Designing for Health: Interview with Seattle Children’s CIO Dr. Zafar Chaudry [Podcast]

Involving the right people during the design phase is essential when creating human-centered systems and processes. This means gathering input from stakeholders, both patients and clinicians, from across the care continuum, a key to ensuring satisfaction and long-term adoption. Leaning on the 80/20 rule and instilling a strong communication pathway with all parties aids in prioritizing needs and mitigating conflicts, leading to a system designed with the end user in mind.

In this episode of Nordic’s Designing for Health, Seattle Children’s CIO Dr. Zafar Chaudry speaks with Chief Medical Officer Dr. Craig Joseph and Head of Thought Leadership Dr. Jerome Pagani. Dr. Chaudry shares his thoughts on the importance of communication and inclusivity in human-centered design, how data play a valuable role in health equity, why the 80/20 rule must be embraced, the benefits of a continuous improvement mindset, and interoperability.

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Show notes

[00:00] Intros

[01:30] Dr. Chaudry’s background

[09:13] How Dr. Chaudry’s unique background helped him understand how to make technology work in a more human-centered way

[14:24] Ways to incorporate health equity into designs from the get-go

[16:50] Resolving and prioritizing conflicts using the 80/20 rule

[24:47] How the U.S. health system differs from elsewhere

[27:40] Benefits of a continuous improvement mindset

[30:49] Interoperability and whether it leads to true knowledge

[35:40] Using data for meaningful insights that affect change

[38:51] Well-designed products that bring Dr. Chaudry joy

[40:34] Outros



Dr. Jerome Pagani: We're here this morning with Dr. Zafar Chaudry, the CIO of Seattle Children's Hospital. Zafar, thanks very much for joining us this morning.

Dr. Zafar Chaudry: Thanks for having me.

Dr. Craig Joseph: Dr. Chaudry, can you tell us a little bit about your background? You seem to speak with an accent that tells me that you may not have been born in the United States.

Dr. Zafar Chaudry: So I was raised in the United Kingdom, I’m from Manchester in the U.K. That's where I grew up, came up to the U.S. when I was about 18, started my career in healthcare as a physician internist, and then four or five years then defected to the dark side and joined health IT in an era when health IT was all green screen. So, you may remember the time when physicians were really great at memorizing function keys and then entering data really fast. And how did I get into this healthcare IT space? There was an opportunity at my hospital where they wanted clinical people to get involved in technology, and I jumped at the chance to try something new. I have to say, I became a physician because it was culturally required of me to be a physician. My dad wanted me to be a physician or a dentist. I picked being a physician, but once I had the physician credentials, I don't think he really cared what I did after that. And so jumped into the healthcare IT space and then slowly and steadily didn't look back. And here I am, probably year 36 in health IT.

Dr. Craig Joseph: So, you were recruited as a practicing physician to help with an IT project at the hospitals, was that an electronic health record?

Dr. Zafar Chaudry: It was Meditech.

Dr. Craig Joseph: Meditech.

Dr. Zafar Chaudry: Yes. Many years ago, when it used to be all based on function keys, they were implementing Meditech. They wanted clinicians to learn about the implementation, what it meant. And I did learn a lot about that system at the time.

Dr. Craig Joseph: You didn't spend a lot of time in the hospital after that. You've moved on to other endeavors. What were some of those other endeavors?

