Advancing Health Podcast

00:00:00:08 - 00:00:19:09
Tom Haederle
Welcome to Advancing Health. How will AI impact the practice of medicine? The most accurate answer is sooner than you think. Join us today for a different kind of podcast as four physicians discuss what AI holds for medicine, for patients and for themselves.

00:00:19:12 - 00:00:53:12
Chris DeRienzo, M.D.
Welcome everyone to a very special episode of the AHA’s Advancing Health podcast. I’m Dr. Chris DeRienzo , the chief physician executive of the AHA, and I am the luckiest human being on earth today because I am in a room with three of the most interesting doctors in the United States of America. I'm going to ask each of them to introduce themselves quickly, and then we have prepared a one of a kind podcast for you that imagined us to be sitting around one of our kitchen tables over a beer, talking about how AI will impact the practice of medicine over the course of each of our careers.

00:00:53:16 - 00:00:57:09
Chris DeRienzo, M.D.
But first, you got to get to know who these folks are, and so Tom, we'll come to you.

00:00:57:12 - 00:01:04:04
Thomas McGinn, M.D.
How you doing? Tom McGinn, I'm a general internist, and I'm the chief physician executive officer at CommonSpirit Health.

00:01:04:12 - 00:01:06:00
Chris DeRienzo, M.D.
Wonderful, Jackie, to you.

00:01:06:06 - 00:01:10:07
Jackie Gerhart, M.D.
Jackie Gerhart. I'm a family medicine physician at Epic and still practice.

00:01:10:14 - 00:01:11:08
Chris DeRienzo, M.D.
And Zia.

00:01:11:10 - 00:01:15:28
Zia Agha, M.D.
I'm also a general internist, and I'm the chief medical officer at West Health.

00:01:16:02 - 00:01:41:27
Chris DeRienzo, M.D.
And you also live in beautiful San Diego. And so for listeners, I want you to put your imaginary hats on and imagine that you are staring out at the lovely Pacific Ocean. It is an absolutely gorgeous view, and we're just sitting reflecting on the era that we're living through right now, but also what's to come. One of the most frequent questions I get asked when I'm on the road visiting with AHA members is, as a doctor, how do you think your life will change with AI?

00:01:41:27 - 00:02:00:19
Chris DeRienzo, M.D.
And I've got to call it maybe 20 years left in the arc of an average career. And what I typically answer them is faster than you think. I remember one year ago I was doing a panel with this amazing CMO who told me, look, right now we're just beginning to get ambient into our systems and it works great.

00:02:00:19 - 00:02:17:27
Chris DeRienzo, M.D.
And I asked him, how long do you think until not only is ambient documentation listening to the conversation, the beginning to prompt questions based on having reviewed the entire medical record. You think it's three years? Five years, he said. Nine months. And I said, Dave, you got to be you got to be joking me. And here we are about a year later

00:02:17:27 - 00:02:30:08
Chris DeRienzo, M.D.
and he was totally right. So my top line answer is, I think it's going to change the practice of medicine quicker than most folks appreciate. But I'm wondering what you all think. And Zia, I see you looking intently at me. So I want to come to you first.

00:02:30:09 - 00:02:54:25
Zia Agha, M.D.
I think, Chris, the speed of innovation and the speed of change is truly breathtaking. I mean, I remember when EHRs were introduced or barcode technology introduced in the hospital, it was a decade long implementation. I think we're seeing AI go from 40% respondents in the AHA survey to now 81% in one year. So it is definitely catching on really fast.

00:02:54:26 - 00:03:04:10
Zia Agha, M.D.
It's also catching on really fast on the patient side. In our own survey with Gallup, 1 in 4 patients are using AI either before or after a clinical visit.

00:03:04:18 - 00:03:25:06
Thomas McGinn, M.D.
I mean, 100% agree, I think. But I do like to kind of pause a little bit and say, I think what I see now hopefully, and is augmentation of - not replacement. And I think that's a big question mark that everyone has, is this replacing you know, physicians, nurses, APPs? Look the ambient scribing - everyone talks about this now

00:03:25:06 - 00:03:46:19
Thomas McGinn, M.D.
and it it's the first time I've seen physicians banging on my door to get new technology. And they want to change. So I think that's fascinating to see them actually want to do this. And we also realize what we've done to physicians over the years with data entry and documentation that this is really a difficult situation, and we're finally have a relief for them.

00:03:46:21 - 00:03:56:07
Thomas McGinn, M.D.
Now, the question is, will they turn around from their computer and look their patients in the eyes, particularly the young physicians, might be anchored on their laptops and not sure how to turn around. So it'll be interesting to see what happens there.

00:03:56:10 - 00:04:15:04
Jackie Gerhart, M.D.
That's a really good point. I think in taking a step back, we've all heard that different clinicians might be having some kind of an identity crisis, and I think you're speaking to that. But as I've looked at my colleagues, it's more of an identity curiosity. I'm curious what it's going to be like for medical students in the next few years.

00:04:15:06 - 00:04:38:02
Jackie Gerhart, M.D.
I'm excited about what it is for me right now. When I went into medicine, thinking I would do whether that was, you know, a lot of documentation, whether it was curating on pre-rounds and then on rounds and then on post-rounds and so forth, some of the burden has really been alleviated. And I'm finding that there's kind of two types of AI that I'm seeing.

00:04:38:02 - 00:04:55:18
Jackie Gerhart, M.D.
The first is something that relieves friction and really reduces burden. And that's great. And the other is one that's really advancing medicine and trying to help us diagnose faster, treat faster, treat better. And really, I think the best AI is what's combining both of those. And that's what I'm most excited about.

00:04:55:19 - 00:05:07:07
Chris DeRienzo, M.D.
You lift up something that I think about a lot, and I was having this conversation with my eighth grader not too long ago. We were doing her math homework and she said, dad, why do I have to learn this? I will never be without technology and..

00:05:07:07 - 00:05:07:25
Thomas McGinn, M.D.
Scary question, really!

00:05:07:26 - 00:05:31:16
Chris DeRienzo, M.D.
I feel like that's sort of the conversation we're having in many professions, but certainly in the in the profession of medicine, I don't know that memorizing the Krebs cycle should be a gate by which we, we ask students to, to pass through their, their medical careers. But at the same time, I don't think we've answered if we don't make sure you memorize the Krebs cycle, how do you understand what a urine organic acid deficiency actually is?

00:05:31:18 - 00:05:35:08
Chris DeRienzo, M.D.
And I feel like this is kind of one of our biggest challenges right now.

00:05:35:10 - 00:05:51:02
Thomas McGinn, M.D.
The term I'm very worried about, and I think, you know, we're talking about, hey, what's this great thing going to look like in ten years from now? The question is from here to ten years. A lot of things to figure out and de-skilling is the big one for me. And, you know, we - CommonSpirit has, you know, two major academic hubs.

00:05:51:03 - 00:06:09:00
Thomas McGinn, M.D.
I'm a professor at Baylor. I work with the students, I make rounds, and I get worried when I ask people like, what's in that, that order you just put? It's a bundled, it's a bundled order, and they don't know what's in the order because it's bundled. That's not AI, that's just the bundled order. Now when I ask them, well, what's in that AI thing you just ordered?

00:06:09:00 - 00:06:19:08
Thomas McGinn, M.D.
And they can't unwrap it and understand all the different moving parts and the implications, that's a little bit of a concern. So de-skilling is something that we're really focused on.

00:06:19:10 - 00:06:25:26
Jackie Gerhart, M.D.
Interesting. You said de-skilling in the same conversation I often hear never skilling and is correct cycle.

00:06:26:03 - 00:06:28:02
Thomas McGinn, M.D.
That's right. Never skill? Absolutely.

00:06:28:06 - 00:06:48:00
Jackie Gerhart, M.D.
If you think about it, a few of us learn to do blood draws. We've learned to do multiple procedures that we probably never do anymore, even for me in primary care. As we go more virtual, a lot of the learnings that we had were around how do you do the perfect physical exam, and what does technology do to actually enhance the physical exam that you had before?

00:06:48:01 - 00:07:07:14
Jackie Gerhart, M.D.
And I think it's done remarkable things. And in many cases we're trying to figure out what technology to augment humans. But I do still think there's this never skilling component of what are the things that we actually can take away from the physician that maybe just were there because of legacy purposes or because that's how it always was done?

