Episode Transcript
[00:00:01] Speaker A: You're listening to the Doc Lounge podcast. This is a place for candid conversations with the healthcare industry's top physicians, executives, and thought leaders.
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[00:00:19] Speaker B: I want to welcome everybody to the Doc Lounge podcast, where we dive into the intersection of healthcare and today, technology. I'm your host, Stacey Doyle, and in today's episode, we are honored to have Doctor Craig Joseph, author of designing for Health the Human Centered Approach, and chief medical officer at Nordic, a leading healthcare consulting firm with over 25 years of experience in healthcare and technology. Doctor Joseph brings a wealth of knowledge and insights into our discussion today. From his early days as a primary care pediatrician to his pivotal roles at EpiC and now Nordic, Doctor Joseph has been at the forefront of transforming healthcare through innovative design and technology solutions. Today, we'll explore the impact of human centered design on healthcare delivery, the challenges and opportunities in health it, and how clinicians and healthcare organizations can navigate this rapidly evolving landscape. So without further ado, let's welcome doctor Craig Josephs to the Doc Lounge podcast. Welcome.
[00:01:26] Speaker C: Thank you. Hearing that introduction, I'm excited to meet this person. Who is this person?
[00:01:34] Speaker B: We're excited to have you on here today. So really, really excited for this discussion. I think it will resonate a lot with both physicians that are using a lot of these health it systems every day and then also healthcare system executives that are listening as well.
I'd love to kick off and just tell us a little bit more about your background in medicine. I know you started out the primary care pediatrician and then you became really an accomplished physician in information.
Tell us more.
[00:02:07] Speaker C: Sure.
First of all, my undergraduate degree was computer science, which was a little weird back in the late eighties, early nineties.
I was a nerd before it was cool to be a nerd. Went to medical school having no intention of doing anything with technology.
Initially wanted to become an emergency medicine physician and then I spent some time in the emergency room and decided that was not for me and figured that kids and I have, we share the height, we share the same senses of humor. And I fell in love with taking care of kids. So became a pediatrician and did, as you said, primary care peds in small office setting for about nine years before making the switch to becoming from a practicing physician to becoming working for a big electronic health record vendor, as you mentioned, epic. And that was fun. That was a big change. Moved the family from Detroit to Madison, Midwest to Midwest, but big change and learned a lot. Learned a tremendous amount. This was right at the beginning of right before meaningful use came about. And so most hospitals and physician offices were still on paper at the time. When I practiced, I was on paper. And so helping move folks from a paper to a big electronic health record was fun and interesting. And since then, I was at epic for about seven years, and since then, I've worked on the provider side and in consulting. So been the chief medical information officer for a few hospitals and been at nordic for almost four years now.
[00:03:49] Speaker B: Wow. Well, that's impressive. What kind of gave you that motivation or impetus to say, I'm going to switch from practicing and go on more onto the business side of things?
[00:04:01] Speaker C: Yeah, it was just a combination of maybe a little bit of burnout. I think I had some burnout before. Again, I was nerdy before it was cool to be nerdy. I might have been a little burned out before it was cool to be burned out.
Just a lot of. There was a lot of pressure in running a small doctor's office, and those are a dying breed. It's difficult. When I graduated from residency, that's what everyone did. You opened up your own office, or you joined someone else that you knew who was just opening up an office and you ran it. And a lot of complications from running your own small business. And I think I was just looking for a change. I certainly wanted to continue to leverage all of the clinical knowledge that I had and experience that I had, but I thought it might be interesting to see what could I do from a technological standpoint. I was a programmer in high school, and in college I got my computer science degree. And so what could I do to combine those things? And naturally kind of led to electronic health records. So it was a marriage made in heaven, at least for me.
[00:05:10] Speaker B: That's amazing. I mean, it sounds. Yeah, your background, it sounds like the perfect blend, and I'd love to hear more. Really, how do you see technology transforming the healthcare industry, specifically when you're thinking about how we can improve patients outcomes and overall experiences?
