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Becker’s Healthcare Podcast
Margaret Fry, MD, President and Chief Executive Officer of Boston Children’s Pediatric Physicians’ Organization
00:12:56
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- [00:01]
A
This is Laura Deardle with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dr. Margaret Fry, President and Chief Executive Officer at Boston Children's pediatric physicians organization. Dr. Fry, it's a pleasure to have you on the podcast today. Could you take a moment to introduce yourself and just tell us a little bit more about Boston Children's Pediatric Physicians Organization.
- [00:21]
B
Good morning, Laura, and thank you very much for having me today. I am Dr. Margaret Fry. I'm the President and CEO of the Boston Children's Pediatric Physicians Organization, which is an association of independent pediatric primary care practices with over 100 locations. We participate in a clinically integrated network with Boston Children's Hospital to care for approximately 450,000 patients across the Commonwealth of Massachusetts.
- [00:52]
A
That's fantastic to hear and, you know, definitely an important population to serve. And you know, I'm curious, what are the biggest winners, successes that you've had over the last year or so?
- [01:04]
B
Laura, I have to say the biggest success this year, and actually I would argue over the last several years, has been the remarkable introduction of augmented Ambient Scribes. Some people call them AI scribes. And we started a pilot of AI scribes about 10 months ago in our organization, initially enrolling about 40 clinicians, including pediatricians and nurse practitioners. This has been an astounding success. Prior to joining the ppoc, I was a practicing pediatrician and physician leader in the San Francisco Bay area for over 20 years. And I have observed, including practicing in Silicon Valley, the march of technology as it relates to health care, including EHR improvements. And typically those EHR improvements are incremental and sometimes they actually go in the wrong direction where we see one step forward and sometimes two or three steps back. These ambient scribes or augmented virtual documentation have been game changing for our clinicians and we're very excited to be able to expand what was initially a pilot and deploy them, offer them to all of the clinicians in our network this year.
- [02:30]
A
Absolutely. I think that's really cool to hear and certainly that AI technology and ambient scribes, I know something a lot of different hospitals and health systems are starting to experiment with or trying to figure out what makes the most sense for them. So throughout that pilot program, is there anything that you learned or would be beneficial for other leaders to know as they're dipping their toes into these ambient scribes.
- [02:55]
B
The first piece I would consider is making sure to have a well designed pilot to try to understand who of your clinicians are most likely to benefit from the scribes. I would also recommend to have some Training. Even though these are designed to improve people's workflow, it is a change. And so we've observed that some of the people who benefit the most from the AI scribes or ambient scribes are people who are not the quickest with technology going into the pilot and so having someone sit with them explain how to use it and how to integrate the AI scribe technology into the existing EHR technology is very important. I also think that the next phase is really to integrate the scribe documentation into the rest of the clinical documentation build to make it as seamless as possible. The idea is supposed to be that this saves people's time and improves the quality, quality of care. So it can't be a standalone build. It has to be strategically integrated with the rest of the electronic health record to really be successful.
- [04:08]
A
That makes a lot of sense. Thank you for going a little bit deeper in there. Now, I'm curious, what are the top two to three issues that you're focused on right now? What is really top of mind for you?
- [04:20]
B
Overall, our current strategy is to enable our clinicians, so our doctors, NPs, PAs and behavioral health clinicians to perform their clinical and administrative work with more ease, thus enabling them to continue to provide very high quality care to all of our patients. We are a primary care organization. In order to accomplish this, we have a few key pillars that we're really focused on right now. One is the strategic evolution of information technology. So I've already touched on AI scribes as one component of this, but it's bigger than just one piece. This is really thinking about how we leverage technology, obviously including artificial intelligence, to really be transformative from the perspective of our clinicians and their teams in order to enable them to reduce administrative burden and continue to provide high quality care for us. This has included a governance framework for artificial intelligence, where we have a way, a methodology of really evaluating new proposed AI solutions to see if they will actually be a good fit for our organization or not. The second key pillar that we're focused on right now is behavioral health. This is critically important for primary care across the country and certainly in our organization. All of our pediatric practices have integrated behavioral health clinicians working side by side with primary care pediatricians. And this has been wonderful. It means that patients and families can receive integrated behavioral health close to home in the medical home. However, we're taking a step back and really looking at a full system approach to behavioral health. This means partnering with our colleagues at the Department of Psychiatry at Boston Children's Hospital, as well as our partners at the state level in the Commonwealth of Massachusetts to really look at the entire behavioral health system for patients and make sure that kids are not falling through the cracks and that the patients have a more seamless transition, Whether it's a need for higher acuity care, such as inpatient behavioral health care, or any specialty services that needs to happen outside of the medical home. The third pillar that we're focused on and most importantly is the relentless pursuit of clinical excellence in primary care. We remain focused on that as the cornerstone of what we do every day.
