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- Welcome back to the Becker's Healthcare Podcast, devote
to the people who power us healthcare.
I'm Molly Gamble with Becker's,
and delighted to have you join us for another episode filled
with insights from healthcare leaders.
Today we're spending some time with Dr. Thomas Maddox.
Dr. Maddox is the Vice President of Digital Products
and Innovation with BJC Healthcare
and Washington University School of Medicine,
and also Professor of Medicine
with Washington University School of Medicine.
Dr. Maddox, welcome to the podcast.
Thanks so much for being my guest today. How are you?
And where does the podcast find you?
- Well, thank you so much for the invitation.
I'm doing well. It's a Monday,
which is always a little treacherous,
but, uh, so far so good.
And I'm in St. Louis, Missouri, which is where, uh,
BJC Healthcare and the Washington University
School of Medicine are based.
- Great. Yeah.
I should mention I'm extra grateful to start the week off
with some afternoon catching up with you.
Um, Dr. Maddox, you know,
as I highlighted in my introduction,
you wear a couple different hats
in your work and your roles.
Can you start us off by sharing a bit more
with our listeners about your responsibilities
and the scope of your work, both with the BJC health system
and then Wash U School of Medicine?
- Sure, sure. So you're right.
I wear several hats, um, all of which I enjoy.
First and foremost, I'm a cardiologist.
Um, I've, I've been practicing for a couple decades now
and, and just love it.
You know, medicine is a, is a wonderful profession,
and it's really cool to be able
to pull on the white coat periodically
and, um, do what I've trained to do for years.
And that is, is try to take really good care of patients,
particularly those with cardiac issues.
So that's part of my job. And then, um, I arrived in St.
Louis about seven years ago
to help found their healthcare innovation laboratory.
And so at that time, 2017, uh,
digital health was really starting to take off.
Uh, and the presence
of digital data in our healthcare system through EHRs
and other methodologies really was starting to take hold.
So the school felt like, um, it was a good time
to have a group focused exclusively on
how might these digital health tools
and this digital information
and the, uh, the communications technologies, uh, be
engineered in a way that could be maximally useful
for our patients, for their families,
and for the care teams to take care of them.
So they brought me on to kind of help think
through how that might work.
And for the last seven years, we've really been trying
to tackle some of these, uh, new approaches to healthcare,
be it, um, predictive analytics, uh,
remote patient monitoring, digital tools
that can be used at the point of care by our care teams,
all the myriad ways that, um,
digital health can provide some innovative
approaches to better healthcare.
Mm-hmm, . So that's, uh, a role that I've had
for seven years, continue to have, enjoy that immensely.
It's, uh, it's, it's fun to be charged
with thinking down the road of what could be coming
and to have that creative component to my job.
Mm-Hmm. , about three years ago, um,
I was asked by our CIO to then, uh, take on, uh,
a digital products effort.
So I think most of your listeners
who are involved in it will recognize that, you know,
digital products and a,
and a product, uh, philosophy is really sort of, um,
uh, the standard now in technology.
And really it was pioneered by a lot
of the big tech companies, the, the Googles and Metas
and others, uh, in the, in the big tech sector.
And it's basically the idea of
how can you really get deep into your user's problems
and then build a product, build a solution, um,
in a rapid way that is continually checking in
with those users to make sure
that it truly is solving the problem
that it's ostensibly designed to solve.
And you use various techniques to develop
that human-centered design, uh,
agile delivery methods, rapid sprints.
And it really is sort of bringing, in my opinion,
the scientific method of inquiry into the development
of technology products
and solutions into, in how we,
in our case and how we deliver care.
So, uh, those teams have product managers, uh,
scrum masters, product designers,
and our first sort of set
of products have focused on our digital front door.
So how do we have digital tools like find a doctor
and online scheduling
and other things to make it easier for patients
to get in to see us.
And then we've also been working a lot on our nursing, um,
front and building some digital tools to help our nurses
who are, who are really at capacity, if you will, um, to,
to enable their work
in a little bit more of an effective way.
As we built a virtual nursing product,
we built our scheduling has to make it easier for them
to pick up shifts and sort of, um, uh, be able
to provide maximum care to our patients.
And we've really had some good success with that.
And, and now, um, I think we're on the cusp
of introducing this product methodology more broadly across
our IT portfolio.
And then finally, most recently, um, with the rise of ai,
both analytic and generative ai,
and seeing some of the possibilities it can provide
for healthcare, um, I've been asked to help lead some
of those AI development efforts in conjunction
with washus chief data scientist, Philip Hane.
And together with our teams, we're really trying to think
through how can we bring the best of what AI's developing
to our patients into our care teams.
