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This is Chris Soer with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Natalie Pager,
chief Information Officer for Stanford Medicine Children's Health, Dr. Pager,
thank you so much for joining us today.
My pleasure. Thanks for having me.
Dr. Pager,
could you please introduce yourself and tell us a bit about your background?
Yeah, sure. So I'm Natalie Pager. I am a pediatric intensivist, intensivist,
uh, and the Chief Medical Information Officer at Stanford Children's Health.
I also serve as the program director for the Clinical Informatics Fellowship
across Stanford Medicine.
Excellent. Dr. Pager, what do you say are top priorities today?
Gosh, there are so many, but, um,
a couple that come to mind immediately are continuing to try to,
uh, optimize the experience and efficiency for providers and staff, um,
especially using, um, our electronic health record. I think, you know,
during the pandemic, uh, especially, we saw such a rise in,
uh, digital health and in basket messages,
so really struggling to help with some of those provider efficiency issues. Uh,
and then a second major issue as we've gone forward with, uh,
health information sharing across, across the nation, um, uh,
I think there's a lot of really exciting, uh, potential opportunity there.
But here at a, at a pediatric organization, pediatric and episte organization,
we are really working hard to figure out how to do that in the most
effective way for children and adolescents and their families,
which has a few extra complications.
I'm glad you mentioned that actually.
Given your background as a pediatric intensivist,
how has that affected the job you're doing right now?
Yeah, so I, I think, I think there's lots of different,
different ways to go there from a health information sharing. I, I, I do think,
uh, there's a lot. I think we are moving in the right direction as an, as a,
as a nation and really trying to empower our patients and families, um,
and ensure, you know,
especially with complex children that we see in at Stanford Children's, um,
ensure that their families,
that the families have all the information they need to,
to navigate the health system. Uh, and so, you know, as I mentioned,
I really think it's the right thing to do. Um,
and we've had really grateful comments from some of our patients and families
saying how much easier it is now that they can see their notes and, um, and,
and take notes from one provider to another or,
or check back in on what the plan had been when they get a little bit confused.
Um, so again, totally the absolutely right thing to do,
but it is a huge shift in how we approach patient care, um, as a nation.
So the, the, the few things that we are working on, I think, you know,
one in the, especially in the ICU setting, um, it is,
it has been a change to have our patients and families, um, be able to see,
you know, lab results or see, uh,
data maybe sometimes even before we've seen it. Uh, and I think a lot of that,
um, we've handled just through expectation setting and talk and telling them,
you know, when we will talk about this information and, and,
and being aware that they're seeing it and, and addressing, you know,
kind of how, how the information, uh, gets released and, and,
and how we will process it, you know,
during rounds or when they have questions afterwards. I think the,
the other issue that we really see, again at a,
especially at a pediatric organization, are the challenges around adolescents.
Um, we really, we know, uh, again,
for some of our adolescents with complex medical conditions,
having their family fully engaged in their care can be the best way to
ensure that they are getting the right care and moving their health plans
forward. However,
for certain challenging or sensitive topics like reproductive health,
like mental health, like drug and alcohol abuse,
we know that some adolescents won't seek care or won't share information
with their healthcare providers if they are concerned about their guardians
inappropriately getting access to that information.
So we've done a lot of work here at Stanford Children's to really thoughtfully
approach how we share information with adolescents and their families and,
and try to ensure the right information goes to the right person.
Dr. Page,
I understand it can be important to deploy not only technological experts in
implementing technology, but also clinicians.
Could you please expound upon that?
Yes, absolutely. So I, I 100% agree that it's,
it's critical to have clinicians involved in, uh,
in all of our, uh, information systems and informatics, uh, implementations.
And so we have a really advanced clinical informatics program here where we
have, uh, physician informaticists, nurse informaticists, um, uh,
informaticists from, from multiple other specialties,
really working tightly with our information services department to ensure that
we are, uh, that we are thinking through any,
any implementation appropriately. Uh, so, so for example,
we have a, a large range of physician and provider informaticists,
uh, who are trained both in clinical informatics, um,
and their own clinical specialty.
And they can oftentimes really be both a partner to our analyst,
but also sometimes that liaison between our analyst, uh,
technical teams and the operational or clinical teams in the hospitals,
um,
and can really kind of help us that translator to make sure that we are clearly
defining the problem and designing, you know, the best,
the best solutions and thinking about how to optimize the workflows and get
technology to support. Um, you know, similarly, uh, um,
amongst our physician informaticists, we have a large group of, of, um,
of ad adolescent medicine, uh, informaticists.
So these are folks who are really on the front edge, uh,
of thinking through some of these adolescent privacy issues that I was
mentioning early, earlier. So, um, Ash and Shivani,
Jen Carlson, Rachel Goldsteins,
are all experts in both informatics and adolescent medicine at our organization.
And having that perspective from, from both viewpoints,
understanding the clinical needs of our adolescent population and understanding
the technical options and the informatics challenges or, uh,
privacy and information sharing issues has really helped them to partner
with our analytics specialists, with our,
our information service analysts and create novel solutions
that, that truly help us optimally serve that population. Uh,
similarly, I'll say, um, we have a,
we have a clinical informatics fellowship program across Stanford venison. So,
um, for those of you who don't know, uh,
clinical informatics is now a board certified specialty.
