Optimizing Healthcare IT in Canadian Hospitals: Data Standards, Governance, and Digital Literacy

[00:00:00] [SPEAKER_00]: Dear listeners, welcome to Faces of Digital Health, a podcast about digital health and

[00:00:05] [SPEAKER_00]: how healthcare systems around the world adopt technology with me, Tjasa Zajc.

[00:00:16] [SPEAKER_00]: Canada spends around $330 billion each year on healthcare, which is equivalent to 12.2%

[00:00:25] [SPEAKER_00]: of its GDP in 2022. This makes Canada one of the top 10 healthcare

[00:00:32] [SPEAKER_00]: spenders in the world. In today's episode, we're not going to focus as much on the structure

[00:00:39] [SPEAKER_00]: of the Canadian healthcare system, the factors that impact high spending, but we are going to

[00:00:45] [SPEAKER_00]: talk about data standards, the improvements of data on hospital level with director of clinical

[00:00:52] [SPEAKER_00]: applications and support at the Women's College Hospital in Canada, and Foresight, who was previously

[00:01:00] [SPEAKER_00]: the manager for data standards at the Canadian Institute of Health Informatics. We talked about

[00:01:08] [SPEAKER_00]: healthcare data management on the hospital level, how can hospitals approach using unstructured

[00:01:15] [SPEAKER_00]: data, cleaning it and preparing it for future use, the importance of data governance and business

[00:01:23] [SPEAKER_00]: continuity, digital literacy and what clinicians should know and what they don't necessarily need

[00:01:30] [SPEAKER_00]: to know and much, much more. Enjoy the show and if you haven't yet, make sure to subscribe

[00:01:37] [SPEAKER_00]: to the podcast wherever you listen to your shows and if you will like this discussion,

[00:01:43] [SPEAKER_00]: do leave a rating or review wherever you get your shows. Thank you.

[00:02:02] [SPEAKER_00]: And hi and thank you so much for joining me for a discussion on Faces of Digital Health,

[00:02:09] [SPEAKER_00]: where we are going to talk about healthcare IT in hospitals in Canada, the Canadian

[00:02:15] [SPEAKER_00]: healthcare system and investments in healthcare IT. You've got a lot of experiences with that.

[00:02:22] [SPEAKER_00]: You're currently the director of clinical applications and support at the Women's College

[00:02:29] [SPEAKER_00]: Hospital in Canada and previously you were the manager for data standards at the Canadian Institute

[00:02:35] [SPEAKER_00]: of Health Informatics. And maybe just before we begin, we connected over LinkedIn and you

[00:02:41] [SPEAKER_00]: shared a little bit about your background and your experiences on the ground on the front

[00:02:47] [SPEAKER_00]: line in healthcare IT and asked if you could share those insights with me. And I was very happy

[00:02:53] [SPEAKER_00]: to see that because I get a lot of pitches and a lot of suggestions for many great speakers,

[00:02:59] [SPEAKER_00]: but it very rarely happens that women would actually do that. They would pitch themselves

[00:03:05] [SPEAKER_00]: for various reasons. So for all the women listening, just do it more often. What's

[00:03:10] [SPEAKER_00]: the worst thing that can happen? You get no response best scenario. You're in a place like

[00:03:15] [SPEAKER_00]: this and thanks again, you're an inspiration. Thank you, Chessa. And it's so nice to be here.

[00:03:21] [SPEAKER_01]: Thank you for having me on and I completely echo your words. If you have even an inkling or

[00:03:27] [SPEAKER_01]: something that you want to do, just do it. That's definitely been the journey that I've been

[00:03:30] [SPEAKER_01]: on over the past couple of years. Shoot for the moon and if you don't make it,

[00:03:35] [SPEAKER_00]: you'll land among the stars, right? Awesome. Since we are already in this very optimistic

[00:03:40] [SPEAKER_00]: and positive spirit, I want to slowly dive into the discussion by asking you what are the two

[00:03:46] [SPEAKER_00]: or three things that you're optimistic about when it comes to digital health and healthcare data

[00:03:51] [SPEAKER_00]: in Canada? And maybe you can also give us a little bit of background around the topic for

[00:03:57] [SPEAKER_00]: anyone that's not from Canada or doesn't have any insights into the whole healthcare system.

[00:04:03] [SPEAKER_01]: For sure. Yeah. So I'll start by saying I'm the vice chair of the board of directors

[00:04:08] [SPEAKER_01]: for digital health Canada. This is a volunteer position that you get voted into by the membership

[00:04:13] [SPEAKER_01]: of this professional association. We are the largest in the country and so I might be a little bit

[00:04:18] [SPEAKER_01]: biased in saying this, but I actually think that this community of membership is one of our

[00:04:23] [SPEAKER_01]: superpowers in Canada. It gives us a platform to learn from each other and solve problems

[00:04:29] [SPEAKER_01]: together and build towards shared goals. And when you're in a country that's as vast as we

[00:04:35] [SPEAKER_01]: are and as large as we are with the big dreams that we have for digital health, it actually doesn't

[00:04:41] [SPEAKER_01]: feel so big when you have this membership of 8,000 very tight-knit individuals in the digital health

[00:04:47] [SPEAKER_01]: sector who are willing to collaborate whenever possible to help move the agenda forward.

