The Future of Digital (ft. John Chelico, MD)

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 Digital Voices. I think I probably have one of the best jobs ever. I love being able to do podcasts because I learn so much and meet such interesting people. And today is no exception with Dr. John Jellicoe, and he is the The CMIO for CommonSpirit, but he's got a great background in addition to that, and we're gonna get right into it. But one question I always ask on these shows are what our guests' mantras are or life messages or passions. And Megan, DJ Megan, producer extraordinaire, we've never asked you that question. What's the answer to that question? Do you have one? You've heard like 150 of them now.

I've heard some really great ones. And when I knew you were going to ask me this question, I was thinking, and I have something I always keep on my whiteboard. I don't know where I came across it, but it's pray when you feel like worrying, give thanks when you feel like complaining, and keep going when you feel like quitting.

Hey, that's pretty good. I think we could all use that on our whiteboard.

I like it. Yeah, that's great.

So, John, we might as well just roll right into it. What about for you? What's your sort of passion or life message, mantra, etc.?

My message is— and it's funny because it's probably the quote in my high school yearbook and I stick with it, but It is— there are thousands of languages in this world, but a smile speaks them all. And I've taken care of many patients from all walks of life, but I think this smile has always got me through it.

Yeah, I like that. Oh, and especially as a clinician, right? Because you're working with patients, sometimes it could be scary situations for the patient and family, and having the smile breaks a lot of barriers.

I hear from my colleagues that it breaks a lot of CMIO barriers too.

So yeah, right.

Yes, your power.

It is truly amazing what a smile can do. So I love that about you. So the other question we always ask are songs on the playlist. But for you, I know that you're doing some work on a contracting side, I mean, in terms of building side. And so everyone has got their go-to home improvement store. So what is it for you?

Oh, goodness gracious. Where do I start? So I dabble in everything. I'm a plumber, I'm an electrician, I do a little carpentry. The only thing I don't do is paint and spackle because I don't like my job. But I grew up having a lot of sort of rental properties and things like that that we managed. And my favorite home improvement project, I probably ended up— and it's probably something I probably will never do again— is I took on a whole bathroom renovation in the house we used to live in. I learned that it's probably better to hire somebody, hire the right people to get the job done, than do it yourself. Because ultimately it was done, but probably not done to my ever satisfaction. So we built this house. I ended up sort of doing it from general contracting, construction managing, but being able to sort of hire the right trusted people and be able to sort of manage the job. And I think it's, uh, it's sort of, uh, something I enjoy and it's sort of a labor of love. The only thing I take on is maybe the low voltage. So I'm in the middle of, uh, putting together, um, a little home theater for my kids in our basement right now. So that's gonna be fun.

Oh, very cool. Yeah, it's always interesting. Everyone has, you know, hobbies and it's always interesting to hear what people do for fun. And also, yeah, as that hobby adds a lot of value as well.

So you get a Bonus out of it. I think it's fun.

I don't get aggravated too much. Like, I can't even put things together. I'll usually put things together and I'll get to the last step and then realize I missed the step, which means I gotta unravel all the previous 8 steps.

It's fun to start. It's never fun to sort of keep going at it.

But now I know who to call next time I'm working on a project.

Anytime you got—

So tell us a little bit about yourself. Obviously, I introduced you in terms of, you know, you're a physician and Common Spirit. But tell us a little bit about your story yourself, personally and professionally.

