This week I am talking to Hal Baker, MD Senior Vice President & Chief Digital & Chief Information Officer at WellSpan Health that continues to be named one of the nation’s “Digital Health Most Wired” health systems by the College of Healthcare Information Management Executives (CHIME), underscoring WellSpan’s efforts to lean into innovative technological advances to improve both patient care and the patient experience. WellSpan offers smooth and reliable care experiences for their communities and ensures that they are always there as their trusted partner.
Hal is a 28-year veteran at WellSpan Health, and he highlights his journey from a traditional analog native to embracing and championing technological advancements in healthcare. We discuss the early foray into voice recognition technology to ease the burden on physicians who struggled with typing and the importance of making technology work for clinicians and patients, moving beyond the initial focus on computerization to enhance the overall healthcare experience.
We discuss the success of initiatives like providing patients access to their medical images, showcasing the positive impact on patient engagement and understanding, and the amazing variety of use cases for allowing patients to see their images, especially in the obstetric department.
Listen in to hear us discuss the latest developments and integration of ambient voice technology, particularly the fully AI version, into clinical workflows and how this innovation not only improved efficiency but also had a profound impact on the well-being of healthcare providers by alleviating the cognitive load of documentation.
Listen live at 4:00 AM, 12:00 Noon, or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
And today, I’m delighted to be welcoming Dr. Hal Baker is the Senior Vice President and Chief Digital and Information Officer at WellSpan. Health. And he’s also an old friend of mine how thanks for coming.
Hal Baker
Great to see you again, Nick.
Nick van Terheyden
So, as I do with all my guests, I know a little bit of this story, but it is absolutely intriguing because whilst you’re a physician, and you still practice medicine, you took a slightly different sort of pathway and indeed a role in the organization. Tell us a little bit about your career to this point and how you arrived here.
Hal Baker
Well, I’m a 28 plus year employee of WellSpan Health, where I spent my first 10 years in residency education and training medical students and residents. But I’ve always had an interest in it. I mean, I grew up as a analog native writing notes, writing orders, like most of us did of our age, but saw the potential and computers and was fortunate enough to work in an organization that saw opportunity for me to help. I am not a technical background person, I took one college course in programming, something called Fortran. And I think the great thing about technology in the last 15 years is it’s been less about Kelly computerize it due to moving to can we make it work for clinicians, patients? Can we make it better? And boy, the last three or four years have been fantastic in that area. Yeah,
Nick van Terheyden
it’s funny you bring up that so first of all, I programmed in Fortran, I was a big COBOL. Guy, I almost re revitalized my credentials around the year 2000, when they were looking desperately for people like me, but I just, I couldn’t bring myself it was all about commas and periods and all sorts of things. I’m delighted to hear that you had some of that experience. And, you know, the point that you make right at the end is, I think hits the nail on the head. For me it was, can we computerize. It was the mantra for so long. But that was really the wrong question we were asking. And I think we’re now starting to ask the right question, which is how does this improve healthcare, in general is Do you think that’s been a shift and a change?
Hal Baker
I do think it has. And I think it’s been an advantage of what we’ve seen in generative AI and some of the capabilities that have come on, frankly, much faster than those of us close to it expected. I think many of us were surprised, including some of the engineers that most deeply involved with this, how quickly this blossomed. But the computer systems that we all put in, we’re very, very good at forced accountability to complete certain administrative actions. And I remind people, I’m a primary care physician every 12 seconds is 1% of the office visit. And we very quickly add requirements there for coding for HCC codes, for documentation for this social determinants, health and that, and, you know, click by click second by second, we eat away at the time that allows people to connect with each other, because that’s what made us all go into medicine in the first place. Now, some of the technology is starting to seep into that seek back into the background and let the people connect. And I think returning joy to practice, and that’s exciting. I’ve got my all three of my kids are in some way tied into the healthcare industry. And I’m very optimistic for what lies forward in the future. Yeah,
Nick van Terheyden
I will tell you, I’ve got the same and, you know, unfortunately, in the case of one of mine, you know, quite honestly miserable at this point, because of the challenges that we’ve overlaid on top, and it can’t come soon enough, quite frankly. So before we get into the detail, I think it’s getting it’s worth getting a little bit of context for those that don’t well, no WellSpan Health, you’ve obviously received some recognition, nationally on, you know, a number of fronts, but it’s quite the mix of a hospital health system. Tell us a little bit about where it is and you know, some of the makeup of the system if you would, yeah,
Hal Baker
well, well, well spent health is located in south central Pennsylvania. It largely is a six county health system hugging the border of Maryland and Pennsylvania. Your county, Lancaster County, Lebanon County, Adams County, which has Gettysburg Franklin County so that area are not large cities, a lot of rural area, a lot of farmland and orchards. But we have been the locally governed locally run health system here, community minded voluntary board, dedicated to providing health care to our communities in every way of meeting the needs. For the journey that is life as our saying goes, and it has been an organization that has been very mission and purpose driven. It’s a reason I chose to begin my career here out of my fellowship, and have been very proud to see what it has maintained over the near three decades, I’ve been with it in terms of its commitment to just do the right thing.
