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Speaker 1: Hey everyone, Welcome to the Restless Ones. I'm Jonathan Strickland.

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Speaker 1: As always, my focus is on exploring the intersection of

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Speaker 1: technology and business by having conversations with the most forward

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Speaker 1: thinking leaders. Throughout my career, I've covered everything from massive

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Speaker 1: parallel processing to advanced robotics, but what truly inspires me

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Speaker 1: are the stories of innovation and transformation. In this season,

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Speaker 1: we'll explore technologies like flexible applications, more capable devices, and

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Speaker 1: advance networking like five G that are helping business leaders

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Speaker 1: act on their big ideas quickly and unlock mission critical outcomes.

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Speaker 1: What's become clear to us after three seasons is that

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Speaker 1: we can't change tomorrow by deploying solutions of the past.

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Speaker 1: So get ready to be inspired and learn from the

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Speaker 1: best today. Our guest is doctor Peter Fleishuot Group's senior

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Speaker 1: vice president and chief Information and Transformation Officer at New

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Speaker 1: York Presbyterian Hospital. Peter's background is as an anesthesiologist, but

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Speaker 1: over the course of his career, he has sought new

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Speaker 1: ways to create positive change in the healthcare industry, from

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Speaker 1: solving challenges facing administration to improving patient experiences and quality

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Speaker 1: of life. It's no small task, and Peter recognizes that

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Speaker 1: technology has an important part to play, and I got

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Speaker 1: a peek at how some cutting edge and maturing technologies

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Speaker 1: are poised to change everything in healthcare. But before I

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Speaker 1: get carried away with all the tech, I wanted to

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Speaker 1: learn more about Peter himself. Peter, I want to thank

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Speaker 1: you for joining us today for this conversation. Welcome to

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Speaker 1: the Restless Ones.

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Speaker 2: Jonathan, thank you very much for having me here today.

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Speaker 2: I really appreciate it.

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Speaker 1: I'm really excited about the topics we're going to get

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Speaker 1: into today. And to start off, I'd like to hear

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Speaker 1: about how your career path in medicine led to you

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Speaker 1: becoming Chief Information and Transformation Officer for a New York

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Speaker 1: Presbyterian Hospital.

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Speaker 2: Jonathan. Way back when, I always knew that I wanted

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Speaker 2: to take care of patients, and I trained in a

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Speaker 2: specialty that allowed me to take care of a patient,

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Speaker 2: one patient at a time, and over the evolution of

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Speaker 2: my career, I ended up taking care of those patients.

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Speaker 2: When I used to take care of liver transplant patients

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Speaker 2: getting surgery, I then started taking and overseeing multiple patients

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Speaker 2: with multiple care teams. I then ended up frankly overseeing

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Speaker 2: our operating rooms when we used to run eighty five

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Speaker 2: locations in a day, and that's led me to my

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Speaker 2: current role.

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Speaker 1: I love that answer. I love starting from the desire

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Speaker 1: to help and then figuring out how to help more

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Speaker 1: people over time out of curiosity. When you're talking with

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Speaker 1: someone in a casual setting and they ask what do

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Speaker 1: you do for a living, how do you actually describe

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Speaker 1: what your job is to someone?

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Speaker 2: First and foremost, I get to work with the most

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Speaker 2: amazing people in the world. I have an unbelievable team

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Speaker 2: where I oversee the management and operations of IT lab operations,

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Speaker 2: pharmacy operations, data analytics, and artificial intelligence, and we are

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Speaker 2: really the backbone of a lot of the system to

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Speaker 2: help the doctors, the nurses, the patients, and the providers

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Speaker 2: as they go through their care. And that really encompasses

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Speaker 2: my day to day responsibilities.

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Speaker 1: Incredible and you sort of touched on this, but can

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Speaker 1: you talk a little bit more about how your clinical

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Speaker 1: experience as an anesthesiologist guided the way you think both

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Speaker 1: like a patient and a provider. That experience of helping

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Speaker 1: people one on one, how that shapes your approach in

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Speaker 1: your current role.

