CareDelivey_Jake Lancaster: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Manav Sevak:
Welcome to the Memora Health Care Delivery podcast. Through conversations with industry leaders and innovators, we uncover ways to simplify how patients and care teams navigate complex care delivery.
Manav Sevak:
Hey everybody, this is Manav from Memora. Really, really excited to have Dr. Jake Lancaster on the call today. Jake, thanks so much for coming on.
Jake Lancaster:
I’m happy to be here. Thanks so much for having me.
Manav Sevak:
Yeah, absolutely. So, you know, you have a pretty interesting background that we were actually just chatting about right before this. Would love if you can maybe just share a little bit about, kind of the role that you’re in with Baptist and maybe a little bit about your background and your story. That’d be helpful for the audience.
Jake Lancaster:
Sure, yeah, I’m with Baptist Memorial Health Care based on Memphis, Tennessee. We’re a 22-hospital system in three states, we also have 185 outpatient clinics. I’m our chief medical information officer, as well as our chief medical officer for Baptist medical group. I’m an internal medicine physician by background, so did my training in Mississippi, went and did internal medicine residency at UAB, and during that time is when I got interested in healthcare leadership and did a master’s in health administration from the UAB School of Health-Related Professions. And I always thought I was gonna be a cardiologist, that was what I planned to do, maybe do electrophysiology, but then I kind of discovered the technology sector and wanted to learn more about how it was growing and affecting healthcare and knew I wanted to, I knew I needed to understand it if I was going to be an effective healthcare leader. So these clinical informatics programs were starting around the country, when I applied there was about seven, now I think there’s 40-ish across the country, but I was the first informatics fellow at Vanderbilt, and it was during our big EHR transition from Epic, from a star panel homegrown system to Epic, and so helped a lot with that, developed some apps, really got to see the long term view of the landscape and informatics. And then from there, I went and was the CMIO at West Tennessee healthcare for a year before coming on to Baptist.
Manav Sevak:
Yeah, that’s awesome. Do you still maintain a practice?
Jake Lancaster:
I work PRN, so I did when I was at West Tennessee. I was working two and a half days a week and then down to one in an outpatient clinic. But now, I try to work one or two shifts a month as a hospitalist, just really, just admitting patients. And then I’ve started to see more and more patients in the clinic really just as needed with some of our urgent cares and helping out with some of the telemedicine work.
Manav Sevak:
No, that’s great, that’s great. And the concept of, and even the role of kind of CMIO is relatively new in healthcare. So it’d be great if you can maybe just kind of level set and share a little bit around. What does that really mean? Like what are the big buckets of ownership that you have inside of the health system? Naturally, the place that my head goes to and what we’ve seen with Memora is that they are folks who can really kind of straddle a combination of having technical depth and understand what it takes to get systems off the ground while also having a lot of clinical knowledge and as a result, should be responsible for a lot of the work … integration … tools but would love maybe your perspective as well on what it really means to be a CMIO at a system that large.
Jake Lancaster:
Yeah, and certainly I think the role is different at each institution and it has evolved a lot over the years. Initially, CMIO’s were really just, were the position champions for maybe a new EHR, going from paper to EHR, and it’s continued to evolve. I feel like its grown a good bit to where you’re a core member of the administrative team. But I mostly see myself as the bridge between the physicians, the clinical side and the technical side, help translate a lot from both IT to physicians and physicians to IT about different needs and requests that we’re trying to get across or any projects that need to happen. Also, we work heavily with the administration and trying to translate from both the IT and informatics side to them and vice versa. One of the core things that we do today and it’s always been a core responsibility of the CMIO, but it’s gotten more acute over the last couple of years, is focusing on physician burnout and especially how we can reduce the administrative burden of the EHR to make physicians lives a little bit easier. So I’d say that’s what I primarily focus on, is how to optimize the EHR, make it more efficient so that physicians can get back to what they want to do, and treat patients.
Manav Sevak:
Yeah, that’s awesome. And you know, you had mentioned that you thought that it’d be important to understand technology and moving into more of a leadership role in healthcare. What are some of maybe the broader trends that you’ve seen around how healthcare’s changed over the past 15, 20 years, that, that kind of gave you that intuition, right? And maybe big technologies that you think have really completely changed the game for what care delivery looks and feels like today that get you really excited?
