From ER Doctor to CIO: A Journey (ft. Dr. Joel Klein)

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. Welcome to another edition of Digital Voices, and thank you to the audience for making us number 13 on Apple Podcasts for tech. I, I would never have thought, never would have guessed That could happen, but I think it's because of awesome people that we have on the show like Dr. Joel Klein. Joel, welcome to Digital Voices.

Thank you so much, Ed. It's great to see you as always.

Yeah, I'm so stoked about having you on because you're one of the most humble leaders I know. You're a great leader doing great things, and I want to just dive into a little bit of your, of your life and your philosophy so more of us can learn about you and, and, and be inspired. You're currently the senior vice president, chief information officer at University of Maryland Medical Systems, and we're going to dig a little bit deeper into that as well. But before we get there, everyone wants to know what songs are on your playlist.

Well, I'm a big Van Halen fan, so there's a bit of that. I have been listening to Linkin Park lately. There's a band called Racing Glaciers, which I've never— I was not previously familiar with them, but Spotify led me there. And then if I'm working, I listen to binaural beats.

Nice. And what about Van Halen? Did you ever see them in concert?

Of course. I've seen all 3 of the lead singers. Yes, there were 3. We could talk about that for 30 minutes if you want.

Yeah. Which was your favorite?

So, you know, that's like, who's your favorite child? You know, I think they both are important. I will say watching David Lee Roth bounce around on a giant, you know, inflatable hot dog is not something that will ever leave my head.

So, you know, yeah, yeah, I, I kind of stick with David Lee Roth as well, kind of being the original. And yeah, they're a great band, very formative, definitely in my, in my life as well. And I still go back to some of their songs quite a bit. What about life message or mantra? Are there words that sort of guide you and who you are?

I think if I had, you know, one, it would be some version of we all get one ride only on the merry-go-round. Just, you know, the idea that life is short and memento mori, or however you want to say it.

Yeah, I love memento mori actually. And, you know, I discovered that in some old paintings from the Renaissance era where, where they would just have skulls. And I was like, well, what's the deal with the skulls? And it goes back to the whole concept of memento mori. And yeah, that's definitely one of my favorite things. So tell us a little bit about your personal life. So before we get to University of Maryland Medical System. Tell us a little bit about who you are as a person.

Sure. So live just outside of Washington, D.C. We have 2 kids, a senior in high school and a sophomore in high school. We've got a bunch of cats. My wife works at a nonprofit that is focused on science policy. We met in college and we're, we're still together. I love to cook. I used to work at a fancy restaurant where I was the only one who hadn't gone to cooking school and If this whole doctor IT gig ever falls apart, I'll probably end up opening a bar or, or a restaurant or something like that.

Oh, that's super fun. What kind of cooking? Like, what's your favorite thing to cook?

So I am an ER doc at heart, so I am more of a line cook kind of guy, but I do like to bake as well. I would say my, you know, if I'm making dinner, special dinner for you, it's a big piece of outstanding fresh tuna that you sear off. And then if you take some soy sauce and some wasabi and you stick that in a pan, And slowly just start adding butter until it's delicious. Yeah, put that on there. It's that simple. It's amazing.

You know, I was just watching on Netflix some movie that just came out. I don't know how long it's been around, but it's on dining, it's on cooking, but it's a little bit morbid. I don't know if you've seen it.

With Ralph Fiennes?

Yes.

So I had no idea that that movie was over-the-top morbid. You're underselling how crazy a movie it was. I thought it was like a great movie about cooking.

No.

No, it's a bunch of people getting murdered.

Yeah. It was pretty fascinating though, right from even a cook's point of view, because, you know, they were so on point and precise about the delicacies they were making and how they went about curating all the ingredients.

Well, the problem is if you like, you know, that world, and I kind of do, you know, you're like, wait a minute, don't, don't murder, you know, don't do that. Like, let's get back to the food. And then, you know, halfway through the movie, you realize the wheels are off the train and this is what the movie's really about.

