Physician CIO on the Value of Clinical IT Support

Phil Sobol:

Today on the CereCore podcast, we're pleased to talk to Dr. Patrick Woodard, the chief information officer at Monument Health. Dr. Woodard brings a unique perspective to the podcast because he is both a physician and a CIO. He has experienced firsthand how technology solutions can transform the way healthcare is delivered and the positive impact it can have on patient outcomes.

Dr. Woodard, welcome to the CereCore podcast.

Dr. Patrick Woodard:

It's my pleasure to be here. Thanks for having me.

Phil Sobol:

Excellent. Well, we always like to get started with just a little bit of background. So, you know, and Dr. Woodard, you've, you've had a pretty unique story that shaped your path from practicing internist to healthcare technology leader at monument health.

We'd love to know, did. Did you always want to be a doctor? You know, how did you get into technology? And then we'd love to hear a little bit about how those pieces came together and more about Monument Health and the great care that you provide for the populations across multiple states.

Dr. Patrick Woodard:

Yeah, absolutely.

I think first I'll start with just commenting about how grateful I am to be at Monument. I grew up in the state of Nevada, which is two population centers with nothing in between. And so I've always felt connected to the types of care that needs to be available for people who otherwise may have to drive hours or, you know, hundreds and hundreds of miles to receive high quality care.

And so being in a place like Monument, which is based in Rapid City, South Dakota, Western South Dakota, our patients come from all over. It can be from southeastern Montana or western Nebraska, Wyoming, North Dakota, and all of South Dakota. And one of the things that really is impressive to me about the way that Monument exists is just how integrated and integral it is to the community.

And so from that perspective, it's both kind of a relationship to the community that I've had since I was young, but also a really core pillar of healthcare in Western South Dakota. So from that perspective, it's a place that's very near and dear to me, even though I've only been here for two years.

I'm very grateful to be here and look forward to many more years here. I think when you look at where I started, I never would have thought that I would be a CIO, partly because I didn't know that that was even a job until later in my career.

I became a physician almost by accident in that when you're a kid, I remember I had a book and it was one of those books-- if you can be anything you want to be, whatever, but there were only like 10 options, right? There's like astronaut, police officer, sanitation, worker, doctor, teacher, right? Like there's not that many options. And so when you're thinking I'm six or seven, well, some of those are cooler than others. And I kind of gravitated towards the idea of being a physician, partly because those are the, I mean, you go to your pediatrician, you see a teacher. I don't know too many astronauts.

So you kind of like anchor on the ones that you can see. But I ended up going to college initially to be a performing violinist, because both my parents had been musicians and I was a decent violinist. And so I went to the Peabody Conservatory in Baltimore, Maryland for that first year of college. In the course of being there, I recognized that although I really love music and it's still part of my life today, it wasn't something that I necessarily realized would be a great day to day because when you're in high school and you're practicing, it's part of your life, right?

When you're at a music school, it's your whole life. And I recognized that there was something else that was missing. And it was kind of like that academic element., That I really loved violin and I still do, but that wasn't the only thing that I loved. And so it became increasingly difficult for me to rationalize, dedicating and kind of narrowing down on this one part of my life.

And so I made the difficult decision to change schools because when you're at a music school, believe it or not, you can't go get a psychology degree, so I needed to change schools. And I went, I changed and moved to Georgetown University where I finished up college. The challenge there was that I needed to tell my parents who again were musicians that they were right the whole time. And I probably shouldn't have gone to music school, but you're 19. You can't tell your parents that they're right. So I needed to tell them that something reputable. And I kind of went back to that early anchored idea of becoming a physician.

I kind of, I got in the pipeline. The med school pipeline is a one way trip. And so by the end of college and I had been admitted to med school at that point, um, I hadn't really thought about it again, didn't look back. And realistically I'm glad that I didn't cause here I am now and I'm very happy with what I do.

One thing I would say about living in DC though, is that you kind of get looped into politics, whether you want to or not. There's two cities in DC, there's Washington and there's DC and the two don't really overlap unless you go to Georgetown where everybody's very interested in the politics that exists in that town.

