Ancora Imparo (ft. Brooke McSwain)

Thanks for tuning to Digital Voices Podcast, where we chat digital transformation, challenges, and opportunities across healthcare and life sciences. And now, your host, Ed Marx. Ed Marx here, Digital Voices. Welcome. Today we have as our guest Brooke Yeager McSwain. Welcome, Brooke.

Thank you. Glad to be here.

So what I'm excited about is we're going to get into a topic that we don't breach very often, and that's really— we met through your husband. So your husband's been a previous guest. He's a fantastic person, but he said, hey, Ed, you might think I'm pretty cool, but there's one person much cooler than I am, and that's my wife, Brooke. And so, Brooke, that's how—

Yeah, he has to say that. He has to say that.

Yeah, he's a very smart husband right there. But Brooke, so, you know, because you've heard your husband's podcast, you know what question's coming next, and that is, what are the songs on your playlist?

Yes. So I was just— I just flew in from DC last night, and on the, you know, I only— I download Spotify, and I was listening to Revisionist History. So that's my podcast. I like to do the Malcolm Gladwell. But I knew this was coming, so, you know, I was looking at the last I was listening to, and it was Canary in a Coal Mine. Please love it.

Oh my gosh, yes, I love it. It's one of their first—

It's running through my head right now.

I love that song. Oh my gosh, yeah, it's off of one of their first couple of albums, I think. And, uh, yeah, that's awesome. I love that. And Revisionist History, I'm totally down. One of my go-tos. My only complaint Is that they don't drop— unlike Digital Voices, we drop every week. Revisionist History has seasons and they don't drop quite as often.

Yes, that's true. But I don't fly as often as I used to, so it serves its purpose still. Yeah, it's often enough for me.

He's so fascinating. I've loved his books. I've heard him speak. And yeah, the podcast is just almost too much. What about any sort of life message or mantra, words that you live by, Brooke?

Yes. In my office at home in Charleston, I have the big letters over my office door, which have been over every office door for almost— for a little over 20 years now, which is Ancora Imparo, which is Latin for I am still learning. And that is what I base sort of my life around. I have a deep curiosity about life. I really enjoy learning, just the process of it itself and meeting new people. And I feel like if I'm not learning, I'm in a rut. So that has been a mantra for me for a long time. Learn about all kinds of different things, not just your stated profession, but, you know, go out and find new things and meet new people. And I think that's how to live a good life.

Brooke, I love it. Say the Latin one more time.

Sure. Ancora imparo.

All right. I'm definitely looking that up. I've got some Latin permanent on my body. That sounds like a really— that's like a really good— another excellent Latin phrase right there. Hey, tell us a little bit about yourself, your story, just how you came to be who you are today.

Sure. Well, so I had a really weird upbringing, or it was interesting. I didn't know at the time, of course, that it was going to be unique. But I am the only child of 2 only children. They— my parents are both college professors, and we grew up together. They were very young when I was born, in their early 20s. And we moved around the country for every degree and every first job. So I got to see a lot of the country. I was always the new kid. And I got to meet a lot— there was a lot of international folks around because my father was an international communications professor. And my mother was an economist. So there was no shortage of interesting debate at the dinner table. But I used to just hang out with my father a lot in the summers because he had the coolest offices. For some reason, economists have boring offices and communications professors are always in the old cool building. And so I would hang out with my dad a lot and we moved to Louisiana, Southern Louisiana, Lafayette actually, which is the heart of Acadiana for your listeners who do not know and is just very culturally rich. And I think I was 6 when we moved there. And I would go hang out with my dad during the summers in his very cool communication building that upstairs had the theater department, costume department, and wigs and makeup, and down the hall had the radio station. And so I grew up in that radio station in the summer because they were very tolerant of me and I was well-behaved as an only child. I was good at talking to adults. So I would just go hang out in the radio station all day long. And I met some folks who were pretty formative for me. I met B.B. King when I was very young. I met Stevie Ray Vaughan, Paul Simon. I got to sit around. I even met Ella Fitzgerald once. I got to sit around and listen to these people sing and talk about their lives and did not realize how lucky I was until I got older.