So my story really starts— I was an EMT in high school, actually. We had a little experimental program in my high school where high school students got to become EMTs. And we actually weren't even— most of us couldn't even take the test because you had to be 18. But I sort of got into sort of healthcare from that early age. I spent a lot of time really kind of really enjoying getting into being an EMT, spending time around hospitals and things like that. But I always sort of saw a broken system, and that was It was something I kind of drove through. I actually ended up early on studying computer science. I was a software developer. I worked through 2 health IT startups in the early '90s. One was actually bought by WebMD. The other one was bought by a medical bookstore company. I ended up doing a lot of mobile app development for NYU Langone Medical Center, but knew I had something here. We didn't call it anything. We didn't call it medical informatics. We just really called it helping people solve problems. What really turned into something, what ended up I went to SUNY Downstate for medical school after computer science at NYU. I ended up sort of, you know, helping put my curriculum online in medical school, and then I went to residency, formal training in internal medicine, where I dabbled in really redeveloping a lot of the work we did around sign-outs and handoff and things like that. I kept sort of going at it. I did formal training in biomedical informatics at Columbia. And then I was really lucky because I got to really work in some wonderful organizations. I've been a career CMIO now for close to 20 years. Really, originally, my first job was at Bellevue Hospital, SafetyNet Hospital in New York City, part of Health+ Hospitals Corporation. That was very fun. I went on to NYU Langone, where that was the beginning of their Epic implementation, and we did a lot of wonderful things there. And I'm really envious of the team there and the work that they do there. And for the past 10 years, I was at Northwell Health, where I was the CMIO of North Shore University Hospital and Long Island Jewish Medical Center. both the sort of the cornerstone tertiary medical centers that started the health system, which now is named Northwell Health, the largest healthcare provider in New York State. I was the local CMIO, I guess, in this system for the first 5 years of those 2 large tertiary hospitals, each one 800 beds in Long Island, New York. But for the last 6 years at Northwell Health, I was the Chief Informatics and Innovation Officer, and I started what we called the Center for Research Informatics Innovation. It was really an opportunity for us to say, there's a lot of wonderful work that we can do with industry. It was just never priorities to actually get that done with our internal IT teams. So we created a dedicated team. We have embedded folks in IT security, development, research data analytics to really work with industry pharma partners and working in real-world evidence type projects. And I really enjoyed that 'cause we got to push the envelope using the work of the foundational work we did in implementing the electronic health record system in Northwell and moving that on. But earlier this year, I got to sort of burst my New York bubble and sort of get out of New York, but I had the opportunity to sort come across my desk to really be the Chief Medical Information Officer at CommonSpirit Health. I went from the largest healthcare provider in New York State to one of the largest healthcare providers in the country. And it's been eye-opening. It's been a wonderful ride. It's been almost 7 months now. And really, I've learned so much about how things operate and how things work across the organization, across this country, this wonderful country that we live in, and really the wonderful people that we have in every different nook and cranny of this organization. I mean, The spirit of CommonSpirit really is that we want to be the right— provide care for every part of this, every facet of this health, where we deliver care and in the communities where we deliver care. It doesn't matter if you're one of our academic, large academic medical centers or one of our safety net hospitals somewhere in the country, you should sort of have access to the right care.

And I think that is something that I'm looking forward to sort of continuing and No, John, it's super fascinating because, you know, you can call BS on any IT person, right? Because you've got this big IT background and, you know, like sometimes clinicians, right, they don't know, they get BS'd by someone on the tech or digital side and then they don't know. But you know both sides, so that's pretty cool.

In this job, I think you're really the translator. I mean, you know, I always say, you know, I work with wonderful physicians, smartest of the smart. And, you know, the one thing is I also work with the smartest of developers. I was a software developer and a physician, and they both sort of talk different languages, and you have to sort of break things down for either side. And I think that's one of the things that's really made me successful in my career, and the fact that, you know, there's another message I could say is be humble and respectful of everyone's talent. And I think that's something you have to sort of bring to the table because it's not an easy task to sort of put together a proper program. It's not an easy task to take care of a sick patient. Yeah.

Producer Megan and I, when we were summarizing our first 100 guests, humility was sort of the number one thing that jumped out on our guests, and that's probably why they're so effective. Yeah, and CommonSpirit has a great mission. I know a bit about the organization, and it seems like wonderful work that they do in the communities that they serve. So yeah, big change. And I didn't realize the Bellevue connection. So when I was CIO at New York City Health+ Hospitals at Bellevue, Of course, our anchor. I love—

I predated you, but I, I, I, it would have been nice when— if we crossed paths there.

It's a great institution. Isn't it the first hospital in the country?

It technically is the first hospital in the country.

Probably.

There's a lot of wonderful stories around Bellevue Hospital. It is an amazing place. And, uh, I think that, uh, I learned a lot, you know, I learned a lot just from being there. And I think really understanding how to do things on a very, very slim budget is one of the first things I learned. So it was kind of good to be in that environment. Yeah.

And despite that, excellent quality of care, you know, amazing medical staff. It's, it's a wonderful place. Someday we'll— next time we meet up, we'll, we'll share our stories on Bellevue.

Yeah.

So you're, so you're in a new role. And so what sort of led you to this role? Like you mentioned, you know, you weren't looking, sort of comes across your desk. But yeah, it's a big change, right, from the city where you grew up and went to school, and now, you know, it's national. And, you know, it's much— it's probably a lot different.

