From AI to EHR: How to Approach Healthcare Innovation Today

Phil Sobol:

Welcome to the CereCore Podcast, where we focus on the intersection of healthcare and IT. From practical conversations to strategic thought leadership, let's unpack the decisions, challenges, and journey of those whose purpose it is to deliver technology that improves healthcare in their communities.

Today we are pleased to welcome to the CereCore Podcast, Darrell Bodnar. Darrell is an IT executive with over 30 years of experience in healthcare IT. He got his start as a network administrator at Weeks Medical Center in Lancaster, New Hampshire, and kept growing as an IT leader from there. Today, he's the Chief Information Officer at North Country Healthcare. Darrell is passionate about healthcare and really understands how to connect with medical staff members, executive leaders, and the board of Trustees. He's a strategic thinker and leader, with a keen focus on making sure technology and organizational goals align in a way that drives innovation and improves efficiency. Darrell, welcome to the CereCore Podcast.

Darrell Bodnar:

Phil Sobol, thank you so much for having me. It is a pleasure to be here. Thank you for that introduction. I appreciated that. Always difficult to hear it when somebody else is doing it.

Phil Sobol:

That it is, and quite frankly, the introduction really, I mean, barely scratched the surface of your healthcare IT leadership story. So perhaps we'll just start right there. Did you grow up in New England? Is there maybe a personal backstory as to how you got started working in healthcare in hospitals in New Hampshire, and perhaps any pivotal moments along the way into your journey as CIO of North Country today?

Darrell Bodnar:

Well, it's odd. I am definitely from New England. My entire life has been spent growing up in New England and the majority of it in New Hampshire. The backstory behind this is an odd one. So, I was originally preparing myself to go to college and finish off school in culinary arts. That was a passion of mine in school and as I got later on in, I had three years of it during my high school years, for just prepping myself for that. And as I moved towards it, I took various positions and found out I love to cook, but I hated commercial cooking.

So, I decided to pivot and in the interim when I was pausing for school, I took a job at a hospital, working in their materials management department. And that was my first exposure to healthcare and became very, very passionate about it, had some great mentors and leaders, and eventually worked my way up through, developed a sort of liking for technology and actually had started college again, moving towards the computer field. And lo and behold, a network administrator job opened up and the rest is history. That's sort of how I got here. It was an odd intro to it. Healthcare was not on my radar during high school, but you find home, you find what you're passionate about, or it finds you.

Phil Sobol:

You're absolutely right and we love just kind of hearing those stories. Some folks are, "Hey, this is exactly what I want to do, because my parents were in it," or so on and so forth.

But others, it's interesting to see those intersections in life, where all of a sudden that mission presents itself and you have that aha moment, so that's great to hear. North Country recently achieved level nine in CHIME's Digital Health Most Wired program, for both I believe acute and ambulatory. In fact, North Country really was the only healthcare organization in New Hampshire to achieve this caliber of digital health maturity, which is a tremendous honor. Talk about what goes into integrating technology into healthcare to drive such a high level of performance.

Darrell Bodnar:

I think when I think of the technology and implementation of what we've done, I think it's more than the implementation of technologies. I think it's the adoption and adoption isn't necessarily strictly an IT function, but IT has to be intimately involved and we need to provide the guidance for end users, so that they can interpret it, so they can adopt it, they can build it into their workflows. It takes a long time to do that , especially across three organizations. And we've been building this for years just going towards it, and initially we started out with the level sevens and so forth, and have slowly worked our way into the level nines. I was myself surprised that we achieved level nine in both of those this year, but it's a testament not to my efforts, but to the entire organization's efforts. It's the team's efforts, it's their willingness to adopt and implement best practices that will lead us down that path.

Phil Sobol:

I think it's a great point, and so many times people put the burden and the responsibilities solely on the shoulders of IT, and that's just not right. I do think it truly is an entire organization. Technology's that underpinning, but at the same point, you've got to have leadership and then the folks using the technology truly bought into that. So well-spoken there. There's so many pressing topics in healthcare IT today. AI, cybersecurity are probably the top two that we hear all the time now. You've been studying and watching these disciplines for a number of years now. Observations, thoughts? What are some of the ways that you're preparing your organization for both the current and future benefits of AI, and then do you have any advice for leaders as they're talking about these sorts of topics with their stakeholders, clinicians, board of directors?