And right now we're exploring a couple
of different predictive models that use AI
to help us understand how patients are progressing
through their inpatient stay, trying to make that
as most efficient as possible.
And then we're also experimenting with some
of the new generative AI technologies,
and particularly how they might help our clinicians be more
efficient in their documentation,
which is often a real time suck
and a, a real dissatisfier
to our care teams drives a lot of burnout.
So we're trying to see if generative AI can help, um,
with them generating notes in clinic visits
and really knock down some of the time needed to, uh,
to record, uh, those clinical encounters.
We're also using it to help the clinicians respond
to the sometimes hundreds of secure message
and end baskets, um, email responses they receive daily
from, uh, from, uh, patients and care teams.
So it's a lot of different hats.
They're all connected in my mind. Mm-Hmm.
, um, and, and sort of speak to one another.
So it's not like they're totally disparate jobs,
but it does make for full days and weeks.
But I, I really enjoy it.
- I imagine, you know, as, as you're walking us
through this, I mean, not to go too deep on the,
the hat metaphor, but some of these hats that you described,
I mean, these are new hats.
These are roles that you were asked to take on.
It was a first of its kind opportunity or position. And Dr.
Max, can I ask you a question for other leaders
who might one day be invited to head up such opportunities,
which I think at academic medical centers
and large integrative health systems,
it's really interesting.
It's like, directionally, we know where we're headed,
it's time to formalize a lot of the idea generation we have
around this, a lot of the potential.
We want someone to head it up and take it on
and lead formally and properly.
And that in several instances was you, what,
what's really critical as a leader in those times?
What leadership traits
or qualities really emerged as you were working
through these new enterprises with BJC
and Washington University that you relied on most?
- That's a great question. Um,
and I'm not sure there's, you know, a, a
pat answer at least I don't have one.
But, um, things that have really helped me
in starting to understand a new area on behalf
of our organization is, you know,
one, don't go it alone.
Um, I think both internally
and externally, I've relied a lot on folks
who maybe have deeper knowledge in certain areas like
technology than I've had, and just the, the type of training
and experiences I've had to date.
So, for example, I have a lot
of peers in our technology group who've just taught me a ton
about the, the technical mechanics of digital tools
and infrastructure and information security
and all the other things you need to have
to have an effective technology solution.
I've also learned a ton from our care
teams and our patients.
Like what are they experiencing?
What are they running into issues with
that innovations may help them with?
And I think that's where some of the methodologies
as human-centered design, which I've, you know,
recently learned, have been really powerful, particularly,
um, the, so-called ethnographic interviewing,
where you really kind of walk along with somebody,
literally walk along with them as they're trying
to get care if they're a patient
or trying to deliver care if they're a doctor or nurse,
and really sort of see
and ask like, why are you doing it that way?
What are you trying to solve?
And really sort of getting deep into the user journeys
and experiences that ultimately fuel the
solutions you need to develop.
Mm-hmm, . And then externally, you know,
there's a lot of people trying to tackle all
of this other people at other am, uh,
academic medical centers, um,
other people even in industries outside of healthcare who,
um, who are also trying to harness technology
to do a better job for them.
And I have found that just being open
and connecting to those folks
and making time to just sort of run ideas by them
or talk through problems really has sort
of expanded my ability to be more effective in my job.
And then the final thing I'll say,
and this has been true my entire life, read voraciously.
Um, I have a couple of ways that I maintain reading lists
and receive input about interesting things to stay on top
of, either on the web or books or just other materials.
And even though you can quickly run out of time to read,
if you aren't conscious
and like block out time, which I do into your calendar,
I find that your ability to get smart about things
and make connections about things
that ultimately fuel innovations is greatly accelerated.
Um, the more that you can read
and the more broadly that you read.
So those are just some of the things that I have found,
you know, both internal and external community, um,
taking advantage of some
of the human-centered design insights,
and then just being a voracious reader.
I find all of those to be really helpful in some of these,
these roles I've had to date. Can
- You talk about reading broadly?
Is there something you've read recently
that might surprise me?
- Hmm. That, oh, that's a got got you.
Question, isn't it? , you told me you were gonna ask
me one of those . Well, if you
- Need a minute, I don't, I'm a reader myself always
looking for suggestions.
- Yeah. You know, I, um, I'm a little bit of a history buff,
and I just find it fascinating to read
about different parts, different times in history.
I, I just recently finished the Truman biography,
which I felt like I needed to do now
that I'm here in Missouri and he's, uh,
obviously a Missouri Missouri son.