Jake Lancaster:
Yeah, so 15, 20 years is a long time and most systems wouldn’t have even had an EHR 20 years ago. Certainly, the majority do now, after the high-tech act, so that was a piece. I wouldn’t say that was why I thought technology was important purely because of the EHR, you know, I’m a big fan of Eric Topol as one of his books, he wrote early on, The Creative Destruction of Medicine, talked a lot about digital applications. And after reading that is kind of when I thought, okay, technology is going to be able to do a lot more and change the landscape in healthcare, and I need to get a better grasp on it. So anything from apps to just telemedicine to remote patient monitoring, things of that nature that we’re able to do now that we’re not possible 20 years ago. With the pandemic came along, a lot of hospitals started doing hospital at home, we did that as well, and so just having the understanding of where it’s going is nice. And then data science, just what we’re able to do from a data perspective, of the understanding of medicine, how artificial intelligence, how that plays a role. All things that I knew that I was going to have to react to if I didn’t understand the underlying pieces. And so I wanted to be in a position where I wasn’t reactive, but I could be more proactive and kind of design and mold these things that are coming through medicine in a way that was more receptive to the practicing physician. So that’s kind of why I decided to go in the technology route.
Manav Sevak:
Yeah, that’s, it’s super, super interesting. And if you maybe think a little bit about that from, kind of like the piece that you mentioned around helping to navigate both the clinical and the technical piece, one of the challenges that I know every single early-stage company runs into, plus every single health system has to deal with, is that there’s so many different areas in the healthcare systems right now that are ripe for, quote-unquote, innovation or ripe for new technologies that can help move the needle significantly. And obviously, there’s a lot of validation that has to go into that to figure out what technologies actually are helpful and not helpful. But regardless of that, there’s so much prioritization that has to happen to figure out where people should be spending their time. It feels as if, one thing that I’ve seen and that our team has seen is that that prioritization looks dramatically different for an IT team or a technical team than it does for a clinical team, right? So sitting in the place that, and the role that you sit in, how do you think about being able to effectively communicate those priorities? Plus, how do you kind of, any like strategies or secret sauce that you have found around getting clinical folks to understand IT’s priorities, getting IT folks to understand clinical priorities, and getting everybody on the same page around those?
Jake Lancaster:
Yeah, the prioritization, it depends on how big the project is. So I think most systems everywhere have an IT steering committee, we certainly do, that any new project that comes in, we have the appropriate stakeholders from across the enterprise. So we have our CEOs for our different markets, our IT team, our CFO, as well as clinical leaders on that group that are evaluating these new projects that come in, determining if it’s right. Is it, do we, one, do we have it in the budget? Which if you’re reading the news about health systems today, most of us have struggled over 2022 and 2021 and expect it to do so into 2023 based on forecast, so that probably is the main driver of what we can and cannot prioritize right now. I would say anything that doesn’t have a positive ROI is really hard, really hard to get behind. There’s a lot of things that I would love to do that would improve physician efficiency and improve physician satisfaction. But at the same time, it’s difficult to quantify that impact in a way that makes sense to the bottom line. I mean, there’s, a bunch of people have done it. I can show that it’s a physician’s 30 minutes and that a minute of a physician’s time costs X amount, but at the same time, that doesn’t necessarily show up on the balance sheet, if you know what I mean. So that is one way we prioritize things. What is going to have the biggest clinical impact for the organization? And a lot of that does come back to, is it going to have a positive ROI? There’s a lot of things that we do that will have a clinical impact as far as, does this improve patient satisfaction, does this improve some of our other quality metrics? So different things we’ll take on that will affect hospital-acquired infections or other things that are kind of related to our core quality measures as well. That ROI does have, doesn’t always have a price tag tied to it. We do get reimbursed and we get penalized based on quality. So it does kind of tie into that prioritization matrix there. Then the other way that we prioritize work, and these aren’t big projects, new software, or anything like that, but I run our, both our inpatient and outpatient optimization committees. So any changes related to our EHR or changes related to any other device that we use, that our physicians are currently using, that are team support, we bring those to that group which is made up of physicians across the system that are interested in technology, and we go through the change request and determine if it’s going to be right or wrong for the system. And so those are kind of the two major ways. And then if it’s a patient safety-related change, that’s kind of the number one. And then, does that have a financial impact? That’s number two. It’s just a nice-to-have, that’s prioritized a little bit lower and we’ll get to it when we can.