Dr. Zafar Chaudry: Yeah, so my journey took me out of the hospital space, into the dotcom space and I did the dotcom before it went dot bomb. My career has taken me to multiple parts of the world. So, as I was working in Chicago, I actually went back home to the U.K. I went back my father had a heart attack, and I went back to take over the family business. We were in the manufacturing business of cooking oils. And I took over that business because I grew up in that business, and I sold that business to Kraft Food very successfully. And I was going to come back to the United States. And my mother said to me, “Why don't you work in the National Health Service? They might be able to use some of your skills.” And I was like, I don't think I want to do that. And she said, “Well, why don't you just apply to one place and see what happens?” So, I did. I applied to Liverpool Women's Hospital to be their CIO. Interviewing processes in the National Health Service are different than here. They first put you through a barrage of psychometric testing. You sit with a psychologist and then you actually have an interview. I didn't think I would pass the psychology review. I'm a bit mad if people know me. And I thought, “This is great because I'm not going to pass that stage.” But I did pass that stage. Maybe they were looking for a crazy person, and I tried very hard not to get the job. But when I got home, they called me and said, “You got the job,” and I guess I lost that bet with my mother. So, I stayed in the National Health Service, and Liverpool Women's is the largest women's hospital in Europe, didn't have a lot of technology, so it was a fun journey. We then turned that into a shared service between Liverpool Women's and the Children's Hospital, Liverpool, which is also the largest in Europe, and I became the CIO for both. It was a sort of service being provided for both, two separate entities but one single IT service with cost models for both. And that was the first of type. We did a lot of cloud back then, 2000, seven or eight. In that journey of working for those organizations, I was approached by an organization called Gartner, and they said, “Hey, you know, we provide advice around the world, and we would like to get you involved in our global healthcare practice. And you get to see the world, and you'll see new things and new health systems.” And they had lots of clients, and I thought this might be worth jumping to the other side, maybe an even darker side. And so, I did. I jumped in and worked for them for about four years, and they sent me all over the world, probably did about seven or 800,000 miles on a plane in four years all the way up to Australia, Singapore, the Nordics, the U.S., etc., and got heavily involved in their sort of EMR work around Epic and did a lot of good projects in an advisory consultative capacity. Whilst working at Gartner I got a call from Cambridge University Hospitals, and they said, “Hey, we've just started implementing Epic in the U.K., we're the first. As part of that, we've outsourced our IT services to HP, and I think we might be in some trouble. Would you like to have a conversation?” And I'm like, “Yeah, I'm Gartner, I'd like to have a conversation. That's what we do, provide advice.” So, I showed up to say, “Hey, we are ready to provide advice.” And they were like, “Yeah, we, we don't want to buy advice. Can we just buy you? Would you like to just come and work for us?” And I thought, “Oh, does that mean you have a problem to fix?” “Yes, we do.” So, I thought this might be a good idea. It's a great hospital. It's large. It's got a good international reputation clinically, in terms of outcomes, patient care. And what I'd also learned in being in the advisory capacity is you never really got to complete anything because you provide advice to people. And then people would either take your advice or not take your advice. And I felt like I needed to have my finger on the pulse. So, I said, this is a good opportunity to get back into the CIO space. So, I became their CIO, did a lot of work to finish the Epic implementation, refactored the whole outsourcing to another company, which was quite interesting because we had made contracts. It's sort of a government-led organization, so you have to navigate some of the politics to do that. I did that successfully and whilst I was there, I got a call from one of the well-known recruiting agencies here that I've known for a long time in the U.S., and they said that there's a children's hospital in Seattle, I've never been to Seattle, and they would like to hire someone with more of an international background because they had gone through many CIOs, a couple of CIOs in as many years. So, I came to Seattle, it was June. They told me the weather's always like this. I didn't know any better. I interviewed with probably about 70 people in three days and then went back and they then called me and said, “Would you like to come and join Seattle Children's?” And I was like, I'd worked in pediatrics before. The good thing about working in pediatrics is you always know why you come to work. There's no real challenge around helping kids. So, I thought, why not come and do this? And now I'm here at Children's five years later.

Dr. Craig Joseph: So, it's a very interesting background. The key takeaway for me is, try to fail interviews, and ultimately you will succeed despite your best efforts. So, I think that's important.

Dr. Jerome Pagani: Or you have to be mad, that's part of the job requirement.

Dr. Zafar Chaudry: That could be. And I think. Yes, absolutely. Don't take bets with your mother. That's my takeaway.

Dr. Craig Joseph: So many takeaways. I think that's great. So, as you are aware, we are interested in understanding how people make technology and healthcare work for humans. And so, this very interesting background of your being a practicing physician and being a consultant, giving advice, and now actually doing the work. Are there any key parts of your background that you would say like, boy, I, I learned an important lesson with this project, or I think this job really helped me understand how to make technology work in a more human-centered way?