[00:04:53] [SPEAKER_01]: So I would say that's probably the thing that makes me the most optimistic is

[00:04:56] [SPEAKER_01]: this concept of community and continuing to build it up across the country. And then the other

[00:05:02] [SPEAKER_01]: thing that I'm very optimistic about in terms of digital health in Canada is just the innovation

[00:05:08] [SPEAKER_01]: that happens here where honestly our healthcare budgets are quite tight. We're a publicly funded

[00:05:14] [SPEAKER_01]: system so across all levels, so local, provincial and federal levels of government people are

[00:05:20] [SPEAKER_01]: trying to make ends meet as best as possible within the healthcare space and within digital

[00:05:25] [SPEAKER_01]: health, but we still find ways to get things done. And I think it's that saying necessity is

[00:05:30] [SPEAKER_01]: the mother of invention. And so if you do even a quick scan of projects that are happening

[00:05:35] [SPEAKER_01]: across the country, you'll find stories of really incredible creativity and

[00:05:41] [SPEAKER_01]: enhancement in digital health. So for example, we're one of a few handful of countries that's

[00:05:47] [SPEAKER_01]: working to progress national connected care for interoperability legislation.

[00:05:53] [SPEAKER_01]: And the foundation of this is actually collective impact, which is another way of saying that

[00:05:58] [SPEAKER_01]: interoperability is about more than just the technology. We're attacking this problem by

[00:06:04] [SPEAKER_01]: trying to keep the patient at the center of the whole story. And that's the thing that I really

[00:06:09] [SPEAKER_01]: love about the Canadian healthcare system, it always comes back to the patient, that's

[00:06:14] [SPEAKER_01]: always the foundation of any of the work that we're trying to do in digital health or

[00:06:18] [SPEAKER_00]: healthcare more broadly. I was just reading a recent report by McKinsey analysis that was

[00:06:26] [SPEAKER_00]: actually done for this year. And it mentions that there's a lot of potential in Canada, as in many

[00:06:33] [SPEAKER_00]: other countries to use AI to decrease the cost of healthcare. If you look at the spending, Canada

[00:06:41] [SPEAKER_00]: spends 12% of GDP on healthcare, which is quite high, not as high as in the US,

[00:06:48] [SPEAKER_00]: which is probably at 20 or more percent at the moment, but still very high compared

[00:06:54] [SPEAKER_00]: to many other countries in the developing world. And the opportunities to use AI in care delivery

[00:07:02] [SPEAKER_00]: is with the use for clinical decision making, for public health and more. So how do you see

[00:07:09] [SPEAKER_00]: this estimate? And what I'm currently interested in learning more about is what kind of funding

[00:07:15] [SPEAKER_00]: opportunities or constraints do hospitals and healthcare providers have when it comes to

[00:07:21] [SPEAKER_00]: introducing and testing out and adopting technologies such as AI, because you started

[00:07:28] [SPEAKER_00]: discussing standards, which is something that we're going to address. And that's basically the basis

[00:07:33] [SPEAKER_00]: that you need to address when you want to really tackle population health and dig into

[00:07:39] [SPEAKER_01]: the data on the population level. Yeah, absolutely. There's so much opportunity to

[00:07:44] [SPEAKER_01]: leverage new technology, not just AI but other technology that will help us be

[00:07:49] [SPEAKER_01]: more efficient across the healthcare system. We are starting to hear about the pockets of

[00:07:54] [SPEAKER_01]: examples where hospitals are adopting this and it's to help not just with the actual delivery

[00:07:59] [SPEAKER_01]: of care, but also for a lot of the administrative use cases, which often people forget about

[00:08:05] [SPEAKER_01]: and take up a lot of time and effort. We spent a lot of money employing people to do some

[00:08:11] [SPEAKER_01]: work that is maybe not as high value. And so we're thinking about in terms of projects that

[00:08:18] [SPEAKER_01]: are being implemented across the country, I've heard that we're looking at these hospitals

[00:08:22] [SPEAKER_01]: are looking at examples where you can implement or introduce this technology to start to

[00:08:27] [SPEAKER_01]: digitize processes that are very easy to automate because they're repetitive. And then those people

[00:08:34] [SPEAKER_01]: that are spending time on that can be freed up to spend time on tasks that are higher value

[00:08:38] [SPEAKER_01]: and you're interacting more directly with patients or providers. And so there's lots of

[00:08:43] [SPEAKER_01]: ways to come at this. And I think that there's some really cool examples that we're working

[00:08:47] [SPEAKER_01]: on at my hospital included. So looking forward to the future there.

[00:08:53] [SPEAKER_00]: The hospital that you're currently in, you started this position in early 2024. Before

[00:09:00] [SPEAKER_00]: that, as I mentioned in the beginning, you were working at the Canadian Institute for Health

[00:09:06] [SPEAKER_00]: Informatics. Can you talk a little bit about that transition? So you were recommending standards

[00:09:13] [SPEAKER_00]: and the use of data in healthcare. And then you came into a hospital to actually drive the change.

[00:09:20] [SPEAKER_00]: How was that? What surprised you? What were you suddenly up against when you took that role?

[00:09:28] [SPEAKER_01]: Yeah, for sure. What I love talking about is because I think one of the reasons I actually

[00:09:32] [SPEAKER_01]: took this role that I mean now is because it had both the data in and the data outside of

[00:09:39] [SPEAKER_01]: the data lifecycle under one portfolio. So most hospitals are too large to put all of this under

[00:09:44] [SPEAKER_01]: one director, but we're able to at our hospital. And so it's really cool to be able to see where

[00:09:49] [SPEAKER_01]: the data needs of the hospital are from a decision support in analytics perspective

[00:09:54] [SPEAKER_01]: and then be able to influence the quality of those data points that are used to do those

[00:10:00] [SPEAKER_01]: metrics and calculate those metrics right at the point of data creation and collection

[00:10:05] [SPEAKER_01]: within our electronic patient record. So I made the jump from the quasi-government

[00:10:11] [SPEAKER_01]: organization into hospital because I wanted to understand healthcare data and its most raw

[00:10:16] [SPEAKER_01]: and preliminary form and being in a space hospital is definitely the place to do that.

