December 12, 2024 • 32 mins
Join us as we welcome Dr. Jonathan Perlin, President and CEO of The Joint Commission, the world-wide leader in accreditation of healthcare institutions.
The session explores and provides a personal journey, as a physician and researcher who served as Under Secretary for Health and CEO of the Veterans Health Administration. After his work with the VHA, Dr. Perlin later became the President of Clinical Operations and Chief Medical Officer with HCA Healthcare. Dr. Perlin provides valuable insights to early careerists entering the world of a profession that balances health equity, environmental sustainability, learning and performance integration.
To learn more about Dr. Jonathan Perlin: https://www.jointcommission.org/who-we-are/joint-commission-officers-group/jonathan-b-perlin/
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Well, Melissa, thank you very much for that
introduction and a warm welcometoday to John Perlin.
John, thanks very much forjoining the podcast today.
Speaker 2 (00:11):
It's a delight to be here with you, Anthony.
Thanks to you and Kami for allthat you do.
Speaker 1 (00:16):
Thank you.
Well, john, let me start out.
You know, I know everyone inhealth care knows what the Joint
Commission is, but this podcastand this episode is
particularly target sometimes topeople who are looking at
starting their careers inhealthcare management and are
thinking about growing in there.
So I'm going to ask you one ofthe questions that you probably
(00:39):
don't get asked a lot, whichtell me about the Joint
Commission.
What does it do, what's itsrole, what's its purpose?
Speaker 2 (00:46):
Well, thanks for that question.
It's really an importantquestion and while those of us
who've been in healthcarecertainly know the Joint
Commission, I doubt that manypeople know why the Joint
Commission is called the JointCommission.
But in 1951, jointly, theAmerican College of Surgeons
wanted to continue what it hadstarted in 1913, which was
inspecting hospitals fortechnical capacity, for quality.
(01:09):
In fact, ernest Codman, one ofthe founders of the quality
movement in the early 20thcentury, started the American
College of Surgeons and thepredecessor Physicians ran
hospitals until World War II.
They got drafted to theater.
There was a deficit ofphysicians and the early 50s was
the rise important to Cammie ofprofessional healthcare
(01:30):
management.
But with the depletion ofphysicians and physician
executives, the American Collegeof Surgeons turned to the
American Medical Association,the American College of
Physicians, the American DentalAssociation and the American
Hospital Association and jointlyestablished the organization we
know today as the JointCommission.
It's the largest accreditor ofhospitals in the United States
(01:53):
and Joint CommissionInternational operates in 86
countries.
With the advent of the Medicarelegislation in 1965,
accreditation became requiredfor hospitals to participate in
those federal programs, whichmeans they couldn't be paid
unless they were accredited andorganizations like the Joint
Commission were deemed to havethe authority of CMS to assure
(02:17):
that certain marks of qualityand safety are foundationally in
place.
Speaker 1 (02:24):
John, the intersection with CAMI to me is
just amazing because it's thesame kind of time period the
formation of Medicare andMedicaid and which really kind
of kicked in the importance ofthe Joint Commission.
Also, in 1968, CAMI started tooand that was really kind of
designed with the same purposeto make sure students are
well-prepared to lead in anincreasingly complex world.
(02:46):
You mentioned Codman and Ithink that's a fascinating kind
of link for me.
Prior to the session, I wasjust looking at your LinkedIn
profile and your own backgroundand you listed three skills and,
John, I kind of got a kick outof it because, as I think about
you multi-skill, but you listedthree skills and those are
(03:06):
interesting to me telling.
One was data analysis, one wasclinical research and one was
electronic health records Dataanalysis, clinical research and
electronic health records and itwas fascinating to me when I
thought about that, becauseyou're an MD and a PhD and
basically, John, you're ascientist, You're someone who
(03:29):
continuously explores how datacan better interpret the world
and make it a better place.
And to me, the Joint Commission, that's what it's all about.
It's the continuous improvementof quality.
Speaker 2 (03:44):
Well, we think it's a really important organization
and I came here to really giveback after a career that I've
been very blessed to have had.
It was interesting JointCommission was recruiting for a
new CEO who had academicbackground and indeed, as you
mentioned, I have a PhD but Iturned my attention to health
services research because I keptasking the question why things
(04:05):
didn't work better.
They wanted someone with seniorgovernment experience and I
think running the VA healthsystem counts for that and they
wanted someone with operationalexperience.
And you know, being at HCA forover 15 years and leading the
clinical enterprise really gaveme that you know boots on the
ground, operational experienceas well, and so being able to
(04:29):
bring that to the JointCommission has been really
important, because we workclosely with CMS, we work
closely with the majororganizations that I mentioned
that were the founders of theJoint Commissions, and the truth
of the matter is is that in ourcareers there's never been a
more complex time in healthcare.
(04:51):
It's a tough time for healthcareorganizations, it's a tough
time for healthcare workers andyou know, whether it's you and I
as patients or advocating forfamily or friends, we still
don't have the type of qualitythat we want, and one of the
things I'm most proud of in theearly stages of my tenure here
at Joint Commission is thatwe've eliminated 400 standards
(05:14):
that we viewed to be notevidence-based, redundant juice,
not worth the squeeze.
And we only have one newstandard, and I'll come to that.
Um, and we only have one newstandard, and I'll come to that,
but um, the truth of the matteris there are other ways to get
accredited.
Um, we want to put the focus onthose things that count.
I know it's often attributed toEinstein, but it really is
(05:37):
potentially attributable to manythat old saying not everything
that counts is measured and noteverything that's measured
counts.
Um, we want to make sure thatthose things that get measured
count, and that's the basis forour HELP agenda, which is an
acronym for health, equity,environmental sustainability,
learning, healthcare, which isreally, at this moment, about
the responsible use of AI andperformance integration, making
(06:01):
the survey process much lessperformative and much more
integrated with the realities ofoperations.
Today.
Speaker 1 (06:08):
And John, I think that's where you and I serve a
common philosophy me and Kamiwith the we accredit graduate
healthcare management educationprograms and you with the Joint
Commission, which is we're notout there with a clipboard
checking off, going met, not met, you know.
But really our purpose, and ourboth your and my purpose is how
(06:32):
do we make institutions better,how do we give them the tools
and the knowledge to becomebetter, with the overall, you
know, guiding principle, how dowe make our society better and
healthcare better and thecommunities better?
Speaker 2 (06:48):
Yeah, well, first let me just say what a privilege it
is to partner on the CAMI JointCommission Sustainability
Fellow, and I know we'll have achance to talk about
sustainability because it's apassion for both of us and our
organizations.
But you're right, what CAMIsees across health management,
professional education, allowsnot only individual institutions
(07:08):
to be better, but it createsthe world's best library of
practices, of leading practices,that can elevate all.