Yeah, it was. Yeah, it was pretty fascinating for sure. So you already mentioned, Joel, that you're an ER doc. When did you know you wanted to be a physician? Was this something like early childhood or later as you were in high school or college?

Yeah, you know, it was a gradual thing. I don't, I don't think there was any, you know, one particular point. I think if I look back and I'm being really honest about it, you know, my folks split up when I was in elementary school. And so one of the things that's always been really important to me is Kind of self-reliance and knowing that, you know, I wasn't going to have to rely on, you know, other grownups, you know, to make my way in the world. And so something stable, something that I wasn't ever going to have to worry. I didn't understand back then that there's a lot of things you can do, you know, that have that outcome. But at the time, I know that that was one of the things in the back of my head. I got a work-study job in college as a student athletic trainer. I needed to make money pretty badly. At first it was folding towels and making bags of ice and stuff, but I pretty soon learned to tape people's ankles. And before I knew it, I was traveling with the crew team to Florida and, you know, staffing all these other crazy sports events. And I realized I liked it and got to know the orthopedic surgeons who would, you know, drop by the training room and see their patients. And pretty soon I was watching in the OR with them. You know, it kind of all came together. It was a gradual thing. The harder thing was how did I become an emergency doctor? I think that's one thing people don't realize. You know, you go to med school, you then have a really, really difficult decision to make, like what specialty.

Right.

And you have very, very incomplete information. I mean, there's stereotypes of what these lives are like and what these specialties are like, but you really don't know. And I got very lucky that, uh, from a personality and brain functioning point of view, uh, to, to settle on emergency medicine. It was absolutely who I am, and I got very lucky.

Yeah. And you still practice today, right? Part-time in addition to your administrative role?

Well, yeah. So I still have my privileges and my license and all that, but I did stop seeing patients, gosh, 4 years ago. Is that possible? I did the first half of COVID And, you know, remember when my first patient I had to intubate with COVID rolled into into the ER, but I was splitting shifts with my old partners, you know, while doing this job. And I was getting up at 3 in the morning and getting to the ER at 5 and leaving at 8 and then coming and doing this all day. And it was getting a bit exhausting. So anyway, but I, you know, I miss parts of it for sure. And, you know, certainly one of my old partners actually just stopped by a little while ago. So I'm still very, very connected to the world.

Yeah, no, no, that's perfectly understandable. It makes a lot of sense. So tell us a little bit how you got into the administrative track and leadership and ultimately, you know, serving as Chief Information Officer.

Well, my first administrative thing was very funny. I was working a shift one day, and the clerk in the ER said, you know, Dr. Klein, there's an angry person on the phone who wants to make a complaint. And I was like, what? Why are you telling me? And it was another doctor, and she didn't know what to do with the call. So fine. And it was an ophthalmologist who was very upset that one of my partners had done something that he didn't agree with. And I kind of listened and took a few notes and went into my boss and said, hey, I got this call from so-and-so, here you go. And he handed the piece of paper right back to me and said, deal with it. So what do you mean? And he said, well, go call your buddy, you know, your colleague, and tell him what happened. And I didn't really understand, but that was my first patient complaint. You know, you, you've got to go to your colleague and say, this is the complaint we got, and listen to their side of it and be equitable and, and, and so forth. And I guess he felt like I treated him fairly because the next thing I knew, I was in charge of patient complaints, which is a pretty interesting job. It is super educational. You learn what pisses people off, what, what really frustrates people.

Yeah.

