Smarter Tech, Leaner Systems: Reducing Cost Without Sacrificing Care

In this podcast episode, Dr. Beverly Wright and Dr. Neal Patel, discuss how aligning the right technology with real-world clinical needs can lead to leaner systems, lower costs, and better care delivery.

Speaker details:

• Dr. Beverly Wright, Vice President of Data Science & AI at Wavicle Data Solutions
• Neal Patel, MD, MPH, Chief Information Officer, HealthIT, at Vanderbilt University Medical Center

Watch the full podcast here or keep scrolling to read a transcript of the discussion between Beverly and Neal:

Beverly: Hello, I’m Doctor Beverly Wright, and welcome to Tag Data Talk. With us today, we have Neal Patel, CIO, HealthIT at Vanderbilt University Medical Center. I just love having MDs on this show. Thank you. How exciting. And we’re talking about smarter tech, leaner systems, and reducing costs without sacrificing care. Thanks for being here.

Neal: Glad to be here.

Beverly: Awesome. So, let’s start off with some quick background. Neal, tell us, why are you so cool?

Neal: Why am I so cool? Well, I’m a physician who complained about technology, and then they made me go to meetings, and now they’re making me lead technology.

Beverly: That’s what you get.

Neal: That’s what I get.

Beverly: Yeah. What did you do before?

Neal: I’m a pediatric critical care physician. But really most of my career I was lucky enough to get involved when technology was first being introduced into the clinical workflow in the mid-90s and was able to really play a role translating between the two worlds, the clinical world to the technologist and the technology to the clinical world. And found I had a knack for it and have been in the right place at the right time to continue to grow in that role over the years.

Beverly: Yeah, so your frustration paid off and now you’re helping.

Neal: I guess I’m always frustrated because I’m living a pretty good life now, yeah.

Beverly: Yeah, that’s very good. I had a colleague who was at a health system and his number one data science person was an RN and she said I went into this field so that I could help people. And I realized that with technology I can help a lot of people, not just one at a time.

Neal: Exactly.

Beverly: Was that some of your driving factor? Besides the frustration, of course.

Neal: No, my driving factor was that I was a lazy resident, and I saw this technology come in. I’m like.

Beverly: How can I use that?

Neal: My writing is awful. The pharmacy keeps calling me back when they can’t read my writing on the fax machine, and there you go. Maybe this will help.

Beverly: Yeah, it’s incredible that the fax machine is still so prominent in healthcare today, isn’t it? That’s bizarre. We’re talking about smarter tech, leaner systems, and how to reduce costs without sacrificing care. So, what do we mean by this? You know, smarter tech. Like, it doesn’t have to be AI necessarily, but what does that mean? Smarter tech in the healthcare space.

Neal: So, unfortunately, when you think about technology, oftentimes it’s bought and implemented, but we haven’t really leveraged it for what it could be leveraged for or even in the way it was meant to be used because we never took the users into account. And so oftentimes either the technology is underutilized or poorly utilized and doesn’t meet the need for what needs to be accomplished.

And oftentimes that results in frustration all around from the users, but also from the IT teams who feel like people are complaining about something that they followed all the steps and got it in the way they were told to get it in. And so I do feel that being smarter about the technology and putting it into workflows where they truly act as solutions and not just implementing technology.

Beverly: Interesting. I hear checkbox twice, at least in that kind of summary. So, it’s not about, hey, let’s go get this cool fancy thing and then implement it. We checked a couple of boxes because we went and bought it. We got the budget, we went and bought it, we implemented it. We’re done. The end. But it’s not the end, is what you’re saying . It should have been, well, some other way.

Neal: Well, it’s almost the same as checking the check box when, you know what, I’m going to get in shape. And I went to the store, and I got a treadmill, and I got it in the house and I’m done.

Beverly: Got it. So how would you reverse engineer it so that you can implement something that’s effective?

