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Hello, and welcome to the Becker's Healthcare Podcast,
recorded at the 9th Annual Health IT Digital
Health and RCM Conference. I'm joined today by
Tino Tedeshe, associate chief medical information officer at
University Hospitals Health System.
Tinu, to get us started, can you please
share a little bit about your background, your
organization, and your role at that organization?
Thank you for having me. I'm excited to
be speaking at this podcast. My name, like
you've heard, is Tinu Tadeshi, and I am
associate CMIO at University Hospitals.
I have responsibility
for the community hospitals.
My background is pediatrics. I'm a general pediatrician.
A few years ago, well, over a decade
now, I decided to go into informatics,
and I have worked for a health IT
company. I did that for about 6 years,
helping with design and, different things touring the
United States,
helping implement,
EHRs
across the country.
About 6 years ago, I decided to get
off the,
just
the hustle and bustle of traveling and became
a a VP of clinical informatics at Lake
Health System,
in Ohio.
That system was acquired by University Hospitals,
and I am now an associate CMIO,
for community care,
and regulatory.
So from a 3 hospital system, I became
responsible for,
12 hospitals.
So right now, that's what I do. We,
continue to work to improve our informatics
team.
Perfect. So as I'm sure you're aware, you
know, AI adoption is exploding in healthcare right
now.
In your view, what's the most significant or
promising application of this technology right now? And
how is this informing your organization's innovation strategy?
Indeed, AI is exploding. It's exploding in such
a way that everywhere you turn it is
AI.
Well, so, about 2 years ago, you know,
it was like, oh, AI is going to
come and the question is,
do we wanna embrace it? What does that
mean for patient data? Is it gonna be
secure and so on?
Are we gonna have are we gonna be
infringing on patients' right, their data, and so
on?
Right now,
it's in everything.
EHR
has it in every way you can think
about for patient access.
It's in our documentation.
It's in our revenue cycle.
That's one of my specialties rev cycle as
well.
So we are using it in every which
way,
trying to see how can we simplify,
what we do on a day to day
basis for our clinicians
and also for operations.
So we we are also using it in
our
rev cycle,
managing denials,
interacting with payers,
also using it for physician documentation. We're using
it in a lot of ways. I can
go into details if you want me to.
Go for it. Yeah. Yeah. Yeah. Alright. Well,
I guess my first interaction with AI really
was about, 4 years ago when we started
to use AI in the area of,
physician documentation.
When you think about it, there is a
lot of data. There's a lot of regulation.
There are things
physicians need to do to be able to
make sure that they're,
paid for the services they've rendered.
Rev cycle being one of my passions, we
started to look at the business of care,
how can we assist
our physicians
to reduce the burden? How do you remember
all these things you're supposed to document to
be able to be paid for a certain
DRG?
And,
so what we did was we partnered with,
another,
well, we'll call it a 3rd party and,
just to give our physicians some help at
the point of care. So while they're documenting,
they start to get nudges as to you
mentioned this patient had chest pain,
and it looks like you're going towards this
diagnosis. Were you thinking of mentioning this? We
do not see this in your notes. Do
you wanna do that? Mhmm. And not leading
them to a diagnosis, but if you've made
a diagnosis
and you've, you know, talk, thought of 1
or 2 things to complete your,
your documentation,
we started to see do that, and we
started to realize almost immediately a return on
investment. So case mix index within a month
went up for specific
service lines. So that was my first interaction
with AI,
machine learning, large language models, just doing that
at the point of care, being able to
use
what AI can do to reduce the burden
on the physicians and yet get paid for
it. And then as things progressed, we started
to realize we could use it in so
many ways. So after we merged as a
health system
with university hospitals, university hospitals being one of
the greatest health systems I can think of
in the United States,
they already had things. So even last year,
they started to,
they got a grant where they're being able
to, do predictive analytics on cardiovascular
disease Oh, wow. Using large language models. We
have just been recently,
given a badge,
for our radiology department
for quality in AI. So there's a lot
we are doing with it, and it's just
exciting.
Of course, we are newly implemented.
EHR now has AI in every nook and
cranny of it. Mhmm. It's exciting. It's an
exciting time. Yeah. Well and and I'm curious.
You know, so you've been working with AI
for a while. How has your overall view
and, you know, understanding about what what what's
possible with AI and the expectations around that?
Like, how has that evolved over your time
working with it? So
initially, when I first started with this, it
was like, wow. This is amazing. Now Mhmm.
Let's talk about it. In in the amazing
way it is, it's the adoption was a
little hard. Right. So
providers,
or physicians are really used to their autonomy.
They wanna document what they wanna document.
I, being a physician, know I wanna scribble
2, 3 lines, do my Mhmm. Medical decision
management, just put it in there and go.
Well,
our payers were not gonna pay for that.
And and so I saw how that was
able to elevate
not just the documentation for patient care, but
how we got reimbursed in in a very,
I mean, it was like night and day.
So Right. I thought, okay, that that's not
bad.
Mhmm. And then now starting to think about
it, how do we do change management
to bring this
not just to the physician, but to nursing
and and to rev cycle?
So I saw,
how wide we could go and how deep
we could go,
and the turnaround
in implementation
was so short
compared to when we first started. Mhmm. It's
it's just so everything is in the clouds
now. Right. And you can something that would
have taken me 6 months to implement will
take 4 weeks now. It's amazing. Right. Right.
It is amazing. I can I can understand
your excitement now?
So, you know, on a daily basis, health
care leaders such as yourself
are managing greater volumes of data across, a
growing number of devices and care settings and
populations.
In this complex environment, what clinical data integration
tools or practices are you seeing drive improvements
in patient
outcomes and operations?
And, can you share an example or 2?