It was incredibly impactful on how I practiced and, you know, how I just, you know, talk to people. Then, then it turned into me getting elected to run the group. And that turned into, Joel, the way that we pay people in this group is supposed to be based on merit. And instead, it seems to be a little bit, you know, ad hoc and haphazard. So do you think you could get us some objective door-to-doctor time, or, you know, how many patients you saw or something, you know, that would be a little more data grounded. So that meant trying to get some data on how we practiced, which meant befriending the IT people. And this is 25 years ago, so they didn't really know what to do with me. So they kind of gave me access to things and I had to root around in the forest and try to, you know, find data that would be relevant, but that's how it started. And then of course we got on the Epic train and I was in the right place at the right time for that. And then it was really just a snowball at that point.

Tell us a little bit about the University of Maryland Medical System. So for those who are unaware, you know, even the location, you're in one of the most competitive environments in the country, but tell us a little bit about the system.

Yeah, so we're a system that's grown through acquisition, but it has a little bit of a strange origin. So we were founded 40 years ago. We're celebrating that anniversary this year, and it used to be that there was a hospital that was part of the university. system. And it was a typical academic hospital. It was always getting bailed out, you know, financially by the state. And finally, the state, in a piece of legislation, spun the hospital out to a separate nonprofit company, and that was how the system got founded. It was from that point on, you know, responsible for its own finances. And so from there, it grew very, very slowly. In fact, when I was hired as part of the system, whatever, 25 years ago, we weren't part of the system at the hospital where I was working. It was just a community hospital, and which is why I joined it. I wanted, you know, a super high-functioning, super efficient, uh, you know, greased lightning kind of place where everything just works. The opposite of many teaching hospitals, certainly. And, um, because I had just trained at Hopkins and I, I really, as much as I appreciated that, I wanted something else.

Yeah.

So we've grown through acquisition over the years and we now are up to 12 hospitals, including our flagship downtown. There isn't much healthcare that we can't provide. I mean, it's a quaternary care center. We do transplants of all kinds and everything else. And I'd say the thing that we're probably the most famous for is the Shock Trauma Hospital, which is kind of like one of those Vegas hotels within a hotel. It's a separate hospital that's within our flagship hospital, and all they do is trauma. And they're really, really good at it. One of the leading places in the world on managing trauma. Of course, This being Baltimore, unfortunately, that is a necessary thing here. And it's a great place. You know, we're still on that journey to systemness, like so many other places. COVID was a big driver there. But it's— I'm still here because it's a great place to work.

I didn't realize, and that's why I asked the question, you know, that it's only been around as a University of Maryland Medical System for 40 years. That's pretty new, especially compared to your competitors around the area. that have been, you know, together as systems for, for quite some time. So, and that's kind of fun. That's got to be kind of fun too, because you've been there 25 years. So you've been serving there over half the history of the organization. So you've helped sort of make the organization what it is. Yeah.

And if you, if you think about, you know, the Jurassic period of the system, you know, the first half where not much happened.

Yeah.

It wasn't really a system, you know, as opposed to the last 20 years. I mean, we've added over half of our hospitals in that time. And of course, Epic, like so many other places, brought the whole thing together and really, you know, got people talking and thinking, hey, we could actually be smarter about this and work together, you know, like a system. So yeah, no, it's been a great ride.

That's very cool. Let's switch a little bit towards your work. You have been a physician for quite some time, as we talked about. How has that helped you in your role as CIO?

I think the biggest thing is, you know, I've been on the receiving end of it, right? So I know what happens when IT shows up and says, you're going to do it this way now. And, you know, because that's how it gets heard a lot of the time, right or wrong.

Right.

And I remember our first CPOE project. I was not, you know, really involved. And I remember, gosh, I'll never forget this. My first shift, I had done all the training and everything, but now you have to put your orders in the computer and it wasn't great. This is like some ancient system from a long time ago.

Yeah.

And I remember getting behind and the nurses were starting to come up to me and saying, you know, hey, Dr. Kahn, you're— we can't— you need to deal. I mean, we can't do any of this until you put these orders in. I mean, the computer won't let us. And I'll never forget that. It was a flashbulb memory of panic of what am I gonna do? I mean, What am I going to do? And I've never— that has always made me, I think, maybe not uniquely empathetic, but certainly empathetic to what life is like as a user. I think the tricky part being a doctor in this role is remembering that we cannot be dococentric, right?