Being in 86 countries and theopportunity to learn this works,
(07:29):
this doesn't work, or how didthey do it, how did they do that
in a low resource environment,is really one of the great
opportunities to bring evidenceto the practice of healthcare
and one of the privileges of thekinds of roles we have in our
organizations seeing peoplereally elevating the practice of
health administration, thepractice of healthcare, to its
(07:50):
highest levels.
Speaker 1 (07:51):
It's so true, john, it's not just you know.
Here's what we know in theUnited States, and how do we get
better.
But what's going on globally?
What are people doing betterelsewhere?
How can we learn, how can weimprove and how can we help
other places get better as welltoo?
Speaker 2 (08:08):
Well, you know, when I first came on board, I did a
bit of a listening tour and wentaround to some really prominent
organizations and some smallerorganizations and you know the
message was the same.
It's that why aren't yousharing best practices?
Why aren't you helping us withbenchmarking?
Why aren't you kind ofdemystifying the accreditation
process?
Now let me dissect that alittle bit.
(08:31):
About two-thirds, 75% of thesurvey we have to do any
accrediting organization has todo is based on the Centers for
Medicare and Medicaid Servicesor CMS's conditions of
participation, and thosestandards that are required come
not only from CMS but areconsolidated from a variety of
sources.
(08:51):
For example, the infamous waterbottles and not having them in
clinical areas that's OSHA,that's for health worker
protection, the penetrationsabove ceiling tiles to prevent
the spread of fire that's fromthe National Fire Protection Act
, and so those things arestructured by CMS.
But we really get to bringcreativity in working with those
(09:14):
organizations that are part ofthe Joint Commission.
Accredited family is really inthings that we know we have
great opportunities, and that'sagain the health agenda, health
equity, environmentalsustainability, learning and AI,
and really performanceintegration is about linking the
have-to-dos of accreditationwith the want-to-dos of the
(09:36):
operators' priorities at theirown institutions.
Speaker 1 (09:39):
Right, john, let me go to sustainability, because
you mentioned it a couple timesright now and you and I had
lunch I guess it was a littleover a year ago and you brought
back the Hippocratic Oath to meand it was first do no harm.
And I love repeating it andgiving you credit for reminding
me of it too within CAMI when wetalk about sustainability first
(10:03):
do no harm.
You've brought an interestingkind of focus to joint
commission kind of talk aboutwhy you've done it and what you
hope to accomplish through it.
Speaker 2 (10:15):
Well, a lot of this focus comes from the real world
of providing care.
Let me just digress for amoment and talk about health
equity.
You know, martin Luther Kingfamously said in 1966 at the
Medical Committee for HumanRights of all the forms of
inequality, injustice in healthis the most shocking and most
(10:36):
inhuman.
He didn't say inhumane, hedidn't say it was cruel, he said
it was beneath humanity.
And sadly, nearly 70 yearslater, those words are still
true.
The age-adjusted mortalityrates for African-American
versus white are over twice ashigh and, using the OMV
(10:56):
categories, american Indian andAlaskan Native, even higher.
And oh, by the way, the cost ofdisparities is substantial.
Today, we spent a third of atrillion dollars because of
disparities in healthcare and by2040, trillion dollars because
of disparities in health care.
And by 2040, that number, thatcost notwithstanding, the human
toll rises to a full trilliondollars.
(11:17):
I saw the dislocations from careduring COVID, my health system,
we had virtually eliminatedmaternal mortality in women of
color.
In fact, in two years, 2018 and2019, no women of color
succumbed, which isextraordinary against the
(11:40):
backdrop of a three to 400%greater risk for mortality in
women of color.
And in 2020, with the advent ofCOVID, 19 women showed up to
the emergency room, pregnant,ready to deliver and at death's
door.
And it wasn't just COVID, itwas dislocation from care, it
was the fragmentations in ourhealth system, and what was
always unacceptable really to mebecame intolerable.
(12:01):
So that was at the top of theagenda and I promised myself
that, given the opportunity tolead Joint Commission,
domestically, internationally,that would be a focus.
Now, what may not be apparentis that there is a direct link
to environmental sustainabilityand the impact of healthcare.
It's really interesting.
(12:22):
First, let's jump back for amoment.
In 2021, the British MedicalJournal partnered with over 200
other journals around the world,listing climate change as the
number one threat to health, andI defy anyone to go to a
(12:44):
healthcare organization and lookat the mission.
And I guarantee that missionsays improve health, improve
lives.
And I guarantee that missionsays improve health, improve
(13:15):
lives.
And the fact that healthcare isa major emitter.
And, considered a country, itwould be the fifth most
polluting country on the planet.
And if the United States were astate in that country, well,
we're overachievers.
We're 27% of the worldwidefootprint and, on any given day,
9% of our carbon footprint inthe United States comes from
healthcare.
It's a matter of health.
There are diseases that used tobe called tropical diseases.
(13:38):
They're now endemic.
They're now found each andevery day throughout the
continental US.
For example, things that Ididn't study much for in medical
school because I thought I'dnever see them Chickangunya,
dengue Every state south of theCanadian border has them.
Now it's a matter of healthequity.
The people who are mostvulnerable to bad health
(13:59):
outcomes can't buy their way outof harm's way Safety.
We know that, at the very timesthat cities and individuals
need health care, many of thosehealth care organizations are
offline, and so we've got tobuild resilience.
As TS Chan School of PublicHealth at Harvard points out,
four out of five primary careclinics were closed for at least
(14:23):
one day in the last three yearsbecause of extreme weather
events directly attributable toclimate change, so that's why
we're focused on these things.
Speaker 1 (14:32):
Yeah, john, it's just an amazing kind of set of
statistics and the place thatwe're in right now where you're
you know that focus is soimportant.
I look at sustainability in thesame way and I think how do we
educate our students to becomemore aware of the issues and the
(14:54):
impact on sustainability?
And when you and I talked aboutthat again a little over a year
ago, we came up with this ideaof a fellowship, and it was a
fellowship sponsored by theJoint Commission in coordination
with CAMI, and I'll let youtalk a little bit about it
because I know you're incrediblyproud of it.
Speaker 2 (15:16):
Well, I am proud of it.
You and I should both takepride.
The inaugural recipient of thefellowship is Sadie Joba, a
young woman from Rush Universitywho wants to make a career of
studying and improvingsustainability in healthcare and
, by the way, we'll berecruiting again and it's such a
privilege to partner with youon this.
But I need to really throwcredit your way because, as I go
(15:40):
around, not only to healthcareorganizations but to healthcare
training organizations, healthmanagement programs, I see now
that, thanks to the Camiinfluence, sustainability is
increasingly a part of thecurriculum and it's something
that particular youngerindividuals are very interested
(16:01):
in.
Did you know that, according tothe Robert Half Company, over
50% of individuals between 18and 34 do not want to work for
organizations that don't have aproactive commitment to
environmental stewardship?
