The Exec: Setting the Right Tone for Technology Adoption

As the new Chief Medical Information Officer at Stanford Medicine Children's Health, Keith Morse has to make sure now tools prove themselves immediately, because clinicians don't have the time to get used to something.

Healthcare innovation may be all about the "fun stuff," says Keith Morse. But none of that will matter if the technology that forms the backbone of the healthcare enterprise doesn't work.

Morse, the new Chief Medical Information Officer at Stanford Medicine Children's Health, stands at the crossroads of the innovation and technology space. It's his job to make sure clinicians, patients and everyone else can access the data they need, but at the same time new ideas like AI and digital health are adding more data to that pool, offering new opportunities but making data management more difficult.

"That is a much trickier problem than many folks realize," says Morse, who laments that few people understand how much work goes into making sure that everything's running smoothly.

"It is critically important that our systems that we have already implemented, that our providers have already used, that our patients are already expecting, that those continue to function in a way that meets the standards of our organization," Morse says. "But then, we also have this sort of forward-facing view of healthcare. We recognize that things are changing around us, new technology becomes available, and how we plan for that, how we evaluate that, how we implement it, is another big part of my job."

Morse has been at Stanford Children's for more than five years, rising up through the ranks from Medical Director of Clinical Informatics to Medical Director of Clinical Informatics – Enterprise AI to the CMIO role, which he took over in October following the departure of Natalie Pageler. He's also a Clinical Associate Professor of Pediatrics at the Stanford University School of Medicine, and prior to all this he spent a few years as a resident physician at Phoenix Children's Hospital.

Putting Data in its Place

Suffice it to say, Morse has his finger on the pulse of Stanford Children's. It's his job to make sure the data is where it needs to be. And data, as we all know, is never where it needs to be.

The typical response, he says, is to put all the data into one big pool. But as each new program or technology is introduced to the health system, it pulls data out of the pool and into separate silos, straining the resources of EHR platform to keep track.

Morse says AI can be used to create patient care summaries for clinicians based on data stores in the EHR and other platforms within the hospital. But it gets tricky when those care pathways move beyond the hospital.

"The problem is that the patient's history outside the hospital is in many different places," he notes. "Some of it is in our EHR. Some of it is visible in our EHR through our health information exchange systems. Some of it is on CDs, some of it's on paper, and then obviously a big chunk of it comes from talking to the patient."

As a result, an AI tool might think it has access to all of the patient data, and it will tell a clinician that the chart summary is complete, when in fact it's missing key information that can affect patient care.

"That's not a technology issue," Morse says. "It's a data [management] issue."

"Although AI is a new technology, the implementation of new technology and the process of implementing new technology in healthcare are not new," Morse adds. "There are so many parallels between rolling out electronic health records and rolling out AI tools. They are sort of enterprise-wide software systems [that] rely on centrally managed data sources [that] require training, education, adoption, and change management from our end users. All of that stuff is essentially copy-and-paste from lessons that the field has learned from the electronic health record rollouts."

That's why, he says, today's healthcare technology executives need to think about change management and workflow processes alongside the introduction of new technology.

Understanding Value and Adoption Rates

In this environment, however, the introduction of new technology like AI also has to come with an understanding of value. CFOs and CEOs don't want to spend money and time on something that will eventually show ROI. And clinicians aren't likely to embrace something that takes a while to settle in.

"We have to recognize that the technology has to be ready for prime time, even at the initial rollout phase, because we run the risk of souring folks' initial impression of the technology if the first time they try it, it falls on its face," Morse says. "It's really hard to get folks to try it again. It's one thing to get folks to try it the first time, but if they've tried it and it sort of doesn't work, even if the technology itself evolves, if the integration of the technology within the workflow evolves to where maybe their original concerns have been identified and resolved, it's really hard to get folks to try it a second time."

That's why it's important to identify up front who will benefit most from the new technology and make sure their concerns are addressed. That means accounting for the first adopters and tech-savvy clinicians as well as the old-fashioned, conservative clinicians who don't easily adjust to change, and focusing on that large middle group of people who will try out a new tool if it helps them.

It's not an easy job, but Morse says the successes are memorable, especially when one remembers that he's behind the scenes in pediatric healthcare. Getting something to work right means he's not only gotten the clinicians on board, but he's also made things a little bit easier for their young patients and families.

"It's really satisfying to see how slow and methodical progress can overcome immense challenges within the organization or nudge people to change and nudge projects to get over the line," he says. "Once you recognize that persistence pays off in this space and that we can actually do amazing things with patience and persistence, I find that to be really satisfying."

"Then we can go to our providers, our patients, and our patient family advisory councils and say, ‘Hey, here is a thing that we now have available. You as the end user have no idea how much work it took us to get here. But it's here, and this is awesome. And I find that to be really satisfying."