There was definitely, um, people from my organization that sort of put this in front of me, people that I'd worked for and worked with in the past. You know, our chairman of medicine, Tom McGinn, actually was at Northwell Health. He had joined CommonSpirit a number of years ago. And this opportunity was, you know, an opportunity to work for— within that organization, working under Tom McGinn. And that's what kind of introduced me to the role. But, you know, it was something of a different— you know, it was a challenge in the sense that, like, you know, I take all of— take this on as a new opportunity to learn From what I can from other folks around the country, I think I took for granted how things operate in different states and different markets across the country. And whether you take our dignity health platform in California, where we have a lot of we're not allowed to hire physicians, the dynamics are different. There's medical group practices that are different to some of the markets where we make very good margins in some in some parts of the country like Colorado and Centura Health. And if you take other parts of the country like the Southeast, we're poised.

Yeah.

Just every pocket has its own nuances, its own different market forces. I think they have different challenges in how we sort of roll things out. But I think the fact of the matter is that if you can sort of really provide opportunities at a national level to help folks at the divisions, the focus is a lot different because I get to work with wonderful CMIOs at every different level in our organization. The fact of the matter is that I get to sort of think of more larger strategic things that would help them do their jobs better. That's sort of another sort of piece of it. I find myself a little bit more removed at the national level, which is something a little bit not that comfortable for me, but it's something I'm getting used to. But at the same time, you know, I use all that time being the local person and being the person in the sort of the smaller health system role. And I've sort of brought that to the table. And that's where sort of I have to really kind of respect the folks and see what I can do to help them versus me telling them what to do.

Well, that comes back to the humility, the approach of a servant leader. And so, and there's a New York Times You have the New York City connection now, right? Because we're recording in November of 2022. And so my good friend Daniel was announced as the CIO. So you'll be working together, I imagine.

I got to sit down with Daniel for lunch last week because we have the New York City connection. I am so happy that he's on board at CommonSpirit Health. I think his knowledge and his experience brought to the table for CommonSpirit Health is going to be sort of a huge benefit for all of us. I'm looking forward to actually working with Daniel. He has a lot to learn, and I think I'm still learning as Well, but I think that the ability for someone with that experience to sort of help us on this journey at Commspire Health is gonna be wonderful.

Yeah, and he also comes from the same mindset as yourself, very humble leader and yet very confident and has the great experience. And you too will be a great asset to the organization. And then again, at the end of the line, you know, the patients and the clinicians that you serve.

So that's really cool.

It's gonna be really fun to sort of watch what happens.

I think a lot of people are looking 'cause you both are stellar It's going to be interesting because I think, you know, we're only early in this journey with CommonSpirit. I mean, this health system came together between Dignity and Catholic Health Initiatives in, you know, 2018, 2019. The pandemic hit, right? So we're very much forming the health system from the beginning and getting an operating— but if we accomplish what we want to accomplish and have an operating health system across the country, I think the ability for us to make an impact is going to be amazing.

Oh yeah, I have no doubt that you all will make a huge impact. We'll pull it off. So let's switch a little bit now to talk about digital, because you're obviously— you've been a sort of leader of, you know, digital, quote unquote, where you came from, and very progressive organization. And where do you think that we're headed? You know, of course, we got virtual care and things like that. So I don't want to ask too much of a leading question, so I kind of leave it generic. So where do you just think we're headed with digital?

I think we're headed in a place where the responsibility is really with the patient. And giving them— giving the patient the tools they need to help them on their healthcare journey. As much as we want to, as a primary care physician, I can say— I've said this, I can say this. If I had— JAMA, it was an article that was published, you need 27 hours in the day to sort of go through all the things you need to do for one patient. There's not enough hours in the day or time in a month or a year to actually do what you need to do for your patients. And it's really developing tools that can really help us do what we need to do for our patients. We recently had in our clinical symposium the chair of the US Preventive Health Task Force and the ability to take sort of those recommendations that we all know that we need to do. But the reality is that most of us and most of us in this country probably only receive only 50% of that for any of our own selves or any of our patients. So I think the fact of the matter is that we now have more ubiquitous electronic health record systems throughout the country. We have the ability to have patient portals that now patients have more control over. I would say not 100% control over, but the ability to use some of the more commercially available monitors and other things. But helping patients make informed decisions to do the right thing for their health on a global scale, Is something that I see, I see it. And I see us physicians, I see us taking care of groups of patients versus sort of taking care of just individual patients one at a time, because I think it's just better use of our time. Now, I'm not saying we're gonna do this tomorrow.

Right.

I do see the ability and the fact that we have transparency to the data and patients can actually, are well-informed and are, you know, the same way they are in many other facets of their lives. I think the self-service options need to sort of really come to bear in healthcare in order for us to, Sort of, you know, fix a broken system.

Yeah, you're definitely spot on. Are there a couple objectives? I know you're early at CommonSpirit and Daniel has just started, but are there one or two things that you've been thinking about, or when you were hired, they were like, you know, hey, yeah, what we'd like to do?

