Future of Global Informatics_Episode 16_Blake Lesselroth: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
TJ Southern:
Hey, y’all! Welcome to the Outcomes Rocket Network – The Future of Global Informatics Podcast, where we discuss global informatics through conversations with industry leaders and innovators so that you can understand what it is, what it does, and how it shapes the healthcare of our future. I am your host, TJ Southern.
TJ Southern:
Hey, y’all! Hey, y’all! Good day! Good day! And welcome to another episode of the Future of Global Informatics. It’s your girl, TJ Southern, and today we have Dr. Blake on the cast with us. Yay, hey, Dr. Blake. Welcome, welcome, and how are you today?
Blake Lesselroth:
I am actually very happy, actually. I will say for, in full disclosure, one, I was just excited to meet you, and I feel very privileged to be asked to speak, and two, then I get a chance to actually meet you, TJ and you are, if there’s anything I can think of that would be more, I cannot think of anything more inspiring to want to be in informatics than to talk to somebody like you because you’re just, it’s really cool to see you.
TJ Southern:
I love informatics, I love informatics. Okay, enough about me. Let’s talk about you. Tell the people about yourself. Tell them about you, Dr. Blake.
Blake Lesselroth:
Okay, I’ll try to be concise, and then you can ask more questions. So my background, my undergraduate degree was in anthropology, and I was very interested in sociocultural anthropology. And then, because I figured, well, if I don’t go to medicine, maybe I’ll, maybe I’ll do some field work, because that sounded pretty interesting, and then, I did my medical training. So I went to school, my undergraduate degree, I went to UCLA, and then I did my medical training at Tulane University in New Orleans. And at that time I was very fortunate in that I think oftentimes amongst healthcare professionals, I imagine it’s probably true for nursing and pharmacy and all the other incredibly important specialties, but certainly, with medicine, I think in large part it’s just a function of where you’re at, what culture you’re embedded in, and who are the mentors that really speak to you. And so I actually had a mentor, a gentleman by the name of Mark Kahn, who now I believe is the dean of the School of Medicine at UNLV, but back at Tulane, he was the person that inspired me, that I wanted to be an internist. And so then after Tulane, I went to Oregon Health Sciences University, and at about that point and I was doing my internal medicine residency, and this is the point where people are like, oh, well, you’re really into computers, oh, you program or, oh, you’re actually the, one of the things that people say all the time is, oh, you’re a computer guru, which sort of makes it sound like I’m like sitting like sort of crisscross applesauce on like a carpet, like with, like, with, like letting doves fly or something, I don’t know. It conjures an image that is completely not me. So I actually went to OHSU and I was really interested in internal medicine and I think why I got attracted informatics, which is a surprise to people is, one, I like teaching. I wanted to stay in education, actually, I want to stay in academics. I like, more than even research, I like teaching, I like being with other learners. And then the second thing was, is I liked internal medicine because as a field in general, for a general internist like myself, you tend to have to think broad, you think in terms of systems and processes and whole health medicine and, you know, and the biopsychosocial model or social determinants of health, but internists, and I don’t think this is unique to just internists, I mean, I think it’s true with practitioners and pediatricians, and a lot of other professions out there. I was very, it doesn’t appeal to me to be super specialized on one area. I’m much more interested in coordination of care. Education, care coordination, and then the last thing that appeal to me was, is where I was at Oregon Health Sciences University, I’d noticed the pain points in things that I was doing in my clinical workflow, like, oh, we could use a wiki to store information about how to manage something. Or I think these menu systems in the VA, they don’t actually lead you to use the evidence-based practices, wouldn’t it be great if just like all the cascading orders would sort of set you up for success, like, like a cockpit of an airplane? And it was that, at that point that two people actually got me into informatics. They’re like, you know, you seem very interested in how to fix problems. One person was up here, MB, who’s now at Vanderbilt, who I love dearly, and another person is David Dorr, who’s at Oregon Health Science University, both of whom are prominent in the American Medical Association and both of whom were co-residents with me, they’re like, think about this as a field. And I’ll tell you, and this is what I tell people coming up, like TJ, like you and I meet, when people come up to me and they go, oh, I couldn’t do in informatics because I’m not into computers, or I’m not, I don’t know, I’m not building a web server in my basement. I wasn’t either. I was actually just more interested in having, I was interested in teaching, I was interested in fixing problems, I was interested in how the systems work together, and I think most importantly, and this is why I tell people that are in any health professional field, or any field for that matter, if you want to have an amplifier effect, if you get joy, derive satisfaction from helping a patient, imagine the satisfaction from helping a population of patients, or if you’re supporting a clinician doing something that actually transforms your entire practice. And so I think it was sort of that, and I know this sounds very solipsistic, but truthfully, I wanted to know that you could do something, I could do something that would have the largest impact possible. So even though that sounds a little self-serving, I will say to your audience, if you’re interested in having a large impact and you want a way to, you know, you look at how healthcare systems are functioning and you go, there’s a better way to do it, I can’t really think of a field … more so than informatics that will provide you a pathway to do that.
