In the medical field, the ability to transfer and interpret data in real time can be the difference between life and death. That data needs to be of high quality, moved at a high speed, and handled with the highest safeguards possible to ensure patients and their providers can receive and provide the most effective care. Building the processes that manage this ecosystem is a constantly evolving challenge.
In this episode of The Restless Ones, I sit with Peter Fleischut, Group SVP and Chief Information, and Transformation Officer at NewYork-Presbyterian, who is actively deploying innovative approaches and solutions in a field too often known for lagging behind. From remote monitoring and robotics to telemedicine and the modernization of medical records, unpredicted connectivity is creating an entirely new way to care for patients. Whether overseeing annual telemedicine visits' growth from 1,000 to over 1,000,000, simplifying the record and prescription process, or building the backbone that will ultimately allow for multimodal data transmissions, Peter’s work is life-changing and saving.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Hey everyone, Welcome to the Restless Ones. I'm Jonathan Strickland.
As always, my focus is on exploring the intersection of
technology and business by having conversations with the most forward
thinking leaders. Throughout my career, I've covered everything from massive
parallel processing to advanced robotics, but what truly inspires me
(00:24):
are the stories of innovation and transformation. In this season,
we'll explore technologies like flexible applications, more capable devices, and
advance networking like five G that are helping business leaders
act on their big ideas quickly and unlock mission critical outcomes.
What's become clear to us after three seasons is that
(00:45):
we can't change tomorrow by deploying solutions of the past.
So get ready to be inspired and learn from the
best today. Our guest is doctor Peter Fleishuot Group's senior
vice president and chief Information and Transformation Officer at New
York Presbyterian Hospital. Peter's background is as an anesthesiologist, but
(01:09):
over the course of his career, he has sought new
ways to create positive change in the healthcare industry, from
solving challenges facing administration to improving patient experiences and quality
of life. It's no small task, and Peter recognizes that
technology has an important part to play, and I got
a peek at how some cutting edge and maturing technologies
(01:31):
are poised to change everything in healthcare. But before I
get carried away with all the tech, I wanted to
learn more about Peter himself. Peter, I want to thank
you for joining us today for this conversation. Welcome to
the Restless Ones.
Speaker 2 (01:51):
Jonathan, thank you very much for having me here today.
I really appreciate it.
Speaker 1 (01:55):
I'm really excited about the topics we're going to get
into today. And to start off, I'd like to hear
about how your career path in medicine led to you
becoming Chief Information and Transformation Officer for a New York
Presbyterian Hospital.
Speaker 2 (02:08):
Jonathan. Way back when, I always knew that I wanted
to take care of patients, and I trained in a
specialty that allowed me to take care of a patient,
one patient at a time, and over the evolution of
my career, I ended up taking care of those patients.
When I used to take care of liver transplant patients
getting surgery, I then started taking and overseeing multiple patients
(02:30):
with multiple care teams. I then ended up frankly overseeing
our operating rooms when we used to run eighty five
locations in a day, and that's led me to my
current role.
Speaker 1 (02:41):
I love that answer. I love starting from the desire
to help and then figuring out how to help more
people over time out of curiosity. When you're talking with
someone in a casual setting and they ask what do
you do for a living, how do you actually describe
what your job is to someone?
Speaker 2 (03:00):
First and foremost, I get to work with the most
amazing people in the world. I have an unbelievable team
where I oversee the management and operations of IT lab operations,
pharmacy operations, data analytics, and artificial intelligence, and we are
really the backbone of a lot of the system to
help the doctors, the nurses, the patients, and the providers
(03:23):
as they go through their care. And that really encompasses
my day to day responsibilities.
Speaker 1 (03:29):
Incredible and you sort of touched on this, but can
you talk a little bit more about how your clinical
experience as an anesthesiologist guided the way you think both
like a patient and a provider. That experience of helping
people one on one, how that shapes your approach in
your current role.
Speaker 2 (03:50):
So a lot of people don't know, but antithesiologists are
uniquely positioned all throughout the health system. When I trained
to be an antistesiologist, I got the exposure of working
in an outpatient area as a pain provider. I got
the opportunity to work in operating rooms, in ICUs and
critical care. I got to be in various radiology areas,
(04:16):
endoscopy suites, cathartization labs, and you really end up working
in many, many different parts of the system. One from
a patient perspective, it's especially that I feel is kind
of behind the scenes to help support the patient get
safely through their experience. And it's heavily reliant on technology,
(04:39):
but it's also very multidisciplinary in its nature, and that
really helped set me up for success.
Speaker 1 (04:47):
And I imagine as an nesthesiologist, in your relationship to patients,
a lot of your work also would come in the
form of communication and to make certain that you're able
to communicate with peers patients what you're doing, why the
approach is the way it is. And I see that
as a key element in the role of technology and
(05:09):
healthcare as well, the ability to be able to communicate
the purpose of that tech in a way where everyone
involved in the discussion, whether it's c suite executives or
it's the patient in the hospital room, that they understand
the role that is playing and how it supports the
(05:29):
overall mission of overseeing health for patients.