[00:10:23] [SPEAKER_01]: And a lot of people will say that you're hit with the reality of how imperfect data is

[00:10:30] [SPEAKER_01]: in healthcare and what a long way we have to go. I'm like ever the optimist and always positive

[00:10:35] [SPEAKER_01]: and I'll say it after eight months in this role now more than ever, I'm convinced that we can get

[00:10:41] [SPEAKER_01]: to a future where good data is the norm in healthcare. So that's data that's accurate

[00:10:46] [SPEAKER_01]: and fit for use reliable, timely and comprehensive. But I do think that in order to get there,

[00:10:53] [SPEAKER_01]: we have to be very deliberate in our deployment of projects and all of our digital tool

[00:11:01] [SPEAKER_01]: and implementation of all of our digital tools. We always have to keep data and how it will

[00:11:06] [SPEAKER_01]: be used at the forefront when you're planning out your implementations and your projects and

[00:11:11] [SPEAKER_01]: your design. So I've been in this role about eight months and I think my biggest aha moment

[00:11:17] [SPEAKER_01]: is you can ignore the fundamentals, whether it's a country-wide digital implementation or

[00:11:22] [SPEAKER_01]: just one small digital tool within a local hospital. The basic principles of IT, they have to be in

[00:11:29] [SPEAKER_01]: place. So that's good governance, good training and workflow. And these are the things that people

[00:11:35] [SPEAKER_01]: don't always talk about at keynotes and conferences, things like intake processes and prioritization

[00:11:41] [SPEAKER_01]: framework and user experience and training and communication. But that's what matters at the

[00:11:47] [SPEAKER_01]: end of the day. That's what's going to lead to sustainable process and enable our users to

[00:11:53] [SPEAKER_01]: collect data in a way that's not going to add extra burden when they're already so burnt out.

[00:11:58] [SPEAKER_01]: The healthcare providers of every country are facing massive administrative burden, asking them

[00:12:04] [SPEAKER_01]: to collect more discrete data, more structured data, more clean data. It's heavy but it

[00:12:08] [SPEAKER_01]: doesn't have to be if you design your workflows properly and if you communicate and train

[00:12:13] [SPEAKER_01]: properly and you design a good user experience for them. And I will say, so I did just return from

[00:12:19] [SPEAKER_01]: we reuse the Epic EMR at our hospital and I just returned from their user group meeting

[00:12:24] [SPEAKER_01]: and there was a quote that they said in the executive address and I just loved it.

[00:12:28] [SPEAKER_01]: I wrote it down because it just speaks to this philosophy of working and it was that

[00:12:33] [SPEAKER_01]: it takes an ounce of consensus to make a workflow decision in the moment

[00:12:37] [SPEAKER_01]: and a pound of consensus to correct it in the future when tens of thousands of people use it

[00:12:43] [SPEAKER_01]: every day no matter how bad it is. So it's worth the effort upfront to correct and fix your workflow

[00:12:51] [SPEAKER_01]: issues rather than letting bad workflows perpetuate and then lead to bad data that you collect.

[00:12:58] [SPEAKER_00]: In the last two episodes, I spoke with a consultant and we had this really broad

[00:13:06] [SPEAKER_00]: discussion about the importance of strategy and how to create a framework and a path to

[00:13:14] [SPEAKER_00]: success when it comes to healthcare and make the call it mentioned that oftentimes governments,

[00:13:22] [SPEAKER_00]: hospitals, institutions have an idea or very broad thinking about what they want to do but

[00:13:29] [SPEAKER_00]: they don't have the basis. So for example, they want to implement AI but they don't have

[00:13:34] [SPEAKER_00]: a data strategy and one of the things that you mentioned before this discussion when we were

[00:13:39] [SPEAKER_00]: still online was that you noticed immediately the lack of workflows which basically caused

[00:13:48] [SPEAKER_00]: the data to be scattered in silos unstructured so this is the problem that you are now in charge

[00:13:56] [SPEAKER_00]: of solving. So can you talk a little bit more about how you're going about that? Are you

[00:14:02] [SPEAKER_00]: also just taking the time to design a broader strategy? How are you transferring that vision

[00:14:09] [SPEAKER_00]: to people because you really got me thinking how people just get told what to do, just get

[00:14:16] [SPEAKER_00]: told that they need to now gather more data, use more information without potentially having a

[00:14:22] [SPEAKER_00]: broader understanding of why, what's the end goal, what's the bigger picture. So how are

[00:14:29] [SPEAKER_00]: you going about all these issues? I wish I had a magical wand or an easy button that could push

[00:14:35] [SPEAKER_01]: to solve all of this. I think it's a long journey and it takes every day, you need to stick with

[00:14:40] [SPEAKER_01]: exactly what you said those principles front of mind. This digital health is complex and healthcare

[00:14:45] [SPEAKER_01]: is complex and there's lots of interest and players and needs and it's very easy to just get

[00:14:50] [SPEAKER_01]: lost in like the noise and caught up in trends and think that AI is going to solve all your

[00:14:54] [SPEAKER_01]: problems. But it's not digital health is just so like fundamentally part of healthcare now.

[00:15:00] [SPEAKER_01]: Our providers can't do their jobs without the tools that my team, the teams like mine support.

[00:15:06] [SPEAKER_01]: We have doctors that are graduating from medical today that don't know how to do paper

[00:15:09] [SPEAKER_01]: charting and when digital health is so fundamental to healthcare and healthcare is so

[00:15:14] [SPEAKER_01]: fundamental to humanity we need, we owe it to our industry to make sure that we don't

[00:15:18] [SPEAKER_01]: forget the basics and we don't cut up in the trends and the noise and try to find quick

[00:15:23] [SPEAKER_01]: win solutions. It's hard work every single day that will get us to our end goal.

