The new campaign will address a range of issues, including rural healthcare, challenges in post-acute care, and the state of mental health services in New Hampshire.
The healthcare system is notoriously complicated, and The Thread is designed to educate patients, policy makers, and members of the general public about key healthcare issues.
"One of our greatest motivators for launching The Thread is that historically a lot of our campaigns have been driven by informing communities about the services we offer, and we wanted to go beyond that approach," says Maria Padin, MD, CMO of the Dartmouth Health Southern Region/Community Group Practices. "We are the only academic medical center in New Hampshire dedicated to education—not only the education of our future clinicians, but also the education of the public."
One of the goals of The Thread is to explore issues and opportunities related to rural healthcare, according to Padin.
"That is important for our government officials, who are often making decisions that we want to be fact-informed around the needs of communities," Padin says. "We want to focus on solutions and partnerships."
Padin says rural healthcare issues that will be addressed by The Thread include access to clinical services in rural areas, recruitment of clinicians in rural communities, challenges in maternity services in New Hampshire because several hospitals have discontinued those services, and transportation options for patients in rural communities.
The Thread will address a range of other issues.
"The other areas we will tackle include transgender care in the state and within Dartmouth Health, challenges in post-acute care such as access to long-term care facilities, and exploring models of care for our aging population to remain at home," Padin says. "We also want to address the state of mental healthcare in New Hampshire."
Maria Padin, MD, is CMO of the the Dartmouth Health Southern Region/Community Group Practices. Photo courtesy of Dartmouth Health.
For patients, The Thread is an opportunity to have concise information from a reliable source.
"The Thread will guide patients to where services can be obtained," Padin says, "but, more importantly, the value of The Thread for patients is to inform them and educate them around the issues that face healthcare in their communities."
The Thread will also help patients navigate the complexities of healthcare, Padin explains.
"Our hope is to at least provide a basic foundation of understanding in a simple format of facts," Padin says. "We want to help patients during a time when reliability is not always present in what we read."
Dartmouth Health has a responsibility to offer the kind of information that will be provided through The Thread, according to Padin.
"As an organization that serves communities across the state, it is a responsible shift for us to be engaged during a time when there is polarization and risk for our communities," Padin says. "For us as a leader in the state's healthcare, we want to take the lead in education of our communities as it relates to issues that are relevant to health and wellness."
UnityPoint Health CMO Gregory Johnson was involved in a successful crisis management effort last year after Hurricane Helene inflicted severe damage on a medical-grade fluid manufacturing plant in North Carolina, which led to a nationwide shortage of IV and sterile fluids.
When the health system was notified that there would be a 60% reduction in the supply of IV and sterile fluids across the country, executives activated incident command protocols within 24 hours. They assessed their supply of IV and sterile fluids and convened an ad-hoc committee of 60 physicians, advanced practitioners, nurses, and other clinical team members led by Johnson and the chief nursing officer.
View a video of Johnson describing UnityPoint's response to the IV and sterile fluid shortage below.
Health systems can be early adopters, fast followers, or incremental movers, according to this ProMedica executive.
As health system leaders think about adopting AI tools for clinical care, they need to think strategically, according to Brian Miller, MD, the top AI officer at ProMedica.
Miller is CMIO and vice president of telehealth at the Toledo, Ohio-based health system. He is one of nearly a dozen executives who are participating in HealthLeaders' AI in Clinical Care Mastermind program.
Miller says health systems can take one of three strategic approaches to AI tool adoption: early adopter, fast follower, or incremental mover.
The early adopter approach involves high benefits and high risk.
"You are going to see positive clinical impacts earlier than others," Miller says. "You are also going to incur the highest risk because the early tools tend to be the most expensive up front, and in an industry with tight margins you need to think about risk."
One of the risks of being an early adopter is riding the wave of explosive growth in clinical AI, according to Miller, who adds explosive growth comes with winners and losers.