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Speaker 2: So a lot of people don't know, but antithesiologists are

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Speaker 2: uniquely positioned all throughout the health system. When I trained

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Speaker 2: to be an antistesiologist, I got the exposure of working

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Speaker 2: in an outpatient area as a pain provider. I got

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Speaker 2: the opportunity to work in operating rooms, in ICUs and

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Speaker 2: critical care. I got to be in various radiology areas,

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Speaker 2: endoscopy suites, cathartization labs, and you really end up working

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Speaker 2: in many, many different parts of the system. One from

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Speaker 2: a patient perspective, it's especially that I feel is kind

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Speaker 2: of behind the scenes to help support the patient get

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Speaker 2: safely through their experience. And it's heavily reliant on technology,

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Speaker 2: but it's also very multidisciplinary in its nature, and that

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Speaker 2: really helped set me up for success.

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Speaker 1: And I imagine as an nesthesiologist, in your relationship to patients,

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Speaker 1: a lot of your work also would come in the

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Speaker 1: form of communication and to make certain that you're able

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Speaker 1: to communicate with peers patients what you're doing, why the

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Speaker 1: approach is the way it is. And I see that

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Speaker 1: as a key element in the role of technology and

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Speaker 1: healthcare as well, the ability to be able to communicate

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Speaker 1: the purpose of that tech in a way where everyone

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Speaker 1: involved in the discussion, whether it's c suite executives or

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Speaker 1: it's the patient in the hospital room, that they understand

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Speaker 1: the role that is playing and how it supports the

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Speaker 1: overall mission of overseeing health for patients.

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Speaker 2: I couldn't agree more. You're spot on. Communication is critical

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Speaker 2: to our frontlines all the way to our board, and

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Speaker 2: getting the right amount of information to the right amount

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Speaker 2: of people is essential. I've also found, as you mentioned,

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Speaker 2: technology has transformed that landscape. The sheer amount of connectivity

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Speaker 2: that exists amongst our employees and amongst our patients is

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Speaker 2: unprecedented and it really enables what I think is the

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Speaker 2: digital transformation. The connectivity and the speed at which people

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Speaker 2: get information today is astronomically faster than they have in

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Speaker 2: the past, and things like which I'm sure we'll talk

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Speaker 2: about later. Chat EPT will fundamentally and is fundamentally changing

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Speaker 2: information delivery, the ability to be answered questions. The challenge

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Speaker 2: as a provider is we've got to get the right

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Speaker 2: information to our patients, and it needs to be high quality,

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Speaker 2: and it needs to be secure, and it needs to

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Speaker 2: be protected. So I see my job in a couple

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Speaker 2: ways to further that transformation, but to do it in

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Speaker 2: a secure and in a high quality way.

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Speaker 1: Connectivity is one of those technologies that enables everything else.

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Speaker 1: So one thing I wanted to ask you about is

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Speaker 1: can you describe your efforts to reduce friction in the

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Speaker 1: patient experience using connectivity? How has connectivity changed that process

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Speaker 1: for the average patient?

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Speaker 2: Great question. Let me set a baseline. Three years ago,

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Speaker 2: we were on nine different electronic records and that was

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Speaker 2: one part of how disconnected we were at the time.

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Speaker 2: But it wasn't just there. We also had ten thousand

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Speaker 2: order sets and these are the care pathways that the

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Speaker 2: doctors would be using to care for our patients. We

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Speaker 2: also had what's called five formularies. Those are the drug

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Speaker 2: catalogs of all the drugs that the doctors would use,

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Speaker 2: and there was five of them. One of the efforts

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Speaker 2: we took on with our ten thousand doctors at Wild

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Speaker 2: Cornell and Columbia was how do we standardize all that work?

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Speaker 2: So we go from ten thousand to one thousand pathways,

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Speaker 2: go from five drug catalogs to one, and we've done

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Speaker 2: that transformation. Most other systems have done it, but we've

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Speaker 2: done it in a way where we went to one

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Speaker 2: instance and one connected system across our whole health system

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Speaker 2: of eleven hospitals. And these are academic hospitals, they're small

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Speaker 2: and large community hospitals. And so that connectivity in the

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Speaker 2: process by which we went through fundamentally changed our operations.

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Speaker 2: It's fundamentally changed how we care for patients. Now we're

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Speaker 2: probably in the second of nine innings right now, we

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Speaker 2: know we need to go even further. It's not easy

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Speaker 2: for a patient to interact with the system. There's thousands

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Speaker 2: of phone numbers to call, there's maybe multiple mobile apps,

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Speaker 2: there's multiple pieces of education, there's multiple options to either

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Speaker 2: schedule yourself or to call or to deal with a chatbot.