[00:15:28] [SPEAKER_01]: We're doing a lot at the hospital that I'm at to try to live this every day. So one of the things

[00:15:35] [SPEAKER_01]: that we're trying to put in place is a data governance structure and we're very deliberately

[00:15:40] [SPEAKER_01]: rolling it out in a slow way because we want to make sure that people understand their

[00:15:46] [SPEAKER_01]: accountabilities and their role to play in data. It's not something that's well

[00:15:50] [SPEAKER_01]: understood. People don't always realize that like when you're documenting about a patient and that's

[00:15:57] [SPEAKER_01]: forming their medical record those are all data points that can then be used for so many different

[00:16:02] [SPEAKER_01]: purposes to help with better decision-making for clinicians, to help with better operations

[00:16:08] [SPEAKER_01]: over the hospital overall and so helping people understand their role in this through very

[00:16:15] [SPEAKER_01]: intentional use cases that's the approach that we're taking to bring data governance

[00:16:19] [SPEAKER_01]: in our organization. We're also doing just some really fundamental things like we're revamping our

[00:16:25] [SPEAKER_01]: approach to training, our healthcare providers to make sure that they are using the digital tools

[00:16:31] [SPEAKER_01]: that my team provides to them in the most optimal way possible and in a standardized way because

[00:16:37] [SPEAKER_01]: they're busy people and they're in a clinic and they have patients and people waiting for them

[00:16:42] [SPEAKER_01]: in the waiting room. They're not going to think about what's the perfect way for me to

[00:16:45] [SPEAKER_01]: document this diagnosis, where does it go? It's going to be the easiest and the fastest and the

[00:16:49] [SPEAKER_01]: most accessible thing. We want to make sure that we're training them and learning from them at

[00:16:55] [SPEAKER_01]: the same time to make sure we're designing our solutions to enable that data to be captured

[00:17:00] [SPEAKER_01]: as easily and as quickly as possible. Then there's just like the basic things that sometimes

[00:17:06] [SPEAKER_01]: you forget about in the digital vault space like keeping your underlying like terminology

[00:17:11] [SPEAKER_01]: systems up to date. All of our EHRs and EMRs are built on these classification systems that are

[00:17:18] [SPEAKER_01]: provided by SNOMED and ICD and these large international standards organizations. If you

[00:17:24] [SPEAKER_01]: don't do the work to maintain them and do your updates and do your patches and do all of that,

[00:17:29] [SPEAKER_01]: then they fall out of sync very quickly and you don't keep up to the practice of medicine

[00:17:34] [SPEAKER_01]: and it's an ever evolving field and just keeping all of that in mind is important as well.

[00:17:41] [SPEAKER_01]: That's not to say that we don't have some really cool cutting edge projects, but

[00:17:44] [SPEAKER_01]: I think the point I'm trying to make is that in all of the work that we do, whether it's our

[00:17:48] [SPEAKER_01]: fundamentals or our cool projects, we take a very mindful approach to it at the hospital

[00:17:53] [SPEAKER_01]: where we think about workflows and user design and evaluation and change management

[00:17:59] [SPEAKER_01]: right at the outside when we're designing a project. Maybe you could argue it slows us

[00:18:04] [SPEAKER_01]: down a little bit, but I think it actually helps us build more sustainable processes and

[00:18:08] [SPEAKER_01]: happier users at the end of the day, which is a win for my perspective.

[00:18:12] [SPEAKER_00]: If I would try to summarize, I would say that you opened up two very important topics.

[00:18:17] [SPEAKER_00]: One is the long-term approach to healthcare digitalization and how you're going to go

[00:18:23] [SPEAKER_00]: about that. And the second is training and knowledge and digital health literacy.

[00:18:29] [SPEAKER_00]: If I start with the first one, so the broader digital health strategy,

[00:18:34] [SPEAKER_00]: I mentioned earlier that you said that instead of sitting on a goldmine of data that could

[00:18:42] [SPEAKER_00]: further be used for analysis for AI, for everything else, you are now sitting on a lot

[00:18:47] [SPEAKER_00]: of unstructured and inconsistent data. How are you going to go about that?

[00:18:53] [SPEAKER_00]: So for example, in Europe, a lot of regions, cities or institutions are going in the

[00:18:59] [SPEAKER_00]: direction where you keep what you currently have, but start building new applications with

[00:19:06] [SPEAKER_00]: potentially new standards such as OpenAir to design a future proof model where the standards that you

[00:19:14] [SPEAKER_00]: put the data in are vendor neutral, are structured in a very clinical detail and then slowly

[00:19:22] [SPEAKER_00]: because medicine is changing and clinical needs are changing. There's always this need for new

[00:19:27] [SPEAKER_00]: software, new data capture and going forward with this approach can bring a sustainable long-term

[00:19:34] [SPEAKER_00]: model where eventually you are saving all the data in a structured form. So how are you

[00:19:40] [SPEAKER_00]: going after that? And what do you think about these approaches?

[00:19:44] [SPEAKER_01]: Yeah, I think that these approaches are so cool. So in my previous life, I would say

[00:19:49] [SPEAKER_01]: working at Kaihe, which is the Canadian Institute for Health Information,

[00:19:53] [SPEAKER_01]: and that kind of worked at a federal level to bring together data and cleanse it. Actually,

[00:20:00] [SPEAKER_01]: it came to us in a very clean state because there is a process that happens in Canadian hospitals

[00:20:05] [SPEAKER_01]: and in a lot of US hospitals as well where you take the raw data in a patient chart and

[00:20:10] [SPEAKER_01]: codify it and structure it and then you submit it. It also creates a very long time leg between

[00:20:15] [SPEAKER_01]: when you can actually get that clean data and use it. And we were always thinking about

[00:20:19] [SPEAKER_01]: different ways of getting at that data in a more kind of real-time or timely basis.

[00:20:24] [SPEAKER_01]: And it was approaches like this that were very appealing at the time. And then before that,

[00:20:29] [SPEAKER_01]: I used to work for a provincial agency called eHealth Ontario, which is now part of Ontario

[00:20:34] [SPEAKER_01]: Health. It's just essentially like a crown agency of the Ministry of Health in this province.