TJ Southern:
I love it.
Blake Lesselroth:
Is that helpful?
TJ Southern:
I love it, I love it. First, I’m going to tell you that I don’t think that it’s self-soothing. I don’t think that it’s self-gratification because that is actually our purpose here on this earth is to make the biggest impact in our timeline, the timeline of our life. And we don’t know how long that timeline is, so I’m going to snatch that from you. I don’t think that that is appropriate. I am going to say that it does make us unique because we are actually the individuals that want to make that impact. You have others that want to sit on the sidelines and they just say, oh, somebody else can do it, but then you have others such as ourselves that are like, why not me, right? So I love the fact that you took that chance to do that.
Blake Lesselroth:
And that’s great, I think that’s actually a good thing for your audience. I mean, for somebody like, look at you, you’re the kind of person where you see the opportunity for transformation. And I think you’re right, I think if you’re speaking to people that are thinking about informatics, it’s, it ain’t a bad gig when you surround yourself in a professional field where everybody essentially is a doer, a problem solver or a visionary. There are very few people just sitting around whining. I, kind of, I do like that.
TJ Southern:
That’s that, and that is the crux of informatics that, where I wake up every day and I’m like, it is a joy, it is a pleasure, and it is an honor to be an informaticist because we are innovation. Informatics is innovation. You’re right, we do solve problems, we look always at the glass half full, and we also want to know how can we add a little color to this or how can we add a little bit more to this, you know, soup it up like a car, ride it up. How can we make things easier? And I was telling another interviewee this or another person that I was speaking to this, you know, the joy that I love about my job is it not only impacts me and what it is that I do, but it also supports my colleagues that are out there in the thick of things that are in the firefight. So that is the one key point that I saw that you mentioned, you know, being able to assist your colleagues, that is like, to me, the golden key. Because, yes, we know that people do our jobs day in and day out, but being able to come back to the table to say, okay, we know that you see X, Y, and Z, this is our improvement. What do you think about this improvement? Having that dialogue between us and the persons in the real world, or I call them the ones that are on the floor, in the firefight, thick of things to be able to, you know, join with them together to make an all-inclusive workflow or a comprehensive workflow, as you talked about, and I love that fact, I absolutely love that fact. The second thing that I love about having you here is that you love to educate. That is one of the big, big holes that we’re missing in informatics, is we don’t have enough educators. A, we don’t have enough educators, B, we don’t have enough educators with actual backgrounds. So for you to have a background, a love, a passion, and you’re giving that to your students, you’re almost lighting their torch, and I absolutely, I love that, I love that.
Blake Lesselroth:
Well, bear in mind, though, I think, I’d love to like to think I’m lighting their torch, but sometimes when they just want to learn about hypertension, like, let’s talk about data science, they literally burst into flames. So I know, I know, if you, yeah, if you want to like, if you’ve never, you know, I don’t know, mixed Vicodin with daiquiris, talk data science, and watch your, watch your students slowly slip into a coma. Now, I agree with you, but I do think it’s for people like you and me, I mean, I’m glad you’re doing things like the podcast because I think for people like you and me trying to share that passion, we have to be pretty creative about how we do it. Because once you’re there, yeah, our job is pretty cool. But for people that aren’t sort of the uninitiated, I think it sounds, it can sound dry, right?
TJ Southern:
It does, it sounds boring. You, let me tell you, I can’t even tell you how many people that I’ve gone to school with who got informatics degrees became informaticists, they were nurses, became informaticists and then they got the computer, right, or they got the analyst job, and six months later they were like, I’m going back to the floor. So it is not for everybody and I’ll make sure that I, you know, voice this on the cast so that people know, no, it’s not for everybody, you have to have a certain level of passion. You have to have a certain level of, you know, self-starting. You have to have self-determination, right? Because there are many times where you’ll come into these projects or you’ll do things in informatics and you’ll be like, Oh my God, like this ain’t me, right?