00:07:07:18 - 00:07:27:02
Jackie Gerhart, M.D.
And yeah, I feel like there's this we have this concept of eliminate, automate and rebalance, which is if you can just get rid of the work period, not put it on someone else, but just get rid of it, period. Maybe give it to AI, just get a better workflow and get it out of the system immediately. That's kind of the question I ask before I even start using a certain technology.

00:07:27:03 - 00:07:29:04
Jackie Gerhart, M.D.
Do I even need to be doing this in the first place?

00:07:29:10 - 00:07:46:06
Zia Agha, M.D.
I think I want to take the conversation outside of the patient-physician encounter, because we've talked about that a lot. You know, we see patients and then we say, okay, come back in six months and they say okay, he's going to be fine for six months. What happens when something goes wrong in between? And I think that's really where the opportunity is.

00:07:46:08 - 00:07:53:20
Zia Agha, M.D.
How do we use these technologies to sort of keep our patients tethered to the healthcare system and be proactive?

00:07:53:22 - 00:08:12:27
Thomas McGinn, M.D.
We have a connection centers. We have five hubs to the country that are really well done. They reach out to patients and now we're automating auto reach outs. One vendor did come to me,  an AI vendor to show me these outreaches to patients who you can model they might be at risk. Think of an older woman with multiple chronic illnesses just discharged a few months ago.

00:08:13:00 - 00:08:29:04
Thomas McGinn, M.D.
The conversation the AI tool had with the patient was unbelievable, but it was really the purpose would be augmenting between the visits, touching base, looking for signals, and just comforting patients that, you know, hey, just checking in. You just had surgery. You want to make sure you're doing okay.

00:08:29:07 - 00:08:55:06
Chris DeRienzo, M.D.
I think we're centering on something that that, to me, is a fundamental aspect of how the practice of medicine will change. And that's there are things that we've never had the bandwidth to do that are now doable. And given the nature of the workforce crisis we face, with 12,000 people turning 65 in America every single day, and the population pyramid that we had in the 1960s narrowing itself to more of a population pillar, we never will have enough people to do these things.

00:08:55:06 - 00:09:18:04
Chris DeRienzo, M.D.
So technology can allow us to do things we've never done. But it also means, and you hit on this a little bit, Jackie, that there is some things that maybe we don't have to do anymore. And I think the open question, I think about my life as a neonatologist. I don't think that, you know, robots are going to be putting in central lines in the next five years, but 20 years from now, maybe, maybe.

00:09:18:06 - 00:09:37:07
Chris DeRienzo, M.D.
And so what am I doing as a neonatologist if, you know, five years from now, I don't have to be doing what I remember doing as a medical student like you go into the manual chart writing the vital signs. You know, that same shift is transitioning from the electronic space to the physical space in the course of our professional careers.

00:09:37:09 - 00:10:02:24
Thomas McGinn, M.D.
I worry a little bit about this. This never skilling thing is fascinating to me, because training in a big county hospital and putting IVs in patients that were very difficult to access veins, and then an IV team came in and suddenly took over. I mean, it's a different - it's not a bot - but it's...Actually I think we didn't we missed a lot of moments with our patients sitting with them, trying to put an IV in the middle of the night doing work like that.

00:10:02:26 - 00:10:08:01
Thomas McGinn, M.D.
There's some things you lose in that process, so particularly around the patient.

00:10:08:08 - 00:10:29:12
Jackie Gerhart, M.D.
I love the idea of giving back a certain amount of time, or maybe even freeing up time that you never had in the first place. And what will you do with that time? There's been a couple of surveys on would you see another patient? Would you learn more? Would you actually eat or go to the bathroom? I think some of those are just, you know, it speaks to the survival that a lot of us are feeling.

00:10:29:12 - 00:10:50:25
Jackie Gerhart, M.D.
And how does one survive? For me, for example, I started out in general what some might consider country practice, family medicine, where I did inpatient, outpatient, OB, nursing home. Followed all of the same folks that were in my panel and really knew them by name. And I think your point is a good one that, you know, as we take away the administrative burden of what does that mean

00:10:50:25 - 00:11:15:01
Jackie Gerhart, M.D.
to bring you back to your patient, is what other things are there that the patients actually want that we haven't really been listening to? We're still in this age of where, you know, whether it be fee for service or whether it be in front of the patient or whether it be in an institution. I think there's this concept of asking patients how they want their health to be, what their goals are, and who do they want to be tethered with, who is their care team now?

00:11:15:01 - 00:11:18:22
Jackie Gerhart, M.D.
And that might look very different now in the age of AI than it did before.

00:11:18:25 - 00:11:42:15
Thomas McGinn, M.D.
Well, when you listen to these conversations with the AI tools, patients love them. The one thing you'll hear me say when I talk AI, we're rolling out ambient scribing across the system. We as leaders in healthcare cannot make this a throughput engine only. We need to look at the moment of care and are we enhancing it and not just ratcheting up the RVUs only?

00:11:42:16 - 00:11:46:10
Thomas McGinn, M.D.
I mean, you may get 1 or 2 visits in, but you'll also get better visits.

00:11:46:13 - 00:12:17:24
Chris DeRienzo, M.D.
I did a panel not too long ago with the CEO for a large multi-state health system, and he described the primary ROI that their system was measuring on an ambulatory AI rollout for ambient for physician APP documentation was the experience of a clinician and the experience of the patient, because they recognized that the generation we have all lived through has layered technologic burden on as we digitized a manual process, and that we've now spent a good ten years realizing that need to be optimized.

00:12:17:24 - 00:12:48:02
Chris DeRienzo, M.D.
And so we're working through that optimization. But at the same time, anything we can do to relieve some of that burden gives us back time for what, at least for me, have been the most meaningful moments of my clinical career. And I can remember sitting with human to human, having these conversations, making hard decisions. To me, that's my hope for the next 20 years, is that the physicians who are not even in medical school yet, because I guess 20 years from now, there would probably be preschoolers right now or something like that.

00:12:48:02 - 00:13:00:12
Chris DeRienzo, M.D.
So, so the four year old preschool classes, who will be graduating medical students when I am finishing my career, that that most of their time will get to be in those impactful relational settings.

00:13:00:13 - 00:13:22:19
Jackie Gerhart, M.D.
And maybe the measurement changes as we think about - sometimes I'll look at the term to work at the top of your license, and I like that term because I think it tries to imagine what it is that when we're doing our best work. But inherently in that term is the word license. And working at the top of your license means that you literally are getting licensed by an exam that probably was created before AI.

00:13:22:20 - 00:13:47:04
Jackie Gerhart, M.D.
And so what does that mean for your skill set? I think for me, I highly value if I were on a medical school admissions committee, I would value curiosity and judgment and ability to communicate. I think we as clinicians need to be thinking more about how do we take science and be able to translate it and amplify it to the rest of the public so that they can really make decisions?

00:13:47:04 - 00:14:06:09
Jackie Gerhart, M.D.
And I think in this age of democratization of data, when patients have all of this information in front of them, we can really be a helpful guide, not someone that tries to push it aside, but someone that really brings it into how we're going to advance medicine and have individualized, personalized care that can be done faster and more effectively.

00:14:06:13 - 00:14:25:15
Chris DeRienzo, M.D.
So I've got to ask, just like closing thoughts, because we talked our viewers, our listeners through some pretty interesting rollers here over the last nearly 20 minutes. What gives you the most hope about the rest of the arcs of our career? If you had to just sum it up in one thing, Tom, what gives you the most hope?

00:14:25:18 - 00:14:50:24
Thomas McGinn, M.D.
Well, I think we've been talking about this. I think this will free up clinicians to be with their patients. And I use the word caring very intentionally. So I think we've somehow, through our productivity mindsets, kind of knocked caring out of a lot of the health system. And by caring really wanting to be with the patient and care with them in their entire journey.

00:14:50:26 - 00:14:57:12
Thomas McGinn, M.D.
I hope, I really hope this helps us be with them in their journey, because the journey is not a visit.

00:14:57:16 - 00:15:14:25
Zia Agha, M.D.
Couldn't agree more. I think the key word is we are all caregivers and I think if these tools can help us be better caregivers to help our patients. You know, we work at rest with a lot of older adults and sort of dignity, with respect and with the right outcomes is so important.

00:15:14:26 - 00:15:16:17
Chris DeRienzo, M.D.
Jackie, last word comes to you.

00:15:16:18 - 00:15:41:07
Jackie Gerhart, M.D.
I'm really hopeful about reimagining what it means to have health and health care. And for a long time we've thought about it as something that you physically go to. You do a physical exam, you physically go to appointment, maybe even a virtual appointment. But I really liked the discussion we had around this continuous care. And most of the points that patients have in their life and their well-being are not going to be in front of a clinician or a doctor or a hospital.