[00:20:39] [SPEAKER_01]: And one of its responsibilities was to build a provincial electronic health record. So they're

[00:20:44] [SPEAKER_01]: the golden record, the single source of truth for patients that would connect all of their health

[00:20:49] [SPEAKER_01]: records from all the different care settings that they've been to plus the provincial kind of

[00:20:55] [SPEAKER_01]: repositories of data on their health card, their demographics and things like that.

[00:20:59] [SPEAKER_01]: So in those roles, I think my eyes would light up when I would think about these concepts of

[00:21:03] [SPEAKER_01]: the open EHR and all of these other approaches to structuring data regardless of what it's

[00:21:09] [SPEAKER_01]: like in its kind of native format. But in the state that I'm sitting in now and the

[00:21:13] [SPEAKER_01]: role that I'm sitting in now, I think that I have an obligation to do whatever I can possible to try

[00:21:19] [SPEAKER_01]: to clean the data as much as I can at its point of creation and collection. So I have the privilege

[00:21:24] [SPEAKER_01]: of leading a team that literally supplies the digital health tools to doctors and nurses

[00:21:30] [SPEAKER_01]: and medical secretaries and we're doing the painstaking work now of mapping out our

[00:21:35] [SPEAKER_01]: workflows from the time that a patient is referred to our hospital up until the time

[00:21:40] [SPEAKER_01]: that they're discharged. And what are the data points that we capture along the way at each

[00:21:44] [SPEAKER_01]: point that we interact with them or that they interact with one of our digital tools?

[00:21:48] [SPEAKER_01]: And we're thinking and it's a long painstaking process, but we're thinking about is this the

[00:21:52] [SPEAKER_01]: right time to ask the patient this question and gather this data? Is this the right provider,

[00:21:58] [SPEAKER_01]: this nurse or the secretary of this position that's gathering the data? Can it be done by

[00:22:02] [SPEAKER_01]: someone else that can then create efficiencies downstream? So it's really cool to do this

[00:22:07] [SPEAKER_01]: kind of work and think about data in this way. And hopefully all of this effort will actually

[00:22:12] [SPEAKER_01]: help with those broader efforts, provincially, federally, globally to get to more clean data.

[00:22:19] [SPEAKER_01]: So I do think it's important like regardless at the local level, it should be as clean as possible.

[00:22:25] [SPEAKER_00]: Sounds like a lot of data to basically map all that out and try to do

[00:22:29] [SPEAKER_00]: broad analysis on where you could improve efficiencies. How long do you think this

[00:22:34] [SPEAKER_00]: will take? I'm not sure if this is a silly question. When I started in healthcare IT,

[00:22:40] [SPEAKER_00]: even before I started in healthcare, when I was still a journalist 10 years ago,

[00:22:44] [SPEAKER_00]: I once spoke with a healthcare IT specialist and he said that they're optimizing

[00:22:48] [SPEAKER_00]: workflows. And I said, what are you going to do after you finish? It's like you're

[00:22:52] [SPEAKER_00]: optimizing that's it. No, I know that's a silly question.

[00:22:57] [SPEAKER_01]: It's not actually it's a question my steering committee asked me every time we meet with them.

[00:23:00] [SPEAKER_01]: When will this be done? But we're actually breaking the patient journey until

[00:23:05] [SPEAKER_01]: kind of manageable chunks and we're tackling things. So we're starting with registration

[00:23:09] [SPEAKER_01]: and chicken. So we're tackling things in smaller chunks so that we can roll out the best practice

[00:23:15] [SPEAKER_01]: and training and all of that other stuff that we love to do with our projects.

[00:23:19] [SPEAKER_01]: I don't know that it'll ever be done. There's so much scope to keep improving,

[00:23:23] [SPEAKER_01]: keep optimizing, keep standardizing. So yeah. Yeah, I guess as long as you at least

[00:23:28] [SPEAKER_00]: measure and can compare the before and after effect, that's good because that's often the

[00:23:35] [SPEAKER_00]: challenge that either hospitals don't take time to actually compare the before and after state of

[00:23:42] [SPEAKER_00]: introducing digital tools or they do that. But they realized that the baseline data where they

[00:23:48] [SPEAKER_00]: would just capturing or analyzing data once a week is not comparable to something that's now

[00:23:53] [SPEAKER_00]: continuously being updated. So what are you doing in that sense?

[00:23:58] [SPEAKER_01]: Yeah, for sure. So we're we actually have our an evaluation plan that's running in tandem with

[00:24:03] [SPEAKER_01]: this project. And so we're capturing the pre intervention data and then we'll be doing

[00:24:09] [SPEAKER_01]: the post after we've trained all of in this particular phase of the project. We're focusing

[00:24:13] [SPEAKER_01]: on her medical secretaries and what they do at check-in. And so we'll capture the post and

[00:24:17] [SPEAKER_01]: make sure that we're actually improving efficiencies and improving their experience as

[00:24:22] [SPEAKER_01]: says stuff at the hospital. We want to make sure that they're feeling like there's value in

[00:24:26] [SPEAKER_01]: in this work and in the digital tools that we're supplying to them. And the reason that I said

[00:24:31] [SPEAKER_01]: that this will never be done is because as we run through this project, everyone gets like more

[00:24:35] [SPEAKER_01]: and more ideas about how we can apply the same approach to all the nursing workflows and all

[00:24:39] [SPEAKER_01]: the physician workflows and all the surgeon workflows. And there's so much in healthcare

[00:24:44] [SPEAKER_01]: like it's just a never ending journey. And I totally agree evaluation is key.

