Outcomes Rocket Podcast_ViVe_John Chelico: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Saul Marquez:
Hey everybody, Saul Marquez here with the Outcomes Rocket at VivE and I am so excited to have the amazing Dr. John Chelico with us today. Dr. Chelico is a board-certified internal medicine physician with former fellowship training in biomedical informatics. He has a subspecialty board certification in clinical informatics and his expertise is in the use of electronic health record systems for the improvement of clinical care, quality and research. John is the system VP Chief Medical Information Officer for Common Spirit Health, prior to joining Common Spirit Health, he was VP and Chief Informatics and Innovation Officer at Northwell Health in New York. Dr. Chelico, it is a pleasure to have you here.
John Chelico:
Thank you so much, thank you for having me! I’m very excited, it’s definitely an interesting week for me, my first week on the job at Common Spirit Health, but also the opportunity to be at ViVE and, and be a speaker at ViVE this year, and it’s been an awesome conference.
Saul Marquez:
Yeah, it really has been. And so as you, as you think about the one thing that stands out for you, Dr. Chelico, what’s been the best for you from the conference so far?
John Chelico:
I think the fact that I think they gathered enough senior level, senior-level leaders that have come together and in a very manageable conference. I think the talks have been great, I think the sort of the exhibit hall has been manageable.
Saul Marquez:
Yeah!
John Chelico:
My feet don’t hurt as much from walking from end to end at some other conferences, but we’ll definitely take some good notes and looking forward to the remainder of the conference here.
Saul Marquez:
That’s great. I appreciate the feedback. So you’ve got to talk, come in tomorrow, and for folks that aren’t able to make it either because they couldn’t come to the conference or maybe they, they went somewhere else. Give us a synopsis of what you’re going to touch on.
John Chelico:
Yeah, definitely sort of carryover from what I had done in Northwell Health, I was there for about ten years, but the last five years, I ran the Center for Research Informatics Innovation. It was to sort of enable research and innovation within the context of a large health system, but I would say that a health system is probably the best place to run a clinical trial. From a feasibility perspective, we have every patient to match every inclusion and exclusion criteria that any industry player can throw at us. However, those patients are spread over a larger geography, so we may have one PI, a principal investigator in one geography, but the patient may, patients that fit that criteria may be spread over for our geography or in, in Common Spirit terms, they may be all over the, all over the United States, in 21 states. But, you know, how do you sort of capitalize on that? So COVID proved one thing to us is the ability to sort of do a decentralized model around this, meaning that the patient doesn’t have to physically be in front of the PI, they don’t have to be in the same geography, they don’t even need to be in the same time zone. And I think the ability for a patient to, a doctor to be able to sort of provide what a clinical trial gives, what essentially is care that you do not have access to as a cardiology patient, as an oncology patient, in order to get the most up to date treatments these days, you have to really be enrolled in clinical trials. And if you’re a doctor, that’s with, you can’t do that. Well, someone in the health system may be able to do that, and they don’t need to be, travel to their office to do that, they can actually do it in other ways. And I think that model of decentralization for clinical trials is going to be something that, you know, has been proven during COVID. But I think as a model for health systems to do clinical trials in the future, I think is something that of a perspective that I think is very important, to bring that level of care to all aspects through a health system. In Common Spirit, you know, there’s places where, where patients would not have access to academic medical centers. Patients have, don’t have, you know, don’t have the means to get to that, to though, but now we can actually bring that to the patient, which is really going to be amazing.
Saul Marquez:
Yeah, that’s really amazing. And a couple of things that, that come to mind, Doctor Chelico, this is number one access, right? So, so this, in my mind, expands and improves access to these to these medications, and then on the, on the second hand, it’s the, the need for, for more diverse sets of patients for drug companies. Do you want to comment on that?
John Chelico:
Oh, of course. I mean, I think that, I think that bringing clinical trials to health systems where they have access to patients of many diverse populations. I remember at Northwell Health, we had patients that were in Queens, in Brooklyn, I mean, there was about 230 different practice, spoken languages just in our databases for patients in those areas, they represented not just sort of geographies, but they represent sort of certain dialects within those, spoken in those areas. And I think, you know, those people never have access to clinical trials or the most up-to-date opportunities for treatments and others, not that they don’t need them, bringing that opportunity and access is something that would be I think it would be great for people that would never even think of that, or the physicians taking care of them, bringing the opportunity to give that treatment to their patients is really what I’m very interested in as a physician, as someone that otherwise wouldn’t think of that opportunity for that patient.
Saul Marquez:
I love that. Yeah, you know, with the physician in mind, making sure that they’re also empowered.