00:15:41:07 - 00:15:50:06
Jackie Gerhart, M.D.
And so how do we respect those? And in the age of AI, having that be part of the care team and really help them get to what they want for their lives is very promising.

00:15:50:07 - 00:15:54:20
Chris DeRienzo, M.D.
I promised you a conversation with three of the most interesting physicians in the world.

00:15:54:21 - 00:15:56:19
Thomas McGinn, M.D.
You're the fourth one,

00:15:56:20 - 00:15:57:15
Thomas McGinn, M.D.
yes, please, Chris!

00:15:57:18 - 00:16:06:09
Chris DeRienzo, M.D.
You all are far too kind. I promised you a fascinating conversation. This more than delivered and we so appreciate it. Thank you all for listening until next time.

00:16:06:12 - 00:16:15:06
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.</pre>

00:00:00:03 - 00:00:19:06
Tom Haederle
Welcome to Advancing Health. For victims of incidents of mass violence, the long road to recovery can be costly in many ways. Every state offers a victim compensation program that can help, and we get some tips on how to access that assistance in this podcast.

00:00:19:08 - 00:00:47:04
Jordan Steiger
Welcome to AHA’s Advancing Health podcast. My name is Jordan Steiger, and I'm the director of behavioral Health and Violence Prevention at the AHA. I'm really, really excited today to have two of my favorite partners with us talking about a topic that I think we really all need to dive a little bit deeper into today, which is mass violence, but specifically victim compensation and the resources that are available to all of our hospitals across the country around this topic.

00:00:47:07 - 00:01:08:28
Jordan Steiger
So a little background before we jump in and introduce our speakers for the day. We have been a partner of the National Mass Violence Center, which is housed at the Medical University of South Carolina since 2017, since they started the National Mass Violence Center. And this work, I will let Anne and Mike go way deeper into this, but is really important to hospitals and health systems.

00:01:08:28 - 00:01:28:21
Jordan Steiger
Just thinking about how we can better be prepared for mass violence, how we can respond as part of the community, and then how we can also support our workforce and our community long after the event happens. Because I think we all think sometimes at this event or these things are not going to happen to us, but we really do need to be prepared.

00:01:28:22 - 00:01:35:06
Jordan Steiger
So before we get started on our topic, I would love to have some introductions. So Anne, why don't you start us off?

00:01:35:08 - 00:01:53:15
Anne Seymour
Thanks, Jordan. I'm so happy to be joining you and Mike today. I'm Anne Seymour. I have been a national advocate for crime victims and survivors for 42 years, and at the National Mass Violence Center, I have been working with them since 2017, since our inception. I am the associate academic program director.

00:01:53:19 - 00:01:55:25
Jordan Steiger
Great. Thank you. And Mike?

00:01:56:02 - 00:02:26:21
Michael Schmidt, Ph.D.
So I'm Michael Schmidt, I'm a professor of microbiology and immunology. And you probably are wondering, how did someone who deals with germs get into mass violence? And that stems from the fact that I've been collaborating with the National Mass Violence Center for many years, starting way back in 2001 with the anthrax attack. And as a microbiologist, I'm well versed in all things icky.

00:02:26:25 - 00:03:01:04
Michael Schmidt, Ph.D.
Consequently, it was a natural flow, and I've been a component of the state's integrated disaster management team as well as our health systems integrated disaster team. And I was part of our pandemic flu planning committee before we had COVID. So I've been worrying about the mental health aspects and all the other things that go into mass violence for many years beyond my role as microbiologist.

00:03:01:07 - 00:03:22:18
Jordan Steiger
Makes total sense how you ended up here once you explain it. But I always think that's a fascinating connection. And I know you bring so much experience and just a wealth of knowledge to this space as well. So thank you again both for being here. Before we jump in, I want to just kind of plug the work that we've been doing together for the last few years and kind of the reason we're here talking about this today.

00:03:22:24 - 00:03:46:07
Jordan Steiger
So earlier this year in January, we co-released a guide that is focused on health care leadership and preparing for, responding to and mitigating mass violence. We'll put a link in the description bio so you can all check that out in our additional resources. But one of the things that we developed in addition to this guide is a tip sheet on crime victim compensation. And Anne,

00:03:46:07 - 00:03:54:24
Jordan Steiger
I would love to just hear a little bit more and tell the audience why we developed this. And really just what is crime victim compensation?

00:03:54:26 - 00:04:21:18
Anne Seymour
Well, we can thank the AHA for jumpstarting this tip sheet, Jordan. As you know, Mike and I presented at your Rural Health Leadership Conference in Arizona a few years ago, and our discussion and our slides were about mass violence, you know, preparation, response and mitigation very much focused on the guide. And when we hit the slide on crime victim compensation, the interest level in the room went through the roof.

00:04:21:19 - 00:04:44:15
Anne Seymour
And it wasn't that they didn't know about crime victim compensation. They asked us for specific information about the role of hospitals and their billing departments in facilitating crime victim compensation, so that mass violence victims physical and mental health needs could not only be addressed, but paid for to the degree possible by crime victim compensation. And so our tip sheet was born.

00:04:44:21 - 00:05:29:24
Michael Schmidt, Ph.D.
And one of the reasons this topic matters so much is that the mass violence response doesn't end when the last patient leaves the emergency department. In many ways, that is when this next phase begins. Helping victims, helping survivors, helping families and communities navigate that long road of recovery. So our guide was built around the idea that hospitals must be prepared before, during, and after an incident because the consequences can affect patients, families, even your staff in the broader community long after the immediate threat has passed.

00:05:29:26 - 00:05:51:04
Jordan Steiger
You know, I just want to reiterate for the audience that this is a huge resource that I think is underutilized by probably many hospitals and health systems across the country. I mean, we're saying now that this can help cover the costs of some of that care. So, Anne, can you tell us a little bit more about what crime victim compensation is and what it covers and why this matters?

00:05:51:07 - 00:06:30:21
Anne Seymour
Yeah, I'm happy to. Crime victim compensation is actually considered the original crime victims rights beginning in California in 1965. So it's been around a long time. CVC programs reimburse victims, including victims and survivors of mass violence and terrorist crimes, for crime related expenses, which, as you both know, can be absolutely overwhelming. Every state, the District of Columbia, US Virgin Islands, Puerto Rico and Guam have a crime victim compensation program that can provide substantial financial assistance to eligible mass violence crime victims and their families.

00:06:30:24 - 00:06:36:16
Jordan Steiger
That makes sense. And what kind of like services does crime victim compensation cover?

00:06:36:24 - 00:07:15:01
Anne Seymour
Well, crime victim compensation programs can pay for a wide variety of expenses and losses. Each state is different. It's really important to state that up front. Each state has a cap for remuneration to survivors, which generally ranges from $10,000 to $50,000. In some states it can be a bit higher, but in general, comp benefits can help cover the cost of things like funerals, hospitals, physicians, mental health counseling, dentists, ambulances, physical therapy, prescriptions and medication, medical supplies and equipment that are needed or that were damaged as a result of the crime.

00:07:15:02 - 00:07:45:13
Anne Seymour
Things like prosthetic devices, dental devices, walkers, canes, eyeglasses, and things like that. Also covers medical co-pays and deductibles and home health care and things like transportation to medical treatment and appointments. And Jordan, it's really important for hospitals to know that crime victim compensation is a payer of last resort, which means that victim comp can be provided only after payment, such as insurance or victim restitution have been paid.

00:07:45:13 - 00:08:13:06
Anne Seymour
In some states, medical expenses for treatment received will be paid to hospitals or other health care providers on behalf of the victim at prorated reimbursement, for example, 70% and considered a payment in full. And that's again in accordance with every state's law. Every state is different. So in the process of applying for victim comp, survivors will be asked to document other reimbursements, such as insurance that they have received.

00:08:13:08 - 00:08:49:19
Michael Schmidt, Ph.D.
I'd like to encourage hospital executives to think about crime victims compensation as part of their patient centered financial navigation. These programs can help victims and families with costs that may otherwise be overwhelming to them. Hospital care, physician services, counseling, prescription, transportation to treatment, medical equipment, and, in the case of the fatality, as Anne mentioned, funeral expenses. But survivors should not have to discover that support on their own.

