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[00:00:00] Today on Keynote
(Intro) we have people both and outside the area to come to us so that they can see the CPT code, and they can pay for it, and it includes everything from, your procedure to your anesthesia to your lab testing, and it's an all inclusive bundled price, , you don't feel like on a surgical procedure you got nickled and dimed and you weren't sure what the full cost of that was.
My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week.
Now, let's jump right into the episode.
(Main)
It's Keynote. And today we're joined by Chad Brisendine, the CIO at St. Luke's in Bethlehem, Pennsylvania. My old stomping grounds where I grew up Chad, always great to catch up with you.
Always good to see you, Bill.
We were just joking about the morning call. I actually, delivered that newspaper for about seven years.
When [00:01:00] delivering newspapers was a great job, had more money than you knew what to do with when you were in high school if you delivered papers in the morning.
Fast forward how many ever years later, you're doing the newer version of that. The newer version, the
digital, digital version.
I've never left the industry. Just
in IT for a while.
keep getting updates., my two parents at the same time were both in your hospital over there off of Freemansburg Highway. And my dad had a really good view. And so I said hey, dad, while you're there, look out the window, tell me, how it's progressing and how that campus is progressing.
It sounds, from his perspective, it sounds like that's a really awesome campus.
Yeah, we were talking earlier cardiology reports to me and the company, and we're building a 250 million heart hospital at that campus right now. It's a beautiful campus, 500 acres. We have an organic farm there, a huge walking trail and pond, and it's overlooking the river.
It's really a magical sight in our valley and our care there is obviously phenomenal, but the new heart hospital is going to be huge nice addition for our folks with heart [00:02:00] failure and other progressing heart disease, as one of the leading causes of death in the country.
And as baby boomers continue to grow, we're going to need more space, and so we're building that new capability for everyone within our region.
Well, St. Luke's used to be landlocked. It was originally built for the steel workers over on side where all the steel work was being done. But over time, that all got built up around it.
You guys had no land. Now you have plenty to dream about and you're going to do. I know you were doing a lot of things around digital hospital room in the future and those kind of things. What does it look like and where are you experimenting with some of those things?
about 1, 700 beds total.
We have 225 beds where we've been doing virtual nursing, tele sitting, and we're looking at working to expand that and expand our partnership on that. most of our rooms within the organization, as well as look to add on additional features. So we've been working a lot \ Not just on provider productivity, but also on nursing productivity, looking at things like ambient documentation and fall risk [00:03:00] and other things to help, expand the use cases in that area.
I would say we're fortunate. Our vacancy rate for nursing is down to 8 percent now, where, it was in the high. to mid twenties during the pandemic. So we've seen that climb way back down, but still there's, I think a lot of opportunity to offload work from the nursing workforce and make that job more satisfactory.
And we're seeing that through the technology implementation.
Do you have any Greenfield stuff going on where you're building new buildings?
So when I got to St. Luke's, we were four hospitals. Now we're 13 hospitals, and seven of those we've built since 2013.
So we don't have a new one, but we're doing a lot of what I call vertical expansion within those. The Heart Hospital being one our Upper Bucks campus down closer, if you're familiar with Bucks County or Closer to our Philly area, we have a hospital there that, we're continuing to grow.
OB, as an example, we just got finished building an OB unit at our Allentown campus. We just got finished building a whole brand new tower at our Monroe County. So if you're familiar with the Poconos outside of New York [00:04:00] City, we have a hospital there and we're growing vertically at those campuses. And we have a new campus out we actually have a joint venture with Geisinger St.
Luke's that continues to grow out and what we call It's an area out past in Carbondale Carbon County. And then we also have a new hospital in Lee Heighton that just opened in the last three years that we're growing vertically at right now as well.
, that whole Southeast even Northeastern Pennsylvania.
you guys are up into the Poconos and going North in that direction as well. Let's talk about the hospital room of the future a little bit. What does it need to enable? We talked about nurse efficiency, talked about ambient a little bit the use of cameras, I think cameras are starting, I'm hearing that more and more that people are like haven't gone to scale yet on that, but we are definitely, playing we're experimenting with it.