Darrell Bodnar:

Well, you're right. It's a very broad subject and the topic is huge. You're right. In 2018, I became very interested in watching where AI, machine learning, artificial intelligence was going to lead, and it's gone places that even then I couldn't have imagined. And in fact, this year I'm presenting it at Becker's Annual Healthcare Conference, and the topic that we'll talk about is the impact of generative AI and healthcare operations. For me, it's a key component and people have embraced this in so many ways. In fact, it's really, really hard to hold it back now. I think the responsible adoption of AI is the key focus going forward in making sure that we do it in a secure and safe manner for our patients. But it requires, once again, it's not an IT function, it's an organizational function. It is an organizational risk if they want to adopt it or implement it, there's a financial risk. 

We're using ambient voice technologies, a pilot. We have 15 of our providers that is currently using it and it's going extremely well, but their workflows had to change. You can't just implement this. Our providers are very, very engaged, and to come back and have discussions with us to say, "I felt odd walking into a room, I had nothing to type. I had nothing between me and the patient. I had to reiterate things I was saying to make sure that they were captured by the ambient scribe."

And going through that process was a complete workflow change. So it's not the technology, although it's a key component. It's how you adopt it, how you blend it, how you work through it. Our pilot has been four months in the making and it's still going. We're still learning. Our vendor is still learning. We're still learning as we go through this now, but those partnerships are what really, really, I think develop it. Where it's going, oh my God, I think it's impossible to tell.

I think about generative AI, where we currently are, and I think about agentic AI, where it's going to autonomously address issues, take care of things without our knowledge. I believe with all my heart, that's the path that we will go down, but the inherent bias that's built into the technologies, those types of things need to be called out. They need to be made transparent. We can't avoid them. There's bias in our conversation right now, but I think building that in so it's transparent and visible is a key to that success, but I honestly think, Phil Sobol, that the sky's the limit on this. This is what's going to change our entire healthcare system. 

Phil Sobol:

I think you're spot on there, and you touched on it earlier in the context of bringing a couple of hospitals together, mergers and acquisitions are naturally introduced opportunities for some standardization and optimization, and you've been working, I think to unify three separate hospitals, as well as home health and hospice, and each has kind of a unique adoption of technology and in your instance, meditech expanse. Maybe tell us a little bit more about your experience with the unique adoption of that tool, and the challenges and opportunities, and maybe any tips for leaders planning for M&A, things that they should be doing right now to get ahead of the curve.

Darrell Bodnar:

We learned a lot from this, and we went with a Big Bang Theory when we came together for EMR implementation, which was the primary driver. I think we could have focused a lot more in the earlier stages of the merger and acquisition on the development of standardized best practices, regardless of which EMR platform that we were on at the time. Because as we implemented the EMR across all of these affiliates, it became apparent that we had different best practices.

I'm not saying one was better than the other, but it's hard to build standardized order sets or standardized and annotation build without that homework being done. We had a good governance structure in place, but it really needed to have an overarching command of all the elements, and it didn't necessarily come together. We came together as three tertiary, I mean three independent critical access hospitals without a tertiary affiliation, which meant that there was not your typical merger and acquisition, where a tertiary hospital would come in and say, "This is how you're going to do things." We had to find our way. We had to go through this in an agreeable format. There were winners and losers in that implementation.

Having all the hospitals move to a single standard practice was great. Specialty practices and primary care, they were accustomed to having software that was specific for them and to move into an environment was a loss for them, in some ways. They didn't have best of breed, if you will. But they certainly had a single transparent record that was a visible pane of glass over our entire patient population that we serve, which is the entire northern third of New Hampshire. It made a big difference, and I think the focus when you ask what we should focus on, is the governance structure that oversees this and making sure that holds people accountable and honestly sets a strategy. It's for the patient.  It's one there. We've struggled with it, but we've gotten through it.

Phil Sobol:

Yeah, it's a challenge to build an effective governance approach, group strategy inside of the four walls of a singular system. It is exponentially challenging when you have those disparate organizations, and so certainly as I think our folks are listening to this who are in similar situations, I have no doubt there will probably be a few people reaching out to you for some tips and tricks, and how in the world have you possibly pulled that off?

Darrell Bodnar:

Oh, I'd be happy to answer any, but I think governance is a great place to start, because if you don't, you'll fail.

Phil Sobol:

Well, it is just absolutely critical and I think you hit the nail on the head, which is there's going to be wins and losses for everybody involved, and having that understanding going in order to achieve where you all are trying to get collectively, is just critical and so important. And we talked a little bit about that, that EHR, and like it or not, EHR still kind of remains the foundational technology for clinical care and is an integral piece in helping drive those operational efficiencies and clinical workflows. We've been working together a little bit on some of that EHR optimization. Let's talk a little bit about the strategy and process for optimization that you guys have gone through there at North Country, any before and after results that you've seen with efficiency gains or improvements in adoption satisfaction, maybe any successes that you could share?

