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The 229 Podcast: Journey From First Ever EMR and Enabling Proactive Care with Deborah Muro

Bill Russell: [00:00:00] Today on the 2 29 podcast.

Deb Muro: healthcare, we're very reactive, we don't know what's going to happen tomorrow generally. And so my goal is for us to move into a predictive model of care where we know exactly what's happening

Bill Russell: My name is Bill Russell. I'm a former health system, CIO, and creator of this Week Health, where our mission is to transform healthcare one connection at a time. Welcome to the 2 29 Podcast where we continue the conversations happening at our events with the leaders who are shaping healthcare.

Let's jump into today's conversation.

All right it's the 2 29 podcast, and today we're joined by Deb Muro, El Camino Health. Deb, how's it going?

Deb Muro: It's going great. Great to talk with you today, bill.

Bill Russell: I'm looking forward to it. I assume you have the D in your title. You're the CIDO?

Deb Muro: I am the CIO, but I'm also leading innovation and digital strategy, so it's like have to have, whether you have

Bill Russell: the [00:01:00] initial or not, you get to do it.

Deb Muro: You do.

Bill Russell: you know, you have an interesting background and I'd like to start here. You started as as a nurse at the bedside before moving into healthcare IT leadership. I'm curious how that shapes your role as CIO, like when you walk into a room with clinicians now as the CIO, how does that nursing foundation either assist or change the conversation that you have?

Deb Muro: it was interesting when I moved into my role the organization had been interacting on a more technical level with the, you know, previous leadership. And so as I moved into my role, I found that I was able to approach conversations with empathy, understanding that the workflow that nurses and physicians are trying to accomplish the challenge that they have,

the fact that technology doesn't meet the needs of the clinician and how can I help? And so I love to have my ear to the ground. I love, I round often, especially to the emergency [00:02:00] department, and I see how nurses and physicians are interacting. I see what patients are dealing with in the care that we provide for them, and it really grounds me in the work that I do.

And I, and the background helps me really understand. Next step solutions. Nurses are trained to see data very quickly and come up with a solution. And so that's served me well in my current role.

Bill Russell: So, to give people a little bit of background, so El Camino is literally in the shadow of Cupertino and the big spaceship that happens to have landed out there.

And Google's down the street as well and whatnot. So it's not a slam dunk that they hire a nurse for their CIO mean. It's a very technology focused area that you live in.

Deb Muro: It is however, you know, you build a great team, obviously, and so we have technicians and leaders that are experts in all aspects of the technology that we provide.

And so it, it's not just my role, it's the team and we come together and deliver. Well, [00:03:00] you know, you mentioned the area that we're in Silicon Valley, and you can imagine the patients and the patient expectations are very unique. And we also deliver the most babies in the Bay Area. We deliver the Google babies.

And so as we're thinking about technology it's great to have those types of patients that can help us. Stretch us and make us do things that you might not be thinking about otherwise.

Bill Russell: Do they stretch you in the area of the patient experience or user experience? Do they expect more digital tools?

Obviously everybody wants high quality. When you go into a health system, I mean, where do they push you the most?

Deb Muro: the expectation because they are providing technology to consumers. I think they really want us to be retail oriented in the way that we do our work. And we're not in healthcare.

We have so much opportunity to really move the dial, if you will, for using all the technology that's out there. The example I love to use is online scheduling, when you think about the [00:04:00] industry, is about 18% at best of consumers using online scheduling for appointments. The retail industry would never accept that.

If you think about airline industry, if you would think of 18% of all consumers, you know, booking their airline through online, and then the rest of the time they call center, that's what we're dealing with here is how do we move the dial and really catch healthcare up to where retail is? And our patients are expecting that in this area because of their background in high tech.

Bill Russell: Yeah. And you know, the pushback I would give people on that is essentially that healthcare is not one business. It's a hundred businesses within a campus. And yeah, the part that's retail, we can do online scheduling without breaking a sweat. The stuff that's not retail, it's a little bit more complicated.