Speaker 2 (05:34):
I couldn't agree more. You're spot on. Communication is critical
to our frontlines all the way to our board, and
getting the right amount of information to the right amount
of people is essential. I've also found, as you mentioned,
technology has transformed that landscape. The sheer amount of connectivity
(05:54):
that exists amongst our employees and amongst our patients is
unprecedented and it really enables what I think is the
digital transformation. The connectivity and the speed at which people
get information today is astronomically faster than they have in
the past, and things like which I'm sure we'll talk
(06:15):
about later. Chat EPT will fundamentally and is fundamentally changing
information delivery, the ability to be answered questions. The challenge
as a provider is we've got to get the right
information to our patients, and it needs to be high quality,
and it needs to be secure, and it needs to
(06:36):
be protected. So I see my job in a couple
ways to further that transformation, but to do it in
a secure and in a high quality way.
Speaker 1 (06:45):
Connectivity is one of those technologies that enables everything else.
So one thing I wanted to ask you about is
can you describe your efforts to reduce friction in the
patient experience using connectivity? How has connectivity changed that process
for the average patient?
Speaker 2 (07:07):
Great question. Let me set a baseline. Three years ago,
we were on nine different electronic records and that was
one part of how disconnected we were at the time.
But it wasn't just there. We also had ten thousand
order sets and these are the care pathways that the
doctors would be using to care for our patients. We
(07:30):
also had what's called five formularies. Those are the drug
catalogs of all the drugs that the doctors would use,
and there was five of them. One of the efforts
we took on with our ten thousand doctors at Wild
Cornell and Columbia was how do we standardize all that work?
So we go from ten thousand to one thousand pathways,
go from five drug catalogs to one, and we've done
(07:53):
that transformation. Most other systems have done it, but we've
done it in a way where we went to one
instance and one connected system across our whole health system
of eleven hospitals. And these are academic hospitals, they're small
and large community hospitals. And so that connectivity in the
process by which we went through fundamentally changed our operations.
(08:17):
It's fundamentally changed how we care for patients. Now we're
probably in the second of nine innings right now, we
know we need to go even further. It's not easy
for a patient to interact with the system. There's thousands
of phone numbers to call, there's maybe multiple mobile apps,
(08:37):
there's multiple pieces of education, there's multiple options to either
schedule yourself or to call or to deal with a chatbot.
And I look at our opportunity is to streamline that.
We got to reduce the friction so that there's one
number to call, there's an ability to do it self
(08:57):
service to me, that's just found aational But then you
layer on some of the more advanced NLP models, you
can start to even see how you can be able
to get that into a care pathway and make it
even easier for patients so that you can integrate it
with the education and the scheduling and the prescriptions, and
that type of digital care model is ultimately going to
(09:18):
get us to higher level care, much more productive, much
more efficient, and allow not only patients to be happier,
but allow providers to be able to operate at the
top of their license.
Speaker 1 (09:30):
I love that and the implication that through the implementation
of technology or removing barriers that patients might run into
otherwise that could even potentially discourage them from seeking care
that would otherwise be transformational in their lives. People who
genuinely need those services are able to get them with
(09:51):
as few bottlenecks and pain points along the way as possible,
and anything that makes that smoother is a huge benefit.
Speaker 2 (10:00):
If it's okay, I'd love to give one other example.
A significant majority of our patients go through processes to
see a provider and they choose to give a patient
what's called a specialty pharmaceutical. Specialty pharmaceuticals are very high cost,
they're hard to get a hold of, they're hard to deliver,
they're very difficult to administer, and any patient who's had
(10:24):
to go through one of these processes knows how fragmented
it is. It's not easy to find the drugs, it's
not easy to get them in their home. They're expensive,
there's not good follow up. By using technology and a
better care model, we've been able to make it so
that we could have liaisons working side by side with
our doctors. They can be able to look and identify
(10:47):
patient's insurance and their benefits to get them the right
structure so they have the right copays. We've been able
to integrate into our electronics systems so that we can
get the drugs ordered seamlessly and make it so that
patients normally would get these drugs within two to three weeks,
we get to to them within two days. We have
follow up processes with clinical pharmacologists and pharmacists that are
(11:11):
following up with the patients to be able to help
them so that if they happen to be taking something
like an oral chemo, they not only are more educated
about it, they know what to do, and if they're
getting side effects, they don't have to come back in
through the ED. They can take care of it in
their home. That type of care model transferation using data
and people has led us to having a system where
(11:34):
our net promoter score of that care model is around eighty.