Darrell Bodnar:

Yeah, I agree with you entirely that the EMR is still the foundation of all of our work. And whether that be good or bad in some people's eyes, it is clearly the base for all. Working with the optimization team from CereCore was extremely helpful. First of all, I found that when we worked together, the key to the special sauce, I think from CereCore was made up of multiple ingredients, but one of the key ingredients I think is the depth that you bring to the table, the depth and experience of your bench is huge, because there's a lot of resources that we can pull from. You are explaining things that we didn't know existed, so it's really hard to optimize something when you didn't realize there was an opportunity there before.

Typically with EMRs, you implement them and then you upgrade, upgrade, upgrade. Rarely do you take advantage of all of the functionality that comes out within an upgrade, and if you miss something that was two versions ago, you're certainly probably not going to adopt it. You may not even remember it exists. Somebody may stumble across it. Having a thorough assessment of your environment by an independent third party, who understands the software and has familiarity with best practices and workflow, is I think is a key to this. Because when you can bring those individuals in and they can say, "We would recommend you do it this way."

And the initial response, "Well, I've always done it this way, and it works well."

Until you start to push them through and they get to see that improvement. It's a partnership. There's no light switch to say, "Now you're optimized." It takes time, and I also think it's an ongoing endeavor. We've gone through a huge optimization opportunity with CereCore and I suspect we will be going through those on a regular basis, because we need to keep improving and keep evolving. As soon as you stop optimizing your EMR, it is going to stop functioning to its fullest potential. 

Phil Sobol:

I think that's a lesson that people are slowly beginning to learn, that these are not set it and forget it type of systems. And honestly, I think if people just think about it momentarily, medicine's always changing. The demographics are always changing. There's one constant and that constant is change. And so, to not look at optimization as part of your ongoing strategy and approach, really puts you at a disadvantage. And so, I feel like that approach is spot on.

Darrell Bodnar:

I completely agree. It needs to be part of the ongoing evolution of your EMR. Just as you take upgrades, you need to continue to optimize.

Phil Sobol:

Indeed. We talked a little bit about the EHR, certainly a couple of the other topics that come to mind a lot, right? Revenue cycle management, cost savings, workforce shortages. You might have a unique perspective on these as being affiliated with the critical hospital and multiple leaders in rural health for decades now. Have you seen any changes in this area? What are kind of the big challenges or opportunities that you're seeing right now?

Darrell Bodnar:

Well, I think you're right, that the cost pressures are going to continue to evolve. I think we're going to see that. I think the workforce shortages are probably more prevalent in a rural environment than they are in some of the larger metropolitan areas, and I think it demands innovative approaches. I think it demands technology. When you look at automation and artificial intelligence, machine learning, those types of things, I think they all come into play. What was it? I think the prediction for 2024 is that the healthcare portion of GDP will be 17.9%. Progressively growing every single year. To me, that is just unsustainable. It is not something we can continue to do and those cost pressures are going to continue to increase. Regulatory oversight is going to increase. We have some new leadership over the country, and I think there's going to be some significant changes to there, whether it's Medicaid funding 340B, telehealth reimbursement, there's just payment model changes, there's cuts to grants, there's prescription, there's all sorts of challenges that could be coming our way that are the small margin that makes critical access hospitals in rural healthcare possible.

Usually one or 2%. You're not going to see days of five or 8%. It doesn't occur anymore, and I think they're a critical lifeline to those communities. And I'm hopeful that perhaps some oversight into current insurance markets paying practices, I think the Medicare advantage is just a horrible thing that has set the healthcare organizations up to really just continue to line the pockets of larger payers. And I'm sorry, but when you look at United Healthcare being the fifth-largest company in the US and the eighth largest in the world, and there is a problem here. They're up 8% on their revenues. I mean, this is a challenge and I think all of these combined, and I'm not picking on them individually, but all of these combined to be pressures on healthcare organizations, where it's a fight to just get reimbursed for what we're doing, whether it's prior auth being refused, whatever it may be. To me, those are the biggest challenges that we face going forward. And I'm sorry, Phil Sobol, I kind of went off on a tangent there, but I tend to on those.

Phil Sobol:

That's all right, because ultimately that's what every healthcare leader's thinking about. They may not say it, they may not do, but at the end of the day, we talk a lot about EHR optimization, but who's thinking about the optimization of the overall system? Not just the health system, but the overall healthcare system. And I do think, to your point, there's a lot of challenges ahead, but there's also a lot of opportunity for some fresh ideas, different perspectives. I think there's different lenses that are being looked through now to kind of see, "Hey, maybe there's a better way."

