Episode 5 : Weaving Ambient Intelligence into the Fabric of Care Delivery:

SCTS_Eve Cunningham.mp3: Audio automatically transcribed by Sonix

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Intro/Outro:
Welcome to the Smart Care Team Spotlight presented by Care.ai, The Smart Care facility, platform company, and leader in AI and ambient intelligence for healthcare. Join Molly McCarthy, former CNO of Microsoft, as she interviews the brightest minds in healthcare about the transformational promise of AI and ambient intelligence for care teams.

Molly McCarthy:
Too often, technology makes caregivers lives harder, not easier. It's time for smart technology to empower care teams with a more human touch. We're fortunate to have a unique and compelling digital health innovator, Dr. Eve Cunningham on the Smart Care Team Spotlight today, Dr. Cunningham is an OB-GYN by training and currently serves as the chief of Virtual Care and Digital Health at Providence, one of the largest and most innovative health systems in the country, operating 52 hospitals across seven states. I also wanted to share Dr. Cunningham's LinkedIn bio as I think it's fantastic: techy Dr. Innovation catalyst, Data Nerd, AI and LLM evangelizer, blockchain enthusiast, digital care dreamer, cybersecurious, early adopter, care transformation accelerator, physician and provider whisperer. So health care is changing, physicians and providers need to be part of that change. So I'd like to welcome you, Dr. Cunningham, today, and thank you so much for joining us today on the Smart Care Team Spotlight.

Eve Cunningham:
Thank you for inviting me to be here. I'm really excited to have this discussion.

Molly McCarthy:
Great. I'm going to jump right in to our first question. And we talked a little bit before we got started, but we launched this podcast intentionally naming it the Smart Care Team, recognizing the team array of clinical roles and disciplines that must come together in unison to provide the best possible care, and how transformative technologies may enable these caregivers to work together in new ways. And just for our audience, and just from your experience, I would love for you to define a smart care team and your vision for how care delivery will look different in the future as a result.

Eve Cunningham:
Yeah, that's a great question, and hopefully I can get people thinking really what the future of healthcare is probably going to look like. And when I think about a smart care team, I don't necessarily think about the players necessarily being different. We will need doctors, we will need nurses, we will need medical assistants, we will need CNAs, hucs. We'll need all of these folks that are supporting the care team pharmacists, diabetes educators, behaviorists. All of those folks are still going to be very, very critical. But we're going to have to reorganize to some degree, how we do the work and how we deliver care, and technology has so affords us so many different opportunities to be able to do that in different ways. But it's almost like you're repiping the way that we deliver care, and so that's really challenging. It's not going to happen overnight. It's going to be kind of messy probably in the beginning, but it has been messy, we already know it's been messy. But I see, for example, for inpatient care, I currently oversee a very large virtual care and digital health team, at Providence. We deliver nine enterprise clinical services, we have a hospital at home, remote patient monitoring, tele hospital home, and we have digital products and things that we deliver into the clinical space. We also have a telenursing or co-caring model that we've launched as well. And what we're doing is we're integrating technology into all of these spaces and leveraging that to be able to deliver clinical care in a different way or more efficiently. And I see in the future in the hospital, every single hospital bed is probably going to have what we call an endpoint.

Eve Cunningham:
It's going to have a TV with cameras and sensors and things like that inside of it. That's going to help us be able to work more smartly or beam in and out specific caregivers or specialists in and out of the room, so that we can stretch the capacity of those individuals and also take some of that administratively burdensome work off of the backs of the people who are boots on the ground. Again, it's more like we're reorganizing the way that we provide the care, but not necessarily changing who the players are. And then the same thing for hospitals. Not everybody necessarily needs to be in the hospital to get hospital-grade care, or can we get patients out of the hospital sooner because we're providing more monitoring or support for the patients in their homes. So care in the home is another one where we're just scratching the surface of that. But that's really going to start to grow. And part of the reason that we need to do all of these things is because I see these three very significant macro trends that are that we're experiencing here in healthcare today. One is we have a workforce shortage, I mean a massive, massive workforce, shortage of nurses, of doctors, of clinicians. We just don't have enough people to take care, with the way that we're doing and delivering care today, we don't have enough people to do it. We have to do it differently. Reorganizing our teams is going to be one way of doing that and the way that we deliver care leveraging technology.

