1 00:00:03,705 --> 00:00:06,965 It is so important for leaders at the top of organizations to keep learning, 2 00:00:07,115 --> 00:00:07,875 stay sharp, 3 00:00:07,875 --> 00:00:11,685 grow their networks to help our audience better do this in a more simplified, 4 00:00:11,685 --> 00:00:16,125 personalized, and meaningful way. Becker's Healthcare has launched my BHC, 5 00:00:16,595 --> 00:00:19,925 it's your trusted Becker's healthcare experience and more with content, 6 00:00:19,955 --> 00:00:22,125 connections, events, and learning opportunities. 7 00:00:22,875 --> 00:00:27,805 Join the community free of charge@www.my dot becker's hospital 8 00:00:27,805 --> 00:00:29,685 review.com, and we'll see you there. 9 00:00:33,235 --> 00:00:35,485 This is Chris Soer with the Becker's Healthcare Podcast. 10 00:00:36,305 --> 00:00:38,365 I'm thrilled today to be joined by Natalie Pager, 11 00:00:38,575 --> 00:00:42,445 chief Information Officer for Stanford Medicine Children's Health, Dr. Pager, 12 00:00:42,445 --> 00:00:43,765 thank you so much for joining us today. 13 00:00:45,795 --> 00:00:47,015 My pleasure. Thanks for having me. 14 00:00:48,555 --> 00:00:49,175 Dr. Pager, 15 00:00:49,175 --> 00:00:51,655 could you please introduce yourself and tell us a bit about your background? 16 00:00:52,695 --> 00:00:57,385 Yeah, sure. So I'm Natalie Pager. I am a pediatric intensivist, intensivist, 17 00:00:57,965 --> 00:01:01,225 uh, and the Chief Medical Information Officer at Stanford Children's Health. 18 00:01:01,745 --> 00:01:05,065 I also serve as the program director for the Clinical Informatics Fellowship 19 00:01:05,065 --> 00:01:06,065 across Stanford Medicine. 20 00:01:09,235 --> 00:01:11,875 Excellent. Dr. Pager, what do you say are top priorities today? 21 00:01:14,085 --> 00:01:15,855 Gosh, there are so many, but, um, 22 00:01:16,015 --> 00:01:20,415 a couple that come to mind immediately are continuing to try to, 23 00:01:20,995 --> 00:01:25,895 uh, optimize the experience and efficiency for providers and staff, um, 24 00:01:25,895 --> 00:01:29,415 especially using, um, our electronic health record. I think, you know, 25 00:01:29,415 --> 00:01:33,975 during the pandemic, uh, especially, we saw such a rise in, 26 00:01:34,515 --> 00:01:37,575 uh, digital health and in basket messages, 27 00:01:37,595 --> 00:01:42,215 so really struggling to help with some of those provider efficiency issues. Uh, 28 00:01:42,215 --> 00:01:46,055 and then a second major issue as we've gone forward with, uh, 29 00:01:46,055 --> 00:01:50,535 health information sharing across, across the nation, um, uh, 30 00:01:50,695 --> 00:01:54,495 I think there's a lot of really exciting, uh, potential opportunity there. 31 00:01:54,555 --> 00:01:59,295 But here at a, at a pediatric organization, pediatric and episte organization, 32 00:01:59,435 --> 00:02:04,175 we are really working hard to figure out how to do that in the most 33 00:02:04,175 --> 00:02:07,695 effective way for children and adolescents and their families, 34 00:02:07,695 --> 00:02:09,335 which has a few extra complications. 35 00:02:10,965 --> 00:02:12,105 I'm glad you mentioned that actually. 36 00:02:12,105 --> 00:02:15,265 Given your background as a pediatric intensivist, 37 00:02:15,525 --> 00:02:17,465 how has that affected the job you're doing right now? 38 00:02:18,525 --> 00:02:20,695 Yeah, so I, I think, I think there's lots of different, 39 00:02:20,695 --> 00:02:24,975 different ways to go there from a health information sharing. I, I, I do think, 40 00:02:25,195 --> 00:02:30,055 uh, there's a lot. I think we are moving in the right direction as an, as a, 41 00:02:30,055 --> 00:02:34,615 as a nation and really trying to empower our patients and families, um, 42 00:02:34,675 --> 00:02:35,895 and ensure, you know, 43 00:02:35,895 --> 00:02:40,135 especially with complex children that we see in at Stanford Children's, um, 44 00:02:40,595 --> 00:02:41,815 ensure that their families, 45 00:02:42,005 --> 00:02:44,375 that the families have all the information they need to, 46 00:02:44,475 --> 00:02:49,015 to navigate the health system. Uh, and so, you know, as I mentioned, 47 00:02:49,055 --> 00:02:51,615 I really think it's the right thing to do. Um, 48 00:02:52,595 --> 00:02:57,295 and we've had really grateful comments from some of our patients and families 49 00:02:57,295 --> 00:03:01,765 saying how much easier it is now that they can see their notes and, um, and, 50 00:03:01,825 --> 00:03:04,005 and take notes from one provider to another or, 51 00:03:04,345 --> 00:03:08,005 or check back in on what the plan had been when they get a little bit confused. 