- Nuance is a pioneer
and a leading provider of conversational AI
and cloud-based, ambient clinical intelligence
for healthcare providers used by 77% of hospitals
and 10,000 healthcare organizations worldwide.
Our AI powered solutions capture 300 million patient
stories each year.
We help unburdened clinicians, radiologists,
and care teams with efficient new ways
to capture clinical information,
applying real time intelligence
for better decision making across the continuum of care.
Now, a Microsoft company Nuance brings industry leading
generative AI and deep vertical expertise.
To address your biggest challenges
and accelerate healthcare outcomes, visit
www.nuance.com/healthcare for more information.
- This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr.
Ben Holman, the Chief Medical
Informatics Officer at Geisinger.
Dr. Homuth, it's a pleasure
to have you on the podcast today.
- Thanks for having me. Dere, a pleasure to be here.
- Now. I'm really looking forward to our conversation.
I, I think, you know, there's
so much happening in the healthcare space
and certainly, um, a lot to be excited about.
But before we dive into the broader questions,
you tell me a little bit more
about yourself and your background.
- Sure, yeah. I guess my background's a little bit eclectic.
I, my background is, I don't come from a it
or technology space.
Um, you know, I was,
'cause I've always been focused on breadth over
depth and, and variety.
I was an anthropology major who wound up going
to medical school who couldn't make a decision
and wound up in internal medicine.
And my clinical practice, uh,
for my first five years was a mix of emergency medicine,
urgent care, hospital medicine.
Um, my administrative roles, you know,
were also fairly varied,
included roles in medical education, hospital quality,
patient blood management,
and then a significant amount of time leading departments
of hospital medicine.
Um, and I found that informatics
and the intersection between technology and people
and process we're often the means
to the desired ends in both my very personal
and professional roles in the past
and sort of wound up in this role almost
by accident in 2018.
And, um, six years later,
this is the longest I've been doing a single
thing in a single place.
And I, I think I found my home in informatics.
And, and what I've really loved about it is, um,
that it really touches every part
of the organization from the health plan, uh,
to the hospitals, to the physicians and nurses
and the clinics, uh, to the medical school
and every layer of the organization from the CEO down
to the folks at the bedside.
And so, you know, my passion really is
clinical operations quality, trying to make it easier
for our folks at the frontline to take better care
of our patients and members.
- Well, that's great to hear. And certainly such an
important aspect of healthcare today is being able
to have the understanding of both the clinical world as well
as the informatics and technology.
Because like you said, you know, it touches so many aspects
of healthcare delivery as well as system operations and,
and certainly, um, you know, it continues
to evolve and, and grow.
Could you tell me about your most successful project
from the last year or two?
What did you do and how did you measure results? Yeah,
- So it is hard to pick out one project.
I mean, I have two biases that I'll be upfront about.
One is I'm always biased towards projects that simplify life
for our clinicians at the front line
and make it easier for them to do their job.
You know, we, we spend a lot of time standardizing
and creating high reliable systems as we should.
But, but the reality is, at the end of the day, um,
you know, a major, if not probably the most important
variable contributor to the quality
of the care we provide is still
that clinician at the bedside.
And when we can unburden them, take away unnecessary tasks,
make it easier for them to use their judgment
and easier for them to do the right thing, it winds up in,
um, you know, a better experience, better retention,
less burnout, and better care.
So on the physician side, I think everyone knows
that documentation and in basket are two hot,
hot button topics right now in terms of burnout
and, uh, decreased the GA engagement and attrition.
So, um, we're working on both, um, uh,
along with a lot of other things.
And we've spent a lot of time over the end basket over the
past year focusing on things like better triage at the front
door, um, you know, optimizing our choice architecture
for our patients to promote self-service
so the patient gets what they need.
If they need a me med refill, an appointment,
a virtual urgent care, uh, visit that day, let's get them
that without burdening the care team downstream,
it's a better experience for the patient.
And it's one less message for our physicians
and their care team, um,
eliminating low value messages with another focus.
We realized over the years, we developed this culture
of CCing the primary care doctor on just about everything.
And that a lot of that was unnecessary.
Some of that was automated, some of that was behavioral.
The automated things are easy to turn off,
the behaviors were harder to change, uh,
but we've made progress on, on both fronts.
And so, you know,
we discovered things like when you start digging.
We've been live with EPIC since 1996,
so there's a lot there.
We found things like, you know,
every ED visit not only was the ED note routed to the PCP,
but they also got an a DT notification
and there was no value in having both.
