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the description. We are excited to welcome you in October.
This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr. Sh Aja,
director of ambulatory E m r and portals at Stanford Medicine Children's Health.
Dr. Aja is a pleasure to have you on the podcast today.
Thanks for having me. I'm, I'm very, um, excited to be here.
Excellent. Well, I know we've got a lot to talk about and, you know,
it's definitely, um, such an important, interesting time in healthcare today,
and especially thinking about children's health and,
and the real needs for pediatric healthcare in this country.
But before we dive into my questions,
can you tell me a little bit more about yourself and your background?
Sure. Um, again, my name is John and I am, uh,
director over ambulatory and portal at the Stanford Stanford Medicine Children's
Health. And, um, I oversee, um,
all our ambulatory clinics, workflows, special primary care,
and, uh, patient portals,
as well as some health information exchange across the organization.
And, uh, from a background perspective, I, um, I've been with Stanford, uh,
children's for the past, um, eight years in this current role. Um,
from a background perspective, I'm a physician.
My background a foreign graduate, originally from Turkey. And, uh,
I'm working in the healthcare IT industry.
That's fantastic to hear,
and I'm excited that you'll be able to bring this very unique perspective to our
conversation because I think, you know, you, I can imagine, see a lot in our,
a very important connector within the organization from the E M R and portals
through the h I e and all of that. So, you know, given your role in,
in everything that you oversee,
what are some of the opportunities that you really are,
are looking forward to at Stanford Medicine Children's and, uh,
the headwinds that you have your eye on as well?
Sure. Um,
so I think we are in a unique time and space in healthcare, in, in this country,
especially post pandemic. There is a lot of, um,
focus on digital patient experience and also digital healthcare worker and
provider experience.
So some of the things that we're working on is to how to make the patient
experience more streamlined and flawless while using digital tools.
Um, especially as an organization who's in Silicon Valley,
that is a very big priority for us because, um,
a lot of our patient population is very used to use digital tools in,
in different things as well as our, um, workforce. So, um,
some of the things that are in our focus right now is that, um,
definitely digital from a digital patient experience perspective, the use of,
um,
some language processing tools to be able to help patients to
navigate better, especially in the portals, uh, use. Um,
I oversee the portals team and, uh, we are trying to integrate some, um,
auto response and chat bot to our portals patients experience at the moment.
Uh, one other thing that our team is, um,
currently focused on is to improve some, uh,
workflows from patient, um, perspective. Like for, for example, in the past,
patients would fill questionnaires on papers when they come to the clinic and
someone would like manually enter them, but right now we are trying to get that,
um, in a more digital workflow format. So, um, it,
it creates a better patient experience and better clinical, um,
patient reported outcome. Um,
one other aspect is that especially with the changing, uh,
environment in healthcare,
lot of organizations are now moving into eConsults or virtual visit workflows,
and we are following the same, um, especially around, um, getting,
uh, virtual visits and eConsults on, uh, electronically, uh,
is one of our top priorities.
We are trying to roll out more electronic referrals. Um, the, it's,
it's a very challenging for a physician office to send referrals in different
ways to different places. Some of them are on paper, you know,
they're being faxed or some of them are via phone and and such.
But we're trying to utilize the seamless EMR integrated, uh,
referral workflow so our team can resi receive the referrals with
fully populated patient information on the EMR and can, um,
schedule patients with ease and, and more efficiently. Um,
some of our other focus,
because we are unique in Stanford Children's from a teen and uh,
adults from care perspective is the teen and adult confidentiality.
We also oversee ob ob gyn patients. So, um, for adult confidentiality,
some wounds care issues is also, um,
on our focus with the current developments in the, in the country. Um,
so my team is constantly working on how we can make the information shared
across, uh, you know, between the patients and the caregivers appropriately,
while we are also adhering to their confidentiality needs. Um,
and also lastly, I would say, uh, we have a lot of focus on health equity, uh,
from a social determinants of health, uh, perspective. Mike team also oversees,
uh, the infrastructure and workflows for our team band,
which is an essentially a fully equipped clinic that is on RV and goes
to, uh, underserved areas, uh, to help support, um,
teen health in, in schools. So a lot of,
lot of things exciting things are going on, and we're trying to, um,
make sure that we evaluate new technology to make a difference for our patients
and our, uh, healthcare, uh, workers.
That's amazing to hear. And you know,
that focus on making sure you've got the digital tools available and information
that's shareable and easy for, like, as you said,
the healthcare workers as well as the patients and their families, and,
and improving that access to care I know is so, so critical, um,
and really makes an impact on the patients you're serving. Now, you know,
when you look at what's happening in healthcare today, are there any, uh,
challenges or roadblocks as you, you know, are,
are trying to deliver some of this great patient experience and additional, um,
digital tools and technology and data? You know,
what kind of challenges do you run up against?