[00:05:31] Speaker C: Sure. Well, electronic health workers have been around for a long time. That's not the only technology, of course, that physicians and clinicians and patients engage with, but it's the big one, and it's the tool that most of us spend much of our time in. Certainly started off with a bang in the mid two thousands when meaningful use came about. And the federal government decided that every hospital and doctor's office should be collecting information electronically and exchanging information and gave a lot of monetary incentives to do so. So we went very quickly, and that was the good news. We all got, virtually overnight, went from paper to computer. The bad news is that we didn't exactly know what we were doing. We were building that plane as we were flying it and did the best that we could. I think some folks have been very critical of the EHR vendors and the hospitals and healthcare systems that implemented those EHRs. I think that some of that is valid.
The design usability of some of these systems has been suboptimal for sure. But I think we're moving along and getting in the right direction. So we're seeing consolidation. There's a lot fewer electronic health record vendors around, but we're also seeing disintermediation, and that's just happening with new technology. So we're seeing the ability for smaller players to kind of come in and say, hey, we do this particular aspect of care. We do medication reconciliation.
We summarize the chart for physicians who are about to go see a patient in the clinic, and we do it better than the EHR, the big players in the EHR world. And so those are kind of slowly creeping in. And so there seems to be, I think it's a pretty exciting time in healthcare technology, both for patients who have transparency that they really never had before.
Most of our notes are now available through a patient portal, so we can actually see what the doctors are writing about us, which is either scary or amazing, or both at the same time. I'm a patient. I read all the notes that my doctors write about me. Being a physician is helpful because I get to, I can kind of translate a little bit better, I think, than the average person. But that information certainly was not available to me ten or 15 years ago. And so there's lots of opportunities for both on the physician side and on the patient side, and everyone in between, quite frankly, including the payers, to exchange information and to really kind of move knowledge along. And that's the goal.
[00:08:22] Speaker B: I'm sure you've heard of stories of when hospitals or healthcare payers, they're implementing these new, larger health it solutions or maybe changing from one system to another.
What are some of challenges that you've heard, and how would you recommend, with all your experience, to kind of go about overcoming some of those?
[00:08:45] Speaker C: Yeah, those are huge projects, huge transformations, and we typically see the same problems repeat themselves. So, you know, problem number one is I want it to work just like that other thing work. And so maybe that's paper, so I want it to replicate the paper processes, or I want it to work just like that, that electronic health record system or that technology that we're getting rid of, which really, if you look back on it, makes no sense at all. And so, you know, that's problem number one. Hey, make it work that way. Problem number two is I'm smarter than the vendors that I'm paying millions and millions of dollars to about how to leverage their systems, right. And again, I totally get it. I've been, if I'm the CEO of a healthcare system, I've been running this healthcare system, and I know how it works. And the folks that report to me, the smartest folks in the room, and they should be dictating how this all kind of can go down. Unfortunately for you, you've done it maybe once, maybe twice as a senior leader in a healthcare system. And the vendor of this technology, whether it's software or hardware or whatever it is, has hopefully done it tens or hundreds of times. And they've seen lots of things that you could never imagine before and can really often predict problems before they happen. And so really taking their thoughts and recommendations into mind before making decisions is a good thing. And a lot of people miss that. Another thing that they do that you can do wrong when you're implementing or making a big change or a big transformation is to ask the wrong people for their advice. And so what do I mean by that? Asking the chief of cardiology how this cardiology system that the chief hardly probably will use, how it should work and how it should function, is probably not your best bet. The chief of cardiology typically has minions around him or her who do a lot of things for them that the average cardiologist doesn't have. It's probably better to get information about, hey, what's the typical day like? What are things that you're struggling with? What are things that are super easy and you want them to remain super easy? Those are questions probably best for a mid level person or someone who's actually in doing the work every day, not a senior leader who spends a lot of time doing administrative and other leadership roles. Those are important things to do, for sure, but that's not the person I want to ask about. Day to day flows through a cardiology.