"When the first personal computers came out, there were dozens of manufacturers and a whole lot of claims, and now there are just a couple of manufacturers," Miller says. "When the robotic surgery craze started, there were seven or eight manufacturers; now, there are just one or two manufacturers in that space."
Miller says one area of explosive growth in clinical AI that is destined for consolidation is AI scribes, which record the encounter between a clinician and a patient then produce a clinical note for the electronic health record.
"There are about 70 companies in the past 30 months that have launched an AI scribe tool," Miller says. "In a couple of years, there will not be 70 companies—there will be five at best."
The primary challenge of being a fast follower in AI tool adoption is being fast enough, Miller explains.
"Waiting to see how AI shakes out, waiting to see which tools land, waiting to see where the ROI might be, and waiting to see where the standard of care lands is going to put you behind the curve," Miller says. "Because the pace of change is so quick, when you finally make a decision, implementation and adoption is going to be a steep curve."
The incremental mover strategy is probably best suited for AI tool adoption, according to Miller. The goal with this approach is to create knowledgeable users in your organization.
"You are going to need to get IT people educated," Miller says. "You need to get people ready in your IT departments, your security departments, your clinical departments, your legal departments, and your compliance departments."
Incremental movers are agile, Miller explains.
"You need to be reviewing and adapting your governance structures," Miller says. "You need to be prepared. You need to grow your knowledge base."
Incremental movers advance continually and thoughtfully in the AI space, Miller explains.
"The industry will not stop moving forward—there is no going back," Miller says. "You need to keep up thoughtfully and incrementally."
Brian Miller, MD, is CMIO and vice president of telehealth at ProMedica. Photo courtesy of ProMedica.
AI's impact on physicians at ProMedica
The physician experience with AI tools at ProMedica is best described as a bell curve. According to Miller, there were a small number of clinicians who had personal experience with AI tools where there was a miss that they didn't actually miss.
"For example, radiologists have looked at a CT scan and said they would not have seen an abnormality unless the AI tool was steering them to it," Miller says. "It could have been found later and impacted the outcome of the case."
For the bulk of the physicians in the middle of the bell curve, AI is just another tool that they have adopted and expect to be present, according to Miller.
"They don't think about the impact on their lives that much," Miller says. "AI is just something that they have come to expect from the tools we give them to help them do the job that we ask them to do."
There is a small percentage of physicians who are disgruntled over AI tools, who experience AI as a continuation of digital intrusion, Miller explains.
"It's like the experience with the electronic health record, where there are too many alerts and too many digital interactions," Miller says. "For them, it feels like a barrier to care."
Miller and his colleagues are taking the disgruntled physicians seriously by listening to them and hearing their feedback.
"In some ways, they are not wrong," Miller says. "In general, the switch to the electronic health record as well as the digitalization of our documentation tools and our encounters with patients have been an additional burden for our clinicians."
Healthcare leaders need to focus on making digitization better, according to Miller.
"There is an incarnation in the next phase of AI that is going to make the clinician experience better," Miller says. "The more we can just let clinicians focus on patients and have more components where the computer is for all intents and purposes listening to clinicians, we will be able to tee up interventions more cleanly and more simply."
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This Mastermind series features ideas, solutions, and insights on excelling in your AI programs.
To inquire about participating in an upcoming Mastermind series or attending a HealtLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Focusing on too many quality measures is counterproductive, this CMO says.
Simplifying the metrics is the key to success in UnityPoint Health's quality program, according to the health system's CMO.
Gregory Johnson, MD, became UnityPoint’s CMO in July 2024. Prior to joining UnityPoint, he held several clinical leadership positions, including CEO of hospital medicine and chief health equity and diversity officer at Sound Physicians, a physician-founded multispecialty group based in Tacoma, Washington.
To promote high quality care, Johnson says, UnityPoint has gone from focusing on more than 140 quality measures to concentrating on 26 metrics.