So the inconsistency with themission of health care, the
opportunity to improve healthcare, the opportunity to improve
(16:24):
health and equity this is acompelling area and an important
new discipline or subdisciplineof health administration and
one, frankly, that's inescapablefor the foreseeable future.
Speaker 1 (16:37):
I see it, john, as you and I tapping into that vein
and going yes, that's animportant vein, go with it and
make change in health care.
Change in health care.
And you know it's.
Sadie is a fabulous firstrecruit from Rush University,
someone who is so dedicated tothe issues of sustainability,
improvement of health care,quality improvement and, like we
(16:59):
, we were really fortunate, andI think anyone listening to this
, you can go to the CAMI websiteand learn more about the CAMI
Joint Commission Fellowship forSustainability and how to Look
Live Again the partnership isjust amazing to me, john, thank
you very much for that.
Speaker 2 (17:15):
Well and we're learning as well and we
appreciate Sadie being thepioneer in this area.
I was just speaking with JohnBalbus at the Office for Climate
Change and Health Equity OCHEat HHS and Health Equity Ochi at
HHS.
He indicated that the officewould welcome future fellows to
(17:36):
have an experience in the officeas well.
So this is an opportunity forindividuals to really meet the
leaders around the countryworking on sustainable health
care.
Speaker 1 (17:46):
Yeah, john, I want to go back a little bit because
you know again, besides your MDand your PhD, at one point you
were also an MHA student at theVirginia Commonwealth University
, a CAMI accredited program, andI know part of your passion for
CAMI kind of comes from thatpedigree.
If you would, when you were youknow again, I'll kind of ask
(18:08):
you when you were back in thatprogram at that time and I know
you, if I'm correct, you alsohad your MD, like you were, you
were.
You went back on the executivekind of track on that.
Why did you do it?
Speaker 2 (18:22):
Well, that's a great question.
I didn't intend to go intohealth administration.
Truth be known, an intent to gointo health administration.
Truth be known, I did thecombined MD-PhD program and I
was headed toward a career inmolecular neurobiology not the
obvious course to healthadministration.
But my very first patient was aheart transplant patient
(18:42):
smoking.
10 days after his transplant,my wife, a pediatrician, turned
to me and said you realize,every kid in Richmond could have
been immunized for the cost ofthat transplant.
In any event, short story isthat I got sent to talk to the
dean.
The dean said well, it'sdifficult as a state school for
us to take on big tobacco, buthe said you know, we would
(19:05):
support students who wanted totake this on and, working with
faculty, we became tobacco-freein the next year and I learned
this empowering lesson, which isthat everything that brought me
to want to be a doctor, to wantto improve health, I realized
could be amplified if you had apolicy lever.
And I had an absolutelywonderful mentor, a new chief of
(19:27):
medicine, a guy named RichardWenzel, one of the founders of
the Society for HospitalEpidemiology of America, who
said we need to approach qualityand safety using mathematical
and epidemiologic tools.
He said you need to get trained, and so he let me, as chief
resident and as a junior facultymember, join the executive
program at Virginia CommonwealthUniversity and I retread as a
(19:50):
health services researcher.
I actually used the opportunityof my health administration
capstone project to write abusiness plan for an interstate
telehealth network and do someother things, and so I have an
extreme debt of gratitude to VCUbroadly, but also to the health
administration program.
(20:13):
Now, I will tell you at thatpoint, having, as you indicated,
already been become a doctor, Iwas working really hard and the
MHA executive track was, Ithink, harder because I had a
day job and I, you know, got upevery morning at three o'clock,
studied till five o'clock fortwo years in that program.
(20:36):
But it was absolutely the bestpossible career decision that I
could have made, and so I wantto congratulate VCU on their
75th anniversary as a healthadministration program, tracing
their roots to exactly thatperiod of time that led to the
formation of the JointCommission, the formation of
CAMI, and you know and I'vegotten to learn a lot about
(20:57):
other health administrationprograms too I have the
privilege of being on theNational Advisory Board to
Columbia Mailman's Health Policyand Management Program program.
And you know it's just sointeresting to see the traces of
CAMI, the preparation for theiraccreditation visits and, you
(21:17):
know, to see the influence thatorganizations like CAMI and
Joint Commission can have interms of giving a little boost
to things that we know areimportant, like health equity
and like sustainability.
Speaker 1 (21:29):
You hope, john, that everything you do is really kind
of having an impact in some way, shape or form, and every now
and then in your life you seelittle threads of it kind of
occurring and you think, yeah,there's a little part in there
that I had a function in.
So I appreciate you kind ofsaying that VCU, one of the
founders of CAMI, we started oneof the original programs too.
(21:51):
There are two other things Iwant to kind of point out.
One of them was your role atthe VHA as undersecretary, and
what a critical time that was,because at that particular point
VHA was starting withelectronic health records and
you had a huge part in that too.
Vha was starting withelectronic health records and
(22:13):
you had a huge part in that too.
It's hard to kind of think inthe time of 2024 what life was
like before electronic healthrecords, but there was that
point and the VHA at thatparticular juncture was really
known for what it wasaccomplishing with EHR.
Speaker 2 (22:29):
Well, you know, I came into the VA as the chief
quality officer and then held anumber of jobs chief research
officer, chief operating andthen chief executive officer.
But in that first role as chiefquality officer, the Secretary
of Veterans Affairs asked me ifyou could do one thing to
improve safety, quality andvalue.
What would it be and why?
I said full deployment of anelectronic health record.
(22:52):
We can create systemness out offragmentation VA has a large
footprint but it's a giantcountry and that we could
measure and mark progress.
And I remember he gave me thego-ahead, said make it happen.
And I remember that in about2005 or so when I became the CEO
(23:14):
before that, but when I was CEOundersecretary I got this call
from the White House and thepresident says we've got a very
special guest.
Could you come over and showhim that EHR thing?
And you know, I didn't say I'mgoing to check my calendar.
I said of course, and I go overand it turns out it's Bill
(23:36):
Gates and he was very interestedin the fact that we had a
national health record.
But he wasn't thoroughlyimpressed.
Now, mind you, this was 2004,2005-ish, and no one could track
a patient from Washington DC toWashington State because there
were no national data exchanges,there was no national
(24:00):
electronic record except VA.
He asked this question whyaren't you learning?
And, honestly, I didn'tunderstand that.
And if you go back to thatperiod of time, we didn't have
multi-terabyte hard drivessitting on our desk.
We were talking megabytes,sometimes gigabytes.
It wasn't until 2009, when thenext President, obama, invited
(24:21):
me to chair the Health ITStandards Committee, where I had
this epiphany that it wasn'tjust about having information,
be able to follow patients fromWashington DC to Washington
State.
It was about really creatingthe basis for a learning health
system, one that uses all datacreated for discovery and
(24:42):
research, for improving qualityand safety and for improving
operations.
