Solving the Last Mile: Improving Patient & Staff Outcomes (ft. Dr. Albert Chan)

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, Digital Voices. You know, I always say something like, I'm so excited, or I'm so thrilled, or stoked to have so-and-so as a guest, and I really mean it every time. And I certainly mean it this time too with Dr. Albert Chan. He's like a good friend of mine. He's just one of the smartest people I've ever met and humblest people and great thinker, pioneer. We'll get into all of that. It's gonna be really fun. So we're gonna talk about digital transformation from a physician pioneer point of view. But Meaghan, before we get started, have you ever met a Fulbright Scholar before?

Full transparency, no. I actually had to Google what a Fulbright Scholar was, but after today's show, I feel like I can confidently say Yeah, they're like the most brilliant people.

You're going to meet Dr. Albert Chan here. So he's the Chief Digital Health Officer at Sutter Health, but he does a ton of other things, and we'll get into that when we talk a little bit about his journey. I think when we first met, it was at Epic UGM, like 2015. So we have a mutual friend that introduced us, and he was like, I've heard all about you. And I was like, I've heard all about you. And we just became fast friends and followers. And he's just a great person. And I got a chance to visit him out in San Francisco a couple of times, Silicon Valley. It's cool. So Albert, welcome to Digital Voices.

Thank you, Ed, for the invitation. It's kind of crazy for us to be meeting like this again, but it's great to talk to you.

Yeah, I know. I'd rather definitely be in person and out in Cali for sure. So everyone wants to know, especially from a Fulbright scholar, what's on your playlist? Like, what songs do you like to listen to when you're chilling?

If I'm in the groove, I'm writing something, I listen to Prince. Because that's— my wife loves Prince, and so that's how we kind of got together.

So, oh, well, we have to have you back for our second podcast on how Prince brought the two of you together. So that sounds really interesting. All right, so the other thing people want to know, what is your passion or life message or mantra? Is there some sort of words or quote or inspiration that you live your life by?

I guess it's simply just I want things to be better for people. I made a promise to my grandfather actually long ago that I would do something to help people and it was kind of at his deathbed actually. So, he— this is a story that I don't share very often with people but so essentially, when we were— I was applying to med school, my grandfather got very ill and on his deathbed, he made me promise that I would take care of people and that same week is the week I got into med school. So, I think there's a lot of inspiration from that and I take that with me each and every day.

Wow! That's really cool. Thanks for sharing that. And I love the simplicity of it as well. Sometimes we try to get too fancy, but it's just like help people. That's really cool. Albert, would you mind telling us your story? It can go from a personal level or professional level, whatever you're comfortable with, but, you know, sort of like who you are and how you got to be where you are.

Gosh, that's a long story. Do we have enough time?

You can do the abridged version.

From the very beginning, I always wanted to, as I said, help people. I actually thought I was going to be an engineer in high school. I was going to do engineering and actually even worked at HP for a summer. And then I realized it wasn't lighting my fire. It wasn't doing what you would think it would do. So when I got to college, I thought, hey, let me find something different for myself. And I had an opportunity to meet with some folks who said, why don't you come out to San Francisco and volunteer in a hospital? I said, really? Saturday morning? And I was a young buck, so I drew the 8 AM shift on a Saturday morning. And that was— I worked at San Francisco General Hospital and volunteered in the ER, and I just loved it. I fell in love with it, and that sort of set me on a path to To become a doctor, that's kind of really what got me started. One of the early stories I had actually was that it was a young Chinese man who you know obviously I wasn't a med student, I wasn't anything, I was just a young college student. But I could talk to this man who just accidentally got his hand stuck in a noodle machine, and the ability to be able to calm him down, help him through his fears, so forth—that really inspired me to do better. And that's that's what got me started in this path. And then I went off to college and med school, and. Life's history after that.

That's cool. And then along the way, you, uh, via Prince, you met this beautiful young lady, and today you have, what is it, 3 kids, right?

Yeah, we have a son going off to college starting in the fall. I'm kind of scared about that for, for all of us, and, uh, gonna miss him terribly. And I have 2 twins as well, so 3 kids.

That's awesome. So you are the first Fulbright Scholar we've had on our show, and can you share with our audience a little bit about what a Fulbright Scholar is and some of the training and education that entailed?