00:08:49:19 - 00:09:09:10
Michael Schmidt, Ph.D.
In the middle of a trauma, hospitals can take that pathway visible, understandable and accessible. It's all about access to help that patient navigate the complexities that candidly, every hospital will say, yeah, our billing system could be better.

00:09:09:16 - 00:09:30:03
Jordan Steiger
I mean, absolutely. And I think this is just so important to kind of underscore the patient centeredness of this. I'm so glad you brought that up, that this is really trying to make it easier for people that have already gone through the unthinkable and just giving them one more resource that we can help them kind of navigate through these really, really tough situations.

00:09:30:04 - 00:10:12:12
Michael Schmidt, Ph.D.
From the perspective of a hospital leader, crime victims compensation should be viewed as something separate from emergency preparedness. It belongs in your response plan. A mass violence incident is not simply a high volume clinical event. It's also a criminal event, a community trauma event, and often, unfortunately, a long term recovery event. This means clinical care, documentation, victim services, billing, legal considerations, and most importantly, community partnerships all have to be aligned.

00:10:12:12 - 00:10:18:20
Michael Schmidt, Ph.D.
And that's really what a hospital leader is all about, aligning those priorities.

00:10:18:22 - 00:10:40:07
Jordan Steiger
I would like to shift this now a little bit more to kind of operationalizing this and making this more tactical. So, we know what crime victim compensation is now. But what actually happens when a mass violence victim applies for crime victim compensation? What kind of documentation do they need? What is required of hospitals and health systems? Tell us a little more.

00:10:40:14 - 00:11:14:22
Anne Seymour
Well that's the most important point of this podcast, Jordan. There's a lot of paperwork involved in victim compensation, but I understand that hospitals have some experience here. So generally crime victim compensation require victims and survivors to submit a lot of detailed documentation, things like itemized bill in their name with each service listed, including the name and address and telephone number of the hospital that's providing the service, the date of the service, type of services provide, and the amount that's charged for each service.

00:11:14:22 - 00:11:46:09
Anne Seymour
This is pretty standard, I think, for hospitals. For prescription and medication reimbursements, they need a copy of the actual prescription or a printout from the pharmacy that includes a victim's name, type of medication, date prescribed, and the doctor's name. And CDC program staff in different states may also request doctor's verification for any medication for which the victim is seeking reimbursement, to make sure that the expenses are crime related. And if the victim or claimant is covered by medical insurance,

00:11:46:12 - 00:12:13:09
Anne Seymour
an insurance explanation of benefit statement for each bill has to be included again, including all the details we talked about above, such as co-pays and deductibles and the amount that was paid by insurance. Sometimes justification is required from the victim if they are covered by an insurance plan or medical assistance, but did not utilize that coverage, for example, if they did not obtain the required care, or there may be travel considerations or other things related to that.

00:12:13:09 - 00:12:48:20
Anne Seymour
And sometimes victims who have health insurance and go to an out of network provider also need to submit those bills to their insurance company before CVC can consider reimbursement for such bills, and this includes documentation of the insurance companies partial payment or indication that they have denied the payment. So lot, lot of information, a lot of paperwork. And I think for hospitals, it's important for them to think how they can ease the process by making this documentation readily accessible to survivors who have been through a terribly traumatic event.

00:12:48:22 - 00:13:31:27
Michael Schmidt, Ph.D.
Bottom lining all of these points Anne offered: while the phrase payer of last resort sounds intimidating, operationally it matters a lot. It challenges hospitals to help their victims document what has already been paid by their insurance, restitution, or other sources before the Crime Victims Compensation Fund can determine what remains eligible. If you can, as a hospital, offer a template or better yet, as part of your plan, develop a crime victims compensation dashboard for both the patient and as well as the hospital.

00:13:31:28 - 00:13:48:15
Michael Schmidt, Ph.D.
If we be build these things into our billing workflows, the process can hopefully transition from being confusing and frustrating to survivors and even the billing people to something manageable for both parties.

00:13:48:18 - 00:14:09:12
Jordan Steiger
That's a really, really good idea. Let's definitely talk about it. Anne, I want to bring in a story that you recently told me about being in a hospital recently, and you said that you saw some, you know, advertisement kind of patient focused information around crime victim compensation in the waiting room, is that right?

00:14:09:14 - 00:14:38:12
Anne Seymour
Yeah. And, you know, that's where it needs to be. And thank you for letting me give a shout out to Howard University, one of the great, great hospitals here in Washington, DC. And, you know, every single state, Jordan, has informational brochures for crime victims and survivors about crime victim compensation, often available in multiple languages. Hospitals should have a ready supply of these brochures, like Howard University Hospital, and it's likely they already have them in their emergency rooms

00:14:38:12 - 00:15:07:19
Anne Seymour
for all victims of a violent crime. Folks can also visit the website of the National Association of Crime Victim Compensation Boards. And that's NACVCB.org. I'm going to say it again, NACVCB.org. And they give you a direct link to your state's crime victim compensation program. As we've clearly discussed, every single state has different benefits, different requirements for applications.

00:15:07:19 - 00:15:31:26
Anne Seymour
So it's really helpful for hospitals to be able to be specific to their state and to their community. And the thing that makes me very proud is that we have over 6000 organizations that are funded by the federal Victims of Crime Act, or VOCA, and a requirement of all VOCA funded programs is that they assist all victims with their crime victim compensation application.

00:15:31:26 - 00:16:03:27
Anne Seymour
So, Jordan, there are literally thousands of victim service professionals available nationwide to help mass violence victims and survivors with their applications, and also to help them coordinate their applications with hospitals and health care systems. And I think the most important message I have for hospitals in health care is that state crime victim compensation programs offer many opportunities for free training about comp. State hospital associations, or individual hospitals and health systems -

00:16:03:27 - 00:16:20:21
Anne Seymour
they can pull together different hospitals in a community. They can contact their state crime compensation program and request either on site or virtual training programs, and also a ready supply of those all important victim compensation informational brochures and applications.

00:16:20:21 - 00:16:28:08
Jordan Steiger
I didn't know that, and that is an awesome thing to share with our audience today. And you said that's free and available at the state level.

00:16:28:10 - 00:16:56:15
Anne Seymour
Yeah. You know, some states like Florida, they actually have regional folks that are available to do training for folks who need it. And, you know, it's not just hospitals, it's law enforcement. It's emergency management, mental health professionals. There are so many people who are part of the compensation complex. I mean, I say that and it is very complex, and they need to know about the specific things related to their state, and they also need to know their role in helping victims

00:16:56:15 - 00:17:01:28
Anne Seymour
as we discussed earlier, Jordan, document everything that's needed for a comp claim.

00:17:02:01 - 00:17:25:15
Michael Schmidt, Ph.D.
And if I were speaking directly to the chief financial officer of a health system, the revenue cycle leader, or even the billing director, I would say this is not something to figure out for the first time during the event, during the mass violence incident. Build the process now. Know your state program. Take advantage of that training. Know what documentation is required.

00:17:25:16 - 00:17:51:26
Michael Schmidt, Ph.D.
Make sure your billing team understands the need for itemized statements, especially when it comes to prescriptions, explanations of benefits, the out of network denials, and the kinds of records that survivors may need for a successful claim. And part of that successful claim - it not only goes to the victim, but also to you, the health care team. And again, I'm going to end,

00:17:51:27 - 00:17:59:17
Michael Schmidt, Ph.D.
the most compassionate response is often one that has been operationalized in advance.

00:17:59:21 - 00:18:20:21
Jordan Steiger
I think that's a really strong and impactful message to kind of end this on. We really thinking about how to do this in advance, how to make sure that you are prepared to support these victims once they walk through your door and need support. Before we end today, how can people access all of the work that we've done together on crime victim compensation?

00:18:20:21 - 00:18:23:04
Jordan Steiger
The tip sheet that we've put together?

00:18:23:07 - 00:18:47:27
Anne Seymour
Well, Jordan, in addition to being available on the AHA website, it's also available on our website. And that's nmvvrc.org. And folks who are tuning in to our discussion, I think, could also benefit from the wide range of resources that we have about mass violence preparedness, response, recovery and resilience, with many of them focused on physical and mental health care.

00:18:47:27 - 00:19:04:02
Anne Seymour
And also, you know, we're so proud of our partnership with y'all. There are so many other important partnerships that are needed to provide effective services and support related to mass violence incidents and including, of course, at all times, hospitals and health care systems.