- [07:03]
A
I love that. And it's really helpful to understand exactly where you're seeing some of the big challenges, as well as opportunities to have better patient care to reduce that administrative burden and really transform your clinical teams. I love that idea. Idea of making sure there aren't any patients or families that are falling through the cracks, that you're able to meet the needs of your patient population in a really smart and strategic way. Now, in looking ahead, where do you see some of the big opportunities for continued growth, for continued success and evolution of that clinical care?
- [07:39]
B
For us, I think the biggest challenge is also the biggest opportunity, and I would say that is the physician workforce. And certainly we see across the country workforce challenges in primary care, addition to many other specialties as well. But I'm focused right now on primary care. So physicians, we don't have enough physicians to care for the population of the United States. And certainly from a primary care perspective, and we know that the cost of physician turnover is very high. We estimate that for every physician who leaves the organization, it costs two to three times their annual salary. And that includes recruitment costs and the cost of an unfilled clinical schedule where this physician could be taking care of many patients. So this is a burning platform for us that is both a threat and I think also an opportunity if we do this well, to really address the workforce issues head on. We have partnered with the American Medical association with the Joy in Medicine project. They also have a Steps Forward project. And we're really doubled down and focused on the well being and retention as well as recruitment of all of our clinicians. So our physicians, our nurse practitioners, PAs and our behavioral health clinicians, because that's how we view the way that we're going to be successful in the future.
- [09:11]
A
Got it. That makes a lot of sense and I appreciate you digging deeper there because it is so critical to think about where technology is headed, where healthcare is headed, and how you can continue to serve your patients in a meaningful way. Before we wrap up our conversation I wanted to ask, what do you think it will take to lead a thriving organization over the next five years, especially given how quickly things are changing.
- [09:36]
B
Thanks, Laura. I think that's a great question and I think acknowledging everything that's happening around us and the rapid pace of change is very important. When I think about what it takes to lead a successful organization today and within the next several years, I think about a few key aspects. Number one is a clear commitment to commitment to mission. At the PPOC and at Boston Children's Hospital, we are very clear we are here to provide world class care to children and families. And it informs everything that we do. And we know that the people involved here, whether it's our physicians, our other clinicians, our staff, and certainly our patients, all want to be a part of an organization that has the privilege to be honest, to be focused on the care of kids and families. So we need to embrace the mission and we need to really lead from the mission because everything else flows from that. Number two and related to mission is culture. I think that provide leaders need to provide a culture that is supportive of innovation. So there's a lot of noise in the system right now, a lot happening in the world around us, and it's really important that leaders see through the noise and that we're able to really promote a culture where people feel safe, that there is a high level of innovation and tolerance for change because change is going to happen and people feel supported. So it's really support for people and support for innovation at the same time. And then the third pillar, which I think is going to really differentiate successful organizations in the next several years is good governance. So I've already talked about the importance of a governance framework for artificial intelligence. At the PPOC we have an IT steering committee which really acts as our committee. It's a board subcommittee that really looks at everything that's happening in terms of the evolution of IT and making sure that we're approaching this strategically in a way that's supportive of our patients and of our clinicians. And I think taking a step back and making sure that the entire organization is run from a well governed framework is going to be very important as organizations navigate the turbulent waters of all of the change that's happening around us.
- [12:06]
A
Absolutely, that makes a lot of sense. It's a very clear and concise way of responding and reacting to changes, but also preparing for how you can proactively be great in the future. So that's amazing to hear. Dr. Fry, thank you so much for your time today. This has been a lot of fun to talk through all this with you to get your perspective, to hear more about some of the cool things that you're doing. And I'm looking forward to continuing the conversation under CEO CFO Roundtable. It'll be great to hear you speak there, just really be able to get down deep into some of these themes as well.
- [12:38]
B
It's been great being with you today, Laura. Thank you.