Dr. Zafar Chaudry: I think in my journey, what I've learned is it's never really about the technology. You can always buy the next shiny thing, and there always will be another next shiny thing. I think a lot of it is about the culture of the organization that you're in, as to how you would pivot your approach to the use of technology or the design of it. And I would say that what I've also learned is that 20% of my job on any given day is probably a sales job. So, first of all, I have to convince people, I have to understand what problem we're trying to solve. So, there's a lot of communication in that human-centric design, right? Lots of personalities, as you know, Craig. There's lots of personalities in healthcare. And you have to get to know those personalities in the organization that you have. And I sort of look at the organizations that I've worked in as who are the internal customers? So, the nurses, doctors, allied health professionals. Who are the external customers? The patients, parents, caregivers. And you have to pivot the style to both. So, certainly at Children's we look at what do the patient's parents and kids want, and I'm not in person to really tell them what they want. They have to tell me what they want, and I have to understand that, and then translate that into do I need to process change? Do I need a new technology, or can I sweat the assets of a technology that I have? And you do the same for your clinical staff. But it is a lot of conversation, a lot of listening, a lot of patience, some political wrangling to actually get to that end result. So, I think when you're designing something new, you know, we put in a new EMR during the pandemic, a lot of conversations were had as to how to design that. We even involved parents in the project group, when we were designing the MyChart component of Epic. It was really that type of hands-on, and I do shy away from buying more and more technology. I think sometimes you may have invested too much. Sometimes you need to take a step back. And the biggest thing I've learned in all my journey is don't assume that the people that you're serving can either use technology or have access to it. So, there's this equity thing, certainly seen in the pediatric space, right? If you look at the state of Washington, eastern Washington is less connected to the internet than western Washington. So, if you've got a family who lives on the farm who still needs to consume healthcare, they may not be able to consume it in a way that somebody can living in downtown Seattle, which is so well connected to everything.

Dr. Jerome Pagani: A couple of things that I'm hearing as kind of takeaways from that is that you start with the people on both the delivery side and the receiving side of healthcare and being as inclusive as possible.

Dr. Zafar Chaudry: Absolutely.

Dr. Jerome Pagani: And then you design a process both for their needs and their capabilities.

Dr. Zafar Chaudry: Yeah.

Dr. Jerome Pagani: And that you then try to abstract away from that to a very clear objective about what you want, whatever you're using to do for them as that.

Dr. Zafar Chaudry: Absolutely. But also, not forgetting the before picture. Because what we always want to do is when we're designing something new, how do you measure that that new thing really made a difference? And a lot of times we missed the step of first, let me sit down with you, Doctor Bob, and you show me how you do it now. And can I, whether I'm going to use a manual way of drawing this out on a board or make it electronic, but I need to understand how you do it now. And then, what's wrong with how you do it now? What do you think? And then when I'm redesigning it, what's the future state that you want to get to? Same thing with parents, right? Because most parents will say, I need an app. Everybody says I need an app. Well, what does that mean? Did you have one before? No. How did you use our facilities, where they used to print out informational handouts and give them to me? Well, how would you like it to be? And then they'll describe that. And what's most interesting is, in pediatrics, is if you have a conversation with the 10- or 12-year-old, I would say the average 10- to 12-year-old is far smarter than I am when it comes to technology. I actually learn more from them than what I can teach them. And so that's how you have to get to that human-centric design.

Dr. Jerome Pagani: The U.S. has an enormous problem with health equity. Health outcomes really depend on your socioeconomic status, your race, your sex, your gender identity, a whole host of factors. And I know this is something that you really work hard to try to address. So how do you think about incorporating those elements in the design right from the beginning?

Dr. Zafar Chaudry: I think you'll always have a multidisciplinary group. So, any group that you form as an advisory group to build something new that may involve technology, you need to look at the membership of the group, make sure that all different groups are represented in that conversation for sure. You have to understand your organization from a demographic point of view. So, we do use analytics well. We're sitting on a whole bucket load. So, what's interesting is people talk about interoperability and data and sharing of data, but most organizations are sitting on a goldmine of data. So, you probably want to start with what does my data show, because I need to know what my mix of patients looks like based on what you've described, sex, race, other things. Then make sure that I am representing in my cohort design group that exact same mix. Same thing you would do on the clinical side. You would make sure that your skill mix is what is represented on the group. You know, based on how many physicians, nurses, other professionals you have. And then whatever you design, it's highly likely that that would get adopted because you've represented the different groups. Obviously, it sounds really easy describing that to you versus actually getting that done because you need volunteers. If you're doing it with clinicians, you need to protect clinical time so that they don't feel like they're rushed into doing that design. So, if I come to you and say, Dr. Bob, I need to spend an hour a week on this panel helping me build something. I need to make sure that he or she isn't concerned about what's going to happen with their clinical practice for that hour. Are they covered? Is their workload now going to increase? Because Zafar said, “Oh, I need an hour or two of your time,” I certainly need to make sure of that. On the patient's side of it, it's somewhat easier because there are always keen patients willing to help a health system improve because it's going to improve their experience in that health system.