Right.

That there are so many other walks of life in the hospital, not just clinicians, on which the whole operation depends. And so it can be very, very easy to just You know, put on your white coat costume and kind of run with that. But early on, I had to really, you know, force myself to don't do that.

Right.

Careful. So.

Yeah, no, you're a very thoughtful leader in that respect. What recommendations might you have for CIOs, you know, like myself who don't have that strong of a clinical background, but are in the same role? You know, obviously, they're not gonna go to medical school, but any recommendations for them in terms of how they might Relate a little bit better?

The biggest thing, and I think this is probably true across industries, even just get out there. Go hang out in the hospital, in the office, in the operating room, in, you know, the rehab thing, in the front desk. Just go see what people are doing. You, you get stories, you get these snapshot ideas, you get impressions, you get examples that you can take back to your team. You make friends and you can follow up with people and say, hey, you know, I heard what you said and I talked to 3 people and here's what they told me. So we're going to try to work it. You can get so much goodwill doing that. And if you do it enough, you really do start to build up a picture of the people that you're working with and what their life is like. I mean, that's how a lot of us chose, you know, our professions by watching other people. The trap is staying in your office. Don't do that.

Right. Yeah, that's great words of wisdom right there. And you also write a lot. Like, I follow you on LinkedIn and you offer great leadership insights. Have you thought much about writing a book, or how'd the writing come about?

Well, first of all, I'm going to tell my wife you said that because she thinks my posts are pretty corny, which maybe they are. I don't know. I was approached, you know, a while back by our marketing guys who seemed to think maybe I could contribute to the whatever, the universe. And so I started writing some of these things and they gave me somebody, you know, who would work with me, who would sanitize it, and then I would unsanitize it and we would go back and forth. And it was pretty funny. I usually win most of these arguments, but not always. I, you know, I don't consider myself to be a particularly wise person. I sometimes think I'm You know, I swear I was just in high school and I'm not nearly as mature as the rest of you think I am. Yeah. You know, back to the David Lee Roth conversation.

Right.

But, you know, exactly. So, in fact, maybe, maybe that'll be a good challenge, is work David Lee Roth into the LinkedIn conversation sometime in the next month. I think a lot of us who have been doing something for a long time, you know, say what's on your mind and, and do it in a way that's honest and You know, you don't have to put yourself all the way out there. In fact, I think maybe sometimes probably shouldn't do that.

Yeah.

But I think there's a way that we can be authentic without being social media crazy. And I'm trying to straddle that a little bit. I don't know if I'm successful, but I'm—

Well, I appreciate it. I know a lot of other people do, you know, because you just get to hear insights, especially if it's someone different than yourself. So like, I'm not a clinician. So it's always great to hear a perspective of a CIO who is a clinician. And again, given your background, I just think it's helpful when people share and we learn from one another. One or two things you're most proud of that you and your team have done. You already mentioned you implemented Epic, but I'm sure there's some other things that you've all done as well.

Well, I guess I'd say two things. One is just the team itself. So the people who report to me, I hired all of them with one exception. And, you know, when you do that, when you build a team yourself, when you really have an opportunity to hire people that really reflect your values and your expectations around things like customer service and responsiveness and, you know, being available and getting back to all that, all that kind of thing. I feel like I don't need to be here. And that to me, that's when you know.

Yeah.

You've done it right. And so I think in terms of, you know, look at that, we did that. It's got to be the COVID stuff. You know, we did one of the field hospitals across the street, you know, in the convention center here, and we did the vaccination thing in the Baltimore Ravens stadium. I mean, that was half a million vaccines.

Yeah.

