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Hello. Welcome to the Becker's Health Care podcast,
recorded the 9th annual health IT, digital health,
and RCM conference in Chicago. We're joined today
by doctor Bimal Desai,
chief health informatics officer at Children's Hospital of
Philadelphia.
Bimal, to get us started, could you please
tell us a little about your background, your
role in your organization?
Sure. So I'm, Bimal Desai. I'm a practicing
pediatrician and the chief health informatics officer at
CHOP. I've been with the organization for about
25 years. Came there straight out of medical
school and just never left.
I'm board certified in pediatrics and in clinical
informatics.
And I oversee the programs in clinical informatics
and digital health, which in our organization includes,
remote patient monitoring, telehealth,
econsults,
and all those virtual
technologies.
Okay.
As you know, AI, adoption is exploding in
health care 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?
Yeah. That's a great question. And, as you
can tell from many of the presentations
here Mhmm. Probably the number one technology that
sort of captivated the imagination of health care
has been ambient,
listening or, artificial intelligence in general.
And,
I think that time will tell
if there are,
ways that we can use AI
beyond ambient Mhmm. That are just as effective,
or just as likely to help our health
systems.
And I'll give you one example.
We had a clinical division,
who did some work to try to measure
how much time
providers spend,
in what we call para clinical work. So
the kind of work that you are required
to do in order to see a patient,
but that's not direct patient care. Right. Right.
So this could be like pre certification,
prior authorization,
letters of medical necessity, complex scheduling, like all
these other healthcare tasks that you have to
do to complete a visit and take care
of a patient, but,
take time away from actually seeing patients. And
what I'm really excited about is the idea
that we might be able to use AI,
whether it's ambient tools, the for note summarization
for generation of these, some of these artifacts
that are required by insurance companies,
whether it's,
robotic process automation, whatever the platforms are, I
think that we're at the cusp of showing
that these technologies will actually have direct utility
or physicians, nurses, and allied health professionals. Mhmm.
And that feels different than it did, like,
even just 3 to 5 years ago, where
I think most health care providers felt like
they were
passive recipients or even victims of technology and
not like,
collaborators who could actually benefit from the technology.
So Right. That's what excites me about this.
Okay. Well, you know, on a daily basis,
health care leaders are managing greater volumes of
data and more devices across a growing number
of 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?
For sure.
I've noticed
that inpatient care, specifically in, like, the intensive
care areas Mhmm. Has really exploded in complexity,
we have the ability
to do a lot more real time monitoring
through bedside monitors and integrated devices.
And we're at the point where the volume
of data
and the need for frontline providers to synthesize
and actually make decisions or take action on
those data is becoming
almost overwhelming. Right? So the most promising set
of tools I've seen, and these are not
necessarily new tools, but I think we're finding
a general
utility from them is the types of platforms
that the ECRI Institute calls CHIPS Mhmm. Platforms.
So these are consolidated health informatics platforms or
health information platforms. Correct. So you imagine it
takes real time waveforms from the bedside monitors.
It takes ventilator data. It can take pump
data. It can take, vital signs and lab
results and any other clinical parameters you want.
But the magic is that they can actually
render them in a in a single display
that just
completely reduces
the cognitive burden of having to look in,
like, 15 different places
in the medical record. And I was actually
coincidentally on service a few weeks ago
when I had an, an infant who was
having these unexplained spells. Mhmm.
And what we noticed was that when the
critical care team came down to assess the
child at our request, they were able to
pull up this CHIPS platform that we have
at Children's Hospital of Philadelphia
and immediately diagnose that this child was having
some, cardiac arrhythmias. Mhmm. That historically would have
taken a much, much longer time. This would
not have been a 3 minute task at
the bedside. It would have been way more
complicated. And, it really highlighted for me the
power of these sort of, you know, big
data platforms that can bring insight to the
just a huge amount of data that we're
seeing.
So how can health care organizations better support
IT and clinical teams as they carry out
innovation efforts? And, what are some of the
common pitfalls here?
Well, I think one of the things that
health systems can do is really make innovation
a strategic mandate. Mhmm. And I don't I
mean, more than sort of the lip service,
but I mean, like direct ties to your
strategic plan. So for example,
our organization has a recently refreshed enterprise strategy
that specifically calls out two things that are
of interest to my team. Well, it's all
interesting to my team, right, right, to specifically
that are relevant to my team. One of
them is what we're calling the next gen
operating model. So figuring out how our health
system will actually operate in the future, where
we're going to eliminate waste and ineffectiveness.
