The 229 Podcast: 20 Years, Zero Paper, One Vision Pioneering on a Budget with Tanya Townsend

0:00 Today on the 229 podcast, >> how do we as CIOS get our arms around the conundrum of we want to enable, we want to enhance, we want to continue to invest in things like AI and technologies, etc., but we also have these budget constraints because of all of those headwinds happening. >> My name is Bill Russell. I'm a former health system CIO and creator of This Week Health, where our mission is to transform healthcare one connection at a time. Welcome to the 229 podcast where we continue the conversations happening at our events with the leaders who are shaping healthcare. Let's jump into today's conversation. All right, it's the 229 podcast and I am excited to be joined today by Tanya Townsen, the CI well actually you're CIO CDO role at Stanford Medicine Children's Health and look forward to our conversation. Tanya, >> pleasure to be here. Thank you.

1:03 >> The CIO CDO role in academic pediatrics, you know, it's it's interesting. Talk a little bit about that role. I mean, what what makes it distinct? talk about the digital initiatives that maybe are on that plate versus just the traditional CIO role. >> This has been my first role where I have worn both hats which I have appreciated. So have had experiences in the past where the digital officer is different from the information officer and what I appreciate about this role and combining it is just because there there is so much integration and so now that I have the opportunity to mold those together.

1:42 So it's not just about the tools and technology, it's also about the enablement and understanding the patient experience, understanding the clinician experience. So I've really been enjoying this journey that we're on now that we're calling our digital transformation journey. And it does embrace all things technology as an enabler, but it also is really understanding the business and how can we leverage those digital tools to advance the future of healthcare through digital technologies. So, it's been really fun to blend those roles together.

2:15 >> We're going to go in a lot of different directions today. I I was looking at your bio and your background. My my staff sent it over to me. It's impressive. And you just received a lifetime achievement award from Chime. That's hot off the presses. That was last week. And congratulations on that. I I just didn't know you were that old. I mean, I'm looking at this, I'm like, you know, 20 years in healthcare IT. You've been the CIO at several places.

2:38 LCMC, you were down there for a while. It says Epic Consolidation. So, you've gotten that under your belt, which is no small deal. Built the first security offices from from scratch down there in 2016. Does it feel like a world away? And does it feel like it's been that long that you can receive a lifetime achievement award at this point? >> Oh gosh. No, but you just reminded me some walks down that memory lane, but yeah. No, it seems like it's like yesterday was my first opportunity stepping into this type of a role almost yeah 20 years ago. And so it seems like yesterday, but I also have enjoyed really reflecting on every step of along the way. And I've been just so fortunate to have stepped into this specific role in this industry and because healthcare it even when I think about the last 20 years if I think about that first experience which was like 2005 and we were still on paper there's so much experience >> I was going to say what were we doing in 2005 that was >> like what was the role in 2005 what were you doing >> so I had this amazing opportunity to and I was asked to lead the opening of what we as far as we know was the first all digital hospital of its kind and that opened its doors in 2005 in Wasau Wisconsin. It was a green field opportunity to build a hospital from scratch and we designed it with the thought of in mind of we were not going to have paper. We weren't going to have a medical record filing room. Everything was going to be captured in an automated way at the point of care. So we were truly pioneers and had that vision. And if you can think about 20 years ago, like Wi-Fi wasn't as stable as it is now. The whole concept of computer on wheels wasn't it was new at the time.

4:27 Voice recognition was just in its infancy. And even things like CPOE and electronic health records were not really embraced yet. That didn't happen until a few years later with this little thing called meaningful use where we really started to build on that vision. But yeah, it was just such a great experience. I was really fortunate to have very early on in my career. And I want to say I brought my last hospital that I was involved with. I got them off of paper in 2018. So that was not very long ago. So, it's it's been quite the journey over those 20 years and a lot of different experiences from putting in new electronic health records to mergers and acquisitions and consolidations to building teams and developing strategies to now really being focused on pediatrics and what do we mean when we say digital transformation and building upon that whole experience has been so fun and so rewarding. you've done a lot of stuff from scratch and and innovative and and you know leading things really from nothing to something but you step into Stanford. Stanford was already very well established and had probably a fair number of initiatives already going and those kinds of things. How did you change your sort of I mean did it require you to change your leadership style or to approach things a little differently? Yeah, I would say every organization I've been a part of has a little bit of a different personality, different culture so to speak. So my leadership style is to come in really just observe and assess. So you're right, Stanford already very mature, very well organized. My predecessor Ed Capetsky did a fabulous job having a wonderful team that now I get to just build upon but great team doing great things. And we had a vision or the organization had a vision of just bringing it to the next level. So how do we take the tools and technologies that we've already invested in and just take it to that next level? How do we embrace the new technologies that are coming out AI digital front door analytics all of those sorts of things like how do we build upon this already very stable mature organization that's doing great things and has wonderful culture. So that's been really exciting to just focus particularly around patients and families and pediatrics is really rewarding as well.

