The Cleveland-based health system does not shy away from taking time to ensure that an AI tool is a good investment and is the right solution for its patient population.

When it comes to AI tool adoption, The MetroHealth System has a robust validation process. Health system executives are willing to take the time to review whether the tool will work regardless of its track record.

Faced with a plethora of available AI tools. executives should be cautious when adopting these solutions, according to Yasir Tarabichi, MD, chief health AI officer at MetroHealth. He is among nearly a dozen executives participating in the HealthLeaders AI in Clinical Care Mastermind program.

"How we implement our AI models is unique because we are a little slower in validating them than others and are extremely careful in validating them," Tarabichi says.

As a clinical informaticist, he focuses on the concept of the learning health system when it comes to AI tool adoption.

"You are constantly developing a huge repository of data both in terms of patients and their conditions, as well as the things we are doing in our health system," Tarabichi says. "For example, how are we communicating with patients, what are the protocols we are activating, what are the clinical pathways we are leveraging, and what are the medications we are using?"

The key is taking the learning health system concept and actualizing it, according to Tarabichi.

"There is often a gap in this area," he says. "A lot of organizations talk about being a learning health system and learning from their data. They do research. They look back and they say this worked or that did not work."

A learning health system conducts tests in real time in its patient population to identify whether a change in what they do makes a meaningful impact, Tarabichi explains.

"We need to be able to do that in an agile fashion," he says. "We need to understand whether something is working."

An example is the process that the health system used to adopt a predictive tool for sepsis.

"When we took on our AI sepsis model from a vendor, it was being used by several organizations, and everybody said it worked," Tarabichi says. "When we evaluated how others were using this AI model, we approached it with a grain of salt. We were not entirely sure that this predictive model was going to work for us."

With quality oversight and a multidisciplinary group, MetroHealth developed a quality improvement process, where patients who came into the emergency room either got to be on the AI tool's scoring system or didn't.

"We set up a response team for sepsis," Tarabichi says. "We made sure everybody knew their cues and what they needed to do in the standard practice, using clinical pharmacists as the main driver. We ran the model, and we compared the data. We wanted to know how patients who got the score did and how patients who did not get the score did."

The validation process found the AI sepsis model was effective for MetroHealth's patient population.

"By the end of the study, which was a couple of months, we found that the patients who got a score got antibiotics faster than patients who did not get a score, which is important in the treatment of sepsis," Tarabichi says. "We even showed decreased mortality in the hospital associated with that outcome."

This validation process showed that people and process are at least as important as the technology, according to Tarabichi.

"The technology was a catalyst that drove the process, but what really mattered was getting the team to think about how they would use this new information and how it would drive what they do at the point of care," he says.

The AI sepsis model is designed with clinical care teams in mind, Tarabichi says.

"Our sepsis predictive algorithm provides information about the patient's risk for sepsis in a place on the chart where emergency room providers typically look to see how a patient is doing overall," he says. "It sends an interruptive alert only to the clinical pharmacists who actually want that information. They want to be stopped in their tracks when a patient comes in who could have sepsis."

Yasir Tarabichi, MD, is chief health AI officer at The MetroHealth System. Photo courtesy of The MetroHealth System.

Understanding the AI tool life cycle

Paying attention to the life cycle of AI tool implementation is another hallmark of MetroHealth's approach to AI.

Tarabichi encourages his counterparts at other health systems and hospitals to look at the frameworks for the AI life cycle that have been set out by the Coalition for Health AI (CHAI) and the Health AI Partnership.

"Thinking about the life cycle of the solution means by the time you have launched the solution you have already figured out whether it works, whether it is biased, whether it is fair, and how you are going to use it," he says.

This includes knowing when a solution should be terminated.

"What are the criteria for success and when do you need to sunset an AI tool?" Tarabichi says. "The big thing we have found in the informatics and change management world is we have done a good job of turning things on, but we do not do a good job of turning things off."

Understanding the life cycle of an AI tool is critical, Tarabichi says.

"You need to have an offramp and to understand how you are monitoring an AI tool," he says. "Do not implement a solution if you have not thought about the life cycle."

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.

Hendricks Regional Health has gained recognition in a community survey, Newsweek's best hospital list, and Healthgrades awards.