Manav Sevak:
Yeah, no, it completely makes sense. And I think that that’s one of the, it’s one of the realities of digital health is that the concept and industry of digital health is so, so, so new that there are so many companies that will have that first layer of validation of, yes, this helps save time, or yes, this helps improve engagement, but are still struggling to figure out the second part of that is, how does that actually translate to some financial value for the system? Or how does it translate into some improved terminal outcome for a patient or something like that, right? And the reason is it just takes time. It’s hard to get data like that and it’s really, really hard to build data like that’s statistically significant and applicable across multiple systems.
Jake Lancaster:
Well, you know, it’s just the way our financial institutions are set up that pay for healthcare. It’s difficult to do the right thing if you’re not going to get paid for doing the right thing sometimes. So, you know, there’s a lot of things that we would love to improve. We had a baby last week and I was staying in the hospital and, with my wife, and you know, the experience of staying in the hospital for patients is pretty brutal, and especially if you’re not the patient. You don’t get the meal, you don’t get a nice place to sleep or anything like that. I was just like, well, why couldn’t we have just this extra things where, if you wanted to, I could go in and pay for my own meal so I could split it with my wife or a better, upgrade to a better place to sleep, but that’s just not.
Manav Sevak:
It’s not an option.
Jake Lancaster:
It’s not an option, but it could be.
Manav Sevak:
Yeah, no, 100%, and congratulations by the way.
Jake Lancaster:
Thank you.
Manav Sevak:
Awesome, I know that we’re coming up on time here. So maybe one thing that, or two pieces. I think the first is you mentioned that, and we just talked a little bit about prioritization, what are maybe big things that you are spending your time on right now? Any big initiatives at Baptist in particular that you can share I think would be great. And then second is would love to just hear a little bit of your reflection on the state of where the healthcare industry and the healthcare system in the United States is right now, and naturally, there’s a lot of challenges, but it’s also never been this exciting of a time to be working in healthcare in terms of how much opportunity there is to kind of improve the system and how much motivation people in leadership seem to have across the board. So what are some of the things that are getting you excited, whether or not they’re happening at Baptist?
Jake Lancaster:
Yeah, no, so like I said earlier, burnout is a big thing that I’m working on. One of the, if you’ve gone to any conference related to EHRs or just any physician conference over the last couple of years, these messages from patients and … messages just overload our systems daily, and it’s, because patients are more, we got more signed up for using the portals over the last couple of years and they’re more used to using it, and they’re sending a lot of messages to the physicians and we don’t have the staff to deal with it. And our physicians are spending a lot of extra hours after work returning these and a lot of times providing free care, so how to deal with that and how to reduce that burden. Two, for us, is we are experimenting with ambient dictation, so these ambient scribes that, we’re using the Dak’s Nuance product with 15 … users were, records a conversation between the patient and the physician and writes the note for them, taking away that administrative burden. So those are the two big initiatives I’m working on right now. As where we’re going in the future, things I’m optimistic about. I do think finally we’re seeing more movement into reducing administrative burden for the physicians and clinicians. You know, CMS and AMA have worked some to reduce some of those documentation requirements that never really made sense. So we’re finally seeing some effort. We saw that in 2021 on the outpatient side, we’ll see that again on the inpatient side in 2023, so I’m optimistic that that is going to continue. At the same time, there’s still plenty of opportunity to reduce, further reduce administrative burden, and hopefully, we’ll make a lot of headway.
Manav Sevak:
Yeah, that’s super, super helpful to hear. Awesome, Jake, thank you so much for coming on, and thanks so much for sharing your perspective. Always helpful for me to personally hear and for our team to continue to keep in mind at Memora, but also hopefully helpful for the audience as well. So just appreciate the time and hopefully, I’ll have you back on here again soon.
Jake Lancaster:
Thank you so much. …
Manav Sevak:
Thanks for listening to the Memora Health Care Delivery podcast. For more ideas on simplifying complex care for care teams and patients, visit MemoraHealth.com.
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