<v Jordan Cooper>We are here today with Jake Lancaster, Chief Medical Information Officer at Baptist Memorial Healthcare CMO at Baptist Medical Group and Co, host of the right care at Baptist Podcast and the Baptist management system connecting the Dots podcast. Jake, thank you so much for joining us here today.</v>

<v Jake Lancaster, MD>Glad to be here. Thanks for having me.</v>

<v Jordan Cooper>Sure. So today what we're gonna do is we're gonna dive into a pilot project that you've been working on over at Baptist Memorial Healthcare. And that's with the Dragon ambient experience or DAX pilot for our listeners. Dax is a comprehensive AI powered, voice enabled solution, uses ambient sensing tech to listen securely to patient, clinician and counters. There's a phone app. It's part scribe, part AI. You started this.</v>

<v Jordan Cooper>Demo this past summer.</v>

<v Jordan Cooper>In addition to talking about what it is and how you're using it, I know there's other episodes out there where you've described that I think our listeners are particularly interested in the challenges of implementing this new technology. So like to ask you, in addition to speaking about the nuances of how it's unique to Baptist, Jake, would you tell us about what some of the cultural challenges are associated with the implementation?</v>

<v Jake Lancaster, MD>Yeah. Yeah. It's a great question. So yeah, you describe the product, you know very well. You know the goal of the product was to have a, a virtual scribe for the physicians. So they're not spending as much time documenting in the note burnouts high. We're really trying to get them more time with patients, more time at home. And so using this virtual scribe software as a way to reduce that burden, it was the goal.</v>

<v Jake Lancaster, MD>What were the challenges? Well.</v>

<v Jake Lancaster, MD>There there's, there's quite a few, you know, starting with.</v>

<v Jake Lancaster, MD>You know, we initially we're looking for 15 physicians, 15 providers that were interested in going live with the software using our internal data, we're able to identify those that were.</v>

<v Jake Lancaster, MD>That could benefit the most from it, so those that were spending a lot of time in the chart, those are spending a lot of time after hours and notes. We're the ones we really focused on. And so we approached them early on about hey, would you like to participate in this pilot now when you start saying artificial intelligence, you start saying apps to some of these physicians that are struggling with the EHR, you get a lot of skepticism. I mean there's they don't want to try and pilot.</v>

<v Jake Lancaster, MD>A a new tool.</v>

<v Jake Lancaster, MD>You know, in that manner there may not be the the best people to pile the software, but if you went to your your doctors that are maybe part of your, you know informatics group and come to all those meetings, they're already really efficient in the EHR. And so the benefit, the ROI of the software might not be there for them. So it was really tough to find that sweet spot of the physician who would embrace and be willing to try something new.</v>

<v Jake Lancaster, MD>With those that are also struggling. So I would say of the of the 15 initial providers that we approached, we probably got half that were in that struggling group. That really solved the benefit and then we actually had half from our informatics.</v>

<v Jake Lancaster, MD>Uh, you know, interest group that that helped us out because we couldn't find any anymore to to fill those licenses. So that was that was struggle #1.</v>

<v Jake Lancaster, MD>And and as we saw that played out actually at the end of the pilot, the ones that struggled the most that we identified as benefiting the most were the ones that ended up wanting to move forward with it going forward. And then that the ones that were efficient already, some of them decided that it wasn't necessary for them. So it kind of but it did help, did help spread the word to the rest of the physicians that it was useful and it's not as scary that the second time around.</v>

<v Jordan Cooper>So Jake, I want to go out on a limb.</v>

<v Jordan Cooper>Maybe some of the patients who are spending sorry, some of the providers are spending a lot of time after hours. I wonder if there's a correlation with perhaps an older provider population and the more efficient ones are younger and the reason I'm going there is because I wanna talk about bedside manner. It may not be the first thought that comes to mind when you're thinking, oh, well, you know, if I'm reducing time, putting in notes during a patient interaction.</v>