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Speaker 2: And I look at our opportunity is to streamline that.

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Speaker 2: We got to reduce the friction so that there's one

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Speaker 2: number to call, there's an ability to do it self

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Speaker 2: service to me, that's just found aational But then you

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Speaker 2: layer on some of the more advanced NLP models, you

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Speaker 2: can start to even see how you can be able

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Speaker 2: to get that into a care pathway and make it

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Speaker 2: even easier for patients so that you can integrate it

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Speaker 2: with the education and the scheduling and the prescriptions, and

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Speaker 2: that type of digital care model is ultimately going to

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Speaker 2: get us to higher level care, much more productive, much

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Speaker 2: more efficient, and allow not only patients to be happier,

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Speaker 2: but allow providers to be able to operate at the

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Speaker 2: top of their license.

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Speaker 1: I love that and the implication that through the implementation

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Speaker 1: of technology or removing barriers that patients might run into

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Speaker 1: otherwise that could even potentially discourage them from seeking care

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Speaker 1: that would otherwise be transformational in their lives. People who

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Speaker 1: genuinely need those services are able to get them with

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Speaker 1: as few bottlenecks and pain points along the way as possible,

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Speaker 1: and anything that makes that smoother is a huge benefit.

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Speaker 2: If it's okay, I'd love to give one other example.

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Speaker 2: A significant majority of our patients go through processes to

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Speaker 2: see a provider and they choose to give a patient

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Speaker 2: what's called a specialty pharmaceutical. Specialty pharmaceuticals are very high cost,

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Speaker 2: they're hard to get a hold of, they're hard to deliver,

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Speaker 2: they're very difficult to administer, and any patient who's had

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Speaker 2: to go through one of these processes knows how fragmented

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Speaker 2: it is. It's not easy to find the drugs, it's

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Speaker 2: not easy to get them in their home. They're expensive,

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Speaker 2: there's not good follow up. By using technology and a

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Speaker 2: better care model, we've been able to make it so

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Speaker 2: that we could have liaisons working side by side with

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Speaker 2: our doctors. They can be able to look and identify

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Speaker 2: patient's insurance and their benefits to get them the right

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Speaker 2: structure so they have the right copays. We've been able

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Speaker 2: to integrate into our electronics systems so that we can

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Speaker 2: get the drugs ordered seamlessly and make it so that

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Speaker 2: patients normally would get these drugs within two to three weeks,

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Speaker 2: we get to to them within two days. We have

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Speaker 2: follow up processes with clinical pharmacologists and pharmacists that are

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Speaker 2: following up with the patients to be able to help

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Speaker 2: them so that if they happen to be taking something

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Speaker 2: like an oral chemo, they not only are more educated

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Speaker 2: about it, they know what to do, and if they're

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Speaker 2: getting side effects, they don't have to come back in

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Speaker 2: through the ED. They can take care of it in

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Speaker 2: their home. That type of care model transferation using data

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Speaker 2: and people has led us to having a system where

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Speaker 2: our net promoter score of that care model is around eighty.

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Speaker 2: Patients absolutely love it it's thoughtful and to your point,

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Speaker 2: it also helps the doctors. Prior authorizations is the process

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Speaker 2: our doctors have to go through to get approval to

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Speaker 2: get patients their medications. We've now been able to enable

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Speaker 2: that with this care team, so the doctors don't have

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Speaker 2: to be the one doing the prior authorizations. And this

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Speaker 2: whole model has led to better quality, a better patient experience,

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Speaker 2: and overall a better experience.

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Speaker 1: When I was doing research before speaking with you, one

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Speaker 1: of the topics I came across was a collaboration with

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Speaker 1: Royal Phillips, and I was wondering if you could talk

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Speaker 1: a little bit about that and how New York Presbyterian

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Speaker 1: incorporated Phillips technology for things like remote monitoring, and how

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Speaker 1: that system works both from the provider side and from

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Speaker 1: the patient side.