"One of the things that we recognized for our overall quality program is getting away from a focus on many metrics because so many people were getting thrown various metrics at various times," he says. "By keeping it simple, reporting it consistently, and having structures such as market performance reviews and service line clinical reviews, in each of those cases everybody is focused on the same items so that we can row in the same direction."
Johnson says the two dozen quality measures that UnityPoint is focusing on are similar to the top quality metrics at other health systems. These include length of stay, mortality, hospital-acquired infections, and hospital-acquired conditions.
Readmissions are also a crucial quality measure, he says.
"One of the biggest areas that we recognized to function as an integrated health system was to take a step back and look at readmissions," he says. "A lot of people roll their eyes at readmissions and say it is a financial metric. For us, we spend a lot of time focusing on readmissions for our acute care space, but we also look at UnityPoint at Home for preventable hospitalizations as well as our UnityPoint Clinic in terms of looking at transitional care management visits."
Johnson says readmissions have a significant impact on patient experience.
"To create an exceptional experience for our patients, we do not want them coming back to us unnecessarily," he says. "We have reconfigured ourselves to intentionally focus on the steps we have to take to deliver an exceptional experience. We want to help our patients avoid unnecessary hospitalization."
UnityPoint has seen a 9.6% absolute reduction in its observed-to-expected ratio of readmissions within the first few months of rolling out readmission initiatives.
Gregory Johnson, MD, is CMO of UnityPoint Health. Photo courtesy of UnityPoint Health.
Promoting patient safety
Structural elements are essential to boosting patient safety, according to Johnson.
"Recently, we have focused on making sure that when we discuss a culture of patient safety, that it pervades every level of the organization," he says. "We have highlighted and simplified what we had in terms of reporting for patient safety concerns. We recognize that when we support just culture, it avoids blame and focuses on the best outcomes. We want people to increase their reporting."
Structural elements include what is happening at the bedside and at the health system and local board level, Johnson says.
"We want about 20% of what our boards are discussing to be around patient safety and how they can engage in terms of being notified of serious safety events as well as getting these events resolved," he says.
Another structural element is the use of "respect huddles," according to Johnson.
"These huddles occur at every level of the organization on a daily basis," he says. "Last year, about 17,000 respect huddles occurred across the health system. Ultimately, these huddles highlight areas of safety, whether there are concerns or great catches that we identify."
Johnson says UnityPoint is also fostering a culture of patient safety.
"It can't be a sign that we put up," he says. "It must pervade everything that we do."
"Ultimately, we want zero harm to come to our patients, and it takes a level of rigor in terms of daily interactions with the staff to achieve the zero-harm goal," he says.
Crisis management
Johnson was involved in a successful crisis management effort last year after Hurricane Helene inflicted severe damage on a medical-grade fluid manufacturing plant in North Carolina, which led to a nationwide shortage of IV and sterile fluids.
When the health system was notified that there would be a 60% reduction in the supply of IV and sterile fluids across the country, executives activated incident command protocols within 24 hours. They assessed their supply of IV and sterile fluids and convened an ad-hoc committee of 60 physicians, advanced practitioners, nurses, and other clinical team members led by Johnson and the chief nursing officer.
"Once we were able to articulate the concerns that we had about conserving fluid, then each group went back and did their homework," Johnson says. "They identified where we could conserve fluids and the process for notifying bedside team members of what was going on. Ultimately, that led to more than 140 clinical interventions that were applied."
With UnityPoint now in the recovery phase, Johnson says the health system rose to the challenge and made permanent changes to how it uses IV and sterile fluids.
"Almost 70% of the clinical interventions we developed have been accepted as the new standard at UnityPoint," he says. "Most importantly, we never turned a single patient away in terms of procedures, including surgeries that needed to be performed during the peak of the national emergency."
The shortage has had a lasting impact on operational considerations at UnityPoint, according to Johnson.
"We are setting a new bar for what our approach is not only in terms of understanding what a clinically integrated supply chain looks like, but also how we involve our clinicians in terms of operational decision making," he says.