[00:24:51] [SPEAKER_00]: I love the fact that earlier you mentioned all the classifications that exist in healthcare

[00:24:58] [SPEAKER_00]: and the mapping that needs to be done. And the fact that snowman is getting updated and you

[00:25:02] [SPEAKER_00]: need to be up to date with those update. And at the same time, you also said how challenging it

[00:25:10] [SPEAKER_00]: is for new clinicians to get into clinical practice and start using these digital tools.

[00:25:15] [SPEAKER_00]: So we often talk about the need for upskilling the workforce and increasing the digital health

[00:25:21] [SPEAKER_00]: literacy. But I don't think we talk often enough, what does that mean? Like I often thought that

[00:25:27] [SPEAKER_00]: doctors should just know more about the technology and the technology trends. But now

[00:25:32] [SPEAKER_00]: I'm thinking that what exactly is digital literacy. So in your view, what do you think

[00:25:38] [SPEAKER_00]: are the subjects or the things that doctors should know about? Should they be taught about the

[00:25:46] [SPEAKER_00]: ICD code, about snow med, interoperability, just the use of the software that they need to use so

[00:25:55] [SPEAKER_00]: they can use it properly and don't create garbage data. So what would be the three

[00:26:03] [SPEAKER_00]: things that you see are missing in the education of clinicians or nurses when we talk about digital

[00:26:12] [SPEAKER_00]: health literacy or high health care IT literacy? That's such a good question and it's so

[00:26:18] [SPEAKER_01]: interesting. I was just talking to our CMI yesterday about this idea of cognitive overload

[00:26:24] [SPEAKER_01]: and sometimes we forget in IT that providers, healthcare providers are there, they're there

[00:26:30] [SPEAKER_01]: to take care of patients. They're not there to be expert in IT and digital and any of that.

[00:26:35] [SPEAKER_01]: I think that with kind of the younger generation of practitioners coming into the field, they're

[00:26:40] [SPEAKER_01]: going to be just more aware of digital tools and the literacy will naturally increase but

[00:26:46] [SPEAKER_01]: it's not their job to know about interoperability and what an ICD code is. It's

[00:26:51] [SPEAKER_01]: that's why our teams exist to make it as seamless and easy to use as possible for them.

[00:26:56] [SPEAKER_01]: We're always going to need our champions of people who do get it a little bit more and

[00:27:00] [SPEAKER_01]: we're just naturally more interested in that we can work in and hand with them to design out

[00:27:04] [SPEAKER_01]: these experiences so that it is as optimal as possible. But I think that literacy has

[00:27:10] [SPEAKER_01]: different tracks like there is what you need to know as a provider and that's really just

[00:27:14] [SPEAKER_01]: how to use your tools in the correct way, in a standardized way, in a way that's

[00:27:20] [SPEAKER_01]: resulting in good data and it's making sure that you're meeting your medical legal

[00:27:24] [SPEAKER_01]: obligations. And then there's the literacy that informatics team needs and IT professionals need

[00:27:32] [SPEAKER_01]: and we get that in that space it is important to understand why terminology systems are important

[00:27:38] [SPEAKER_01]: and what interoperability is and I would say maybe this is just a Canadian problem but there

[00:27:43] [SPEAKER_01]: there is a lot of scope there to increase that knowledge and to and have people see how all

[00:27:49] [SPEAKER_01]: these pieces come to get worth and so I always encourage anyone that I run into is to just learn

[00:27:55] [SPEAKER_01]: get involved. There are plenty of international organizations that operate on a largely or

[00:28:01] [SPEAKER_01]: advance their mandates or largely like input from volunteers in Canada and as small as we

[00:28:08] [SPEAKER_01]: are in comparison to the US in terms of the size of our digital health industry,

[00:28:12] [SPEAKER_01]: we're actually quite a force on the global standard stage. So we're involved with

[00:28:17] [SPEAKER_01]: organizations like ISO, HL7, SNOMED, ICD and we have groups of volunteers who spend their free time

[00:28:24] [SPEAKER_01]: just bringing together the coalition of the willing and collecting input on the latest

[00:28:29] [SPEAKER_01]: standards making sure that they're fit for a Canadian beat, making sure that we're keeping up

[00:28:33] [SPEAKER_01]: with evolving practices in medicine. And then we join council meetings we attend a

[00:28:40] [SPEAKER_01]: webinar to keep ourselves in touch with those parts of the industry and I would say like

[00:28:44] [SPEAKER_01]: anyone coming into this digital health profession should be doing the same and

[00:28:48] [SPEAKER_01]: it's something that we always encourage and to educate through digital health can and well

[00:28:53] [SPEAKER_01]: is just keep on top of your profession and your practice because that is what you need to do in

[00:28:58] [SPEAKER_01]: order to design those tools that will help providers do their jobs and practice to their

[00:29:03] [SPEAKER_00]: optimal efficiency. I love that point because with digitalization what's increasing is also

[00:29:11] [SPEAKER_00]: the number of people with technical expertise and especially in healthcare.

[00:29:20] [SPEAKER_00]: One of the reasons why software is developed really slowly, why we've got such a challenge

[00:29:26] [SPEAKER_00]: with the workforce is because the best case scenario is that you actually have a clinical

[00:29:33] [SPEAKER_00]: person that also understands IT. So that's where I see the challenge when we talk about

[00:29:40] [SPEAKER_00]: digital health literacy and workforce shortages because the technology is developing so fast and

[00:29:48] [SPEAKER_00]: just cybersecurity needs for example are increasing so much that you really need these two profiles

[00:29:55] [SPEAKER_00]: combined in one person and a lot of these people with these two profiles. So what do you see on

[00:30:03] [SPEAKER_00]: the ground in that respect? What kind of challenges are you faced with? Yeah, just

[00:30:07] [SPEAKER_00]: you know, feel free to share. It's a great question and I would say it's they're like the

[00:30:13] [SPEAKER_01]: unicorns of informatics right so when you understand the clinical side of things and