[00:11:22] Speaker B: Clinic that makes a lot of sense, and I think really good advice for any of our healthcare system executives that may be listening. Tell us now, you wrote a book. It's called designing for the human centered approach. I know this emphasizes a lot about the importance of human centered design within healthcare.
Why don't you share some of those key principles from your book and how they can be applied in settings.
[00:11:53] Speaker C: Yeah. So one I've already kind of thrown out there. These are mistakes that I've seen and my co author has seen over and over again. And so kind of, you know, we go from a consulting perspective and say, hey, this customer is saying that they're having this problem. We want the physicians, I'll just give an example, a made up example. We want physicians to order these antibiotics for patients who are admitted for community acquired pneumonia. We find that these are the most reasonably priced, they work well based on the kinds of bacteria that we're seeing in our area. And so this is what we think most doctors should do most of the time.
But doctors aren't doing that, and we're shocked as leaders, why won't they listen to our recommendations? But then when you kind of start peeling back the onion to see that you haven't made it easy to do the right thing, again, a core element of human centered design, make it easy to do the right thing. And maybe even, I'll just add a corollary, maybe even slightly difficult, more difficult to do something else but possible. And so what do I mean by that? Well, most of the time, you're going to want to use those antibiotics. And so if you don't have an order set, which is just a set of orders, an easy way of putting in information or putting in orders for commonly diagnosed diseases like community acquired pneumonia, well, that's step one, make sure you have that order set and that physicians know how to find it. And then two, default in the orders that you think most doctors will want most of the time. And so that includes those antibiotics. You might have three or four there. Why would you not just check one of them that you think is the, that you or your infectious disease experts think is the best one, and that's probably the one. Knowing how humans work and how even physicians, I say humans and physicians, I'm doing this sarcastically, how we think, yeah, if it's already there, that's probably what I'm going to go with. Now. Do I want to do that all the time? Absolutely not. Maybe my patients coming in is allergic to that antibiotic. Maybe my patient that's coming in that I'm admitting has already been on this antibiotic and failed. Giving them more of the same would probably be a bad idea.
What do you do? Well, it's just another click away. So we've got a few more antibiotics in there that we think are good. Probably you'll want one of those. Now maybe I want a different antibiotic. Totally. And one that is very expensive and maybe marginally better, but not a lot better. Well, that shouldn't be in the order set at all, in my opinion. That should be somewhere else, and the physician is going to have to do some work to get that. Now, what do I mean by work? Scroll to the bottom of the order set and type in that antibiotic. Now, is that onerous? I don't think so, but it is more work than clicking one of the pre decided or pre approved antibiotics.
That's what we're talking about. This is simple, straightforward stuff. A lot of people think that they're doing it today, but they're not. Or they set up their order sets. So they set up the electronic health record to make it easy to do the right thing when they set it up five years ago. But things have changed, and no one's gone back and kind of establish that continuous improvement mindset where you're going back, looking through things, making sure that the decisions that you made five years ago are still relevant, either from a technology standpoint or actually from a practice standpoint. Our practice patterns change. The evidence changes, the availability of medications and tests change. And if you're not keeping that up to date, then you can't be shocked when doctors aren't doing you're what you think is the right thing.
Another core principle in the book that we talk about is gross. And when we were writing this book, we got some feedback from one of our editors. Like, you can't say gross in a book about healthcare and design. I can because I didn't come up with the term getting rid of stupid stuff. GRosS and this is the name of an article in this vaunted medical literature called the New England Journal of Medicine. Many people have heard of this. The chief medical information officer of Hawaii Pacific Health wrote a very short article about getting rid of stupid stuff. And what she did was not that crazy and not that uncommon. She went around asking doctors and nurses and therapists and clerks, are there things that are in our electronic health record or any aspect of the technology that we give you to do your work? Are there things in there that just don't make any sense? Now? That's not uncommon. A lot of people do that. What she did is the next step, which was very uncommon. She did something about it, right?