Dr. Jerome Pagani: So, one of the principles that we know is very important is to listen to your experts, because they're the experts. On the care delivery side, your physicians and nurses, your other clinical care staff are really an expert in healthcare and healthcare delivery, but patients are experts in their own journey and what it's like to be them and their disease state and sometimes those things are at a tension point, or there's a little bit of a clash. How do you resolve or prioritize? And I'm sure there's not a cookbook answer, but how do you think about when there are potential conflicts?

Dr. Zafar Chaudry: When designing anything new, I don't think you're ever going to get 100%. I believe in the 80/20 rule. If we get 80% of the way there, or 80% of agreement, then it's good enough to try something new. And that's pretty much worked for me throughout my career. I think the future role, the evolving role of the CIO, the chief digital officer, is focused on being the broker between the translator of said things, right? So, I have to explain in simple terms to some of the smartest people in the world, right? If you're a neurosurgeon and you can work on the brain, and you can save someone's life under a microscope, doing that kind of fine work doesn't mean you always understand the complexities or the simplicity of technology. So, I have to explain what the art of the possible is, because many times people will believe it can do something, and we are all victims of marketing, so we buy something because we saw it on TV, it's a piece of technology and they absolutely will. It's the best thing since sliced bread when it really isn't, and a lot of people believe that. So, I have to be the broker in the middle to explain to the parent group and the patient group. This is as far as we can push or do, based on what you're asking. Same thing on the clinical side, right? Not everything can be achieved through technology. Sometimes it's a hard conversation to sell someone, well actually, now that we've looked at what you're doing and where you want to get to, you can keep the tools you have, and maybe you just need to change their processes, right? If you want to see a patient on the same day, do their labs, do the radiology, and tell them the outcome, you can do that on the same day if you build your clinic portfolio that way, or not, you may choose not to do that on the same day. And then that patient will go through weeks of a lifecycle and then understand what their outcomes are.

Dr. Jerome Pagani: That sounds very much like an advisory role. Again, you start with sort of the problem is, and you …

Dr. Zafar Chaudry: You're an advisor, you're a troubleshooter. Sometimes you're dealing with political wrangles, right? Power plays, etc. And at the same time, you have to explain it, I like to say you have to explain it in the simplest terms, you can, maybe an eighth-grade level. Or you can be the polar opposite you can be a highly technical CIO who bamboozles people with super difficult technical terms when we all know that some things aren’t really that complicated. But I think it's evolving to, you know, you are a business-centric individual who understands technology but doesn't really care about it. You’re really more focused on what are the problems you're trying to solve, what is that end result for the health system that you work in? And I think that's really where I'm seeing it going.

Dr. Craig Joseph: That's great. So, certainly, the role of the CIO is evolving, as you just described. Let me pivot a little bit in this conversation and talk about an issue that's pretty common in user-centered design, which is who knows best, the designer or the user? And so, specifically, we can talk about the electronic health record that you implemented a few years ago. There are decisions to be made where someone might say, that neurosurgeon, hey, I like to have this tool work this way, but the tool is actually presented to you in the standard way. And sometimes it's possible to change that either at a system-level, kind of a customization, or at a user-specific level, personalization. And so oftentimes, we've seen folks struggle with this decision. And so, I'm curious how you approach that. How do you say to someone, hey, I understand that this might not be perfect for you, but it's going to get you 80% of the way there, and it's already well defined and it works for everyone else. Or, you know, you're right, we're going to change that just for you, and now we're going to be maintaining that, it’s a lot more work for us in the future.