Eve Cunningham:
The second is hospital capacity. We have a massive amount of patients who are aging into the Medicare system every day, I think it's like 10,000 and from the boomer generation, and we don't have enough hospital beds in most areas of this country. And hospitals are closing, especially in rural areas. And so we have to figure out a way to expand hospital capacity without expanding brick and mortar, because nobody's really building hospitals. Nobody has capital to build hospitals today. So again, how do we address that? Through technology, through innovation, through virtual and digital care. And then the last is around access, access to care and care fragmentation that's occurring. Patients can't get in to be seen, and I just recently got an appointment for primary care provider. It was a four month wait for me to get in to establish care. And so we have significant again, it kind of goes back to some of the shortages that we have of providers. But if we reorganized ourselves a little bit better and leverage the technology, we can better deliver that access. And then the last thing I would say is we talk about smart, not only is it virtual and digital and having cameras and sensors and things like that, but then Ai, right? How do we augment, not replace, but how do we augment our teams and support them with this game-changing technology that just came out and is exploding? And how do we implement that in a smart way?

Molly McCarthy:
I think those are all such wonderful points, and just to recap, I loved your point in the beginning. Just in terms of the smart care team, we're not necessarily eliminating members, but we're really reorganizing and different formations, so to speak. And also just the three macro trends I want to mention, again, workforce shortage across really all disciplines, not just nursing, physicians, but looking across the broad spectrum of players. The second point really around hospital capacity, not enough hospital beds. I know you mentioned in rural facilities, some closures. I know like maternal services, for example, and some areas no longer able to support those. The last point around access to care. And we'll talk a little bit more about some of the technologies you mentioned. But, I do want to go back to the point where you started to talk about some of the different enterprise services that you have within Providence. You mentioned hospital at home, remote patient monitoring, telestroke, telenursing, I think, virtual nursing, and really across the care continuum. And so as you start to think about workflows and reorganization and technologies to support these various programs, how do you guard against the risk of fragmentation? And think about how best to ensure we are better serving our patients? Our physicians? Our nurses? and our team members at the same time? So that's part one of my question.

Eve Cunningham:
Yeah. And actually, can I make one point about the last question before I answer that?

Molly McCarthy:
Sure.

Eve Cunningham:
I talked about reorganizing the work for the nurses, and the doctors, and the different care team members, and I forgot to mention that one of the members of the Smart Care team is the patient themselves. Right? And how do we empower our patients too? Right? With and enable them to self-serve with some things and leverage technology to support them as well. So do think that's an important part because they are a part of their their care team as well.

Molly McCarthy:
100%. Thank you for mentioning that.

Eve Cunningham:
Yeah. As far as fragmentation and workflow, that is just that is the actual, gazillion-dollar question actually. That's what I preach all the time because we have been subjected over the last decade I would say most I would say intensely over the last like five years to technology companies coming in and saying they know how to solve for healthcare and throwing technology into our space and assuming something's going to stick and it's and it doesn't get adopted and nothing changes, or it only solves a little piece of the problem, but it does. It's like a piece of technology that doesn't talk to this piece of technology, that doesn't talk to this piece of technology. And so the most critical aspect I talk about workflow, workflow, workflow. One of the most critical aspects of bringing technology into a clinical space is understanding how the work is done, which is why I think it is so incredibly critical and important that clinical folks are involved. Clinicians and clinical operators need to be involved. Now they have to be willing to change. They have to be willing to think differently about the work, but they need to be part of the process of evaluating the technologies, and they should be partially responsible for the success and implementation. It's not just a function of an IT department anymore.

Eve Cunningham:
IT is there to partner with us on all of these things, but really we need to own it. And so that's what my team does. When we're looking at solutions, when we're evaluating solutions, we are also evaluating it in the context of how is this going to fit into our ecosystem. How will this integrate with our EMR or with our other systems that we have? What is the workflow experience going to be for the clinician if they're leveraging this? Do they have to do extra clicks? Do they have to do extra steps? Because all of those things need to be factored in, when you're evaluating what you're going to bring in and your goal with any solution, obviously when you're first trying some things out, maybe all those integrations are complete, but your goal is like envisioning, like what is the end to end seamless experience going to be? Because that's going to set me up for the highest opportunity for success. And so we really, I mean, I preach human-centered design. I say clinician-centered design, but if you create a solution or implement a solution that is clinician-centered, meaning it makes it easy for the clinician, it makes it easier for them to actually deliver care, then they're going to take better care of their patients.