And this, I think, is where VAis, where many systems are,
where really, in my next role atHCA, have the opportunity to
use data at scale to reallylearn and accelerate improvement
.
So it's been an exciting runwith respect to health
(25:05):
information and I think the mostexciting is ahead with AI.
Speaker 1 (25:10):
Yeah, no, it's true.
Talk about AI, I have to say Ihad, our whole team read Malik's
book and I think you know howcan we incorporate AI, both in
terms of, you know, ouraccreditation standards, but
also in terms of what we do justas part of our normal you know,
(25:30):
standards of work,co-intelligence by Ethan Malek.
What's the Joint Commissiondoing around AI?
Speaker 2 (25:40):
We're doing a lot around AI.
During COVID, when we had alarge health system, we had the
largest data set and we wantedto share that with NIH and AHRQ
for accelerating theunderstanding of COVID and its
therapy.
But we didn't have anunderwriter's laboratory to say
that our stewardship of the datawas as responsible as it might
(26:04):
be.
So we started this past yearreleasing the Responsible Use of
Health Data Certification, andit's about appropriate secondary
uses of data Definition.
Secondary use means using dataother than for the original
clinical purpose.
So if I get a blood test, let'ssay a blood count, obviously
the clinical information is theblood count, but the secondary
(26:27):
uses may be in improving qualityoperations, safety, research,
et cetera.
And patients do have a right toknow how their data might be
used.
And so we followed guidancefrom Health Evolution, which
convened privacy experts,patient advocates as well as
(26:48):
technical experts, and listed anumber of criteria, and the very
first organization receivedtheir responsible use of health
data certification just thispast month, and that was Inova
Health System in Fairfax,virginia.
But AI is obviously going to bedefining.
It is the defining technologyof the century, and I live
(27:09):
between two fears the fear, onthe one hand, that we won't have
guardrails to prevent misuse orbad things from happening, even
unintentionally.
But I have a greater fear isthat we don't stifle the
capacity to improve safety andquality with rigid
over-regulation and legislation.
(27:30):
And so I think the healthcarefield needs to take its own lead
, and so we had a convening inWashington recently, had
majority and minority members ofCongress with leadership in AI.
We have the new ASTP orAssistant Secretary for
Technology Policy, mickeyTrabathy, speak at that as well
(27:50):
as patient advocates, and youknow, if there was a key message
, it was patient at the center,but sub-messages were that we
need to figure a path betweenthose two barriers
underregulation on the one sideand over on the other.
And I want to offer a bit of aframework.
You know Michael Howell andKaren DeSalvo have a fabulous
(28:14):
paper on what they call thethree epochs, time periods of AI
, and they sort of coexist.
But epoch one is really theprobabilistic models, the
if-then statements.
You know we already use thosein healthcare.
If your blood pressure is high,treat it, and we don't want to
over-regulate that.
Epoc-2 is deep learning, machinelearning.
(28:36):
So, for example, training asystem to read mammograms They'd
already show, but those systemscan help perform low-volume
radiologists who don't do enoughmammography to really be at the
top of their game.
Flipping that around, though,it can also kind of reduce the
(28:59):
rote work for very experienced,and the best of all worlds is
where the hyper-experiencedperson has some workload sorting
by the machine and thenoverreads for the really special
cases, and we want a differentlevel of regulatory oversight
there.
But really where it getsinteresting is what comes to
(29:21):
mind today when we think of AIis generative foundation or
large language models, where theuse case for the application of
that engine may be verydifferent than the data that is
trained on, and that's wherethere have been some problems.
Notoriously, an insurancecompany wanted to improve heart
failure for minority patientsand because the training data
(29:45):
were biased, instead ofameliorating the bias, it
amplified it.
And this is part of where wesee a role for certification in
terms of endorsing three skillsets simultaneously the
technical capacity to build amodel, the domain expertise, for
example heart failure, but alsothe cultural competence to know
(30:06):
what are the biases or to havedrift in the model if it's doing
things that aren't appropriate.
But let me just close with thiswith an anecdote.
When I was at HCA, we trained amodel to identify sepsis
earlier Sepsis I know mostpeople think of as an end stage
(30:30):
of overwhelming infection, butit's really total body organ
failure and every hour ofdelayed diagnosis or delayed
recognition increases the chanceof death by up to 8%.
So time is life and on top ofbenchmark levels of sepsis
response across 63,000 beds, weintroduced an AI system, an
(30:53):
algorithm, to detect the earlywarning signs.
In the first 18 months we saved8,000 lives, 8,000 individuals
who went on to celebrate a newyear, to welcome a grandchild,
celebrate a birthday, and wedidn't say your patient has
sepsis.
(31:13):
We used what I call a peanutbutter and jelly approach.
We said, hey, the machine seesA, b and C.
Now this had the virtue ofbeing understandable to
clinicians and some of thegreatest response back was not
only that it saved lives, butthe clinician said this is what
makes using an EHR worthwhileand you know, I want to make
(31:37):
sure that these opportunitiesexist to really magnitudinally
improve healthcare.
Speaker 1 (31:44):
John, I remember working with you at HCA and
that's where I first becamefamiliar with you and I was with
a company called Solution atthat time and I just remember
leaving HCA in awe of what youfolks were doing, both in terms
of how you used our data andsome of our data sets and
algorithms and stuff and how youincorporated that into HCA data
(32:07):
.
And I have to tell you it wasone of I know we had a very
small part in there in terms ofdoing what you're doing.
We weren't the implicationbehind it, but I have to tell
you the folks at Solution andmyself personally, we're very
proud to at least play a part inthat and the work that HCA was
doing.
Speaker 2 (32:26):
Well, as they say, it takes a village.
Thank you for that part, andeven more thank you for the
important role you're playingnow with CAMI, because we get to
spread this gospel of a betterworld ahead.
I think both of us share that,despite optimism about how we
(32:55):
can make progress in some ofthese critically important areas
.
Speaker 1 (32:59):
Oh, thank you, John.
This is a conversation I cancontinue on for a long time and
I know our lunch that we hadprobably, I think, lasted two
and a half hours when we did it,just simply around this.
But I really want to thank youvery much for participating on
this episode and I think for anyof the early careerists out
there or students consideringhealthcare, you know your
(33:19):
message of optimism, hope andmaking a better world, I think,
is really one that shouldresonate in what we want to do
in healthcare.
Speaker 2 (33:27):
Well, thank you, anthony, for the privilege of
being with you today, and let mealso take the prerogative not
only for thanking Cami you,Anthony, for the privilege of
being with you today, and let mealso take the prerogative not
only for thanking Cami, but allof those health professions
educators around the country.
I mentioned two of the greatinstitutions I get to work with
VCU and Columbia, and so just tocall out to the teams there,
(33:48):
led by Paula Song at VCU andMichael Sparer at Columbia, you
know I wouldn't have had thegreat opportunities that I've
had in my life were it not forprograms like yours.