Deb Muro: What we like to do is remove all the friction on the front end. So we brought in some scheduling technology that sits on top of our electronic health record and it [00:05:00] presents to the, well, first of all, it acquires the consumer wherever they are. You know, if they're on a LLM, if they're on a Google search page, it acquires them and brings them in to our website or to our scheduling product, and it gives them options.

So today, at this moment, your issue is back pain. Here are some options for you. We have an urgent care visit this afternoon that you could schedule. We have a virtual visit you could schedule right now over lunch. Nice. Or you could see a primary care physician next week. So it gives the consumer some choices that they can choose based on their preferences.

We then do some questioning of insurance, but we do a lot of that on the backend. We let them get the appointment scheduled. We'll work through any of the challenges with the, you know, insurance and other questions that we have, and then we'll call them and do some concierge help if we need to help direct them to a new place.

Bill Russell: Do you have a standard mobile experience or did you go all in with Epics, MyChart and [00:06:00] just build around that?

Deb Muro: Currently we are all in with MyChart. We do have a digital front door app that we've toyed with over the last several years, and we're just embarking on selecting a patient experience platform that will bring in MyChart, we'll bring in other applications and really create journeys for the patient and be very robust.

So we are excited about that. That's one of our big projects for this next year is to really deliver on patient experience and retail is constantly bringing you into their products, their ecosystem. We wanna do that in healthcare as well, is engage the consumer often to meet their needs of what they have.

You know, is it wellness that they wanna learn more on? Is it a condition that they are trying to deal with? We're gonna meet them, we're gonna personalize the experience, and we're going to guide them. Through their care journey.

Bill Russell: That's awesome. You know, we are gonna talk about AI and automation somewhat, but I wanna talk about your journey.

So it's you've been at El Camino since what, 2014? Yes. [00:07:00] So you come in, you lead the the Epic implementation and move the organization in that direction. But you've been there a decade. And one of the things that I think is interesting for a leader, especially one that's brought in to do a specific project or a turnaround, is you almost have to, after that project's over like reinvent yourself and like, okay, what are we gonna focus on now?

Talk about that transition into. Focusing on other areas you do that big project and then, how did you sort of define where the organization was gonna go from there? Who did you pull in and what were the conversations like?

Deb Muro: You know, the experience at El Camino was so unique. I had actually executed Epic at, I don't know, 50 plus hospitals in my career. And so I came to El Camino with all of my model that I had utilized in know really best practices and. But when I came to El Camino, I found that we were the first organization in the country to, to implement an EMR back in 1971.

We started with Lockheed Martin [00:08:00] and we developed this platform. We kept it in our ecosystem for many years. It evolved and it actually became Allscripts at the end of the day. And so I came and I replaced Allscripts and we're doing a video right now about that history because the engineer that worked on that project is still alive and he's one of our patients.

And so we're really recreating that history. But when I arrived, that was our first focus. We had just you know, we were developing and building a new data center. We were implementing a new EMR, so we kind of set the table for two big areas, but when I moved into the CIO role, I found that we had a lot of opportunities with the 300 plus other applications that were in the environment, really making sure that we were following lifecycle management, that they were where they needed to be.

And so we replaced our ERP system. We brought in an ITSM system. I mean, we have been working on. Many projects over the last few years, and in fact, my technology leader said, you know, I feel like we're finally caught up and now we can focus on the really exciting, innovative [00:09:00] areas. So we've been spending years doing some, you know, things that we needed to do for lifecycle management.

Cybersecurity obviously came into that era where we had to do some things immediately, and now we're at a place where we're innovating and transforming while we're growing as an organization.

Bill Russell: Did you say 1971? The first EHR.

Deb Muro: Yeah.

Bill Russell: I'm trying to think what that was running on. I mean, that predates me in the industry, so I'm not

Deb Muro: Right.

Well, you know, in 1969, Lockheed Martin approached us and they were wanting to diversify out of the defense contractor business and they thought healthcare would be a good idea. And so they approached us and actually they had developed the light pen technology as part of, you know, some of their product.