Wow.

And got to spend a lot of time around my dad's international students. I, you know, I just had a really fascinating upbringing. And for some reason, I guess because I wasn't raised so much around other children, I didn't have any cousins, obviously, there was no family around.

Right.

I loved TV, like every good child of my generation. And I had a love of politics growing up, born no doubt from the fact that my mother started out as a political reporter and my dad was a news anchor when they first got together. So I had that in my blood. Yeah. And they make fun of me for this all the time, but I had roller skates that year for Christmas. I was 7. And I was roller skating around the kitchen table and watching the convention, the Democratic National Convention that year. And Barbara Jordan came on to speak.

Mm-hmm.

And I don't know if people remember Barbara Jordan, but she was a senator from Texas, a Black woman in a wheelchair. And she was such an incredible speaker. She grabbed my attention. And as a 7-year-old on roller skates, I sat down at the kitchen table and listened to Barbara Jordan finish her speech and was in tears by the time she was done. And that's when I knew I was going to do something in politics or medicine. And I couldn't decide. Went back and forth. So I did a lot of going back and forth. I majored in poli sci, actually, initially. Um, in college. And then I did my internship, got all the way to my internship and went to a law firm and hated it.

Mm-hmm.

Um, and so then I went back and I did sports medicine and I loved that. And I was an EMT for a while and I worked my way through exercise phys, got on up to, um, I worked in outpatient physical therapy, went back to respiratory therapy school, which was fascinating. I thought about going, uh, into nursing, but I really like emergency situations. I'm calm in those kinds of situations. And so that appealed to me. Respiratory therapists are like the 911 of the hospital. So you can imagine what we see on a daily basis.

Right.

And so I went and got my master's in respiratory therapy and worked for quite a while there, ran a cardiopulmonary rehab program for transplant patients and general populations as well. Um, did some research, uh, for a while. And then while I was at the Medical University of South Carolina, which is where I met Dave, um, I got recruited into telehealth. So, um, back in like, back in 2014, which, you know, in telehealth is like dog years. So that's a super long time ago. Um, but yeah, I've been in telehealth and policy ever since. I went back and Got another degree from Hopkins in government and political communications. So it's all in a loop and everything has somehow turned out to work together. So.

Yeah, that's a pretty fascinating story because yours actually makes a lot of sense, right? So many people, our stories are sort of fragmented, like this kind of happened, this kind of happened, but going all the way back to your youth and your parents and the professorships that they had and the things that they did. And then also the music, right? The passion that you have on a personal level, singing and things like that. I mean, it all came around. So it makes total sense. Like, you're this policy wonk now, right? You're like this expert in policy. And so that's pretty cool. So let's jump into policy because that's not something we've covered very often on Digital Voices. So I want to kind of go on a macro level on policy for those who might not have a clear understanding, and then we'll jump a little bit more into detail on the AHA policy and the sort of things that you're working on. And so this will be super fascinating. So what is policy? So let's just start at a very basic level. What is policy?

Yes, begin at the very beginning. So policies are essentially just laws or regulations that define for us the space that we are working in. And so in our case, that's healthcare. And policy analysts work in either the national or federal space, and they spend their time amassing and evaluating data, understanding the current and future needs of the space, the healthcare space in our case again. And then we make informed decisions about the efficacy and existing policies that we have, and then we try to lay groundwork for new and evolving programs and policies. I might say, I think it's probably important to note that there is a difference between big P policy, that's what we call big P policy, is the national and federal, right? And small p policies, which are more, which are not small in terms of importance, but are called small p policies because they govern institutions and smaller organizations. And so, Those of us who've worked in hospitals are very familiar with the small p policies of, you know, like JCO visits, fun stuff like that, how hospitals run, you know. So, I think, you know, it's important to note that there's a big difference there between the two. I think that's the broadest definition I can give you of what policy is.

No, that makes perfect sense. And I like the big P and little p and how they're both important and actually Interrelated. So why is it important? So many of our audience are executives in digital tech, and why is it important to have an understanding of policy?