52 00:03:08,545 --> 00:03:11,565 Um, so again, totally the absolutely right thing to do, 53 00:03:11,985 --> 00:03:16,885 but it is a huge shift in how we approach patient care, um, as a nation. 54 00:03:17,305 --> 00:03:21,085 So the, the, the few things that we are working on, I think, you know, 55 00:03:21,265 --> 00:03:25,045 one in the, especially in the ICU setting, um, it is, 56 00:03:25,145 --> 00:03:29,645 it has been a change to have our patients and families, um, be able to see, 57 00:03:29,905 --> 00:03:31,885 you know, lab results or see, uh, 58 00:03:31,885 --> 00:03:36,485 data maybe sometimes even before we've seen it. Uh, and I think a lot of that, 59 00:03:36,625 --> 00:03:40,085 um, we've handled just through expectation setting and talk and telling them, 60 00:03:40,105 --> 00:03:43,165 you know, when we will talk about this information and, and, 61 00:03:43,305 --> 00:03:46,205 and being aware that they're seeing it and, and addressing, you know, 62 00:03:46,205 --> 00:03:50,165 kind of how, how the information, uh, gets released and, and, 63 00:03:50,625 --> 00:03:52,285 and how we will process it, you know, 64 00:03:52,285 --> 00:03:56,085 during rounds or when they have questions afterwards. I think the, 65 00:03:56,105 --> 00:03:58,765 the other issue that we really see, again at a, 66 00:03:58,765 --> 00:04:02,485 especially at a pediatric organization, are the challenges around adolescents. 67 00:04:02,945 --> 00:04:05,965 Um, we really, we know, uh, again, 68 00:04:05,965 --> 00:04:08,885 for some of our adolescents with complex medical conditions, 69 00:04:08,885 --> 00:04:13,765 having their family fully engaged in their care can be the best way to 70 00:04:14,105 --> 00:04:17,725 ensure that they are getting the right care and moving their health plans 71 00:04:17,725 --> 00:04:18,845 forward. However, 72 00:04:19,065 --> 00:04:23,845 for certain challenging or sensitive topics like reproductive health, 73 00:04:24,115 --> 00:04:26,925 like mental health, like drug and alcohol abuse, 74 00:04:27,385 --> 00:04:32,245 we know that some adolescents won't seek care or won't share information 75 00:04:32,245 --> 00:04:36,245 with their healthcare providers if they are concerned about their guardians 76 00:04:36,245 --> 00:04:38,445 inappropriately getting access to that information. 77 00:04:38,825 --> 00:04:43,085 So we've done a lot of work here at Stanford Children's to really thoughtfully 78 00:04:43,565 --> 00:04:46,485 approach how we share information with adolescents and their families and, 79 00:04:46,625 --> 00:04:51,005 and try to ensure the right information goes to the right person. 80 00:04:52,425 --> 00:04:53,125 Dr. Page, 81 00:04:53,125 --> 00:04:58,125 I understand it can be important to deploy not only technological experts in 82 00:04:58,245 --> 00:05:00,605 implementing technology, but also clinicians. 83 00:05:01,955 --> 00:05:03,305 Could you please expound upon that? 84 00:05:04,715 --> 00:05:07,855 Yes, absolutely. So I, I 100% agree that it's, 85 00:05:07,855 --> 00:05:12,055 it's critical to have clinicians involved in, uh, 86 00:05:12,475 --> 00:05:17,335 in all of our, uh, information systems and informatics, uh, implementations. 87 00:05:17,435 --> 00:05:22,255 And so we have a really advanced clinical informatics program here where we 88 00:05:22,255 --> 00:05:27,015 have, uh, physician informaticists, nurse informaticists, um, uh, 89 00:05:27,155 --> 00:05:30,375 informaticists from, from multiple other specialties, 90 00:05:30,635 --> 00:05:35,055 really working tightly with our information services department to ensure that 91 00:05:35,055 --> 00:05:37,455 we are, uh, that we are thinking through any, 92 00:05:37,955 --> 00:05:42,575 any implementation appropriately. Uh, so, so for example, 93 00:05:42,675 --> 00:05:47,495 we have a, a large range of physician and provider informaticists, 94 00:05:48,035 --> 00:05:51,735 uh, who are trained both in clinical informatics, um, 95 00:05:52,075 --> 00:05:53,695 and their own clinical specialty. 