We're seeing what the application of it is. How are you guys utilizing. technology to support the nurse, support the doctor, support workflows that normally happen, as well as deliver that experience for the patient.
We spent a [00:05:00] lot of time on like actually this, cause we've had a number of different technologies in the room over the years through pilots and other things and saying, okay, what's our kind of high level capabilities that we think we need.
Do we need it to have some kind of AI voice recognition or voice scraps? It doesn't have to be built in, but we need to have some kind of capability for voice recognition, voice scraps. So we want that capability in our hospital room in the future. And we're looking at it not as a vendor, but as a package.
Set of capabilities that we might have to have one vendor, hopefully, but we might have to have two or three alongside of AppDate working in parallel. We need to have the ability for some kind of computer vision because we want to be able to do fall detection. So if we want to do documentation and get rid of some of the documentation problems, we'll use the voice recognition.
We'll use the computer vision for things like fall detection, things like monitoring within the room as well. And then not a must have, but one of the nice to haves that we have, and we are actually moving forward with this right now, which is language translation.
So we want language translation built in not to be a standalone thing but to be an integrated service within the [00:06:00] room. We have a big Spanish speaking population within the Valley, and so we need to be able to cater to that population. We have a lot of ethnic groups, but that's our primary one.
And then we've had in the past, if you've seen the dry erase boards in the room in the past we've put in their own dashboards or their own stand alone monitors for that. And on that would be like the nurse's name, the physician's name, maybe the patient satisfaction, high level score, and some of the daily activities that were coming up.
So again, that's not a required feature, but it would be nice to have that integrated because we also have my chart bedside in the room as well that so we want to have patient education in the room. We need the ability for virtual observation and As with some of these patients, some of them being behavioral, some of them being significantly made need restraints and other things, the need for tele sitting has certain requirements that it has, both at the state level that we need to be able to comply with, and some of the video capabilities, although don't seem to be all that sexy, it's things like, oh, can we see it in the middle of the night in the room with no lights on?
How can [00:07:00] we get bidirectional or is it unidirectional? How does the sound and video quality meet in the room? So all these little things matter, especially when we're trying to get, adoption and engagement by our providers. And those things that we need to get, Video 4 are many things, not just, a nurse or a tele sitter, but also our physician consults.
We've seen a lot of physicians consulting into these rooms. We have every specialty consulting now at our campuses that we have that are, reducing windshield time, if you will, helping with transfers. So we've seen a large engagement from our physicians and a lot of that has to do with how easy it is to just click on it, get into the room now versus having to have a separate carton that you will in and, all that.
So having this stuff static in a room is a big piece of making sure that we have, real time video in there. And then it's all the policies and practices around how you do that and how you enable it with the patient and what's that experience feel like. And then we have general clinical engagement, which, you know, if you think of things like just results, where's my orders at today?
What are the, again, upcoming tasks and activity for the [00:08:00] patients? And then there's add on things that you can think about. Which it comes down to a lot of the operating model, right? Some of this comes down to what do you do at the bedside versus what do you do remote?
For example, EICU, that is a huge investment to make, primarily not in the technology. But in the infrastructure for the people related to, how you do call and call coverage for critical care and what that looks like in an EICU model. The technology tends to lean itself a little bit more towards the monitoring capability that you need on that and the video.
And there's obviously a few other major requirements on that, but those are those lean you there. So when you stack all that up, the last thing, and I probably put this as the lower thing, but it's important for the patients, is like we have to have personal entertainment. People in here for a long time.
There's got to be things like Netflix and all that stuff. So when you look at it, there is a ton of requirements. I think over the last, Five, 10 years, there's been a ton of, bolts on technology. Some of these things are newer, more advanced. When you talk about, like, all the new generative AI stuff that you can do with voice and everything.[00:09:00]
As far as newer capabilities, some of the things for three years, maybe three to five years, where it's just more like vision, computer vision is a little bit more stable on some of the use cases that it has. Trying to put all that into a bow so we have a more of an integrated approach, an integrated platform on that.