That thing did, and with our stuff, our computers, our Epic, all that, and we did it like overnight. I mean, we did so much of that stuff. I mean, everybody did, but just knowing that we could turn on a dime, incident command style, Yeah. No problem. Any, you know, next load, any road, just no problem. We'll take care of it. That's just, that's work of a lifetime right there for everyone that was part of it.

Yeah. You all saved a bunch of lives and did really good for the community. What's the next big thing that you can share that you're working on there? You know, any big initiatives?

Well, I think we're all trying to make sense of, you know, this whole AI situation, you know, what to do, what to pilot, what's hype, what's not hype. I think the other thing is, you know, we're trying to find budget, bandwidth, people to pursue, you know, the oddball projects, what some people would call innovation. How can we find some space for that? How do I reserve some bandwidth for people to just go work on something without, you know, the promise that there's going to be ROI? How do I take that pressure off just a little bit in a world, you know, of scarcity? I'm not saying we're going to be Thomas Edison here, but there's, There's some bright people that work in our IT shop and I want to try to give them some runway. So figuring that out, I'd say.

Yeah. Love that. That's good. So switching now to leadership, you know, you've had this amazing career, Joel, and you have family, but certainly there's a time perhaps that you failed. How did that failure shape who you are today?

So if I think about the time that I was most underwater at work, So it was with a patient. I'll never— I never remember people's names, but I remember what room they were in and funny little clinical details. So this was a patient who was in room 3. It was soon after I became an attending. It was an older woman and she couldn't breathe. And so we had to intubate her and it wasn't a code, but it was, you know, she was pretty sick. And after about 20 minutes, we kind of got her stabilized and, you know, now you've got to figure out, well, why can't she breathe? And there's a million tests you have to do. And in the middle of all that, they let the family back. And, you know, the family's here. So I go into the room and the, you know, what is wrong with her? And I said some version of, well, we're not, we're not quite sure yet.

Yeah.

And no sooner did I say, what do you mean? What are you talking about? I don't understand. How come you don't? And it, the conversation got super adversarial super quickly. I was, you know, thrown completely off my game. And, you know, I was still new at this, right? I mean, when you're a new attending, it's hard to appreciate people get scared. You know, young doctors are scared. They may not fake— they probably fake it pretty well, but there's a little bit of fear in all of us that we're going to make a mistake. And I, I somehow held it together to get out of the room, but that family was like, we want somebody else. Like, get somebody in here who knows what they're doing.

Yeah.

And I called my intensivist and I kind of said, this is what I got. And by the way, I think I, I think I need a little reinforcement here. Could you, could you come down here? And so he was like, yeah, sure. And he was, you know, an older guy and he came down and, no problem, I'll take care of it. And to this day, when you get— I mean, all of us who have crazy jobs, right?

Yeah.

You get handed a piece of information or, you know, you get some text message with some adverse thing. How do you pull yourself together and figure out, okay, this is what we're going to How do you manage through that? You know, you get better at it, you get more experience, you get more at-bats. But, you know, even today there's times I get scared.

Yeah.

And you've got to be upfront with that about yourself and, and just fall back on your training. Maybe take a minute. I will never forget the kindness that my colleague did me in bailing me out there. I've always, you know, Stu Jacobs, if you're out there, thanks. And it's something I've certainly tried to pay forward. Well, Preserving the dignity of the person that you're helping, because that's right. That's important too.

Yeah.

But you got to muscle through.

No, that's, that's a great story and great learnings and how it shaped you and how you pay it forward. What about the best piece of advice you've received? So certainly along the way, you've received a lot of advice. What's one that you want to pass on to our audience?

I would say some version of just say yes. So, you know, people will come to you and say, would you be on this committee or that committee? Just do it. You know, people ask, would you help me with this? Just figure out how to do it. You may have to get out of it later. You may have to delegate it later. Just say, no problem, I will figure out a way to help you. I have found that when people start coming to you more and more and more, it's because you've developed a reputation for, of course they'll help. And that is gold.

Yeah.