Neal: So, I think it’s easy to say we’ll start with what problem are you trying to solve, right? And we ask that. But in healthcare, the difficulty is that you’re dealing with so many different types of stakeholders that are involved, and each portion of the healthcare team has a different need. And so many of the solutions must work across these silos. So, having an effort to truly understand the problem end-to-end is important.

More often than not, you might have a champion from one aspect of the process who’s excited about the technology for their space without realizing what upstream data is needed or processes, or the downstream information or processes that will actually result in making it a success or not.

Beverly: Oh boy.

Neal: And that’s why we have so much technology in healthcare, but still an incredible amount of clinician and staff frustration and burden.

Beverly: Manual type of things even with the, so you’re spending a lot of money to bring in like the industry, not you specifically, but we’re spending a lot of money to bring in technology solutions, but we’re not seeing the value and part of it I think let me unpack some of this because there’s a lot there. So, number one, there is a very broad and diverse set of stakeholders, and potentially they all want different things.

Neal: Or need different things because their workflows are slightly different. They all center around the patient. But you have direct patient care, you have the indirect patient care, like laboratory, radiology, and communication between that and the bedside. You have all the back-office stuff of making sure that the data that’s created by the front-end providers end up in a revenue cycle system, billing, denials, all that stuff. And you have all those folks trying to choreograph this event called a patient encounter.

And the way the systems were built, were built from the aspect of one group or another instead of looking at the whole system. In the end, what that results in is that we’ve continued to put in technology almost at the peril of destroying the joy of medicine, which is what clinicians got into this field for. It was not to use technology; it was to take care of patients.

Beverly: Oh, this is heartbreaking. OK, so tell me, tell me more about that.

Neal: So, I think the biggest key is that so many people find that they’re having to do all their work, which now they feel is a chore, like documentation and finishing their charts and all of those things. They do it at night at home after they put their kids to bed.

Beverly: They have to spend all their time while they’re in front of patients doing care, doing care. And so, then they have the second job of working with the technology instead of the technology supporting them.

Neal: To get it done.

Beverly: Yeah, and there’s no way you can do that in a regular workday.

Neal: And you wouldn’t tolerate that any other way in your personal life. You wouldn’t tolerate something that is making it more difficult to accomplish what you’re wanting to accomplish. And this has been a problem for a long time. And now technology is getting better, faster, and we have comprehensive platforms that we can begin to leverage to actually do a better job with technology. And I think that’s the curve that we must get around and really bring joy back to medicine.

Beverly: Yeah. Well, a second thing that you said, aside from different stakeholders with diverse needs, was the holistic view, you know. So, tell me more about that because that’s a tough thing to do, right?

Neal: It is a tough thing to do, but I think it is important to understand what we are trying to accomplish and what’s needed. I think there are often a lot of pressures from different angles, whether it’s regulations from the outside, whether it’s requirements from the peers, whether it’s your own standards that you want to adhere to, as well as just the variability of care.

Because healthcare is very personal for each patient and each person is uniquely different. It’s not an automated, natural, repeatable process, no matter how many people want to make it, akin to an airline industry, right? Turning around an airplane at an airport gate is a very different manner from turning around a patient in the OR.

Beverly: Oh, for sure.

Neal: But the metrics are often similar, so we have to look at them just to make sure that we keep costs down so that we can have the resources care for as many patients as we can.

Beverly: Yeah. And I think the third barrier that I heard was, and I may be saying this wrong, but that instead of focusing on, like, here’s the challenge we’re trying to solve that we somehow end up just saying we need to go buy this technology.

Neal: Well, it’s the easier way, right? Because you think you’re doing a good job. I would make it equivalent to, gosh, your spouse is complaining about not being very organized, and you come home with an electronic organizer and hand it to them.

Beverly: Here you go.

Neal: And after you pick up the 15 pieces that are off the floor, you realize that probably wasn’t the best implementation of technology. You probably want to understand why they are having the difficulty that they’re having. Because you never evaluated whether this technology would work, and will they use it in a manner that will solve their problem.