And a lot of thinking, a lot of strategic thinking, a lot of conversations and dialogue to get there. And, We implemented this in 2019 when we put it all together. We've modified it three times, as far as what the capabilities are that it's needed as things progress, but we've always had this kind of, how do we continue to progress in this hospital room of the future, and I don't think it's going to end, right?
We're still in, If you say we're five years or seven years into that, what's it going to look like in another five to seven years with all the AI capabilities that are going to come out and what else can really be done virtually in the room? I think we're beginning to make a lot of traction in the area of nursing, but it's going to expand beyond that.
I'd love to hear your thinking as health IT leaders, we're leaning more and more on platforms, and we're leaning more and more on capabilities that can be integrated, brought in [00:10:00] to bear, and what you just described is really interesting, because if we rewind to 2018, 2018.
and putting a hospital room of the future together. I imagine if we could just bottle up that meeting and a meeting from last week, they would look very different because the capabilities keep changing and shifting and oh, now we can do this. Now, all of a sudden, ambient is much more of a real possibility and the cameras and how we're looking at that is changing.
Talk to me about how, a technology leader, how you think through, I'm going to use these words you can frown on them, but future proof some of the things that we're trying to do.
Yeah. I wish there was an answer for that. Cause, I would say we're probably in our third. Version of vendor on this and the reason for that, I think it comes down to, and how early do you want to be on the curve?
Do you want to be first to 10? Do you want to be 50? Do you want to work through an innovation cycle on it? Or two a lot of it for us, I think, comes down to the business case and the ROI and what [00:11:00] we see is the momentum behind it and the need.
That tends to decide, determine whether we want to jump out early and unfortunately probably have strategy that's a little bit more agile and realizing that we might. have multi vendor thing that gets consolidated and then regrouped and then gets re refined multiple times. And I think this is an area one that we have decided because of the pain points in the use cases.
Now, again, we didn't put it in every single hospital. It's very expensive to do that. very expensive to then replace it two or three times when you think about it. And so I think on this one, we've been conservative as far as The required functionality that we have to have in the room and then these other things are then things that we'll add in that don't have to be in the platform, would be preferred to be, but don't have to be in the platform.
And that's how we've got around having to constantly, I think, replace it as much as you have. But I struggle with this as a CIO a lot, Bill, because, it's when to get in, when to not get in how much to innovate. A lot of what we learn on these is not the tech, but the operations.
Like, how do we actually get this thing implemented and make it work [00:12:00] in an environment? And how do we get people to champion it and drive change and actually use the technology? And so I tend to lean a little bit more on that when we have momentum on things and try to let the two or three or whatever vendors we're going to work with will work to figure that out.
Just because we have momentum, because as a CIO, you know this. You can grind an axe against something that makes a lot of sense. Strategy looks great on paper. Execution doesn't happen because engagement's low. And, no one within the company wants to drive it because they don't see value or it's not top of their problem list.
And I have, to work on things where we got a lot of momentum and people that want to, push and drop things beyond IT.
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one of the things that's unique about you, and we've talked about this a little bit on the show before, is that you've picked up service lines.
So imaging being one of those, you have radiology and cardiology is actually under your management structure. And curious what you've learned since the last time we talked about, leading that, and then you're also doing. an enterprise imaging solution. You're doing a PAC solution that's an enterprise imaging solution.
I'd love for you to walk us through what you've learned and where imaging solution fits in.
Probably be easier for me to describe what I haven't learned. What I [00:14:00] will learn tomorrow. No, I think I probably expected in, I'll just use cardiology and radiology because I think there's a lot of differences, obviously, but there's a lot of similarities when you look at the ITP capabilities.
