← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Laren Tan, MD, MBA, Chair of the Department of Medicine at Loma Linda University School of Medicine and COO of the Loma Linda University Faculty Medical Group
00:20:37
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- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.
- [00:33]
B
Hi everyone and welcome to Becker's Healthcare Podcast. My name is Giles Bruce. I'm an assistant editor with Becker's Healthcare. I'm pleased to be joined today by Dr. Laren Tan. We are going to be talking about some AI and digital health related projects at his organization, following up on our discussion at the Becker's AI Summit at our CEO CFO Roundtable recently. Larry, we're really pleased to have you join us today.
- [01:01]
C
Thank you, Giles. It is a great honor. I'm humbled to be able to be here on this podcast and thank you for the introduction.
- [01:11]
B
Of course. And can you tell me a little bit more about your role in your organization and what you're doing these days?
- [01:17]
C
Absolutely. Currently at this time, I am still a practicing pulmonary and critical care physician. I do inpatient in the medical icu, do pulmonary consults, and also have a very small footprint on the outpatient side. I've been blessed to serve as the chair of the Department of Medicine here at Loma University School of Medicine. In addition to that, also serve as the chief operating officer for our faculty medical group, which is the physician side of Lomaley University Health.
- [01:51]
B
Excellent. Well, again, we're pleased to have you join us. And yeah, I just want to keep the conversation going from the last time we talked. So, yeah, talking about that, we were at the Becker's AI Summit at our conference in the fall, and there you drew a parallel between Star wars and New Hope and how clinicians view AI. It was a cool metaphor and one that stuck with me. So what does New Hope, what does that new hope look like to you today? Is it more about relief from burnout or renewal of purpose in medicine? And how do you balance that optimism with the practical fears that clinicians still have around AI?
- [02:30]
C
That's. And that's, I think that that is, that is probably one of the biggest issues that we're facing right now, especially in healthcare, where everywhere you turn there seems to be more work to be done. Access continues to be piling up or extremely hard to provide adequate access. And as a clinician I'm looking and we're looking for hope, right? And that's where that, that example of looking at Star wars and the title of A New Hope. And I know that during Becker's it was, it was cool, it was a lot of laughter. But you know, I wasn't trying to just be cute, I was really being honest. There's so much pressure that we're feeling, as if we're fighting an empire, right. Much like within Star wars. Only this empire that we're, that we're battling has to deal with the clicks, the inboxes, the documentation access throughput, trying to review medical histories and clicking all these various different things. These are all important components, but it is just so much duties. And that's where a new hope came in. Right? And where it is not necessarily just a new hope in how we do things, but really a new hope in both relief and renewal.
- [03:50]
B
Yeah, that really paints a great picture, particularly for someone like myself who grew up watching those old Star wars movies. But yeah, great examples there. So in the panel you also said that AI could help clinicians get back to doing what they love to do. What specific technologies or workflows have actually freed your physicians to spend more face to face time with patients? And how are you measuring whether AI is truly improving the human connection and care?
- [04:17]
C
I think this is where part of that new hope and where we're looking.
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D
At.
- [04:23]
C
Is being able to get us back to what we love. And I want to be at least very clear with all the listeners and I think many that are listening in will actually agree that not all AI are going to deliver on that promise. Some are actually just moving the burden around. And that's not what I am actually talking about. It's where, where that real impact that we're seeing within healthcare especially is through ambient AI documentation, intelligent chart like summarizations, whether that be on seeing a new patient for the first time or on discharge summaries, utilizing the like inbox triages. All these various things may, I know we've probably heard this time and time again are flashy, they draw our attention, but they truly are liberating when used in the right fashion. See many times when as physicians we walk into a room, we do see that there is this barrier, this barrier between the patient and what I need to type and document. But through utilizing, let's say ambient AI documentation now our eyes are actually replacing actually the typing, right, the eye contact with our patients. And I feel at least when I'm in clinic or seeing these patients, they do see this immediately. It's like, oh, you used to spend more time typing and not even looking at me and, and now you actually are looking at me, let alone also I think that there are some clinicians who, who are utilizing AI ambient but are still looking at the computer screen and not at the patient. So, so this is where again, just because you have some new AI technology, it doesn't necessarily mean it actually relieves everything. It's just how we're going to end up needing to use it and using it appropriately. To answer your other question on how we're actually measuring things, we've seen a reduction in after hours documentation very similar to what others have already reported. Somewhere between 10 to 35%. Time to note closures is another one that we've looked at. What used to for some people could be hours, even days have now been minutes right after the encounter is done. Physician reported presence during visits have actually improved. And yes, patient experience scores have actually improved too. But you see, again, it really depends on how that clinician is actually utilizing the AI tool. Right. Just because you have it, we still have to be able to use it in the right way. So you know, when we look at things AI saving time, but it isn't how we feel is actually eroding trust. I think the human connection still can be preserved at this scale as we continue to use more and more AI solutions.