<v Jordan Cooper>You actually have more time with bedside manner. I've heard it said that there's been less emphasis for younger graduates in the last decade or two of medical school to teach them about bedside manners. I'm trying to see what kind of positive and negative externalities may there be with this program. What I'm trying to ask basically, is if you free up more time for a patient provider interaction, how does that affect the the interaction? How does that affect the patient experience to provide our experience? Is there anyone who has trouble with having more time with patients?</v>

<v Jake Lancaster, MD>That's a good question and said looking at, I guess the demographics of the the physicians that went live on the software, we had a mix of old and young. We had a mix of male and female.</v>

<v Jake Lancaster, MD>You know, if I haven't looked at a cross section of our data, but there's other.</v>

<v Jake Lancaster, MD>Other studies out there that have done that with who spends more time with patients who spends more time with.</v>

<v Jake Lancaster, MD>In the EHR and writes longer notes and and it tends to be your, your female population will spend more time with patients and write longer notes and we certainly see that with some of the ones in our pilot, the physician that was spending more time than anybody else in the system writing notes was female.</v>

<v Jake Lancaster, MD>You know, and she was.</v>

<v Jake Lancaster, MD>You have been in practice for a while, but we certainly also have younger females that will spend a lot more time in the EHR.</v>

<v Jake Lancaster, MD>Sure.</v>

<v Jake Lancaster, MD>You know, and what do they do with their time when?</v>

<v Jake Lancaster, MD>We give them that time back after they've been using the software as a good question and we only we do have some survey results.</v>

<v Jake Lancaster, MD>83%, I think said that they were able to spend more time with patients and had you know higher patient satisfaction due to their perception of using the software. We've got a lot of anecdotal comments that they were able to get home in time for dinner. One said that she was able to exercise and hadn't been able to do that consistently for a while because of the work after hours. So some are, some are choosing to spend more time.</v>

<v Jake Lancaster, MD>You know, outside of the office, which is what we would hope for, I would imagine that, you know, some are also spending a couple of extra minutes.</v>

<v Jake Lancaster, MD>You know, maybe with patience or or face to face visits, but I think it really comes down to they're not having to, you know, in this came from one of our physicians and he mentioned it on the podcast we did with him recently in the room. You know, the app is recording your conversation. So you don't have to worry about making a node in the chart while you're seeing that patient. A lot of them will have the EHR still up. So if they can place orders or review lab data with their patients that way, but they're not having to spend any time precharging in their notes.</v>

<v Jordan Cooper>So.</v>

<v Jake Lancaster, MD>So they're getting about 3 minutes back per appointment using the software, about 30 minutes a day, and so some of that will go into more direct patient care or more face to FaceTime at the patients imagine. And then some of it hopefully is being spent doing outside healthcare work or not work, but enjoyment with family, friends, whatever they want to do.</v>

<v Jordan Cooper>I've heard you speak about some of the goals of this program being to alleviate burnout, reduce burden documentation, burden, increase efficiency, improve throughput and and integrate into the new workflow. One of the providers you interviewed said that on average, he had been spending 3 hours a day documenting his notes after he finished seeing patients, and that's now reduced to 30 minutes a day.</v>

<v Jordan Cooper>I guess the question I'd like to ask is how have workflows been affected? How have patient outcomes been affected? How do you think this may affect turnover? And of course, if it's too early to say then how do you expect it may affect those KPIs in the future?</v>

<v Jake Lancaster, MD>Yeah. So a couple different questions there. You know the workflow question is an interesting one. You know the doctor that you just mentioned said he did have to adjust his workflow to the software initially. And I think that may be the one of the challenges that I didn't talk about at the beginning when you asked the question was, it's not just an app you download on your phone and you do your go about your business the same way you normally would. You really do have in order to get the full benefit, you kind of have to adjust your templates.</v>

<v Jake Lancaster, MD>Adjust the way you interact with the patient slightly, and for some that's easier to do than others. But if you really want to get the benefit out of it, you have the full benefit of it. You really need to embrace and do that piece.</v>

