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- This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr.
Krista Fletch, vice President
and Chief Medical Information Officer at Penn State Health.
Chris, it's a pleasure to have you on the podcast today.
- Hey, Laura. Thanks, uh, for having me. I appreciate it.
- Now, you know, I'm looking forward to our discussion
and really learning more
and catching up on what you're doing at Penn State Health.
I know, you know, it's just such a amazing, um, organization
and system that's supporting patients in the community in
many different ways, and so I'm looking
forward to diving in.
But before we do that,
can you tell us a little bit more
about yourself and your background?
- Yeah, sure. Um, uh, so I'm an emergency physician.
I, uh, I grew up in Western Pennsylvania.
I'm an unapologetic Steeler fan.
Uh, I got my undergrad degree in physics,
and my whole family thinks like engineers,
and I say that only
because it's really, uh, you know, kind of is
who I am when I'm, uh, doing things at work
or home or, uh, like that.
Uh, I, my first connection to Penn State is actually, I went
to medical school, uh, at, uh, the College
of Medicine in Hershey.
Did my emergency medicine residency up at UMass
and Worcester, where I got lots of good friends up there
and learned lots of good things there.
Worked in the community hospital
and then came back to Hershey.
Uh, now, 25 years ago, I had my 25th anniversary, uh,
and I came back only to take care of patients in the ed.
I ended up doing a lot of administrative things, though.
It was kind of fun just to improve systems.
And that's sort of how I've gotten to, uh, informatics, is
that a system improvement guy.
Uh, some people would call me an industrial engineer,
want be, uh, I'm big into lean and six Sigma
and trust improvement, and how can we do things?
And I learned a long time ago,
the technology's right smack dab in the middle of it,
both in a good and a bad sense.
And so, um, since then I've, you know, started a residency.
I have, uh, started observational medicine, deployed
the EMR at the Hershey campus.
And over the last few years, we've become a pretty, um,
involved health system, whereas in the last couple of years,
we've actually built two new hospitals.
We've acquired two other hospitals
and have converted well over a hundred ambulatory sites into
a standard, uh, EMR platform.
And so I obviously can't do that myself.
It's our whole IT team along
with the informaticists that I have.
And, um, it's, uh, it's, it's been a journey.
I think one of the fun things though is I still get the
practice emergency medicine every Thursday.
Um, so I still get to teach
and I still get to take care of patients,
and I still use, use the own systems that I, that I deploy.
And, um, I still do some research too.
I'm a professor in the college of medicine
and I've done a, uh, a lot of granted research in the space
of healthcare delivery science
and systems, uh, processing, uh,
and more recently into, um, advanced decision support.
Some people call it machine learning,
AI type things, uh, like that.
And, um, it's been a,
it's been an interesting journey
over the last quarter century.
- Absolutely. I can imagine. You know, you've seen, um,
such an evolution in the healthcare delivery space
and then just the whole healthcare ecosystem.
Um, and you know, it's cool to hear your journey through,
uh, the medical school
and just kind of how you've seen your role
and your career change.
Um, and, and, you know, given all the accelerated change
that's been happening in the healthcare space over the last
couple of years, and looking ahead, what are some some
of your top priorities right now?
What do you really keep top of mind?
- Yeah, I think, you know, I,
I've always been a people person
and I think people is really the top things we as, uh, uh,
information technology professionals should keep at the top.
You know, we all get, you know, enamored
by the bright shiny objects or the next new tools
or, um, you know, abbreviations
that mean different things to different people.
Uh, but at the end of the day, it's
about the people we take care of.
And so always trying
to keep the priority, why do we do these things?
So making sure the patient is always first
and making sure we're caring for the people who are caring
for people that is our staff,
our physicians, that sort of stuff.
And how we deploy technology,
how we use technology is actually
really snag dab in the middle of it.
So, you know, our, our work
and priority is to do the best we can for our people.
And how do we do that? Well,
some big things we've been working on is one standard
platform across all of our, um, organizations.
So we're almost there. Two is really advancing the
communication tools that we have.
So we've, um, standardized on a secure texting platform, um,
and, uh, have been deploying that now,
like you imagine an academic center
that's been using pagers since the eighties.
Um, it's a heck of a, uh, transformation.
So we've, we've actually been able to do, uh,
some work there to try to help that.
And it's really enhanced the bidirectional communication,
if you look at the errors that occur in health systems,
and it's about the,
the people in the process much more than it is about the
technology, but the technology can enhance those,
those gaps, uh, in systems.
And so, uh, those are some big pieces we're, you know,
moving away from old things, you know, getting rid of paper,
getting rid of, um, dictations, uh, you know,
and actually going to to front end, uh,
voice recognition technologies
that we have deployed across there, even dabbling in the,
uh, generative AI space.