"There is a metric that we call time outside of scheduled hours, which is simply how much time physicians are spending in the EHR outside of the patient schedule. Our physicians are scheduled to see patients from 8 a.m. to 4:30 p.m.," Weiner says. "The other euphemism for this is 'pajama time,' which is the time physicians spend at night finishing up documentation, answering patient inquiries, and refilling medications."
Physicians working in the EHR during their time off, particularly pajama time, is also a concern at Ardent Health, according to the Nashville, Tennessee-based health system's CMIO, Bradley Hoyt, MD.
"It happens all the time," Hoyt says. "It's just the way things are. I did it for years."
There is a primary consequence of physicians working in the EHR during their time off, Hoyt explains.
Recent research found that a significant percentage of primary care physicians work in the electronic health record during vacations.
In this episode of HL Shorts, we hear from Sam Weiner, CMO at Virtua Medical Group, about ways to reduce the amount of time that physicians spend working in the electronic health record. To view the episode, click on the video below.
John Phipps' goals for strategic clinical growth include improving access to primary and specialty care.
The inaugural chief clinical officer of UF Health is looking forward to defining and building out the new position.
John Phipps, MD, begins working as UF Health’s chief clinical officer on April 14. Prior to taking on his new role, he was chief care transformation officer at Inova health system. Phipps also held several leadership roles at Novant Health, including president of Novant Health Medical Group.
Phipps has several aspirations for UF Health, including taking the existing structure and high-performing clinicians as well as leaders and creating a more integrated approach so that everyone is working more collaboratively across the UF Health geography.
"We also want to turn up the volume on clinical outcomes such as safety and quality," Phipps says. "In addition, UF Health wants to use the chief clinical officer position to help strategic clinical growth opportunities."
Phipps has initial goals for strategic clinical growth opportunities.
"At a high level, I will be trying to improve access to primary and specialty care as well as seamlessness in clinical operations," Phipps says. "I consider access to be a quality measure. I will try to take some of the friction out of navigating the health system."
Although the chief clinical officer role has yet to be fully defined, Phipps says he wants to help coordinate, integrate, orchestrate, and advance delivering clinical excellence and care transformation across the health system.
"Some of it is as straightforward as having a unified approach to quality and safety," Phipps says. "Other aspects are as nebulous as being a go between among various stakeholders to advance the health system's priorities."
John Phipps, MD, is chief clinical officer of UF Health. Photo courtesy of UF Health.
Implementing patient safety and quality initiatives
Phipps says there are several elements of launching successful patient safety and quality initiatives.
"The biggest key to success in any system-wide initiative such as safety and quality is a strong commitment from the leadership of the organization," Phipps says. "There must be an organizational priority from the board of directors, the CEO, and other leaders."
There must be an understanding about organizational attributes that promote safety, according to Phipps.
"You need to be a high-reliability organization, including elements such as culture, psychological safety, and reducing variation," Phipps says.
Fostering psychological safety, which promotes the reporting of adverse events by staff members, involves messaging and modeling by a health system's leadership, Phipps explains.
"It's the things that you talk about and the behaviors that you exhibit," Phipps says. "If patient safety and psychological safety for staff are important, you need to talk about those things. People need to see that the behaviors that leaders are endorsing are the behaviors that they exhibit."
Reducing unwarranted variation in clinical care is hard work, and there are primary steps to follow, Phipps explains.
"First, you must believe that reducing variation is important," Phipps says. "We know that reducing unwarranted variation reduces waste, improves safety, improves outcomes, and improves the experience of caregivers and patients."
Health system leaders such as CMOs should get caregivers aligned around reducing variation, which requires cultural and technical work, according to Phipps.
"Culturally, you need to get people to understand that reducing variation is a pathway to excellence," Phipps says. "Technical work can include getting everyone on the same electronic health record, sharing information, and aligning around order sets for common conditions."