00:19:04:04 - 00:19:28:07
Jordan Steiger
Absolutely. Well, we're very proud to be part of this work as well. With that, please check out our resources. Please take advantage of some of the resources that Mike and Anne shared today. I think this is really important work that is happening. And there's a lot of, I think, underutilized support that's out there for members of the American Hospital Association and other health care providers that we could be taking advantage of.

00:19:28:07 - 00:19:37:03
Jordan Steiger
Anne and Mike, thank you again so much for being here. We're so happy to have you as a partner and for you sharing this information with us today.

00:19:37:10 - 00:19:39:22
Jordan Steiger
Thank you. It's been really nice to be with you.

00:19:39:22 - 00:19:43:03
Michael Schmidt, Ph.D.
And the partnership couldn't be better.

00:19:43:06 - 00:19:51:28
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:03 - 00:00:19:02
Tom Haederle
Welcome to Advancing Health. In recent years, hospital trustee boards have had a new and extremely important responsibility added to their oversight portfolio: the integration of AI. Success depends on understanding the basics and knowing what questions to ask.

00:00:19:04 - 00:00:43:27
Rebecca Chickey
Hello, my name is Rebecca Chickey and I am the vice president of Behavioral Health and Trustee Services at the American Hospital Association. And it is my honor today to be joined by Ajay Gupta. He is bringing two hats to this conversation today. And so, Ajay, if you will, go ahead and tell the listeners what two hats you're bringing to the table.

00:00:44:00 - 00:01:06:28
Ajay Gupta
Rebecca is a pleasure to be here. Thank you for inviting me to be on the show today. My name is Ajay Gupta, as you mentioned, and I have the privilege of serving as this year as the board vice chair for Eternity Health Mid-Atlantic, which includes Trinity Health hospitals across Pennsylvania, Maryland and Delaware, and previously was on the board and board chair for Holy Cross Health, which are the hospitals for Trinity in Maryland.

00:01:07:00 - 00:01:30:04
Ajay Gupta
And so we went through a merger, and it's been it's been a great experience going from a still large regional system to an even larger multi-state system. I do, in my day job, run an artificial intelligence company that focuses on the health care space. Artificial intelligence, of course, applies to anyone. And what we do also applies to healthcare and to mission critical and to other organizations.

00:01:30:04 - 00:01:36:26
Ajay Gupta
But our focus is on healthcare, given that's our background, my own background and my partner's background as well.

00:01:37:01 - 00:02:04:01
Rebecca Chickey
So you nailed it. Those are the two hats I wanted you to share, because the focus of our podcast today, for the listeners to know, is really, how should boards be engaging with AI decision making in hospitals and health systems across the country? And this is happening at an incredibly rapid rate, I'm sure you are all aware. And more and more boards are saying, what questions do I need to be asking?

00:02:04:01 - 00:02:32:24
Rebecca Chickey
What do I need to know? What really is my role? What should my role be as hospitals and health systems continue on their AI journey? I want to level set though, because many of the listeners may not know all of the sort of common terms around AI. We use AI generically, but there are different types of AI. So could I ask you to put on your AI hat, tell the listeners what an LLM is, and go on and build beyond there the different types of AI.

00:02:32:26 - 00:03:13:26
Ajay Gupta
You are absolutely right that AI has become an industry term. When we use what we now call AI, we're often using LLMs and other types of artificial intelligence. LLMs are just large language models. These are the ones that have become popular: ChatGPT, Gemini, Claude, which is now very popular. These are large language models. Essentially what they do, or the core of what they do, is having been trained on the sum of human content creation, the internet and beyond, they predict the next word in a sequence of words, and that's really the core of what they do.

00:03:13:27 - 00:03:30:28
Ajay Gupta
They have grown and become far more sophisticated over the several past several years when people have been using them globally, but that's what they are, their models of understanding of the human language. We use them for everything. But that's what an LLM is.

00:03:31:01 - 00:03:35:16
Rebecca Chickey
So what's the next gen of that? I think the term may be agentic.

00:03:35:22 - 00:03:55:09
Ajay Gupta
Yeah, the next generation is always a tough question because we don't know if we're talking about three months in the future or three days in the future. Agentic AI is just an LLM - or just is a bad word, right? It minimizes everything. And when we're talking about artificial intelligence and what we've built in the modern computing world, these are very powerful tools.

00:03:55:12 - 00:04:22:04
Ajay Gupta
Agentic AI is an LLM that is connected to some other piece of software, could be an AI system as well, but it doesn't necessarily have to be that can do something, that can take an action, that can book a flight, right? That can make a hotel reservation, dinner reservation, that can order supplies, right. So it gives you the capacity to use artificial intelligence systems to ask questions, to have a chatbot experience.

00:04:22:04 - 00:04:46:18
Ajay Gupta
But then when you come to some decision point, it can execute that decision on your behalf. That's potentially very powerful, potentially dangerous. There's been a number of stories where unfettered agents have caused havoc on a network, but there have been a lot of positive use cases and increase in productivity at the personal level and company levels as well.

00:04:46:20 - 00:05:01:20
Rebecca Chickey
So given that as a foundation, we have LLMs, agentic, the latter one thinks more on its own, although my son would say they don't really think mom and we've had a conversation about that. Your thoughts on that?

00:05:01:26 - 00:05:28:02
Ajay Gupta
It's a deep question. What is the thinking, right? Are they thinking? They are certainly doing a math problem, right? They're determining what word comes next in a sequence of words at the greatest probability. That's math. That's hard. Right? It's a complex equation. It can be a complex equation. Does that relate to thinking? I don't know. So this is artificial intelligence, right?

00:05:28:03 - 00:05:52:08
Ajay Gupta
The concept of artificial comes from that these are originally mirrored after or patterned after how our human brain thinks. Do we really understand how our human brain thinks when we figure out what we want to say? You're asking me a question and I'm giving you an answer. How is my brain figuring out what the right sequence of words is that's responsive to your question?

00:05:52:10 - 00:06:14:25
Ajay Gupta
It may be figuring out probabilistic decision on a sequence of words. So we don't know. There are a lot of people, if you just go on to the, you know, the podcasting universe, you'll find a lot of interviews with people who are saying that LLMs today are reasoning. They are more advanced than the ones that came out initially, which were really just doing probabilistic math.

00:06:14:25 - 00:06:38:03
Ajay Gupta
And now there's some reasoning going on. I would say, though, from the perspective of hospital boards and health systems, we need to know what they can do for us. Whether they're reasoning, whether their level of intelligence is equivalent to or better than humans. Honestly doesn't matter. Let's figure out what they can do for us in terms of our ability to operate health systems and care for our patients.

00:06:38:06 - 00:07:08:02
Rebecca Chickey
Well, you've led me to my next question. I'm going to lay the foundations here. This is happening rapidly. AI is growing, changing, evolving, as are the applications of AI, not just in healthcare, but across the country, but particularly in hospitals and health systems. So what questions should board members be asking? What information should they be seeking to help shape the discussions that are being had at the board level around AI?

00:07:08:09 - 00:07:15:26
Rebecca Chickey
I've given you two questions there. I'll stop. So what information should they be seeking and what questions should they be asking?

00:07:15:28 - 00:07:37:16
Ajay Gupta
You know, I'd like to say that maybe board members shouldn't ask any different questions than they currently ask in all of the areas where they operate. Because at the end of the day, our role is still strategic advisory. And to help ensure quality, right. Make sure that the organization is sound, is financially sound, is doing the right things in the community and is caring for patients.

00:07:37:18 - 00:08:02:14
Ajay Gupta
AI is a very powerful tool along those lines across the entire spectrum of hospitals operations. AI systems can help both at the bedside as well as operational decisions in the administrative wing of the hospital, right. So to that extent, we should know how are we using AI? What's our vision for using artificial intelligence going forward? I'd suggest we should all ask who owns AI?

00:08:02:16 - 00:08:26:27
Ajay Gupta
I say that because as powerful as it is, as fast as it's moving, it's still fairly new. ChatGPT was released in November of 2022, not even four years ago. And that's really when the common consumer retail version of AI exploded. We were operating before November 2022. There wasn't anybody in October of 2022, in a hospital system in charge of AI necessarily.

00:08:26:27 - 00:08:49:22
Ajay Gupta
Maybe there were a few advanced systems, but this is so new that there may not be an owner designated for AI in a hospital. And that's, I think, the place to start. In order to have a strategy, typically you need to have one owner and they can have a committee to make decisions, but somebody who's going to be the champion. That person, that organization, that that structure probably needs to be defined.