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Speaker 2: The telemedicine was a key component to what we needed

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Speaker 2: to do for our patients. We were very early on

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Speaker 2: in the journey at the time. I think then we

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Speaker 2: did about one thousand visits in a year, and then

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Speaker 2: the next year we did about ten thousand visits, which

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Speaker 2: at the time we thought was just unbelievable. The year

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Speaker 2: after that we did two hundred and fifty thousand visits

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Speaker 2: and then five hundred thousand visits and it started to compound.

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Speaker 2: Now to say that today is not as much of

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Speaker 2: an achievement because we all know when COVID started and

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Speaker 2: in twenty twenty eight we did one point three million visits.

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Speaker 2: But at the time we felt, not only if you

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Speaker 2: can provide the video interaction and the expert physician, what

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Speaker 2: other things need to be there, like remote monitoring and

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Speaker 2: being able to provide the ability to get blood pressure,

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Speaker 2: heart rate, oxygen level. And doing that with Phillips was transformational.

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Speaker 2: As an example, it enabled a whole team of physician

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Speaker 2: assistants with the doctors that remotely monitor patients that are

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Speaker 2: all in an evolution and severity of heart failure, so

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Speaker 2: a patient could be at home, be able to check

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Speaker 2: their vitals based on those results, it goes to a

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Speaker 2: central team and they can help advise and guide them

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Speaker 2: with various pathways as to when it's appropriate for them

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Speaker 2: to come in or when it's appropriate to stay at home.

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Speaker 2: This will only compound and it fundamentally enabled us to

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Speaker 2: take care of patients better in the home than we're

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Speaker 2: ever able to do in the past.

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Speaker 1: And again it gets back to how connectivity enables all

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Speaker 1: of this to happen. Obviously, without the connectivity piece in place,

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Speaker 1: you can't do this. I'm curious, do you foresee technologies

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Speaker 1: such as the fact that we're now seeing low latency,

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Speaker 1: high bandwidth wireless connectivity. Do you see that playing a

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Speaker 1: growing important role in the healthcare sector as it opens

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Speaker 1: up the opportunity to do things that in the past

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Speaker 1: we've just been unthinkable.

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Speaker 2: I think in short, yes, I feel that's essential. And

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Speaker 2: now ultimately five G and some of the connectivity will

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Speaker 2: be needed. We'll definitely need that advancing technology as we

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Speaker 2: start to use more multimodal data. We currently primarily use

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Speaker 2: data from our electronic health record, which ends up to

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Speaker 2: be a lot of numerical data. But I think the

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Speaker 2: true value is and architecture that enables multimodal data. What

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Speaker 2: I mean by that is data cores of all the

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Speaker 2: imaging that's done, data cores of all the pathology, all

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Speaker 2: the genomics, all of the live physiologic streaming data, all

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Speaker 2: the exposone data. As we start to develop models using

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Speaker 2: multimodal data, we're going to need more and more advanced

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Speaker 2: technologies in terms of bandwidth and five g connectivity to

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Speaker 2: be able to run those models, so eventually we'll get

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Speaker 2: to a point of needing them.

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Speaker 1: Yeah, that to me is one of those dream applications

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Speaker 1: of the technology. The ability to do things like move

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Speaker 1: huge packages of data in the form of medical imaging

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Speaker 1: rapidly between points that don't require a physical connection. It's

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Speaker 1: almost magical in how fast it moves. I love technology

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Speaker 1: in all its forms, but when I'm starting to talk

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Speaker 1: about technology and it's potential to impact people's lives and

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Speaker 1: on the back end make things smoother, to me, that's

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Speaker 1: just a beautiful story. Being able to improve the quality

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Speaker 1: on the back end is just as important in order

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Speaker 1: to ensure that that healthcare quality is present for the patients.

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Speaker 2: I couldn't agree more.

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Speaker 1: What role is AI playing right now in medicine and

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Speaker 1: where do you see it going in the near future.

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Speaker 2: I see it in two major areas. I think it

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Speaker 2: can be used to reduce friction for our patients and

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Speaker 2: providers in very seamless ways, better care navigation, call center automation,

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Speaker 2: prior authorization provals, things that we can do to streamline

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Speaker 2: the front end processes. Those will have a direct benefit.

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Speaker 2: They will definitly reduce that burden of disease. But ultimately

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Speaker 2: I think there's a bigger vision, and that bigger vision

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Speaker 2: really is in the reduction of the burden of disease.