Hendricks Regional Health has posted impressive results on several performance metrics.

In a biannual community survey, 80% of respondents said the Danville, Indiana-based health system is an essential care provider. Hendricks ranked 337 on the U.S. hospitals list in Newsweek's World's Best Hospitals 2025, with particularly high scores for patient satisfaction and quality metrics. The health system has received an Outstanding Patient Experience Award from Healthgrades for 17 years in a row.

In a recent interview with HealthLeaders, Ryan Van Donselaar, DO, CMO of Hendricks, shared the keys to the health system's success.

Patient engagement at Hendricks is multifaceted, according to Van Donselaar. As the community grows, the health system is prioritizing expanding access to care.

"Our primary care base has grown in the past couple of years, as have our specialists," Van Donselaar says. "We have added technology to connect with our patients through the electronic medical record. We are trying to grow virtual visits and online scheduling."

In other efforts to boost access, Hendricks has been hiring nurse practitioners and physician assistants as well as adding service lines, Van Donselaar says.

Ryan Van Donselaar, DO, is CMO of Hendricks Regional Health. Photo courtesy of Hendricks Regional Health.

Managing population health

Hendricks has invested in promoting population health.

"We are blessed to have an executive director of population health," Van Donselaar says. "When you think about managing a population of people, it is easier to do inside your own four walls when patients are getting care. We leverage our EMR to manage data."

Hendricks has invested in a third-party platform that allows the health system to track where patients are going when they are receiving care from other organizations.

"Once we get that data, we can work with our partners in the community such as skilled nursing facilities and home healthcare companies to improve the care that patients are getting even though they are not within our four walls," Van Donselaar says.

A Hendricks vice president and the health system's transitions of care team meets regularly with these community partners. To Van Donselaar, the process of establishing collaborative relationships with community partners takes years.

"If we do not have a relationship with one of the community providers, the first thing to do is to call them and talk to someone such as the nursing director about what they desire, which is usually patient referrals," Van Donselaar says. "From there, you can start to talk about patient care and grow the relationship from ground zero."

Boosting patient satisfaction and patient experience

Patient satisfaction is a byproduct of high-quality care, according to Van Donselaar.

"You cannot have patient satisfaction without great clinical care. That is the primary focus," Van Donselaar says. "Beyond great clinical care, you must empower your staff to help patients fix a problem in the moment or escalate the problem to leadership so we can take care of it."

It is a team effort.

"From the CEO down, we have worked on pulling together teams to talk about the importance of patient satisfaction, quality, and patient experience," Van Donselaar says. "In the moment, our staff can impact the patient's subjective feelings and their care."

Similarly, the cornerstones of patient experience include access, safety, and quality, but there is another level to achieving a positive patient experience, Van Donselaar explains.

"You need to realize that anywhere the patient interacts with the health system such as phone calls and the billing office requires standardization and education on how to work with patients," Van Donselaar says. "If you provide great clinical care, then the patient is discharged and has a negative experience with the billing office, one phone call can ruin the whole experience."

To standardize interactions with patients, Hendricks has an executive responsible for systems excellence who looks across the entire health system and provides education on interacting with patients.

"We also have directors for different patient areas who educate staff members about simple things such as responding to voice mail and answering a phone call," Van Donselaar says. "That education is distributed to all office coordinators."

Ardent Health's CMO shares how embracing technology is retaining physicians and nurses.

Health systems and hospitals have been grappling with high turnover rates for physicians and nurses since the beginning of the coronavirus pandemic in 2020. High turnover rates compromise access to care and have financial consequences for the bottom line.

Ardent Health has been focusing on technological approaches to addressing staff turnover at its hospitals and clinics.

"The turnover work that we try to do is clearly predicated on what we can do to improve workflows," says FJ Campbell, MD, CMO at Ardent. "Those are the most sustainable impacts that we can create."

To Campbell, the goal at Ardent with technology should be to improve workflows.

"We believe in the notion that good workflows lead to good clinical outcomes and lead to good financial outcomes," Campbell says. "As we consider the technologies that we leverage, it always gets back to how it is improving workflows."

Three factors related to cognitive burden are driving turnover at hospitals and clinics, according to Campbell.