It's a moniker on my title, and thank you for mentioning it. It's actually a cool program. Essentially, Fulbright Scholars are invited to help other countries around the world participate in programs, and unfortunately during COVID actually much of that got interrupted, so I haven't been able to go out, but that's the idea behind the Fulbright Scholarship to be able to go out and serve in fellowship. What I did have an opportunity to do was actually what was called the Eisenhower Fellowship, which In 2017, there was a program where I actually was one of the 10 US scholars to go overseas to actually discover new cultures, new lands, and new ways to innovate. So, that's really my path to some of this work.

That's cool. And, what country did you— as part of the Eisenhower Program, what country did you go to?

2 countries actually. I was very fortunate. First country was Brazil. So, I went to South America and go to Brazil and saw innovation in the context of a big country. And actually had an opportunity to meet one of the largest health systems in Brazil and actually to this day help them out with some innovative ideas.

That's awesome. What was the other country?

South Korea. So the contrast between Asia and South America was pretty stark. And to see innovation, the whole pathway from a Verizon Fellowship perspective is to see different models for innovation. So in South Korea, I saw the big power of the conglomerates. So Samsung, Other health systems and seeing healthcare in a new context was really, really powerful. Extremely powerful to see how people did it differently and how they could take care of people in different ways. And it's those stories that I have from both Brazil and South Korea inspire me today.

That's what a great opportunity. It's just such that you're like going to go down as one of the most interesting people in the world.

Oh, hardly. I'm not like a Dos Equis commercial or something like that.

That's crazy. Now you are Chief Digital Health Officer. So what do you do at Sutter Health? What does that title entail?

I like to think of it as bringing digital health power, the power of digital health at scale for the enterprise. So figuring out the details, the nitty-gritty details of the workflows for people to empower our doctors and our patients to be able to serve each other better, to empower each other for better health. And that's kind of a synopsis of what I think I do each and every day, trying to be inspired by digital and what we can do to make things better for people. So that's what I try to do each and every day.

And digital health is always evolving. And you've already mentioned just by part of your story, you know, the Eisenhower experience, the Fulbright experience, how you sort of keep up. But how would you recommend other people keep up? You know, because it changes so fast. There's always new technologies that come along, new ideas. How do you stay current?

Well, I don't know if I stay current. I just say I'd like to be inspired by others. So I look for inspiration all over the place. So if it'd be in our routine lives, my biggest inspiration— so if I look at any consumer experiences I have, I think, hey, if that's good enough for consumers, why can't that be good enough for healthcare? That's where I try to draw inspiration. I try to learn from others. Folks have actually done the natural experiments for us and we say, hey, how can we extend those lessons to healthcare? Why not? Why not make it better for people? Here's an example. This is something we just recently launched. And you mentioned that I have 3 kids. So let's say despite having 3 kids, it's not like I know everything, right? And when I had my own children, I thought, God, there's so much to know. So much. And even I studied some of this stuff. It's like, God, I don't know all this stuff, right? And each and every week I'd be reading books and reading articles and I think, this is not very powerful. This is like reading a book over and over again, right? So what can I do that's different? And I said, hey, why don't we actually empower people with an app? So we tried different ways to do this and then we actually stumbled upon this idea that, hey, can we use the data in the EHR to personalize healthcare for people as they go through the pregnancy journey? So we recently launched that. It's been an incredible journey with that. And the idea of being able to give week-by-week insights to patients who are pregnant Help them be, if you will, be their digital Sherpa throughout their pregnancy journey. That's been really, really inspiring and powerful.

Yeah, that's cool. Let's talk a little bit more about digital transformation, but let's go back historically. As I have spoken to you in the past or sort of did a little bit of research on you, you've been involved with informatics since early 2000s. Like 2002, you had your first role in informatics. That's like 20 years ago.

Thanks for reminding me, man. I'm an old guy. Thank you. Appreciate that.

And then you were one of the first CMIOs, right? 2010, CMIO role was still pretty new. In fact, even today, right? Not all organizations have them, but definitely Sutter was one of the first. And then you were all about the patient portal in 2011. Okay, again, 11 years ago. You're definitely a pioneer. So can you describe a little bit about that journey from 2002 to now, sort of You know, some of the one or two like cool things that, you know, you always remember along that journey that you were able to help others with?

