Digital Transformation of the Future (ft. Dr. Dave Levin)

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 here with another episode of Digital Voices. Really excited to have another physician leader as our guest. Dr. Dave Levin is joining us. So welcome, Dave.

Thanks, Ed. It's really good to be here. Nice to connect again.

Yeah, no doubt. And I can't wait for you to be able to share with our audience a lot of the perspectives from a leadership point of view on digital and what we can look forward to. And Megan, as we jump in, how many physician executives have you worked with? I know you're early in your career at Divergent, but have you run into many physicians who've been both a clinician as well as an executive? Not really, no. Although since working with you on this podcast, I feel like I've had the honor of sitting in on some really great conversations, but not really directly, no, not so far. Yeah, it's a great combination when you have a clinician who understands digital and applies that and takes a leadership role. And so we have so much to learn from individuals like them. And so Dave and I first connected when I first showed up at the Cleveland Clinic. So Dave, I don't remember the precise circumstance, but I know you were in town. And you were like, hey, Ed, I'm happy to share with you my perspectives at the Cleveland Clinic because you, I believe, were the first— were you the first CMIO?

Yeah, I was their first CMIO. That's correct.

Yeah, so you pioneered this whole sort of— you're one of the pioneers for the whole CMIO track and one of the leaders. And you were so gracious with your time with me, kind of filling me in on the background since I was new to the organization and getting some of your insights. So I always appreciated that time that we had together. And I still remember the restaurant. I still remember sitting outdoors with you, and we just had a great time.

It's true. You know, Ed, I have a completely different perspective on that meeting. So from my perspective, you are one of the gods of healthcare informatics and, you know, a larger-than-life figure. And so for me, it was like, hey, I've got an excuse to go grab some of Ed's time. So it was— I'm glad you feel like it was useful. For me, it was a wonderful opportunity to establish a more personal relationship with you. And, and like, like you, I remember the evening very, very clearly.

Yeah. Well, thank you very much. As you know, it's all about the team that you surround yourself with and the organizations that you align yourselves to that make for such great experiences. And yeah, I really enjoyed my time. I, I felt the same way and still do about you and, and what you bring as a leader, as an innovator, and, and just plain as a friend of mine. And so we'll be talking a lot today, but the first thing everyone wants to know, Dave, is what's on your playlist?

What's on my playlist? Yeah. You know, I'm a big Phish head. I love improvisation. So I like jazz and I like jam bands. And so my playlist right now is— Phish is on the summer tour. So between Phish and the Trey Anastasia Band and Trey playing solo, and he sat in with Billy Strings recently and set off quite a sensation. So pretty much it's live Phish all the time on my playlist.

Very nice. The other question people always want to know is, what is your life message or mantra or, you know, passion? You know, what really drives Dr. Dave Levin?

Yeah, it's really 2 things, if I could. So the first is I've really come to believe, Ed, that it is true, if you want to change the world, go form a small group and go change the world. I think that's how real innovation and real transformation starts. And so I'm always looking for Those kinds of groups, or if I personally want to stir up good trouble, that's usually the very first thing I will do. I'm grateful that we have large organizations and large groups, but I really think most of the truly cool, rapid innovation starts within a much smaller circle. And then my other mantra is balance. And I got that from my dad very early on. And, you know, that applies to just so many different aspects of life. And I've actually become even more formal about that. Culture is of great interest to me. And there's this whole concept of polarity thinking, and it's basically this idea that most things are not yes or no. They're not binary. They exist in tension. So for example, Ed, is it better to breathe in or breathe out? The question really doesn't make sense. And I think I spend a lot of my day trying to look at problems from that polarity perspective, that balance, because I think we tend to— get in one camp or the other and we forget actually what we're after here is to get the best of both and minimize the downsides of each. So a favorite here right now is, do you work remotely or do we make everyone come into the office? I think the answer is yes.

Yeah, no, I love that thinking because you're right, that really stifles innovation as well. You know, that's what we'll be talking about is healthcare technology, digital innovation. And if you force yourself into sort of that binary thinking, which we're sort of raised to be, Right? It starts in school very early. It really limits your opportunities for sure.

Yeah, it does. It does. I think it generates conflict that's not productive.

Right.

And instead, when we can get people into think into a polarity mindset, it actually can shift that conflict to be very productive.