Patients absolutely love it it's thoughtful and to your point,
it also helps the doctors. Prior authorizations is the process
our doctors have to go through to get approval to
get patients their medications. We've now been able to enable
that with this care team, so the doctors don't have
(11:55):
to be the one doing the prior authorizations. And this
whole model has led to better quality, a better patient experience,
and overall a better experience.
Speaker 1 (12:05):
When I was doing research before speaking with you, one
of the topics I came across was a collaboration with
Royal Phillips, and I was wondering if you could talk
a little bit about that and how New York Presbyterian
incorporated Phillips technology for things like remote monitoring, and how
(12:27):
that system works both from the provider side and from
the patient side.
Speaker 2 (12:33):
The telemedicine was a key component to what we needed
to do for our patients. We were very early on
in the journey at the time. I think then we
did about one thousand visits in a year, and then
the next year we did about ten thousand visits, which
at the time we thought was just unbelievable. The year
after that we did two hundred and fifty thousand visits
(12:54):
and then five hundred thousand visits and it started to compound.
Now to say that today is not as much of
an achievement because we all know when COVID started and
in twenty twenty eight we did one point three million visits.
But at the time we felt, not only if you
can provide the video interaction and the expert physician, what
(13:15):
other things need to be there, like remote monitoring and
being able to provide the ability to get blood pressure,
heart rate, oxygen level. And doing that with Phillips was transformational.
As an example, it enabled a whole team of physician
assistants with the doctors that remotely monitor patients that are
all in an evolution and severity of heart failure, so
(13:38):
a patient could be at home, be able to check
their vitals based on those results, it goes to a
central team and they can help advise and guide them
with various pathways as to when it's appropriate for them
to come in or when it's appropriate to stay at home.
This will only compound and it fundamentally enabled us to
take care of patients better in the home than we're
(14:00):
ever able to do in the past.
Speaker 1 (14:02):
And again it gets back to how connectivity enables all
of this to happen. Obviously, without the connectivity piece in place,
you can't do this. I'm curious, do you foresee technologies
such as the fact that we're now seeing low latency,
high bandwidth wireless connectivity. Do you see that playing a
(14:25):
growing important role in the healthcare sector as it opens
up the opportunity to do things that in the past
we've just been unthinkable.
Speaker 2 (14:33):
I think in short, yes, I feel that's essential. And
now ultimately five G and some of the connectivity will
be needed. We'll definitely need that advancing technology as we
start to use more multimodal data. We currently primarily use
data from our electronic health record, which ends up to
(14:54):
be a lot of numerical data. But I think the
true value is and architecture that enables multimodal data. What
I mean by that is data cores of all the
imaging that's done, data cores of all the pathology, all
the genomics, all of the live physiologic streaming data, all
(15:17):
the exposone data. As we start to develop models using
multimodal data, we're going to need more and more advanced
technologies in terms of bandwidth and five g connectivity to
be able to run those models, so eventually we'll get
to a point of needing them.
Speaker 1 (15:33):
Yeah, that to me is one of those dream applications
of the technology. The ability to do things like move
huge packages of data in the form of medical imaging
rapidly between points that don't require a physical connection. It's
almost magical in how fast it moves. I love technology
(15:55):
in all its forms, but when I'm starting to talk
about technology and it's potential to impact people's lives and
on the back end make things smoother, to me, that's
just a beautiful story. Being able to improve the quality
on the back end is just as important in order
to ensure that that healthcare quality is present for the patients.
Speaker 2 (16:18):
I couldn't agree more.
Speaker 1 (16:29):
What role is AI playing right now in medicine and
where do you see it going in the near future.
Speaker 2 (16:38):
I see it in two major areas. I think it
can be used to reduce friction for our patients and
providers in very seamless ways, better care navigation, call center automation,
prior authorization provals, things that we can do to streamline
the front end processes. Those will have a direct benefit.
(16:59):
They will definitly reduce that burden of disease. But ultimately
I think there's a bigger vision, and that bigger vision
really is in the reduction of the burden of disease.
We have over one hundred projects that we deploy across
the system focused in these areas to help identify patients
where we can impact the mortality. Another example of one
(17:22):
is we do approximately twenty six thousand deliveries a year.
Moms come in when and they're pregnant, getting ready to deliver,
and they put monitors on to monitor the baby. There
are signals in those fetal heart rate tracings that can
indicate when a baby may not be getting enough oxygen,
(17:43):
and the obstetricians and the doctors know and have a
series of protocols in place of what to do when
that occurs. But the sheer volume of data coming in
is so large and so massive that we've now implementing
an AI system that's reading and looking at those fetal
heart rate tracings to be able to prompt the doctor
to say we think that this patient may be experiencing
(18:07):
some type of hypoxia meaning not enough oxygen, to be
able to identify those babies faster, so that we can
be able to intervene to fundamentally save their lives. And
it's that type of transformation that I'd love to see
us happen in cardiac in breast cancer, in neonatal situations
where there's hypoxia, that reduction of the burden disease will
(18:30):
be fundamentally transformational.