[00:30:17] [SPEAKER_01]: my T-space and like I wouldn't hold my breath for too many of those there are definitely some

[00:30:23] [SPEAKER_01]: physicians that I've come across who know technology in like a much deeper way than

[00:30:27] [SPEAKER_01]: I ever will and I really admire how much time they can spend to get to that point but where

[00:30:33] [SPEAKER_01]: for the most part you're not going to find that within a hospital or a chair setting and I think

[00:30:38] [SPEAKER_01]: the power really is in collaboration so I work so closely with my CM I know and to the perspective

[00:30:44] [SPEAKER_01]: that she brings in terms of like her day-to-day clinical practice and the expertise that she

[00:30:49] [SPEAKER_01]: does have with use of the digital tools that we provide it's invaluable. It's things that I

[00:30:55] [SPEAKER_01]: would never think of and just having that kind of second person to talk through things with

[00:30:59] [SPEAKER_01]: is it's I just I can't say enough about how much that's needed for an IT team within a hospital

[00:31:07] [SPEAKER_01]: and there have been times where you know we're communicating a change that we're rolling out

[00:31:11] [SPEAKER_01]: to the hospital and I'll write up like a draft communication and run it by her and she'll flag

[00:31:17] [SPEAKER_01]: things like jargon to me that it's just I think I like to think that I'm careful about this

[00:31:21] [SPEAKER_01]: stuff but it's so embedded in our brains and our day-to-day lives that we don't even see

[00:31:25] [SPEAKER_01]: it anymore and she's the clinicians aren't going to understand what you mean by this you

[00:31:29] [SPEAKER_01]: need to simplify this language or if I didn't have that second check it would our communications

[00:31:34] [SPEAKER_01]: probably wouldn't be as as good as they can be so I would say know where your weaknesses are and

[00:31:39] [SPEAKER_01]: then find the people that are going to be your strengths to combat those. Absolutely it's when

[00:31:46] [SPEAKER_00]: you are in such deep expertise as either healthcare IT is or medicine is doctors also

[00:31:53] [SPEAKER_00]: use jargon you go to a medical checkup or a medical exam and the doctor says everything's fine

[00:32:00] [SPEAKER_00]: and then you get the actual discharge letter and it's full of jargon that doesn't really sound

[00:32:05] [SPEAKER_00]: that fine as the doctor said it was but I also actually just wanted to very briefly comment

[00:32:11] [SPEAKER_00]: you reminded me when you said that it's important to have the clinical perspective and that

[00:32:16] [SPEAKER_00]: on the ground perspective for from the clinical practice I once spoke with a nurse that started

[00:32:22] [SPEAKER_00]: to specialize for digitalization and she said that she's still working in clinical practice

[00:32:28] [SPEAKER_00]: once or twice a week because she wants to be on top of the changes that are happening and I thought

[00:32:34] [SPEAKER_00]: to myself what exactly is changing that much like doctor street patients nurses like how much does

[00:32:41] [SPEAKER_00]: a work of a nurse change in a year because from a software perspective but actually like

[00:32:47] [SPEAKER_00]: software and EHR is just one little piece of technology that they're using there's the infusion

[00:32:56] [SPEAKER_00]: pumps new monitoring devices like all sorts of things that we are expected expecting them to know

[00:33:05] [SPEAKER_00]: how to use but that's not easy at all because you have to learn each of that things so that's

[00:33:12] [SPEAKER_00]: I think one of the aspects of complexity that we often don't talk about or forget when we just

[00:33:18] [SPEAKER_00]: talk about the need for upskilling and the demand of just technical knowledge or affinity to

[00:33:25] [SPEAKER_01]: technology for healthcare providers yeah absolutely I feel like you're living in my brain and reading

[00:33:31] [SPEAKER_01]: right but being brain hell because that's exactly what we talk about with me in my CMI talk about

[00:33:36] [SPEAKER_01]: all the time she's an endocrinologist and she's always telling me about like the

[00:33:40] [SPEAKER_01]: how fast the technology is changing with their glucose monitoring devices they've got everything

[00:33:45] [SPEAKER_01]: is a wireless and can you can control your glucose dosage or an insulin dosage on an app and like

[00:33:51] [SPEAKER_01]: to keep up with that is think about how much is on it like the cognitive burden is on providers

[00:33:56] [SPEAKER_01]: that are having to keep up with those changes plus we're rolling out a new form that you need

[00:34:01] [SPEAKER_01]: to fill in your EHR it's a lot and so we owe it to them to keep it as simple as possible

[00:34:07] [SPEAKER_00]: make it as consumable as possible and we didn't even mention all the new

[00:34:12] [SPEAKER_00]: medical procedures or new things in just medications and therapies that they also need to be aware of

[00:34:21] [SPEAKER_00]: and understand very well so if anything I think we outlined the complexity that healthcare

[00:34:26] [SPEAKER_00]: providers are under one thing that's also very important here is the cybersecurity part

[00:34:34] [SPEAKER_00]: as you mentioned the wireless devices the seamless data flow has potential vulnerabilities

[00:34:42] [SPEAKER_00]: so how where do you see the biggest challenges did you already see a cyber attack in practice

[00:34:49] [SPEAKER_00]: how are you preparing for the time when that might happen because with cybersecurity they always

[00:34:57] [SPEAKER_00]: say it's not about if it's when it's going to happen so how are you mitigating that potential

[00:35:03] [SPEAKER_00]: danger yeah that's a good question it's something that we like force our fingers every day that we

[00:35:09] [SPEAKER_01]: don't have to experience because I think that would it would be painful yeah like I said earlier on in

[00:35:14] [SPEAKER_01]: this in this interview like it was digital health and healthcare are just the same thing now

[00:35:20] [SPEAKER_01]: they they go hand in hand and trying to practice medicine and doing your documentation without