Yeah, the magic started in college actually. So as I mentioned, I worked in the ER as a volunteer, and then I actually noticed I had this— as I mentioned, I thought I was gonna be an engineer prior to college. And so I thought, hey, I like computers a lot. I didn't know what that meant, but I, you know, I wanted to be a doctor and I like computers. So it turned out in med school I had this opportunity, this opportunity to go overseas I went to China for a year as an exchange student, and while I was in China for a year, I actually had this opportunity to play with the internet and actually developed a website, now defunct, but a website that essentially allowed us to take primary care topics and educate people in different languages. That was my senior project, my senior thesis. And so I thought, hey, this is kind of cool, this idea of I can do both. I can play with computers and I can be a doctor. What a cool concept. So that's how I got started. And then that led me to go to med school, to finish med school and go to residency. And then I had an opportunity to go to Stanford and do the program in biomedical informatics at Stanford, which to this day I actually serve as adjunct faculty for. But that was a great opportunity to get involved in informatics. And still at the time, it was like, what is a role like a CMIO? What is that, right? So, but that's the informatics fellowship kind of really inspired me to think broadly about how I could do things differently using the powers of computers to influence medicine. My senior thesis actually was a project to study the implementation of a decision support system for hypertension at 3— at multiple VA sites around the country. And here's the powerful thing. I had a great mentor, Mary Goldstein, great faculty, great research team, and our primary outcome trial was negative. In other words, we did this great work, we studied these great things, but the patients did not actually receive better control of hypertension with the decision support system. And there's nothing wrong with the technology of the time. It was very, very powerful. It linked with the VA. But I realized something in that partnership, which was in that fellowship, which was who would benefit the most from the care of this decision support system is the patients. So that's kind of what led me to say, hey, let me get involved in patient portals because I realize if you can empower people with the information they need, that's where the action is. That's where things should happen. That's how I got started in patient portals. And I happened to meet a guy named Paul Tang who was really inspiring as a mentor. And, uh, he gave me a role and we got going from there.

That's awesome. But, you know, in addition, you know, you've been speaking mostly, you know, talking about technology and helping people, and you're also a leader and a pioneer, I think. I don't know what you called it, but you had offices in San Francisco and downtown San Francisco, and I visited them. And I don't know if you used the words human-centered design, but that's really what you were doing. Can you talk a little bit about that as well, sort of like your collaborative space and how Because that's a little bit different, right? A lot of people, especially from the tech side, don't necessarily operate in that way. But can you talk a little bit about what you were doing there and sort of that design work that you did?

Well, actually, I should give credit where credit is due. I actually have a great partner named Chris Wall, who's our chief innovation officer, who came from IDEO. And he has brought human-centered design to Sutter Health. And I've learned a lot from him about how to combine skills to actually bring new solutions to patient care. And that's, that's, that's what we do together. So that, that then he, you know, he and I occupied that center in San Francisco as kind of an innovation hub to inspire our organization and patients and our partners to do better for our patients. So that's where you get an opportunity to meet us.

Yeah, no, I loved it. And the way that you've always been so helpful in Sutter, been helpful to others in the healthcare community to allow us to come visit, you know, and, and learn from what you were doing so that we could replicate some of that and, and apply those ideas to our own particular subset of culture and geography. And that's very cool that you all are so open about doing that. So you've seen a lot, obviously, as a pioneer. Where do you think we're headed? And I know it's hard to go too far in the future, so whatever you're comfortable with, but let's just say 2 to 3 to 5 years max. Where do you think we're headed with sort of digital and patient experience and those sorts of things?

So I actually believe it's funny, we use these terms like digital and innovation and so forth. I think it's all about access to care, right, at the end of the day. And I'm looking for every opportunity to say, hey, how we can use technology, how we can use new workflows, new ideas to bring more access to care for people. Because at the end of the day, you can have quality outcomes, you can have quality tools, but if people can't access that care, then there's no quality of care. People have to get access to it. So that's what we're day in, day out, every each and every day, we're looking for opportunities to improve access to care and That's, you know, at some point digital is not just the empowering— empowerment of care, it's actually the care itself. Someday we're not gonna say it's e-health, it's health, right? That's what ultimately this is all about. That's what we're here for, the outcomes for people. So that's why I focus on that stuff.