So tell us a little bit about your story, Dave. How did you— you can go as deep as you want on the personal side, but how did you become who you are today?

And I usually describe myself as the Forrest Gump of healthcare. I really feel like most of my career, I just wandered into the frame and there were cool, smart people doing really neat things and they let me hang out. And as you said earlier, so much of this is about team and I think I was just very fortunate to connect with a variety of teams over time. I do think there's a lot of truth in that Warren Buffett statement about luck is when preparation meets opportunity.

Yes.

The other thing you touched on earlier was about the kind of boundary crossing of being a clinician and knowing something about IT. I think that's a really powerful idea for any boundary crosser. And so a lot of my career, frankly, has been being knowledgeable about multiple areas that aren't— don't normally come together in the mix. And it's allowed me to think about problems from a different perspective or to bring really basic concepts from one field that would look really advanced in another field. And I'm sure you've seen that as well. You're marinated in informatics and then you come into healthcare and all of a sudden you just see dozens and dozens of opportunities that your colleagues on the operational clinical side might not see simply because they don't have that IT experience. Take all of that and the only way to make any sense out of my career, my dad used to say, it's a really erratic career. And I say, no, Dad, it's eclectic. But the theme has really been Looking for a bigger and bigger lever to affect change at scale. So I started as a clinician seeing patients one by one. I gradually got more involved in managing the operations of a practice and then multiple practices. And then when the big push came to deploy EHRs and begin to really digitalize healthcare, I was standing in the right spot at the right time. The opportunity at Cleveland Clinic, and then that's led to some other entrepreneurial opportunities. But That theme has been there, which is cross-fertilize different fields and look for ways to have greater and greater impact at scale.

I love that. And Dave, were you like in high school one day and you woke up and was like, I'm going to be a physician, or how did that come about?

It's a crazy story. I'm of that generation of the dawn of the personal computer. So I read those same articles in Popular Mechanics that Bill Gates read and others. Obviously, Bill's had a much more successful career than I did, but it really I had an older brother who was training to be a pediatrician. And so, as crazy as it sounds, really from about the age of 14 or 15, which would have been in the mid-'70s, I saw this potential for information technology in healthcare. Now, I couldn't be specific about it. It was more of an instinctual thing. And I had a first career in IT, and then I went to medical school. And the intent was to combine the two. What I realized as I was finishing my clinical training was, you know, healthcare is not really ready for this and the technology is not really mature enough either. So I ended up doing a bunch of other things and doing some small informatics work until the big revolution started in the late 2000s.

Yeah, that's pretty cool. And yeah, the background makes sense. And, you know, I'm just thinking out loud here, you know, the commonalities that I hear between you and a lot of the other fantastic leaders that I've spoken to is around the concept of humility. You didn't use those words, but your description, Dave, as you talk about your early career or how you came to be who you are, there's a lot of humility wrapped in there. And, if I just think about one of the keys to super successful leaders, and not all leaders are humble, but at least the majority or all of our guests have been, I just find it super interesting. You know, as people tell their story.

I have a mentor here at Flowd, Mr. Bob Mooney, and one of the things that Bob talks about is striving to be humbly confident.

Yeah.

And I just think that's such a beautiful way to think about it. So we do need to be humble for lots of reasons, not the least of which is we're wrong a good part of the time and we can't do it by ourselves. But we also have to have some confidence or no one's going to follow us or we won't have faith in ourselves. So it's a very interesting kind of balance there.

Right. Yeah, I was going to say it goes to the boundary crossing, as you mentioned earlier, is being in and going in between. It's not either or. It's both. So yeah, I love that. So we were just talking now about your story and sort of how you got there and become an early pioneer. And you just jumped right in because you had this sort of this tech bent to you already. And when you look back historically— and I won't limit you to a time frame— But what are some of the major shifts that you've seen in the last few years? We'll talk about the future in a minute, but sometimes it's good to look back and see, okay, we've made some major shifts here.