Eve Cunningham:
Patients are going to benefit. So the way that we look at it, the other thing I would say is there are so many great innovative solutions out there. I have not the opportunity to be exposed to a lot. But, we as a health system, we are a big beast. Okay, we're eight states, 52 hospitals or seven states, 52 hospitals, 10,000 employed providers, millions and millions of patients, one of the largest epic customers in the country. We can't have, like, all these little point solutions integrated into our system. We have to be looking at things from a platform approach and the things that we plug into our system. We're looking for scale, we're looking for mass impact, we're looking for multi-use cases. We just don't have a tolerance to have individual little point solutions stacked up against each other. We can't maintain it. There are security risks associated with that. So we just we have to we have to think broadly. And so whenever there's vendors approaching me and everything like that, think about the problem you're trying to solve. And also like what is the size, scope, and scale and how does it fit into our ecosystem, our current technology ecosystem? And does it fit? Those are questions that they need to ask.

Molly McCarthy:
I think that's so critical. And having been in the tech space and healthcare space for a while, but I loved how you started this question out. Answer out rather, and just we can't throw tech into the space and expect it to stick or fix. And really going back to the workflow and how work is done, regardless of who that person, or clinician, or patient is. And also, I've heard, just to reiterate your point around the EMRs and the investment you've made as a health system into the EMR, just to the ability to scale the solution. I remember talking with one CIO who had, I think he named over 10,000 point solutions that he had seen come in over his time. So I think the point solutions, some can be great, but I think also the ability to scale, especially when you're talking about 52 hospitals and multiple employees. What did you say? 10,000 providers.

Eve Cunningham:
10,000 providers in over 100,000 employees. Yeah. Yeah.

Great. My next question, I want to dig a little bit deeper into some of the buzzwords that are happening right now. So obviously, there's been just a deafening amount of noise surrounding AI in general. I know more so this year specifically since January probably, and generative AI in healthcare specifically, and somewhere in between the irrational exuberance on one extreme and then the paralyzing fear on the other, are we going to be replaced? Or how do you think about where you see generative AI making the most immediate practical impact? We talked a little bit about making the care team smarter. And then where do you see the greatest opportunities for transformational change in care delivery? And any if you have any examples to we'd love to hear.

Eve Cunningham:
Well, I would say providence. One of the benefits of being at Providence is that we are a very innovative organization. We're very forward-thinking. Our CIO is like all in on making sure that we have a great strategy around how we're going to approach AI. But also is realistic about the hype. And we actually have a couple of use cases at Providence where we're actively leveraging large language models. We have a partnership with Microsoft, so we work very closely with them, and we've benefited tremendously from having that partnership with them. I would say initially just low-hanging fruit, and I'm an enthusiast myself, play with GPT like daily. So I'm experiment with it and I encourage my team. I am not afraid of what's coming and do not believe that physicians will be replaced. But if you, as a physician or a provider, are not thinking about how you're going to start to incorporate this into your practice, that's when you might get replaced. And it really is going to be woven into the fabric of what we do, most likely over the next 5 to 10 years, maybe even sooner than that. What I will tell you is what we're doing at Providence is, we have a couple of things that we're doing. We have a dragon ambient experience, which is an AI scribe technology that basically listens during the patient visit and actually constructs a note for the clinician really reduces documentation burden. We've been doing that for about two years, and we have almost 2000 providers using it, and it's been impactful.

Eve Cunningham:
We have an In-basket management product that we just started piloting. That helps not. There's a lot of buzz around the In-basket management, but it's not drafting in-basket messages for our clinicians. That's not what it's doing. What it's doing is it's categorizing and and it's auto-categorizing. It's kind of understanding what the sentiment is of the patient and the question that they're asking, and helping speed up some of our nurse triage teams because they get these massive dumps of patient messages and they're not, they're not organized from like high acuity low. They're just going through one by one. And so now they can prioritize, which is really important from a safety perspective. And then the last thing I'm going to put a plug in for is a product called MedPearl, which is a product that we've been incubating at Providence for the last two years. And this is a digital assistant for providers. It's currently being used by over 5000 providers at Providence, so it's been fully it's been scaled. And basically what it does is the providers launch it, it's almost like a copilot. They launch it when they're in the electronic health record. And, they basically can ask it questions and it provides curated information, medical knowledge, that's been curated and reviewed and gone through a governance process to support them with clinical decision-making around specialty referrals. And it also pulls the relevant patient data in the context of the information that they're looking up. So it speeds up our ability not to.