6:51 >> We have a children's 229 project meeting every year and we like to continue the conversation on the podcast. I know that significant part of that discussion was on digital transformation. A bunch of it was on the challenges facing pediatric health systems across the country. Let's start with the fun one first. Let's start with the digital transformation initiatives. You just mentioned some of them. How much is the digital front door changing how families and children interact with Stanford medicine?

7:20 >> So I think we talked about this maybe about a year ago. We were just starting our journey leveraging the capabilities that we already sort of had. So we are live on Epic. We have several other tools that intersect or integrate in with what we call our digital front door. But what we found is the utilization and adoption was maybe not where we wanted it to be. So that's what we've really been focused on is how do we standardize that experience not only for our patients but also for our operations. So nothing's more frustrating for patients that want to use the tool to not have anything available to schedule or there's no slots to be able to schedule in. So that's what we've really been focused on over this past year or so was standardizing the experience on both sides. So setting expectations with our operational side of we are going to turn this on, we're going to allow patients to schedule wear appropriately. And that's a little bit of change management that comes with that. But I could go into to more details there as to how we did that and what that looks like. But we did find when as soon as we went live, this was probably in the springtime frame, but we've now improved our online scheduling capabilities, we jumped up by 36% in some areas of being just having appointments allowed to be scheduled. We have a jump of almost 20% in what we call wa weight list acceptance. So, so patients do want to get in the door. We have almost 20% improvements in being able to get a weight list appointment scheduled. We've decreased significantly our no-show experience because we've been having more real-time messaging with our patients and we've seen just a huge increase in self-scheduling for our patients as well as people are willing to pay their bill online as well. So, there's been a huge increase in just revenue collections as well.

9:14 >> I'm not sure people appreciate how much of a heavy lift that is to just say, "All right, hey, we need to increase adoption of the tool and you think, well, let's put up more signs in the hospital and people will will log in and that kind of stuff." But the experience matters and the experience a lot of times is dictated based on the how the how the organization has decided to operationalize scheduling being one of those things and time slots and making those available whatnot. How much of a lift is that and what does that look like to orchestrate that throughout an organization as complex as pediatric healthcare is?

9:47 >> yeah well we definitely wanted to start with areas that are maybe I don't want to say easy but maybe less complex. So because we are a pediatric organization, we have a lot of different specialties. We have a lot of different complex types of patients or appointments to schedule potentially in different specialty areas. So we started with primary care just because that is pretty straightforward. Not easy ne necessarily, but a little bit more straightforward where we can sort of predict and standardize what the patient experience as well as those time slots should look like. So that's where we started. But again, it really came back to a lot of change management, a lot of we've always done it this way, you know, from an operational standpoint. So, we did have to do a lot of negotiating, meeting, building, and a lot of partnerships with our operational partnership partners as well as it to help get that experience ready. And now we're going specialty by specialty and rolling out that same approach.

10:45 >> Where are you guys at on your ambient listening journey? Everybody seems to be on that continuum somewhere. >> That has been a really fun story to watch. So, I remember like I mentioned earlier, I remember when voice recognition was still in its infancy and it wasn't necessarily ready for prime time 20 years ago. And now we think about how that's like just expected now. the whole Dragon or just voice recognition experience and the clinician's fingertips having it available and now what we're calling DAX or the ambient experience has just brought that to a whole new level and I didn't necessarily expect it to explode as quickly as it did to find the clinician happiness and efficiencies that we found almost overnight but we were careful. We piloted that in a couple areas first just to make sure before we completely bought on to to the whole plan, but we very quickly were able to prove the results and the value.

11:42 We've got so many testimonials from clinicians that love it. Couldn't imagine life without it now. And so we are completely across the board on the ambulatory side completely rolled out. And the savings and the value is just a really fun story to tell. It's everything from clinicians getting home on time, home for supper we call that to we reduced what we had as scribes in the past which was significant dollars that we were spending on scribes to help out with documentation and now we're improving our ability to close our charts much faster. So that leads to faster revenue in the door hopefully. So there's just been so many pieces and parts of fund to tell that story. But it was really it was rapid. We did that all in the last year. started out piloting maybe about a year ago and now it's completely implemented across the board in our ambulatory setting.