But when you look at the business functions, they're obviously much different than there's, different components to each one of them. But I would say probably, less IT issues than I imagined. Came in thinking, okay, this is just going to be a slew of IT dumping, and it actually wasn't that.
It was much more leadership, focused what I would say. And that says everything from operational to strategic to leadership development to helping our The departments be better. I think that's at the end of the day what they've wanted and what I think they enjoy working with a lot on is they want to continue to push These departments and these leaders want to push these departments to be better.
And so for me, it's been easy because I think they've embraced, having more Hey let's try new things. Let's push the envelope and those things could be tech. And those things could be just people in process and career development and [00:15:00] coaching and leadership development and organizational change and structure and just Whatever, as a CIO, you get to see a lot of the things and departments and how things work and projects execution and org design and leadership development and just different things in different departments.
And so you're able to take a lot of those learnings, and bring them in. to those structures. So I think if anything, I've learned how to adjust those things in each one of those areas. But I've learned a lot about cardiovascular medicine. I cannot go do any of the surgeries and you would not want me near one of the rooms.
But, I've watched a lot of the procedures. I've spent time with our CT surgeons and our EP physicians and our non invasive physicians. And so I have a really good understanding, I think, of what their challenges are within the job role. So when we're looking at technology, not just digital tech, but device tech as well, and I'm not a device tech person, expert.
When I'm looking at them, I can determine and help them determine which of those things I really think will help them, improve the quality of the patient care, improve the quality of the experience of the patient [00:16:00] experience or improve their productivity. And we've done some really exciting AI work in both of those departments lining up with them on their needs and potential solution companies out there as well as put together more strategic planning for them on their roadmap for like, where do we need to be at in one, two, three years from now?
How are we going to get there? Some of that, things I think the CIOs Swedish Strong Act, which is strategic planning helping them do more of that planning exercise so that we can, put budget and plans and things together to help, get more things in motion for those departments.
So I know that's a little all over the place, Bill, but I think just bringing what the CIO knows through its in the job role to those departments.
Yeah, and I'm going to come back to enterprise imaging. I talked about you, I talked about the other CIOs. I think you and Chero Goswami are in a race to see who can have more things.
They're over. Chero, last time I was talking to him, he was like he's over busing between the hospitals. I'm like, busing? Explain to me how that happened. And then, and But the imaging one makes [00:17:00] sense to me. You lead people and you lead them effectively.
You just went through that pretty well. Imaging more than any other area within healthcare feels to me like there's an awful lot of technology being applied to it right now. And so having a technical leader for it makes sense from that perspective. And then there's really expensive, big equipment associated with imaging.
And how do you plan for it? And what's the business case? And how do you position that internally? And, a lot of the stuff has AI on it. And a lot of the stuff that's coming out with AI has a huge opportunity. For us, and helping them really make sure that we are on the front of that., we have one of our imaging projects within radiology right now I love it because it's easy.
From a business case development, a lot of the IT projects can be very tough to put a business case together on. You know this from years of working on these things, right? Is it going to save labor? Is it going to increase revenue? Like how much can we tie to soft versus hard?
Extremely difficult on. 80 percent of healthcare IT projects, I think. [00:18:00] In those projects on that side, , 95 percent of them easy to put together from my viewpoint because they have revenue directly associated with them or they have expense associated directly with them. So I find those easier to put together.
Working with them and I like it because it's very easy to tie it together and we have one of the major equipment vendors that we have, I won't speak to it, but we just did a whole roadmap with them with AI capabilities and we're going to increase 30 percent of our appointments across our board.
on one modality across every single one of them. And we have 32 of these one and a half million dollar machines and that are already have a fixed cost in them, right? A fixed capacity, a fixed everything for staffing and everything. And by now making those appointments faster, more efficient, we're creating more slots, we're opening up slots.
Those slots then turn into more patients. We have a backlog of patients already existing in those. So it's perfect for us to be able to put those AI capabilities in there, make that machine faster, open up more slots, and then that creates all kinds of opportunities for us to get them in faster and get them into [00:19:00] services faster.