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Speaker 2: We have over one hundred projects that we deploy across

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Speaker 2: the system focused in these areas to help identify patients

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Speaker 2: where we can impact the mortality. Another example of one

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Speaker 2: is we do approximately twenty six thousand deliveries a year.

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Speaker 2: Moms come in when and they're pregnant, getting ready to deliver,

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Speaker 2: and they put monitors on to monitor the baby. There

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Speaker 2: are signals in those fetal heart rate tracings that can

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Speaker 2: indicate when a baby may not be getting enough oxygen,

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Speaker 2: and the obstetricians and the doctors know and have a

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Speaker 2: series of protocols in place of what to do when

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Speaker 2: that occurs. But the sheer volume of data coming in

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Speaker 2: is so large and so massive that we've now implementing

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Speaker 2: an AI system that's reading and looking at those fetal

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Speaker 2: heart rate tracings to be able to prompt the doctor

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Speaker 2: to say we think that this patient may be experiencing

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Speaker 2: some type of hypoxia meaning not enough oxygen, to be

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Speaker 2: able to identify those babies faster, so that we can

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Speaker 2: be able to intervene to fundamentally save their lives. And

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Speaker 2: it's that type of transformation that I'd love to see

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Speaker 2: us happen in cardiac in breast cancer, in neonatal situations

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Speaker 2: where there's hypoxia, that reduction of the burden disease will

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Speaker 2: be fundamentally transformational.

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Speaker 1: I'm very curious to hear your perspective on communicating the

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Speaker 1: role of artificial intelligence to say board members, for example,

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Speaker 1: how do you approach the challenge of talking about such

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Speaker 1: a nuanced and complex topic in order to get buy

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Speaker 1: in from an organizational level.

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Speaker 2: That's a great question. Facts are critical, but the story

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Speaker 2: is what's very convincing, and you hear me on this

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Speaker 2: call walking through very specific patient examples of how it

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Speaker 2: can be applied. If you look at technology adoption and

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Speaker 2: look at productivity, healthcare is one of the least productive

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Speaker 2: fields in the country, if not the world, and the

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Speaker 2: reason for that is the adoption of technology. And I

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Speaker 2: think we need to approach AI in talking through what

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Speaker 2: are the people, what is the process, and then what

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Speaker 2: is the technology. I don't think leading with AI is

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Speaker 2: a start, Otherwise we're leading and trying to find a problem.

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Speaker 2: We need to highlight what is the problem we're trying

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Speaker 2: to solve and how can technology help support solving that problem.

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Speaker 2: And if we start there and we're clear about the

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Speaker 2: communication and we use concrete patient examples, I think it

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Speaker 2: makes a lot more sense.

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Speaker 1: Absolutely, Peter, I'm curious what role do robotics play in

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Speaker 1: your healthcare system at the moment. I remember being fascinated

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Speaker 1: with documentaries in the healthcare industry about how robotics were

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Speaker 1: informing healthcare.

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Speaker 2: So there's two types of robotics. We look at physical

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Speaker 2: and we look at virtual. I'll start first with physical.

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Speaker 2: We've been able to implement robotics in various areas throughout

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Speaker 2: our hospital. We have rooms the size of let's say,

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Speaker 2: twenty foot by twenty foot by twenty and there's massive,

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Speaker 2: large robots that do all of our pharmacy pill picking,

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Speaker 2: individual pills from orders that are placed with a massive

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Speaker 2: robot that runs twenty four to seven. And then what

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Speaker 2: we call box picking, which is our ointments and our

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Speaker 2: creams and non pill medications. Two robots run twenty four

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Speaker 2: to seven. We've been using them for about six years

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Speaker 2: now and it's been transformational because what it's allowed us

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Speaker 2: to do is have some of the technicians that we're

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Speaker 2: normally in these large rooms primarily in basements, and now

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Speaker 2: move them to the bedside. So now they are the

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Speaker 2: teams of embedded care team members that are now interacting

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Speaker 2: with the patients because we now have robots that can

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Speaker 2: be able to do it, and we now have those

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Speaker 2: team members interviewing patients, talking to them about their medications,

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Speaker 2: talking to them about their side effects. We've done this