What do you think might be 2 to 3 of the biggest barriers that keep us from moving faster? So we've got— I think we've got all the technology we probably need for now, but, you know, still Some would argue— and Sutter, you're a little bit of an outlier, you move faster than others— but some would argue that we haven't moved fast enough as an entire industry. What are some barriers that you think about?

If you will, I'll borrow a story, and I think it's a lesson learned. So a few years ago, I had a plan, a 2.5-year plan to promote telehealth throughout Sutter Health. And this grand plan, it's going to take 2.5 years and it's going to be 5,000 doctors, right? That was the plan. And then this magical inspiration called COVID, the unfortunate thing called COVID, happened. And we did that in four weeks, right? I mean, we all we've all had this experience where we went from you know et cetera. We went from seventy hundred seven thousand many visits in one year prior to COVID to one point one million visits in the following year after COVID. And I think at the end of the day, as you say, one and two three barriers. One of those is frankly incentive alignment. So can we align incentives to make sense for people and make it work? That's really what came in alignment with COVID nineteen. We said, hey. The incentives aligned. We need to take care of people. We had this pandemic, this horrible pandemic, empower people. Well, telehealth was an answer. That's a lesson I've learned for many years for any, any number of things we've done. Make sure it makes sense for both all parties involved, you'll get the magic to happen.

Yeah, that's great. How do you measure success of initiatives? So you, again, Sutter in particular, have been very good about being first out there with, with many experience-enabling technologies. And how do you sort of know, hey, that is successful and this isn't successful? Do you, do you have some sort of criteria that you use?

We're a little disciplined in that sense. We actually try to have a measurement plan before we get started because, you know, at the end of the day, you can, you can get with this, this famous disease. It's called pilotitis. Lots of, lots of folks suffer from it. And, you know, I like to do things at scale, so that takes time and takes energy and an approach. So what I like to try to do is Obviously, in first phases, test things out, but imagine and plan for the future and plan for scale. So whether it be telemedicine or this Care Companion pregnancy app that we talked about or so forth, we have a discipline, a discipline that says we need to measure the outcomes of each and everything we deploy. Because digital health, as I said, ultimately is not just the empowerment of care, but the care itself. And so it should be as rigorous as clinical trial, for example, for medications. It is ultimately a treatment that we apply for patients, and we try to measure the outcomes to make sure that we're actually on track and course correct if we have to. So we actually measure these things.

Yeah, you definitely have the discipline and rigor. You know, earlier I'd asked you about where we're headed in the next couple years. You know, one of the things you talked about was really all about access. And sort of related to that, I wanted to get your opinion on this: hospital at home. So I mean, it's kind of an access— definitely an access thing. And what are your thoughts about hospital at home? Do you think In our future, we're looking at only like the most acute care might be at an inpatient facility, hospital. Everything else might be able to be handled at home.

I think if we've learned anything from the pandemic, it's we can open our minds to new possibilities, right? At the end of the day, there's this simple saying, right? Right place, right time. Hospital home is one of those concepts. Absolutely. Can you bring care to the home? We did it during COVID We brought it via video. Why not extend that concept to bring monitoring to the home? Bring the doctors to the home, so forth. It's all within the realm of possibility. I think it's a big opportunity. Again, right place, right time for things and for people.

I think of you as, well, expert in a lot of different areas, but in particular, sort of patient, consumer, family experience. What about on the clinician experience side? Do you spend much work there? What sort of things do you think we could lever technology to help with the crisis that we hear about? You, and you in particular, would know related to, you know, clinician burnout, things like that.