I think the reality is when you and I started our careers, healthcare was done on paper. I mean, there were pockets that were digitalized. And I would argue most of what we've accomplished in the last decade plus was the basic digitalization of healthcare. We got folks to put down their pens and start using a keyboard. I know that can sound like really simple or an understatement, but as you and I and the folks that did that work know, that was a huge accomplishment. It was the laying of the foundation on which we're going to build everything else. What I see happening now is the sort of next logical steps to follow that. And to me, it's about things like better interoperability. We have tended to focus on the technology part of what I call the iron triangle of people, process, and technology. I think there's huge opportunity to go back And focus on the process part. So how many of us really did careful process redesign as we were doing that initial digitalization? Some did, some didn't, some did it to a great degree, some to a lesser degree. That's a— it may sound boring or not fun or whatever, but I'm telling you, there's huge low-hanging fruit there. And then I think the other is the people part. And some of that is technical. It's about human factors and reliability. But I'm going to make a kind of radical statement here. I've come to believe that the biggest barriers to advancing technology in healthcare are cultural. They're not technical. It's not to say there aren't technical issues, but those are things we can manage through and chip away at over time. I really believe the biggest opportunity in healthcare IT and candidly in healthcare in general is cultural. And so I'm gonna get on my soapbox here for a minute. You may need to knock me off, but I've become kind of an extremist about this. I actually think culture is the work and everything else is a byproduct of that. Now, that's a little bit of an overstatement, but to my mind, it's not a huge overstatement. That if you get culture right, and as leaders, if we focus on that, Our teams will get the tactical stuff done. They'll figure it out themselves organically.

I don't think that's overly radical. I think the world, I think that healthcare specifically is coming to that realization that, you know, not to overuse, you know, trite statements, but, you know, culture eats strategy for lunch and that sort of thing. But it's true.

It is true.

And we know we've lived it. And yeah, a lot of the success and failures of programs have really come down not to the tech, but to the culture. Absolutely. And, and I, and I agree with you too on, on sort of the things you were saying about process. We didn't spend enough time on process and where we did, we got fixated with, you know, I'm gonna come out with my own radical statement here and say Six Sigma is dead. It's really about human-centered design. It's more about looking at the entire workflow workstreams instead of little pieces of it. Because what we did is we did really good process improvement techniques in certain areas or Six Sigma, but then We never thought about it from a longitudinal point of view. And I think, yeah, so people are going back now, right? And they're redesigning and then addressing culture and things like that. So I agree with you. I think people might have expected, oh, we're going to have hospital at home and we're going to be able to do pharmaceuticals within your— controlled substances within your house, which is true. And I know we both would advocate that. But the real issues, again, like we're talking about, it comes down to culture.

It does. There's still— like you, I love the cutting edge, and I'm fascinated by what things might look like in 20 years. But I also believe there's some really basic blocking and tackling that we still need to do. And there's tremendous value to our organizations in pursuing those things.

Dave, if you were— and we're going to talk about what you're doing today in a couple of minutes. I really want to know more about it. And I know our audience does as well. All about flow. But before we get there, knowing everything you know today, and including what we just talked about culture, if you were to go back to a hospital now, you get hired as CEO, and you go back, what should hospitals do now in terms of digital transformation? What should they— because a lot of them are sort of late to the game, right? Some have just finished implementing EHR. And even the advanced ones, 10 years ago, they didn't have an EHR either. So it's all pretty new. But what should hospitals do now in order to succeed in the future? I'm going to—

I'm gonna make a generic statement, and then I'm gonna talk about analytics a little bit. So the generic statement is, these things should be led by operations. It really should be the operational leaders deciding, this is our strategy, and this is the kind of technical enablement that we are going to need to execute that strategy. And then I think the role of our IT colleagues and others is to, first of all, translate that into language that our more technical colleagues can understand, and also to partner with our operational colleagues because there's a give and take there.

Right.

Often, a lot of my experiences, my operational colleagues will show up and they'll tell me the solution, which is not really what I want. They'll say, I need application X, and and I say, okay, well, tell me more about it, because what I really want to understand is what's the problem you're trying to solve or the capability you're trying to create? And then I will help you figure out, does technology even play a role here? And oh, by the way, we got to talk about process and people. And of course, they don't like it when I do that because we'd like to just throw technology at the problem and solve it. But my experience is that doesn't usually work very often.

Right.