And when it comes into those things.
And, um, so those are the things that we're really looking
to do, is to make things more eff effective and efficient.
And, you know, as I tell my team, uh,
there's a lot of technology out there.
It's a lot of good stuff. Um, but it's how you deploy it
and it's how you use it for outcomes.
So I've challenged the team to say,
if you're gonna do something, let's not do something else.
So we've been on a big, uh, waste removal lean approach
to our systems where we're going through
and looking at the alert alerts and rules
and things have been in place for a while, or unused orders
or, uh, order sets that have been, you know, uh,
not reviewed in the last year and, and,
and really getting crisp on, um,
becoming lean, uh, in an approach.
And that takes a mindset change, uh, in some locations.
And, you know, once people realize how you can help people
to care for patients
and how you can help patients directly, um, you know,
that efficiency's there, I mean, you know, one thing
that we've seen, like most places have seen is the, um, uh,
texting and, um, messaging to, from patients to providers
and, and that contributing to
long work hours and things like that.
Well, we've always had a sort of a, an approach where,
you know, there are messages
and patient's messages are important,
but there's some things that aren't best cared for,
you know, with patient messaging.
So we did put some limits on the numbers of characters that,
that, uh, patients, uh, can send at any given time
and put some process and policy around, um, numbers
of messages and how we can then
redirect them towards a more efficient, uh, area
of care rather than texting maybe that, uh,
virtual visits will be there.
So, we'll, you know, maybe hop in the EMR and,
and do an ad hoc, uh, visit, uh, related to it.
So it's things like that that I think, um, is
where we've been spending our time
and I think is gonna make a big difference, uh, in,
in the healthcare delivery system as we move forward.
- Well, that's fascinating to hear.
And you know, I really love your emphasis on the person
connection or that personal connection, just keeping that,
um, you know, a, as a really important part
of the way healthcare is delivered
and continues to, um, you know, care for communities.
I think you're definitely right in terms of, you know,
technology can be really helpful to boost, especially some
of the administrative tasks,
but then, you know,
having those relationships is so important.
And too, when you're talking about the texting
and messaging, I know that's something that so many, um,
physicians, uh, nurses as well as health systems are trying
to put those policies and procedures in place
and, um, set the right boundaries
or funneling systems there.
Um, you know, were your teams pretty, um, pretty receptive
to some of those changes in, in, you know, patients as well?
How were you able to kind of navigate, um, some of
that training when you think about, you know, wanting
to make sure that patients have access to care,
but then to, you know, not, um, overburdening the clinicians
with, uh, some of the longer requests or,
or things that are, um, you know, not best suited
for a text chain and those kinds of things?
- Yeah, I mean, it, it, at the end of the day,
healthcare is about people taking care of people, right?
And sometimes, you know,
people are more comfortable in texting formats,
sometimes they're more comfortable in video format,
sometimes they're more comfortable in person formats.
Sometimes they think they need to see a specialist
for a primary type activities,
and it's about the relationship
and communication that you have with them.
So it's, it's not say no, it's, geez,
it seems you have a lot of, lot
of information in this message.
I don't wanna lose things in translation.
Let's hop on a call. Um, and, and then we have policies
and procedures that guide our staff to be able to, you know,
um, direct the person to the type of care that they deserve.
Not just because, you know, they want to, you know,
text here or text there.
And, and there is the technology as part of that,
but it's really not necessarily the right thing to do.
I mean, there's some great things that occur, you know,
via telehealth, right?
So, you know, we did lots of very creative things
during the, during the pandemic with it,
and we learned a ton.
Now we're applying them in, in real time,
and we know that some things you could do really,
really well through a telehealth visit,
but some things you need an in-person, uh, visit to do.
So let's direct them in that scenario.
Now we're gonna blur
that line even further when we start using peripherals
associated with, you know, different technologies to listen
to the heartbeat or, you know, looking in the ear
or even a retina scan, you know, that you can do remotely.
And I think those things are gonna come up
and be creative in here.
But again, at the end of the day, it's about us taking care
of our community people, taking care of people,
and, you know, those of us who have the honor
and privilege of, of leading healthcare organizations,
especially those through technology,
have to keep that in mind.
And it's, that's really at the
end of the day, that's why we're here.
- That that's really amazing to hear and think about
and certainly, you know, um, right.
Makes a lot of sense. Now when you look at, um, the future
as well, how do you see Penn State Health growing
and evolving over the next two
to three years from your vantage point,
and especially that fascinating intersection
between technology and clinical care?
Where do you see it all headed?
- Yeah, I, I, it's a great question.
Um, you know, we're in a relatively competitive markets in,
in, in the area here.
Uh, and so, you know, we know that we've, you know,
got the best outcomes for our heart transplants.