So she went took that list, went back with the team and got rid of some stupid things that were in her system. One example of what we're talking about are things that are not they're not going to kill anyone. They're not going to cause you to have quality issues. One example was nurses were being asked to document the status of the patient umbilicus. So we're talking about a belly button here. And for a newborn and for maybe four or five, seven days after, maybe two weeks after they're born, it's important to talk about what the umbilical cord looks like, because sometimes it gets infected, sometimes it oozes a little bit. We want to make sure that there's nothing there that we need to address. And so it makes sense if you have a patient in the hospital that the nurses should document on that once a day or so. Well, somehow that got extended to, like, the first six months of life. And so four month olds were coming in, and this was required documentation in a nursing flow sheet where the nurses had to go in and say, nope, belly button looks great. Now, does that make the nurses unable to do their jobs? No. Is it just a half a second of a click? Yes, but it's dumb and it's pointless. And it makes those nurses reasonably question whether the people who set up this electronic health record know anything. And maybe they blame the vendor, maybe they blame the IT system, maybe the it director, maybe they blame the CMIO.
But under any circumstance, you're giving them reason to question your ability to do work. Taking that out and is just a big morale booster. And you might say, well, it's just a little thing. You listened. You listened to someone and you responded, and it made a big difference. I have personally found, I've gone to physicians and said, hey, you know, we just did all this work on putting, let's just say, a new blood bank module in. It was a big project, lots of work, lots of testing, hundreds and hundreds of hours. And I would go to a physician and say, hey, you know, I'd give them the opportunity to tell, to praise me and tell me how great I was for doing this amazing thing for them. And oftentimes the response was, yeah, that's okay, but I really appreciate the fact that you took out that typo in the second sentence of the third paragraph of that documentation template that I used all the time.
And I would say, like, well, that was simple. That was like a four minute project right there, and I'm talking to you about a thousand hour project. But they didn't care. That was a little pebble that was in their shoe that every time that they saw that they used that documentation template, they had to fix.
Why? Because physicians are anal retentive in general, and we're detail oriented, and we want it to be right. And so that little change makes a big difference to people. And not acknowledging that is a big problem. So she went around looking for things that were stupid and got rid of them. But she also did something else, another aspect of human centered design, which is transparency. She was transparent about the work that she did. So sometimes people complain that, hey, this is. You're asking us to do this documentation, it's really dumb. It doesn't make any sense, doesn't serve a purpose, doesn't help me. It doesn't help my patient. Well, sometimes she had to go back and tell them, well, you know, there's actually this regulation, and you might think it's kind of silly, and I might think it's kind of silly, but it's required by the state or it's required by some group somewhere. And we checked it out and actually really is required. Oftentimes we say it even though may not be true. This was true. And so that transparency of saying, hey, we're working on getting that requirement removed. But you know how it is. You can't fight city hall or the state government that effectively. And so that might be there for a while. And people really appreciate that feedback so that they know who to complain about. It's one thing to complain about your healthcare chief medical officer. They're the ones that are, that make all of these rules. Some of the time you're right, but oftentimes it's someone else and finding out that, yeah, this is a rule that we don't agree with necessarily, but we do have to follow because it's on the books. Again, it's a morale booster and really helps with burnout. I think a lot of times what burnout is, it's very complicated, but there's an aspect of it that is being out of control.
I'm not in control of my work. I'm not in control of helping the patients. Anytime you can give people back a little bit of that, that's a big boost. So if you can point to a specific law or specific regulation or specific group and say, like, this is where that comes from, I think that kind of takes a lot of. Some level of anxiety. It takes you a little lower. You're like, okay, it's not people making stuff up. So these are some of the things that you can do that we talk about in the book. And when we wrote the book, we tried to make it very clinically specific. Every chapter begins with a clinical scenario that actually happened to me and, you know, talks about the design flaw or design problem. That I encountered. And then the chapter goes into more detail explaining how to fix it.