And then, so then to be really, really concrete, I think the other area is what I call actionable insights. It's analytics that can lead to action. And I think this is another area where we had big promise. We really thought we were gonna hit it out of the park. We'd do the basic totalization, all this data would be exhaust out the backend, and then we would have this mind-blowing analytics that would tell us what to do. And I just haven't seen that in nature yet. Maybe you have, or maybe there's pockets of it. And I think you and I also lived through that age of the giant data warehouse. So, you know, we'll capture everything, we'll be able to answer any question you ever want to answer, and it just never seems to actually come to fruition. And so, what I've learned from that is it's about reverse engineering. So, my advice to my CEO colleague would be 2 things. The first is your data management probably sucks. So, you probably should start to dig into that because if you think You have the fuel to put in your fancy analytics engine, you're probably wrong. Most places have a lot of work to do there. And then the second thing is, just like I said earlier, this should be operationally led. Analytics should be operationally led as well. I'm going through this exercise right now with my colleagues, and I'm basically making the head of finance and the head of our manufacturing and the head of our commercial operations define very clearly What are the important strategic questions that you are going to need to answer in the next year or 2? Because from that, I can reverse engineer the data that's required and the analytics to process that data to provide a meaningful answer. So check back with me in a year on how well that's working. I think that's a kind of wisdom that's emerged over the last couple of years about how to focus those efforts and ensure That there's an actual measurable ROI in, in your lifetime.

Yeah, it is interesting. I'm recording today from Denver, Colorado, and I was listening to sports radio last evening and there's a new quarterback for the Broncos. And so they're already predicting, you know, Broncos are gonna go to the Super Bowl. But they had this debate about data and analytics that was really interesting. And one of the analysts actually got it and he understood the difference between tons of data, right? They got all the data. they don't use it. It's not actionable during the game.

Yeah.

And then actually taking it, sort of that Moneyball baseball, but taking it during game time and using the analytics to help drive decisions. So it's kind of— they're having the same sort of discussion. It's very fascinating. And it goes back to culture. So you mentioned culture on the top. And so I've been in fantastic organizations, as you have, that have all the data resources you could possibly want. But they didn't get the outcomes they expected because of cultural reasons, you know, infighting, you know, people being very protective of data. And so, in the end, it still comes down, even once you, you know, reverse engineer and all those sorts of things, comes down to culture.

I think that's right. I mean, part of my hope is that by taking this approach, we're setting ourselves up for a more cultural success. Because, in effect, I'm putting my colleagues on the hook as well. And I'm, I'm helping them to find— I mean, so eventually this is going to lead to targets and objectives and goals and measurement of all those things as well. And so it's not just doing the work, but the way you do the work is just so important.

Yeah. Let me shift gears on you a little bit because I know some of our audience, Dave, are clinicians who are dabbling a little bit in digital and want to get more involved. You obviously are one of the pioneers of that whole move and shift. What would your advice be for physicians who are practicing a lot today but thinking, hmm, I'd like to maybe part-time or full-time move into informatics?

I have a couple of pieces of advice there. The first is, volunteer. Just raise your hand and let people know that you're willing to give some time. Come in with an open heart and an open mind. Don't come in with your own agenda. Don't come in trying to drive your own project. Find out what's already going on and how can you join the team and be a contributor. That's the way to get in the door and begin to learn and begin to build the relationships that, that can lead to other greater opportunities. And I'm sure at any organization, there are many opportunities. And if you're willing to show up and be humbly confident that you will be most welcome. And, you know, so you gotta do a little bit of pro bono work, if you will, before the other rewards come. I think the other thing that's really interesting, and Ed, you're closer to this day-to-day than I am these days, so maybe this has changed, but I was struck a few years ago that you have to decide, do I wanna be Scotty down in the engine room, or do I wanna be Captain Kirk up on the bridge? Because I think those are completely different skill sets. And I think folks tend to have a natural inclination towards one or the other. So if you really like coding and you like to be down in the details of the work and you want to write the next great epic report, fantastic. You are Scotty. We need to find a role for you down in the engine room. And oh, by the way, There's some rules of the road about how we operate down in the engine room, so you do need to come in and learn some of those as well. But we welcome you for your talent, your subject matter expertise, your enthusiasm, and all of that. To me, that's very different from Captain Kirk up on the bridge. And Captain Kirk up on the bridge, you know, he needs to know enough about the technology that he can call BS on his colleagues. Or at least smell it. But that job is not one to master the technical details. That's a job about strategy and vision casting and resource allocation and kind of empowering others to achieve the vision. Completely different skill set, I think. And again, my life experience is people tend to have natural aptitude in one or the other. It's the rare unicorn that has both. But like I said, I'm not close to this on a day-to-day basis, so maybe the Maybe the environment has— the zeitgeist has shifted a little bit. Am I making sense to you? Does this still resonate with you?

