Hi, everyone. This is Laura Dierda with Becker's
Healthcare. Thank you for tuning in to the
Becker's Healthcare podcast series. We are thrilled today
to be joined by doctor Holly Urban, vice
president of business development strategy and clinical effectiveness
at Walter's Kloer Health. Doctor Urban, it's a
pleasure to have you on the podcast today,
and thank you so much for joining us.
We are excited to dive into your journey
and experience.
Thanks so much, Laura. I really appreciate the
opportunity
to, speak with you all.
Fantastic. Well, let's dive right in. Doctor Urban,
could you introduce yourself and your work in
the health care to our listeners?
Yeah. Absolutely. I'm Holly Urban. I am a
pediatrician by training.
I practiced in primary care pediatrics for several
years before starting a second career in health
care IT, and I've been in health care
IT for about 15 years.
In multiple leadership roles, I was vice president
of product management at McKesson Horizon Clinicals,
and then recently was CMIO at Oracle Cerner
for their federal business.
And I started working at Wolters Kluwer this
year in,
and my role in business development
is really focused on innovation opportunities and how
we do innovation,
with some of Walter Scott's most influential and
important products, which are our,
up to date product,
our up to date patient engagement, and, up
to date Lexi drug content, formerly known as
Lexi Comp.
People who don't know the UpToDate product, it
is probably the most used clinical decision support
product used by physicians and other clinical users
across the US. We have about 2,400,000,
clinicians who use UpToDate,
and clinicians really trust the content. They know
that our 74100
medical experts
who are leaders in the field,
they curate the content. They author the content
as well as it's being updated
every business day. During COVID, it was every
day.
So it's constantly being updated with the most
important, most recent evidence. And so the our
customers who use the content have a lot
of trust in the content.
So we did a big study of of
providers
this year that said, how do you think
about generative AI tools? Since I'm in innovation
with UpToDate, this is something I think about
a lot.
And, you know, we did learn that over
40% of these users are are ready to
use generative AI. And that's been a change
over the past year. So that's been increased
quite a bit, 68%
over they're they have changed their views on
generative AI since last year.
But 91%
said that any generative AI tool, they would
wanna know where the materials were sourced and
and know that they were created by physicians
and medical experts,
and they'd also want their vendors of j
Gen AI tools to be transparent where the
information came from.
So
as we think on up to date clinical
decision support,
we we know that there's some limitations. And
and I'm and I'm not talking about,
some of the really amazing tools out there
that are all about physician efficiency. So, like,
you know, some of the ambient listening or
chart summarization tools. What I'm really talking about
is
AI tools that are focused on, clinical decision
support, like diagnostics
decision support or therapeutic decision support. And, you
know, to be totally frank, we see a
lot of limitations.
You know, hallucinations are 1. I mean,
even today, it continues to hallucinate. And when
you're talking about making care decisions for a
patient,
that level of risk is just unacceptable for
most clinicians. Again, it comes back to trust.
So if if you're if you're concerned that
there may be a hallucination, how can you
possibly trust what the what the LM is
telling you? The other is the inconsistency
of the response. You ask the same question
3 days in a row, you could get
different answers from an LLM, which again,
I think would impact trust. Right? So it
how can you trust what they're really telling
you if you're not getting a consistent response?
And then the final, and this is something
that I think about a lot is,
is patient context. So
one example is so let's say you,
put it into an LLM,
there's a patient who has a urinary tract
infection, a bladder infection,
and they're allergic to penicillin, so what antibiotic
should I use?
And you'll get a response, it's probably a
fluoroquinolone.
Great. I've got my answer. I'm gonna go
write a prescription for a fluoroquinolone
for my patient.
Well, the challenge there is you don't have
the L and M didn't have all the
patient context. What if it's a pregnant patient?
Patient is pregnant. You do not wanna be
prescribing a fluoroquinolone.
What if it's a child?
Again, you do not wanna be prescribing fluoroquinolone.
What if it's a recurrent bladder infection? What
if it's a complicated bladder infection? There's just
a lot of patient context that's there that
you don't get in that LLM response,
and that makes it really challenging again to
trust what the response you're getting. And that's
why at UpToDate is we're looking at some
of these models is we're also really gauging
how do we make sure that
no hallucinations at 0 risk, so it's really
grounded in the up to date content,
as well as giving those nudges or giving
that guidance to say,
have you really thought about all the patient
contextual factors?
Well, it's fascinating to hear. You know, there's
some really impressive results and things you're talking
about that make a big difference in the
clinical space. So
excited for what's ahead, but I know as
you mentioned, still things to work through. Yes.
More hospitals and health systems right now are
also getting serious about value based care. As
a former care provider for pediatric patients, how
do you view this shift,
toward more proactive preventative care? Yeah. It's it's
really interesting to me. So as a pediatrician,
I mean, you're sort of grounded
in proactive preventative care from the beginning. It's
really the core of pediatric medicine.
I mean, we
do growth charts where you measure a patient's
growth against the growth chart. And if they
fall off the growth chart, that may be
a sign of a problem. We do developmental
screening to make sure kids are hitting their
develop developmental milestones.