Yeah. And I realized that Health policy was very interesting. Science policy was very interesting. I had a really great professor who led a science policy class in my senior year of college, and I realized that the power of policy is that you can change the way that you deliver education or health care or social benefits on a grand scale that isn't possible in other ways. And so I thought when I was in med school, you know, health policy would be a way for me to kind of expand my impact, expand my reach.

Fast forward to residency. I was actually back in DC kind of still thinking this health policy realm. And I trained in internal medicine at Howard University, an excellent training program. And there was a bad outcome that happened there that everybody heard about, and I realized that using some technology, rather than the paper we were using, probably could solve that problem.

And I dusted off some kind of coding skills and some of my old nerdy nerdiness from my youth and wrote an application that would prevent that type of bad outcome from happening again. Went to the hospital chief medical officer and said, Hey, I think this would solve the problem and prevent it from happening again.

He immediately saw the utility in it. And asked me, well, how much are you charging us? And I hadn't actually thought that far ahead. So I made up a number. I think I low balled myself, but in the course of that, turn that into a company and, and that's how I got into technology. I've been really lucky to be able to turn that into a career on the health system side of things. The impact that I saw in health policy, which was the ability to extend your reach beyond just the person in front of you, is what I see in technology as well as an internist.

And I practiced as a hospitalist for many years. You go from room to room and bedside to bedside and you're able to care for one patient at a time. And you may see 20 or 30 patients a day, but that's the max. You can't, you're really, and through technology, I know that the work that we do impacts the care that we have for all 500, 000 patients that we have who come through the doors here at Monument Health.

And I know that everything that we do to make it easier or better or faster or more human is really something that our whole teams are able to support and I know that the impact that we're having is felt throughout the whole community. So I'm very grateful to be able to extend my medical knowledge in that way and be able to care for the community in that way.

Phil Sobol:

Oh that's fantastic. Greatly appreciate you sharing those individual journeys from where you started from to where you get to I think so important and quite frankly, lays the framework for the rest of our conversation, but at the same point, you know, what the good work that you're doing there at Monument.

So, I want to dig into just a little bit about what you touched on there at the end. Healthcare technology has come a long way. We were on paper and now we've got these big things called EHRs. But it's made tremendous progress over the past years.

And, as a physician from the conversations that you have on a day to day basis with providers and what's the overall sentiment from that side of the house about today's technology and what are some of the challenges that really still exist that you're trying to help solve .

And then really, what would you hope or what do physicians hope that healthcare technology leaders would understand about the convergence between technology and patient care?

Dr. Patrick Woodard:

It's a great question. I think we have to remember that 10 years ago, the vast majority of health systems were still just kind of in the midst of putting in an EHR, right?

Maybe they'd had one for lab or radiology for a bit, but they hadn't gotten to physician. Maybe they were doing physician orders, but they weren't doing documentation. And 10 years is not that long of a period of time. If you're thinking about the arc of a career. So if you're, most physicians come out, finish residency and their fellowship when they're in their early to mid thirties, and so they have a 30 or 35 year career ahead of them.

That means that in a 10 year period, a third, maybe, let's say, of physicians can remember a time or can't remember a time without EHRs. But. Two thirds of them didn't start. So it's, it's a big change from where we were, even when I was in med school documenting up even residency, frankly, documenting on paper.

And the promise of the EHR was always that you'll have all the information you need at your fingertips, which is true. That's still true today. But the peril was that now you have even more information than you ever could possibly need, things that are completely irrelevant to your day to day practice.

And by the way, the government and payers want you to follow a set of arcane rules that no one really explained to you to be able to get reimbursed for the care that you've rendered. The EHR to me is more of a speed limit sign and a police officer for those types of things. And those, and I think a lot of frustration in technology today is driven by the EHR is the thing that I see.

I get mad at the cop who pulls me over and tickets me. Well, they're just enforcing the rules. The EHR is just enforcing the rules that a regulator or payer put in place. Do we like the rules? Maybe, maybe we don't. Are they intended to provide safer, more high quality care? Probably, or in some cases just to reduce cost, which is good on a societal level.