Yeah, well, it impacts your day-to-day life, right? I mean, meaningful use came out of an Obama-era policy, and it was well-intentioned, it was patient-focused, But the evidence wasn't really sufficient to implement the programs appropriately. So here we are, right? Still dealing with all of this, you know, all the MIPS and MEPS and all the fun stuff that we deal with constantly.

Yes.

And, you know, I think that it's just important to understand that we— and I don't have to— I'm preaching to the choir on your— on to your audience here, but data is the currency right now in healthcare, right? And so data policy is a really monumentally important policy space right now. So paying attention is a good idea. Otherwise, we're going to end up in another situation like meaningful use.

Yes. Right. Yeah, you have to engage and participate and understand because Yes. You don't want to be the recipient of poor policy. So the only way to ensure, right, that it's good policy is to get engaged and be a part of it. Be a good citizen. Yes, exactly. How should an exec, like, again, not directly involved with policies such as yourself or government relations, which many of these hospitals and health systems have, but as an executive, Are there some tools? Are there things to track, or listserv, or websites, or blogs, or podcasts? How do you keep engaged in understanding what's coming down?

Well, I think if I were going to tell an exec, and I do tell an exec daily what they might want to be focused on, I think listening to, tapping into Politico, they have really great free newsletters that they put out. They're not as in-depth, but they're a great brief read on morning tech. They've got a morning tech one that comes out. They've got e-health. And there are lots of services like that, stat news.

Yeah.

And those listservs, and they're fantastic for talking about the kind of policy that you might be interested in, whatever your given field is or specialty is. I think also though, You know, maintaining a really good relationship with your GR staff at your institution and going through your professional society is really important. Whatever that professional— whether that's HIMSS, whether that's, you know, or whether you're a practitioner and that's, you know, the AHA or it's AAP or it's whatever, ACC, whatever, you know, your professional society is, their job is to leverage the expertise of their Constituents, right? And so they do lots of great programs locally and nationally. So on the Hill, there are lots of Hill days, and we're always looking for, you know, passionate and informed voices to bring with us to advocate for legislation and initiatives.

So yeah, that's, that's really great. Those are great ideas. And it reminds me, I've been fortunate to serve in some great organizations, and the GR, government relations staff, was very active, and they would proactively reach out to me or other people that might not normally be in-depth in policy whenever there was something coming up, like what do we want, you know, the Texas regulations to be around telehealth? You know, we need to get involved and help, like we were talking about earlier, and help push the agenda to make sure that it serves our clinicians and our patients the right way. So yeah, those are really, really good suggestions. So Brooke, we've talked about, you know, policy at the macro level and then the small p and capital P, and then we talked about why we should be engaged with it and how we can be engaged with it. Now let's take a step down into the AHA. Tell us about your role in the AHA and then what does AHA do with policy?

Sure. Well, I am the national— I just got a new title. I am the National Policy Research Analyst and my portfolio is digital health, public health infrastructure, and systems of care. And so what I do on a daily basis is pretty much what I said earlier about policy analysts. I spend a lot of time understanding the environment we're working in, both political and just healthcare, and amassing data, looking for trends, doing some deep dives on that data to understand what would make for best policy and evaluating the policies we have. A great example of that is HIPAA, right? We've got a lot of work to do to modernize HIPAA. We've got a lot of work to do around data modernization in general. As I said, data is really our currency right now in healthcare, and so how we exchange it securely how we, how we continue to build upon our infrastructure, which— but we don't— and let me just give an example. I mean, I'm kind of— we're doing forecasting right now for the upcoming Congress, right? And it can be pretty confusing given the current— I mean, it's always confusing when you get a new Congress in, but right now it's particularly challenging. But, but we're looking to see what trends we see coming up now. And I think Bernie Sanders is now the chair of the HELP Committee, which oversees healthcare and some other stuff, labor. And he is very public health friendly. And so I foresee maybe working on workforce issues in public health, training workforce, both existing and new, in IT. Working on our crumbling infrastructure. We're going to get ourselves, if we're not already there, and I think we are kind of already there, into a Southwest Airlines kind of situation where we're sort of not able to— I mean, COVID pointed to the fact that we weren't up to task. We did not have the infrastructure to deal with that kind of response. So we've got to work on building up our surveillance, syndromic surveillance capabilities. And that's all data modernization, right? So, we have a lot of work to do there. And that's what I work on, on a daily basis. And, you know, I'll tell you, the reason I was drawn to the AHA initially was because they're a science-based institution. And our currency, our trade, is in being the most trustworthy voice in the room.