Blake Lesselroth:
Well, you know, so I 100% agree with you. One of the things I tell students, though, is my suspicion is, as most of the stuff I’m saying, you know, like the back of your hand, one of the things I do tell people, though, as I go, you know, I’m middle-aged, mid-career, I’m mid-career, and I’m like, you know, and I have had people ask, well, you seem still pretty happy. How do you do that? I go, Well, one thing I do like about informatics is that there are enough different niches out there that you can kind of pivot and reinvent yourself. So there was a period of time where I was doing lots and lots and lots of ops because to, operations, because again, for your audience, you know, what do I mean by operations? I was doing a lot of systems reengineering, data analytics, menu design, and it was fun. But then there was a point where I’m like, I needed to reset a little bit. And the thing is, is, so now like the number one thing I do, so I actually went from Oregon Health Sciences University in the Portland VA. I moved over to University University of Oklahoma School of Medicine. Why? It was time for a reset. Not anything bad before, but it’s like I need, I actually want more interpersonal interaction. So you were talking about, hey, you’re a nurse, you’re now a nurse informatitian, they sit you in front of a computer. Hey, man, this isn’t for me. You know what? Great. Then get up out of the seat. Find a position that basically, it gives you lots of human interaction. I, now, the majority of my job now is teaching informatics, and right now, my area of emphasis is telemedicine, it’s really fun. I mean, it is really fun. So I agree with you. I do tell people that I’m like if you’re the kind of person that you’re looking for career longevity, protection against burnout, flexibility, and the autonomy to sort of change trajectories as it’s, as your personality changes. My personality has changed, my age is different, my goals are different, that’s okay, I can readjust my job to meet those things. So for younger people, I’m like, that gives you a lot of flexibility over the long term. I’m sure you’re thinking, I’m guessing you’ve had the same experience.
TJ Southern:
I love it, I love it, I love the fact that you have just bust the whole door wide open to tell people that there are so many niches in informatics. Y’all, have heard me say this before. So let me say this again to y’all, get your pen and your paper because Dr. Blake did drop some nuggets, so I hope y’all taking notes. There are a lot of niches in informatics. So if you try the first time and it is not what you want, pick up and start again, go to another arena, do something else. There’s so much available in informatics. It is literally a Rubik’s Cube, I’m telling you, y’all can design, create, whatever position it is that you want. It’s not a one-all shot in the dark. So please don’t leave informatics just because it didn’t, you know, it didn’t work out the first time. Go somewhere else, do something else. So what are some of the biggest challenges that you’ve seen, right? Because it seems like you’ve been in this industry for quite some time. What are some of the biggest challenges that you’ve seen over your year, years of career span?
Blake Lesselroth:
I mean, I don’t want to suggest that they’re insurmountable and I want to kind of keep floating on your, sort of, your ray of positivity. So without trying to bring the audience down too much, one thing that I’m still, I still have mixed feelings about, that I guess I’m kind of working through is, when I started, and I don’t know if you’ve had the same experience, TJ, when I started, there were, there was a much more sort of, there is a much more sort of mixed ecosystem out there of systems and approaches, EMRs, peripherals, you name it, like programs. And I was actually working in the Veterans Health Affairs where, for those people that don’t know the Veterans Health Affairs, they had their own EMR that essentially was public domain, the computerized patient record system. So the beauty of it was is, so I was sort of initiated into this profession in an environment where you could sit down and go, you know, I think we need to design a new alcohol withdrawal protocol that’s safer and is evidence-based or whatever, and you just go and boom, you can put it in and you can sit down with stakeholders. So I think the things to say are, one, there’s a lot of flexibility just sort of build to suit based upon local contexts. Two, it was a great opportunity where it was sort of democratized in that a lot of people could sort of pull up a chair to the table, people that either content experts, developers or implementers and go, I have something that I can share as a member of an interdisciplinary team. And also, it was a very sort of open time for sharing knowledge. Hey, this worked, how do we basically get that information out there and published? We try this particular implementation bundle, it seems to be the secret sauce in this environment, or we try this and it was a complete dumpster fire, you know, sharing that research for how it was meant to be used. Research is really most importantly, is to share knowledge so that we, each, basically all boats rise together. Over time, and this is where I’m ambivalent, as the industry of EMRs matures, you’re going to start to see some players sort of prominent in that environment, you know, commercial vendors. Now, on one hand, you need that maturation, I know this, and I’m going to be interested in what your response is, TJ, I know this is part of the lifecycle in technology. You’re going to have some programs that emerge as stronger, you have some products that are more user-friendly or that provide more of the functional capabilities. And in our environment, especially in a capitalist economy, some are going to become more dominant, great. What I wonder, though, is, at what point does that actually slow down innovation? Because I read a, I read, I was reading a book once where they were talking about one of the benefits of like open source, like Apache and Linux is that you crowdsource from the community and the wisdom of crowds dictates that you’re going to get the best products over time, and then the community kind of polices that product to make sure that it’s safe, that it’s standardized, that it meets needs, that it’s shareable. But when you’re in something like more like where you’ve got specific vendors, it’s a very different environment where the motivations to develop are different, the people they hire are different, the primary driver consumer may not be the clinician, it may be the healthcare administrator or the, and so to me, I’m sort of wondering, is that either slowing innovation? Is it creating embargoes on how we data share or our technologies? And also, is it also impacting research if there’s nondisclosure or gag clauses, and some of the things that you found on an ADD. The unpleasant side of it is are we sharing that in a way that we’re all, again, it’s all rising together? I don’t know. I guess so, challenges to me, I’ve had a sort of a roller coaster of emotion about what that means in terms of people like you and me. I don’t know, TJ, I don’t think there’s a right answer. And I’m kind of curious, what do you think? Has that been a source of?