Yeah, yeah, it makes total sense. I think the volunteering is great. I can't think of a fellow chief digital officer or CIO who would turn down a doc who said, hey, I'm really interested, and let me spend some time with you. I've done that with so many docs, and many of them went on to become CMIOs or CIOs, and others have decided, it's fun to dabble, but I'd rather practice. or practice the majority, and that's fine too. But yeah, I think volunteering, then you get a better understanding of what you're getting yourself into. And then you may find out, oh my gosh, I love this. I want to do this full-time, or at least majority of time. And that could lead to other things. So yeah, I think that's really great advice. Now, in our last few minutes, I really want to be future-focused and also talk about flow. So I know you're on several boards, so your perspective is really good. Yeah, you did the CMIO thing and did it really well. And then now you've, you know, been part of companies, creating companies, on boards and with Flow. So, so tell us a little bit about Flow and, and what you're doing to help organizations enable digital transformation.

Well, this is another chapter in Dave Levin, Forrest Gump. I was starting to network to look for a new opportunity and called a friend of mine based here in Richmond, Virginia, who had been a successful entrepreneur, Dr. Eric Edwards. And I was really just looking for introductions and advice. And in the middle of the call, Eric asked me if I'd be interested in coming to work for him at Flow. And oh, by the way, folks, if you want money, ask for advice. And if you want advice, ask for money. And it was a really classic kind of experience like that. I think that was in September. And by November, I was working for them, just completely taken with the mission. And honestly, if you told me 2 years ago I'd be working in the pharma segment of industry, I would've suggested you needed to have your medications adjusted. I mean, it's just not an area I knew much about. Or had much calling to, but our mission is really unique. So we are a public benefits corporation and we are focused on solving the chronic shortage of essential medicines in the United States. And those of us that have been practicing healthcare know this has been an ongoing issue for decades. It got dramatically worse during the pandemic, or maybe the stress fractures were revealed.

Yeah.

During the pandemic. These are not fancy, cutting-edge, super expensive medications. These tend to be the basic things we need every day to run a hospital or clinical practice and care for patients. Many of them are sterile injectables. They're generics. They've been off patent for decades. And frankly, we're trying to disrupt the entire pharma industry because we think at every node of the supply chain is broken. Where we're starting though is in the middle, in the re-engineering these basic molecules and the manufacturing process. And our intent is to totally onshore these things. These will be made in the United States in highly advanced automated manufacturing. We're building some of the leading edge plants in the world about 20 minutes south of here in Petersburg, Virginia. And we've got these world-class chemists that are basically taking these molecules that are 30 and 50 years old, And rethinking the chemistry all the way back to the starting materials. And the net result is a process that is better, cheaper, faster, greener, like 90% reduction in waste, that kind of thing. And our economic analysis tells us with the right kinds of customer arrangements, we can make these things in a sustainable way. And then the other part of this that I'm really proud of, Well, the many parts, but 2 I'd emphasize. So one is this has huge national security implications.

Yeah, that's what I was thinking.

Whether it's medical countermeasures or preparedness for the next pandemic. And so we've been really fortunate to have a strong relationship with the US government. And one of the things that we are building on their behalf is the first strategic API reserve. So think of this as the equivalent of the strategic petroleum reserve, But instead, we're storing the active pharmaceutical ingredients. They can be rapidly converted to finished drugs, and the shelf life for those is much, much longer. So it's that combination of preparedness, of really focusing on how we can onshore these things and develop a stable supply chain. And then the other piece of it that I'm real excited about, and I'm personally deeply involved in, is we have formed a Children's Hospital Coalition. Most folks may not be aware, but we really don't make drugs for pediatrics in the United States. We make drugs for adults, and then our pediatric colleagues have to figure out how to manipulate those to take care of kids. And the quality, safety, cost efficiency, satisfaction— I mean, you know, sort of obvious all the deficits that come with that. So we have formed a coalition with now more than 20 of the leading children's hospitals around the country. And they're doing a couple things with us. First of all, they're helping us design the drug portfolio. So we're going to make the drugs they want in the way they want them. And the second thing is we're entering into long-term contracts because— and aggregating volume, because part of what we've got to solve is the economics of this.