On an individual patient level is maybe a little bit more challenging when you know that the right thing to do for this patient, doesn't need to necessarily be hindered by a payer who wants to argue about whatever preauthorization and what have you. I think so to that extent, I'd say largely physicians are over their irritation of the EHR from that perspective, right?

There is, we're kind of into a new realm where when things, things should just work and things should just make sense.

I sat down with one of our cardiologists recently, and we were using an AI documentation tool, which I think is a fantastic time saver. We meant to do it as a small pilot of 25 docs.

Within a month we had over 100 on it because it was just so successful, which is unusual. You know as a technology leader. You don't usually get to put something in that people like that much. So it's rewarding to know that you have something that is that useful. Right. And so I was sitting down with one of our cardiologists and he was commenting that -- you know, it's great. It saves him some time, but it's leaving out some of the elements that he needs for his clinical practice. So, as a cardiologist, especially with somebody with heart failure, you would need to, you would want to know how often, for example, the patient gets short of breath when going upstairs. Can they go up two flights of stairs?

Can they go up six flights of stairs? How many blocks can they walk before getting short of breath? Those are important when you're when you're caring for someone with heart failure. And an AI tool may not recognize that that's important. It may just summarize it to they get short of breath.

Most cases, that's probably useful. In fact, if I'm not specifically managing that problem. And so there is some frustration on the lack of specificity there. And so it's, we're almost at the place where he didn't, he wasn't complaining about the EHR, he wasn't complaining that, uh, the tool isn't good.

He was saying almost in a way that it's too good and it's over summarizing. And it doesn't, It can't read his mind. So if, if that's what we're worried about, I think we've made great progress and I'm really encouraged by that. And what I think is a challenge now for docs is how do all of these things fit together?

We ask people to do more with less every day. That's been true for years. That this is accelerating. It's becoming more and more true every minute. And to that end, every new tool that we give someone, how do those all fit together? If you pick up your phone today and you look through all of the applications that you've downloaded, how many of them do you actually use?

Did you just download the kind of rewards app at Qdoba once and never have looked at it since? That doesn't add any value. It's like, it's just there. And I think we need to be really cautious as we Think about what we're putting in front of providers. How do these all work together? Because we can't be number one, spending money and number two, asking people to dedicate their mind power, which should be spent on patient care or wellness or, avoiding burnout or their families, and instead be asking them to figure out What does this app do?

So I think we have to be really cautious as technology leaders to recognize that By and large, providers come to work every day to do a good job caring for patients, and the more kind of clutter we put in front of them, it makes it harder to really focus on the things that are truly important.

Phil Sobol:

Interesting. I think that's a great point. Maybe expound upon that a little bit more, just even in the breadth of the overall organization too, because you've experienced all phases of technology, right? From ideation, implementation, adoption, ongoing improvement.

You've talked a little bit about some of those things in the context of the physicians, but holistically what are some of, what are those barometers for success and satisfaction, for the providers, but then also for the remainder of the organization, when you're looking at these types of new technologies.

Dr. Patrick Woodard:

It's all about adoption, truly, because it's adoption is both the end game and also the metric. By which I mean, if people are using it, it's either because there is some sort of policy or dictatorial version of it, which is probably less effective than we think, or it's because the tool actually just works. And if I look at the, let's take the AI documentation tool, our goal really was to replace a different tool that wasn't quite meeting our needs.

And we were just hoping, frankly, to save some money for the organization because. The new one was less expensive than the old one, and we can put something in for the docs that were using the old one that maybe would at least be not worse and perhaps better. And so by that metric, we hit that day one because we were saving money and the four or five docs who were using the previous tool now are using a new tool that hit the mark. But I think where you're really able to see the joy come out of it is where it was so explosively successful just because of word of mouth and that again, we had to expand the opportunity for more docs to get up on it. So in the grand scheme of things, we're actually spending a little bit more money than we were before.

But our adoption is, let's see, 50 X what it was before. And if you want to take a lean perspective and do a time study and see how much time is being saved across the organization by using this tool, you can't. It's almost impossible. Incalculably high, which is great.