TJ Southern:
There is not a right answer. But let me tell you, the embargoes that we have had on data sharing have existed from the beginning. We have vendors, large vendors, that do not want to play with other vendors in the sandboxes. We have vendors that will lock down their sources so that other vendors cannot connect to or pass through data. We have a whole host of vendors that will not share, don’t want to share, don’t want to link up, don’t want to implement. I can’t even tell you how many vendors I’ve worked with that don’t want to do that, don’t want to do.
Blake Lesselroth:
Health information exchange?
TJ Southern:
They, don’t want to do HIE at all. And I’m like, there’s no way that you could have a complete healthcare picture of your patient without having HIE.
Blake Lesselroth:
Oh, yeah, absolutely. My, actually, the chair of my department at OU, Dr. David Kendrick, so he oversees a health information exchange for Oklahoma, my health, and the exact same thing, he’s like, how can we possibly move to a better state of quality unless we at least are able to connect and see a longitudinal picture of either how patients receive care, where they are in our environment? I mean, exactly, you’re exactly right.
TJ Southern:
And then what happens is, so now we have all of these things rising to the top now, right? Social determinants of health, right? And we’re finding that SDOH is not just in the healthcare system, it affects all the other things around the patient: where they live, where they work, where they pray, where they play. And the persons that are going to be responsible for gathering all of this outside information that is going to end up in the healthcare systems, because we are the ones that have the databases to capture that data, right? And I’ll throw one question back at you, even in this same vein. So getting to that HIE exchange, right? Where vendors don’t want to share the data, but now we know we have these things that are rising to the top, like all of this stuff with the SDOHs, is that really going to be fair to put that back on providers to collect all of this data because we’re the only ones that have the database to do so?
Blake Lesselroth:
Wow, that’s an interesting question. So, you know, gosh, I so wish, God, I would love, love, love to host you here at OU. We did, just last week I was actually chairing, so at our campus, the School of Community Medicine, the reason where the School of Community Medicine is, we put our school mission as there’s a heavy emphasis upon, on what we’re doing as healthcare professionals to be good stewards of our community and to help with that transformation. So it’s interesting you say that. So I was the chair of the advisory planning committee for this year, and bear in mind this is an interdisciplinary event. So for four days, matriculating students in medical school, PA school, nursing school, social work, urban development, we bring them together and that’s the overarching mission, is kind of what you just said is, we said, look, and this was sort of part of my keynote, as I said, you know, we’re at a point where we, there’s two roads ahead of us. We can either continue to do what we have been doing, which is … freedom, or we can embrace a larger professional role and accept that if we’re going to break the cycle of illness, improve our community’s quality of life, then we’re going, I said, we are going to have to accept a mantle of responsibility. We have a banner of purpose that we have to pick up. We have to lead transformational change, and that doesn’t happen just in the primary care clinics or in the hospitals. It’s going to happen at the community health centers, at our school systems, in our churches. And so I kind of looked out on this audience of students, you know, and I said, so you guys, we have to galvanize around this sort of shared vision. You know, we have to kind of look between the stars and to sort of that blackness of the unknown and go, how are we going to transform our community? And it’s not going to stop at our clinic doors. And I said, So I hope this inspires you. I said, I hope it doesn’t scare you. I hope that doesn’t scare you off of medicine or healthcare practice, I said, but I looked around the room and I said, You know, I honestly believe when I see you, you know, each and every one of you, first of all, you guys all have an incredibly important role. We have to have flat organizations where we each respect each other’s professional skills. And I said, But then also we have to, I said, we’re going to have to be educators, project managers, data scientists, implementers. I said, we’re going to take on, I said, So when I look at each one of you, I don’t just see a person, a doctor, or nurse, I see sort of a Swiss army knife. But I guess the good thing is, I think, TJ, while maybe that would have scared people in the past, like, Whoa, whoa, whoa, I didn’t sign up for this. I think this generation maybe is willing to take on that responsibility to sort of own that. And I guess when you say, what gives me hope or where do I find joy, that actually made me pretty happy. Actually, there was a lot of joy that day because I looked around the room and I didn’t really see people sort of locked gazes and they’re like, Yeah, I might be that person that’s going to transform healthcare. So, but it’s interesting you say that because that was the entire sort of thesis statement was, is you are here not just to manage disease, you are here to cure communities or to not even cure, to help communities be the best versions of themselves.