Nick van Terheyden
Yeah, that’s not always the case. Let’s be clear, we certainly see a fair amount of that. And in terms of the the makeup of patients, customers, you know, consumers, however, you want to sort of phrase that what’s, what’s the makeup? I mean, it sounds rural, but it’s not exclusively rural? It’s
Hal Baker
no, no, we have, we have inner city problems, food deserts, transportation issues, we have a fairly large Spanish speaking population. So we deal with the bilingual nature, we had to do a lot of work with the Spanish speaking churches to help get COVID information and COVID vaccinations out to that community. When we saw disproportionate outcomes affecting that community, we work a lot on equity and trying to drive equity in our care. across all groups. We’ve been supporting the LGBTQ community. Well, before that became legally a right of people, I remember recruiting residents, because we offered same sex benefits when very few hospitals did, just because we could meet them where they were. So that’s what always made me proud about the organization. But we’ve also while being very stupidly, not grandiose by any means. We have always been really focused on making sure we made the investments in the technology that helped get us better. Some of our cardiovascular services are just world class. Our work in some 4d imaging, in cardiology, I think, is groundbreaking. And we, we built a patient portal, that wasn’t what we were always comfortable with as providers. But it was what we wanted when we were the patients. And if you follow that golden rule of Do unto others, as you would want them to do under you when you’re sick. Boy that does help you make some decisions at times where they’re difficult forks in the road. Yeah,
Nick van Terheyden
I’ve got to call you out as one of the big supporters of you know, open sharing of information. You know, every every few months, we see an email thread that shows up on a message board that you and I are both part of people going, well, you know, should we share results? Should we share all of these things with patients and you’re one of the first to always jump in, we’ve been doing this for a very long time by the sounds of it. And I I’m certain that it’s not without bumps and challenges. But overall, it sounds like that’s been a you know, a foundational piece of information sharing with your community. It
Hal Baker
is and you do have those moments where people will find out devastating news on the patient portal because we now are not legally allowed to withhold it. But sometimes the result comes back and it is some tragic news. But when you see that the person was hitting refresh every five minutes for the last 90 minutes, you know that they desperately wanted it. And now they’ve learned something bad, but they’ve learned it and they didn’t learn it in the warmest way. But when they do come into the office, they’ll have their questions clear. And they clearly had that demand and need. And while we have those stories, we also have the people who got to sleep through the weekend because they now know their kid doesn’t have leukemia, that the the tumor hasn’t recurred in their chest CT. And I do believe that sometimes Limbo is the worst place you can leave yourself for a prolonged period of time and his greatest suffering and uncertainty. It’s That’s my belief as a clinician, we’ve had good support for that ideal amongst our leadership, and it’s kept us true to that path.
Nick van Terheyden
Well, I’ve always been grateful for your voice and support on the matter because I do I feel very strongly about it as well. You know, I think vacuum just creates opportunity for misinformation and all sorts of mind games that we play with ourselves. So you know, all credit to you. As you think about the path to this point, I mean, I you know, it’s a long period of time. In terms of the technology, innovation, I mean, if you go back far enough, you’re talking pre cell phones, pre iPhones even. And tell us a little bit about some of the highlights of the things that you created that have been successful through that journey that gets you to this point of, you know, the recognition that you received in, you know, recent piece talking about the digital health most wired health system, which you you maintain for a number of years now. So you’ve clearly worked very hard at it. What are some of the highlights, and
Hal Baker
I think some of the things I’m most proud of are the rapid way we rolled out voice recognition in our electronic health record rollout, because we recognize pretty quickly there’s a lot of our doctors resistance was they just didn’t know how to type. And it’s very hard for people that are highly respected to look foolish typing with two fingers. I sometimes joke that we had a dragon outbreak, not a rollout plan. But we did that and that was able to help us really roll out the electronic health record, and then start to embrace the opportunities with it, we had two different vendors for our inpatient outpatient record, both of them had portals that just couldn’t represent the other made no sense to have to. So our team literally built our own portal. And we, by the time we flipped to epic in 2017, we had over 150,000 patients on it, using it, we were doing online scheduling. And we built that integrated approach from the ground up, which was not something I plan to do, we build our own portal. But we were able to keep it certified. And it really was better than many out there, we had a very open proxy function where I could, for instance, invite you to be the proxy of my record. And Epic looked at that and said, Wow, that’s better than what we’re doing. Can we adopt that and they built it in and we were, by all means. So you know, when you’re taking the opportunities to build on top of something as strong as epics my chart, it’s kind of amazing where you can go, something that