Speaker 1 (18:32):
I'm very curious to hear your perspective on communicating the
role of artificial intelligence to say board members, for example,
how do you approach the challenge of talking about such
a nuanced and complex topic in order to get buy
in from an organizational level.
Speaker 2 (18:53):
That's a great question. Facts are critical, but the story
is what's very convincing, and you hear me on this
call walking through very specific patient examples of how it
can be applied. If you look at technology adoption and
look at productivity, healthcare is one of the least productive
fields in the country, if not the world, and the
(19:15):
reason for that is the adoption of technology. And I
think we need to approach AI in talking through what
are the people, what is the process, and then what
is the technology. I don't think leading with AI is
a start, Otherwise we're leading and trying to find a problem.
We need to highlight what is the problem we're trying
to solve and how can technology help support solving that problem.
(19:38):
And if we start there and we're clear about the
communication and we use concrete patient examples, I think it
makes a lot more sense.
Speaker 1 (19:47):
Absolutely, Peter, I'm curious what role do robotics play in
your healthcare system at the moment. I remember being fascinated
with documentaries in the healthcare industry about how robotics were
informing healthcare.
Speaker 2 (20:01):
So there's two types of robotics. We look at physical
and we look at virtual. I'll start first with physical.
We've been able to implement robotics in various areas throughout
our hospital. We have rooms the size of let's say,
twenty foot by twenty foot by twenty and there's massive,
large robots that do all of our pharmacy pill picking,
(20:25):
individual pills from orders that are placed with a massive
robot that runs twenty four to seven. And then what
we call box picking, which is our ointments and our
creams and non pill medications. Two robots run twenty four
to seven. We've been using them for about six years
now and it's been transformational because what it's allowed us
(20:45):
to do is have some of the technicians that we're
normally in these large rooms primarily in basements, and now
move them to the bedside. So now they are the
teams of embedded care team members that are now interacting
with the patients because we now have robots that can
be able to do it, and we now have those
team members interviewing patients, talking to them about their medications,
(21:09):
talking to them about their side effects. We've done this
in other areas. We have physical robots that deliver food
to patients. They call elevators, they go up and down elevators,
They deliver linens, they deliver medical devices, and we've found
them to work very well. There's also an a other
(21:29):
area which you don't hear talked about as much, but
there's virtual robots things we call robotic process automation that
has also served us well. And those are highly repetitive
tasks that are occurring on a computer. So we have
thousands and thousands of tasks that occur the same way
(21:49):
every day, and how do we automate that using a
virtual robot. Like when a patient gives us an insurance card,
we have team members need to go out to a
website and validate that insurance card to make sure it's
correct and do that process. We can now do that
with a high throughput, high volume RPA process and do
(22:12):
it in a virtual way, so once again we can
get more people to the bedside from a care team perspective.
Speaker 1 (22:20):
Before I could let Peter go, I needed to ask
him a couple more things. Is there a particular technology
that really made an incredible first impression on you, whether
in your profession or in your personal life.
Speaker 2 (22:39):
I have to say, and I don't mean to bring
up a recent technology, but I can't emphasize enough how
chat GPT will fundamentally transform education information throughout our world.
I saw it for the first time, and the method
by which it's being utilized, the distribution, and the power
(23:01):
and potential of that technology is going to be fundamentally
transformative for us over the next ten years. And that
was probably one of the most impressive things I've seen
since the advancements that have occurred in early twenty ten
in other areas.
Speaker 1 (23:18):
What advice would you give to other tech leaders in
the healthcare space.
Speaker 2 (23:24):
As my prior boss used to mention, it's all about people,
process and technology, and I think it's some of the
best advice. It is all about people. The technology works.
The technology has worked in every industry. It's all about adoption.
It's all about working with the providers, working with the
care team members, and working with the patients to drive adoption.
(23:48):
And that's critical for us as healthcare leaders. And as
we see that adoption accelerate, we're going to see productivity accelerate.
We're going to see more patients taken care of, we're
going to see less mortality, we're going to see better outcomes.
And I think that is truly the exciting part of
where we're going to go with the digital transformation.
Speaker 1 (24:08):
Peter, thank you so much for joining the show. I
really appreciate it. This has been a fantastic conversation.
Speaker 2 (24:15):
Jonathan. I can't thank you enough for having me on today.
Speaker 1 (24:23):
Peter's deep background in medicine and patient care clearly play
a pivotal role in his leadership strategy and leadership decisions
take on a new meeting when the outcome of those
decisions has an undeniably critical impact on patients and caregivers alike.
I was struck by how advanced technologies that will change
healthcare are built on the foundation of connectivity. It wasn't
(24:45):
that long ago that the tools doctors and nurses had
at their disposal were limited. That healthcare professionals took all
notes by hand, and those notes had to be entered
into medical records that weren't always easy to share or access.