Yeah.

And they really live that mission. And I thoroughly enjoy being on this small team of 5, just really bright, engaged policy professionals. And we cover a huge swath of policy issues. This is my world, and I'm engaged in data modernization and all of the privacy issues and everything. But there are folks who are doing air quality and nutrition and farm bill stuff.

Yeah.

And, you know, so we're kind of all over the place, but we cover a huge swath of stuff. The AHA has just been an amazing place to work, and I learn on a daily basis, which, as we mentioned earlier, is sort of my goal in life. So, yeah, it's great.

It's awesome when you, when you work with, serve in an organization like you're describing. And I agree with you, the AHA has a tremendous brand, you know, a trusted brand, and it's people like you that are doing good work and being bipartisan and all that kind of stuff, you know, and it's tricky.

Yeah.

Tricky, tricky world. So you mentioned the sort of digital and, you know, you have this background in telehealth as well. What are you able to comment on sort of where you see things going? You know, there's all this concern, right, with telehealth video, the parity of office visits versus in-person visits. And as we know, because of COVID there's been some extensions in terms of payments and favorable payments. Can you comment on either, you know, from an AHA point of view, like where you'd like to see this go or how you're maybe looking at this?

Well, I think where we're going is actually where I'd like to see it going, which is unusual. So we're gonna celebrate that for a minute. You know, I think Congress, one of the— there are actually bipartisan issues. Not everything is partisan these days, even though it feels like it. And one of them is telehealth. A lot of it is digital health. And telehealth in particular, there's been no real incentive to have to make a decision yet. And Congress has been told repeatedly by the AHA and many other of our collaborators and sister organizations that we don't have the data yet. We just had this massive pandemic. And I know you've heard this on your show, I'm sure a million times, but we've got this huge trove of data.

Yeah.

But now what are we gonna do with it, right? We really have to understand that. We've gotta understand what kind of gaps it's left. We've gotta look at equity issues. We've gotta look at quality and safety issues. We've gotta look at usage and utilization. And, you know, I think we just need time. That kind of thing does not just occur overnight. It requires a lot of collaboration and a lot of research, and we just need the time, and we need the flexibilities maintained so we can continue to have that information coming in. And that's what Congress has pretty much agreed to do. So I suspect that even if the PHE ends in the spring, and, you know, we saw in the omnibus that there's a 2-year extension of a lot of the telehealth flexibilities.

Mm-hmm.

I think we're gonna keep seeing some extension work to allow us time to organize ourselves and really get good informed research. And so we can make evidence-based decisions. I think that, Something that's really important for folks who are researchers in the field of digital health is to understand that you might wanna start working on research that answers some of these policy questions and not the other way around. Don't just—

Yeah.

Go out there and do what sounds fun to you. Look at where we're headed and what our big questions are and point your research in that direction because the time is right. We are here now. And we probably have a good 2 years before we have to really lock down and, you know, put some of these guardrails permanently in place.

No, I love that suggestion, Brooke. You know, as we're doing these things anyways, might as well codify the data, take a research point of view, even if you're not a research organization, but, and all this care that you're giving, you know, looking at the outcomes and then publish it and report on it. And that'll only help us, you know, continuing down this sort of digital transformation pathways. So that was really good, Brooke, talking about AHA and the policy things that you're working on is awesome, but you're also a great leader in person. So I wanna sort of finish up on a couple questions more along the lines of leadership.

Okay.

And, but, but, you know, you're, you're, you're not the first couple that's been on Digital Voices.

Yeah.

And, you know, I'm sure other people listen that are, you know, especially when both work in healthcare and they kind of like wonder, Hey, how do you make that work? So, so obviously your husband is a physician and how do you separate, or do you separate sort of like on, you know, when you come home over dinner, do you separate sort of the work life? How do you make it work?