So adoption there to me is a proxy for every everything else. And now the tool could also not work, right? I mean, people could be adopting or maybe they're adopting things. We don't necessarily want them to have tools that help them solve a problem that we don't necessarily know about. And so they go out on their own and find something that happens occasionally.

I think it's a good opportunity for us to step back and say, Hey, well, what is the problem they're trying to solve, and is there something that we either already have in place that they don't know about or that we can expand the use of? So I think there are always opportunities to chat with your docs, hear what people are doing. I've spent a lot of time talking about physicians, but they're not our only caregivers here. Really trying to understand who, what are the real challenges we're trying to solve and what are the pieces that we can put in place to do that. But again, I would go back to. How does this all work together? I was chatting with a really innovative AI company the other day, but their product asks clinicians to document both in their tool and in EHR.

And I don't want to do that to my teams, right? To our caregivers. Why would I ask you to do double work? Maybe it's because it helps you. The organization, I don't know. It's a really hard sell for me.

Phil Sobol:

No, that makes that's a hard one for sure. And, one that I think you see some of that technology wise, particularly on the onset of a technology and then that usually goes away pretty quickly. So, that's a great segue into talking about the fact that guess what, you know, it's a shock to everybody, but no technology is perfect. IT issues are going to happen. And, as a physician, what are those some of those key ingredients for really good healthcare IT support, and then pretend that you're not a physician and only a CIO. Would that key ingredient be the same? Or is there something else there as well?

Dr. Patrick Woodard:

I hope it's the same but you never know I suppose. I liken it often to when you walk into a room and you flip a light switch and the lights turn on you don't think anything actually. It's just it the lights came on. Only when it doesn't turn on, then you have to start going into kind of your troubleshooting mode.

Well, is this, did this light burn out? Is it only this light that's not turning on? Well, did I fail to notice that there are no other lights on in the entire building? Is it just this, is it just the kitchen that's not turning on? And so I have to go downstairs and find the breaker and flip that or what have you.

It's the same in the technology that we put in front of our caregivers as well. When it works, you shouldn't notice. And I hope that almost everything that we do or that we put in place just works. And you just kind of don't notice it. The computer logs in quickly. The EHR loads, you find your patient, you get your work done, and you go home. So from that perspective, that's the goal, right? That's the kind of invisibility of the technology that we put in place is really all about support, supporting the relationship between caregiver and a patient, and ensuring that we're able to render high quality care in a way that's compassionate and human oriented.

When things deviate from that kind of, it just works philosophy is when there's the friction that makes people either irritated or frustrated or leads to burnout or leads to dissatisfaction with the working environment or the tools in front of them. And I think that's what we're needing to constantly fight against. There's really no benefit in asking people to do extra, right? Everything that we should be asking folks to do should be in direct service of high quality care, human-centered care, making this a great place to work. And anything that is just extra for, we really need to define why we'd be asking them to do that.

Everyone has so much that they could be doing, and the only thing that adds value are the things that add value. Anything else is just extraneous. So I think when you think about it from a physician's perspective, you really need to understand why would I do this?

And to a physician, I mean, we all swore a Hippocratic oath usually early in med school, and then we kind of redo it later in as we are graduating from medical school. It's, that's the perspective we come to it from, which is we should be not doing harm. We should be adding to the patient's quality of life and it should be the same with any of the tools we do.

If I have to log out into another tool to read an echo, I don't necessarily mind too much because I know that this is an imaging tool and that one's not. That's not hard for me to understand. It's pretty straightforward. If I have to then log into a second imaging app, and we don't do this, but I can imagine a scenario in which this could exist to have an AI then read the ejection fraction and get to a better level of granularity there. Well, that doesn't make as much sense to me because those are both imaging related things and where's the added value to the patient there?

I think it comes down to where's the, where's the value for the patient as a CIO taking off the doctor hat. If I don't, if I'm not going to the front lines and asking those questions, then I don't know what I'm doing. You have to really be able to understand it from the people who will end up using it. Ultimately, our whole existence is based around high quality care for patients in our community.