And so, certainly I think it's going to be leaders like yourself, but leaders across the country, they're going to bubble those sorts of suggestions, comments, better ways forward. And ultimately, we have to as an industry, because where we're going, you can only optimize EHR so much. You can only do this so much. At the end of the day, there are other factors, large factors in play that have to be dealt with.

Darrell Bodnar:

Yeah, your point is exactly that. We'll do everything we can on our end to optimize things, but when you're fighting windmills, it's very, very challenging. And I am optimistic. I am a half-full kind of guy when it comes to this, because I see so much opportunity ahead of us. And you're right, there's a lot of different people looking at this that could really present a much better lens and perhaps better outcomes.

Phil Sobol:

Agreed. So we talked about challenges at a macro level. Certainly there's challenges inside of the health system, and as a healthcare leader, how do you keep your teams motivated and pushing towards that innovation? It's easy to become overwhelmed. "Oh, there's so much to get done." But maybe what's worked and help maintain that focus to really achieve betterment for patient care? Any problems or perhaps creative solutions that you've deployed to help with the staff as they execute?

Darrell Bodnar:

Yeah, I think one of the things that we've done is we've tried to make sure that a lot of our work is driven by the subject matter experts and not IT. And that has been a historic challenge, is that I don't mind identifying technologies to help, but the implementation and use of those really needs to come from the subject matter experts. North Country Healthcare went through a really unique, over the past two years, a really unique endeavor. We trained all of our staff in Lean Six Sigma Yellow Belt training. It's 1100 people went through training. It was a huge commitment when you think about the hours that this took to put these individuals through, but then you have 1100 Yellow Belt, little engineers out there looking to try to improve process. And I think what I've seen is that when we've tried to drive people towards success, it is now more focused.

It is not a generic, it's not generically this roadmap that's out there. People are identifying things. We tend to bring together our teams. We have a clinical information management team that is led up by a variety of different people within the structure. They're multidisciplinary teams that have come together, and this is what we use to dry our EMR modifications, optimization and improvements. These are the individuals who modify order sets, but also will review new AI technologies that we want to bring in and review.

So, having some focus on strategy and direction led by subject matter experts has made it easier on my team, I think, because we are not challenged with identifying solutions for these people all the time, they are identifying some of their own solutions and we're helping vet those out. They know best. I think it's built a more integrated team, which I think brings a level of satisfaction. However, to your point, that does not help reduce the workload that comes with all of that going on. And I think the staff still struggle with that, but I think they're more passionate than they've ever been.

Phil Sobol:

Yeah. Well, I think that, one, the investment is tremendous in your people. And two, when you invest in your people, when you empower your people, then you're motivating your people. And so, I think that's a fantastic path.

Darrell Bodnar:

We've had some goals this year that were identified and driven by Yellow Belt projects that people have done.

Phil Sobol:

That's great.

Darrell Bodnar:

And they've gone right to the boards. So these are individuals at a work level that are getting to deliver their presentations to board levels, to say, "This is what we did to improve." It's really inspiring to watch them when you do empower staff to improve.

Phil Sobol:

Indeed. Oh, that's excellent. That's excellent. Staff is one level, but it's also important for leaders, right? And particularly IT leaders to collaborate with each other. I think it helps us all stay sharp. What have you found that works well for you in that manner over the years?

Darrell Bodnar:

Our New Hampshire Hospital Association has a monthly meeting with most of the CIOs from the state. I find that to be very, very rewarding, because we all have the same pain points. I'm sure that we could bring a thousand different CIOs to this conversation, and they would all have very similar pain points, same conversations. So talking through what others have done in that environment to help solve some of their problems, particularly regionally, it is helpful.

I think, I do enjoy going to conferences, I'm very particular about some of the ones I would go to, but I do appreciate those, because it's a time to pause work, focus on the future. Try to meet with people, understand what they've done to solve some of their problems, and it allows you to focus. And that's something that we just don't have time to do on a day-to-day basis. We are barely able to get through the week. And as leaders, we are supposed to be setting this strategy, setting this focus, and sometimes it's hard to present that. So I think having those pauses a couple of times a year, along with separate meetings has been very helpful for me.

Phil Sobol:

Indeed. That's great. So you mentioned the locality from a New Hampshire standpoint, and certainly giving back to the community is a huge part of what we do in healthcare. You're an active board member of the North Country Healthcare, Home Care and Hospice Agency. Tell us more about this important work and maybe how you got involved.