I'm gonna be really honest. We don't. I mean, I'm kidding. I mean, we, we really don't separate a lot. You know, we started working together. We're both really passionate. about— it's just sort of built into— I think our parents on both sides really built into us that you got to leave it better than you found it. And this is just— these are our lanes. And so, and we share that. And honestly, most husbands and wives don't come home from a day of work and understand what the other one's been doing as well as we do. So, there's a real joy in that.

Yeah.

And we enjoy a good debate. So our dinners are never quiet. But, you know, we do— when it gets too much, and this sounds crazy, but it's really true, we have built a bar into our garage. It is a karaoke bar, and it is encased in cement because we lived in a raised house in Charleston in a floodplain. And we go down there and we just sing at the top of our voices together and enjoy ourselves.

All right. I'm definitely coming down next time I'm your way in the Carolinas. I'm coming down and we'll do some police. Sounds like we probably have police in common and some canary coal mines.

Let's do it. Yes.

That sounds cool. Yeah, my wife also is a clinician, and so it's kind of nice because you don't have to explain every— everyone sort of understands if you talk about, well, we had this situation at work. There's an immediate understanding. Or we're talking about virtual care. She understands virtual care. So, so there is some definite pluses to it. In terms of leadership, what's, what's the most important advice anyone ever gave to you? So when you think about, you know, your own leadership and your development, you know, is there someone who gave you some, some advice that you have leveraged?

You know, this isn't going to sound like it's leadership related, but I think the best advice I ever got was actually from an EAP. So somebody in the organization who worked in employee— I can't remember what EAP stands for, but basically a shrink I went to see because I was so stressed out and so burnt out that the university provided. And we were just talking through stuff. And I said, you know, she said, what do you want out of this? And I said, I just want to be able to do my job and be happy at the same time. And she said, then you better learn to love yourself. And then you better put all your time into making yourself as good as you can be every day, and the rest will follow. And I did. And I'll tell you, it works. It works. Yeah, it's a viewpoint. Yeah, it's a viewpoint. And if you can shift it from always being right, always whatever your problems are at work, if you can shift it into understanding that you're doing this for a larger reason or a larger purpose, everything does sort of fall into place.

Yeah. And I'll say one, I'll call one other thing out that I recognize in you is humility. So I think that was a great example with employee assistance program, I think is how they were referred to in the past, EAP.

Yeah.

And, you know, you're a very humble person as well. So I think that has served you well in your leadership. So we covered a lot of ground, and this is really, I learned a tremendous amount, you know, all the way again from From, uh, not only the beginning of you and Dave, but, you know, the policy and your background is just fascinating as well. And sometime we'll have a separate podcast on all the singers that you met. But, you know, everything on policy and then the AHA stuff, your karaoke in the basement, um, you know, all the, all the different things we spoke about. Is there something that we missed or something, Brooke, that you want to double down on?

I don't think we missed much. I mean, you're very good at that. You're pretty good at this. So I don't think we missed much. But I guess in terms— I would just like to reiterate that there really is a need to have healthcare professionals actively engaged in the policymaking process. I mean, you know, we're already in a broken system, and now it's faced with adapting to this really rapidly evolving technology and globalization, which is very challenging. And the only way we're going to make that better is to share our knowledge and collaborate. I mean, you really— it goes back to my Barbara Jordan moment. You know, you really have to learn to be a good citizen. You got to share. You got to dig in and do the work, and you got to share. So if you're, you know, if you're an exec out there and you don't normally think about policy at all during your day, maybe just Devote a few minutes a day to maybe just go out and, you know, and subscribe to Policy eHealth— I mean, Politico eHealth, or whoever the person, the deliverer of your choice, Vox, whoever. And, and just spend a little bit of time getting to know, getting immersed in the issues and advocate or encourage your staff to do so. It's really important. We need you.

Brooke, that's a beautiful way to end our session, you know, where we focused Heavily on policy. Thank you so much for being our guest on Digital Voices. Thank you for listening to Digital Voices podcast with Ed Marx.

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