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Speaker 2: in other areas. We have physical robots that deliver food

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Speaker 2: to patients. They call elevators, they go up and down elevators,

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Speaker 2: They deliver linens, they deliver medical devices, and we've found

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Speaker 2: them to work very well. There's also an a other

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Speaker 2: area which you don't hear talked about as much, but

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Speaker 2: there's virtual robots things we call robotic process automation that

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Speaker 2: has also served us well. And those are highly repetitive

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Speaker 2: tasks that are occurring on a computer. So we have

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Speaker 2: thousands and thousands of tasks that occur the same way

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Speaker 2: every day, and how do we automate that using a

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Speaker 2: virtual robot. Like when a patient gives us an insurance card,

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Speaker 2: we have team members need to go out to a

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Speaker 2: website and validate that insurance card to make sure it's

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Speaker 2: correct and do that process. We can now do that

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Speaker 2: with a high throughput, high volume RPA process and do

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Speaker 2: it in a virtual way, so once again we can

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Speaker 2: get more people to the bedside from a care team perspective.

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Speaker 1: Before I could let Peter go, I needed to ask

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Speaker 1: him a couple more things. Is there a particular technology

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Speaker 1: that really made an incredible first impression on you, whether

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Speaker 1: in your profession or in your personal life.

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Speaker 2: I have to say, and I don't mean to bring

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Speaker 2: up a recent technology, but I can't emphasize enough how

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Speaker 2: chat GPT will fundamentally transform education information throughout our world.

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Speaker 2: I saw it for the first time, and the method

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Speaker 2: by which it's being utilized, the distribution, and the power

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Speaker 2: and potential of that technology is going to be fundamentally

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Speaker 2: transformative for us over the next ten years. And that

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Speaker 2: was probably one of the most impressive things I've seen

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Speaker 2: since the advancements that have occurred in early twenty ten

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Speaker 2: in other areas.

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Speaker 1: What advice would you give to other tech leaders in

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Speaker 1: the healthcare space.

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Speaker 2: As my prior boss used to mention, it's all about people,

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Speaker 2: process and technology, and I think it's some of the

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Speaker 2: best advice. It is all about people. The technology works.

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Speaker 2: The technology has worked in every industry. It's all about adoption.

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Speaker 2: It's all about working with the providers, working with the

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Speaker 2: care team members, and working with the patients to drive adoption.

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Speaker 2: And that's critical for us as healthcare leaders. And as

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Speaker 2: we see that adoption accelerate, we're going to see productivity accelerate.

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Speaker 2: We're going to see more patients taken care of, we're

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Speaker 2: going to see less mortality, we're going to see better outcomes.

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Speaker 2: And I think that is truly the exciting part of

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Speaker 2: where we're going to go with the digital transformation.

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Speaker 1: Peter, thank you so much for joining the show. I

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Speaker 1: really appreciate it. This has been a fantastic conversation.

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Speaker 2: Jonathan. I can't thank you enough for having me on today.

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Speaker 1: Peter's deep background in medicine and patient care clearly play

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Speaker 1: a pivotal role in his leadership strategy and leadership decisions

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Speaker 1: take on a new meeting when the outcome of those

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Speaker 1: decisions has an undeniably critical impact on patients and caregivers alike.

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Speaker 1: I was struck by how advanced technologies that will change

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Speaker 1: healthcare are built on the foundation of connectivity. It wasn't

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Speaker 1: that long ago that the tools doctors and nurses had

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Speaker 1: at their disposal were limited. That healthcare professionals took all

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Speaker 1: notes by hand, and those notes had to be entered

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Speaker 1: into medical records that weren't always easy to share or access.

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Speaker 1: But digitization and connectivity have created opportunities to change all that,

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Speaker 1: and the thought of five G enabling high tech medical

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Speaker 1: processes is really exciting. Reducing the amount of time spent

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Speaker 1: sending large image files across a network can literally save

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Speaker 1: a life. Be sure to join us for more episodes

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Speaker 1: of The Restless Ones. We'll be talking with more incredible

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Speaker 1: leaders about their approach to leveraging technology and how this

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Speaker 1: tech creates opportunities even in places we never thought to

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Speaker 1: look before. Until next time, I'm Jonathan Strickland, and this

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Speaker 1: is The Restless Ones.