But digitization and connectivity have created opportunities to change all that,
(25:06):
and the thought of five G enabling high tech medical
processes is really exciting. Reducing the amount of time spent
sending large image files across a network can literally save
a life. Be sure to join us for more episodes
of The Restless Ones. We'll be talking with more incredible
(25:26):
leaders about their approach to leveraging technology and how this
tech creates opportunities even in places we never thought to
look before. Until next time, I'm Jonathan Strickland, and this
is The Restless Ones.
Hey everyone, Welcome to the Restless Ones. I'm Jonathan Strickland.
As always, my focus is on exploring the intersection of
technology and business by having conversations with the most forward
thinking leaders. Throughout my career, I've covered everything from massive
parallel processing to advanced robotics, but what truly inspires me
(00:24):
are the stories of innovation and transformation. In this season,
we'll explore technologies like flexible applications, more capable devices, and
advance networking like five G that are helping business leaders
act on their big ideas quickly and unlock mission critical outcomes.
What's become clear to us after three seasons is that
(00:45):
we can't change tomorrow by deploying solutions of the past.
So get ready to be inspired and learn from the
best today. Our guest is doctor Peter Fleishuot Group's senior
vice president and chief Information and Transformation Officer at New
York Presbyterian Hospital. Peter's background is as an anesthesiologist, but
(01:09):
over the course of his career, he has sought new
ways to create positive change in the healthcare industry, from
solving challenges facing administration to improving patient experiences and quality
of life. It's no small task, and Peter recognizes that
technology has an important part to play, and I got
a peek at how some cutting edge and maturing technologies
(01:31):
are poised to change everything in healthcare. But before I
get carried away with all the tech, I wanted to
learn more about Peter himself. Peter, I want to thank
you for joining us today for this conversation. Welcome to
the Restless Ones.
Speaker 2 (01:51):
Jonathan, thank you very much for having me here today.
I really appreciate it.
Speaker 1 (01:55):
I'm really excited about the topics we're going to get
into today. And to start off, I'd like to hear
about how your career path in medicine led to you
becoming Chief Information and Transformation Officer for a New York
Presbyterian Hospital.
Speaker 2 (02:08):
Jonathan. Way back when, I always knew that I wanted
to take care of patients, and I trained in a
specialty that allowed me to take care of a patient,
one patient at a time, and over the evolution of
my career, I ended up taking care of those patients.
When I used to take care of liver transplant patients
getting surgery, I then started taking and overseeing multiple patients
(02:30):
with multiple care teams. I then ended up frankly overseeing
our operating rooms when we used to run eighty five
locations in a day, and that's led me to my
current role.
Speaker 1 (02:41):
I love that answer. I love starting from the desire
to help and then figuring out how to help more
people over time out of curiosity. When you're talking with
someone in a casual setting and they ask what do
you do for a living, how do you actually describe
what your job is to someone?
Speaker 2 (03:00):
First and foremost, I get to work with the most
amazing people in the world. I have an unbelievable team
where I oversee the management and operations of IT lab operations,
pharmacy operations, data analytics, and artificial intelligence, and we are
really the backbone of a lot of the system to
help the doctors, the nurses, the patients, and the providers
(03:23):
as they go through their care. And that really encompasses
my day to day responsibilities.
Speaker 1 (03:29):
Incredible and you sort of touched on this, but can
you talk a little bit more about how your clinical
experience as an anesthesiologist guided the way you think both
like a patient and a provider. That experience of helping
people one on one, how that shapes your approach in
your current role.
Speaker 2 (03:50):
So a lot of people don't know, but antithesiologists are
uniquely positioned all throughout the health system. When I trained
to be an antistesiologist, I got the exposure of working
in an outpatient area as a pain provider. I got
the opportunity to work in operating rooms, in ICUs and
critical care. I got to be in various radiology areas,
(04:16):
endoscopy suites, cathartization labs, and you really end up working
in many, many different parts of the system. One from
a patient perspective, it's especially that I feel is kind
of behind the scenes to help support the patient get
safely through their experience. And it's heavily reliant on technology,
(04:39):
but it's also very multidisciplinary in its nature, and that
really helped set me up for success.
Speaker 1 (04:47):
And I imagine as an nesthesiologist, in your relationship to patients,
a lot of your work also would come in the
form of communication and to make certain that you're able
to communicate with peers patients what you're doing, why the
approach is the way it is. And I see that
as a key element in the role of technology and
(05:09):
healthcare as well, the ability to be able to communicate
the purpose of that tech in a way where everyone
involved in the discussion, whether it's c suite executives or
it's the patient in the hospital room, that they understand
the role that is playing and how it supports the
(05:29):
overall mission of overseeing health for patients.