"No. 1, it is the patient volume," Campbell says. "No. 2, it is the patient acuity—the severe illness that we are seeing in our hospitals. No. 3, it is the rigor around the documentation, which is increasingly about what we must do to support a bill or authorization versus using documentation for communication in the record."

Addressing nurse turnover

Virtual nursing has been the primary strategy to address nurse turnover at Ardent, Campbell explains.

"In one of our markets, we put telehealth technology in 400 rooms," Campbell says. "This allowed for a new breed of nurses—virtual nurses."

Virtual nurses at Ardent are rounding on patients, and completing intakes, admissions, and discharges, and they can come into the room at any time. The work that the virtual nurses are doing is cerebral, according to Campbell.

"They are usually seasoned nurses, and they are not getting interrupted," Campbell says. "That allows the nurses that are on-site to have a greater opportunity to handle complex tasks that are taking place, have a greater opportunity to be aware of the acuity of the patients in their panel, and have greater oversight of patient care technicians."

Virtual nursing is having a positive impact at Ardent, Campbell explains.

"Where we have virtual nursing, turnover has decreased sharply, and we have seen a reduction in the cost of care," Campbell says. "What is most important to us is we are trying to create a situation where nurses want to work for us and not leave."

Automated patient monitoring that helps to identify deteriorating patients is also addressing nurse turnover. According to Campbell, Ardent is partnering with FDA-approved BioIntelliSense, which provides a sensor that can be put on the patient to monitor things such as respiratory rate, heart rate, and body temperature.

"It is creating a situation where we can identify deteriorating patients up to 16 hours sooner than we could typically identify them with vital sign monitoring and telemetry," Campbell says.

As is the case with virtual nursing, automated patient monitoring has achieved positive results, according to Campbell.

"On the units where we have automated patient monitoring, we have seen a 15% reduction in mortality," Campbell says. "For the nurses in those hospitals, we have hospitals that are watching their back. They are less afraid to be at work. That impacts burnout."

Addressing physician turnover

In recent years, documentation burden has been a primary driver of physician turnover, Campbell explains.

"Electronic medical records have not been making significant inroads in reducing documentation burden, including the most advanced EMRs," Campbell says.

To rise to this challenge, Ardent has adopted Ambience, an artificial intelligence scribe tool.

"A clinician starts an encounter with a patient by saying the conversation is going to be recorded, then they have a conversation with the patient," Campbell says. "The clinician can look at the patient the whole time. The clinician then walks out of the room, and in less than a minute a clinical note is completed."

Ambience features the latest generation of AI scribe technology, according to Campbell.

"Early generations of AI scribes were good at dictation," Campbell says. "But the newest generations of AI scribes do a much better job of summarizing and linking to key elements that are going to communicate the acuity of the patient and affect the coding and the subtleties of what is in the clinical note overall."

Adoption of an AI scribe tool has revolutionized clinician and patient experience at Ardent. In one market where the organization is piloting Ambience, Campbell says not one of the 86 clinicians has dropped out, and patient satisfaction scores have gone up one full basis point on their scale of 1 to 10.

"It has improved coding," Campbell says. "Patients are commenting that the clinicians are talking with them directly the whole time of an encounter."

Virtual attending is another technological approach to addressing physician turnover at Ardent. There are clinicians such as cardiologists, neurologists, and nephrologists who are willing to truncate their practice so long as they can have access to patients through video encounters, according to Campbell.

"They do not go into clinics or hospitals any longer," Campbell says. "In many cases, they take a lesser level of compensation. They see patients for consultations via telemedicine."

Ardent has had video consultation for stroke patients for years, but the new virtual rounding strategy is different, according to Campbell.

"You don't have a cart come into the room as you would for a stroke patient," Campbell says. "This is seeing a patient in a setting such as the emergency department, where there is audio-visual equipment in every room. Clinicians can round on many patients virtually."

For physicians, virtual rounding reduces travel time and cognitive burden, Campbell explains.

"I have cardiologists who have been rounding on patients in certain hospitals, and they have not entered those hospitals for months," Campell says. "I have neurologists in our East Texas market who will never go into those hospitals. These are individuals who are basically moving beyond the traditional confines of having an office practice and going to hospitals for consultations."