00:08:49:26 - 00:08:56:15
Rebecca Chickey
Do you think there needs to be a subcommittee of the board related to AI?

00:08:56:18 - 00:09:20:04
Ajay Gupta
Sure. I think the way an individual board operates is so unique to the people who serve that board that I'm sure that answer is different for every everyone. I would say, though, the health system probably needs to have a committee or a task force designed to see how AI can help everywhere. I say that even though it's a tool and it is a tool, it's very powerful.

00:09:20:07 - 00:09:33:15
Ajay Gupta
It's not inconceivable to assume that we could take an entire administrative task and have 80 to 90% of the tasks within that job task given over to AI systems, whatever it might be.

00:09:33:18 - 00:09:58:08
Rebecca Chickey
I heard a podcast once that was talking about how there's a lot of equipment in a hospital, and there is information available about when, you know, on average, any one piece of equipment needs to be serviced or it may expire, needs to be replaced, and that AI can help monitor across the inventory of equipment at a hospital and help alert the individuals responsible for that.

00:09:58:08 - 00:10:09:09
Rebecca Chickey
This one needs to be serviced. You know, this one is coming up to its expiration date in a way that is really difficult for a human to monitor. It'd be a massive spreadsheet.

00:10:09:14 - 00:10:32:21
Ajay Gupta
It's a very interesting application, and I don't think that's all that novel, right? So building management companies have been using computerized systems, not necessarily AI, right. This is for some long time ago. But distributed sensors based systems to track the status of buildings for maybe decades. And now we're just saying that that concept can be applied to the equipment that's in the hospital.

00:10:32:21 - 00:10:58:15
Ajay Gupta
And that's true. Hospitals have a lot of heavy equipment. Hospital infrastructure is an expensive infrastructure. Can we use artificial intelligence systems, distributed sensors to track the utilization of those and the status of those systems? We probably should be doing those things. We should be enabling that level of intelligence to staff at throughout a hospital to be able to do their jobs of tracking and maintaining the infrastructure.

00:10:58:20 - 00:11:20:22
Rebecca Chickey
So I have two more questions as we bring the podcast to a close. One, what should the board be involved in related to AI oversight? You mentioned earlier patient safety and quality being one, and where they should not. Because as we are moving through this at a rapid pace, I anticipate that there could be some friction there.

00:11:20:25 - 00:11:22:18
Ajay Gupta
I think the reality is that the board

00:11:22:18 - 00:11:49:04
Ajay Gupta
is there for the strategic advice, right. So I think they should not necessarily get involved when it's coming to a decision between which two vendors to use, right. Do they want to use a system based on open AI or Claude? Maybe that's probably not the right decision, but strategic decisions are important. And the strategic decisions may be, for instance, are we going to use AI first on the clinical side or the administrative side?

00:11:49:07 - 00:12:13:27
Ajay Gupta
That could be a strategic decision. There's risk involved there, right. Obviously everything that we do on the patient side has greater risk and sensitivity. That's our core purpose. Those are areas where the board should be involved. And the board should be involved in not necessarily deciding that, although in some situations maybe that is what is called for, but they should be involved to ensure that the administration and the leadership have a plan to make these decisions.

00:12:13:28 - 00:12:36:04
Rebecca Chickey
Do you also see a role for the board in terms of risk mitigation as part of this whole process? Because I've read that as we add more AI, that also increases the potential for cyber security breaches. Does a board have a role in, you know, asking the question? So if we add this, what are the risk mitigation strategies that you have put in place?

00:12:36:04 - 00:12:45:03
Rebecca Chickey
Or how are we going to put up guardrails to make sure that this is the most effective? Is that a place you see for the board?

00:12:45:08 - 00:13:05:03
Ajay Gupta
Yeah, that's what I was getting back to saying that some of the questions that board will ask for AI are the same questions we ask everywhere. Managing risk or helping the institution manage risk. Ensuring the institution is managing risk is a core board function. So finding out what is the risk exposure to whatever decisions we make on artificial intelligence is important, right?

00:13:05:04 - 00:13:29:19
Ajay Gupta
So many companies in and outside of healthcare have used these tools. I'm sure you've seen them. There's many of them that transcribe a meeting into notes and then send those notes to everybody who participated. Well, that's a risk, right? That you're talking hospital business, and now you have some other agent that is privy to that business. So I'm not saying that one decision is right or wrong, use it or not use.

00:13:29:19 - 00:13:42:08
Ajay Gupta
And I'm certainly not making a selection between all of the tools that are out there. But there should be a process in place. There's a risk exposure there. The board should be on top of knowing that management has thought that through and made a clear decision.

00:13:42:12 - 00:13:50:07
Rebecca Chickey
Wonderful. So my last question to you is what's something that we haven't discussed here that you want the trustees to hear from you?

00:13:50:14 - 00:14:19:04
Ajay Gupta
I think that's incredibly important that we are engaged in artificial intelligence one way or another. And obviously engage in the way that makes the most sense for your institution. That's true. But this is moving fast. It is the next future of the computing world. It's already in the social world, right? People are talking about and using it in every aspect of their lives, and not just the young patients, although definitely young patients, but all patients are using it to care for themselves.

00:14:19:06 - 00:14:40:10
Ajay Gupta
So we have to engage. We cannot avoid the use. We can't just say, let the market figure out what we do, and then we'll be laggards in deploying AI. If we don't engage, we are simply going to have to adopt whatever solutions come about, whether they work for us and our patients or not. So we have to find a way to engage.

00:14:40:10 - 00:14:55:16
Ajay Gupta
And I know that that there's a risk, there's all the risks there. There's also potential cost there, right. So we have to figure out how we're going to manage and carry those costs. How are we going to share those costs to at least with the technology providers who can bring these solutions into our systems?

00:14:55:20 - 00:15:16:27
Rebecca Chickey
Well, thank you so much for sharing your time and your expertise with us here today. Thank you for the work that you're doing with both hats on to close the loop on that. Very grateful. I want to also point the listeners as we close out to AHA Trustee Services has a dedicated web page to AI and what trustees need to know.

00:15:16:27 - 00:15:26:08
Rebecca Chickey
So go to AHA.org/trustees and look for our AI landing page to learn more about this important topic. Thank you so much.

00:15:26:15 - 00:15:29:04
Ajay Gupta
Thank you. Thank you for having me.

00:15:29:07 - 00:15:37:28
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:02 - 00:00:18:06
Tom Haederle
Welcome to Advancing Health. Advanced Practice Professionals - or APPs - perform many duties similar to physicians and are an increasingly important part of the health care ecosystem. Which is why the right leadership is needed to guide this critical part of the health care workforce.

00:00:18:08 - 00:00:40:02
Elisa Arespacochaga
Hello, I'm Elisa Arespacochaga, group vice president of clinical affairs and workforce at the AHA. Today, I'm really pleased to be joined by Leslie Clayton, program director for APP service at M Health Fairview and chair of AHA’s APP Leadership Advisory Group. We're here to talk about the role of APP leadership, how it is evolved and why it is increasingly important in today's health care environment.

00:00:40:03 - 00:00:55:21
Elisa Arespacochaga
So welcome, Leslie, and to get us started, can you introduce yourself and tell us a little bit about your current role? I'd love to hear sort of your journey into leadership as a practicing clinician, and what drew you to the work and how it's shaped your leadership APP approach?

00:00:55:25 - 00:01:22:13
Leslie Clayton
Sure. Thanks for having me. It's nice to be here. So my leadership evolution really came from genetic makeup. My mom was an RN. My dad was a process improvement guy. I spent most of my childhood really interested in how do I make something better, because I was watching them do it and I saw the impact it was having. And I think that's probably what drew me into becoming a PA was it was an opportunity to make things better through a great variety of creative opportunities.

00:01:22:15 - 00:01:51:27
Leslie Clayton
My leadership journey really evolved throughout childhood and being a student. Even as a PA student, I served on my state academy PA board as a student director. And it's where I learned that if you really wanted to be a fully well-rounded medical professional, you needed to have an understanding of the other aspects of how medicine is practiced. And that led me to state academy roles, serving as legislative chair, president, and then national roles, where I served for the last seven years as one of the speakers of the House of Delegates for the American Academy of Physician Associates.

00:01:51:28 - 00:02:12:10
Leslie Clayton
And I'm now honored to serve as the president-elect. It's through the legislative work, through that parliamentarian speaker of the house process work, that I was able to deploy those skills to help with care innovation, with care model design. And so that's what my current role is as the program director of advanced practice for a large academic health system.