Speaker 2 (05:34):
I couldn't agree more. You're spot on. Communication is critical
to our frontlines all the way to our board, and
getting the right amount of information to the right amount
of people is essential. I've also found, as you mentioned,
technology has transformed that landscape. The sheer amount of connectivity
(05:54):
that exists amongst our employees and amongst our patients is
unprecedented and it really enables what I think is the
digital transformation. The connectivity and the speed at which people
get information today is astronomically faster than they have in
the past, and things like which I'm sure we'll talk
(06:15):
about later. Chat EPT will fundamentally and is fundamentally changing
information delivery, the ability to be answered questions. The challenge
as a provider is we've got to get the right
information to our patients, and it needs to be high quality,
and it needs to be secure, and it needs to
(06:36):
be protected. So I see my job in a couple
ways to further that transformation, but to do it in
a secure and in a high quality way.
Speaker 1 (06:45):
Connectivity is one of those technologies that enables everything else.
So one thing I wanted to ask you about is
can you describe your efforts to reduce friction in the
patient experience using connectivity? How has connectivity changed that process
for the average patient?
Speaker 2 (07:07):
Great question. Let me set a baseline. Three years ago,
we were on nine different electronic records and that was
one part of how disconnected we were at the time.
But it wasn't just there. We also had ten thousand
order sets and these are the care pathways that the
doctors would be using to care for our patients. We
(07:30):
also had what's called five formularies. Those are the drug
catalogs of all the drugs that the doctors would use,
and there was five of them. One of the efforts
we took on with our ten thousand doctors at Wild
Cornell and Columbia was how do we standardize all that work?
So we go from ten thousand to one thousand pathways,
go from five drug catalogs to one, and we've done
(07:53):
that transformation. Most other systems have done it, but we've
done it in a way where we went to one
instance and one connected system across our whole health system
of eleven hospitals. And these are academic hospitals, they're small
and large community hospitals. And so that connectivity in the
process by which we went through fundamentally changed our operations.
(08:17):
It's fundamentally changed how we care for patients. Now we're
probably in the second of nine innings right now, we
know we need to go even further. It's not easy
for a patient to interact with the system. There's thousands
of phone numbers to call, there's maybe multiple mobile apps,
(08:37):
there's multiple pieces of education, there's multiple options to either
schedule yourself or to call or to deal with a chatbot.
And I look at our opportunity is to streamline that.
We got to reduce the friction so that there's one
number to call, there's an ability to do it self
(08:57):
service to me, that's just found aational But then you
layer on some of the more advanced NLP models, you
can start to even see how you can be able
to get that into a care pathway and make it
even easier for patients so that you can integrate it
with the education and the scheduling and the prescriptions, and
that type of digital care model is ultimately going to
(09:18):
get us to higher level care, much more productive, much
more efficient, and allow not only patients to be happier,
but allow providers to be able to operate at the
top of their license.
Speaker 1 (09:30):
I love that and the implication that through the implementation
of technology or removing barriers that patients might run into
otherwise that could even potentially discourage them from seeking care
that would otherwise be transformational in their lives. People who
genuinely need those services are able to get them with
(09:51):
as few bottlenecks and pain points along the way as possible,
and anything that makes that smoother is a huge benefit.
Speaker 2 (10:00):
If it's okay, I'd love to give one other example.
A significant majority of our patients go through processes to
see a provider and they choose to give a patient
what's called a specialty pharmaceutical. Specialty pharmaceuticals are very high cost,
they're hard to get a hold of, they're hard to deliver,
they're very difficult to administer, and any patient who's had
(10:24):
to go through one of these processes knows how fragmented
it is. It's not easy to find the drugs, it's
not easy to get them in their home. They're expensive,
there's not good follow up. By using technology and a
better care model, we've been able to make it so
that we could have liaisons working side by side with
our doctors. They can be able to look and identify
(10:47):
patient's insurance and their benefits to get them the right
structure so they have the right copays. We've been able
to integrate into our electronics systems so that we can
get the drugs ordered seamlessly and make it so that
patients normally would get these drugs within two to three weeks,
we get to to them within two days. We have
follow up processes with clinical pharmacologists and pharmacists that are
(11:11):
following up with the patients to be able to help
them so that if they happen to be taking something
like an oral chemo, they not only are more educated
about it, they know what to do, and if they're
getting side effects, they don't have to come back in
through the ED. They can take care of it in
their home. That type of care model transferation using data
and people has led us to having a system where
(11:34):
our net promoter score of that care model is around eighty.
Patients absolutely love it it's thoughtful and to your point,
it also helps the doctors. Prior authorizations is the process
our doctors have to go through to get approval to
get patients their medications. We've now been able to enable
that with this care team, so the doctors don't have
(11:55):
to be the one doing the prior authorizations. And this
whole model has led to better quality, a better patient experience,
and overall a better experience.
Speaker 1 (12:05):
When I was doing research before speaking with you, one
of the topics I came across was a collaboration with
Royal Phillips, and I was wondering if you could talk
a little bit about that and how New York Presbyterian
incorporated Phillips technology for things like remote monitoring, and how
(12:27):
that system works both from the provider side and from
the patient side.