And so the technology was a medical information system using the light pen for doctors to select orders off of the screen. I wasn't here then, obviously, but what I was told was when we did transfer over to using a mouse from the light pen, doctors were trying to put the mouse on the screen [00:10:00] to select.

So, you know, really just a, an unusual, wonderful project. And as I mentioned we're just finishing a video right now telling that story. It's quite a story to tell. It could be made into a movie, I think. Very interesting.

Bill Russell: you're in the right place for that. Somebody will probably buy the rights and we'll be watching on the big screen

Deb Muro: and we could have used AI for that, right?

So, yeah.

Bill Russell: let's talk about ai. The thing I love about the things I've heard you talk about is it's very practical and you guys at El Camino have a very pragmatic approach. To AI and we were talking earlier just about just all the different things that you are u utilizing it on.

And I think people are, every time we talk about AI in these 2 29 meetings we, people talk about governance and we're gonna put this together and all this other stuff. And it's so refreshing when someone like you goes, oh yeah, we're using it here, we're using it here, we're using it here, we're using it here.

I'd love for you to talk about some of those things that you guys are doing some of the practical applications you currently have stood up?

Deb Muro: Yeah. [00:11:00] Ab absolutely. So, you know, our approach and our, I would say AI strategy is kind of multi-tiered. So first of all, we're gonna use AI to the fullest, which is embedded in our current.

Ecosystem in our current system. So Epic, we are now implementing probably 30 use cases of AI right at the moment. We've started using Deterioration Index several years ago to reduce patient untoward events such as code blues. It has, we've seen a decrease in that. We use it for fall risks. So the.

It alerts the nurse when a patient is you know, getting off of the bed so that we can prevent falls, which is one of our safety and quality goals. When we think about, you know, other platforms in our ecosystem, we implemented AI in a system that provides employee sentiment to the manager. So it alerts the manager of which employees they should be focusing on.

This employee worked overtime this week, this employee. Has a birthday today. This [00:12:00] employee did significant overtime or worked the evening shift. And so we're using AI and not only, you know, clinical applications, but also business applications. Another use case is our radiology department is using ai to show the radiologist.

which are the priorities that they should read, which X-ray or image should they read first? Because it has a higher severity. It also creates the impression for them in a matter of seconds, and then it provides incidental findings. Things that, that would not have been seen by the human eye.

For that x-ray for the purpose of that x-ray. So chest x-ray may be looking for one condition. The AI will show another condition, like an occluded vessel, a nodule, and then we're able to treat patients for that. So it's been exciting to see. How we've been able to utilize that. We're using ambient listening for physicians to reduce burnout, and we're also using the augmented response technology, which is basically the in basket [00:13:00] response back to the patient.

So really we are using all of the technology that's embedded in our current applications. The next layer is then, you know, using generative AI or chat GPT to answer questions on our own internal area of ai. So we are using it, you know, as you typically do to prompt and to get answers from information.

Out in, the world, but it's our area our area of the data. We don't let that data go back into the cloud. Our next level that we're embarking on now is to create a data fabric and then be able to, put AI on top of the EMR, put AI on top of all of our data so that we can answer our very unique, specific questions that are within El Camino.

So we're using that on many levels. And I'll tell you, there's so much interest in AI throughout our organization. All levels are very interested in how AI can help us. [00:14:00] And one other opportunity for us is genic ai using that in areas like call center. So. Lot going on right at the moment.

Bill Russell: Man, I don't even know where to go. You gave me so many things. I the incidental finding things to me is fascinating. One of the things about imaging is it's probably the purest data that we have. I mean, an image is an image. And 10 years from now, AI will be able to look at it's good quality data, which is what we want.

How far back will you go? So obviously you'll do it moving forward. Every image that's taken, you'll have the incidental findings. Will you actually go back like a year or so and start looking at older images?

Deb Muro: Yeah, it does. It brings in priors as appropriate. So for the radiologist that's their workflow is to look at the current image and then they bring in priors to do some comparative there.