Darrell Bodnar:

Well, I am a huge fan of home health and hospice, and the hospice agency in particular for the efforts they do, there's nothing more rewarding than going and seeing that improvement. It is one of the more challenging business lines to be able to do. The people that conduct these hospice engagements and take care of these patients, they're somewhere between superheroes and angels, and I don't know how you put them, but truly they are. Our board chair is a young man who lost his wife six years ago, is now raising their children independently. His wife was on hospice. He's very passionate. Everybody on our board is passionate. Everybody that's there delivering care is very passionate. We have an annual gala, which CereCore was a great sponsor of this year, and I appreciate that, but it tries to generate money to be able to help as people go through this process.

Most people don't realize that a lot of the hospice care is covered as a benefit to most of us under Medicare, Medicaid, or even our payer insurance. But all the other expenses around that, being at home, sometimes having challenges to get food, transportation for family members, all sorts of things come through. The money that we generate is what pays for all the other stuff. So if a family member needs a gas card to be able to get to see another family member to help support, we will pay for that. That's what comes from this. It's really an effort in social engagement to be able to bring these people together. I am a huge proponent of it. I have another separate business that does some support for this, and we've done a tremendous amount. To me, it seems like it's always, it hits to the hearts of people. And if you ever have a chance to see the work that they do, I would recommend taking the time to look at it.

Phil Sobol:

Well, that's inspiring. And personally, I'm getting a crash course in all of that right now.

Darrell Bodnar:

I'm sorry to hear that. It's funny, everybody seems to have been affected in some way by hospice. I'll share this with you, Phil Sobol. We did this, this is no plug for my own business, but I own a brewery. And every year at the Hospice Gala, we do a beer auction. And what it does, it allows a family member, somebody to bid, to name a beer after a family member, come into the brewery, help us brew the beer, make the beer, name the beer after a loved one, and then all of the sales that go on from that, then go to hospice to help support it. And I think so far, we've been doing it for four to five years, and we're somewhere north of $60,000 we've been able to generate for this, because of it. And that's, like I said, it is a full commitment all the way around. I absolutely love what our hospice agency does.

Phil Sobol:

Oh, that's fantastic. That's fantastic. Well, Darrell, you and North Country have been a great partner for us, and I'm sure you've got other great partners in your ecosystem. As a healthcare leader, what do you look for today in a partnership and has that changed over the years? From your perspective, what does it take to make a long-term partnership successful?

Darrell Bodnar:

Well, just the terminology you used, Phil Sobol, there. It's a partnership. It's not a vendor. It's not something, and I feel many times that organizations find a vendor that they think will fit. I'm not looking for a vendor. I'm looking for a partner. And that partner means that they have some skin in our game. They are passionate about the same things that we're passionate about. They care about things that really, really matter. And they hopefully operate in an environment of real honesty, transparency, integrity, and commitment.

And just talking about things like this, it has to come from people. Some of the people that have worked from CereCore, who have come and worked with us on some of our optimization, also on their own dime, attended the Hospice Gala we were just talking about, because they become passionate. So to me, that is where you start to have a partnership. It's more of a family, and everybody is working together to try to make things the best they possibly can be. And focusing on that one thing, the patient, remember, that's the one thing we can't forget about, is making sure that we're here for that patient.

Phil Sobol:

No, you're spot on. You're spot on. Well, Darrell, this has been a fantastic conversation, and we always like to wrap these up with just a call for any final words of wisdom for the healthcare leaders that are listening today.

Darrell Bodnar:

I think spend time within your organization, look inward, understand how it functions, and empower those people that are the subject matter experts, the people actually getting the work done, to encourage them, empower them to be the best they can be. And with change going on within our legislation right now, change can be good, change can be bad. Pay attention. Make sure your voice is heard. Say something out loud. I believe that the country is trying to move in a direction that will improve healthcare overall, and I hope we can continue to stay on that. And never take your eye off the patient. I have a feeling if you focus on the patient, always have them in your first thoughts, top of mind, you'll always succeed.

Phil Sobol:

Excellent advice, excellent advice. Well, Darrell, thank you so much. First for your partnership, but second for your time today and your insights. This has been fantastic.

Darrell Bodnar:

Phil, thank you so much for having me. It's been a privilege.

Phil Sobol:

Excellent.

Thanks for listening to the CereCore podcast. We hope you enjoyed this conversation. Follow us on your favorite podcast platform for more episodes, connect with us on LinkedIn. Visit our US website at CereCore.net and for those abroad, visit CereCoreInternational.net. Learn more about our services and find resources. At CereCore, we are healthcare operators at heart and know the difference that the right IT partner can make in delivering quality patient care 24/7. Let's help make IT better. Here's to the journey.