Speaker 2 (12:33):
The telemedicine was a key component to what we needed
to do for our patients. We were very early on
in the journey at the time. I think then we
did about one thousand visits in a year, and then
the next year we did about ten thousand visits, which
at the time we thought was just unbelievable. The year
after that we did two hundred and fifty thousand visits
(12:54):
and then five hundred thousand visits and it started to compound.
Now to say that today is not as much of
an achievement because we all know when COVID started and
in twenty twenty eight we did one point three million visits.
But at the time we felt, not only if you
can provide the video interaction and the expert physician, what
(13:15):
other things need to be there, like remote monitoring and
being able to provide the ability to get blood pressure,
heart rate, oxygen level. And doing that with Phillips was transformational.
As an example, it enabled a whole team of physician
assistants with the doctors that remotely monitor patients that are
all in an evolution and severity of heart failure, so
(13:38):
a patient could be at home, be able to check
their vitals based on those results, it goes to a
central team and they can help advise and guide them
with various pathways as to when it's appropriate for them
to come in or when it's appropriate to stay at home.
This will only compound and it fundamentally enabled us to
take care of patients better in the home than we're
(14:00):
ever able to do in the past.
Speaker 1 (14:02):
And again it gets back to how connectivity enables all
of this to happen. Obviously, without the connectivity piece in place,
you can't do this. I'm curious, do you foresee technologies
such as the fact that we're now seeing low latency,
high bandwidth wireless connectivity. Do you see that playing a
(14:25):
growing important role in the healthcare sector as it opens
up the opportunity to do things that in the past
we've just been unthinkable.
Speaker 2 (14:33):
I think in short, yes, I feel that's essential. And
now ultimately five G and some of the connectivity will
be needed. We'll definitely need that advancing technology as we
start to use more multimodal data. We currently primarily use
data from our electronic health record, which ends up to
(14:54):
be a lot of numerical data. But I think the
true value is and architecture that enables multimodal data. What
I mean by that is data cores of all the
imaging that's done, data cores of all the pathology, all
the genomics, all of the live physiologic streaming data, all
(15:17):
the exposone data. As we start to develop models using
multimodal data, we're going to need more and more advanced
technologies in terms of bandwidth and five g connectivity to
be able to run those models, so eventually we'll get
to a point of needing them.
Speaker 1 (15:33):
Yeah, that to me is one of those dream applications
of the technology. The ability to do things like move
huge packages of data in the form of medical imaging
rapidly between points that don't require a physical connection. It's
almost magical in how fast it moves. I love technology
(15:55):
in all its forms, but when I'm starting to talk
about technology and it's potential to impact people's lives and
on the back end make things smoother, to me, that's
just a beautiful story. Being able to improve the quality
on the back end is just as important in order
to ensure that that healthcare quality is present for the patients.
Speaker 2 (16:18):
I couldn't agree more.
Speaker 1 (16:29):
What role is AI playing right now in medicine and
where do you see it going in the near future.
Speaker 2 (16:38):
I see it in two major areas. I think it
can be used to reduce friction for our patients and
providers in very seamless ways, better care navigation, call center automation,
prior authorization provals, things that we can do to streamline
the front end processes. Those will have a direct benefit.
(16:59):
They will definitly reduce that burden of disease. But ultimately
I think there's a bigger vision, and that bigger vision
really is in the reduction of the burden of disease.
We have over one hundred projects that we deploy across
the system focused in these areas to help identify patients
where we can impact the mortality. Another example of one
(17:22):
is we do approximately twenty six thousand deliveries a year.
Moms come in when and they're pregnant, getting ready to deliver,
and they put monitors on to monitor the baby. There
are signals in those fetal heart rate tracings that can
indicate when a baby may not be getting enough oxygen,
(17:43):
and the obstetricians and the doctors know and have a
series of protocols in place of what to do when
that occurs. But the sheer volume of data coming in
is so large and so massive that we've now implementing
an AI system that's reading and looking at those fetal
heart rate tracings to be able to prompt the doctor
to say we think that this patient may be experiencing
(18:07):
some type of hypoxia meaning not enough oxygen, to be
able to identify those babies faster, so that we can
be able to intervene to fundamentally save their lives. And
it's that type of transformation that I'd love to see
us happen in cardiac in breast cancer, in neonatal situations
where there's hypoxia, that reduction of the burden disease will
(18:30):
be fundamentally transformational.
Speaker 1 (18:32):
I'm very curious to hear your perspective on communicating the
role of artificial intelligence to say board members, for example,
how do you approach the challenge of talking about such
a nuanced and complex topic in order to get buy
in from an organizational level.