12:32 >> Are there specific how do I how would I ask this digital challenges with regard to the pediatric community maybe privacy or family centered care those kinds of things. >> yeah we did have to think about that with the ambient experience specifically there because the patient aka the baby might not be the person actually speaking in the room. so we did have to put some extra precautions and thought around how ambient listening can make sure it's capturing the correct person that's speaking and the right caregiver. So yes, there's additional things to consider in the pediatric space. And then of course from a confidentiality standpoint, security standpoint, there are additional regulations or privacy things to consider when that baby grows into an adolescent, grows into an adult.

13:21 there are additional things that we just have to think about when we're releasing notes or releasing information through the portal as example. And so thankfully we have a lot of people that are very focused and sensitive to those types of topics. So but yes, it's a great question around additional considerations with AI. >> What are the maybe top two or three challenges facing the children's hospitals across the country that that you heard? I don't think any of these will surprise people. I don't think that it's unique to children's or pediatrics necessarily, but I do think depending on the state that you're in and the type of reimbursement model that you're in. So, us being in California, we do have something called medical, which we do have a significant population that does rely on that part of our revenue reimbursement structure. But I do think these types of headwinds are not unique to children's hospitals. And so I think we're all faced with a lot of different challenges around our budgets and how we're going to continue to stabilize our revenue models. So we are embarking on which we talked about at the T29 event not too long ago. We're embarking on a project called operational transformation and we're trying to get in front of that as best we can. Of course some of this is reactionary as rules change, things change, tariffs are happening, etc. So, we're trying to get in front of it as best we can as well as react to what we know is happening in the moment. But operational transformation, we talked about at our event was how do we as CIOS get our arms around this conundrum, that's my favorite word of the year, the conundrum of we want to enable, we want to enhance, we want to continue to invest in things like AI and technologies, etc., But we also have these budget constraints because of all of those headwinds happening. So how do we balance between cost savings, battling normal things like inflation and growth and how do we continue to be able to invest in our future? So operational transformation for us is at least for this for my role as the CIO is trying to get my arms around all of that and a lot of it is education with the organization and some of it is changing the way we've always done it. So I don't think I speak for myself but often times IT departments are cost centers. We're a cost center at the end of the day and if you don't really get your arms around what's involved in those costs, you kind of forget and then it just looks like this big number just keeps increasing.

15:55 So we are going to reassess how we do our budgets which could lead to where are the non- labor savings. So like I mentioned, we put in ambient listening and now we're reducing scribes. So how do we capture that ROI on the non- labor side? How do we really show the story on how we're generating revenue? So we are a cost center. So I'm not necessarily bringing money into my cost center, but I am generating revenue for the organization. So again, how do we tell that ROI story? This also was an opportunity to reassess the structure of our staff, our labor. So we talked about non- labor, but also need to assess our labor. Do we have the right people? Do we have the right skill sets? Do we have them operating in the right place? So, we are doing a little bit of restructuring around that new lens. And then lastly, as we are balancing all of this out, we've got to get really good at prioritization or that awful word governance, which I know we had a good discussion around trying to avoid the word governance, but it's a reality of how do we have the right partnerships in place to prioritize what we can and can't do at any given time based on some of those constraints we just talked about. You know what? Sarah Drex and I have were preparing for some of our end of year stuff. We went through this year and the conversations we've been having and it was interesting. I mean, this year has been one of the most dynamic years I can remember. I mean, it started in the beginning of the year with people going, we don't even know what to set our budgets at. Like, there's so much uncertainty that it's like, are we planning for this? Are we planning for this? and ranges were pretty dramatic of you know business as usual to significant cuts and so there was a lot of uncertainty then when things sort of came into picture it you know as you said you know Medicare there's different things were on the table and if all those things came through it was pretty significant and then then we had a government shutdown which you know no small deal as well and it caused us more chaos but it did require us to to do things this year I that we haven't necessarily done in the past. I want to drill in on ROI. That was a conversation that came up over and over again this year is that we have been doing a lot of IT projects over the years. We did significant EHR projects. A lot of us have redone our ERP solutions. We've obviously ambient listening and other things. How does, you know, how are we looking at ROI today? How is the organization looking at ROI today? Is it, you know, is it a shorter window for the return? Is it or is it more about the impact on some of the quadruple aim initiatives? I think people get the picture. It's all financial and it's not always all financial. So, how are how are we looking at ROI these days? I could go on and on about this particular topic because I couldn't agree more that like I mentioned, we have to get really good at telling our story and that's not something that I think we've always been great at, not just here, but throughout my career because we kind of just move on to the next project. But that's something that I'm really focused on here is as we're putting together our digital transformation strategies and we want to make sure each one of them has a goal and that we're actually holding ourselves accountable to tracking towards that goal. And sometimes we hit it out the park like in the case of Ambient. And sometimes we maybe didn't hit what we thought we would. And it's not necessarily to be a punitive look back, but it's lessons learned. How do we, you know, reflect on that or pivot faster sometimes or just learn for that for the future? But you're right, everything that we're working on has some sort of goal and sometimes it is financial in terms of we're actually going to be reducing costs by putting in X. Sometimes it's revenue generating like, hey, we're going to automate this process and we believe we're going to be able to improve our visit volumes or improve our charge capture or reduce our denials. And then sometimes it's in the case of just a happier experience like like I mentioned with clinicians hopefully having less burdensome documentation. It makes them happier and they get home on time. And then sometimes it's qualitative like in the case of what we would measure in our quality safety service area and I could go into projects that we're doing in that space too where we're reducing surgical site infections for example or capturing better root cause analysis which then is then reinvested into how we analyze how we care for our patients.