We'll do that as well. And we are doing that as well with our ai and I, we just met with and looked at our data this week and , there's an 80% adoption rate from our radiologist for this product, which that's amazing. I know. And they're seeing the [00:15:00] value.

Bill Russell: Well be between this and ambient listening.

What's your adoption rate on ambient listening? Is it I would assume it's pretty good.

Deb Muro: It is. We're over the 60% rate for a good number of our physicians. And we are just, we're implementing, we implemented, you know, under just under a hundred physicians and we have some that are highly engaged in adopting, and we have others that we're working with, but, you know, we're in the middle of implementation, so it takes some time.

I, I would say the hardest part of. Of the job of a CIO and I would, a technology leader is not only to turn on the technology, but you have to making sure that there's adoption of it and that you're removing the roadblocks, you're removing, you're understanding what the pain points are. That's real, the real work that we do.

Bill Russell: It is the hardest thing that we do. It's the it's the change management, it's the it's the application of the technology. I'm curious, as you roll out AI. And you know, we talked about, everybody likes to talk about governance, but one of the things they like to talk about is oversight of these AI models.

Like, so it's constantly [00:16:00] validating. Are they still getting the same results? Not so much in the ones that are deterministic, but the ones that are more generative that tend to make mistakes I assume at El Camino you guys have some sort of model to validate the use of these tools as you move forward.

Deb Muro: We do, we have a full AI governance process, and then we have an AI steering committee that is made up of you know, many different C-suite players and other individuals. And so we look at first of all the risk and the value of the ai. That group approves that, and then we are monitoring the use of it.

And then there are some new tools out to help you discover where AI is being used in your environment and also the risk. Profile of the ai. So we're interested in a product like that, that will help us even learn and, you know, develop more of our capabilities within that area.

Bill Russell: I want to take advantage of the fact that you have the nurse background.

N nurses have been called the forgotten people of the health it world. Like we [00:17:00] tend to focus on physicians and then we'll even focus on patients sometimes before we Right focus on nurses. What are some of the things that you have been able to do with the team at El Camino? To come alongside nurses and maybe advance how technology's being used.

Deb Muro: First of all, we're a magnet designated hospital. We've been probably one of the first hospitals in the country that became Magnet received that designation. And so there's a whole shared governance model within Magnet where nurses. Are engaged in the decision making related to technology. And we've got some great leaders here at El Camino in nursing that are helping make that happen.

And they really push us to, you know, they're looking at the reports of our EMR vendor and saying, how is nursing utilizing the EMR and how can we improve it? And so we partner together really well. They're also excited now about our project to give nurses smartphones and to have nurses start using ambient listening as well.

In addition to the physician, having the nurse being able to benefit from [00:18:00] voice to text and not having to document, and my goal is that becomes the divisive choice for nurses versus those computer on wheels that wheel around. Just think about how groundbreaking it would be to be able to have that smartphone as your divisive choice.

You are talking and the documentation is occurring as you're talking. So really some exciting things that we're really helping nursing with right now to improve their workflow.

Bill Russell: I've had people push back on me on the ambient and nursing. They said, you know, it's so different from a physician workflow that it would be really hard.

They think it's gonna be really hard to get high adoption rates on nursing ambient listening technology. I'm curious 'cause everybody's pushing in this direction. I assume there's some breakthroughs.

Deb Muro: It is hard work and you know, you think about documentation going from spoken word into a flow sheet.

I mean, that is much different than a note generated by a physician. So I will claim that it is going to be hard work. The vendors, I've been [00:19:00] watching the market watching it very carefully. There are a few of the ambient vendors that have. Really seen success as they're implementing Amand and we are watching the market right now and we'll move to either stay on our current vendor or we'll move to a vendor that's doing both physician and nursing.