And as, as the listeners in, uh, no Doubt know, he was,
he was president at, uh, a specific time in our history
where a ton was being developed not only in the,
in the aftermath of World War ii,
but then, you know, America was starting to reemerge out of
that war and develop in some ways the foundations
of the modern economy and sort of the various things that he
and his administration had to tackle
and deal with, not only sort of the rise of the Soviet block
and some of the, the foreign matters that were going on,
then the rise of nuclear weapons, um,
but also some of the other sort of societal things.
How do you, how do you handle the influx
of all the GIS coming home
and stand up the economic supports
to make sure they can get off to a good start?
The baby boom was starting to happen.
How do you think about supporting all the, the children
that were coming, just starting to sort of think about
how do you take these massive problems
that in many cases people had never seen before.
IE needed an innovative approach.
And just see how smart people at
that time would sort of tackle the issues.
Um, I, I think everybody's always had this challenge.
They've got, they've got new challenges in front of them,
and just sort of seeing in history
how different figures have tackled that
to me, it's both interesting.
But then, um, you certainly get, get lessons about
how you might not apply that to your own set of problems
and challenges you might have professionally.
Mm-Hmm. . So history's, history's a big thing.
Um, you know, all sorts of industry reads that I do.
I stay on top of the medical literature for my clinical job,
but also to see kind of what's coming.
And then every now and then I'll sprinkle it in with,
um, with fiction.
And my current, my current plug is for, um,
a more tolls book, A Gentleman in Moscow,
which I just finished and absolutely loved.
So that's a good, that's a good escape from it all.
So maybe more than you wanted.
I don't know if I surprised you,
but that's kind of what I'm reading.
- Very well rounded. You know,
the last thing you touched on when walking us
through your roles was the, the rise of ai.
And I'm curious if there's one aspect
or one dimension of AI that has been demanding most
of your time and energy as of late, is,
is there one singular thing you could highlight
for myself and listeners?
- Yeah, I think, um, obviously AI
moved into a whole nother realm of public consciousness
when open AI put chat GPT in the public domain.
And I think it's, it's an interesting phenomenon
to just think about almost sociologically,
because why a has been around for decades,
why is this an inflection point?
And I, my theory, I don't know if it's right,
but my theory is that for the first time,
this technology is speaking
to us quite literally in a language that we understand.
Hmm. You know, previously we, we, the lab
and our organization been working with predictive ai,
analytic AI for a couple years now,
but when you build a predictive model, often the output of
that is, is like a numerical score
or maybe a risk level like this, oh, this patient
is at a high risk for readmission, for example.
And even though that's an important thing to know
and, you know, certain teams would act on that information,
it doesn't really capture the imagination, particularly
of the lay public as much as generative ai.
When you ask it a question, it gives you a response
that like, feels like a human is answering you.
Mm-Hmm. . And I think it's that sort of factor,
that sort of interaction with language, that use of language
that this particular approach of AI uses
that has really captured the imagination, both in terms of,
oh, how exciting it can help us in all these myriad ways,
and frankly, probably causes some
of the anxiety we've heard too about, oh my God, here it is,
how he's gonna lock us out of the bay doors
and we're all gonna die.
Um, so I, I think
that's probably the biggest driver of why it's
so front of mind for everybody now.
And now my job is to then take that somewhat hypey situation
and say, okay, that's cool, but in reality, how can it help?
How can it really solve problems that matter to us?
And so I think, um, I'm, I'm excited about
what we're focusing on because clinical documentation,
the amount of information that we generate as we visit
with patients that need to record those encounters
has never been more, um, voluminous than it is right now.
And it's really just a huge challenge for our clinicians.
You know, a huge number of them are spending hours a day
documenting sometimes obviously, to just make sure
that we're staying on top of the care
we're providing for our patients.
But sometimes it's just a lot of regulatory requirements.
Mm-Hmm. , which, you know,
each has their own rationale,
but when you add it all up, it's an enormous burden,
particularly on, you know, a doc who kind of has to pull
that all on their own shoulders.
So even though it's early innings, if this tool,
which does seem to be well-suited
for summarizing information
and putting it in the formats that we typically use
for clinical notes, if this is an opportunity to really kind
of offload some of that clerical burden, which
to be honest is like a necessary evil,
but not really the reason that any of us get into medicine,
I think that could be a huge satisfier
and a huge help to some of the burnout
and dissatisfaction that I
and my colleagues are seeing in some
of the day-to-day practice of modern medicine.
Mm-Hmm. . So I'm hopeful that as we continue
to build this technology out
and it matures in our ability to work with I tours
that we can really see some productive inroads made
into that particular problem.
- I think that's a really interesting theory
that you put forward on why cha EPT this public
fascination took hold, especially early 2023.
I just remember so many of the headlines
and you know, what could be,
and a lot of hypotheticals around it.