Dr. Zafar Chaudry: I think standardization of any tools you have does make sense. if you over-personalize something, you are going to struggle to maintain that. That's what we learned when we had Cerner for 15-plus years. We had over-personalized that EMR, and it was becoming really hard to maintain it to a point where it was even hard to upgrade it. When we put in the new EMR, we tried to stick to the standardized pediatric version as much as we could. I think where the decision comes in is it's not me telling someone that that's the case, but using a peer group of like-minded peers through a governance structure. So if you are having to make a decision about how you build a particular thing, I can certainly be a person who gives my opinion on it, but the likelihood might be that the person may disagree with my opinion. If I say, “Hey, Dr. Bobby, you want to standardize this, does it make sense?” And they said, “Well, no, actually, I don't like a red button. I need a green button. And that's what I need to have.” Then the way in which we've pretty much handled it, and I've handled it in my career is, well, let's send that discussion to a group that is clinical, and it's governance, and then let them decide as a collective as to whether that is what is needed or not. And it still comes down to that 80/20 rule, right? So, you can debate the color of the button or how you personalized a particular tool. And if 80% still agree that it must be a green versus a blue button, then the technologist's job is to see if that can be done in a way that won't break the system and won't make it overly onerous to support. And I have to work with the vendor to make sure that that's validated, because that's the advice they would need from me in the group. And if they decide, no, we won't customize, then I'm still having that 80% of people supporting that. And of course, you’ll still have 20% of folks who are disgruntled in your organization, right? And you get that, right, because you walk around and somebody will say, in a specialty, I was expecting this, and I didn't get it. And then my job becomes, did you know how we made the decision? Because not everybody does, right? Big organizations don't always filter communication. Number one failure in a big health system is what? Communication. So, then I become the person who talks about, possibly sales, why that decision was made.

Dr. Craig Joseph: It's interesting you say that. Often, I've run across someone who was upset at the beginning when we were talking about decisions, and then when I see them after they've been using it for a few months and ask them, they don't recall that conversation at all. And so sometimes it's, to me, much like when I pick up my phone, and my favorite app has been updated, and it doesn't work the way it used to work, and I'm very upset about it. And then two weeks later, I have no idea how it used to work. And just because I've relearned all that muscle memory. Thinking about your background, could you talk about how the U.S. health system differs from some of your international experience with respect to making healthcare work for patients and for clinicians? Are there differences in attitudes? Are there differences in personality and how much, is it still 20% that are upset, or is it higher or lower in the U.K.?

Dr. Zafar Chaudry: Yeah. So, what I’ve sort of seen in my journey, is that healthcare in the way in which it's practiced clinically, it doesn't matter whether you're in the U.K. or Australia or in Singapore, it's pretty much the same, right? Diabetes is diabetes is diabetes. The medications, from a generic point of view, are the same; trade names may be different. The big difference is how healthcare is funded, which then drives the thinking. So, for example, if you're in the U.K., it's predominantly a government-funded health system. Everybody gets free healthcare through a taxation-based system, and the physicians are salaried, and their job is to get through the volume of patients, because their salaries aren’t going to change either way, they have to get through the volume of patients, which then drives a different way of solving a problem. Socially funded health systems typically are always in crisis mode. They're always oversubscribed. When I was at Cambridge, 1200 beds, we were always 10% over, every single day, day in, day out. And people will come to work every day. Absolutely knowing that that was the case, there would be people in corridors, the emergency room would be full. But the approach to it was, well, people aren't going to pay us either way. We have to get the throughput through the system. Obviously, everybody's taken an oath. They have to treat those patients. So, what people would then decide is, so what things can we change. People would huddle a lot more to say. What can we change today that will increase that throughput and make beds available? So, we decided that if we could discharge all of the patients that were going to be discharged that day by 11 a.m., then we could turn the beds faster and get the people on gurneys in the corridor into those beds. And every day, the focus was that. There was never a focus on, “Oh my God, we're full.” It was more of, this is just how it is. So, we have to improve that process. And absolutely, if you get the patient out by 11 a.m., you do get beds faster and therefore less pressure through the network.

Dr. Jerome Pagani: I'm hearing the importance of optimization and continuous improvement mindset.

Dr. Zafar Chaudry: Yeah, absolutely.

Dr. Jerome Pagani: Are there lessons the U.S. can learn without changing the way we pay for care? Other lessons we can learn from how to adapt here?