So thanks for doing what you do.
It's rare that we get to saythank you to our teachers.
Speaker 1 (34:03):
Absolutely All right, John.
Well, appreciate your time.
I know you got importantmeetings to kind of go after
this and thank you very much forbeing part of this.
Take care.
Well, Melissa, thank you very much for that
introduction and a warm welcometoday to John Perlin.
John, thanks very much forjoining the podcast today.
Speaker 2 (00:11):
It's a delight to be here with you, Anthony.
Thanks to you and Kami for allthat you do.
Speaker 1 (00:16):
Thank you.
Well, john, let me start out.
You know, I know everyone inhealth care knows what the Joint
Commission is, but this podcastand this episode is
particularly target sometimes topeople who are looking at
starting their careers inhealthcare management and are
thinking about growing in there.
So I'm going to ask you one ofthe questions that you probably
(00:39):
don't get asked a lot, whichtell me about the Joint
Commission.
What does it do, what's itsrole, what's its purpose?
Speaker 2 (00:46):
Well, thanks for that question.
It's really an importantquestion and while those of us
who've been in healthcarecertainly know the Joint
Commission, I doubt that manypeople know why the Joint
Commission is called the JointCommission.
But in 1951, jointly, theAmerican College of Surgeons
wanted to continue what it hadstarted in 1913, which was
inspecting hospitals fortechnical capacity, for quality.
(01:09):
In fact, ernest Codman, one ofthe founders of the quality
movement in the early 20thcentury, started the American
College of Surgeons and thepredecessor Physicians ran
hospitals until World War II.
They got drafted to theater.
There was a deficit ofphysicians and the early 50s was
the rise important to Cammie ofprofessional healthcare
(01:30):
management.
But with the depletion ofphysicians and physician
executives, the American Collegeof Surgeons turned to the
American Medical Association,the American College of
Physicians, the American DentalAssociation and the American
Hospital Association and jointlyestablished the organization we
know today as the JointCommission.
It's the largest accreditor ofhospitals in the United States
(01:53):
and Joint CommissionInternational operates in 86
countries.
With the advent of the Medicarelegislation in 1965,
accreditation became requiredfor hospitals to participate in
those federal programs, whichmeans they couldn't be paid
unless they were accredited andorganizations like the Joint
Commission were deemed to havethe authority of CMS to assure
(02:17):
that certain marks of qualityand safety are foundationally in
place.
Speaker 1 (02:24):
John, the intersection with CAMI to me is
just amazing because it's thesame kind of time period the
formation of Medicare andMedicaid and which really kind
of kicked in the importance ofthe Joint Commission.
Also, in 1968, CAMI started tooand that was really kind of
designed with the same purposeto make sure students are
well-prepared to lead in anincreasingly complex world.
(02:46):
You mentioned Codman and Ithink that's a fascinating kind
of link for me.
Prior to the session, I wasjust looking at your LinkedIn
profile and your own backgroundand you listed three skills and,
John, I kind of got a kick outof it because, as I think about
you multi-skill, but you listedthree skills and those are
(03:06):
interesting to me telling.
One was data analysis, one wasclinical research and one was
electronic health records Dataanalysis, clinical research and
electronic health records and itwas fascinating to me when I
thought about that, becauseyou're an MD and a PhD and
basically, John, you're ascientist, You're someone who
(03:29):
continuously explores how datacan better interpret the world
and make it a better place.
And to me, the Joint Commission, that's what it's all about.
It's the continuous improvementof quality.
Speaker 2 (03:44):
Well, we think it's a really important organization
and I came here to really giveback after a career that I've
been very blessed to have had.
It was interesting JointCommission was recruiting for a
new CEO who had academicbackground and indeed, as you
mentioned, I have a PhD but Iturned my attention to health
services research because I keptasking the question why things
(04:05):
didn't work better.
They wanted someone with seniorgovernment experience and I
think running the VA healthsystem counts for that and they
wanted someone with operationalexperience.
And you know, being at HCA forover 15 years and leading the
clinical enterprise really gaveme that you know boots on the
ground, operational experienceas well, and so being able to
(04:29):
bring that to the JointCommission has been really
important, because we workclosely with CMS, we work
closely with the majororganizations that I mentioned
that were the founders of theJoint Commissions, and the truth
of the matter is is that in ourcareers there's never been a
more complex time in healthcare.
(04:51):
It's a tough time for healthcareorganizations, it's a tough
time for healthcare workers andyou know, whether it's you and I
as patients or advocating forfamily or friends, we still
don't have the type of qualitythat we want, and one of the
things I'm most proud of in theearly stages of my tenure here
at Joint Commission is thatwe've eliminated 400 standards
(05:14):
that we viewed to be notevidence-based, redundant juice,
not worth the squeeze.
And we only have one newstandard, and I'll come to that.
Um, and we only have one newstandard, and I'll come to that,
but um, the truth of the matteris there are other ways to get
accredited.
Um, we want to put the focus onthose things that count.
I know it's often attributed toEinstein, but it really is
(05:37):
potentially attributable to manythat old saying not everything
that counts is measured and noteverything that's measured
counts.
Um, we want to make sure thatthose things that get measured
count, and that's the basis forour HELP agenda, which is an
acronym for health, equity,environmental sustainability,
learning, healthcare, which isreally, at this moment, about
the responsible use of AI andperformance integration, making
(06:01):
the survey process much lessperformative and much more
integrated with the realities ofoperations.
Today.
Speaker 1 (06:08):
And John, I think that's where you and I serve a
common philosophy me and Kamiwith the we accredit graduate
healthcare management educationprograms and you with the Joint
Commission, which is we're notout there with a clipboard
checking off, going met, not met, you know.
But really our purpose, and ourboth your and my purpose is how
(06:32):
do we make institutions better,how do we give them the tools
and the knowledge to becomebetter, with the overall, you
know, guiding principle, how dowe make our society better and
healthcare better and thecommunities better?
Speaker 2 (06:48):
Yeah, well, first let me just say what a privilege it
is to partner on the CAMI JointCommission Sustainability
Fellow, and I know we'll have achance to talk about
sustainability because it's apassion for both of us and our
organizations.
But you're right, what CAMIsees across health management,
professional education, allowsnot only individual institutions
(07:08):
to be better, but it createsthe world's best library of
practices, of leading practices,that can elevate all.
Being in 86 countries and theopportunity to learn this works,
(07:29):
this doesn't work, or how didthey do it, how did they do that
in a low resource environment,is really one of the great
opportunities to bring evidenceto the practice of healthcare
and one of the privileges of thekinds of roles we have in our
organizations seeing peoplereally elevating the practice of
health administration, thepractice of healthcare, to its
(07:50):
highest levels.
Speaker 1 (07:51):
It's so true, john, it's not just you know.