Well, the first thing is for us to sort of get rid of, or get, or sort of consolidate platforms. I think there's definitely a need to do some application rationalization across the organization. We have now something like 3,000 applications across, bolted onto our EHR or health record environments throughout the country, whether it's on the clinical side or the revenue cycle side. So I think the ability for us, it's really to us to sort of consolidate platforms, us to sort of get to a place where we can really get quickly to sort of innovate on those platforms is something that I, you know, is definitely a goal. It's a goal of the organization. It's the goal of myself. I working sort of particularly in the clinical enterprise as part of the physician enterprise, you know, I think one of the things we're looking to do is we're having major issues in staffing shortages. And I think one of the fires, the first fires we have to put out is understanding of how we can develop technology to help staffing shortages across the country, whether for our providers, for our nursing staff, but as well as many of the sort of the front desk staff and other folks that are helping our providers do the jobs in our clinics and our practices across the country. So doing things like having a connection center strategy across the country where we can actually have folks man the phones, do pre-registration and other things, referral management, other things that we can sort of take out of the office and be able to sort of centralize is something that I think we're looking to do at a global level. And we're doing some of that already in many of our markets. And I think that's going to be one of the major sort of pieces that we'll see. The other thing is really is taking some of those tools and bringing it to the patients. We're doing some wonderful stuff with robotic pre-op process automation. Where we're having virtual registration taken care of prior to patients coming to the, to the office practice or interaction at the hospital and being able to do some intelligent clinical intake. So some of that work, you know, gathering history and other things can be done prior to the patient sort of interacting with their provider and really just gets us a foot up in the right direction. And I think it's getting to a level of efficiency that we're very happy with. So those are some of the larger things. There are also some foundational things like our provider directories, our physician directories across the organization that we need to consolidate. I think some of those things like centralizing credentialing, centralizing privileges, but understanding, you know, all of that work that looks really easy on the front end of our website when you go find a doc is something that you can't really take for granted. And when you're putting together a health system across Many different states. Those things become a lot more important when you really have to have a handle of what are the providers you have in a certain market or other things. Consolidating that data, having the ability to do innovative things with it, you just find those foundational things very important. I think those are some of the things that I've walked into.

That's a pretty big list right there, John. It's not unusual, especially from a health system that has grown through M&A. And like I said, if there's anyone that can pull that off, you know, have— I'm sure Commsphere CEO and the board, they're like just tickled pink to have both you and Daniel, and you will pull it off. We're all working together. I have docs ask me a lot about how they can get into the CMIO track and become a leader within tech.

What are—

and you've obviously built your entire career on this— what 1 or 2 pieces of advice would you give younger physicians who are looking to sort of become a CMIO or even a CIO, a CDO?

Depending on when you want to do it in your career, I think the most important thing is to volunteer and get yourself involved. A lot of providers— I mean, now when I got into informatics, I kind of like to say I did a fellowship in informatics before it was cool. But now we have ACGME fellowships in biomedical informatics and the ability for you to sort of go and get board certified and really kind of understand the crux and the methods Mm-hmm. Of what it takes to really do things. But if you're interested in the field, whether it's in pre-medical school, medical school, or even afterwards, for me it was always just getting involved and getting, you know, volunteering, you know. And that's why I said, you know, when I was in college, I mean, I volunteered to develop mobile apps for the health— for the medical center, NYU Langone. When I was in, you know, medical school, I put the curriculum online. And when I was in residency, I developed handoffs. I mean, I always was the first person to say, hey, there's an opportunity here to make this better. Whenever it's an opportunity to change platforms or bring on a new platform, I think the ability to have physician champions or provider champions is key. You can be a CMIO in every different facet. We need more folks involved in developing these things because if we just leave it to folks that are not practicing or folks that are not involved in the day-to-day, I think it's dangerous. We do need more people to sort of step forward and get involved.

That's sound advice, and I agree with you. And so, I mean, on the other side, what I always did whenever I had clinicians, it could be nurses as well, any clinician, but for sure physicians. And if they had a lot of ideas, they're easy to identify because they'll usually let you know. And so what I would do is instead of having any sort of friction, actually, I embraced it. I'd be like, hey, why don't you come over? Why don't you spend a couple of hours a week with us? Or why don't you lead this particular committee? And, and it reminded me of a, a gentleman, actually, he's my PCP today, has been for many, many years now. And he was the one who always sort of had all these ideas and suggestions. And then rather than have sort of a friction with them, I just invited him. I said, why don't you be on the IT steering committee? And then from there, he got noticed and he worked his way up and he was like head of the physician group. You know, this is a major health system I'm talking about, and on the board of the health system. And then the other, the hack, I didn't even do it on purpose, but now that I think about it, But he became our biggest advocate. Now, on the board, I've got this person that it was like having another CIO vote because he was always helping me out. Anyways.