It breaks my heart to hear my colleagues, frankly. If you think about this, think of it this way. Most of us spend 13+ years, if you count college, med school, residency, fellowship, those sorts of things. You're talking 11+ years or more to become a proper doctor, right? And at the end of that path, at the end of that journey, would it break your heart to hear that in some specialties, up to 50% of people don't want to be doctors anymore? That's an incredible personal cost and great societal cost. It's incredible. Loss in my mind. So I think this is a key element of the quote quadruple aim, right? You've heard this term quadruple aim, but it's to say, hey, we need to take care of the clinician to take care of other people, because that's how that's how we improve care as well. To make sure that our our doctors, our clinicians are cared for as well. So I spend time both on the try to find the intersection between how things work for doctors and for clinicians and for patients. So yeah, absolutely. And, you know, we actually were— we studied this as well. So we actually had a research team look at our own data in the EHR. And for every 3 hours spent face-to-face with patients, our doctors were spending 3+ hours on clinical or administrative time, whether that be reviewing notes, writing notes, looking at lab results. These are all clinically important things. We have an onus in my mind to help people. to be better doctors, you know, people, better clinicians. And that's— we owe that to our— at least I owe that to my colleagues to develop new tools to help them do that. And this pregnancy— and going back to the pregnancy thing, it's a recent example. That's exactly what we're trying to do with that. You know, instead of individually handing out handouts to each and every patient who's pregnant, what if the app would do what you were going to do automatically, automagically for your patients? Saves you— potentially saves you time, saves you answering a question that your patients might have. By anticipating what they need in advance, you can get the information to them in the right place at the right time, and that helps both the doctor and the patient. Yeah, and we're always looking for solutions just like that.

No, that's the best, right? When you can develop something like that and it helps everyone in the entire ecosystem. So if you were— and I bet you've been called in to do this, it sounds like you actually probably did it in Brazil for sure. You're called into the C-suite. So you're outside of Sutter Health where you've got this great ecosystem, great believers in digital and technology and patient experience. But you're in the— you're some average hospital somewhere. And the C-suite realizes, hey, it's time. We need to make a change. We need to take a first step. What advice might you give someone who knows they need to sort of get into patient experience, leverage digital a little bit more, but haven't yet? What are one or two baby steps they might consider?

Well, one of the things I encourage everyone to do is think about their own stories, their own personal— and I I draw, as you noticed today, I draw from my own personal experience, personal stories. And I think we all have to develop our voice. And I encourage health systems to do that, to say, hey, what are we good at? What is our secret sauce? And how can we leverage, in this case, digital to make that even better? So that's what we try to do. And your point earlier about sharing is so, so important to me because we're going to get outcomes. You know what, you can do one-to-one things where you can help a doctor, doctor and patient individually. That's a great thing. And I still do that to this day. I see patients on Fridays because I love that one-to-one interaction. But if you want to get something at scale, you have to share, you have to form partnerships. You can't do it alone. And then whether that be doing it with multiple health systems or across other borders, we can all— we have all something to learn from each other. And that's why I encourage us to mutually learn together. So that's why when you guys came to visit us from Cleveland, I thought, hey, it's an opportunity to learn from Ed and Ed to share some stuff with me. So that's why we share. It's the way to be. It's the way to learn.

Yeah, love it. So we covered a ton of territory in the last 30 minutes, Albert. Everything from your very, very personal story— and thanks again for sharing that— and sort of your motivation. We talked a lot about the role of chief digital health officer, how you stay current with digital, sort of the, the beginnings of, you know, informatics in healthcare, and then some of the things that you all have done at Sutter and beyond, some of the barriers, how to get over them, how do you measure for success. It's just a ton of different areas. And so I wanted to leave the last word with you. Is there an additional area that, that you wanted to make a comment on that we didn't touch on, or maybe double down on something we did talk about?

I'd say it all likes to remember something, which is We have this great unique opportunity to help people, and that's, that's a great responsibility, but it's also a great privilege for us in healthcare to be able to accomplish. And each and every day I'm thankful for that opportunity. So whether it be talking to you or partnering with my fellow doctors or patients, it's just a great gift that we have to be able to participate in that. And I, I love talking about that concept because, you know, at the end of the day, that's what I would try to remember. That's— we have this privilege on this earth to spend the time that we have To do good things. That's what wakes me up each and every day.

Yeah. Dr. Tan, this has been amazing. It's just reconnecting with you again. It makes me realize how much I miss you and miss your friendship. You're an awesome human being first and foremost. You're a great father and husband, and you're a great clinician and digitalist and bringing the two together to help patients and impacting them all around the world. So, wow, I feel very blessed to even call you a friend. So thank you again for being on our podcast. And I wish you continued success out there in Sutter and beyond.

Thank you for your friendship, Ed. 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.