I would say probably, uh, one of the biggest challenges is, uh,
very complex regulations around patient data sharing that we're, um,
we're, um, experiencing, you know, cures act,
which we fully support empowers patients to have their own data at, at,
at their own, um, hands, uh, in a very, very timely manner. But then with that,
there is also keen confidentiality in a very complex relationship between teens
and guarantors and proxies and who can see what, um, so we are discovering,
um, that is one of the major challenges in,
in our work to both empowering people with their own data on, uh,
on the right time, but also adhering to confidentiality. And, um,
our organization is actually leading in that space, our, uh,
clinical teams and rci and we've had a lot of, um,
work going on and published, um, articles and, and, uh,
research on this about like how important it is to keep the teams empowered. Um,
so I would say that conflict between the,
some of the rules and regulations are making our, our lives harder.
Um,
the other challenge that I would point out is that technology is growing really
fast and, uh, moving, you know, at a fast speed, and it's,
it's a challenge to keep up with all the new tools that are available and to be
able to effectively choose from a large inventory of tools that does pretty
much similar things, but have different potentials for the future.
That is another challenge. And I think the whole, like virtual,
um, the whole like virtualization of workspaces and, uh,
mobility of both the patients and providers are adding to another, uh,
layer of challenge for us.
In the past when everything was handled in a closed circuit health system,
we had more control over infrastructure, for example, you know,
which devices are used and which are, um, uh, which are, uh,
utilized in a more efficient way. And, uh, but, but now with,
with everything being like more mobile and virtual,
we are in a position where we have,
like our providers and patients are connecting from different locations,
from different, uh, infrastructures and different devices,
and the solutions that we roll out should be uniformly applicable to
all of these, um, use cases. Um,
and that's one of the big challenges I think like with the,
the whole digital health domain that we do not have to not only
make the, the tools and um, solutions available in our o own infrastructure,
we should also think about the infrastructure of the person off the other end
and where they're connecting with what, which is I think is a huge challenge.
Yeah, absolutely. I can imagine, you know, with just so many, um,
different options available in, in devices and technology. So that's a really,
really great point. Now, I,
I know that right now as we've talked through a little bit, you know,
healthcare is obviously evolving and changing and, um, you know,
growing all the time.
So how do you think about growth from your perspective within the organization
and then adding value to Stanford Medicine Children's on, on a consistent basis?
Sure. Um, so like you mentioned, I think the overall healthcare is in,
in its transformation itself. And as an organization,
we are also constantly growing within the past eight to 10 years.
We went from like about a hundred thousand visits to, um, over 600, 700,
close to 700,000 visits now. So, um,
it's always a challenge to keep up with expanding patient population,
expanding geography,
and also expanding services because we also continue to add, uh,
new specialty services and very unique services for, um,
specialty care, um, in our, in our organization. Um,
there's also a growth from an increased demand perspective from patients. And,
um, they do want their needs to be addressed digitally,
especially after pandemic.
I think a lot of things converted to a ver being virtual,
and there's definitely an expectation both from our patients and from our
workforce, um, to, um,
keep things virtual and make it more efficient at the same time. So, um,
that is something that we're also taking into account from a growth perspective.
It, I, I already mentioned this, but I I think it's worth to call it out again.
Um, the new rules and regulations are also, um,
growing the need for being really mindful and, uh,
about the confidentiality. Um, so for example,
some of the new tools that we're rolling out,
if we don't think about from a confidential to lens, uh, they,
they really easily can, um,
compromise some of the confidentiality team confidentiality.
So that is also one part of the, uh,
work we're taking into account while we're growing. And, uh,
lastly I would say there is a huge, um,
transformation around the ai and every, every morning I wake up to news,
like, check this and that, or AI is used in medicine in, in,
in, in a different way than before. So, um,
I think those are also the tools that we're trying to tap into and utilize
to help with our growing patient population, growing geography,
and growing digital needs.
Absolutely. I think that's a great point. And you know,
we're definitely throwing in, um,
a lot of the new technologies with artificial intelligence, you know,
is is constantly, um, offending the field and, and you know,
coming out with new capabilities,
which I'm sure in healthcare is in some ways is, you know, very helpful,
but in other ways it can certainly be a challenge to just make sure,
as you were talking about, rules and regulations are followed, um, in and, uh,
on all fronts. So, um, that, that's so interesting to hear. Now, I know, um,
right now healthcare resources especially are scarce and valuable,
whether it's time or energy from healthcare providers and workers or,
um, financial resources. So from your perspective,
what do you see as being some of the most important,
either risks or investments that, um,
healthcare organizations should take to especially make sure that, um, you know,
they're, they're meeting their goals, whether it's on a clinical side or,
or some of the other operational things that they're trying to do?
Sure. Um, I think one of the big focus areas should be, uh,
focusing on patient experience, experience overall because, uh,
now we are in a different ecosystem,
especially with the rise of digital tools and also, um,
digital literacy from a patient's perspective. Um, and, um,
you know, one of, one of those,
one of the most important things is to be able to utilize the tools
in a seamless way.