made no business sense, but made great human sense was to let our patients have access to not their imaging reports, but their images, and be able to see the CAT scan, see the ultrasound, see the fetal ultrasound of the baby kicking, we turn this on, on February 1 of 2000. As you may remember, there was a bit of another thing going on at that time. So our entire marketing plan fell apart on that we didn’t tell anybody, but we turned it on. And then we went about working on COVID. About August of that year, I suddenly asked had we turned it on and realized we had and we noticed that there were over 40,000 Lux every month. And now it’s over 60,000 people just looking at their images. And you know, sometimes it’s a kid asking mom to show their their friend, their broken arm. Sometimes it’s a expectant mother showing her future, the future grandmother, the baby kicking, sometimes it’s just seeing for yourself that that tumor that was in your chest has gone after treatment, instead of trusting the words on a page. And that’s been cool, because we’ve had support to do those kinds of things that are just there because they make sense to our mission, even if you can’t show an ROI.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today, I’m talking to Dr. Hal Baker. He’s the Senior Vice President and Chief Digital and Information Officer at WellSpan. Health, we were just talking about some of the innovations that you’ve seen, you know, the inclusion of images and you know, let’s be clear reading and X ray reading ultrasound and go back 20 years, I couldn’t read an ultrasound, those things were just DoubleDutch to me, quite frankly. But you know, they’ve gotten much better with 3d visualization. And, you know, as you talked about 4d, you know, that’s exciting to see that you just sort of throw it out there didn’t do any marketing. And now you see all of this use case. And, you know, there’s I don’t know, I mean, I’m not sure that you can necessarily see an ROI for that. But it sort of harps back to something that you said that really resonates with me do the right thing. That was the right thing to do. You saw the opportunity you were able to do it and delivered on a promise that I think for patients must be you know, it must be extraordinary to hear some of the stories I imagine gathering some of those and sharing them must be quite nice for the staff internally to hear some of that.
Hal Baker
All right, absolutely as it is. And we’ve recognized that our patient experience is one of our leading brand attributes. When we we look at what people recognize and US, but it’s an area that we’re working aggressively on and trying to make even better, and really looking at revamping our entire digital experience to make it more personalized, more easy to navigate, and more effective.
Nick van Terheyden
So, you’ll, you’ll clearly no something of a fortune teller, given that you saw that far back with speech recognition. And, you know, I accept I’ve got some bias here, because I was in that particular party, I could see it. You were clearly one of the leaders in saying, yeah, no, this makes sense. You seen the value contribution, it’s clearly contributed to an expansion of services, I think, relief from a physician standpoint. But it’s getting even more interesting now, I think, right?
Hal Baker
Yes, absolutely. I’ve been using ambient voice for nuance for the last three years. But in the last two months, I’ve been using the fully AI version. And so I get back a note in 30 seconds. And I can give it instructions. If I’m seeing someone named Pat and it puts it down as a male pronoun, I can say no, no, Pat, so a 47 year old woman, and it just changes at all, like an AI would. So that kind of stuff is is cool. What I underestimated until I experienced it is taking off the responsibility for a clinician to run the tape recorder in their head of keeping track of all the details to regurgitate into a note for the business of medicine, instead of just being present. That was much more of a psychological tax tax than I realized until it was removed. And what we’ve seen from our providers is that they are often blown away by how much better they feel how much happier they are, in the office, their spouses, sometimes they’re able to really give us clear information about I’ve got a different partner coming home to me, who’s coming home earlier with less on their mind, and able to be more focused on her family. That’s great. And we’re doing similar work in Nursing with virtual nursing with a company called artist site, which augments with AI paths that can be really repetitive like being a sitter, one on one with a patient with an AI we can get to 1213 to one, but a virtual nurse who can come into the room and do a history, double check on things. It’s creating a new problem for us that we haven’t had in a while, which is how do we survey our staff to quantify the return of joy to their work? Because that hasn’t been a problem for me in a while. But now that’s one of the things we’re working on our methodology to get the impact of this because we think that it is worth capturing. And it’s really out there. And we have anecdotes and stories and interviews. But we want to quantify it.
Nick van Terheyden
So I mean, I think, you know some fantastic progress and opportunities there. You talk about the the ambient listening and how much that’s progressed. And I’ve certainly talked about this recently, I stepped away for a while, and was truly surprised at the capabilities of this. And the number of entrants that are now sort of appearing to say, We can do this, I think this whole area is going to explode. And you know, you talk about the elements of giving back to the physicians, but not it’s not just time you’ll You’re right. It’s sort of hanging on to what did I forget? We’ve changed that. So you must be truly excited. Is this reaching wide rollout in your side?