[00:21:56] Speaker B: I think this resonates so much because I've heard, you know, we've heard on both sides, you know, with these, you know, electronic health record systems, a lot of times it can be just a burden for both on the physician side or even patients feeling like, okay, am I not getting, why are they, does their head buried in this system? So I think just some of those very practical tips about how you can make it more efficient to improve the experience for both the physician that's using it every day and then also the patient is super relevant. Do you have a hard or fast rule about, okay, how often do you want to be looking at your systems and making sure that they're still, you know, up to date with, with what makes sense for these different roles?
[00:22:47] Speaker C: Yeah. Well, you know, first of all, it's continuous improvement, which means forever. So, you know, you're always going to, you always should be on the lookout for things that you need to reconsider. Certainly every few years, most people look back at their clinical content. So if we have an order set or we have a protocol every two to three years, you're going to want to look at those. That's not me saying that that softened the joint commission or other quality organizations saying that. And I think the same goes for any technology that you're leveraging, kind of just going back and often with someone who wasn't involved initially with implementing it and wondering, asking the same questions like, hey, what problem are we trying to solve with this tool that we have? Is that still a problem that we want to solve?
Even though we've kind of been talking about this from a technology standpoint, this goes for not technology as well.
One study, one, or at least peripheral to technology, there was a study where they examined patients in an exam room with a physician. They videotaped them with their permission and understanding that this was happening, and then afterwards said, hey, how much time patient, do you think the doctor spent looking at you face to face eye contact?
And there were two different setups. There was one where the monitor, the computer monitor was kind of in the corner where the doctor was looking at the monitor, then turning away and then looking back at the patient and kind of going back and forth. And there was another setup in the exam room where it was set up like a triangle with the monitor at the top, and then imagine an isosceles triangle with the patient on one side and the physician on the other. And since we, since they had a camera there, they were able to compare what the patient thought in terms of how many minutes were eye to eye contact versus what actually happened. And amazingly, when you share that monitor, when the patient can see everything that you're doing, the doctors got credit, air quotes, credit for eye to eye contact.
So even though the doctor was not looking at the patient, even because the patient could look at the monitor and see what the doctor was looking at, he wasn't playing tic tac toe. He was actually working and trying to help solve some of the problems that the patient was having. You got credit in their mind for that face to face contact. So those are some things. Is that a technological thing? Well, I suppose so, but it's really about room setup right there. There are lots of things that you can do. These little tiny changes. There was just a study that came out, talked about putting a chair in the middle of a hospital room and seeing what happened. It's amazing. This was a hospital system that had fold up chairs that patients, usually their visitors, not the patients themselves, could sit in, and they were folded up away safely in the closet. And so for the study, they took out that folded chair and just opened it up and put it right in the middle of the room, kind of facing the patient. And then they told physicians that there was going to be a medical student in the room observing them so that they could come to conclusions about how, when they were rounding in the hospital, how they talked to their patients. That was not true. What that medical student was there to record was what kind of interactions that they were having with the patient, whether they were sitting down or not. And so they put a chair there. They didn't tell the doctors anything about the chair, and a good number of them sat down.
And when they sat down, amazing things happened. They didn't spend a lot more time in the room. So that's something I. You know, it didn't take them a lot longer to get through the. Get through the visit or the hospital evaluation. But what they found was patients thought that the doctors were much more empathetic because they weren't standing looking down. They were actually eye to eye. They thought the doctors, their perception of how much time the doctor spent in the room went way up, seemed like the doctor was there a lot more.
And surprisingly, their grading of the quality of the care that was provided by that physician, who was statistically significantly better than physicians, who didn't sit down, same everything. But if you sit down, you get all kinds of benefits from that human to human interaction. There's no technology there. But some of these little things really can make a big difference. And as we learn them and learn about them and how we can leverage them, the goal of this book, and I think the goal of anyone that's running a healthcare system or a hospital or a small doctor's office with one or two doctors, the goal is to provide the best care. You can still run the business and improve quality, but also to improve that human to human interaction. You can leverage technology in a way to maintain as much as possible that human connection. We know it's so important. We learned a lot of lessons about its importance from that pandemic thing that happened a few years ago. Do you remember that? I kind of forgot about it, but I try to remind myself about it. We learned a lot about what happens when you just all of a sudden stop human interaction and none of it's good. And so we need to bring that back. Some of it has never come back, and we want to make sure that we have it where possible and, you know, leverage it. So, again, still got to run a business. No margin, no mission. But there's lots of things that we can do to make life a little bit better for all of us.