Leadership, vision, culture, and measuring outcomes are all important in promoting quality, according to Phipps, who adds that a factor that is often overlooked is that quality and clinical outcomes are best expressed by patients.
"An important aspect of a successful quality program includes involving patients and families, understanding their goals and values of care, understanding the outcomes that matter the most to them, and helping them to participate in setting the agenda for what you are trying to accomplish," Phipps says.
Successful physician engagement
Phipps says he learned several lessons about physician engagement during his work as president of Novant Health Medical Group, where there is a rapidly growing, high-performing, largely community-based physician practice.
"Our approach to physician engagement was that physicians were our partners and leaders," Phipps says. "As you would with any other partner or fellow leader, we had to give our physicians a voice in the organization and to understand what was important to them."
There were several other elements of physician engagement at the medical group, Phipps explains.
"We needed to understand what solutions physicians had and to cultivate an environment of ongoing dialogue, mutual respect, honest communication, and alignment around a shared vision of providing great care to the community," Phipps says.
A significant percentage of primary care physicians are working in the EHR during their vacations, according to new research.
Many physicians are working in the EHR during their time off, according to a new study, and their CMOs need to take steps to stop that.
Research published in JAMA Network Open found that primary care physicians commonly worked in the EHR during their vacations. The article, which collected data from 56 primary care physicians, had several key findings.
The median time in the EHR per day off was 16.1 minutes, with 19% of physicians experiencing more than 30 minutes per day.
Longer durations of days off were associated with less time spent in the EHR. Physicians spent a median of 50% of short vacation days and 18% of long vacation days with some EHR use.
Physicians spent more time in the EHR at the beginning and end of vacations. They spent a median of 57% of first days and 63.5% of last days in the EHR, compared to a median of 29% of middle days in the EHR.
Electronic in-basket work was a common EHR task, with physicians spending a median of 39.5% of total EHR time performing inbox-related tasks.
"There is a metric that we call time outside of scheduled hours, which is simply how much time physicians are spending in the EHR outside of the patient schedule,” he says. “Our physicians are scheduled to see patients from 8 a.m. to 4:30 p.m.”
"The other euphemism for this is 'pajama time,' which is the time physicians spend at night finishing up documentation, answering patient inquiries, and refilling medications," Weiner adds.
Weiner says the problem is particularly acute with short periods of time off, as opposed to longer vacations.
"When we try to take a four-day weekend, forget it, we are in the EHR the whole time," Weiner says. "It is only when physicians can take a week or sometimes two weeks off that we truly get that sense of being able to breathe a sigh of relief and finally feel disconnected. That is when physicians can recharge. Unfortunately, those opportunities are few and far between."
This is also a concern at Ardent Health, according to the Nashville, Tennessee-based health system's CMIO, Bradley Hoyt, MD.
"It happens all the time," Hoyt says. "It's just the way things are. I did it for years."
Hoyt says this habit is contributing to physician burnout.
Bradley Hoyt, MD, is CMIO of Ardent Health. Photo courtesy of Ardent Health.
Helping physicians curb their off-hours EHR use
Virtua Medical Group has launched several interventions to help physicians cut back on accessing EHRs during time off, particularly for tasks associated with electronic in-basket messaging.
"We have more than two dozen primary care practices, and some of those practices have a coverage system in place for when physicians go out on vacation," Weiner says. "They have a structured way for the physicians who remain in the practice to cover for the physician who is on vacation. When a physician is out, they can feel confident that their patients will be taken care of."
Virtua Medical Group also has a strategy that the medical group calls "taming the in-basket."
"We take a lot of the messages that come in to physicians on a daily basis and screen them to make sure they go to the appropriate staff member," Weiner says. "Not every message has to go to the doctor—many of them can be fulfilled and completed by other staff members in the office."
Virtua also hires nurse practitioners to serve as "in-basketologists."