It's key. I think there's a lack of understanding of the complexity. A provider may come in and say, hey, can you change this button, or can you just make the system do one thing or the other? I think there are nuances in the fact that you're trying to do this at a global scale across a small part of the health system, a smaller health system, is the nuances and the variation that you have to sort of support in that one single whether it's an application or hardware or anything else, is you have to kind of understand that there are ways to do it right. And I think that's the thing that you kind of have to explain that sometimes to our providers. And them being involved is very important. Also in getting involved is you can never get someone to— and maybe it was a Harvard Business Review article I read— you can't get anyone to buy into your idea. I think the idea is that you always have to get someone to sort of be part of your idea.

Yeah.

Because if we get people involved early on, I think they own the idea. They own the good, the bad, the ugly, I always say. And if you just, you know, you, you come outta your, your shell and say, hey, I got the best thing. I got the, the new, you know, the, the best toaster available on the market today. It, it doesn't matter what that looks like. It's different than what they're used to. But if they'd helped develop that, yes. Or they helped develop that new workflow, you know, they're your champions. They're the people that are gonna sort of get ahead of it and honestly own it. 'Cause it's never gonna be perfect. It's never gonna be well polished. It's gonna be a little bit quirky and it's gonna be whatever. But the fact of the matter is that you built it together. You own it together. That's great insights.

Especially coming from a clinician perspective. We're sort of talking leadership, and I had another leadership question for you because I'm always interested about, you know, how people have grown as leaders. And so is there specific advice someone once gave you that you look back on and it's like, wow, that was real helpful, that was a winner, and I'm, I'm gonna adopt that?

I know we said it already, but I said, yeah, you have to be humble. I can't press on that enough. I learn that every day in CommonSpirit, but even in my old job, We used to have— Pat Thorpe was in my office, right outside the door of my office. She was part of our informatics team, but she was also a nurse in that hospital at North Shore University Hospital for probably now going on 40 years plus. And she'd come back from a meeting, I'd scratch my head and be like, why did they ever do it this way? And she'll always have an answer for me to kind of say, hey, this was the best answer to the situation when they did it. If you're trying to transform something, you're trying to change something, or trying to really get to a new way of doing things, you really have to understand why they're doing things the way they are and where they got the way they are. Whether they installed some old, quirky system, or they did some strange workflow, there was definitely a good reason for it. And if you kind of unbury that reason, you'll have a much easier way to sort of play yourself into the future of that organization. I think that being the historian and being humble to that and Understanding what got them there may not get them to the next level, but at least you understand that they're not crazy. They're not lunatics that ran the asylum prior to you entering. There were good, sane people that were well-intentioned and trying to do the right thing at every step of the way.

That's fantastic insights. So we've covered a lot of ground in a pretty short amount of time and a lot of great leadership insights as well as just your thoughts on future of digital and things of that nature. Is there anything that we need to double down on or anything that we haven't covered? Because I'd like to leave the last word for you.

The one thing that we have to understand is that we're at a very interesting place in this country in healthcare. I think we all feel that we have a system that is, you know, unattainable and broken. I think there's gonna be a lot of changes in the way we do things in this healthcare system. We have to really understand that there's a lot of technology out there, but I think we need technology that really solves problems of today. And I think if we can make the right investments in the right technology, in the right spots, that we could really fix and turn the ship around. I feel like there are a lot of investment in this healthcare system, in the healthcare system today. There's a lot of even outside money that's coming into healthcare, healthcare IT, but I think they're sometimes not solving the problems we have today. And I think that's one thing we need to really kind of keep a laser focus on in the sense that we need to not be distracted and really try to understand And at the crux of it, how we need to look at the care of the patients across the country and how the health system needs to sort of provide that care. It's not going away, but we need to find a better way for it to happen. So I think that's something that I'm looking forward to. Call it a little job security, but I think that I'm happy to sort of be along the ride and being in a place where I can sort of make a difference. So I'm looking forward to continuing conversations.

Yeah, John, thank you so much. Again, this has been super rich, and I know that our listeners really appreciate your candor, the insights that you shared, and, and just your humility. It comes out in a big way. And I wish you just tremendous success at CommonSpirit. I know you'll have it. And thank you for being a guest on our show.

Thank you, and I'm honored to be here. Thank you very much, Ed and team, and, um, I'm looking forward to future conversations.

All right, that wraps up Digital Voices.

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.