[00:28:51] Speaker B: Love that.
I think that kind of brings to this great kind of question that we had is, like, how can healthcare organizations better involve clinicians in kind of designing and implementing these technology solutions? Because they're the ones, you know, on the front lines and dealing with the patients. And like you're saying those, I think the two examples you gave were just. That's really fascinating. Any other, you know, just best practices that you've experienced in your career.
[00:29:20] Speaker C: Yeah. So the first thing is, again, asking the right people. So you want to, if you're implementing some new technology or thinking about changing a workflow or making some sort of change in the architecture of a building, certainly you want to talk to the people who are going to be most directly affected. And so I mentioned, and I'm not sure why I'm picking on the poor chief of cardiology, but going after the chief of cardiology and asking them about how something should work is probably not your best bet. Going to a cardiologist who sees patients 40 hours a week, that's where to go. But it's not just the cardiologist, of course. It's the nurses and the therapists that are working with the same patients in the same areas and making sure that folks who spent all that time are kind of giving feedback. There's another party that we're forgetting about, which is the patient. And so this seems to some people, to me, kind of like, why? Why would I ask the patient? Like, they're just there to, you know, kind of, they're following along in a factory and being told where to go next. But that is a, that is the absolutely wrong attitude. And I've changed my ways as I've seen the impact of, of including patients in these kinds of discussions. They come and they tell you things that you never would have thought of. And I think there have been movies made about doctors who have become patients. We're all patients to some extent, but when you have a serious illness and have to be hospitalized to go through a lot of tests, your perspective changes, no matter how long you've been practicing medicine or been a nurse, and bringing that constantly back to make sure that you're incorporating their opinions and thoughts. On top of all of that, though, it's important to have someone who understands design and intentional applications of design. We can call them whatever we want, call them designers, call them human factors engineers, usability experts. They're the ones to kind of say, to sit on top of this whole kind of interview process and say, I hear what they're all saying, and they're often telling us what they want, but they're not telling us what they need.
And those are slightly different perspectives. But again, it's really important to focus on understanding what the problem is before you can go and design the solution. People often ask me, hey, I need an order set for this, or I need a new EHR tool for that. And sometimes they're right. But I always ask, I always come back immediately with, tell me what problem you're trying to solve, because your problem is not that you don't have enough order sets. No one's ever said I want another order set just because they might come with a specific problem of, oh, I had this kind of patient and I wasn't sure what to do, and there might be another tool altogether that they didn't even know existed, that they didn't ask for. They were never going to ask for this tool because they didn't know it existed. And so that's my job as a CMIO or designer or whatever sort of expert I am. My job is to kind of know what all the options are, hear what the problems are, and then suggest solutions and work with the person who's got the problem to try to understand if I've, if I've got it right and I'm solving it. And so lacking that layer, that, that layer, whether we you know, have a clinical informatician or human centered, I'm sorry, a human factors engineer. Without that person, what you're often doing is just doing well. The doctor said they wanted this, and I gave them that. And sometimes, if not, most of the time, that actually doesn't solve their problem. And so you've checked a box for sure, but you probably haven't alleviated the problem, and the doctor is going to still have that problem a year from now, even though you gave them everything that they asked for, not running into that trap. It's a good thing to do.
[00:33:17] Speaker B: Great advice there. I want to circle back to something that you were talking about earlier, the scary word word of regulatory compliance. I know that this is obviously a big concern in healthcare. So how do you kind of, you know, get the perfect balance of obviously approaching, you know, knowing, you know, what the compliance is or the challenges and then not letting that get in the way of hindering, you know, innovation and making things easier to use in, you know, healthcare? It.
[00:33:50] Speaker C: Yeah, well, I would not promote injuring lawyers. I know that. That's what a lot of my colleagues say.