Speaker 2 (18:53):
That's a great question. Facts are critical, but the story
is what's very convincing, and you hear me on this
call walking through very specific patient examples of how it
can be applied. If you look at technology adoption and
look at productivity, healthcare is one of the least productive
fields in the country, if not the world, and the
(19:15):
reason for that is the adoption of technology. And I
think we need to approach AI in talking through what
are the people, what is the process, and then what
is the technology. I don't think leading with AI is
a start, Otherwise we're leading and trying to find a problem.
We need to highlight what is the problem we're trying
to solve and how can technology help support solving that problem.
(19:38):
And if we start there and we're clear about the
communication and we use concrete patient examples, I think it
makes a lot more sense.
Speaker 1 (19:47):
Absolutely, Peter, I'm curious what role do robotics play in
your healthcare system at the moment. I remember being fascinated
with documentaries in the healthcare industry about how robotics were
informing healthcare.
Speaker 2 (20:01):
So there's two types of robotics. We look at physical
and we look at virtual. I'll start first with physical.
We've been able to implement robotics in various areas throughout
our hospital. We have rooms the size of let's say,
twenty foot by twenty foot by twenty and there's massive,
large robots that do all of our pharmacy pill picking,
(20:25):
individual pills from orders that are placed with a massive
robot that runs twenty four to seven. And then what
we call box picking, which is our ointments and our
creams and non pill medications. Two robots run twenty four
to seven. We've been using them for about six years
now and it's been transformational because what it's allowed us
(20:45):
to do is have some of the technicians that we're
normally in these large rooms primarily in basements, and now
move them to the bedside. So now they are the
teams of embedded care team members that are now interacting
with the patients because we now have robots that can
be able to do it, and we now have those
team members interviewing patients, talking to them about their medications,
(21:09):
talking to them about their side effects. We've done this
in other areas. We have physical robots that deliver food
to patients. They call elevators, they go up and down elevators,
They deliver linens, they deliver medical devices, and we've found
them to work very well. There's also an a other
(21:29):
area which you don't hear talked about as much, but
there's virtual robots things we call robotic process automation that
has also served us well. And those are highly repetitive
tasks that are occurring on a computer. So we have
thousands and thousands of tasks that occur the same way
(21:49):
every day, and how do we automate that using a
virtual robot. Like when a patient gives us an insurance card,
we have team members need to go out to a
website and validate that insurance card to make sure it's
correct and do that process. We can now do that
with a high throughput, high volume RPA process and do
(22:12):
it in a virtual way, so once again we can
get more people to the bedside from a care team perspective.
Speaker 1 (22:20):
Before I could let Peter go, I needed to ask
him a couple more things. Is there a particular technology
that really made an incredible first impression on you, whether
in your profession or in your personal life.
Speaker 2 (22:39):
I have to say, and I don't mean to bring
up a recent technology, but I can't emphasize enough how
chat GPT will fundamentally transform education information throughout our world.
I saw it for the first time, and the method
by which it's being utilized, the distribution, and the power
(23:01):
and potential of that technology is going to be fundamentally
transformative for us over the next ten years. And that
was probably one of the most impressive things I've seen
since the advancements that have occurred in early twenty ten
in other areas.
Speaker 1 (23:18):
What advice would you give to other tech leaders in
the healthcare space.
Speaker 2 (23:24):
As my prior boss used to mention, it's all about people,
process and technology, and I think it's some of the
best advice. It is all about people. The technology works.
The technology has worked in every industry. It's all about adoption.
It's all about working with the providers, working with the
care team members, and working with the patients to drive adoption.
(23:48):
And that's critical for us as healthcare leaders. And as
we see that adoption accelerate, we're going to see productivity accelerate.
We're going to see more patients taken care of, we're
going to see less mortality, we're going to see better outcomes.
And I think that is truly the exciting part of
where we're going to go with the digital transformation.
Speaker 1 (24:08):
Peter, thank you so much for joining the show. I
really appreciate it. This has been a fantastic conversation.
Speaker 2 (24:15):
Jonathan. I can't thank you enough for having me on today.
Speaker 1 (24:23):
Peter's deep background in medicine and patient care clearly play
a pivotal role in his leadership strategy and leadership decisions
take on a new meeting when the outcome of those
decisions has an undeniably critical impact on patients and caregivers alike.
I was struck by how advanced technologies that will change
healthcare are built on the foundation of connectivity. It wasn't
(24:45):
that long ago that the tools doctors and nurses had
at their disposal were limited. That healthcare professionals took all
notes by hand, and those notes had to be entered
into medical records that weren't always easy to share or access.
But digitization and connectivity have created opportunities to change all that,
(25:06):
and the thought of five G enabling high tech medical
processes is really exciting. Reducing the amount of time spent
sending large image files across a network can literally save
a life. Be sure to join us for more episodes
of The Restless Ones. We'll be talking with more incredible
(25:26):
leaders about their approach to leveraging technology and how this
tech creates opportunities even in places we never thought to
look before. Until next time, I'm Jonathan Strickland, and this
is The Restless Ones.
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