[00:35:26] [SPEAKER_01]: having access to your tools if they've been taken down by a cyber attack like it's next

[00:35:30] [SPEAKER_01]: to impossible so we're going through the process of planning what we would do in the event of an

[00:35:36] [SPEAKER_01]: attack or downtime and like the amount of effort that it takes to think back to the days when

[00:35:42] [SPEAKER_01]: we were using paper charts and paper forms and printing labels like it's not an easy thing to

[00:35:48] [SPEAKER_01]: do and I think it really makes it so obvious how far we've come whenever you're feeling down

[00:35:53] [SPEAKER_01]: about our progress with digital health it's great to just sit in on a business continuity

[00:35:57] [SPEAKER_01]: planning meeting or something like that and you'll realize oh we've actually digitized so much and

[00:36:02] [SPEAKER_01]: and made things a lot easier in in so many ways but yeah we're going through that that planning

[00:36:08] [SPEAKER_01]: like many other hospitals are doing right now and making sure we're doing table top exercises and

[00:36:14] [SPEAKER_01]: drills and role playing as much as we can to make sure that everyone understands their role if

[00:36:19] [SPEAKER_01]: this ever happens and we have access to a kit of the material that we can lead on to try as

[00:36:25] [SPEAKER_01]: best we can to make sure we can keep caring for our patients and if we have to shut down any

[00:36:31] [SPEAKER_01]: anything and we have a plan for that as well but it just it also makes you think about

[00:36:37] [SPEAKER_01]: just how big this job is like when you're documenting on a paper chart and then you're

[00:36:42] [SPEAKER_01]: back up and running on your system you then have to restore all of that data into your system

[00:36:46] [SPEAKER_01]: and so now we're just going to take that call and that's it's a big piece of work and it's

[00:36:50] [SPEAKER_01]: simple kind of process or print to put in place which is why I think it's taking hospitals a while

[00:36:55] [SPEAKER_01]: but it's good to have these reminders and like our day-to-day lives and we hear about cyber

[00:37:00] [SPEAKER_01]: to make sure that we're on top of it and we're not letting something like that.

[00:37:06] [SPEAKER_00]: You actually just gave me an idea for a new episode which would be focused on business

[00:37:12] [SPEAKER_00]: continuity because we're I guess focused only or centered on digital and software and cloud

[00:37:20] [SPEAKER_00]: that I think the broader public doesn't really isn't really aware of what business continuity is.

[00:37:27] [SPEAKER_00]: I happen to run a user group of hospitals in the UK and Slovenia where we basically discuss

[00:37:33] [SPEAKER_00]: various challenges related to vacation management in the hospitals and I remember how surprised I

[00:37:40] [SPEAKER_00]: was when we were discussing business continuity and it basically comes down to counting the number

[00:37:46] [SPEAKER_00]: of printers you have having posters on the walls with like key points on what happens if the

[00:37:55] [SPEAKER_00]: connectivity is out, if electricity is out counting the numbers of sockets where that

[00:38:03] [SPEAKER_00]: you have on the wall so you know where the computers are going to be connected to

[00:38:07] [SPEAKER_00]: so they are always fully charged if just an electricity blackout happens and laptops will

[00:38:14] [SPEAKER_00]: still work and things like that are just fascinating to me because it's far from digital

[00:38:21] [SPEAKER_01]: and no input to call. Like we said at the start, it's part of the fundamentals and you could

[00:38:28] [SPEAKER_01]: ever just implement something and forget about it when you're in the space and it's the same

[00:38:32] [SPEAKER_01]: thing with your downtrend procedures if you have dedicated plugs where you're going to plug

[00:38:37] [SPEAKER_01]: in your downtime machines like you have to check them on a regular basis to make sure that they

[00:38:41] [SPEAKER_01]: haven't been used and haven't been taken like we've found that in our checks, people will forget

[00:38:46] [SPEAKER_01]: and they'll use our emergency plans when they shouldn't be and you have to stay on top of it

[00:38:51] [SPEAKER_01]: just like you have to stay on top of your training with your digital tools and you have

[00:38:54] [SPEAKER_00]: to stay on top of your communications and it's a never-ending job. Yeah absolutely.

[00:39:00] [SPEAKER_00]: Perhaps just one last question before we wrap up the discussion based on all your

[00:39:06] [SPEAKER_00]: experiences in driving the guidelines around data governance and data management

[00:39:12] [SPEAKER_00]: and now your role in trying to implement that and structure the unstructured data.

[00:39:20] [SPEAKER_00]: What would be your advice to hospitals that are faced with legacy systems, then the lock-in

[00:39:28] [SPEAKER_00]: and have a really hard time to make all the data that they sit on useful? How do you think is the best

[00:39:38] [SPEAKER_00]: approach to go about that? Obviously it differs based on the institution, the vendors that you

[00:39:44] [SPEAKER_00]: work in but is there any advice that you can give in the general sense? I would say we've come

[00:39:51] [SPEAKER_01]: across this same problem in our organization and I would say that there's always a solution.

[00:39:58] [SPEAKER_01]: You just have to, it might not be perfect, you might not have your data right away and in the best

[00:40:02] [SPEAKER_01]: format that you want it but there's always a way from a technical standpoint to solve a problem

[00:40:07] [SPEAKER_01]: and I think maybe the kind of general advice that I would have is if you want to solve

[00:40:13] [SPEAKER_01]: your technical problems you can only really do that through good relationships and good

[00:40:18] [SPEAKER_01]: partnerships and good collaboration and take the time to invest in your relationship with

[00:40:22] [SPEAKER_01]: your vendors and your relationship with your clinicians and that's what's really going

[00:40:26] [SPEAKER_01]: to help you get to solving your technical problem and they seem un-solvable.

[00:40:32] [SPEAKER_00]: You've been listening to Faces of Digital Health, a proud member of the Health Podcast Network.

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