And so any clinician who has completed their clinical residency, uh,
training can do a two year fellowship after, um,
after their clinical training is complete, and, uh, get,
get specific, develop specific expertise in clinical informatics.
Uh, and again,
these folks are really serving as the liaisons between our
analytics teams and our, and our clinical and operational specialists, um,
and or bringing their clinical viewpoint and divi and designing, uh,
novel informatics implementations to improve the quality of care patient safety
and patient family and provider experience. So having these, uh,
these energized trainees in our program has been remarkable for moving forward
some really cool innovation.
I can certainly appreciate that you used the word translator.
I think that is something that a lot of people can relate to when it comes to
wrapping their brains around informatics. Uh, Dr Pager,
how do you anticipate your role is gonna change over the next 18 months or so?
Again, another great question. Uh, you know, I don't think it would be, uh, uh,
uh, fair to to say anything right now,
but the next 18 months without at least mentioning large language models like
chat, GPT, definitely, uh, those have come on, on the scene,
um, in a dramatic way. And I,
I think we are at the top of the height, the height cycle right now,
and really trying to understand, um,
what these large language models or generative ai, um,
have the power to do, um, and, and what are the potential, um,
unintended consequences. So, you know, I think, um,
we are lucky here at Stanford Medicine, uh, you know,
on the Stanford campus and,
and part of Silicon Valley to have incredible experts in advanced
data science in AI machine learning. Uh,
and thankfully have really been able to be thoughtful over the last couple years
about how we meaningfully safely translate AI and machine learning, uh,
into the clinical setting. Uh, and I think we are, you know,
doing the same thing with these large language models, uh,
and partnering with our vendor partners as well as our data scientists to think
through, um, what the potential implications may be. Both, you know,
like I said, both positive and, and both, uh,
and potential unintended consequences that we need to make sure we, we prevent.
What do you consider the most exciting part of language models and AI in
general?
You know, I think we've, we've,
we've heard so much and seen so much over the last, you know,
decade or so about provider burden, about clinician burden. Uh,
we know that, you know, as the EHRs, uh,
came onto the scene that it significantly disrupted the way, uh,
clinicians do their work and have, uh, and, and,
and that our providers end and other clinicians spend a, a large amount of time,
uh, interacting with their computers, um, with the, with the EHR and,
and having to do documentation. And so I really think, uh,
we are at a point now where we have so much data that has been translated or
then has been entered into the EHR. It gives us huge, you know,
vast amounts of data to, to capture and to innovate upon. So I think these,
you know, I think, I think data science in,
in general and large language models in particular really, um,
give us both the opportunity to create learning health systems,
learn from our, um,
from the data that is being generated every day in the clinical and operational
setting, and also to hopefully mitigate some of the, the,
the challenges that have been introduced by our electronic health systems and,
uh, and help help capture documentation more quickly,
help providers and other clinicians do their work more efficiently. So, um,
both an opportunity to transcend what was ever,
ever possible before through advancing learning health systems and, and,
you know, hopefully to make our, our, our work more efficient, um,
as we continue to adapt to these system systems.
Lastly, Dr. Pager, I will ask you this question,
understanding that it could be a very, very long list. Uh,
but I do want to know from your perspective,
what in pediatrics deserves a brighter spotlight than it's getting right now?
Oh, great question. Uh, so, you know, I think we are,
we are incredibly lucky that we have an,
we have an amazingly vibrant pediatric community across the nation and across
the world. Um, and, you know,
organizations like the AAP and the Children's Hospital Association are helping,
uh, helping to bring us together to highlight and and advocate for some of the,
um, necessary work that needs to be,
that needs to happen across pediatric execution general,
and especially with pediatric informatics. So, um, you know,
one example of that is how do we meaningfully, uh,
enable information sharing for children, um,
and their guardians and adolescents? And there's,
there's multiple complexities there, uh,
that we really need to continue to work through. And, and again, um,
both our vendor partners and our,
our professional organizations are helping us to, um,
to work through those challenges. And so grateful for that work. I also think,
you know, there's, there, um, there are ongoing, uh,
opportunities for optimizing our health information system to specifically take
care of children. Um, and, uh, you know, for example,
uh, pediatric medication safety, uh, is,
is a really challenging area. Uh,
and pediatric dosing is much more complicated than adult medication dosing
because it changes as the child ages. Um, and because, uh, it,
you know, it can be weight-based or it can be age-based, or it can be, uh,
based on, you know, on body surface area. Uh, and so,
uh, and then,
and then you add to it the complexity of making sure that both the patient and
or the appropriate parent or guardian has, has access to that information, um,
and that it's clear, it just gets really complex really quickly.
And so we've been so grateful to our, our vendor partners, you know, like Epic,
um, in really helping us to,
to focus on how do we optimize some of our base,
baseline, uh,
functionality to really ensure the highest quality and,
and highest level of patient safety in some of these,
these pediatric specific areas.
No doubt there are many people who share that Worthy Go. Doctor Pager,
thank you so much for your time and energy and insights today. No doubt,
our audience will find this very useful and hopefully we can connect again soon.
Sounds great. Thanks so much for having me.