It's so important. And that doesn't mean you have to drown, you know, staying up 24 hours a day helping everybody. I mean, you can do that if you want, but it's not sustainable. But you've got to find a way to deal with that. But don't, don't, especially early in your career, especially if you are part of a big complicated organization, you want to be known as somebody who will absolutely pitch in and help no matter how messy it is or dirty it is or crappy it is. And you can always figure it out later.

Right.

But find a way to say yes.

Joel, that's great wisdom. You've shared with us so many different things. First of all, Talk a lot about Van Halen and David Lee Roth. We never talk about favorite album. What about favorite album of theirs?

So it's got to be Van Halen, the first. You know, I'll wait. How can you not listen to that? Panama. How can we?

Yeah.

Wait, that's not. That's 1984. Running with the. I mean, come on.

Yeah. Eruption.

Eruption.

Right. Got me.

Ice Cream Man.

Yes. And I like. Diver Down as well, because they did a remake of Roy Orbison's.

So that is such, you know, and so there are multiple covers on that album, not just Pretty Woman, but Dancing in the Street is another amazing cover, and that is an amazing version of it.

Yeah, yeah. And you know, it goes to their popularity because not too many bands have super popular, you know, like number one albums when there's a bunch, when there's a lot of covers on them, you know, because a lot of times it's just original stuff. But they were able to really do a lot of originals and their covers. You know, pretty, uh, that's just Pretty Woman, but, uh, California Girls was great as well.

Oh, that's the David Lee Roth solo song.

Oh, okay. Uh, that's what he went— yeah, so I could see that now, that tie-in. But yeah, great, great music. It's gonna make me want to listen to them tonight. We talked about Memento Mori, and we're gonna leave that Latin for everyone to look up on their own. We learned a lot about you as a person and your family, and that you like to cook, your career and how you became a physician, and the University of Maryland Medical System being Shock Trauma Hospital. So when I come by next time, I talked about coming to visit you in the offices, that'd be kind of fun to see. And then we talked a lot about your work and the different things that you do and, and, and really your focus really on people. I think you got that, um, on training people, leading people, working with people, working with clinicians, working with non-clinicians. It was great to see what you all have done in the last few years. and what you're working on. Then we sort of wrapped up on leadership and how failures have helped you and always fall back on your training and really the whole kindness thing, which comes out in spades with you. And then, you know, I loved your advice, and that is just say yes, pitch in wherever you can. It'll pay a lot of different dividends. What did I miss, or is there anything you want to double down on? I'll give you the last word.

So, I'll give you 2 things. One is hobbies. Everybody needs hobbies. Don't just do your work and your family. Be interested. So, I've been trying to learn the drums for the last last 20 years. I am no Alex Van Halen, but I'm going to keep trying. You know, you open yourself up to all kinds of things. My next step is finding other people to play with because I think I'm at the point where, if I don't do that, I'm not going to get any better. But, get hobbies. And then, I'd say the other thing, especially if you're in a CIO job in any industry, is talk to CIOs out of your industry. We have a support group here.

Yeah.

I don't know what else to call it. Because we're in DC, we have a lot of government and military and, you know, types, lots of people from agencies, the legislative branch, Library of Congress, and we go and we do tours of their organization. So, whether that's the Federal Reserve Bank or the Pentagon or the shipbuilding yards down in Newport News, and you realize that we're all fighting with vendors, we're all dealing with Microsoft, we're all dealing with cybersecurity. There's a lot more in common than you'd think, and that commonality and connection that you can make to people that aren't in healthcare, it's huge. It's helped me gain perspective on the things that we're trying to deal with, and it's another source of support. CIOs outside of healthcare is a great thing to cultivate.

Even more wisdom. Thank you, Joel, for being our guest. You're a great leader and, more importantly, a great person. Thank you for your time. being on Digital Voices.

Thanks, man. Thank you for listening to Digital Voices Podcast with Ed Marx. If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review. And most importantly, thanks again for listening.