Beverly: Yeah. So how do we get through this? Like, what are the missing pieces in this puzzle? Like, are there certain people that are missing in healthcare in general that would help fix this, or what do we do?

Neal: I think we’re getting better and better, yeah. I think there are a lot more comprehensive teams looking at these. When I first started in this space, we had to beg people to log onto the computer because the computer and our ubiquitous appendage, the smartphone, were not part of our lives. You weren’t used to a digital interface in healthcare when I first started in healthcare, so.

Beverly: It’s hard to even think about now.

Neal: It’s hard to even think about now. I think the game has flipped 180°. We have Gen Zs who are wondering why our healthcare technology is not working as efficiently as the technology in their personal life. How come they can’t do something? How come they have to log into a desktop? They don’t have desktops at home anymore. Everything is either on an iPad tablet or on their smartphone. They can accomplish almost everything in their life, but then they come to work and use interfaces that seem very clunky and very archaic.

Beverly: Yeah. So in a way, it’s like, you know, I went out of the country not too long ago and I thought, well, let me just make sure my credit card knows that I’m going out of the country. And a GenZ said, why would you need to do that? Didn’t you book your ticket with that same card? Like, shouldn’t it automatically just know, you know, and so this mentality of what we’re seeing on the hyper personalized retail space, why is that not being used in probably one of, if not the most important sector taking care of us?

Neal: Exactly. And I think that’s where the pivot now is, because of how far technology has come, but also the price pins have dropped, hardware has dropped. I think the access to begin to leverage these things. And I do think that the healthcare technology vendors are really beginning to think more comprehensively. And that’s what we try to do at Vanderbilt is really partner with our vendors to continue to push the products to be as usable as possible. And that back-and-forth feedback improvement cycle is something that needs to continue to be fostered. And I think that’s the only way things get better.

Beverly: Yeah. So, it could take time, and certainly making things usable for the background of someone that’s an MD, as opposed to like a technologist. I mean, I think maybe that was part of the disconnect, too, is that potentially programs are created, and technologies are created for a technologist as opposed to thinking about an MD.

Neal: It does and it’s not necessarily about an MD as much as you just have to think about what is the mental model that that individual has in the job that they’re doing. And you know, I’ll tell you a story that, fun time. It just seemed like the people that I was talking to weren’t getting it as technologists because we would say, well, that’s not how we think. We don’t think in alphabetical order.

There’s a process of how we were trained to think about certain sets of things. And finally, I just said, you know what? How about if I improve your workflow as a technologist? Because I know that typing can be difficult because the keys on the keyboard are arranged in a haphazard fashion. So why don’t I take away your keyboard and give you one that’s alphabetically laid out, because it will really improve your workflow. You wouldn’t need training because all of you know your ABCs and what the sequence they are.

Beverly: And they got it then.

Neal: Yes, the light bulb went off.

Beverly: Yes, that’s a great analogy. So, if we’re thinking about improving care, well, not sacrificing the care, but still having the technology, are there places where clinical or operational types of technology have really moved the needle? Like where? Or is the? I hate to use this phrase, but the low-hanging fruit. Like where should we be doing this?

Neal: Well, it’s, amazing. We just recently had some wins because everybody is on the buzzword campaign of AI, and there are some AI tools that are ready for prime time. One of them is ambient AI, where you can leverage just putting the smartphone down with our EHR application, launching the AI agent, and having a conversation with the patient instead of the clinician at a keyboard staring at the computer.

And at the end of the visit, the AI summarizes not just straight transcription, but actually eliminates all the garbage, kind of like your sound engineer will do after this podcast and just keeps all the important stuff and generates a note that you can review. And we since we launched that in the middle of January, we’ve had quotes like, ‘this is life-changing.’

Beverly: Oh wow.

Neal: I was going to quit medicine this year, but this has made me realize I can continue to do medicine.

Beverly: Oh my gosh.