John Chelico:
Yeah.
Saul Marquez:
To provide new, new things.
John Chelico:
Of course!
Saul Marquez:
Yeah, that’s fantastic. What would you say is the number one theme health systems need to be mindful of in 2022?
John Chelico:
I think, I think health systems in general are making a huge transition from being health systems and hospital health systems to really having a focus towards the ambulatory and the patients at home. I think we’re all going towards value based care and I think the care that is not happening in the four walls of the hospital or the four walls of a doctor’s office is going to be sort of a major focus at, you know, in the entity that I’ll be joining in Common Spirit, I will be part of the physician enterprise, which is really representing all the physicians across all of what was prior physicians that were part of CHI and part of Dignity Health. And I think that in,not sort of identifying as part of the local hospital or part of that is the piece that I think we’re all part of one united brand and I think one united sort of opportunity for access and one way to sort of represent that to payers, represent that in contracts, but the ability to sort of again have the scale across the organization and not sort of be very mindful to the, at the same time being sensitive to the local geography, but at the same time giving the strength of the of what we actually have in the, you know, the thousands of providers that are across the health system.
Saul Marquez:
Yeah. And it is moving that way, right? And tech is moving toward the home and so care is shifting to the home.
John Chelico:
Correct, correct. I think I think the only thing that I think has to really, eventually sort of be, is the way we get paid needs to be shifted towards that path. And I think, I think that was one of my major excitements of really why I wanted to move from New York, which is mainly a fee for service geography, and I think where digital health doesn’t quite make sense yet because a lot of this really requires you to have investment in value based care. I think the opportunity at Common Spirit in some geographies where they have a lot more concentration on value based care, I think the opportunity to do that at scale is very exciting for me and I think, you know, where digital health solutions start making sense and I think I always, I always joke it’s sense in the sense that it makes sense, but the other thing is it starts making dollars in a sense.
Saul Marquez:
Yes. And as a, reimbursement starts getting more in line.
John Chelico:
Correct.
Saul Marquez:
It will make even more dollars because it makes sense. I love it. So with that shift to the home, there’s, there’s obviously watch outs, right? So, so what watch outs come to mind to you, that you’d like to share with people as they ramp up their efforts in that space.
John Chelico:
Look, I think there’s the oppor, the opportunity to consumerized health is something that we all want. I think the other thing is that, I have to be mindful of the physicians and that the physicians don’t need every data point that is generated by patients at home. I don’t need every heartbeat that is recorded by your app, or your Apple Watch, or your Fitbit, or whatever consumer device you’re wearing. I don’t need to know your blood pressure every waking morning or your weight is on your scale, but I do need to know when it becomes a problem or I do need to know. So I think the ability for us to sort of harness all of this data, develop technology, whether it’s, you want to call it machine learning or AI or just basic analytics to understand when to ring the bell and when to, when does it need to bring to the attention of the health care system, when do they need to intervene, and I think it’s very important from a payer perspective, it’s very important from a just a pure good clinical care perspective, is that, hey, if I got a CHF patients wait every morning and when that wait hit sort of a certain mark, very simply, you know, we can definitely sort of proactively manage their diuretics and be able to sort of get on top of something. Yes, we can avoid them from coming to the hospital, avoid them from, you know, other, other sort of downstream episodes of shortness of breath, whatever, there’s definitely predictors in that. So the ability to sort of harness that is very important, and again, you need technology to actually make it work. Otherwise it’s almost overwhelming the amount of data that’s being produced. And the other thing is, you know, be very mindful of the quality of data that’s being sort of, these are consumer devices. Yes, they have some FDA clearances and other things, but at the end of the day, a blood pressure taking by a machine that you buy at your local is not sort of, in regards the same type of blood pressure that may be recorded in the setting of your doctor’s office. So you have to keep things of that in mind, and consumer data that’s collected through wearables, but also data that’s collected by your patient or something like that. And, you know, but I think there’s, there’s definitely a way to handle that on the electronic health record side.
Saul Marquez:
Yeah, no, I appreciate that. And, you know, that’s why it’s so great to have a physician in, in a position like yours, because you think about the position that they’re in and you’re overwhelmed with alarms, you’re, you’re, there’s just so much stuff coming at you, there’s so much stuff that you’ve got to plug into an EMR, less is best, make it critical and that’s what matters.