Here's what we know in theUnited States, and how do we get
better.
But what's going on globally?
What are people doing betterelsewhere?
How can we learn, how can weimprove and how can we help
other places get better as welltoo?
Speaker 2 (08:08):
Well, you know, when I first came on board, I did a
bit of a listening tour and wentaround to some really prominent
organizations and some smallerorganizations and you know the
message was the same.
It's that why aren't yousharing best practices?
Why aren't you helping us withbenchmarking?
Why aren't you kind ofdemystifying the accreditation
process?
Now let me dissect that alittle bit.
(08:31):
About two-thirds, 75% of thesurvey we have to do any
accrediting organization has todo is based on the Centers for
Medicare and Medicaid Servicesor CMS's conditions of
participation, and thosestandards that are required come
not only from CMS but areconsolidated from a variety of
sources.
(08:51):
For example, the infamous waterbottles and not having them in
clinical areas that's OSHA,that's for health worker
protection, the penetrationsabove ceiling tiles to prevent
the spread of fire that's fromthe National Fire Protection Act
, and so those things arestructured by CMS.
But we really get to bringcreativity in working with those
(09:14):
organizations that are part ofthe Joint Commission.
Accredited family is really inthings that we know we have
great opportunities, and that'sagain the health agenda, health
equity, environmentalsustainability, learning and AI,
and really performanceintegration is about linking the
have-to-dos of accreditationwith the want-to-dos of the
(09:36):
operators' priorities at theirown institutions.
Speaker 1 (09:39):
Right, john, let me go to sustainability, because
you mentioned it a couple timesright now and you and I had
lunch I guess it was a littleover a year ago and you brought
back the Hippocratic Oath to meand it was first do no harm.
And I love repeating it andgiving you credit for reminding
me of it too within CAMI when wetalk about sustainability first
(10:03):
do no harm.
You've brought an interestingkind of focus to joint
commission kind of talk aboutwhy you've done it and what you
hope to accomplish through it.
Speaker 2 (10:15):
Well, a lot of this focus comes from the real world
of providing care.
Let me just digress for amoment and talk about health
equity.
You know, martin Luther Kingfamously said in 1966 at the
Medical Committee for HumanRights of all the forms of
inequality, injustice in healthis the most shocking and most
(10:36):
inhuman.
He didn't say inhumane, hedidn't say it was cruel, he said
it was beneath humanity.
And sadly, nearly 70 yearslater, those words are still
true.
The age-adjusted mortalityrates for African-American
versus white are over twice ashigh and, using the OMV
(10:56):
categories, american Indian andAlaskan Native, even higher.
And oh, by the way, the cost ofdisparities is substantial.
Today, we spent a third of atrillion dollars because of
disparities in healthcare and by2040, trillion dollars because
of disparities in health care.
And by 2040, that number, thatcost notwithstanding, the human
toll rises to a full trilliondollars.
(11:17):
I saw the dislocations from careduring COVID, my health system,
we had virtually eliminatedmaternal mortality in women of
color.
In fact, in two years, 2018 and2019, no women of color
succumbed, which isextraordinary against the
(11:40):
backdrop of a three to 400%greater risk for mortality in
women of color.
And in 2020, with the advent ofCOVID, 19 women showed up to
the emergency room, pregnant,ready to deliver and at death's
door.
And it wasn't just COVID, itwas dislocation from care, it
was the fragmentations in ourhealth system, and what was
always unacceptable really to mebecame intolerable.
(12:01):
So that was at the top of theagenda and I promised myself
that, given the opportunity tolead Joint Commission,
domestically, internationally,that would be a focus.
Now, what may not be apparentis that there is a direct link
to environmental sustainabilityand the impact of healthcare.
It's really interesting.
(12:22):
First, let's jump back for amoment.
In 2021, the British MedicalJournal partnered with over 200
other journals around the world,listing climate change as the
number one threat to health, andI defy anyone to go to a
(12:44):
healthcare organization and lookat the mission.
And I guarantee that missionsays improve health, improve
lives.
And I guarantee that missionsays improve health, improve
(13:15):
lives.
And the fact that healthcare isa major emitter.
And, considered a country, itwould be the fifth most
polluting country on the planet.
And if the United States were astate in that country, well,
we're overachievers.
We're 27% of the worldwidefootprint and, on any given day,
9% of our carbon footprint inthe United States comes from
healthcare.
It's a matter of health.
There are diseases that used tobe called tropical diseases.
(13:38):
They're now endemic.
They're now found each andevery day throughout the
continental US.
For example, things that Ididn't study much for in medical
school because I thought I'dnever see them Chickangunya,
dengue Every state south of theCanadian border has them.
Now it's a matter of healthequity.
The people who are mostvulnerable to bad health
(13:59):
outcomes can't buy their way outof harm's way Safety.
We know that, at the very timesthat cities and individuals
need health care, many of thosehealth care organizations are
offline, and so we've got tobuild resilience.
As TS Chan School of PublicHealth at Harvard points out,
four out of five primary careclinics were closed for at least
(14:23):
one day in the last three yearsbecause of extreme weather
events directly attributable toclimate change, so that's why
we're focused on these things.
Speaker 1 (14:32):
Yeah, john, it's just an amazing kind of set of
statistics and the place thatwe're in right now where you're
you know that focus is soimportant.
I look at sustainability in thesame way and I think how do we
educate our students to becomemore aware of the issues and the
(14:54):
impact on sustainability?
And when you and I talked aboutthat again a little over a year
ago, we came up with this ideaof a fellowship, and it was a
fellowship sponsored by theJoint Commission in coordination
with CAMI, and I'll let youtalk a little bit about it
because I know you're incrediblyproud of it.
Speaker 2 (15:16):
Well, I am proud of it.
You and I should both takepride.
The inaugural recipient of thefellowship is Sadie Joba, a
young woman from Rush Universitywho wants to make a career of
studying and improvingsustainability in healthcare and
, by the way, we'll berecruiting again and it's such a
privilege to partner with youon this.
But I need to really throwcredit your way because, as I go
(15:40):
around, not only to healthcareorganizations but to healthcare
training organizations, healthmanagement programs, I see now
that, thanks to the Camiinfluence, sustainability is
increasingly a part of thecurriculum and it's something
that particular youngerindividuals are very interested
(16:01):
in.
Did you know that, according tothe Robert Half Company, over
50% of individuals between 18and 34 do not want to work for
organizations that don't have aproactive commitment to
environmental stewardship?
So the inconsistency with themission of health care, the
opportunity to improve healthcare, the opportunity to improve
(16:24):
health and equity this is acompelling area and an important
new discipline or subdisciplineof health administration and
one, frankly, that's inescapablefor the foreseeable future.
Speaker 1 (16:37):
I see it, john, as you and I tapping into that vein
and going yes, that's animportant vein, go with it and
make change in health care.