20:31 So ROI can be in any one of those categories not necessarily just cutting costs. It's interesting in the 229 meetings we'll talk about ROI and I'll ask you know how many of you actually do the post project analysis and the numbers rising but it's it was fairly low to begin with and it's and the response was we don't have the resources to go I mean we're on to the next thing there's so the demand is so high the number of projects coming through is so high that you know we don't we we don't have the resources to look back but that not looking back like you know it violates everything we know about lean six sigma and agile and everything. It's like you have to >> that's how you learn that's how you actually accelerate but it's it is still it's hard to culturally do that and it's not necessarily just it entire organization.

21:23 >> Yeah, that's exactly what I was going to say is oftenimes it is just supporting a business plan that came from somewhere else. It's not to be punitive or fingerpointing, but it's learning like, okay, the next time we do a business case, are there things that we could look at differently if we didn't actually hit what we thought we were going to hit? And so there's some accountability around that and we're actually building in this conversation into our entire project life cycle process. But you're right, it is something we need to mature at just as an industry, as a as the IT community.

21:55 Well, I would be remiss if I didn't talk to you about AI and and I'm the one bringing it up. No, actually, you've talked about it in in certain projects. And maybe that's part of the point is that AI is integrated into so much stuff now that there isn't an AI initiative per se. It's just it's it's just another tool that we look at and say, "All right, do we use AI over here or AI over there?" How are you approaching this AI conversation and how are you seeing it sort of play out in healthcare? Yeah, completely agreed. I do think this I don't want to get myself in trouble, but I do think AI is a big buzzword right now. We're kind of on the hype cycle, kind of like cloud was a few years ago.

22:35 I do think it's just another tool in the toolbox that's not necessarily intended or we shouldn't be thinking about it differently than how we looked at other tools and technologies that we needed to assess and govern and prioritize. But we do have an entire governance model around how we are looking at and evaluating AI solutions. So right now we have a framework of three sort of pillars to to evaluate under this AI framework umbrella. So one is what we we'll call prepackaged AI. So these are things that are coming with some of our core vendors. So Epic has a whole Gen AI suite that's that's making a lot of things available and things on their road map. Things like Microsoft Copilot or even you know Microsoft Nuance with the ambient solutions.

23:26 Workday has a whole AI suite. Now there's so many of the our current core tools that have a lot of AI opportunities embedded within the core platforms that we're going to start assessing. And then there's additional products that you can purchase. So there's new third parties that are being developed that we could assess and we're going to be assessing some of those particularly around agentic AI we're looking at and some of that will be embedded in our tools and some of it's a third party new tool and then lastly what might we want to custom develop on our own. So we do have skills and capabilities here in Silicon Valley that we do have some really strong talented individuals that we might be able to develop some niche solutions on our own which we've done a little bit of as well. And so the combination of all of those things will be part of our AI framework. But I do think we need to look at it just like that because it's not just one tool fits all. It's going to be what's the best fit for the right solution.