Every caregiver who works here is coming to work with that same kind of mantra to do the right thing every time to be able to care for those folks. And so, as a CIO, I need to approach it from that same perspective.

I would also note, although I am a physician, I'm an internist. And although internal medicine is itself kind of a more broad discipline, I also don't, I can't possibly know everything. And if I'm assuming that I know what a gastroenterologist would need, even though it's a discipline of internal medicine, I'm making a probably false assumption. And I think I would lean on you still there's no way to skip the obligation of really listening to the frontline, listening to your physicians and caregivers and understanding what are the real problems in front of them. How can we solve them collectively and get there? So I think you still need to listen.

Phil Sobol:

Indeed. Now I think that's spot on. And you know, just focusing a little bit more on that concept to support, I know, you know, our organization started working together a couple of years ago from an IT perspective. And you know, today we support your providers and if they have an IT issue and work closely with your other application teams. You know, from your perspective, what are some of the benefits of working with a partner organization around areas, like that patient facing in clinical support?

Dr. Patrick Woodard:

You know, it goes down to it just working, right? The light switch, the light comes on when you flip the switch. I think the reality is that as a, you know, we're a small, medium sized health system in a geographically challenged area.

We're fairly remote. We're the busiest ER in western South Dakota. In fact, I think we're the busiest ER in all of South Dakota and the next one of any size trauma center or what have you, is more than 300 miles away. Which means that if you're going to get care here, it's us or nobody. Which to me really is important. That means we have to do it right all the time. Our light switch needs to come on all the time too.

But we also have, you know, a fairly small population compared to, you know, New York or LA or even Denver. And when you are trying to balance the right approach to resourcing your own internal teams and functions that you need to deliver, there's a balance between how do we do it in a way that is successful and functional, and how do we do it in a way that recognizes staffing limitations or what have you. And so for us, it's about the ability to extend limited resources in a way, in the most kind of fiscally responsible and staffing model kind of agnostic way allows us to be successful 24 hours a day, seven days a week, 52 weeks a year that maybe we wouldn't be able to do with a fairly small clinical desk, help desk. Those types of things.

So from that perspective, if we are thinking about it from the approach of the light has to come on every time you flip the switch.

Phil Sobol:

That's true.

Dr. Patrick Woodard:

At just the same at two in the morning as it is at, you know, two in the afternoon. So I think thinking about it from the approach of how do we best balance our needs, our true clinical needs with those of the realities of health system, which is, you know, fiscal and who's in the HR pipeline.

Phil Sobol:

That's right. No, that's excellent. You know, you touched on a little bit of balance there, and I think, you know, so many times, you know, you hear the conversation around work-life balance, you know, and that's tough regardless of, you know, whether you're a physician or a really IT leader, et cetera.

But you know, there's also a lot that just an IT leader has to balance and, you know, whether it be innovation, cybersecurity, user satisfaction, patient safety, patient quality, you know, you name it, the list goes on.

Do you have any advice for other healthcare leaders around just how to approach that and maybe balance it out?

Dr. Patrick Woodard:

Several years ago, one of my really good bosses, I've been fortunate, I've had almost exclusively good bosses in my career, but he was a physician leader as well. And I don't know if I was like, whining about something or just having a bad day or whatever. And he was like, well, Patrick, there's no such thing as a work life balance. There's only a work life blend.

And I don't know if he was trying to be reassuring, he was not, it was not reassuring at all. But over time I kind of got to understand what he meant and I think really focusing kind of narrowing down on what are the things that are really important and jetting the things that aren't, or at least putting them on a parking lot. You know, maybe you can come back to them later, but let's really kind of narrow down what we're really focusing on.

I'm reading a really good book, which I might recommend to your listeners called Slow Productivity. And the concepts there are really around get rid of this pseudo productivity, this kind of working for work's sake. There's really no benefit in looking busy if you're not achieving anything. And what are the things that really matter? What are the true items that'll really, for me, drive value for the organization? And then how can we focus on doing maybe less, but higher quality work and getting rid of the chaff, right?

The pseudo productivity elements. And to me, that's, I think where that work-life blend is beneficial. In that I have been fairly aggressive about not doing the kind of meaningless work 'cause there's so much, right?