Change in health care.
And you know it's.
Sadie is a fabulous firstrecruit from Rush University,
someone who is so dedicated tothe issues of sustainability,
improvement of health care,quality improvement and, like we
(16:59):
, we were really fortunate, andI think anyone listening to this
, you can go to the CAMI websiteand learn more about the CAMI
Joint Commission Fellowship forSustainability and how to Look
Live Again the partnership isjust amazing to me, john, thank
you very much for that.
Speaker 2 (17:15):
Well and we're learning as well and we
appreciate Sadie being thepioneer in this area.
I was just speaking with JohnBalbus at the Office for Climate
Change and Health Equity OCHEat HHS and Health Equity Ochi at
HHS.
He indicated that the officewould welcome future fellows to
(17:36):
have an experience in the officeas well.
So this is an opportunity forindividuals to really meet the
leaders around the countryworking on sustainable health
care.
Speaker 1 (17:46):
Yeah, john, I want to go back a little bit because
you know again, besides your MDand your PhD, at one point you
were also an MHA student at theVirginia Commonwealth University
, a CAMI accredited program, andI know part of your passion for
CAMI kind of comes from thatpedigree.
If you would, when you were youknow again, I'll kind of ask
(18:08):
you when you were back in thatprogram at that time and I know
you, if I'm correct, you alsohad your MD, like you were, you
were.
You went back on the executivekind of track on that.
Why did you do it?
Speaker 2 (18:22):
Well, that's a great question.
I didn't intend to go intohealth administration.
Truth be known, an intent to gointo health administration.
Truth be known, I did thecombined MD-PhD program and I
was headed toward a career inmolecular neurobiology not the
obvious course to healthadministration.
But my very first patient was aheart transplant patient
(18:42):
smoking.
10 days after his transplant,my wife, a pediatrician, turned
to me and said you realize,every kid in Richmond could have
been immunized for the cost ofthat transplant.
In any event, short story isthat I got sent to talk to the
dean.
The dean said well, it'sdifficult as a state school for
us to take on big tobacco, buthe said you know, we would
(19:05):
support students who wanted totake this on and, working with
faculty, we became tobacco-freein the next year and I learned
this empowering lesson, which isthat everything that brought me
to want to be a doctor, to wantto improve health, I realized
could be amplified if you had apolicy lever.
And I had an absolutelywonderful mentor, a new chief of
(19:27):
medicine, a guy named RichardWenzel, one of the founders of
the Society for HospitalEpidemiology of America, who
said we need to approach qualityand safety using mathematical
and epidemiologic tools.
He said you need to get trained, and so he let me, as chief
resident and as a junior facultymember, join the executive
program at Virginia CommonwealthUniversity and I retread as a
(19:50):
health services researcher.
I actually used the opportunityof my health administration
capstone project to write abusiness plan for an interstate
telehealth network and do someother things, and so I have an
extreme debt of gratitude to VCUbroadly, but also to the health
administration program.
(20:13):
Now, I will tell you at thatpoint, having, as you indicated,
already been become a doctor, Iwas working really hard and the
MHA executive track was, Ithink, harder because I had a
day job and I, you know, got upevery morning at three o'clock,
studied till five o'clock fortwo years in that program.
(20:36):
But it was absolutely the bestpossible career decision that I
could have made, and so I wantto congratulate VCU on their
75th anniversary as a healthadministration program, tracing
their roots to exactly thatperiod of time that led to the
formation of the JointCommission, the formation of
CAMI, and you know and I'vegotten to learn a lot about
(20:57):
other health administrationprograms too I have the
privilege of being on theNational Advisory Board to
Columbia Mailman's Health Policyand Management Program program.
And you know it's just sointeresting to see the traces of
CAMI, the preparation for theiraccreditation visits and, you
(21:17):
know, to see the influence thatorganizations like CAMI and
Joint Commission can have interms of giving a little boost
to things that we know areimportant, like health equity
and like sustainability.
Speaker 1 (21:29):
You hope, john, that everything you do is really kind
of having an impact in some way, shape or form, and every now
and then in your life you seelittle threads of it kind of
occurring and you think, yeah,there's a little part in there
that I had a function in.
So I appreciate you kind ofsaying that VCU, one of the
founders of CAMI, we started oneof the original programs too.
(21:51):
There are two other things Iwant to kind of point out.
One of them was your role atthe VHA as undersecretary, and
what a critical time that was,because at that particular point
VHA was starting withelectronic health records and
you had a huge part in that too.
Vha was starting withelectronic health records and
(22:13):
you had a huge part in that too.
It's hard to kind of think inthe time of 2024 what life was
like before electronic healthrecords, but there was that
point and the VHA at thatparticular juncture was really
known for what it wasaccomplishing with EHR.
Speaker 2 (22:29):
Well, you know, I came into the VA as the chief
quality officer and then held anumber of jobs chief research
officer, chief operating andthen chief executive officer.
But in that first role as chiefquality officer, the Secretary
of Veterans Affairs asked me ifyou could do one thing to
improve safety, quality andvalue.
What would it be and why?
I said full deployment of anelectronic health record.
(22:52):
We can create systemness out offragmentation VA has a large
footprint but it's a giantcountry and that we could
measure and mark progress.
And I remember he gave me thego-ahead, said make it happen.
And I remember that in about2005 or so when I became the CEO
(23:14):
before that, but when I was CEOundersecretary I got this call
from the White House and thepresident says we've got a very
special guest.
Could you come over and showhim that EHR thing?
And you know, I didn't say I'mgoing to check my calendar.
I said of course, and I go overand it turns out it's Bill
(23:36):
Gates and he was very interestedin the fact that we had a
national health record.
But he wasn't thoroughlyimpressed.
Now, mind you, this was 2004,2005-ish, and no one could track
a patient from Washington DC toWashington State because there
were no national data exchanges,there was no national
(24:00):
electronic record except VA.
He asked this question whyaren't you learning?
And, honestly, I didn'tunderstand that.
And if you go back to thatperiod of time, we didn't have
multi-terabyte hard drivessitting on our desk.
We were talking megabytes,sometimes gigabytes.
It wasn't until 2009, when thenext President, obama, invited
(24:21):
me to chair the Health ITStandards Committee, where I had
this epiphany that it wasn'tjust about having information,
be able to follow patients fromWashington DC to Washington
State.
It was about really creatingthe basis for a learning health
system, one that uses all datacreated for discovery and
(24:42):
research, for improving qualityand safety and for improving
operations.
And this, I think, is where VAis, where many systems are,
where really, in my next role atHCA, have the opportunity to
use data at scale to reallylearn and accelerate improvement
.
So it's been an exciting runwith respect to health
(25:05):
information and I think the mostexciting is ahead with AI.
Speaker 1 (25:10):
Yeah, no, it's true.