So consolidating that,
and there were a lot of similar examples.
And then getting our specialists to break the habit
of just constantly ceasing the PCP
and really ceasing the PCP when there was an action item
for them, not just as an FYI.
And so that was helpful in terms
of decreasing the low value messages.
We decreased a lot of clutter.
Again, having been live on Epic since 1996,
and with no sort of expiration dates for incoming messages,
we found we had close to 10 million age messages
that we were able to purge from the system.
And then going forward, we have expiration dates
because we know that a lot of messages, if not acted on
with a certain date, are never gonna be seen again.
So just in terms of a, a simple cleanup
and then auto closing, certain types of encounters
that are non-billable telephone encounters were a big one
that wind up generating messages, uh, later on, um,
that are low value.
And then for those messages that really do need to be, um,
handled by the care team, we wanted to provide the
support staff for the physicians with best practices on how
to handle those messages so
that the messages are ideally dealt
with without needing the physician's input
or if the physician's input
or the advanced practitioner's input is needed,
that the message is mature
to provide the incremental information that
that results in less back and forth
and allows the provider to more efficiently, uh, respond.
Um, and then also giving providers, you know, we found
that perhaps not surprisingly, that the extent
to which our providers are
using the most efficient tool sets within our, um,
electronic health record to manage those ME messages
as efficiently as possible using quick actions
and shortcuts was highly variable.
So we had some
of our physicians create short little two minute videos
and best practices documents that we really tried
to socialize peer to peer to make sure
that when those physicians
and advanced practitioners were getting messages
that they had the tools, um, to deal with them
as efficiently as possible.
You know, in terms of measuring the impact, um,
we looked at a couple of things.
We looked at the volume of messages.
Uh, number one, we looked at the time spent in,
in basket per appointment, number two.
And then number three, we did a, um, survey
because we found frequently there,
there's two things that matter.
One is objective reality, are, you know, in this case,
are there fewer messages?
And, and did the, uh, physicians
and advanced practitioners spend less
time managing messages?
But equally important is what were their perceptions,
because we've seen times where objectively work decreased,
but perception didn't change.
And we've seen, uh, situations where objectively work, um,
stayed the same, but people perceived that it was easier,
that there was less work.
Ideally, we wanted to, uh, make progress in both areas.
So we also had a survey, uh, asking people both
before the initiative and six to 12 months
after the initiative, things like, you know,
I received too many in basket messages
and, you know, a Likert scale from disagree to agree.
Um, I receive messages that add no value.
I spend too much time in, in baskett.
So in, in those three domains, you know,
we decreased the total number
of messages per provider per day in primary care by about,
uh, 15 to 20%.
We reduced time in, in per, per, per primary care provider,
also by about 15 to 20%.
And we had statistically significant improvement in all
domains, uh, related to perception
as measured by our survey.
So that was exciting
because I think it's something that matters
and it's a burden to our providers,
but it's really only just the beginning
because there's a huge amount of in basket work still to do.
And one of the big burdens is just the, the rise in
advice messages, which manifest either via the,
the patient portal or via telephone calls that are routed
to our providers and are really asynchronous, um,
telemedicine that's, that's handled via the in baskets
and figuring out how best to measure an account
for this work is an ongoing challenge.
So, um, we have a team
that's continuing to work on the in basket.
There's, this is gonna be a big focus as, uh, part
of our work with Ryzen.
A lot of the things that have mattered to Geisinger, one
of them being, you know, creating simpler,
more effective workflows for our clinicians, uh,
are gonna be priorities for Ryzen as well.
So this work will continue
and we'll figure out, uh, ways, um, to scale that, uh,
in the new parent organization.
- Well, that's fantastic to hear,
and it sounds like an extremely valuable initiatives you've
been able to put in place, especially looking at how,
you know, you're decreasing some
of those low valuable messages and,
and really giving the frontline clinicians time back in
their day, um, in a significant way.
And, you know, um, speaking of that, um,
rise in, in that partnership
and now, you know, becoming part of
that larger organization, I can imagine, um, there are a lot
of big opportunities for, for you and Geisinger.
What are some of your top priorities over the next 12 months
or so as you, um, continue on the work
that you've been doing historically as well
as move into this, uh, new situation?
- Yeah, well, really the priority for the next 12 months,
uh, you know, as you mentioned earlier,
the announcement came out this week sort of formalizing
the relationship between K and Geisinger.
And, you know, Kaiser Permanente has created this new
organization called ryzen.