- [07:18]
B
Yeah, yeah, really interesting points there, especially the one you made about, you know, it doesn't mean that clinicians are automatically going to be not looking at the computer screen either you know, out of habits or because there's still things they need to look at on there that AI isn't, isn't accomplishing for them. At the conference you also shared a great story about rolling out ambient AI to surgeons and how culture and not the technology itself determines success. That experience teach you about managing cultural resistance among highly specialized teams and, and how should leaders approach AI adoption differently across different service lines?
- [07:57]
C
Yeah, I gave that example as, and I, and I did use surgeons but, but I'll say I'll broaden it out to surgeons and even non surgeons. It's just that our surgeons really are, are what I would say just really set in a lot in a lot of cultures. And I think that's, that's the thing. It's, and rightfully so. Our surgeons have a way of doing things and just like Mandalorians, this is the way, well, this is the way we do things. And you could say that that for even non surgeons too, but surgeons are precision driven. Right? They don't tolerate inefficiency or loss of control. And so that's why it's very important, at least for when we look at the surgical way or how surgeons actually go about with new change. It's very important to understand at least the culture, because culture beats technology every single time. And while I was trying to roll it out to some of our surgical groups, it made me realize very quick that the tech wasn't the problem. What we were facing as the culture, the egos that were there, the identity, the workflow pride that has taken you years within a surgical practice that we're trying to actually truly disrupt in a lot of ways. So, you know, it really was a time to just understand and see how is it that we could try to reframe it. So this way we would have better adoption. Right? Culture eats strategy for breakfast. That is what Peter Drucker has always stated. Right. Especially in healthcare. So subculture eats culture, even at that. So we have to tailor our adoptions. A lot of times, what I found within our surgical groups, they want proof, they want peer validation for our primary care. The culture is they want relief and speed. For our trainees that are coming up to be the future of healthcare, they want fluency and safety. So all these various different things need to come into play. And really the context is going to end up being leadership. How do we actually go about to make it? So this way everything is reframed. Where it is now, this ambient technology, especially with, with ambient AI scribes, it is your silent assistant, you know, and, and that this is going to be something that's going to help you out. And from a surgical perspective, imagine a silent assistant that never scrubs out. Right? That itself is. Is mine. Is, is almost like just a different mindset, Raym. It's a different change. And that's helped out some of our surgical groups to be completely off. Utilizing live scribes to now changing now to only just using ambient AI scribes.
- [10:53]
B
Yeah, yeah, really great success there. You gave another Star wars example, of course, with Mandalorians, you know, people who might be set in their way, quote, unquote, armored by habit. So how do you persuade these another quote unquote warriors to, you know, take off the helmet and trust these AI powered tools? And have you found any early adopters who later became champions and helped change the narrative of your organization?
- [11:18]
C
I love, you know, just the Mandalorians itself because there's, there's so many parallels to, I think, what we face in life and in Any sector of, of health care or business. And we talked about, you know, what you mentioned is an armor. I think all of us to some degree, shape and form actually have some armor, whether that you're a surgeon or non surgeon. And that at least in healthcare, that armor has kept patients alive for decades. Right. It's such in a way that this is what we do, this is how we do it. And you don't want to rip it off. Right. And in order to even have that change or we would say vulnerable state, you have to earn that right. We have to earn that right in order for them to loosen it. And, and that's why, you know, trying to immediately say that, that we're going to lead with this is the way to do it, because this is AI and this is how everybody else is doing it. Doesn't, doesn't resonate right. As well as this is the way we're going to lead because it gives you five minutes back of your, with your patient right there is this is going to improve the various different cares. Almost like we could say starting back with the why to be able to gain back that trust. I remember very early on when we were first trying to be able to get this in a room full of surgeons, there was a lot of discussions, right, this is not the way we've done things. This is the way I do things. My way is more efficient. And then just things just spiral out of control. But all it took was just one or two early adopters, one or two different surgeons. And it started, the skepticism started to really change now so much so where it's, I can't go without my clinic visit, without ambient AI or utilizing AI in some shape or form to be able to help me be more efficient. So, you know, at least for me, and looking at this and we talked about the Mandalorians, the narrative has truly changed. You know, the peer credibility, the getting the culture clan all together to be aligned has really, really proven to be probably one of the best things, rather than executive decree saying that this is the way it's going to be and this is how you need to do it.