96 00:05:54,115 --> 00:05:58,005 And they can oftentimes really be both a partner to our analyst, 97 00:05:58,105 --> 00:06:01,765 but also sometimes that liaison between our analyst, uh, 98 00:06:01,835 --> 00:06:06,685 technical teams and the operational or clinical teams in the hospitals, 99 00:06:06,905 --> 00:06:07,125 um, 100 00:06:07,125 --> 00:06:10,205 and can really kind of help us that translator to make sure that we are clearly 101 00:06:10,405 --> 00:06:13,325 defining the problem and designing, you know, the best, 102 00:06:13,585 --> 00:06:18,325 the best solutions and thinking about how to optimize the workflows and get 103 00:06:18,325 --> 00:06:22,525 technology to support. Um, you know, similarly, uh, um, 104 00:06:22,875 --> 00:06:27,245 amongst our physician informaticists, we have a large group of, of, um, 105 00:06:27,865 --> 00:06:30,725 of ad adolescent medicine, uh, informaticists. 106 00:06:30,745 --> 00:06:34,125 So these are folks who are really on the front edge, uh, 107 00:06:34,425 --> 00:06:38,045 of thinking through some of these adolescent privacy issues that I was 108 00:06:38,045 --> 00:06:42,965 mentioning early, earlier. So, um, Ash and Shivani, 109 00:06:43,065 --> 00:06:44,845 Jen Carlson, Rachel Goldsteins, 110 00:06:44,845 --> 00:06:48,445 are all experts in both informatics and adolescent medicine at our organization. 111 00:06:48,745 --> 00:06:52,965 And having that perspective from, from both viewpoints, 112 00:06:53,045 --> 00:06:57,925 understanding the clinical needs of our adolescent population and understanding 113 00:06:57,945 --> 00:07:01,445 the technical options and the informatics challenges or, uh, 114 00:07:01,445 --> 00:07:06,405 privacy and information sharing issues has really helped them to partner 115 00:07:06,515 --> 00:07:09,405 with our analytics specialists, with our, 116 00:07:10,105 --> 00:07:15,085 our information service analysts and create novel solutions 117 00:07:15,115 --> 00:07:20,045 that, that truly help us optimally serve that population. Uh, 118 00:07:20,115 --> 00:07:22,645 similarly, I'll say, um, we have a, 119 00:07:22,645 --> 00:07:26,605 we have a clinical informatics fellowship program across Stanford venison. So, 120 00:07:27,025 --> 00:07:29,645 um, for those of you who don't know, uh, 121 00:07:30,165 --> 00:07:32,365 clinical informatics is now a board certified specialty. 122 00:07:32,425 --> 00:07:36,885 And so any clinician who has completed their clinical residency, uh, 123 00:07:37,165 --> 00:07:40,245 training can do a two year fellowship after, um, 124 00:07:40,245 --> 00:07:44,045 after their clinical training is complete, and, uh, get, 125 00:07:44,625 --> 00:07:49,245 get specific, develop specific expertise in clinical informatics. 126 00:07:49,505 --> 00:07:50,338 Uh, and again, 127 00:07:50,415 --> 00:07:55,245 these folks are really serving as the liaisons between our 128 00:07:55,245 --> 00:07:59,085 analytics teams and our, and our clinical and operational specialists, um, 129 00:07:59,345 --> 00:08:03,045 and or bringing their clinical viewpoint and divi and designing, uh, 130 00:08:03,045 --> 00:08:07,805 novel informatics implementations to improve the quality of care patient safety 131 00:08:08,305 --> 00:08:11,845 and patient family and provider experience. So having these, uh, 132 00:08:11,845 --> 00:08:16,085 these energized trainees in our program has been remarkable for moving forward 133 00:08:16,155 --> 00:08:17,445 some really cool innovation. 134 00:08:19,085 --> 00:08:21,885 I can certainly appreciate that you used the word translator. 