Dr. Zafar Chaudry: So, I think the continuous improvement model exists here in the U.S., right? We at Children's use continuous improvement. The pressures are different though, right? So, we at Children's have a certain percentage of government pay versus commercial pay. How we reimburse our doctors is different. So, the level of urgency, crises, changes. Now in the pandemic, every health system sort of saw that hit the fan, right? Whether it is, by the way, the U.K. or Canada, or the U.S. But what was interesting was, you may have noticed, that the way things were troubleshooted in the U.S. healthcare system through the pandemic was very different, right? Because there was a crisis on a daily basis, and they had to get through seeing patients, things were thought differently. So, I think you can think differently. Isn't there a saying that everybody loves a good crisis? So, I think that actually does drive a different way of continuous improvement than what you would get on a day-to-day basis. And if you are a strong health system who sees a particular group of patient and never sees that crisis, you work in one particular way, and then the crisis hits you and you change that way of thinking. So, I think there are some good examples of continuous improvement processes in U.S. hospitals, and there are some very not-so-great examples of that as well. It also depends on what your physicians have dealt with in their own professional careers. And the example I'll give you is, if you have a physician who has spent their entire life working in an African country with a lack of supplies, a lack of equipment, a lack of electricity, all the core basics, and they're in a war zone, so, they're dealing with gunshots and all the huge trauma stuff, they are really well trained to deal with any form of whatever you throw at them. So, when they come here, they practice here, they're most comfortable in the city, emergency room departments, no problem, we can take care of that. The polar opposite is if you've been trained in a med school and then through your residency where, actually it's more country club type patients, and then you decide to take an inner-city hospital job. All of a sudden, I've never seen a gunshot. I've never delivered a baby. I've never done surgery when the electricity went out, right? Which is what the pandemic put pressure on us for, right? If you sort of think of this through, the pandemic pressure put that pressure on people. they really had to think outside the box when they never had to do that before.

Dr. Craig Joseph: Yeah, I've certainly seen where doctors are much more comfortable, especially based on where they've trained, to be able to have that flexibility and to kind of go up or down based on the circumstances. Let me ask you about a topic that everyone likes to talk about, interoperability. So, it seems pretty straightforward. It's much like an ATM. I can take my card and get money from any bank no matter what country I'm in. But it's very difficult to transfer medical information in a similar way. And I think something that you've talked about in the past is this concept of, hey, there, there are certain key pieces of information or data that we can take from one electronic health record and transfer it to a different electronic health record. But so now we have information, but do we have knowledge? And that concept of, how do we explain to folks that those are different things and the ability to make it kind of understandable? It's a big topic. Let me just have you answer that question in about 30 seconds.

Dr. Zafar Chaudry: So, I think technologically moving information from one system to another is absolutely possible. And we're all sitting on a lot of information that we can transfer from one place to another. The question that you ask about knowledge is interesting is, so I'm sending information to you at your health system. You receive that information. The bigger question is, what are you going to do with it? And that's where the knowledge piece comes in, right? So, if you think about, as we were going from Cerner to Epic, one of the questions I asked the clinicians was how much of the Cerner data do you want in the future? And the answer was typical, right? Everything. I need everything from the old system available in the new system. So, what we actually did was we left Cerner on for a period of time to see how many people would use that historic data. And also remember that, what's the average time of a clinic visit? Twelve, 14 minutes or so. If you've got ten patients in clinic, have you reviewed the volumes of information on that patient prior to that visit, or are you still asking the patient, why are you coming to the clinic today? Right. So, we found that the utilization of the historical information existed, but it wasn't huge. So, we didn't transfer all of that 15 years’ worth of data into Epic. We transferred 18 months and the other 14 years' worth of information sits in an archive which is contextually linked to Epic. So, you can see it if you want to see it, but it's variable in terms of what people do with it. So that still goes back to, there's a lot of complaints about interoperability and data. But when you look at systems like Epic and their whole plan, and we can show data of how many millions of records we exchanged with people, the question would be why aren't the outcomes improving then if I'm sharing that information with you? And the question still remains what do you do with that knowledge?

Dr. Craig Joseph: Sure.