Really opening up access has been one of the key things that I'm working on because, as healthcare access is a huge issue, and it's a capacity and a constraint issue, and so I like working with them on those kinds of things a lot because I think it has a lot of kind of and we have a really great management engineering organization within St.
Luke's that we partner with on data and information on, and help us think through those things, and that work has been very fun.
why I think as a CIO, it makes sense. I remember talking to Jeff Sturman about access, and he was talking about the importance of the placement of those machines in terms of location as well.
He said sometimes we place them too close together, sometimes they're too far apart, and you can't take, appointments that were going to be here and move them over to here. And there's an awful lot of strategy associated with this. want to talk about enterprise imaging. lot of people are talking about this.
Imaging is one of those areas where we ended up with 55 to 100 different point solutions across the board. And then the PAC systems. And whatnot. [00:20:00] And it's been interesting to watch because a lot of health systems are examining this whole idea of enterprise imaging as they look at digital pathology and other things that they're trying to bring in.
And they're going, all right, we can't just bring in another point solution. is there a common set of points? functions and features that it makes sense to have an enterprise solution. You're heading in that direction. Talk to us about that journey and what you're learning in that process.
think for us has been trying to time the space and it comes back to the conversation we had a little bit, I won't spin on it too much, but the hospital room of the future. It's like, how many times are you willing to change before it has all the capabilities that you need out of platform?
And I think this is an area where you need a platform. you need multiple workflows within that platform for different specialties. And I can't take the credit for this, but I'll give the credit to our now chair of radiology and our associate CMIO. She works on all of our specialty areas in the two of them.
Along with IT, help drive together a platform strategy. Obviously with support from me and our COO [00:21:00] to put in and shift to sector which we're excited about. And we're a little over a year into that. We're getting close to going live both with enterprise imaging, both at the specialty level.
So we worked out a strategic plan. And if you look at all these organizations, like how deep they've gotten into each specialty's imaging workflow, they might be really good at PACS for cardiology and radiology, but where it falls down, I think, is in the specialty imaging areas. And so we did a lot of work in each specialty, ORGI, et cetera, and mapped out their needs.
And then we have a plan that is designed to bring in imaging in each of the specialties. So we'll have every specialty imaging embedded within these workflows. And then we have a plan for we haven't finalized it, but within a year to two we'll have pathology on there as well, so it'll be a full, and what I understand in mapping all this out with Sectra over the last few years is I think they only have a couple of customers that actually fully have it deployed out to every single [00:22:00] specialty across areas, including pathology so there are a few folks as far as the deployment.
There's a lot of people moving to that. I think the real heart of it is getting it into all the specialties, and there's a lot of work to be done between Biomed and the specialties in IT to get that workflow embedded in there.
You're not afraid to get out ahead. I remember I interviewed your team, and we talked about Epic and Azure, and you guys got out ahead of that.
What's the update on that? Is that performing the way you
It's business as usual, Bill, to be honest. We do our upgrades, things happen. We do switch between data centers as part of our cutover of that. So we'll flip back and forth and we'll run out of one and run out of the other between cycles.
So we'll flip to an A B strategy and we have a lot of our DR and do recovery. That's exactly what you want
the answer to be. Yeah.
You want it to be like, Hey, performance is better and no one remembers anything. only thing that we've done I think and I just say thanks to all the other CIOs out there.
I I get way more than I give. And I think in this area, we, especially with my chief architect on the cloud he was able [00:23:00] to do a lot of calls with folks and I'm always glad to have him or I or our CTO get on the phone and share as much as, people have shared with me on sector hospital room of the future and the like, so.
we're getting close to the end of this. I want to revisit the patient experience. I remember early on we talked about price transparency and you guys had implemented a price transparency tool and talk to me about the evolution your patient digital experience and the evolution of that.