00:02:12:15 - 00:02:31:03
Leslie Clayton
My role reaches across all 11 of our hospitals and our multitude of outpatient clinics in any area or aspect where nurse practitioners, PAs, clinical nurse specialists, nurse midwives and CRNAs are functioning. That's work that I have some implication or work to participate in.

00:02:31:07 - 00:02:43:20
Elisa Arespacochaga
That's great to hear. So for those who may be a little less familiar with the role, how do you define APP, specifically leadership, and why is it such an important part of health care organizations today?

00:02:43:27 - 00:03:12:21
Leslie Clayton
Yeah. Advanced Practice Providers being PAs and advanced practice nurses, really are sort of the undiscovered country at this point in our healthcare evolution. As health care changes, we really need to utilize our workforces as to their full extent. And if you don't have good leadership over a certain workforce, you're not going to deploy them properly. So an APP executive leader really should be focused on things like strategic and organizational implementation, not so much the daily task management or schedule setting up. APP

00:03:12:22 - 00:03:37:26
Leslie Clayton
executive leaders really should be focusing on sort of the broader workforce planning, professional development, quality safety initiatives, regulatory compliance, onboarding, privileging, credentialing, all of those aspects that really come into the professional deployment of a group of workers. We're talking about 40 to 50% of health care professionals now inside of our health systems. And if we don't have proper leadership of them, we're not going to have proper deployment of them.

00:03:37:27 - 00:03:59:10
Leslie Clayton
And that's why APP leadership over PAs and advanced practice nurses is really going to be influential in how care is delivered, and how those models are designed to really meet the needs of patients. We need to be focusing on what does the patient need and who's the right person to provide that. More so on sort of constructs of task management and hierarchy.

00:03:59:13 - 00:04:22:13
Elisa Arespacochaga
Couldn't agree more. We certainly know the demographics are against us. We need every human who's willing to go and care for others to be part of that team and to work as effectively as they can. And I think there's this whole hierarchy    and structure for medicine, and there's a whole hierarchy and structure for nurses. And APPs are somewhere in between. They're pieces of both of those structures, but they need a structure of their own.

00:04:22:18 - 00:04:41:20
Elisa Arespacochaga
Now, those structures can look very different from one health system to another, depending on what that health system is providing, who their teams are. What are some of the different ways you've seen those structures grow up, and what are a few of the characteristics or approaches that you feel are key to really be effective?

00:04:41:22 - 00:05:00:18
Leslie Clayton
Yeah, and there is no one size fits all model because every health system is shaped differently. Every construct is different. Every state has different regulatory practices. And that's going to have influence on how you set up an APP leadership structure. You know, we're very fond around the AHA of saying structure matters and process matters, but culture eats it all for lunch.

00:05:00:20 - 00:05:35:10
Leslie Clayton
And that's true when it comes to APP leadership as well. You've got to support the role across disciplines, in an environment where the PAs and the APRNs, the leadership is going to be empowered to actually contribute to the changes and the evolution of health care. The APP leadership role really needs to be put in a position at the executive level where anytime we're talking about workforce development or how do we meet the needs of a patient, you're including your advanced practice providers in that conversation. We have to fully contribute to patient care through those organizational strategies.

00:05:35:10 - 00:05:49:10
Leslie Clayton
And it's not really who's in charge. It's what does the patient need and how do we get the workforce arranged around the needs of that patient. And APP leaders are essential in designing that new system.

00:05:49:13 - 00:06:09:25
Elisa Arespacochaga
Couldn't agree more. I think that's the bottom line of this, is that we have we're good at putting some friction in the system. And how can we make it frictionless, or at least as close to frictionless as we can, both for the patient and for those providers, so that they are doing the job that they train to do and best supporting the community that they're there to serve.

00:06:09:27 - 00:06:20:09
Elisa Arespacochaga
So as we think about sort of the future and where health care is going, why is investing in APP leadership more important than ever right now?

00:06:20:12 - 00:06:48:10
Leslie Clayton
Because patients need care and we need everybody at the table ready to provide that care. That's the simple tie it up tight. But the reality is we're facing unprecedented challenges. We've got physician shortages that are not getting better. They're only getting worse. We've got workforce burnout, increased complexity of care and financial pressures. And APPs are really the uniquely positioned to be flexible, adaptable in that care model need to meet the what the patients are really seeking.

00:06:48:10 - 00:07:08:27
Leslie Clayton
So some of the tips and tricks that I would put forward for people that are looking at developing their APP leadership, is that you've got to include them at the executive level. They've got to be part of the strategic planning. You've got to invest in them. You've got to create some leadership development programs, and you've got to really emphasize that innovation is what we're looking for, because this is an untapped workforce.

00:07:08:28 - 00:07:32:10
Leslie Clayton
And if we really empower and put a culture in place where invention and looking for new ways to solve problems, you're really going to get the best advantage out of your advanced practice provider leadership. And you've got to foster collaborative models where physicians, PAs, advanced practice nurses, nurses, administrators, and everybody are working together in partnership to meet patient care needs.

00:07:32:10 - 00:07:39:28
Leslie Clayton
That's the organizations that are going to be successful, is the ones that brings everybody to the table with the focus of how do we deliver care smarter.

00:07:40:01 - 00:08:03:13
Elisa Arespacochaga
I love that, and I want to double click on the part about education. Leadership, I believe very strongly is a skill you learn, you hone, you train. It's not something you're born with. And I think it's really important to highlight the clinicians aren't trained to be leaders, that there is a process to learning how to lead others, how to deploy people, how to do all that work.

00:08:03:14 - 00:08:07:21
Elisa Arespacochaga
Any gems you want to share from your own leadership journey as to how to do that well?

00:08:07:28 - 00:08:26:22
Leslie Clayton
I would say that the alphabet after your name isn't the determining factor as to whether you're a leader or not. I would say asking questions and being curious is a key component to being a strong leader and knowing when you have something to share. Share it honestly. Share it openly with the intent of making things better.

00:08:26:25 - 00:08:46:26
Elisa Arespacochaga
As you're working with health system leaders in your own work and across your national role, what would you really like health system leaders to prioritize as they think about the care delivery models of the future, and how to make sure that APPs and all of the clinicians that are working in it are at the table and in those conversations?

00:08:47:02 - 00:09:10:14
Leslie Clayton
Yeah, I would say that we need to change the mindset that PAs and advanced practice nurses are not task managers. They are care providers. They are people who render care, generate revenue and change systems because the patients require us to do so. That's why our professions exist, is because patients needed care. In the 1960s, that's when we were developed and it couldn't be more true than it is now.

00:09:10:14 - 00:09:18:20
Leslie Clayton
And now is the time to leverage the capacity of our flexibility and adaptability to really move health care forward so our patients are getting seen.

00:09:18:22 - 00:09:37:01
Elisa Arespacochaga
Leslie, thank you so much for all the work that you do. Both chairing the committee, the advisory group, chairing the national level work that you do, as well as the local work you do to care for your patients and continue to do that at M Health Fairview. So thank you so much.

00:09:37:03 - 00:09:45:25
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on APPle Podcasts, Spotify, or wherever you get your podcasts.

00:00:03:20 - 00:00:24:09
Tom Haederle
Welcome to Advancing Health. As artificial intelligence is increasingly embedded into the foundation of modern healthcare - from clinical care to emerging biotechnology to business operations - experts say it's important to focus on the quality of the oil that lubricates AI, the data it runs on.

00:00:24:12 - 00:01:01:15
John Riggi
Hospitals and health systems are rapidly adopting AI to power clinical and business services, advanced research and medical trials, and also using it for emerging biotechnology solutions. Most evaluate these AI powered services and solutions from an operational compliance and cybersecurity lens, and don't always address the related and strategic issues. There are often embedded hidden questions of national security, economic security, and public health and safety facing executive leadership and governing boards when adopting AI solutions.

00:01:01:18 - 00:01:32:07
John Riggi
I'm John Riggi, your national advisor for cybersecurity and risk at the American Hospital Association. Today, so pleased and proud to have with me my good friend and former colleague at the FBI, Ed You. He's president of EHY consulting and a senior advisor to the AHA on foreign threats to the bioeconomy. And Ed is also a former FBI leader on weapons of mass destruction, counterintelligence and biosecurity.

00:01:32:08 - 00:01:49:00
John Riggi
With more than two decades of advising the FBI, the White House and the US intelligence community, Ed brings a rare perspective that bridges science, policy and executive leadership. Ed, thank you so much for joining us today.