Dr. Zafar Chaudry: And are you given enough time in your day to figure out what to do? Or are you on that 12-minute clock and then you’re going to the next patien, going to the next patient. The pressures are really high. So, my argument is, technologically, we can move data from point A to point B, lots of examples. If you look at the U.K. national spine, it more or less has the data of every patient in the spine and uses a smart card to access it. The way in which that worked was the government mandated that if a tech company wanted to do business in the country, they had to interoperate to a standard set of APIs, and they all did that, otherwise, they weren't allowed to do business. And you can see all that data in the national spine, which means if you're in London, and you're from Manchester, I can absolutely see what drugs you're on, what reactions you have by just sticking in my smartcard and seeing that on the screen. And that is used to some extent and to some extent, the same problem. Don't have enough time to look at it, so I'm just going to deal with the patient as I'm dealing with the patient on the spot. So, I think that's the challenge we have to solve in interoperability as well. So, we can blame a lot of the vendors and say, “Oh, well, you didn't get the data from here to here.” I think there are some standards, and we can get basic information from data from here to here, but how are we going to change the practices, processes to actually make use of that information whilst not overburdening physicians with what we are dealing with now? Burnout, right? You can't really expect someone to see 30 patients in clinic and look at all their data that somebody sent to you electronically, read it, understand it, and then only spend 12 minutes with the patient and answer all their questions and then get to surgery. What's that going to give you? Burnout.

Dr. Craig Joseph: How do you deal with the concept of too much information, of people drowning in data? Yes. Thank you. I've got 10 years of patient records for my patient from another institution. Now what?

Dr. Zafar Chaudry: So that's quite interesting, right? Because if you take the data you have in your health system, and you show that information to your clinical staff, let's say you build a dashboard, and that information shows big reds. What do I get back from that physician as a technologist? Your data is wrong. I always hear that right. When it's red, it's not me. It's the data is wrong. So, what I've learned in my journey is the best way to utilize the data you have in your health system is to have people who can partner with the clinical staff to explain to them what that data really means without you shooting the data to say the data is wrong. So, we do, and many health systems have data analysts, but they're not really analysts. They're just reporting. And what we need to evolve to is someone who understands the data well enough to sit down with me or sit down with Dr. Bob and say it's red because this is what it means. And then what Dr. Bob can do is actually affect change, which they can see in real-time. I'll give you an example of that. We did that. We did that with our data. We provided self-service access to data in real-time. And it was applied by some of our surgeons to surgery, tonsillectomy, in sort of the inpatient outpatient space. And what we wanted to do was eliminate the use of opioids in that type of surgery. But they didn't know what was going on with the patients ‘til they were able to look at their data. Then we had analysts sit with them to explain the data. They then looked at the data, the trends for their particular practices, and then decided to mirror, if they were to change this, what would happen? If they were to use a new pain medication cocktail that wasn't opioid based, would that make a difference? And over time, we got to opioid-free tonsillectomy surgery at Seattle Children's. Using that data, helping them understand it, and the physicians were doing the self-service once we trained them. And they are the same ones that can tell you the entire story which was published. So that's what I think needs to happen.

Dr. Craig Joseph: Yeah. I think understanding the data, not just being a data architect, that's very important. But also pointing out to folks, your data maybe doesn't look good because you're not putting the information where we're looking. And so sometimes that happens. I'm putting it into the EHR, but no one's seeing it.

Dr. Zafar Chaudry: It's sort of that rubbish in, rubbish out or as they say here, garbage in, garbage out model.

Dr. Craig Joseph: Yeah. Thank you for translating because I didn't understand what you were saying earlier.

Dr. Jerome Pagani: So, Zafar, we've been talking a lot about how to make healthcare work for humans. But we want to change gears for a second and just talk about what are three things outside of healthcare that are so well designed that they bring you joy.

Dr. Zafar Chaudry: Wow. That's a really tough question. I would say that certainly some retail aspects are very well designed. So, as we've moved from physical box stores to the online experience to the, I guess what people call the Amazon effect, I think that that is really well designed. I can order something, receive it to a schedule. I can return it, no worries. Automation is there. That's really well-designed. And certainly, I've seen that growth. I think when you look at industries like airlines, for instance, their technology stack. So, I'm not going to get into all the other horrifics that people have with airlines, but their technology stack pretty much has been solid, right? I can book a flight. I can book a seat. I can change a flight. I can change a seat. I could check in. I can now even self-tag my bag. I can do all those things. And it really interoperates well because when I'm in Seattle, and I land in Dubai, there's no confusion. I know what flight I was on. I know what flight will connect. I know what time I arrived. I know what gate I arrived at. All of that’s interconnected really, really well. And if you look at some of these smart airports, they even understand what flights coming in, what needs it has, how to automate. So, I think that's done that's done really well. So those will be some of the key areas for me.

Dr Jerome Pagani: This has been fantastic. Thanks so much for being here with us today.

Dr. Zafar Chaudry: Thank you for having me.

Topics: EHR, featured, Healthcare, podcast

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