So step number one, step number one, when a regulatory or compliance type person or lawyer says no, step number one is to find out specifically what they're talking about. And this is something that the American Medical association has kind of been pushing on lately. And I agree wholeheartedly. Oftentimes someone will say, well, you're not allowed to do that. When you say why, the answer is because.
And then there's awkward silence.
And so, you know, kind of pushing and saying, well, explain to me exactly what regulation. Can you show it to me? Where is it on the web? Where is it on the, on the web? You know, how can I read this regulation or this law, this interpretation? And often a scary amount of time, there is no such regulation. Or it doesn't actually say that, but someone 10, 15, 20 years ago interpreted it at a different hospital that way. And now everyone's been thinking that. But actually, that's not true. So that's, number one, just make sure it really is a problem or it really is a, you know, a regulation or something that you have to follow.
Secondly, if it, if it is there, understand what, what are they trying to. Why is it there? Right. So what is the problem that they're trying to resolve? Oh, well, it's not safe for patients if you let them prescribe their own medication. Okay, that makes complete sense. We have things called over the counter medications that we allow patients to choose, and we have prescription medications that they can't. So if someone's trying to do something that's just kind of crazy or there's a risk that they didn't understand or acknowledge, kind of bringing that to the table and saying, well, how can we work around this? You know, can.
Is there a middle ground? Is there a different technology or different functionality within the software that we're using that can kind of get to where we need to be? So, really negotiating, not just with the. Not with the person who's asked for the request or the requester, but everyone involved, sometimes it's, well, I need this thing because it's very difficult for me to jump through this hurdle. Okay.
If the hurdle is important, meaning the regulation actually exists, is there someone else on the care team who can help us jump through that? You know, is this work that has to be done by a physician? The question I always ask whenever we try to assign work to a physician is, did you need to go to medical school to answer this question or to check this box if you needed to go to medical school, chances are, I need you, doctor, to do this. But if you didn't, then let's have someone else to answer this question and really start, uh, playing team, you know, making sure that this is a team based approach and having a care team and leveraging that, letting everyone work to the. To the top of their license. And so that's. That's how I've generally been successful. Sometimes the answer is just no. Sometimes it's just, yeah, you. We can't do that. I think it's a great idea, but we. We can't do that. But I'd say, you know, seven out of ten times, we can find a balance. Either that thing isn't really unsafe and we can do it, or we can meet them halfway and leverage some other workflow or some other care team member to kind of help us along and move the process forward. So the easy thing is, no, can't be done, and that's wrong a significant amount of the time. It's kind of crazy.
[00:37:36] Speaker B: Super insightful there.
Looking ahead, what trends are you seeing shape the future of healthcare technology? And how can healthcare organizations get prepared for these changes?
[00:37:50] Speaker C: Stacey, have you heard of this thing called AI?
[00:37:54] Speaker B: I have.
[00:37:55] Speaker C: It's brand new. You've probably never heard of it. It's brand new. No one knows anything about it.
I think, certainly I've been cynical. Most of us in technology are cynical of new things, new shiny objects that our colleagues and friends, oh, we've got to have this software. Oh, we have to have this new diagnostic test or tool. It's the best thing. The rep just told me about it and no, no, no. They said it's great and it connects really well and it's no work on it's part to get it connected. Like, okay, we've been through this rodeo, and I think that's been true of AI and large systems, some clinical decision support tools like that, predictive algorithms have not been really great at predicting things. And we've seen this over and over. It works great at this hospital. And then we take it to the hospital just down the street, and the thing is just false alarming left and right, and it hasn't really been ready for primetime. Well, generative AI seems really close, and this is something that we all can see. Anyone that plays with chat, GPT or Gemini from Google, there are all these AI bots that are out there now that we can interact with, and they seem to do a really good job of certain things. And one of them is scouring large amounts of information and summarizing pretty nicely.