00:01:49:02 - 00:01:58:06
Edward You
Oh, it's an absolute pleasure to be here with you, John. I want to thank you and AHA not only for this opportunity, but its an absolute privilege to be a part of the team.

00:01:58:08 - 00:02:07:02
John Riggi
Ed, let's talk about how the convergence between AI and other emerging biotechnologies is actually affecting health care.

00:02:07:04 - 00:02:41:00
Edward You
Yeah, that's such a critical question. So you hit the key term. It's all about convergence. And what I mean by that is everybody is racing to see how they can adopt and implement AI. It could range from something as simple or as complex as designing new drugs, designing new diagnostics, looking at how do you supercharge manufacturing AI for looking at how do you process medical bills, insurance records, all the way to looking at the entire drug supply chain.

00:02:41:01 - 00:03:07:12
Edward You
So everything in between. And that is a recognition not only of how powerful AI is, but it is not just a tool. It is absolutely being embedded in the entire healthcare ecosystem. It's not just about adoption now. It really is AI is becoming a part of the fabric or operating system of modern day healthcare. Building on that, though, we tend to focus on AI almost exclusively and forgetting that AI doesn't do anything without data, right?

00:03:07:13 - 00:03:30:26
Edward You
And so data is absolutely the new oil that AI is going to train on, AI is going to process. And so it's more about protecting the data, the workflows that are associated with the data and the trust that is going to be part of quality of the data. So we had to think beyond just the tool, but looking at the healthcare ecosystem in total.

00:03:30:28 - 00:03:54:27
John Riggi
Totally agree, Ed. And I love the phrase you always say that data is the new oil. And I often say that like oil, the data does not spoil. It has lasting value. It has retentive value for us and our adversaries who are continuously trying to steal our research and innovation and use it for their own economic or national security priorities.

00:03:54:27 - 00:04:06:24
John Riggi
So given all that, how should healthcare leaders approach governance, oversight and organizational considerations surrounding AI enabled and emerging technologies?

00:04:06:26 - 00:04:35:18
Edward You
Everybody is implementing AI. One of the few things that is missing is very few people actually have an AI enterprise strategy. It's more than just looking at how quickly can you adopt and integrate AI. It's not an IT project, right? It's not something that you just ask your resources and your IT folks to integrate. It is potentially transformational aspect of your organization.

00:04:35:19 - 00:05:01:00
Edward You
Therefore, executive leadership should be going into this understanding that there ought to be a strategy and to kind to put a fine point on this, I've engaged with private sector, with academia. I went to a conference just not too long ago, where it was tended by multiple companies, startups to large scale multinationals, and just querying them like, hey, how are you using AI?

00:05:01:01 - 00:05:28:02
Edward You
And they're very easy in explaining, you know, we're doing it for this part of a business and doing this part. And when I asked a simple question, okay, great: what's your AI strategy? And across the board people are like, never really thought about that before. And so there has to be a recognition that technology is always going to be moving faster than true integrated adaptation for organizations, and that really needs to be recognized.

00:05:28:02 - 00:05:36:14
Edward You
And if we don't do it right, then we're going to potentially leave gaping vulnerabilities, which I think we're going to be talking more about later on.

00:05:36:21 - 00:05:58:27
John Riggi
Great points, Ed. You know, when I when I listen to you speak, I think about how technology was adopted, just basic technology and digitization of healthcare records throughout the healthcare sector. It was viewed as a tool. It was plug and play, that common expression. But there wasn't a strategy and there really wasn't a strategy till later on as organizations became more mature.

00:05:58:27 - 00:06:30:27
John Riggi
And then we began to really understand how the technology risk equated to enterprise risk and ultimately a risk to patient care and safety. So we really need to learn some of those from these lessons we adapted to and some of the issues we adapted to back when we had this large scale adoption and digitization of healthcare. So Ed, can you give us an overview of the growing need for biosecurity in the risk associated with foreign collection of health data?

00:06:31:00 - 00:06:58:10
Edward You
Yeah, I mean that that is such a challenging question because AHA and your, your program in particular has been leading the charge and looking at cybersecurity and the cyber threats are absolutely just relentless. However, if you're forward leaning and understand what's coming down the road when it comes to AI, AI amplifies the opportunities, as I mentioned before, but absolutely, it amplifies the potential risks as well.

00:06:58:18 - 00:07:35:27
Edward You
That also means that it translates into a broader vulnerabilities because you mentioned it before. You know, there's always a historical challenges. You know, when you and I were both at the FBI about intellectual property theft and ransomware. And so what I call the traditional but daunting security challenges. But if data is the new oil, then we really need to be paying attention to what are the vulnerabilities, because it's not just about the final, you know, license or patent, but now it's, well, your genetic information, the genetic code that makes up who you are is incredibly valuable.

00:07:35:27 - 00:08:06:03
Edward You
And people tend to forget that once that's gone, once that's taken, there's no getting it back. And once it's gone, it's gone. It's not like a credit card where you can change your credit card. You can change your PIN code. That information that is intimately you is not retrievable. Moving even further with the future of the Internet of Things, of smart homes and smart cities, smart clothing, for example, we're going to be tracking our lifestyle, our behaviors, and those all ultimately going to have a fitness or medical application too.

00:08:06:03 - 00:08:16:03
Edward You
And we really need to start thinking about, wait, who are the end users? Who's going to have access to this data? We need to be asking those questions today.

00:08:16:06 - 00:08:44:13
John Riggi
Would totally agree, Ed, and your comments remind me of our previous conversation a few years ago, and we talked a lot about foreign threats and foreign influence to medical research and innovation. And we were talking about the potential theft, compromise, or misuse of genetic data. And we pointed out to the field that it's not only your personal genetic data which is at risk, it is the genetic data of your future generations.

00:08:44:13 - 00:09:03:02
John Riggi
So your genetics transfer from generation to generation, which again, are placed at risk if again improperly used or accessed. So Ed, if hospitals are contemplating adopting these technologies, what should they consider and how can you help directly?

00:09:03:06 - 00:09:28:25
Edward You
Well, first and foremost, hospitals should be affiliated with AHA and your team. And that's the important start just to get a full understanding of not only the cybersecurity challenges, but the capabilities, the training and the insight that your program already provides. What I hope to bring to the table is - what I kind of mentioned is - don't just think about today's threats, but we really need to think about tomorrow's challenges as well, too.

00:09:28:25 - 00:09:51:04
Edward You
And I don't want to be complete doom and gloom. It's just that there's so much opportunity because we have an opportunity to really protect not only our patients, but the families, the communities that they live in. We can't miss out on that because it's not just about loss of privacy. It's not just about the IP loss I just mentioned before.

00:09:51:07 - 00:10:22:02
Edward You
Yes, those are real felt financial hits. But so what if a foreign entity gets access to your genetic information or your lifestyle information? The "so what" is that if you're utilizing AI, if you're an adversary or competitor, then what might actually happen - and we're starting to see this play out - is that they're going to have first mover advantage for the next breakthrough drug, the next breakthrough therapeutic, to be able to provide more cost effective health care delivery.

00:10:22:04 - 00:10:59:14
Edward You
That is really scary in that we may inadvertently be rendering our patient population completely dependent upon a foreign supply chain. So that's not theft. And so not only is that a huge vulnerability to our population, but that also means that economic loss, potential work opportunities, job losses as well, too. It's a full stack threat that, as I said, it's not just your traditional cybersecurity challenge, which is already a huge issue, but we really need to start thinking about these things a little more proactively.

00:10:59:16 - 00:11:33:07
John Riggi
Thanks for your comments, Ed. And it's no secret that China remains fixated on becoming the world's dominant superpower economically, not necessarily militarily, but their strategy to acquire and develop research, information, expertise on bioeconomy and pharmaceuticals is very, very well known. And again, we have to keep that in mind as China is aggressively seeking to acquire that information from the United States through legitimate commercial means and illegitimate means as well.

00:11:33:14 - 00:11:55:15
John Riggi
Ed, so thanks again for joining us today. Most importantly, thanks again for joining our team as our resident expert on foreign threats to the bioeconomy. Your services and expertise are now available to the entire health care field and our members here at the AHA. To learn more about Ed and his services, please visit www.aha.org/cybersecurity.

00:11:55:18 - 00:12:07:13
John Riggi
Thanks to all our listeners for joining us today, and thanks for what you do every day to defend networks, care for patients and service your communities. Stay safe everyone.

00:12:07:15 - 00:12:16:09
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.