<v Jake Lancaster, MD>You know, for that particular physician that you mentioned?</v>

<v Jake Lancaster, MD>You know, he said that he early on only was using it for certain visit types like acute visits, but then really got to benefit more when you started using it for more chronic disease management later on. And so that allowed him to get those extra hours back per day as far as you know, things that we are really looking for. You mentioned the big ones. My goal as the chemo is the CMIO is really to drive down that burnout, drive down turnover. We've had some say.</v>

<v Jordan Cooper>Umm.</v>

<v Jake Lancaster, MD>But you know, we're hoping that it will allow especially some of those at the end of their career to stay a little longer and not be overwhelmed and then just extend the careers to some of the others that may decide that.</v>

<v Jake Lancaster, MD>And the medicine is especially primary care is too much for them, and they would pursue something else, so they would stick with primary care longer.</v>

<v Jordan Cooper>A few follow up questions. One, when we say provider we only talking about a medical doctor or we also referring to nurses for whom there is a high turnover rate across the United States.</v>

<v Jordan Cooper>Umm.</v>

<v Jake Lancaster, MD>So when I say provider, I mean the traditional way to describe it. It's a physician, nurse practitioner or physician assistant. Midwives also fall into that category, so any of them would be eligible for use of this. We have not tried it with nursing. We have some other initiatives that working on with nursing. It is not a free tool. So it's certainly is something that we're actually asking our physicians to help cover the cost for through either seeing more patients.</v>

<v Jake Lancaster, MD>Or just sharing, you know, sharing that calls with us directly. So that would be a little bit tougher to do on a nurses salary, I would think.</v>

<v Jordan Cooper>So the well, the provider that we referenced earlier, who's saving 2 1/2 hours a day, he mentioned he was skeptical early on. Many of our listeners are similar to you, CMIO CIOs at large healthcare delivery systems across the country when they encounter a skeptical provider, they often when they get pushed back, it's difficult to get them to come on even when you can use data to demonstrate the value they may receive. How did you convince him to join the program when his initial reaction was he just didn't want to take?</v>

<v Jordan Cooper>Be be part of it.</v>

<v Jake Lancaster, MD>Yeah, that's a good question. And you know, I had better luck with him because he is one of our. He's actually the the CMO for our clinics down in Jackson, Ms and he's on my physician informatics group that we meet. And so when I was looking for extra people to be part of the pilot, I really turned to that group and and got them to join.</v>

<v Jake Lancaster, MD>Not didn't make them, but kind of asked them several times and to get. Maybe it was a little annoying before they joined. And so yeah, he was skeptical when he came on. He didn't think he needed it. He was again very, very efficient Dr.</v>

<v Jake Lancaster, MD>But he he was a high volume doctor, so sees, you know, 30 plus patients a day. And even though he was efficient, even saving a few minutes per encounter saved him a ton of time. Like like he said in in the order of magnitude of hours for him. And so once he trialed it, he started talking to his colleagues down in Jackson. And now I get more requests from them about when you're going to open this up to the rest of the population.</v>

<v Jordan Cooper>Umm.</v>

<v Jake Lancaster, MD>Than any other place in the system. So it's that word of mouth from somebody that is using it that is really helped them. I think the testimonials are key. So the pilot at each organization is is pretty crucial to making it last or or making it go forward if if we wouldn't have had half the doctors in the pilot say that they will go forward. Not only do they want to move forward with it, but they're willing to pay for it out of their own pocket because it's changed their careers.</v>

<v Jake Lancaster, MD>It would have been tough to find others to do so. Now I'm hoping that with some of these testimonials I can share those with those that we approached at first that were skeptical of new technology.</v>

<v Jake Lancaster, MD>The ones that are really struggling and convince them that it's it'll it'll really give it a try and then it's gonna help them.</v>

<v Jordan Cooper>What are some of the challenges of expanding beyond the pilot to the rest of your provider population?</v>