I cannot take any credit for price transparency other than helping, but what I would give our CEO a lot of credit for is saying we need to have price transparency. And we created, a, you pay us a cash number less than you would pay. So you could either do that through high deductible or you can do it out of pocket, however you want to do it.
But as we've have millions in the tens of millions of dollars per year of patients that want to have a cash price based on the way that their insurance plans, and we have people both and outside the area to come to us so that they can see the CPT code, and they can pay for it, and it includes everything from, your procedure to your anesthesia to your [00:24:00] lab testing, and it's an all inclusive bundled price, radiology and testing and the whole thing, you don't feel like on a procedure surgical procedure you got nickled and dimed and you weren't sure what the full cost of that was.
lot of credit goes to our revenue cycle team and our COO and others on pulling that whole model together and keeping it simple. We did that obviously. But we've also done a lot with mobile applications and consumer applications. We built in 2016, our own consumer front end and had all that where we had Epic tied into that.
We actually are working to shift that over to Epic. So we're in the process of doing that. I think EPIC's made a lot of progress in the last eight years on MyChart and MyChart capabilities and what all it can do and the level of customization. So I think it played its proof out for a long time.
we built a lot into scheduling and decision trees and all these things that I think that were not in the market at that time, where we could basically, show up A patient that these are, not only is your primary care available at these slots, but here's other people locally that are our physicians that are available at these slots if you wanna book an appointment.
And we were doing [00:25:00] that, early 20 17, 20 18 late 2017, early 2018 on that we had, direct to consumer televisits tied into that. So we had done a lot of work on that. And then fast forward our physician group has done a massive project with it in the last. It's been, we did an 18 month project we finished it up last year, where we went through and redesigned all the call centers and how they function, and we basically did a whole mapping of the jobs within the physician group and said, here's how many people that are in the practice that could really do their job remote.
And what are all the functions of that? And we centralized all that into call center functions. And so we created scheduling and triage groups within that. And we grouped them by multi specialty together. So we have about 20 different pods that we have. We've done all that work and we have Twilio and CRM and whole ton of work around that, but at the same time, and not as sexy we've ripped out about eight different phone platforms and went to Teams.
So internally within the company, we have Teams. We're in our last couple of [00:26:00] hospitals. It's been about a three and a half year journey, so literally, no other telephony platforms other than that. Other than Twilio, and we use Twilio for large call centers, front facing, consumer because we can do a lot of development, custom development, and custom workflows with texting and all that stuff.
And then we use Teams as your lighter version call center. So if you need a small internal call center for internal calls, but you still want to volumes, you can do that. And then just for peer to peer calling and for collaboration and everything, we use that as well. We've removed, I think, About 40, 000 phones over the last four years.
So a huge, access call center and telephony transition for our organization. So anyway, I think that's probably more than you wanted to know, but
awesome. Hey, how long have you been there?
I'm at 16 years as the CIO at St. Luke's.
Wow. So I'm going to close with this question and I'm going to take it in two directions.
So it's a two part question, which is how do you stay energized and motivated around the healthcare [00:27:00] technology space? And then how do you keep your team energized and motivated to do this kind of work? I
mean, we're always doing exciting projects. think what I've probably learned in my career is making sure that I'm continue to give them more of the big work.
And continue to push that down so that's allowed me to both grow as a leader, but allow them to grow as a leader. So as I've been able to take on these other functions, how do I have them run an ERP project? And I'm literally just go to the meetings, maybe provide some counseling, which they don't even appreciate, but how do I let those do the transformations?
They have the skills. They have the capabilities. How do I become more of the mentor and the coach and the guider? And less in the weeds on some of those things, but still make sure that project execution delivery is high on those things, but give up more control.
And so I think up more control in the CIO job to people that you trust within your team to do more has rewarded me, I think, and rewarded them well.
Man, that's awesome. Chad, I want to thank you. I want to thank you for taking the time. I know that this is a busy time for you, especially in the Christmas city [00:28:00] to take some time before Christmas.
Really appreciate it.
Happy holidays, Bill. Thank you so much.
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