And it seems like,
and I'd be curious what your reaction is to this,
but it seems like in this time we've learned
it's really skillful and good
and helpful in doing a lot of aspects of my job
that I can't even bear to talk about
because it's like the most boring aspects
of my job can now be done by chat EPT.
It doesn't really make for interesting conversation
though, if that makes sense.
Um, compared to the headlines early on that were like,
you know, a a lot of provocative questions being asked
around chat EPT, who it will displace and so forth.
And right now at least it seems like it's really good at
some basic routine admin things.
Um, I don't know if that's similar for, for
what you're seeing in medicine.
- Yeah, I think that's right.
And you know, now the hard work begins, right?
Like, we've gotta figure out how to take this sort of
cool technology and apply it to real world problems.
And I think, um, sure what,
especially when you don't know much about something,
you tend to extrapolate either for, you know,
exorbitant ends, you know, really optimistic ends
or really pessimistic ends.
And there was a lot written about that.
And, and you're right, it was very hypey
right when it first hit the market.
But I think now, um, you know, reality's starting
to set in, it's not perfect.
Um, it takes some doing this, this idea of the right prompts
to direct the models
to generate relevant output is becoming more
and more important is just tricky.
Uh, I think we're getting a little bit better at it,
but I, I, I think this idea that it will
displace jobs we've heard
before, you know, this gets back to history.
Um, there are technological innovations that have happened
for centuries, and at each point society has almost the,
a same question and the same word.
They're like, oh my God, now all this is gonna go away.
Now the Gutenberg designs the printing press, oh my God,
what about all the scribes?
They're gonna lose all their jobs
and you know, so on and so forth.
And I think what we have seen time
and time again is sure, some jobs
can now be replaced, if you will, by the technology,
but the people doing those jobs
almost inevitably have other things to do.
Mm-Hmm. . And one of the examples
that made the most sense to me recently was the idea that,
uh, electronic calculators,
whenever they came out, everybody thought
that is now the end of being an accountant.
There will no longer be a need to be an accountant,
and that's just not true.
The fact of the matter is, being an accountant changed
and you no longer needed to go through the drudgery
of summing up massive rows of numbers
and doing everything
that an electronic calculator can now do in seconds.
But now the job in an accountant became much more strategic
and taking advantage of that technology
to further their thinking
and productivity in the overall world of accounting.
Mm-Hmm. . And I think that'll be true in the
various ways that AI gets applied for healthcare too.
It'll change the nature of my job.
And, and somebody once said, you know,
AI is not gonna replace to the doctors,
but doctors using AI will replace doctors
not using ai.
And I think that's true. Mm-Hmm. .
So we'll see how it plays out.
But if history's a guide
and it very often is, I suspect that's
where we'll land. Yeah.
- We're coming full circle now.
Dr. Maddox, uh, this has been such an interesting
dynamic conversation.
Is, is there anything we didn't mention that you'd like
to leave our listeners with as we wind down here?
- No, I think, um, you know, most of what I,
what I've been saying around the use of AI as an assistant,
as a co-pilot, as an augmentation in medicine, I,
I do feel strongly about, um, I haven't, well,
I should say I haven't seen any signals
to dissuade me from that point of view.
And so I'm, I'm a bit of a techno optimist,
but I also think I'm realistic and, uh,
and I'm just excited to do the hard work.
But I think ultimately the productive work to, um,
to really mature the technology into something
that can be useful for our organization and,
and for the patients that we serve.
I think the other thing that, um, is exciting
to me about the technology is I've mentioned that so much
of a clinician's day,
day-to-day experience right now is filled
with clerical drudgery and administrative tasks
and note generation, et cetera.
And I think it's really exciting to think about
how technology can kind of remove that, at least
to a degree from the day-to-day experience of healthcare.
And, and in some ways re-enable the humanity of healthcare,
that I can finally take my eyes off the computer screen
instead, look at my patient, talk to them,
and really, you know, continue to build the relationship
that frankly underpins all effective, uh,
clinician patient relationships.
And so if this, if this technology can help to that end,
then um, you know, the work
and sometimes the aggravation of all the work is,
is certainly gonna be well worth it.
- Well, Dr. Max, I wanna wish you continued luck in,
in success in your role as a techno optimist,
but a realistic one at that .
I think always a, a real pleasure to catch up
with people like you and, and get your read on things,
um, to set us straight.
So listeners, this has been Dr. Thomas Maddox,
vice President of Digital Products
and Innovation with BJC, healthcare
and Washington University School of Medicine.
Also Professor of Medicine
and Cardiology at Washington University School
of Medicine, Dr. Maddox.
Hope we can catch up again sometime soon.
- Love it.