Uh, the vision of Verizon is
to spread value-based care in
multi-payer provider environments.
You know, Kaiser Permanente is typically a patient
as a member, and a member is a patient at Geisinger.
Uh, you know, half of our patients are members
and about half of our members are patients.
So we deal with other health insurance companies on the,
on the clinical enterprise side.
And our health plan deals
with network physicians on the health plan side.
So, you know, a lot of the things
that we've been working on, we're going, going to continue
to work on, but figure out how we can do it at broader scale
and how we can take advantages, advantage of resources that,
uh, the KP Foundation brings to the table.
But the high level goals are gonna be to ensure
that all patients receive, uh, evidence-based care, um,
when the evidence is there,
and also that they receive the right level
of care at the right time.
And generally that means moving the care upstream.
So most patients would rather be cared
for at home than in the hospital.
So if we can turn an emergency de, uh,
department visit into a
increased services at home rather than a hospital
stay, that's good for us.
That's good for the patients.
If we can avoid an emergency department stay
by having a timely urgent care stay, that's generally good
for patients, and that's good for us.
If we can avoid a urgent care visit by better, uh,
preventative care upstream, again, that's
good for our patients.
Uh, and that's good for us.
So, um, and then of course, we just talked about the example
of the in baskets, but continuing to ensure
that we provide our clinicians with simplified
and efficient workflows that make it easier
to get their work done and to provide great care
for our patients and members.
Those are gonna be our, our priorities, evidence-based care,
the right level of care at the right time, ensuring that,
uh, we provide a simplified environment for our clinicians
to do the right thing with less effort at a high level.
I mean, figuring out what that means
and how to do it at scale is gonna be, uh, consuming a lot
of, um, our informatics time, uh, over the next 12 months.
- That's a huge task and especially important, but,
but I know a lot of moving parts
that when you think about the whole system transforming in
certain ways and really getting used to, um, you know,
how you can, uh, problem solve and be creative
and innovative, um, within that value-based care space.
And, you know, along those lines,
as you're looking at those top priorities
as you're looking at being able to, um,
really scale your resources and,
and make sure that every patient receives, um,
evidence-based care, how do you anticipate your
role in teams will change?
What will you need more of?
Um, is there anything, you know, that you're looking to, um,
pivot away from or just love to hear your insights on,
you know, what that looks like for you
and your teams moving forward?
- Yeah, I don't know.
You know, in the short term, a lot of this is work
that we've been doing.
So it's how can we do it better?
How can we do it differently?
I tend to focus on what won't change.
And I think what won't change is the need for informatics
and it to support the strategic needs of the organization.
And so, uh, Geisinger's vision is
to make better health easier,
and that's gonna continue with ryzen.
And so things like making sure that we're working, um,
hand in glove with clinical operations to improve access
and ease of use for our patients
and members to improve our ability
to manage total health from both the cost
and quality perspective
and creating efficiencies when it comes to operating.
So promoting operational excellence so that we can be, uh,
as effective as possible, as efficiently as possible.
So I think, you know,
those are the things I focus on making sure
that we're really aligned with both the vision and the,
and the strategic priorities down to the tactical level
of the organization.
And so I don't think those are gonna change significantly
because what's important
to Geisinger historically is gonna be what's important
to Verizon, but, um, sometimes hard to predict the future.
So we'll see. But, um, I think as long as we sort of, uh,
keep our eyes on those, you know, that vision
and those priorities, I think, uh,
I think that'll be the most important thing
for our group going forward.
- That makes a lot of sense.
And certainly it is a great way to ground yourself and,
and make sure your continued success, um,
amid all the change and transformation.
And Dr. Homa, thank you so much
for joining us on the podcast today.
This has been a fascinating discussion.
I really appreciate your time,
and I look forward to connecting with you again soon.
- Yeah, sounds great.
Thank you for your time and thanks for the opportunity.
I appreciate it.
- Nuance is a pioneer
and a leading provider of conversational AI in cloud-based,
ambient clinical intelligence for healthcare providers used
by 77% of hospitals
and 10,000 healthcare organizations worldwide.
Our AI powered solutions capture 300 million patient
stories each year.
We help unburden clinicians, radiologists,
and care teams with efficient new ways
to capture clinical information,
applying real time intelligence
for better decision making across the continuum of care.
Now a Microsoft company Nuance brings industry leading
generative AI and deep vertical expertise.
To address your biggest challenges
and accelerate healthcare outcomes, visit
www.nuance.com/healthcare for more information.