<v Jake Lancaster, MD>Yeah. So one of the big challenges for us is the model we have set up is we're asking the providers to, you know, cover the cost of it so that we can expand. It's been a tough year for health systems. If you read the the papers. So we don't have a lot of free cache lying around even if it's going to reduce turnover, if it's gonna make you more, Dax will share that there's an ROI to this. It's hard to convince your CFO to fund something like this. So making it cost neutral was something we wanted to do. And so.</v>

<v Jake Lancaster, MD>With. By doing so, we have to ask the providers need to see more patients or or share that direct cost with the pilot we get. We had some from our foundation some money from our foundation to sponsor 3 months of of licenses for these 15 physicians. We don't have that money anymore. So going forward if if a new person wants to trial it, they'll have to pay for it at least for that first month. And if they don't like it after that first month then we can repurpose that to somebody else. But that's a challenge it's.</v>

<v Jake Lancaster, MD>You know, it's a little a bit of a risk for that provider if they, especially if they get off to a rocky start.</v>

<v Jake Lancaster, MD>Umm, which can happen? You know, such their model the way it works.</v>

<v Jake Lancaster, MD>Is early on.</v>

<v Jake Lancaster, MD>You know, there's not as much artificial intelligence baked into describe process. It's mostly.</v>

<v Jordan Cooper>Yeah.</v>

<v Jake Lancaster, MD>A third party group that's overseas that is actually serving as virtual scribes that are doing this. And then after I forget how many encounters the AI kicks in more, but early on you're relying on people to transcribe these and dictate these for the providers and the quality will vary between those scribes. And so if maybe one provider.</v>

<v Jake Lancaster, MD>In that first 30 days to their trialing it gets some variation that they are not happy with. They may not continue with it.</v>

<v Jordan Cooper>Umm so.</v>

<v Jake Lancaster, MD>So overcoming some of that is will be a challenge for us to move past the pilot phase.</v>

<v Jordan Cooper>Do you are your key KPI reducing turnover and improving patient satisfaction with he does measures or there's some other KPIs that you're using to evaluate the success of the program?</v>

<v Jake Lancaster, MD>Yeah. So right now I'm mainly looking at our data and epic signal, which is time and nodes. Time spent after hours and pajama time is the the majority of what I I care about.</v>

<v Jake Lancaster, MD>You know? And then I wanna make sure that that those are going down, that they're spending less time and and epic. That's the only.</v>

<v Jake Lancaster, MD>You know, and if they're satisfied with the product.</v>

<v Jordan Cooper>Right.</v>

<v Jake Lancaster, MD>You know, it doesn't matter to me because it's cost neutral for us as a system that a mainly want the physicians to be more satisfied and have less burnout. You know, all the rest patients satisfaction. Everything else, yes, if that improves, that's great.</v>

<v Jordan Cooper>What would it?</v>

<v Jake Lancaster, MD>If it goes down, yes, we'll have to reevaluate, but I couldn't imagine that happening. But in the main thing I'm worried about is just reducing that burnout and stress.</v>

<v Jordan Cooper>What would it take to get an executive sponsor with actual funding behind it at Baptist?</v>

<v Jake Lancaster, MD>Well, you know, first of all, I I think just the.</v>

<v Jake Lancaster, MD>The ecosystem that we're living in, you know the financial environment that health care is in needs to turn around before a system like ours, who doesn't have some large foundation endowment innovation fund available.</v>

<v Jake Lancaster, MD>That that environment needs to.</v>

<v Jordan Cooper>Got it.</v>

<v Jake Lancaster, MD>To turn around a little bit before we can, you know, support something like this as at an enterprise level, you know certainly and I'll help with analyzing that data if.</v>

<v Jake Lancaster, MD>I'm tracking these providers over the next year or two and we are showing huge ROI, huge number of being able to add spots and I'm able to take that and show it to the CFO that you know is actually cost effective for us to pay for this.</v>