- [13:36]
D
Yeah.
- [13:37]
B
And at the conference you also mentioned that Loma Linda has about 1100 residents, aka the future of medicine. So how are you integrating AI literacy into your medical education so residents graduate comfortable using these tools? And also what skills do you think tomorrow's physicians will need that today's often don't have?
- [13:57]
C
That is. You're spot on, Giles. And I'm glad you mentioned about at least residents, because you Know our residents, our fellows, this is the future of healthcare. I remember my mentor at some point saying, hey, you know, I'm putting all this time into you because at some point I'm going to need medical care and you may end up being the one that's going to take care of me. And I just see that, you know, if my residents and my fellows and our learners are able to actually learn something that makes it so they can refocus back, be happier at what they do, provide even better medical care, then I'm going to be a recipient of that. That's a selfish, like look into it. But externally looking at healthcare as a whole, it is our responsibility to be able to make sure that our learners, our residents and fellows are able to safely and use this technology in a transparent way. And so being able to train them on how to use it as clinical documentation, use it to synthesize evidence, you know, the, the, the healthcare literature continues to grow exponentially and being able to pull in multiple papers, synthesize it in a way that they can responsibly use it for their patient care is huge. Understanding that there are biases and there, there some ethics is going to be involved. These are all key components beyond just the, the documentation, the various different utilizations of coding and whatnot. So this is the future and this is what's needed and how we actually integrate it within here at Loma Linda is being able to let our learners experience it, letting them be able to experience ambient AI tool for them to start learning so that once they're done and they're graduating into wherever they go, they'll seamlessly be able to integrate into their workflow. Tomorrow's physicians, at least they need to be able to answer these questions on how to explain AI and decisions to their patients, how they're going to be accountable. I'm hoping that all of these things that they're learning now here at Loma Linda will help them to be able to be that much more efficient and also responsible in applying AI.
- [16:18]
B
Yeah, great stuff there. And so important for the future of healthcare. So yeah. Also on the panel at our conference, you predicted that AI will let healthcare do more with less, but also give clinicians the chance to refocus. So when you look five years ahead, what does success look like to you and how will you know if AI has truly transformed the workforce for the better?
- [16:39]
C
I see success in the next five years as is it with fewer physicians doing more work. I don't see it that way. I feel that's a Failure with the better tools. Because what we know more and time and time again is we have to be able to focus back to build that relationship with our patients. And we actually need more physicians, more clinicians to actually do work. And really, what do I mean by that? More specifically, our physicians and clinicians need to be practicing at the top of their license, not be suppressed because of all the various different administrative things that we need to do. Teams need to be augmented, right? Not necessarily replaced. I think there are some positions that are going to be replaced, but we can be able to augment either those different positions to somewhere else or strengthen the current positions that we actually have. One of the biggest things that I see time and time again, at least within healthcare, we've talked about this for years, is burnout, right? The burnout curves really should be bending downward, especially if we're utilizing AI in the right manner and then actually being able to hack medicine feel meaningful again, right? Building that relationship, turning it back to the patient, being able to connect and touch, physically touch that patient again is going to be amazing. So I'll know we succeeded when I'm seeing our clinicians leave work with energy left, being able to go, because I utilize AI, I'm able to go exercise. I'm able to spend more meaningful time with my, my, my family, my friends. And then also seeing that the new wave, the new future, those that may not have already entered medicine or are looking to enter into medicine will want to do it because they go, hey, they found a way to be more efficient. And I'm seeing that there are healthier clinicians or physicians and look at how happy they are. Well, I want some of that too. I think those two things are going to be really important as I see for success. And then lastly, it comes down to what the patient truly feels, right? If we're able to establish great relationship with our patients. And they go, man, my doctor really listened to me because of X, Y and Z technology. Fantastic. I don't think AI isn't the hero of the story. I think our clinicians are going to continue to be the heroes of these stories, but we need to position ourselves through governance structure, through the narratives, to be able to make sure we're using it responsibly for the future of medicine. And that's what that success is going to look like for me.
- [19:26]
B
That's great. And yeah, hopefully we can keep the conversation going and, you know, check back in five years and hopefully all those things will come true. But I know we will keep the conversation going at our Health IT Conference next September in Chicago, where you'll be a speaker on a panel about ambient AI. So appreciate you joining us for that. And Lauren, again, thank you so much for doing the podcast today.
- [19:52]
C
Thank you, Giles.
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D
Sam.