We do anticipatory guidance to say, hey. Have
you thought of you know, are you doing
the right diet nutrition for your patients? And,
of course, we do immunizations
to make sure that you're preventing disease. So,
so having that sort of proactive
preventative mindset is very core to what I
always did and what all pediatricians do. And
so when you think about the broader scale
of health care, you know, most physicians aren't
trained in that model. It's really more, I'm
gonna treat the patient that's sitting across from
me in my office or that's in the
hospital
bed. So you're not thinking about the patient
the other
364 days of a year when you're not
seeing them because there aren't economic drivers to
do that, frankly.
So I really that's why I've been an
early proponent of moving toward the more value
based care to really understand how do what
do we need to do for our patients
in those other 364
days so that they aren't consuming health care
services, so they are staying healthy, so they
don't have to come see me. And that's
what value based care is all about.
That makes a lot of sense. You know,
it is amazing to hear a great vision.
And I I love the idea of pediatrics
being so proactive,
from the get go and then instilling that
within other areas of the health care system.
How can health care
leverage systems thinking and design systems that facilitate
the delivery of the highest quality care to
generate better outcomes,
increase safety, and improve efficiency,
especially in this move towards value based care?
Yeah. Those things these things are very intertwined.
So what I would argue is that in
how we call our health care system,
it isn't a system at all.
It's a very broken, fragmented,
siloed
with very, sort of perverse economic incentives.
And and the data shows that the system
isn't working. You know, if you look at
the Commonwealth Fund,
every year they publish that we spend
3 to 4 times more in our health
care dollars
than other developed countries. And yet our outcomes
are significantly worse. I mean, it's very, very
sobering
that we are just we are just not
getting value for the health care dollars that
we spend.
And so that's why I've been talking a
lot about how systems thinking needs to be
addressed. Because if you if you throw in
other issues like, you know, workforce burnout
and,
and bias, like, if you don't think about
those issues with the systems thinking approach, it's
almost impossible, because they're systemic issues. So how
do you fix it without taking a systematic
approach into a broken system? So
what systems thinking is, it's all about designing
a system to meet the outcomes you're looking
for.
So that's like, in health care, obviously, it's
better care at lower costs.
And, you know, so many health care systems
do process improvement or quality improvement
where the focus is really on fixing people.
Like, how do you change their mindsets or
how do you change their workflow? But, again,
I'd argue that if the system that they're
working in isn't designed to meet the outcome
you want, just trying to fix the people
is not gonna lead to sustainable or systemic
change. So that's why I really advocate for
this broader systems thinking to make sure that
you're designing the entire system and all of
the people in it and all the processes
and all the technology
to meet your intended outcomes. And there's an
interesting,
so the leaders at the IHI published an
article in the Harvard Business Review in July,
that talks about this. So if anybody wants
to read more about it, I highly recommend
the article. It's really well done. And they
call out, James Clear's book, Atomic Habits, and
he says, you do not rise to the
level of your goals. You fall to the
level of your systems.
That's fascinating. What a poignant,
thing to keep in mind in the health
care space and truly
overall just a really important,
lesson, to think about on a regular and
daily basis. Systems are definitely make a difference.
Now I know you're currently working on a
publication that's going to highlight the generative AI's
potential in health care and practical applications for
clinicians.
Can you share your insights on how AI
can disrupt the traditional health care models
and what challenges health care organizations should really
be aware of? Yeah. Absolutely. So the, the
textbook is Digital Health AI and Generative AI,
a concise practical guide for clinicians. It's gonna
come out,
Springer Nature's publishing it edited by Terri Adiram
in in 2025.
And my chapter is on implementing
IA tools.
Again, you have to take a systems thinking
approach when you're implementing these tools. It's not
a very simple plug and play, like, I'm
gonna plug in an EKG machine,
get a patient the leads on, and I'll
get an EKG out of it. It's far
more complex than that. You really need to
think about all of the people and processes
that are gonna be involved with the tool
itself.
So just to take an example, let's talk
about,
a a patient inbox where you're where you're
using AI to do triage of patient messages.
So I would say taking a systems thinking
approach means you start with what metrics are
you gonna follow to know that you're going
to,
meet the outcomes you're looking for, and who's
tracking them, and who's owning them, and who's
reporting out on those metrics,
what resource
is managing those,
triage messages,
how are messages
rerouted to other clinical users when needed, and
what are the criteria to reroute,
and and auditing? So are there any messages
falling through the crack? That's that's to cover
risks.
Is there AI drift? I mean, we know
a lot about these AI models that they're
trained in, you know, with the vendor side,
but once they get into patient population models,
that they can drift and they can change.
So who the only way to really
see that happening is through audits. And then
finally, addressing issues of bias. I mean, doing
subgroup population analysis to make sure that you're
not seeing any bias in the in the
AI response. And then finally, the most important
is governance. Right? Who has governance over all
of that? So you really need to be
thinking people process and technology when you're implementing
these tools.
That's fascinating to hear and certainly
a very poignant reminder in terms of how
you can really
most effectively implement these tools, get them out
to the broader system, and make sure that
they're used and optimized correctly. I know that
can be a big challenge, and a lot
goes into it. So
fascinating to hear. Is there anything else you'd
like to share with our audience that we
haven't already touched on? No. I think that's
great. Thank you again for the opportunity to
chat today, and, I enjoyed the conversation.
Doctor Urban, thank you so much for joining
me on the podcast today. It has been
such a pleasure speaking with you. I'd also
like to thank our podcast sponsor, Wolters Kluwer
Health. You can tune in to more podcasts
from Becker's Healthcare by visiting the podcast page
at beckershospitalreview.com.