<v Jordan Cooper>Umm.</v>

<v Jake Lancaster, MD>You know, for the providers, instead of asking them to share the costs, then that may be a different conversation that we can have, but we'll need a lot more data and a little bit more time and probably a better financial environment for health, large healthcare systems. And when that happens.</v>

<v Jordan Cooper>To Jacob, I've heard you previously mentioned that one of your top goals is in addition to reducing the documentation burden, you're also as an organization looking to increase patient portal sign UPS and patient engagement in your patient portal. Your digital front door. Have you found any correlation between the use of this product which leads to more patient provider interaction time and actually achieving that organizational goal of more patient engagement?</v>

<v Jake Lancaster, MD>Now we have not compared it to patient engagement. I would say that you know, most organizations have had that patient engagement, patient portal sign up as at goal prior to the pandemic with the pandemic. If you had that as one of your organization metrics that you were tracking.</v>

<v Jordan Cooper>Got it.</v>

<v Jake Lancaster, MD>You know you're you hit that easily in 202021 and 22. It was. Everybody flocked to online options. And so yes, that is still something that we have out. There is a goal but it we essentially achieved what and surpassed what we thought was was an appropriate goal at the time just because of the way the world turned. So that has created a different problem because now that we have so much so many patients on.</v>

<v Jake Lancaster, MD>On my chart on the patient portal, sending messages to their physicians and pools digitally, you may have seen that you know in basket messages, patient messages to physicians have spiked over the last couple of years and that has put a different burden on her primary care doctors that I'm working on also, which would probably be a different episode.</v>

<v Jordan Cooper>Yeah. So I think there's kind of a a suite of questions that are all related. I wanna ask you to delve into and I'll let you determine how you'd like to answer. I'd like to ask about the quality assurance challenges and the back end. You said there's variability in quality, but also because you're using a third party app and people who are transcribing it presents a potentially a new cyber security risk. And I'd like to ask how you and then you also have a cloud migration strategy, this on Prem. Is it in the cloud, so a variety of implementation challenges are just to review I asked about.</v>

<v Jordan Cooper>OK, QA with variability, cyber security and cloud migration.</v>

<v Jake Lancaster, MD>Yeah. So the the QA comes in a couple different ways. Like I said, you know.</v>

<v Jake Lancaster, MD>Daggs nuance have been, you know, very supportive. If we do have concerns about particular quality from a particular scribe, they're scribe name is listed on the note. And so we can communicate with them and let them know, hey, this person.</v>

<v Jake Lancaster, MD>Is not doing a good job and what they can do is they can reassign only certain scribes to that particular provider. So you know, we've had to do that in a couple of cases where.</v>

<v Jake Lancaster, MD>Providers that are, you know, I've been working with these, these worked really well. These not so much. I'm having to go in and actually change spelling errors, grammar errors, things of that nature and they've reassigned to have a little bit more tighter focus on with a smaller number of scripts for them also.</v>

<v Jake Lancaster, MD>You know, and like I said, the AI piece is not fully kicked in yet, but each time the provider gets the note back, they edit the note and then those edits are sent back to Dax.</v>

<v Jake Lancaster, MD>So that the engine can learn what was changed from what they had sent over, you know with.</v>

<v Jake Lancaster, MD>The hope that, in my understanding is that in the future those changes should be baked into the artificial intelligence. We're too early in the process to know if that QA yeah QA piece is working yet, but that is part of what is built in.</v>

<v Jake Lancaster, MD>And they have been very receptive if we do have, you know, thoughts or suggestions about ways to change, at least in my experience, early on, we'll see what it's like post pilot, cyber security challenges, like any new technology would bring on. We do have our security review it and to make sure that it meets all of our standards for encryption with the data in transit or in rest I.</v>

<v Jake Lancaster, MD>Stay as far I don't stay as far away from that process is is I. I can. But you know, I was not part of the security review. I just know it passed our security review and we're a fairly conservative organization. So it's.</v>