We know that our, our, our cardiovascular services
are the highest quality.
We know the cancer services are highest quality.
We think that, you know, that's really
where we need to focus.
Again, it's about the care of the people.
You just have to demonstrate that
and such so that, you know, the quality focus
and, and those activity.
And it goes back to some of the communication
technologies that we use.
It enhances that ability for us to interact here.
I, I think it's, it's working, uh, more fluidly as a system.
Um, when you acquire two, you know, two other health systems
and hospitals and you acquire
and you build new hospitals,
there are cultural differences in between there.
And, and we don't take those for granted.
So the transformation of, you know,
those different locations as part of our system,
it's, it's gone really well.
The service line development, this has been spectacular.
We've got some great leaders inside of those service lines,
but I could see our focus being very much in those, um,
systemness developments.
And that's, again, technologies,
you know, part and parcel of that.
So, you know, uh, consolidating, uh, order sets,
power plans, uh, making documentation more efficient
for everybody involved,
but honor the differences that we have
between our specialties.
You know, I'm an emergency physician,
I'm not an ophthalmologist, I'm not a dermatologist,
I'm not a cardiac surgeon, right?
Each of those specialties
and all the other ones there have
different things that we have to do.
So we have to validate
and provide the tools to allow those folks to be efficient
and effective while keeping standards
across the organization.
So that is a, that is tough, um, uh, doable.
'cause we've done it in a, in a number of different ways.
Uh, but I think it's, again, it's about standards,
efficiency and effectiveness.
At the end of the day, all those docs
and all those nurse practitioners
and physician assistants just
wanna take care of their patients.
Same with our nurses, same with our staff.
And I think if we can align the technologies
and get rid of, you know, other technology, dudu,
duplicity, you know, is a challenge.
Um, variability is a challenge.
Localization is really important.
And the differences between all those
and helping people understand that moving
to a system is really, really a good thing.
- I, I agree. You know,
and having that system,
it seems like it can be such a powerful tool, um, you know,
for all organizations and really boost patients.
And from your perspective, you know, um, I would love
to hear what is one change
or initiative that your team has made over the last year
or two that's yielded some great results?
- Yeah. Um, so we talked a little bit about, you know,
converting to secure texting as a, as a primary platform.
We talked about, you know, eliminating dictation,
talked about, um, you know, deploying
to opening two new hospitals
and converting two other hospitals plus a hundred clinics
all within a couple of years.
That's incredible heavy lifting, right?
And you can't do that without a great team.
And so what we try to do, at least in our informatics team,
uh, is to build a structure by which we can manage
and handle change, do it with efficiency and effectiveness,
but do it across the system.
So we set forth on a structural design for informatics,
that includes a number of informatics councils
that focus in on functions.
And we've, uh, had some, uh, local affinity groups
that values the local.
So we have a west shore
and eastern region, the central region, the northern region.
And each one of those groups have their own contingencies
of, of informatic staffing, uh, all come
to the system, I'll report up through me.
Um, and so we've tried to set ourselves up
for the requesters to be able
to have their questions managed in a timely fashion
and for changes to occur in the system, uh, that are,
if they're, they're great ideas from someone, great,
let's make that a a, a new system standard.
And so, but you have to have the structure in place
and you have to have the decision makers
and empower those decision makers, um,
to, to move that forward.
So we built, if you will,
the informatics governance structure, uh, for the,
for the system that allows us to do that.
Um, I'm lucky enough
to recently have our medical records team start reporting
to me that's a new, um, opportunity and, and, and task.
And so we're looking at how can we make that all happen too,
uh, with that, with that group of people.
Um, again, really great folks
and, you know, living in Hershey
and working in central Pennsylvania
with all the other things, just some,
just people are, people are great here.
I mean, they, they're, they're hard work
and they really wanna do the right thing.
And again, what they care about is, you know,
their family and their patients.
They care about Penn State and they care about their jobs
because they know what they do affects
the patients that we care for.
- I love it. I, I think it's so important to remember
and just to keep front
and center as you were talking about, you know,
the community that is within healthcare
and the healthcare system, um, it, it's really cool to hear
what you're doing at, uh, Penn State Health
and continue to grow and develop
and, um, provide additional services.
So, um, thank you so much, uh, Chris,
for joining us on the podcast today.
I, I really appreciate your conversation.
I think, you know, this is so cool to hear
how things are going and definitely lots
of great insights on where you're headed in the future.
- Yeah. Well thanks. Thanks for you guys
for having lots at Penn State Health.
Just talk a little bit about, you know, the people
that we work with and, uh, the, the people who we care for.
It's, it's so important to, to who we are as a community
and who Penn State Health is as a system.
And, uh, we appreciate.