Effective ambulatory clinics have strong leaders and employ tools that bolster insights and decision-making, this chief physician executive says.

The first key to success in operating ambulatory clinics is selecting the right leaders, according to the new chief physician executive of Providence.

As of February, Susan Huang, MD, now serves as the chief physician executive at Providence and chief executive of Providence Clinical Network, which features 1,100 ambulatory clinics. Prior to taking on her new role, Huang served as CMO of the health system's South Division and CEO of the payer-provider Providence Health Network in California.

"In ambulatory clinics, you need to have the right leaders in place, so it is important to recruit the right type of talent," Huang says.

Providence has several programs to develop ambulatory clinic leaders internally, according to Huang.

"What we have found is that when we are able to grow our own leaders, they understand the Providence way, culture, and mission," Huang says. "That helps a lot with continuity."

The health system wants leaders of ambulatory clinics to have exposure to the broad environment of healthcare, Huang explains.

"We try to educate people on what is happening in the global context of healthcare, which is changing a lot," Huang says. "How healthcare was delivered in the past is not how healthcare is delivered now."

Changes in the delivery of healthcare over the years include an increase in administrative burden and a shift away from a paternalistic approach to the practice of medicine. For example, patients are more involved in their care now than in the past.

"The healthcare of the past was top-down. We knew what was best, and the patient was expected to follow," Huang says.

According to Huang, the advent of the electronic medical record was positive because health systems can now collect data in one place and extract information more readily.

"But at the same time, the EMR has created burdens in documentation, not just for physicians, but also for other staff," Huang says. "While we want to realize the potential of the electronic medical record, we also want to decrease the administrative burden that comes along with the EMR."

Successful ambulatory clinics also must have the right tools that lead to better insights and decision-making, Huang explains.

"You need tools that are timely," Huang says. "We have been aided by advancements in artificial intelligence's predictive abilities, including the ability to analyze large amounts of data, so that we can better understand our operations, populations, and the clinical care that we are delivering."

Susan Huang, MD, is chief physician executive at Providence and chief executive of Providence Clinical Network. Photo courtesy of Providence. 

Succeeding in value-based care

Providence has posted positive results in value-based care.

"Looking at the program year for the Medicare Shared Savings Program in 2023, we generated more than $100 million in shared savings," Huang says.

Several factors dictate whether a health system can be successful in value-based care, according to Huang.

"There must be an alignment between the economic model and the clinical care and operational models," Huang says. "You need the right data and insights—you need to be able to make predictions and understand your populations."

Health systems must be aware of misaligned economic models in value-based care, Huang explains.

"With the flow of funds, they need to be aligned with the clinical activities we are expected to do. This includes incentive metrics for physicians," Huang says.

Clinicians play a significant role in delivering value-based care, according to Huang.

"They need to be attuned to evidence-based care, care pathways, best practices, and making sure there is a reduction in unwarranted variation in clinical practices," Huang says.

Providence helps clinicians to limit variation in clinical care. For example, the health system has embraced a decision-support tool called Clinpath in oncology.

"It is a tool that helps direct the chemotherapy regimens that a patient should be on based on factors including the type of tumor and pathology," Huang says. "We can establish the recommended chemotherapy and assess our compliance with evidence-based regimens." 

Everyone in a health system must be involved in value-based care to achieve success, Huang explains.

"It is not just the physicians," Huang says. "It is not just the care managers. It is not just the hospitals or the clinics. Everyone must know they have a role to play in value-based care."

Flexibility and innovation are also essential in value-based care, according to Huang.

"You must be flexible, and you must innovate," Huang says. "You must think about new ways to engage your patients. This can involve technology such as remote patient monitoring to take care of a cohort of your patients."

Success in physician leadership

Providence provides opportunities for physicians to take on leadership roles.

"One of the keys to success in physician leadership roles is creating opportunities for physicians and advanced practice practitioners to understand what they could do in a leadership role," Huang says. "We also want to create a pipeline and a pathway for people to grow in their jobs."                                   

At the health system, physicians can participate in committees and governance structures to experience leadership in different ways, according to Huang.

"Not everyone wants to take on leadership roles in the same way," Huang says. "Sometimes, it is taking a small bite of the apple, getting a little bit of exposure, and learning more about leadership."