And the second one is to develop the
workforce of the future. Mhmm. So that means
cultivating a set of leaders who are facile
with technology, who actually know how we can
use technology to directly improve clinical care. And
the nice thing about having that as our
top level strategic
imperative
is that it gives my team direct visibility,
like every one of my projects, and in
my team's projects directly relate to that strategy.
Right. And so that also helps because
I'm can be somewhat reassured that we'll get
the resourcing and support and visibility that we
need for these initiatives.
Well,
you know, that brings me to my next
question. You talked about, like, fostering that next
leader or the next generation of leaders in
health care.
What advice do you have for these leaders
as they prepare for, you know, further advancements
in technology
and, greater demands for care?
Health care systems are getting larger, more complicated.
Mhmm. They have a lot of competing priorities,
you know, cybersecurity,
financial sustainability,
market expansion, and so on. And I think
my one advice would be to,
if you're a health system leader, even outside
of the technology space, is to say, is
to stay curious,
and to stay connected to the clinical enterprise.
So in high reliability theory, we talked we
talked about sensitivity to operations, like really have
a deep understanding
of what it's like to do the day
to day of patient care delivery.
Because that's where I think
we're discovering there is enormous opportunity for digital
transformation,
for clinical improvement,
and I think we'll be a better health
system because of it. Mhmm. Well, doctor Desai,
you know, it's very evident based on this
conversation. You're very passionate about working with data
and technology. And I'm curious, you know, with
your background at a at a children's hospital,
how is that, say, you know, maybe different
from, you know, with the adoption of technology,
what technologies,
you know, might excite you? What how does
that differ from, you know, say, a big
health system, community health center, and everything in
between? Like, what unique challenges are there? But,
also, like, in that children's hospital space, is
there technologies that you're super excited about coming
down the pipeline 5, 10 years that maybe
a major health system wouldn't be as focused
on? Yeah. I I think there's at least,
well, there's lots of differences, namely the size
and age of our patients. But,
one of the major differences is in reimbursement.
So as you know, children are covered under
Medicaid, not Medicare Mhmm. When they receive public
insurance.
And,
that has some very interesting ramifications, namely that
Medicaid is state administered. So individual states can
opt in or opt out of certain reimbursement
schemes.
And in our state, for example, we've had
to advocate
very heavily for reimbursement for telehealth and remote
patient monitoring and econsults and so on. And
so in some cases, we've been able to
get that concession from the payers,
or sometimes it's required actually legislative advocacy. So
that's sort of one difference is that it's
it's much more fragmented on a state by
state basis.
The second major difference is,
teen privacy. Right? We are beholden to state
laws in almost every state in the United
States,
that requires to protect certain types of health
care data.
And if the teen requests confidential care, we're
not allowed to share it with the parent.
That also differs by state. And so if
you're practicing in Texas, or if you're practicing
in Ohio, if you're practicing in Pennsylvania,
those state by state team privacy laws also
differ dramatically.
And the third difference is that there was
a tonne of stuff I would love to
do with commodity
off the shelf connected monitors, right, like pulse
oximeters and blood pressure cuffs, but
almost none of them have been FDA
approved in children. Oh, really? Most of the
consumer grade devices that you'll find
are actually FDA
cleared for use in patients 18 and older
with a giant caveat
of you can't use this in children in
in patients with preexisting
heart and lung conditions. Right?
Well, that completely
I don't wanna say eliminates, but it very
much hampers our ability to use them in
pediatrics because the populations that I want to
use these on are specifically children with heart
and lung conditions. Right. Right. Like infants who've
undergone congenital heart disease repair and stuff like
that. So that's I think that's a call
really to the device manufacturers is, like, don't
ignore the kids. Right. Like, we really have
a need for these devices,
especially if we wanna be able to do
more remote patient management, and care delivery at
home. And to your point about like, well,
what are the what are the opportunities I
see? I think remote care is exactly where
we should be looking in pediatrics.
Kids are maybe unique from adults in that
they are generally healthy, right? But the vast
majority of kids are very healthy. So if
you look at utilization of health care resources
in kids, it's very much skewed towards the
sickest children in the country. Right? The children
who have surgical conditions and chronic diseases and
stuff like that, but that's a very small
number of children. So if I stand up
remote remote patient monitoring program for children,
there might be a program that only impacts
60 children per year. Right. Right. Right. But
it's incredibly impactful for those 60 kids. Right.
Right. Right. Right. The finances are different. The
numbers are different. The utility is different. And
it's it just deserves a very different thought
process Right. And mental model than adult remote
care. Mhmm. Mhmm. Awesome. Well, doctor Desai, thank
you so much for joining us today on
the show. This conversation is an absolute pleasure.
Thank you so much again, and have a
lovely rest of your day. It was my
pleasure. Thanks for the invitation. Thank
you.