135 00:08:22,045 --> 00:08:25,565 I think that is something that a lot of people can relate to when it comes to 136 00:08:26,365 --> 00:08:29,445 wrapping their brains around informatics. Uh, Dr Pager, 137 00:08:29,505 --> 00:08:32,925 how do you anticipate your role is gonna change over the next 18 months or so? 138 00:08:35,625 --> 00:08:39,655 Again, another great question. Uh, you know, I don't think it would be, uh, uh, 139 00:08:40,755 --> 00:08:42,855 uh, fair to to say anything right now, 140 00:08:42,855 --> 00:08:46,495 but the next 18 months without at least mentioning large language models like 141 00:08:46,495 --> 00:08:51,415 chat, GPT, definitely, uh, those have come on, on the scene, 142 00:08:51,675 --> 00:08:54,975 um, in a dramatic way. And I, 143 00:08:55,045 --> 00:08:57,685 I think we are at the top of the height, the height cycle right now, 144 00:08:57,705 --> 00:09:00,125 and really trying to understand, um, 145 00:09:00,275 --> 00:09:03,645 what these large language models or generative ai, um, 146 00:09:04,155 --> 00:09:08,285 have the power to do, um, and, and what are the potential, um, 147 00:09:08,855 --> 00:09:11,565 unintended consequences. So, you know, I think, um, 148 00:09:11,985 --> 00:09:15,685 we are lucky here at Stanford Medicine, uh, you know, 149 00:09:15,685 --> 00:09:17,245 on the Stanford campus and, 150 00:09:17,425 --> 00:09:22,165 and part of Silicon Valley to have incredible experts in advanced 151 00:09:22,165 --> 00:09:25,165 data science in AI machine learning. Uh, 152 00:09:25,345 --> 00:09:29,845 and thankfully have really been able to be thoughtful over the last couple years 153 00:09:29,975 --> 00:09:34,885 about how we meaningfully safely translate AI and machine learning, uh, 154 00:09:34,955 --> 00:09:37,445 into the clinical setting. Uh, and I think we are, you know, 155 00:09:37,445 --> 00:09:41,165 doing the same thing with these large language models, uh, 156 00:09:41,545 --> 00:09:45,725 and partnering with our vendor partners as well as our data scientists to think 157 00:09:45,725 --> 00:09:49,005 through, um, what the potential implications may be. Both, you know, 158 00:09:49,035 --> 00:09:52,005 like I said, both positive and, and both, uh, 159 00:09:52,185 --> 00:09:56,845 and potential unintended consequences that we need to make sure we, we prevent. 160 00:09:58,965 --> 00:10:02,655 What do you consider the most exciting part of language models and AI in 161 00:10:02,655 --> 00:10:03,488 general? 162 00:10:04,505 --> 00:10:05,605 You know, I think we've, we've, 163 00:10:05,605 --> 00:10:08,325 we've heard so much and seen so much over the last, you know, 164 00:10:08,325 --> 00:10:13,125 decade or so about provider burden, about clinician burden. Uh, 165 00:10:13,225 --> 00:10:16,405 we know that, you know, as the EHRs, uh, 166 00:10:16,405 --> 00:10:20,245 came onto the scene that it significantly disrupted the way, uh, 167 00:10:20,255 --> 00:10:24,285 clinicians do their work and have, uh, and, and, 168 00:10:24,465 --> 00:10:28,245 and that our providers end and other clinicians spend a, a large amount of time, 169 00:10:28,785 --> 00:10:32,845 uh, interacting with their computers, um, with the, with the EHR and, 170 00:10:32,905 --> 00:10:36,565 and having to do documentation. And so I really think, uh, 171 00:10:37,225 --> 00:10:42,025 we are at a point now where we have so much data that has been translated or 172 00:10:42,025 --> 00:10:45,105 then has been entered into the EHR. It gives us huge, you know, 173 00:10:45,135 --> 00:10:49,945 vast amounts of data to, to capture and to innovate upon. So I think these, 174 00:10:49,965 --> 00:10:52,585 you know, I think, I think data science in, 175 00:10:52,765 --> 00:10:56,785 in general and large language models in particular really, um, 176 00:10:57,535 --> 00:11:01,345 give us both the opportunity to create learning health systems, 177 00:11:01,675 --> 00:11:03,505 learn from our, um, 178 00:11:04,015 --> 00:11:07,545 from the data that is being generated every day in the clinical and operational 179 00:11:07,545 --> 00:11:11,665 setting, and also to hopefully mitigate some of the, the, 180 00:11:11,765 --> 00:11:15,385 the challenges that have been introduced by our electronic health systems and, 181 00:11:15,725 --> 00:11:19,225 uh, and help help capture documentation more quickly, 182 00:11:19,295 --> 00:11:23,705 help providers and other clinicians do their work more efficiently. So, um, 183 00:11:23,975 --> 00:11:26,345 both an opportunity to transcend what was ever, 184 00:11:27,095 --> 00:11:31,945 ever possible before through advancing learning health systems and, and, 185 00:11:32,205 --> 00:11:36,825 you know, hopefully to make our, our, our work more efficient, um, 186 00:11:37,125 --> 00:11:39,505 as we continue to adapt to these system systems. 