Neal: For the first time, I finished my work at work, and I went home and played with my kids. I mean, that’s pretty cool.

Beverly: Wow, that gives me chills. That’s impressive. So, in your wonderful world of, you know, I am in charge, and I am Neal Patel. What would it look like? Like, give me an outward view of the future, because that sounds like one great example of how your future might look as far as integrating tech.

Neal: Sure. I mean, if there was an aspect, I would love for our patient rooms, clinic encounters, as well as asynchronous encounters and synchronous encounters, we can have virtual encounters with our patients to be as seamless as when you get into your sedan nowadays, and all the systems work around you to make you a better driver.

Beverly: Yeah, that’s a great analogy too. I like that. OK, so then the things that support you as a driver, if you can move those?

Neal: Into supporting you as a clinician that the right information shows up at the right time. The documentation that needs to be obtained is obtained more easily, instead of the person having to be a data entry clerk.

Leveraging decision support to remind you of things in the right moments and also help you catch things should you not have the cognitive resources to remember them right. And I think all of those things can then lift you and technology as an enabler instead of where it is.

Beverly: It’s like bringing you down. And forcing you to do things you didn’t want to do. Like you want to spend time with a patient. Like, that’s like, that’s why you’re in this. So, if you’re thinking about different use cases, I love the futuristic Neal Patel world.

Are there certain things that make you say like, oh, well, this sort of way of leveraging technology, including AI, but different types of technology, makes a whole lot of sense. But is there a bucket where things you don’t want to replace with AI? Like, are there certain tasks? What does that look like?

Neal: Well, I do think that it’s not about AI in itself. At the end of the day, we want the human connection. We want somebody to care, to listen to us, to pick up on the nuance that even if you don’t verbalize it, we understand that there’s something that we need to dig into deeper or think about or ask the next right question that makes us human.

We need to begin to leverage the technology so that all the tasks that prevent us from paying that kind of attention and being present in that mode are taken away so that we can have more time to be in that mode with our patients, with our colleagues, with the people around us on the care team. Because when everybody is purely just trying to get through their day, everything becomes transactional, and you lose that concept of a team and the connection.

Beverly: Yeah. Well, if you think about it, I was working on a project that dealt with people analytics, and one of the things I always do is jump into the research side. And we’ve talked a lot about the clinician. So, if you think about the clinician and people analytics, making the employee happy makes the customer happy, right? So, all you got to do is make the employee happy, and you’re good. Is it that way, do you think in the medical field for the clinician?

Neal: I do think so because at the end of the day, if you are coming in and you feel, do not feel that oppressive burden on your shoulders that I have to figure out how to navigate my day where I get all my work done and all my chores done.

Beverly: Right, right. Yeah. So, it feels like a tour. OK, so that’s the answer. That’s the key. So, to finish this off, I love this. It’s such a great conversation. What final piece of advice would you give to somebody who’s really trying to better understand, like, how can I contribute in a way to provide lean tech without sacrificing care? What advice would you give to them, trying to figure that out?

Neal: I would say really imagine and or think about where your tech is going to be used and by whom and then take half an hour to follow that person and watch them work in real time.

Beverly: Oh, I love that. So just really walk a mile in their shoes.

Neal: See how it goes. You would then realize a dozen things that you wouldn’t have noticed that the technology may or may not have accounted for.

Beverly: Right. That’s fantastic advice. Awesome. Thank you so much to Neal Patel, CIO, HealthIT at Vanderbilt University Medical Center, for talking to us about smarter tech, leaner systems, reducing costs without sacrificing care.

Digital transformation in healthcare demands more than just deploying technology; it requires thoughtful implementation and alignment with real needs. By taking a holistic view of the system, listening to those on the front lines, and reimagining technology as an enabler, organizations can create environments where both clinicians and patients thrive. Explore the full catalog of TAG Data Talk conversations here: TAG Data Talk with Dr. Beverly Wright – TAG Online.