Hal Baker
Yes, we are. We have over 200 providers using it right now. Physicians APs and the the nursing rollout right now it’s only in 180 bed hospital, but we’re as fast as possible, moving it to other hospitals, because the stories are so compelling. Literally, today, we’re going live with our first emergency room physician using the ambient voice and I can’t wait to hear from him later today. how it goes because with the fully AI technology, it’s possible to keep five patients in play at one time where it wasn’t when it was a single recording.
Nick van Terheyden
Right. It’s that relief of you know, the mental baggage of what did I forget? And I think that’s what people were taking home is what I the sense I get it that
Hal Baker
I think it absolutely was there’s there’s the click flow. And the repetitive epic has recently made a change to something called hyperdrive, which makes the computer much more snappy, but it’s still the same number of clicks, same number of fields, taking away cognitive work that a computer can do. Where we want to go is where repositioning a patient in a doesn’t need need to be documented, because the AI on the computer can see that it happened and recorded it. Let’s not have human beings telling a computer stuff that a computer can see for itself or care for itself.
Nick van Terheyden
It really does feel like that inflection point of, you know, the change from technology being a burden, which let’s be clear, I think the EMR for a long, long time, many of those points trade off. Exactly, you know, we’re not going to get rid of it. But it’s it caused additional burden. I think that happiness score. And I know that W, I think it’s a who produces a Happiness Report by country, maybe you should go to Finland, I think you need to take a trip to Finland, and look at their measurement of happiness, because they do they actually measure happiness. And I think that’s really important. Because ultimately, if we’re not happy, we’re not really doing great job. So we’ve not got a lot of time left. So I want to sort of pick your brain and see if we can help some of our listeners out. You’ve obviously picked some of these things, you must have some exciting thoughts about the future where you see some of this going, where people should be thinking about where they should be focusing based on some of your experiences.
Hal Baker
It may, my particular thought is to stick closer to platforms that are poorly potential, or working with artists sites that we think can go into a number of directions, the technology behind ambient can work in a doctor’s office. But could it also help measure a timeout in an operating room could it help a nurse document passively while she’s doing our work versus having to do it in the document it those are the kinds of things that are interesting to us. Another company called key care that we work with has been great. But one of the challenges, it could help us in so many different ways. It’s sometimes hard to choose. And there is that paradox of choices that you deal with when you have a platform. But I would encourage people not to get too hung up on picking the thing that has the most value. Just pick something valuable, where you’ve got the right leadership and get going. Because there will be many parallel opportunities to pivot to. And it’s most important to get something done and not let perfect be the enemy of right now getting something good done. It is a opportunity rich time for us to return humanity to health care, and let the computers do the work they’re best at while the people do the connections that brought them to healthcare in the first place. So
Nick van Terheyden
it sounds like and you know, I’m obviously going to pick on this because it resonates a lot with my my brand, the incrementalist it’s, you know, don’t let perfection stand in the way of progress. Has that been your mantra throughout? Do you think I think
Hal Baker
I think it is, and also recognizing that it all has to work together. And if you try to stitch together 14 different needs solutions, that it’s each elegant, the ecosystem will still be fractionated versus making a few bets on a key few key platforms. Epic is built everything from one instance. And I don’t think that’s in material to their success or the way things work together.
Nick van Terheyden
So closing moments, as you look forward, what are your Where do you see the highlights for where things are going and the opportunity, it feels like medicine might be at an inflection point, and there’s hope for my Dorthea I
Hal Baker
think there is great hope that the technology will leverage the humanity of people. And we will be able to take some of the drudgery away and let it be handled by very sophisticated computers that have increasingly complex capabilities through AI. It needs to be managed, there’ll be missteps. But the future is so much brighter if we can let the humans and the computers each do what they’re best at.
Nick van Terheyden
Yeah, I too. I’m excited about it. Although I know I’ve been excited about other things that didn’t quite play out. But I think you know, the importance of this whole revolution that’s coming with AI, the generalized term of this. And I think importantly, the fact that it has context that it can apply on an ongoing basis to deliver additional value with the right guardrails recognize all of that it is an exciting time and I’m so I’m hopeful that we can turn the page as it were, and see a better future for clinicians that you’ve clearly seen in your institution where they can spend the time that they want with their patients. Unfortunately, we do each and every week. We’ve run out A time so it just remains for me to thank you for joining us on the show Hal thanks for joining me
Hal Baker
it was great to see you again thank you