<v Jake Lancaster, MD>If there was a a big cyber security risk, I would have expected our team to, you know, pump the brakes on it.</v>

<v Jordan Cooper>Umm and and and the implications of the cloud migration.</v>

<v Jordan Cooper>Yeah.</v>

<v Jordan Cooper>Umm.</v>

<v Jake Lancaster, MD>No, no, not for. For what we're doing. You know we're, you know, participating in epics, hyperdrive migration, you know to its more web-based platform and then also you know nuances is using this in the cloud. So that it really wasn't anything specific. The main thing that we have to do is send HL 7 messages over to Dags that they know what the position schedule is for that day. So they can get the match up that.</v>

<v Jake Lancaster, MD>The recording to that patient and then put it back into to epic.</v>

<v Jordan Cooper>Got. So we are approaching the end of this podcast episode, given that I'd like to ask invite you to offer a message to our audience.</v>

<v Jordan Cooper>To wrap things up, maybe they're looking to implement a new, a new innovative program to address some of their challenges or physician turnover burnout to improve patient experience, patient engagement. What have you learned from this process that you might be able to share with other tech executive leaders, peer organizations that you think could be helpful if they were to try to implement the pilots?</v>

<v Jordan Cooper>Like similar to this.</v>

<v Jake Lancaster, MD>Yeah, learn several things. You know, first I would say that it's one of the more successful pilots I've had.</v>

<v Jake Lancaster, MD>You know, as far as feedback from the the pilot group, you know we we put out a lot of new features, a lot of different things and ask, you know, I asked my informatics group to to help pilot and a lot of times I get back a few. Oh yeah, it's helpful, but it's not gonna make a large impact on my well-being. This is probably the most significant thing that we've put in to help with physician well-being.</v>

<v Jake Lancaster, MD>That I've ever had.</v>

<v Jake Lancaster, MD>And you know, I would say that in that would encourage me to to continue early on I was.</v>

<v Jake Lancaster, MD>I got nervous because I saw a presentation on this at at Epic U GM or ex GM and it was a rocky start for one group's pilot.</v>

<v Jake Lancaster, MD>You know, they mentioned that it really took 100 days for the.</v>

<v Jake Lancaster, MD>For the positions to get used to the changes and get comfortable with the software and we only had a 98 pilot so it's like, well, we're gonna be 10 days short, but.</v>

<v Jake Lancaster, MD>I was really encouraged when I heard back from some of the positions about how how great they liked it, even within the first couple of weeks.</v>

<v Jake Lancaster, MD>The second thing is is choosing your pilot group is very important.</v>

<v Jake Lancaster, MD>Ideally, you're gonna want somebody that is.</v>

<v Jake Lancaster, MD>In clinic every day, seeing a fairly high volume of patients and also you know spending a significant amount of time in notes, you know it's not gonna be for the person that is, you know part academic part.</v>

<v Jake Lancaster, MD>In clinic or somebody with a more administrative role that's in clinic a couple days a week, it really needs to be somebody that's probably there, you know, full time to get that full benefit.</v>

<v Jake Lancaster, MD>And that being said, it's it's going to be tricky, at least early on to to again find the ones that are.</v>

<v Jake Lancaster, MD>In need the most, but also willing to adopt something new and so that's a you'll just have to work within your organization, know who your docs are that are.</v>

<v Jake Lancaster, MD>And easier to work with than others, and you know, circle back to the ones that may be more late adopters after you've ironed out a few of the kinks.</v>

<v Jordan Cooper>Well, thank you, Jake again for our listeners. This has been Jake Lancaster, chief Medical Information Officer at Baptist Memorial Healthcare CMO at Baptist Medical Group and Co, host of two podcasts, the right care at Baptist and Baptist Management system, connecting the Dots podcast. Jacob like to thank you for joining us today.</v>

<v Jake Lancaster, MD>Thanks so much for Jordan.</v>