I mean, you could do 24 hours of work in two hours if you really wanted to, because it's nonstop, right? There's always something, I mean, in the time that we've been talking, I'm sure I've gotten 20 emails, most of which don't matter. And recognizing that if we do more important, higher value, higher quality work, and get rid of the kind of pseudo productivity, the kind of just like working for work sake, then at least then, you know, you're able to understand the meaning and really tie the meaning of what you're here for to what the value is that you're delivering.

And so from that perspective, and this is my perspective only, I think everybody's gonna have to come to it on their own. If I'm gonna get up every day and come do this, I could do a lot of other things if I wanted, I suspect.

And if I'm going to truly believe that I'm having that impact, that I want to have, I have to be able to tie it to the end value. And so it's easy for me to align those two, I know. And I don't wanna say, you know, I think if you're listening to this and you're not a CIO or you're not a senior leader, you may think I don't have any control over that. I think you do. I think at any level, we can all tie the value of the work that I'm doing as long as I am able just to figure these parts out and to really connect yourself to the caregivers and the patients that are, in some cases across the street or maybe they're across the country, but really recognizing that there is a direct value to the work that we're doing and the work that we have that we're seeing in the community.

Phil Sobol:

That makes a lot of sense. You know, you kind of touched on the fact that was, you know, a piece of, I guess, guidance or advice that you had given. Is there anything else or another nugget of, you know, good advice that someone shared with you, you know, that's helped you along your career journey that you'd like to leave with our audience as well?

Dr. Patrick Woodard:

You know, I would go back to the listening component. You know, before this, a few jobs ago, I was the Chief Medical Information officer. And in that role, you don't have any direct control, which is both great and awful at the same time in that, when you can't do anything, you can just be like, eh, kid, eh, sorry.

On the other hand, that doesn't absolve you from the obligation of, you know, trying really hard to get the right solutions for folks. And so in that, you're kind of an emissary either between IT or between physicians or kind of all of it all at once. And from that perspective, you are really forced to learn and listen to your stakeholders across the organization.

Now, as the Chief Medical Information Officer, you think your primary stakeholder, maybe physicians, that is perhaps true, but just if you've ever been in a hospital or had a family member in the hospital, you see the doctor for, you know, 10 minutes maybe. And then the nursing team and the rest of the caregiver team that are there are the ones who are there doing the rest of the work that were, you know, the other 23 and a half hours of the day. And so your true stakeholder group is all of those people, because if you fix something just for the doctors and make it worse for the nurses, number one, you're gonna get hell for it as you should.

And number two, you're impacting a really small part of the care delivery system. So I learned early that you must listen to everyone across the entire spectrum and take into account all of those perspectives. And so bringing together a cross functional collaborative team, I don't think has ever ended up with a worse outcome than doing something in a vacuum.

And now, I wouldn't necessarily advocate for putting a hundred people in a room and trying to manage by committee that way, but at least recognizing that you have a broad group of stakeholders who all have a vested interest in realistically the same outcome, right? It's caring for the patient, but recognizing that you have one viewpoint, and you may have many correct answers, but you don't have the whole viewpoint. And so you're obligated as a leader to listen to those others and kind of put the pieces together in a way that makes sense, recognizing that you may be wrong, and that's okay, as long as you're pulling all of the other pieces together and coming up with something that actually works better for everybody.

So from that perspective, I think it really goes back to listen more, listen frequently, and recognize that the group of stakeholders that you're impacting is much larger than you think almost every time.

Phil Sobol:

Indeed, indeed. Well, Dr. Woodard, I've greatly appreciated your time and honestly our conversation. Today's been fantastic. So, you know, any last words of wisdom that you wanna leave with our listening audience?

Dr. Patrick Woodard:

Keep listening.

Phil Sobol:

That's perfect. Well, excellent, Dr. Woodard, thank you very much. Thank you for your partnership. But at the same point, thank you so much for your insights today. They were fantastic.

Dr. Patrick Woodard:

It's my pleasure. Thanks for having me.

Phil Sobol:

You're welcome.