TJ Southern:
And that is where … Yes, that is where healthcare is going. And the thing that I love about it is that is what informatics supports. And I love that because that’s our job as informaticists, right? Now, we know that all of these healthcare providers, we know that they have to collect now insane amounts of data. Okay, so now as an informaticist, it’s our job to find a way for you to collect that data but not bog you down, slow you down, but make sure that you have all of the parten data that you need and that the appropriate courses of action for care are being taken while your patient is being seen. Somewhere along that continuum, if this patient does not have access to their medications or if they cannot get proper food, or if all their diet consists of is Burger King, somewhere along that continuum of them seeing your primary care, your specialist, your case manager, your regular nurse, your NP, somewhere along that continuum, someone needs to say, hey, can we get you to a dietitian? Can, we need to figure out why you’re not eating properly? Because, yes, we’re doing all this care, but you’re still picking up 30 extra pounds, so something is going on, right? So that I look forward to.
Blake Lesselroth:
Yeah, so, TJ, I really have one question for you. How do I get you here? How do I get you? I need you in Tulsa, I want you here, right here. Because everything you just said, that right there, that is essentially, you’ve just encapsulated our entire school mission better than I could have. So, yes, 100%, yes, yes, yes.
TJ Southern:
Thank you, thank you. It has been a pleasure to talk to you today, a pleasure to talk to you today. So do you have any final words because, you know, I’m going to get DMed, and then they’re going to tell me to bring Dr. Blake back on. So that’s not even a question. Me and you, we’re going to talk, I’m gonna bring you back on, we’re going to finish the conversation. But is there any parting words that you would like to give to informaticists, future informaticists, people that are thinking about coming into this field?
Blake Lesselroth:
Wow, that’s a great question. I would say yes. If you’re an informatitian, my current passion point is design thinking. And if you’re a person, if you, like TJ or like me are sort of, if you’re motivated by a vision of transformation, one way to start to think about it is, when I was younger, oftentimes I thought the best ideas were in my head. I don’t think that anymore, I think the best ideas come from an iterative process of co-creation with other people. And so design thinking, there’s, hey, there’s user-centered design and there’s human-centered design, so your colleagues, depending on what field they’re in, have probably heard some version of this, but at the bottom line, I have definitely, I definitely believe that, I’ve been reading a lot about design thinking, trying to incorporate it into my lesson plans, I’ve been talking about with other people because I feel like a couple of things. One is, it heavily emphasizes the importance of an iterative process. It heavily emphasizes breaking past your first ideas, pushing past the initial ideas to get to breakthrough innovation. Breakthrough innovation is usually not obvious. It forces you to interact with people outside of your field. I think the wellspring of innovation comes from the intersection between unlike disciplines, and at its core, it forces you to think more creatively, artistically, and I like that idea of, I like kind of trying to bring in sort of that creative brain. So I would say, look into that because it might inspire you in ways that, stuff that we said didn’t. So, I don’t know.
TJ Southern:
Love it, love it, love it. All right now, so if y’all want to get to Dr. Blake, y’all can definitely find him on LinkedIn. And of course, you know, I’m always here. You can definitely come and see us here on the Outcomes Rocket.
TJ Southern:
Hey, y’all! Thanks for joining us today for another episode of the Outcomes Rocket Network – The Future of Global Informatics Podcast. If your organization is looking for informatics talent, go to www.Beryllus.net. That is www. B E R Y L L U S .net, and we can assist you in finding some of the best nursing informatics talent this continent has to offer. We’ll talk to you later! Have a great day! See ya!
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