,
the, the convenience stores
and you know, what are, you know, what are outside the box
places that, you know, we could deliver healthcare into, um,
and, and partner with, uh, those, those other verticals
that are along the daily journeys of, of our patients.
And, you know, our health system has been thinking about,
you know, where those opportunities are
and, you know, we're, we're really kind of excited about,
you know, some of the pilots that we're gearing up to
to launch here soon.
- Well, that's amazing to hear
and definitely we'll be excited to speak more about those
as you're able to announce them.
- Yeah, absolutely. - No, you know, as you mentioned, um,
URMC in like most hospitals
and health systems right now, margins are tight
and certainly there are a lot
of pressures there on the financial side,
but I'm wondering from your perspective as we're talking
through all the things that, and possible potential
opportunities, um, you know, what are some of the real risks
or investments that are still worth making this year, even
as, you know, the financial and and budgets might be tight.
- So, you know, I am, I am very bullish on,
on generative ai.
Um, and you know, it's, it's really interesting if,
if you had listened to me speak on podcasts,
uh, maybe two years ago, uh, I was
very pessimistic around the place
that artificial intelligence has, uh, in,
in the healthcare industry.
And that was partly through some of
our own experience at the University of Rochester of,
you know, partnering with our data science institute
and, you know, trying to, um,
develop machine learning models to improve our,
our healthcare service delivery.
And with the exception of computer vision
and developing models to help support our radiologists, uh,
triage scans
or dermatologists to, you know, triage consults
that they, they, they, they might, um, prioritize.
We did not have a whole lot
of success applying machine learning into
language data within our electronic health record.
And, and, you know, it, it, it, it actually made a lot
of sense, you know, and when we look back retrospectively,
you know, our data in our electronic health record has a lot
of noise in it, a lot of variability.
And, um, our ability to leverage a machine
to identify outliers
or patterns in that data, you know, we, we,
we really struggled, fast forward to , um, the age
of generative AI
and these large language models that come
to us already pre-trained on, you know, a,
a a trillion parameters, essentially the,
the entire, uh, internet.
We are blown away with the
applying these models to our
electronic health record data.
And, you know, we, at, at my institution,
we've been actually working with large language models
and some of these generative AI tools for
almost nine months now.
And, you know, we've seen massive,
massive strides on reducing administrative burden
for our clinicians, you know, using these models
to triage patient messages using these models to
synthesize our charts
and, you know, pull out the data that it's really pertinent
for the clinician to see at that specific visits.
You know, the, the use of these models to, um,
allow our clinicians to document in an ambient way,
you know, both by partnering with industry,
but even our own ability to develop our own speech detect
and, uh, ambient documentation tools, you know,
our development time, uh, in our innovation team around
building AI tools, you know, free large language models
and generative ai, it would take us six months to a year
to develop a natural language processing model, um,
with which, again, more, more times than not failed, um,
when we were finally finished our dev time.
Now, you know, by tuning these, these pre-trained models
has gone from six months to a year, to days to weeks for us
to develop our own tools.
So like I am, I am confident
that artificial intelligence will
transform healthcare for the better,
and it's never been easier for health systems
to develop their own models
and tools to solve their current problems
that they're struggling with.
- That's fascinating to hear,
and certainly, you know, it can be, um, so interesting
to see how, you know, the technology can make a difference
and just a little bit of time in, in, um, you know,
the past year, especially as you mentioned with genis, uh,
real development in rapidly evolving, um,
usefulness in healthcare.
It is just really been cool to see.
We've been talking about a lot of different areas
of potential opportunity.
Is there anything else you wanna touch on about growth
and development for the future?
- Yeah, you know, when I think about the last
three and a half, four years, you know,
essentially when covid started
and we all shifted to, um, virtual care
and, you know, delivery, uh,
of care using digital modalities, you know, our focus
as a health system in those early years of the pandemic,
you know, was really honed in on our patients.
You know, we really wanted to, you know, create
convenience, seamless access, um,
to care within our health system using, um, virtual tools.
You know, we, we leveraged this for, you know,
new patient acquisitions so we could continue to,
to grow our, our patient lives a as a health system.
You know, we, we then really focused in on
how do we leverage technology to, you know,
keep our patients engaged with our health system, um,
you know, really creates that stickiness
and that glue so they continue coming back, um, to,
to receive care, um, uh,
through the services that we provide.
But when I, when I think through our successes
and we had a lot of successes focusing in on the patients,
you know, in some ways it was at the detriment
of our clinicians and our providers.
You know, our patients have never
before had the level of access,
direct access to our clinicians than that they, they do now
through, through digital technologies.
At the same time, our clinicians have never been
bombarded with more data, you know,
which is being collected from these technologies
and being pushed back to our clinicians than ever
before, which is again, causing significant
stress and, and burnout.
So in some ways, you know, our digital transformation
strategy has, has really pivoted, you know,
where we were really narrowly focused in on, you know,
using technologies, you know, for our patients.
Now we're pivoting to how do we focus in on our clinicians.
When you think, think back of just the history of technology
and healthcare, technology has not been the friend of,
uh, of the clinician.
You know, you think about the last major technology
that was supposed to improve the lives of our clinicians,
the electronic health record, it's did the exact opposite.
So, you know, going forward, you know, we are, we are now,
you know, really digging our heels in on
how do we leverage generative AI and,
and some of these tools to reduce the burden off
of our, our, our clinicians' shoulders
and allow them to do what they really went
into the field for actually providing clinical care, um,
with patients, um,
and really giving them their own time back, giving them
that precious pajama time so they can get out of work
and go home at a decent hour
and spend it with their own loved ones and, and,
and, and family members.
Um, and that's really where we're honing in.
And so, you know, on the, the provider side,
it's really focusing in on leveraging, you know, uh,
generative AI technologies.
And then, you know, for our nurses, you know,
we're really starting to do a deep dive into virtual, um,
nursing, uh, care models, uh, within our hospital walls,
you know, leveraging some simple, you know,
video conferencing technology,
but then overlaying on top of that, you know, uh,
computer vision, um, uh, you know, speech recognition, uh,
AI to really, um, reduce the burden on our nurses
and make them more efficient.
So for me, you know, growth in the future, if,
if we don't have clinicians to provide care,
it doesn't matter what technologies, uh, that,
that we have for our patients, uh,
it's not gonna be successful.
So we are really focusing in on, on,
on our cl clinical workforce right now.
- That's amazing to hear. And certainly very,
very needed in terms of, you know, making sure
that the clinical workforce has what they need and,
and can deliver the care that is appropriate and,
and important for the community.
Michael, thank you so much
for joining us on the podcast today.
This has been such a fun and, and interesting conversation
and certainly, you know, looking forward
to touching you on many of these topics too,
at our annual meeting next April.
Um, you know, we're having more than four 50 speakers there
talking about technology and healthcare,
and especially some of those disruptions too,
while also tackling workforce issues, challenges in,
in the financial issues.
So definitely looking forward to that.
And, um, excited to have you, um, join us
as well on a podcast to get in the future.
This has been just a really great conversation.
- Yeah. Thanks again for having me, Laura.
It was, it was a lot of fun.
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