But it is a challenge and out of the gate you have to do it well. You can't have a product that's going to make nursing have more time, you know, dedicated to that has to improve their time and their efficiency. But it is gonna be hard work. I will claim that quite upfront. So,

Bill Russell: Yeah, I was, so looking at your calendar for the next let's call it 12 to 18 months what's the technology, or probably a better word, is capability that you're most excited about implementing?

Deb Muro: There's this concept of intelligent health and being predictive in healthcare, we're very reactive. We wait till a patient walks into our ED and then we treat them and you know, we don't know what's going to happen tomorrow generally. And so my goal is for us to move into a predictive [00:20:00] model of care where we know exactly what's happening for our care providers.

so we're looking at. A couple of things. First of all, having sensor technology throughout our organization that's with the vital signs coming in. We talked about deterioration index, that's predictive of the patient experience. I'd like, you know, with our analytics and informing data fabric and being able to put chat on top of it.

, We should be able to predict tomorrow what type of patients will be coming to our, ed, ed based on seasonality, what supplies they need. Things. So looking for a world where it's predictive where it, the patient experience is forefront. We're implementing a patient experience platform, as I mentioned, so, and using AI to its fullest and then inserting agents.

I think one of the challenges for CIOs is going to be how do I integrate humans and agents together and make that workflow work? And so we're gonna try that out in our call center. Then move hopefully [00:21:00] to other use cases that will help increase efficiency such as RevCycle, some other areas.

Bill Russell: Do you find that the conversations around technology and AI and ambient listening and computer vision and all the things that are coming to, is it easier 'cause you're in Silicon Valley?

Are the nurses and doctors more receptive or do you feel like it's the same across the board.

Deb Muro: I think there is this openness to the newest technology. So I'm excited about that. And as I implemented Epic here, the doctors were so used to order entry. It was very, it wasn't the challenge that I had experienced in other areas or other parts of the country.

But I think our challenge is that we have so much technology that people bring in such great ideas. We have to really think through priorities. We have to think through what's the right thing for our organization. I mean, we have startups. We have a Fogarty Institute here that's always involved with research.

We have doctors that are doing innovative procedures and wanting new [00:22:00] technology. So our challenge isn't that people are, you know, not adopting our challenges, that we have so many ideas that we have to really think through those and use it governance and partnering with our operations to decide what's the right priorities for the organization.

Bill Russell: So if you were talking to a smaller health system potentially without the innovation focus and the Silicon Valley focus. You talked about a two. A two layer implementation. It sounds like, I mean, you are focused first and foremost on your partners are bringing AI to you.

Like you don't have to wake up in the morning and go out shopping for it. It's showing up at your doorstep. That's probably where most CIOs should starch, isn't it?

Deb Muro: Yeah. Again, yeah, looking at the landscape, I love to see what's out there and I'm constantly the great part of Silicon Valley is that there's so many opportunities for CIOs to get together and it's cross industries.

So I was just at an event this week where CIOs from all different industries we're together and we all have the same problems. [00:23:00] We all are dealing with same challenges and we're all talking about ai, and so it's great. As I'm interacting with individuals from cross industry I really learned about how they're dealing with the opportunities.

But then, you know, the area itself, we have so many joint venture opportunities. We have so many opportunities with investment capital groups. It's exciting time, but it was really important that you focus on what's the pain point that we have and what's the technology that's gonna help us with that pain point.

And I always like to link that back to our strategic vision and plan so that the work we're doing is enabling the organization to be successful.

Bill Russell: Everything is resource constrained at some point. I mean, the opportunities are limitless. I joke with the only person probably who has more people knocking on their door than you is effer over at Stanford?

'cause Right. You know, it's just some, somebody who's just walking across campus goes, Hey I've got this thing. It's gonna change healthcare. And it's fun to be in that environment to hear what people are [00:24:00] thinking and how they're thinking about things. But at the end of the day, you have, I mean, you're doing 30 use cases.

For Epic and I think they introduced like 150 every year because like you're, they do.

Deb Muro: It's just, it's mind boggling. It's hard for us to stay on top of it all. And we have to, you know, obviously make sure that we're doing everything else that we need to do with growing our organization, but it's so important.