187 00:11:41,935 --> 00:11:45,035 Lastly, Dr. Pager, I will ask you this question, 188 00:11:45,195 --> 00:11:48,435 understanding that it could be a very, very long list. Uh, 189 00:11:48,435 --> 00:11:50,275 but I do want to know from your perspective, 190 00:11:50,345 --> 00:11:53,765 what in pediatrics deserves a brighter spotlight than it's getting right now? 191 00:11:56,415 --> 00:12:00,555 Oh, great question. Uh, so, you know, I think we are, 192 00:12:00,655 --> 00:12:02,315 we are incredibly lucky that we have an, 193 00:12:02,695 --> 00:12:06,875 we have an amazingly vibrant pediatric community across the nation and across 194 00:12:06,875 --> 00:12:08,435 the world. Um, and, you know, 195 00:12:08,435 --> 00:12:13,155 organizations like the AAP and the Children's Hospital Association are helping, 196 00:12:13,495 --> 00:12:18,235 uh, helping to bring us together to highlight and and advocate for some of the, 197 00:12:18,335 --> 00:12:20,075 um, necessary work that needs to be, 198 00:12:20,075 --> 00:12:22,275 that needs to happen across pediatric execution general, 199 00:12:22,415 --> 00:12:25,875 and especially with pediatric informatics. So, um, you know, 200 00:12:26,015 --> 00:12:29,875 one example of that is how do we meaningfully, uh, 201 00:12:29,895 --> 00:12:33,315 enable information sharing for children, um, 202 00:12:33,415 --> 00:12:35,875 and their guardians and adolescents? And there's, 203 00:12:35,875 --> 00:12:38,035 there's multiple complexities there, uh, 204 00:12:38,035 --> 00:12:41,035 that we really need to continue to work through. And, and again, um, 205 00:12:41,035 --> 00:12:43,155 both our vendor partners and our, 206 00:12:43,495 --> 00:12:46,755 our professional organizations are helping us to, um, 207 00:12:47,135 --> 00:12:51,235 to work through those challenges. And so grateful for that work. I also think, 208 00:12:51,235 --> 00:12:55,315 you know, there's, there, um, there are ongoing, uh, 209 00:12:55,865 --> 00:12:59,435 opportunities for optimizing our health information system to specifically take 210 00:12:59,435 --> 00:13:04,315 care of children. Um, and, uh, you know, for example, 211 00:13:04,695 --> 00:13:07,875 uh, pediatric medication safety, uh, is, 212 00:13:08,055 --> 00:13:11,155 is a really challenging area. Uh, 213 00:13:11,175 --> 00:13:15,715 and pediatric dosing is much more complicated than adult medication dosing 214 00:13:15,715 --> 00:13:20,675 because it changes as the child ages. Um, and because, uh, it, 215 00:13:20,695 --> 00:13:23,995 you know, it can be weight-based or it can be age-based, or it can be, uh, 216 00:13:24,125 --> 00:13:28,395 based on, you know, on body surface area. Uh, and so, 217 00:13:29,095 --> 00:13:29,955 uh, and then, 218 00:13:30,015 --> 00:13:34,435 and then you add to it the complexity of making sure that both the patient and 219 00:13:34,535 --> 00:13:39,435 or the appropriate parent or guardian has, has access to that information, um, 220 00:13:39,435 --> 00:13:42,675 and that it's clear, it just gets really complex really quickly. 221 00:13:43,015 --> 00:13:47,195 And so we've been so grateful to our, our vendor partners, you know, like Epic, 222 00:13:47,695 --> 00:13:49,515 um, in really helping us to, 223 00:13:49,695 --> 00:13:54,115 to focus on how do we optimize some of our base, 224 00:13:54,955 --> 00:13:55,788 baseline, uh, 225 00:13:55,875 --> 00:14:00,715 functionality to really ensure the highest quality and, 226 00:14:00,815 --> 00:14:03,195 and highest level of patient safety in some of these, 227 00:14:03,365 --> 00:14:05,275 these pediatric specific areas. 228 00:14:08,045 --> 00:14:10,785 No doubt there are many people who share that Worthy Go. Doctor Pager, 229 00:14:11,115 --> 00:14:15,825 thank you so much for your time and energy and insights today. No doubt, 230 00:14:15,825 --> 00:14:19,385 our audience will find this very useful and hopefully we can connect again soon. 231 00:14:20,715 --> 00:14:22,455 Sounds great. Thanks so much for having me.