So actually the patient experience feels seamless from the patient
perspective, which, which starts with like a digital front door and then,
you know, allowing patients to be able to self-schedule, um,
and then even like looking at their results and everything else online and
having, having interactions with the, with their, uh, physicians or providers,
uh, online as well. Um,
I would also say probably another investment or focus that should happen in this
year and in the coming years is the whole digital transformation concept. Uh,
many organizations are already, uh, in, in that transformation process.
And from a digital transformation, I think we should also,
we should consider that it's not only moving things to digital because we are
already there. I mean that's what the IS departments are it departments are for,
but also looking at how we can transform the way we work, um,
where we put our resources and how do we utilize our resources
most effectively. One of the things that we're observing is, um, how we can, um,
transform the work that is done in a repetitive fashion and automatize it
while we are using our resources to do a deeper work and,
and enhance the system further. Um,
so probably patient experience and digital transformation is the top, um,
priorities for us and, um,
I think they're worth to make more investments than looking, um,
more into.
Absolutely. I love that. And I think that's such a great point in,
in making sure the patient experience is seamless and easy and that digital
transformation is possible. And I know it's easier said than done. So, you know,
from your perspective, um,
what's kind of the most important thing to keep in mind,
especially for organizations that might be early on in their digital
transformation journey, you know,
to really build in that patient experience from the, um, early side of the,
the digital transformation versus trying to add it in after, you know,
you've got your platform set and those kinds of things.
Sure. I would say like in our, uh, first assessments, what we found is that, um,
workflow standardization is the key because unless the workflows are
standardized, that, uh,
the whole transformation to a digital experience is not really gonna work. And,
uh,
we are learning it from other healthcare systems going through a similar journey
and we're also observing it internally. Um, one, one example,
for example, we're trying to roll out like more and more virtual, um,
patients have scheduling tools and, and virtual tools,
but if it's not standardized, um,
it becomes a very challenging task and the end users
and the patients do not, um,
like the experience that they're going through and it becomes also a maintenance
nightmare.
So I would say probably the workflow standardization is one of the key
thing. And also looking at from a patient journey perspective,
for example, if you are rolling out something electronically,
there should be a consensus across the organization to stop doing it in other
ways. Because I'll give a very simple example. For example,
if you are rolling out your questionnaires electronically to a patient,
if I'm a patient and if I fill that questionnaire electronically at home on my
mobile device and then I go to the clinic,
if I'm being giving the same questionnaire in the clinic on paper to fill it,
again, that is a horrible patient experience for me as a patient.
So I think just to make sure that we are,
while we're designing these digital workflows,
we're also looking at their counterparts on,
on paper or manual counterparts and ensure that we don't end up
doing duplicate work for ourselves or having patients to,
um, do duplicate work for us.
So I think that is one of the key points that we're discovering and trying to,
um, build workflows to accommodate that.
That's great insight and definitely makes a lot of sense. Uh,
thank you so much for sharing that. Now, before we wrap up our discussion,
I wanted to ask you, taking a another look, um, through the future,
where do you see some of the best opportunities for you and,
and your teams to grow and develop?
Um, I think from a growth and future of healthcare, um,
the rise of AI is something that is already here and it's gonna
be, I mean, every day I'm seeing like some, you know,
exciting news about the AI and that sounds scary news about AI and how it's
kind of gonna be out of control and whatnot. But to me,
I do see this as a new tool to add to our inventory and I think it
can have like huge implications to help us with documentation,
which can be very heavy from time to time, patient engagement, you know,
image interpretation, predictive analytics,
like basically anything that we can um, integrate into successfully,
we should look into it.
And I think just to understand the benefits and limitations of this new
tool and how it can help us, um,
both from a patient perspective and our workforce perspective is gonna be very
important in the future. Um,
I would say the other one which we already talked about partially is the whole
like patient journey and medical life cycle from a patient's perspective.
I think with the new tools that we're integrating more workflows into each
other, uh, we're going from a fragmented patient experience to a full patient,
um, journey, patient experience cycle, um,
starting with wellness and going into an acute care,
I think those are the areas, um,
that we will have the most opportunities and growth in the future and make it,
um, make it better for our patients and their families. Um,
data sharing is another one, and with that, um,
comes not only data sharing to healthcare of the patients,
but also data sharing with the patient to empower them more, um,
which is I something that is also, um, we need to consider. Um,
and then I already mentioned that innovative technology to support model for
both patients and workforce we're in a different world after the pandemic.
And I think that, um,
two or three years helped us to understand like some of the work can be done
anywhere in the world, um,
and that is something we need to take into account and consider while we're, um,
building our strategies for the future.
What a great point. And Dr. Agen,
thank you so much for joining us on the podcast today.
This has been a really fun and an interesting discussion and I look forward to
connecting with you again soon.
Thank.