"Their role throughout the day is to mine the in-baskets of the other clinicians in the practice and take out everything that a doctor does not need to see and handle those messages," Weiner says.
Nurse practitioners, who are licensed and trained clinicians, can answer clinical questions in a way that medical assistants and even registered nurses sometimes cannot answer, according to Weiner.
"This has been shown to significantly reduce the amount of time that our physicians spend in the EHR outside of their scheduled hours," Weiner says.
Ardent Health is using AI to tackle the problem. The health system is deploying an ambient AI tool, called Ambience, to capture the doctor-patient conversation and reduce the time providers need to spend in the EHR.
"No provider likes to write notes," Hoyt says. "It is the bane of our existence. We love talking with patients—we love connecting with them. Having to leave the examine room, then dictate the note before seeing the next patient is a huge weight on the physician's shoulders."
"With ambient dictation, we have cut our pajama time by 50% [and] reduced total documentation time by 41%," Hoyt says. "That is a big win for our providers. They don't have to work at home as much."
Sam Weiner, MD, is CMO of Virtua Medical Group. Photo courtesy of Virtua Health.
The Iowa City, Iowa-based health system has established stable paths for AI governance and strategy.
University of Iowa Health Care has taken a consistent approach to artificial intelligence governance over the past two years.
James Blum, MD, chief health information officer at UI Health Care and a participant in the HealthLeaders AI in Clinical Care Mastermind program, says the technology needs to be treated with the proper safeguards, but that doesn't mean separating it from all other innovative tools and processes.
Blum explained in a recent HealthLeaders podcast that AI and healthcare shouldn’t exist in a vacuum, and health systems shouldn't be acquiring AI for the sake of it.
"We should probably be looking to solve problems that people have, and if that involves AI, great," Blum said. "If it doesn't, that's probably in many ways better because it takes out display of governance and potentially a lot of additional expense."
UI Health Care has launched two AI tools for clinical care: An ambient transcription platform developed by Nabla, which roughly 1,100 of the health system's 3,000 doctors are now using, and a chart mining platform from Evidently that collects all relevant data on a patient from multiple sources to give clinicians a concise view of the patient.
Blum says both AI tools were carefully reviewed by UI Health Care through a normal process for reviewing new vendors. With AI, that includes bringing in clinicians and IT personnel who understand the nuances of the technology.
"It is with a group of individuals that are qualified to review the AI right and really understand the performance characteristics and what can be expected of the technology in addition to our typical acquisition process," Blum says.
James Blum, MD, is chief health information officer at University of Iowa Health Care. Photo courtesy of University of Iowa Health Care.
AI strategy, adoption of new tools, and measuring outcomes
Over the past year, IU Health Care has maintained a consistent AI strategy, according to Blum.
"We have continued our existing AI strategy which was extensive and democratic," Blum says. "Our implementations have been across the institution to support all of our clinicians."
The health system is planning to adopt new AI tools in two areas of clinical care.
"We will be adding AI coding and clinician draft technologies," Blum says.
Costs and adoption challenges are the biggest obstacles to growth of AI tools in clinical care at IU Health Care, according to Blum.
"Regarding adoption, many of those that can most benefit are reluctant to adopt the technology," Blum says.
IU Health Care is measuring three key outcomes related to the health system's utilization of AI tools, Blum explains.
"We measure clinician burnout, clinician after hours work, and clinician satisfaction with their electronic tools," Blum says.
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This Mastermind series features ideas, solutions, and insights on excelling in your AI programs.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Maria Padin, MD, is CMO of the the Dartmouth Health Southern Region/Community Group Practices. Photo courtesy of Dartmouth Health.
Gregory Johnson, MD, is CMO of UnityPoint Health. Photo courtesy of UnityPoint Health.
John Phipps, MD, is chief clinical officer of UF Health. Photo courtesy of UF Health.
James Blum, MD, is chief health information officer at University of Iowa Health Care. Photo courtesy of University of Iowa Health Care.