Yeah. So I I would say analytics
would be the place I wanna go with
that. Mhmm. You have all this data.
That's the one thing about implementing the EHR.
I was involved with the meaningful use, getting
Mhmm. Hospital systems from paper
to electronic medical records. This was exciting, it
was hard, but we did it. Now you
have all this data.
And if you are in an IDN or
complex organization
like I'm in, the question is how do
we reconcile
all this data and how do we bring
the standardization
or what what we call systemness
across the whole
health system? As you start to think of
various hospitals,
academia and community hospitals and the small,
critical access hospitals, how do you bring that
systemness
without losing
the uniqueness of each one? So
having
huge data, but that it goes through
analytics.
For me, that's where it all works. I
have an operational background as well. So when
we start to pull
pull data out and start to determine how
do we decrease our length of stay, how
do we increase our CMI across service lines,
that's where I start to use it. So
integrating tools that will help you
use that data in an operational way that
would make
decision making very easy. Right. Or
my patients are going to various health systems
other than my health system. Mhmm. Some are
going for cardiovascular
care even though we do have a great
center,
they're going elsewhere. When they go, how do
I see their data? So health information exchange,
making sure,
that we have the tools that bring in
the data from,
from wherever they go. In Ohio we have,
especially where I come from in Cleveland, we
have a lot of our patients flying
to Florida,
you know, when the weather is not as
nice.
How do I get that data? They come
back, and how do I use that data
in their day to day care? So
we have to integrate these tools.
Mhmm. So health and then clinical decision support
is another one. A lot of EHRs right
now have it, but it's clunky. Right. So
how do we streamline it, make sure it
it makes sense to the clinician, to the
physician at the point of care? These are
all tools that are available, but how do
you adopt it, Adopt them and use them
in a way that makes sense. Right. Right.
And so how can health care organizations and
health care leaders
better support IT and clinical teams as they
carry out some of these innovation initiatives?
And what are some of the, common pitfalls
here?
So,
just from my experience, collaboration
sometimes is lacking. We're very siloed.
IT many times is siloed
from clinical,
from operations. Mhmm. These are all very strong
departments
and,
aspects of health care. The the way to
make this work in this very fast changing
environment
is to make sure that we cross collaborate.
Mhmm. We have to have at the table
each time
operations. We have to have IT there, and
we have to have clinical there. Now one
of the pitfalls is clinical would go. So
one of my colleagues' physicians may go to
a conference
and they see all this great software and
applications.
And sometimes they are leaders, and they almost
signed off. And many times, they've signed off
on that
without asking IT,
one, do you already have it? Because we
may already have it. Right. Right. We just
may not have deployed it yet because of
so many priorities we have. Mhmm.
So why, well, you may say, well, my
department will will pay for it. Think about
that. It's not really your department because you're
of a health system. Right. So it's all
our money. Mhmm. It's not just your money.
Mhmm. So the question is, do we already
have it? A little bit more collaboration will
make this work. Mhmm.
And then infrastructure.
So
are we, as a as a leadership, are
we invest in put in the the the
investment where
we've we've said we wanna go? So you
have this great,
vision for innovation, but what does that really
mean? Right. It means infrastructure
and
and investment, not just of time, but but
money. Mhmm. Do we wanna do that?
So we can support
a lot of this initiatives
by by just thinking through collaboration,
money investment,
infrastructure investment,
training,
and having everyone at the table.
So what is your top piece of advice
for other health care leaders as they prepare
for, you know, further advancements and adoptions of
technology and greater demand for care?
I want us to think at the very
beginning, when we start to think about the
new thing you wanna do or innovation,
think about
the change management aspect of it. Mhmm. Mhmm.
What does that really mean?
And if you're in a big health system,
what does that mean when you think about
the microcultures?
I'll as a physician, I wanna talk about
the medical staff. So a lot of mergers
and acquisitions
happening right now. So when we start to
merge and acquire new
small critical access hospitals
or big,
community hospitals,
remember that there are micro cultures. Mhmm. How
are you gonna manage that? Right. You have
a great vision, but how do you bring
everyone together?
Otherwise, the vision will be hard to achieve
unless change management is a strong, strong pride
of of the planning Mhmm. From the get
go. Right. And so, you know, as we
wrap up this conversation,
you know, one thing that was really obvious
to me was just how passionate you are
about your job and your role in kind
of, like, technology and health care. And one
thing really stuck out to me, and that
was when you mentioned how excited you are
about seeing some of these things. And and
you you I'm just genuinely curious.
You know, 5, 10 years down the road,
is there a piece of technology or something
that will be possible with technology in the
future that you're just especially excited about?
So I am
excited about
centralization.
Mhmm.
There are a lot of things that we
are doing today that we're doing based on
almost 200 years Mhmm. Of health care, of
doing it the same way. Right. But the
question is,
with all the technology out there
and many times a patient is seen by
a physician and the physician spends 5 minutes.
If you spend 5 minutes and you were
scheduled for 15 minutes,
what was it that you were able to
do in 5 minutes?
And the remaining 10 minutes,
could we centralize all of that? Mhmm. Could
we do it in such a way that
somebody else picks up that aspect and does
it centrally so that you focus on what
you are the only person who can do.
So we have the central corporate
aspect of health care that is under guarded
by IT. Mhmm. We have all the tools,
really. Even now we have the tool. We
just have to reimagine
health care and how we deliver health care.
Mhmm. And and and with that in mind,
I am seeing that there are a lot
of things that are repetitive, that are redundant,
that we can cut out of, the way
we provide health care. It's an exciting time.
Right. Right. Right. Well, thank you so much
again. This was a great conversation. I absolutely
loved it. Thank you again for joining us
today. Thank you so much for having me.
My pleasure. You have a lovely rest of
your day. Thank you.