Right.

And so if I can make what they really want, and they will commit to fixed purchases over an extended period of time, we can actually make the economics of this work and resolve a lot of the drivers of the chronic shortages. There's many other aspects to this. Clearly, there's a data and analytics play here, and I could talk about that if you want me to go on for a few more minutes, or I could come back. But it's been truly exciting work. And back to one of our earlier themes, I didn't know anything about pharmaceutical manufacturing. What my boss said to me is, I'm hiring you because Yes. Because I want someone in the mix that will ask the stupid questions and will ask why 5 times, that won't be afraid to go do crazy stuff because they don't know how crazy it is. And I'd like to think that I've actually brought some of that to the mix here as well.

That's awesome because we don't talk too often on Digital Voices, although I've wanted to a little bit more, talking about transformation, not just on the provider side, and we talk a lot about it on the payer side, We've had a few guests on the pharma side, but what you're talking about is truly transformational, what Flow is doing with the 2 very major examples that you shared. And I actually didn't know some of that information that you shared about the meds, about the repository, about children's— the medications for children that are specific.

Yeah.

And that's awesome. Yeah. And I could see all of the analytics that would be required. And the other thing is I loved— just were to summarize, Dave, our discussion, but I'm going to let you have the last word, is we talked about a couple of really key things. One was boundary crossing. And I'm just kind of doubling down on a couple of things because I thought they were really important. The boundary crossing, and things don't have to be binary. And with boundary crossing also, like the example of you coming in. So you are a longtime provider-side leader, and you come in on the pharma side, and that's what they wanted and needed. And it's so healthy to have that diversity. of thought and experience. And then the whole humbly confident, the whole thing on culture, you know, we've talked about that before generally in the past, but it's really come to a head here, I think, as of late, and will continue as we do more and more digital transformation. We talked about docs who want to come into tech and some good, great ways of doing that. And then sort of digital transformation in the future and specifically pharma. So this has been such a rich experience and I'm so happy to get reconnected with you. But before we leave, I'm going to let you have the last word. Anything else that we may have missed or one of these topics that you want to go just a little deeper on?

So I'm going to get really macro and philosophical on you here.

All right, let's do it.

It's no secret we live in some challenging times. The macro environment, there's the political environment, the economic environment. There's a lot of challenges, a lot of things to be concerned about for sure. But I urge my colleagues in healthcare to Practice gratitude and grace. We have some of the best jobs in the world. That doesn't mean they're easy, but they're meaningful. We are well compensated for what we do. We get to work with generally terrific colleagues and we're healing our communities. This is God's work here.

Yeah.

It's easy to Lose that theme and lose the joy because the work is hard and I got 10 more patients to see and all those things. Those are real. I don't mean to dismiss those, but I think there is this perspective of gratitude. And then I think the other is grace is— and I urge that on all of us in all settings right now. We need to try harder to extend grace to our colleagues and to our fellow citizens. We need to understand. That most of us are really trying to do what we think is best and what's right. And we all have challenges and you can only see the tip of the iceberg of my challenges and I can only see the tip of the iceberg of yours. I try to enter every new relationship with the assumption that this is going to be a positive and it's going to be fair and that I should approach with an open heart and with joy. And occasionally I'm disappointed by that. Far more often, it's been a great reward. So I hope I don't sound Pollyanna here because I'm not. Again, I don't want to downplay the challenges. They are real. But there's so much gratitude to be found and there's so much goodness in extending grace.

I love it, Dave. What a great way to end this episode. And speaking of gratitude, thank you for being my guest, being my friend. Thank you to our producer extraordinaire, Megan, for the great work she does behind the scenes to make this happen. And yeah, those are great words. I, I— there's really nothing more that I can add to it. So thank you so much, and we need to make sure it's not another 5 years or so before we talk again.

Oh, I agree, Ed. Thank you so much for the opportunity.

All right, that wraps up Digital Voices. We'll talk to you next week.

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