Talk about AI, I have to say Ihad, our whole team read Malik's
book and I think you know howcan we incorporate AI, both in
terms of, you know, ouraccreditation standards, but
also in terms of what we do justas part of our normal you know,
(25:30):
standards of work,co-intelligence by Ethan Malek.
What's the Joint Commissiondoing around AI?
Speaker 2 (25:40):
We're doing a lot around AI.
During COVID, when we had alarge health system, we had the
largest data set and we wantedto share that with NIH and AHRQ
for accelerating theunderstanding of COVID and its
therapy.
But we didn't have anunderwriter's laboratory to say
that our stewardship of the datawas as responsible as it might
(26:04):
be.
So we started this past yearreleasing the Responsible Use of
Health Data Certification, andit's about appropriate secondary
uses of data Definition.
Secondary use means using dataother than for the original
clinical purpose.
So if I get a blood test, let'ssay a blood count, obviously
the clinical information is theblood count, but the secondary
(26:27):
uses may be in improving qualityoperations, safety, research,
et cetera.
And patients do have a right toknow how their data might be
used.
And so we followed guidancefrom Health Evolution, which
convened privacy experts,patient advocates as well as
(26:48):
technical experts, and listed anumber of criteria, and the very
first organization receivedtheir responsible use of health
data certification just thispast month, and that was Inova
Health System in Fairfax,virginia.
But AI is obviously going to bedefining.
It is the defining technologyof the century, and I live
(27:09):
between two fears the fear, onthe one hand, that we won't have
guardrails to prevent misuse orbad things from happening, even
unintentionally.
But I have a greater fear isthat we don't stifle the
capacity to improve safety andquality with rigid
over-regulation and legislation.
(27:30):
And so I think the healthcarefield needs to take its own lead
, and so we had a convening inWashington recently, had
majority and minority members ofCongress with leadership in AI.
We have the new ASTP orAssistant Secretary for
Technology Policy, mickeyTrabathy, speak at that as well
(27:50):
as patient advocates, and youknow, if there was a key message
, it was patient at the center,but sub-messages were that we
need to figure a path betweenthose two barriers
underregulation on the one sideand over on the other.
And I want to offer a bit of aframework.
You know Michael Howell andKaren DeSalvo have a fabulous
(28:14):
paper on what they call thethree epochs, time periods of AI
, and they sort of coexist.
But epoch one is really theprobabilistic models, the
if-then statements.
You know we already use thosein healthcare.
If your blood pressure is high,treat it, and we don't want to
over-regulate that.
Epoc-2 is deep learning, machinelearning.
(28:36):
So, for example, training asystem to read mammograms They'd
already show, but those systemscan help perform low-volume
radiologists who don't do enoughmammography to really be at the
top of their game.
Flipping that around, though,it can also kind of reduce the
(28:59):
rote work for very experienced,and the best of all worlds is
where the hyper-experiencedperson has some workload sorting
by the machine and thenoverreads for the really special
cases, and we want a differentlevel of regulatory oversight
there.
But really where it getsinteresting is what comes to
(29:21):
mind today when we think of AIis generative foundation or
large language models, where theuse case for the application of
that engine may be verydifferent than the data that is
trained on, and that's wherethere have been some problems.
Notoriously, an insurancecompany wanted to improve heart
failure for minority patientsand because the training data
(29:45):
were biased, instead ofameliorating the bias, it
amplified it.
And this is part of where wesee a role for certification in
terms of endorsing three skillsets simultaneously the
technical capacity to build amodel, the domain expertise, for
example heart failure, but alsothe cultural competence to know
(30:06):
what are the biases or to havedrift in the model if it's doing
things that aren't appropriate.
But let me just close with thiswith an anecdote.
When I was at HCA, we trained amodel to identify sepsis
earlier Sepsis I know mostpeople think of as an end stage
(30:30):
of overwhelming infection, butit's really total body organ
failure and every hour ofdelayed diagnosis or delayed
recognition increases the chanceof death by up to 8%.
So time is life and on top ofbenchmark levels of sepsis
response across 63,000 beds, weintroduced an AI system, an
(30:53):
algorithm, to detect the earlywarning signs.
In the first 18 months we saved8,000 lives, 8,000 individuals
who went on to celebrate a newyear, to welcome a grandchild,
celebrate a birthday, and wedidn't say your patient has
sepsis.
(31:13):
We used what I call a peanutbutter and jelly approach.
We said, hey, the machine seesA, b and C.
Now this had the virtue ofbeing understandable to
clinicians and some of thegreatest response back was not
only that it saved lives, butthe clinician said this is what
makes using an EHR worthwhileand you know, I want to make
(31:37):
sure that these opportunitiesexist to really magnitudinally
improve healthcare.
Speaker 1 (31:44):
John, I remember working with you at HCA and
that's where I first becamefamiliar with you and I was with
a company called Solution atthat time and I just remember
leaving HCA in awe of what youfolks were doing, both in terms
of how you used our data andsome of our data sets and
algorithms and stuff and how youincorporated that into HCA data
(32:07):
.
And I have to tell you it wasone of I know we had a very
small part in there in terms ofdoing what you're doing.
We weren't the implicationbehind it, but I have to tell
you the folks at Solution andmyself personally, we're very
proud to at least play a part inthat and the work that HCA was
doing.
Speaker 2 (32:26):
Well, as they say, it takes a village.
Thank you for that part, andeven more thank you for the
important role you're playingnow with CAMI, because we get to
spread this gospel of a betterworld ahead.
I think both of us share that,despite optimism about how we
(32:55):
can make progress in some ofthese critically important areas
.
Speaker 1 (32:59):
Oh, thank you, John.
This is a conversation I cancontinue on for a long time and
I know our lunch that we hadprobably, I think, lasted two
and a half hours when we did it,just simply around this.
But I really want to thank youvery much for participating on
this episode and I think for anyof the early careerists out
there or students consideringhealthcare, you know your
(33:19):
message of optimism, hope andmaking a better world, I think,
is really one that shouldresonate in what we want to do
in healthcare.
Speaker 2 (33:27):
Well, thank you, anthony, for the privilege of
being with you today, and let mealso take the prerogative not
only for thanking Cami you,Anthony, for the privilege of
being with you today, and let mealso take the prerogative not
only for thanking Cami, but allof those health professions
educators around the country.
I mentioned two of the greatinstitutions I get to work with
VCU and Columbia, and so just tocall out to the teams there,
(33:48):
led by Paula Song at VCU andMichael Sparer at Columbia, you
know I wouldn't have had thegreat opportunities that I've
had in my life were it not forprograms like yours.
So thanks for doing what you do.
It's rare that we get to saythank you to our teachers.
Speaker 1 (34:03):
Absolutely All right, John.
Well, appreciate your time.
I know you got importantmeetings to kind of go after
this and thank you very much forbeing part of this.
Take care.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.