24:27 And you go to UGM and they go, "Hey, we've got 150 new AI tools." And then you go back the following year and they go, "Hey, we've got 100, you know, plus AI tools." And you're like, "Wow, that's, you know, we've got to vet that." And then Workday comes out with theirs and Service Now comes out with theirs and Microsoft comes out with theirs. You're like, just the trusted partners that you're already working with. Vetting those is a full-time job for a team of 10 people and you're in Silicon Valley. So everybody in their brother probably is like, "Well, let's go over and talk to Stanford. They'll, you know, we could do this in healthcare." And and those require even more in-depth review because they're not in that trusted partner category. So you have to vet them not only as a solution, but you have to vet them as a partner as well. I mean, I'm wondering how we're going to get in front of the the appetite for all these solutions and be able to vet even just the ones that we know are going to be wins for the health system.

25:26 >> Yeah, if somebody has the answers to that, let me know. But yes, it can be overwhelming, but we are taking a little bit of an approach of platform first. So if we already have the tools like an epic or a workday, we already have our core partners, we should probably evaluate that first for capabilities because chances are we might already be paying for it or it might or that integration is already key before we look at get a third party. But there is reason to have a third party. Again, epic workdays etc aren't doing everything. So there is opportunity to have those partnerships. And then like I said lastly, there is some opportunity for core custom development, but that's probably not the first thing that we're going to start down the path with. But yes, it's it takes a lot of energy and talented people and a lot of focus on how do we start this assessment. And we're actually taking an inventory of all the AI types of tools that we've already introduced. And I mean, this is still pretty new. It's been the last, you know, maybe year, a little bit more.

26:28 and we've already got almost a hundred tools or technologies that we would consider AI types of arrangements that are up and running or underway in development. >> I'm curious if you know if we fast forward three years, staying on the AI theme, where do you think AI is going to have the most impact on healthcare over the next three years? We're reporting this for posterity. So in three years, people are going to dig it up and they're going to go, "Oh, wow. She was spot on." Or, "Oh, she missed by a lot."

26:56 I mean, it's it this is this is hard. The answers for this are all over the board. They're very you have people who are really bullish and saying, "Well, it's going to transform certain areas dramatically." And then there's there's other people that are like, you know, it's it's it's not trustworthy, but we we've already seen that it's fairly trustworthy like in imaging and it's being used extensively in in certain areas. So, you know, I'm curious three years from now, what's your prediction on this?

27:27 >> I think the clinical side, like you just hit on, the clinical side is going it's going to be better and become more trustworthy. And it's almost just like I mentioned, like 20 years ago, voice recognition was just not quite where it needed to be. And a few years later, it's now like expected and adopted and fully embraced. And we can't imagine life without it. So, I have a hunch that we're going to experience something similar where we're a little skeptical, rightfully so. We want to be careful and make sure that it's fair and equitable and accurate and all those things, but I think it's getting there very fast. And so, we're going to have to embrace it.

28:02 It's here to stay. So clinically, I think it's going to just help with advancements in how we use analytics and how we can do precision or even predictive medicine and how we just use it as an enabler or an augmentation. It's never going to replace our own experience and the human logic. It will never replace all together, but it will be a tool to assist. I think that's what we're afraid of a little bit on the administrative side is of course we're fearful that it's going to replace our jobs. Same thing there. I think I mean we do know our workforce does need to do things differently on the admin administrative side. So it's a tool to help us augment and potentially prevent us from inflation and things like that going forward. So it's just going to be an expectation of how we do business going forward. And so I think again it's here to stay. I don't think we should be afraid of it. We're going to have to learn how to use it in the best most effective safe way.

28:59 >> Fantastic. Tanya I want to thank you. lifetime achievement award and you know it feels like you should be getting ready to retire. I don't think you are getting ready to retire. >> Nope. Nope. I'm I'm really actually mostly energized like like I said it's been like such a journey and it's never been boring and it's even more exciting than ever. So I'm looking forward to where we're going from here for the next decade or so.

29:20 >> Well, I appreciate you spending some time with us and I look forward to seeing you at the next event. >> All right. Thanks, Bill. >> Thanks for listening to the 229 podcast. The best conversations don't end when the event does. They continue here with our community of healthcare leaders. Join us by subscribing at thisweekalth.com/subscribe. If you have a conversation that's too good not to share, reach out. Also, check out our events on the 229pro.com website. Share this episode with a peer.

29:52 It's how we grow our network, increase our collective knowledge, and transform healthcare together. Thanks for listening. That's all for now. >>