John Chelico:
Yeah. And look, I mean, I think, I think we all want to practice to the top of our game, whether you’re a nurse, an advanced care provider, a physician, you do, you do want to sort of do the right thing by your patients in the end of the day. But, you know, there’s almost so much time in the day. And if technology can help that sort of do the right thing and help you or leave your, your brainpower to the most critical of decisions, then we’ve, we’ve done a good thing. And I think that’s what it comes down to. I mean, you always sort of compare, you know, medicine practice 30/40 years ago, where we only had like 400 medications to choose from and we only had like, you know, now we have thousands of medications and thousands of surgical opportunities to just pounce on, and there’s, and there’s a million diagnosis that you can sort of, you know, diagnose patients. So there’s so much more to digest as a physician, there’s no way for you to keep up, and I think that’s what really kind of brought me to this field as a physician to say, say, we need to find a better way. And, you know, other industries have done this. We need to do harness, obviously harness, harness this even further as as many of these people at ViVE are trying to do.
Saul Marquez:
Yeah, for sure, for sure. I definitely agree with you. And so on the theme of burnout, you know, there’s there’s definitely a lot of folks struggling and retention is a challenge, what are some examples that that people could sort of consider and do to to help?
John Chelico:
Yeah, no, I think so. I think on the top, on the top tier of things that burnout physicians is their EHR, as much as I love electronic health records and I love the fact that we need to digitize things, I think we’ve also caused enough pain. I think in that sense, I think we can start working smarter. I think there’s things that we still burden a physician with when we kind of, we say, we, when we go into an office and we say we’re going to make something electronic or even move something from one electronic system to a new electronic system is really what’s happening these days, not just paper to, paper to electronic, we tend to sort of add things. It was this was nice, but now we have these new regulatory measures. We need to now ask DVT prophylaxis questions on every hospitalization. So like, we tend to sort of say we don’t do in like for like, we had to do like like for like plus and we end up sort of adding all these onerous things which we are totally think from a good, from a regulatory perspective, from a quality improvement perspective are great, but we’ve now added that extra 30 seconds, that extra minute, extra 2 minutes. You know, I think that those are the things that I think that are sort of incrementally burning out physicians and that sort of, you know, just piles up and piles up and piles up. And the other thing is, you know, if it’s already documented somewhere, maybe it’s not in your EHR, the ability for you to know that the patient was on a treatment or put by a treatment, maybe it was outside your four walls of your health system, the ability for us to use standards to actually bring that data together and not have the doctor ask you the same question every time you go to another doctor’s office. I mean, it’s bad enough we do it within a health system, but if we can not do it at all, it would be it would be amazing.
Saul Marquez:
Yeah. Some great callouts there.
John Chelico:
Yeah.
Saul Marquez:
And so what do you think about tools like Nuance, right, just acquired by Microsoft, is there a play there to get even better at lifting some of the burden?
John Chelico:
What I’ve seen in some of this is sort of have the more passive version of that, I think. I don’t know, I don’t know a lot about technology, but I know the ability to sort of passively collect data while the doctor’s documenting his note and being the ability to sort of prompt them on the things that are, billers want to have explicitly written out in the chart or have the ability for the doctor to even, I think there’s even technology now that that will, you know, it’s rough and it’s, and it’s in its inception right now but in idea it makes sense but have the doctor have a conversation with the patient and have some, something documenting your note as we speak. It still needs to be, you know, right now, it’s, it needs to be reviewed and edited and it’s almost maybe adding to the thing. But I think as that progresses, it can only get it can only get better. So, you know, right now, I think you still have to be a little bit more scripted about what you try to do. But yeah, I mean, look, we’re all going in the right direction.
Saul Marquez:
Yeah, I agree. Well, thank you. Listen, this has been a fantastic opportunity to connect with you, for you to share your thoughts on the space and where it’s going. Any any closing thoughts, Doctor Chelico, and then what’s the best where, where folks can follow you and the work that you do?
John Chelico:
Yeah, definitely. You can find me on LinkedIn, I need to be more active on Twitter, but I think it’s probably LinkedIn is probably the best thing, and, and definitely look at me there. I think, as a closing remark, I think, you know, I think everything is, it takes time to actually get these things. And I think, I now doing this for like 20 years in healthcare IT, I think we’re in a much better place than we were 20 years ago, 10 years ago, 5 years ago. And I think just, you know, it requires some patience and I think we’ll get there. But the opportunities are amazing. And, and I think the opportunities and the investments that are being made in digital health and how health systems can harness those things, I think will continue to see, so, excellent.
Saul Marquez:
Yeah. Thank you, thank you, Dr. Chelico, and also the work that you’re doing on on these clinical trials is also very exciting. So let’s definitely stay close. We’d love to hear updates on that.
John Chelico:
For sure! The pleasure’s all mine. Happy to, happy to come back anytime.
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