Eve Cunningham:
It speeds up our ability to make better, make decisions, and to surface information that's relevant about a topic without us having to go back into the chart and dig around for things. And the reason why I think knowledge management is one of the biggest opportunities is because as a clinician, when I went to medical school, what, 20-something years ago, medical knowledge doubled every 30 years. Now it doubles every three months. So we just don't have the brain capacity to remember everything that we need to know. But having information at our fingertips in the context of a visit that can help us with those conversations with our patients, is going to help us deliver better care. And so I believe knowledge management, whether it's nursing, clinicians, even patients, is going to be one of the most, one of the greatest opportunities, I think, with these large language models. And I just want to point out with MedPearl, we are not using an LLM to create the content. What we're doing is we are leveraging AI to help with not yet at least helping with search experience, understanding what the intent of the questions are, helping the clinician navigate through the library of content that's been curated to support their decision making. So we're using it in a very step-by-step fashion to ensure that we're testing for safety, that everything's being reviewed by clinical folks before it gets released. We have a high bar for safety in mind as we think about using these technologies.

Molly McCarthy:
I love your examples. Both a dragon, the in-basket management, especially the part around being for technology to be able to scan through and look at, I don't know, triggers, etcetera. That might elevate the priority of a particular message, and then the last example I think the MedPearl can't wait to hear more about that. And to your point, there's so much information coming at us, coming at our clinicians. And how do you dig through? We they shouldn't have to dig through. We have technology that can help with that. And really to build a team that is smarter and working at the top of their license and really doing, providing that care that the patients need for a specific problem at that specific time. So great examples.

Eve Cunningham:
I tell everyone MedPearl is like taking a Super Mario Power Pack and putting it on the back of a frontline clinician. I mean, our clinicians, they love it because they that's the way they feel. They're getting like a specialty expertise like medical group basically like in their pocket that they can query and access at any time. So it's like what we call curating with wisdom. Right?

Molly McCarthy:
Right, right. That's a great analogy. I wish we had more time because you obviously had an amazing experience and insights into this world. But I do want to wrap up and considering our listeners, our really CNOs, CNIOs, their care teams throughout the healthcare system. I would love to hear from you as an entrepreneurial and innovative physician, just your at this point in time and we've heard a lot of great nuggets today, but your single most important practical piece of advice to ensure their voices are heard in the care transformation and digital health conversation wherever they reside.

Eve Cunningham:
Single? I had a couple of things that, okay,

Molly McCarthy:
Well, you can give me 2 or 3.

Eve Cunningham:
Okay. Well, the first is you need thick skin to get into this space, okay? There's going to be naysayers and that's okay. In fact, you get better from learning and listening to the feedback of the people who aren't quite on board. But identify your change agents and the people that are enthusiastic and build an army and a team of them to help bring the organization along. Become a change management ninja like you got to, and there's a whole psychology involved with that, both from a socialization perspective. Making sure that you're building good relationships and that you understand the psychology of the folks that are being asked to change. And just be patient and be proactive. But be patient because eventually you get a groundswell of support if it's the right thing to do and it's working, and you'll start to steer that ship in the right direction.

Molly McCarthy:
Well, thank you, Dr. Cunningham. I'm just going to reiterate. Thick skin. Identify your change agents. Be patient. And then the last one, which was actually the third one, a change management ninja. I think you should add that to your LinkedIn bio. That would go along with it.

Eve Cunningham:
Maybe I will. But the great thought I use that one all the time. I love that.

Molly McCarthy:
Yeah, well thank you so much for your time. It was great to chat with you and wish you the best of luck as you continue to transform at Providence.

Eve Cunningham:
Thank you. Thanks for inviting me. Take care.

Intro/Outro:
Thanks for listening to the Smart Care Team Spotlight. For best practices in AI and ambient intelligence, and ways your organization can help lead the era of smart care teams, visit us at VirtualNursing.com, and for information on the leading Smart Care Facility platform, visit Care.ai

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