They can also create text, right? So you can give it a short prompt and get information back. And that's already happening. So several EHRs are already leveraging AI's and chatbots to make one of the more onerous aspects of post pandemic care. Interacting with patients online, which we've done for a decade or two, but just kind of exploded with the pandemic because everyone became very comfortable not going to visit their doctor, but instead messaging their doctor. And so there are now lots of systems out there where when the doctor sees the message for the first time, there's already a response, an edited, drafted response from the, from an AI saying, based on how you react to other messages and based on the information that the AI has. This is how the AI, I keep wanting to say I, but it's a program that, this is how the program kind of suspects that you're going to respond. And then physicians can obviously have to edit that or at least review it. And it's not amazing functionality yet, because the amount of data that, that AI can consume from the patient record is still small in the interventions that I've seen so far. And some of the data, however, it, it's a little thing, and we mentioned earlier in the podcast, sometimes very little things can be very rewarding to the user. And so I think generative AI is coming for us. Tests are going to be explained. Messages, responses to patients are going to be drafted by an AI and then either approved or slightly edited by the physician we already know. It seems that AI's can act like they're more empathetic than humans. It's probably not that they're more empathetic because a, they're a thing, so they can't really have empathy, but more importantly, b, they don't get tired. And they can write a long message back to a patient where the doctor would say, it's okay, don't worry about it, because they're at home in their pajamas trying to get, trying to get to that.
So I think generative AI is one big change that's going to be coming towards us. It's here already, but we're really going to start to see it in the next few years is a word I mentioned earlier, disintermediation. So organizations, companies, software apps coming between hospitals and healthcare systems and doctors and the patients. And this is something that we're seeing.
We first saw it in retail, right? So urgent care. Urgent care wasn't really a thing when I was practicing long time ago. If you're kid got sick, you brought them to the pediatrician or the family physician, not to the drugstore.
And so we've seen kind of organizations move in and now we're seeing apps like, hey, this app can answer this question and in fact, often can get you a prescription or, you know, get you to a physician who can get you a prescription pretty quickly. And so we're going to be dealing with that. And hospitals and healthcare systems really have to decide what are they going to be very good at and stick with those things. It's you that I think the days of being good, very good at some things and okay at others are going to be few and far between. In the future, there's going to be someone else that's going to be able to deal with that, maybe faster, cheaper, maybe even a little bit better than you. And so you're going to have to think about how you're going to respond to that and make sure that you, you know, you, what you do well, no one else can do, stick with that and make that as good as it can be.
As we see kind of healthcare breaking up into little tiny specialties here and.
[00:43:14] Speaker B: There, that is an incredibly insightful look into the future of healthcare and technology. So thank you. I'm sure everybody is interested in all the things you just spoke about.
Doctor Joseph I want to give you a chance to let our listeners know how to a get a hold of your book, designing for health, the human centered approach. And then if they any healthcare systems that may want to work with you, let them know how they can do that.
[00:43:46] Speaker C: Sure. So first of all, the books available on Amazon, it's also available on most of the booksellers that are online. You can just search designing for health a human centered approach, and you should be able to find it.
Secondly, to kind of learn more about me or to reach out, I'd love to be connected. LinkedIn is really the best way. So again, just search on Craig Joseph. You'll find me. I like to say I'm tall and good looking, but you can't really tell either of those things by my picture on LinkedIn. So just some dude with glasses. That's my description of me. You'll find me. Just type in some dude with glasses. You probably won't find me, but if you type in my name, Craig Joseph at Nordic Consulting, you'll find me. And I love to be connected to people, so feel free to check out that social media and give me a connection request.
[00:44:38] Speaker B: Amazing. Thank you so much for being on today. It was such a pleasure and it's so insightful. So thanks for your time, doctor Joseph.
[00:44:47] Speaker C: Thanks. Appreciate it. It was fun.
[00:44:49] Speaker A: Thank you to all of our listeners. If you would like to be notified when new episodes air, make sure sure to hit that subscribe button. And a big thank you to Pacific companies. Without you guys, this podcast would not be possible. If you would like to be a guest, please go to www.pacificcompanies.com.
[00:45:07] Speaker C: Thank you.