I find that if I don't optimize the core platforms that we have, I will have someone asking for new technology that duplicates what's already in our core platforms. And so I really do spend time making sure that we've enabled that so that we're not duplicating technology because you know that increases your exposure risks for cyber and other things when you're duplicating, especially if PHI is involved.

Bill Russell: Were you at UGM this year?

Deb Muro: I was.

Bill Russell: Cosmos and the, what they showed in that I mean, what were your thoughts on that? I'll just open-ended. What were your thoughts?

Deb Muro: [00:25:00] Well, I love the fact that thinking about in the future, we're not gonna have to write all these reports.

You know, like I, I have a cadre of report writers and they write reports. And when we went live with Epic 10 years ago, or you know, a little bit longer than that, we wrote. A thousand reports that were never used. I

Bill Russell: know.

Deb Muro: Like such a waste of time, and so I'm excited about people being able to ask a question and get the answer.

That they need and not having to go find a report, not having to ask someone to write a report for them. I think that's gonna be transformational. Of course, we're gonna have to make sure the data's accurate. We're gonna have to go through a lot of you know, making sure the data definitions, data governance, all that's going to be really important and role based.

You know, you don't want someone going in and asking a question. They didn't have the right to that data, like a salary. Can you imagine someone going in and saying. Gimme the salary information for a certain role. So we're gonna have to be very oriented to security and then, and really making sure that the data is valid.

It's been, you know, confirmed [00:26:00] and it's accurate. And we have some training to do with individuals, with literacy on data and ai.

Bill Russell: That, that, that was one of my learning experiences. When I came in as A-C-I-O-I was pretty green and the report writing team came to me and said, Hey, we need four more people.

And the first year I was like, okay, here's your four people. Then the second year they came and said, Hey, we need four more people. I was like, what? What? What's going on? And they're like, oh, well, the number of report requests I've gone up and said, as you dig into that, you're like. Hey, are we using all these reports?

And the answer is no. Not even close.

Deb Muro: You know, it's funny when you implement new technology, people try to think about the old technology and they try to build all of that into the new technology. And so. You do a lot of wasted work there. And so my mantra is go live with the new system as designed, and then over time, learn where the gaps are and what you need to do versus building all of these reports up front that you'll never use because the system can take care of that in a different way than you before.

Bill Russell: Deb, I want to thank you for your time. I wanna thank you for your participation in our events. I always love being in the [00:27:00] room and hearing you interact with your peers, and share what's what's going on. I don't know when the next time we're gonna be in the same room. Is it could be a while.

Deb Muro: Oh, I hope not. I hope that, you know, I have loved 2 29. It has been one of those opportunities to. I always love to go to events, and I give information. I'm able to, you know, be part of the conversation and participate, but also get so much back. And your organization has, first of all. This job is a hard job and it's a lonely job.

And so, you know, you were in the job, you know that. And so creating that networking where we feel like we're with peers, we're, we can share our thoughts, we can really get a reaffirmation of what we're doing and we're on the right path. 'cause this is a hard job. Often you're moving cheese daily for folks and you know, it is really great to be together.

And so thank you for your leadership of. Helping us do that.

Bill Russell: I appreciate it. Look forward to I don't know, maybe I'll come out to the Palo Alto. I couldn't be farther away from Palo Alto if I [00:28:00] tried, but it would definitely be worth the flight, I'm sure.

Deb Muro: Well, we would love to have you and it would be, you know, it's fun.

There's a lot going on in our area here and so love to have you come, be great.

Bill Russell: Thanks for listening to the 2 29 podcast. The best conversations don't end when the event does. They continue here with our community of healthcare leaders. Join us by subscribing at this week health.com/subscribe.

If you have a conversation, that's too good not to share. Reach out. Also, check out our events on the 2 29 project.com website. Share this episode with a peer. It's how we grow our network, increase our collective knowledge and transform healthcare together. Thanks for listening. That's all for now.