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December 19, 2024
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On this episode of The Digital Patient, Dr. Joshua Liu, Co-founder & CEO of SeamlessMD, and marketing colleague, Alan Sardana, chat with Dr. Romil Chadha, Chief Medical Information Officer at UK HealthCare, about "Building Solutions on Paper First, When to Introduce Friction vs. Automation, Why Too Many Measures Can Hurt Healthcare, and more..." Click the play button to listen or read the show notes below.
Audio:
Video:
Guest(s):
- Dr. Romil Chadha (@romilchadha), CMIO at UK HealthCare
- Dr. Joshua Liu (@joshuapliu), Co-founder & CEO at SeamlessMD
Episode 144 - Show Notes:
[00:01:10] Early Influences in Healthcare: Dr. Romil Chadha shares his journey to healthcare, influenced by his father's role in rural medicine in Uttar Pradesh, India, and his early interest in both healthcare and computer programming.
[00:02:27] Career Shift to Hospital Medicine: Dr. Chadha describes his transition from aspiring hematologist oncologist to hospital medicine due to his preference for immediate patient care outcomes and less invasive practices, branding himself as a "no needle, no blade doctor."
[00:03:04] Introduction to Informatics: How mentors, Dr. Carol Steltenkamp and Phil Bernard, introduced Dr. Chadha to healthcare informatics, igniting his interest in blending medical practice with technology.
[00:04:21] Impact of an MBA on Healthcare Leadership: Dr. Chadha discusses how an MBA enriched his skills in managing and leading in the informatics sector, emphasizing the importance of understanding the business and social aspects of healthcare technology.
[00:05:18] Adopting New Technologies: Dr. Chadha explains his strategic approach to technology adoption in healthcare, utilizing insights from the podcast "Hidden Brain" to enhance understanding of social behaviors affecting technology use in healthcare settings.
[00:07:09] Value of Simplistic Approaches in Healthcare: Dr. Romil Chadha discusses the importance of simplifying solutions, often starting with paper-based methods to ensure thorough planning and understanding before jumping to digital solutions.
[00:10:15] AI and Healthcare Friction: Dr. Chadha emphasizes the distinction between tasks that require human cognitive skills and those that can be automated. He references the concept of "System One" thinking from Daniel Kahneman’s work, which advocates for automation in straightforward, routine healthcare tasks, enhancing efficiency without compromising care.
[00:12:21] Educational Influence on Healthcare Decisions: Dr. Chadha shares how insights from behavioral economics, particularly from books like "The Friction Project" and "The Element of Choice," influence his strategies in implementing healthcare technology, stressing the need to discern when to introduce friction to safeguard against oversimplification.
[00:13:16] Key Performance Indicators (KPIs) in Healthcare: Addressing the effectiveness of AI initiatives, Dr. Chadha critically evaluates the relevance and impact of KPIs in healthcare. He advocates for metrics that genuinely enhance patient experience and provider well-being, cautioning against blindly following KPIs without assessing their real-world applicability and impact.
[00:15:57] Optimizing Healthcare Culture: Dr. Romil Chadha discusses the potential to run a healthcare organization focusing solely on patient experience and staff well-being, highlighting the importance of a positive culture where caring for patients is inherently valued by staff.
[00:16:33] Data Variation and Long-Term Analysis: Dr. Chadha reflects on the importance of analyzing long-term data to understand health trends and outcomes, suggesting that what may seem like causality could just be variations over time.
[00:17:01] Future of AI in Healthcare Documentation: Discussing ambient AI and its impact on clinical documentation, Dr. Chadha raises concerns about potential long-term effects, such as the loss of essential skills due to automation and dependency on technology.
[00:18:02] Evolving Healthcare Skills in the Age of AI: Dr. Chadha compares the historical transition from manual labor like farming to more specialized tasks, suggesting that as AI integrates more into healthcare, similar shifts will occur in medical professions, possibly leading to hyper-specialization.
[00:19:39] Healthcare Skills and Knowledge in the AI Era: Dr. Chadha discusses the distinction between mechanical and cognitive skills in healthcare, emphasizing the need for critical thinking and decision-making skills that AI cannot replace, despite advancements in technology.
[00:21:32] AI and Workplace Efficiency: Dr. Chadha touches on how AI could streamline tasks that are currently time-consuming for healthcare professionals, potentially leading to more focus on patient interaction and care quality.
[00:24:23] Evaluating Incentives in Technology Implementation: Dr. Chadha discusses his approach to evaluating incentives and disincentives when implementing new technology, emphasizing the importance of a robust governance structure that involves clinical, operational, and IT perspectives.
[00:25:48] Philosophy on Incentives and Process Integrity: He shares his skepticism towards monetary incentives for cognitive tasks, suggesting that such incentives can often distort intended outcomes and lead to unintended gaming of the system.
[00:26:36] Motivating Technology Adoption: Dr. Chadha prefers intrinsic motivators over monetary incentives, focusing on mastery, autonomy, and purpose to drive technology adoption among healthcare professionals.
[00:27:08] Challenges with Quantifying ROI: Discusses the difficulty in quantifying return on investment for new technologies, particularly when benefits include qualitative improvements like staff well-being.
[00:27:56] Long-Term Impact and Measurement of Interventions: He reflects on the challenges of measuring the long-term success of interventions and when it might be appropriate to cease ongoing measurement efforts.
[00:29:34] Leadership and Vision in Technology Adoption: Emphasizes the importance of visionary leadership in recognizing the non-quantifiable benefits of new technologies and interventions, particularly in enhancing staff well-being and patient care.
[00:30:35] Sustaining Innovations and Measuring Success: Dr. Chadha touches on how successful interventions are sustained over time, and the role of continuous improvement and reassessment in maintaining their relevance and effectiveness.
[00:34:28] The Importance of Process over Targets: Dr. Chadha discusses the importance of focusing on processes rather than rigid targets in healthcare, cautioning against the unintended consequences of pursuing specific metrics.
[00:35:06] Reevaluating Medical Metrics: He reflects on historical shifts in medical guidelines, such as blood pressure and diabetes management, illustrating how what was once considered best practice can change over time.
[00:36:02] How Group Targets to Foster Teamwork: Dr. Chadha promotes the use of group targets to enhance teamwork and align goals across healthcare teams, rather than focusing solely on individual metrics.
[00:37:29] Philosophy of Simplification and User Focus: Dr. Chadha explains his approach to clinical decision support and order entry systems, emphasizing the need to reduce unnecessary complexity to make the right actions easier for healthcare providers.
[00:38:27] Continuous Improvement in Healthcare: Discusses his commitment to a growth mindset in clinical practice, leadership, and informatics, focusing on learning from failures and fostering an environment where staff feel safe to share and learn from mistakes.
[00:39:22] Creating Psychological Safety: He elaborates on methods to create a safe environment where team members feel secure in discussing failures and learning from them, highlighting the importance of transparency and role modeling by leaders.
Fast 5 Lightning Round:
- Favorite book:
"Thinking, Fast and Slow" by Daniel Kahneman.
- Person to Meet:
Daniel Kahneman, known for his work in behavioral economics, and Hans Rosling, known for his work in data visualization and public health.
- Preferred Superpower:
Rather than choosing super strength, speed, or mind reading, Dr. Chadha wishes for the ability to control time, emphasizing the value of time management over physical superpowers.
- Healthcare Belief:
The importance of standardization in healthcare.
- Last Film/TV Show:
John Oliver's show featuring RFK Jr., and also the film "Knox Goes Away" directed by Michael Keaton, reflecting on its profound messages about human behavior and decision-making.
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