The Digital Patient - Episode 66 - Lydia Lee: Why Digital Health Pilots Are Doomed to Fail and How to Engage Stakeholders for Digital Transformation

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In this episode of the SeamlessMD Podcast, Dr. Joshua Liu, Co-founder & CEO at SeamlessMD, and marketing colleague, Alan Sardana, chat with Lydia Lee, Partner, National Digital Health Lead at KPMG, Global Co-Lead, KPMG Connected Enterprise for Health and Chair of HIMSS Americas Board of Advisors, about "Why Digital Health Pilots Are Doomed to Fail and How to Engage Stakeholders for Digital Transformation." See the full transcript below.

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Guest(s):

Lydia Lee (@lydialeetoronto), Partner, National Digital Health Lead at KPMG, Global Co-Lead, KPMG Connected Enterprise for Health & Chair of HIMSS Americas Board of Advisors

Dr. Joshua Liu (@joshuapliu), Co-founder & CEO at SeamlessMD

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‍Episode 66 – Key themes:

• How to implement a digital health pilot with longterm sustainability in mind by engaging multidisciplinary stakeholders (e.g. Leadership, Administration, IT, Physicians, Front-line workers) to ensure there is alignment on goals and governance for post-pilot operations;
• How health-tech has enabled health systems to reimagine the patient journey with an emphasis on UX/UI for patients;
• Why Ms. Lee believes billing codes, incentive models and even licensure will have to change to support digital innovation;
• Why Ms. Lee prioritizes hiring diverse teams to avoid single-minded thinking and to balance implicit bias;
• Why Ms. Lee prefers consulting to being a hospital CIO because consulting allows her to focus on projects as opposed to operations and the flurry of activity a CIO is responsible for (e.g. dealing with ransomware attacks, system outages, tight budgets, etc.);

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Full Transcript:
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Alan: Welcome to "The Digital Patient" where we discuss the latest advancements in digital patient engagement and share stories from the frontlines. I'm your host, Alan Sardana, and with me as always is SeamlessMD co-founder and CEO, Dr. Joshua Liu. Today, we're joined by our very special guest, Lydia Lee. Lydia Lee is a partner at KPMG Canada and national leader for the Digital Health Transformation Practice. With more than 25 years of experience in technology-enabled business transformation, she focuses on digital strategy, complex multi-organizational governance, information systems modernization, and data management. Prior to joining KPMG, Lydia was the senior vice-president and CIO at the University Health Network in Toronto, Canada's largest academic health center and learning institution. She was awarded the distinction of IT Association of Canada Public Sector Canadian CIO of the year for her demonstrated leadership of provincial e-health initiatives. Lydia is also a lifetime member of Digital Health Canada and the chair of the HIMSS Americas Board of Advisors. Lydia, welcome to the show.

Lydia: Thanks, Alan. Thanks, Joshua. Great to see you guys.

Alan: It's amazing to have you on the show. You've been a leader in health IT and digital health for decades now. But you actually started in consulting and hospital administration. So, we are curious, how did you first get into this wonderful world of digital health?

Lydia: Well, I started actually in consulting right after my MBA, I'll just say a long time ago. And I worked in healthcare. I was doing work in the U.S., actually working in Houston, of all places, and doing what they called revenue maximization work. This is all about just how do you get more revenues from....at that time, it was patient billing, or patient-provider billing back to insurance companies. And even back then, like, all of the work was super manual. And I always just kind of thought like there's got to be an easier way to deal with the reams and reams of paper forms and spreadsheets that were being used. So, in my project back then, I was a very junior staff person on a very large engagement and I didn't really have an opportunity to heavily influence the approach that we were taking. But it was always in the back of my mind.

It wasn't really until I got to the London Health Sciences Center, which was my first hospital job. And it was when we were actually doing some really cool work to help patients who had surgical procedures at LHSC repatriate back to care with their community providers for follow-up and ambulatory care clinic. And it was an interesting process to actually negotiate the collaboration and the handoffs, the patient transitions. But we were always struck by the lack of data to use to evaluate whether or not the repatriation process was working. And we had no electronic systems whatsoever to track and monitor this stuff. So, that was when we really said, like, we've got to find a different way to actually make this happen. Otherwise, it's not going to be sustainable over time. And so, we heavily relied on the IT department of the LHSC and the IT departments of the hospitals back then to see what we could do. But even then, it was rudimentary. And I just knew there's got to be a better way to engage with the technology.

Alan: That's great. It almost seems like that kind of formed your focus then. You figured out all the disjointed, fragmented pieces of care. I think it was also just interesting, jumping ahead in time a little bit, during your time at UHN, when you were the CIO, you were the executive sponsor and project lead for several major e-health initiatives, things like Connecting GTA, which was a regional EHR for 7.5 million citizens. You also were project lead in the GTA West Diagnostic Imaging Repository, as well as the resource matching and referral system. And these kind of all point to what you noticed back at London Health Sciences. I'm curious, at the end of the day, all of these initiatives are centered around the patient experience and providing more accessible care for patients, curious in terms of digital. From the context of digital, what does patient-centered care mean to you?

Lydia: I think that true patient-centered care really means that the entire health enterprise, whatever that is, it's a hospital, an integrated health system, but that all of it's really aligned to and engineered to deliver on what the patients actually expect. And, in order to be able to do that, you have to first understand what is it that our patients want and expect from us as care providers, and to be pretty specific about that, right? So, if for example, patients expect that they should have direct access to their health records, okay, well, are the functions in HIM set up to deliver that? Or is it this really complex process where you actually have to go down to some department, pay a fee, get some papers faxed, or whatever, right? Or is that actually an easy process for the organization to facilitate?

Are all of the strategies, functions, and processes in the organization aligned to deliver on those patient expectations? Do we have technology and platforms that actually support those functions, right? So, all of this stuff is basically a giant alignment exercise, Alan, to go back to being able to meet our patients' expectations. And it's only when all of those things actually happen and you have the KPIs to evaluate whether or not you're doing that is when I think we can say that a system or a health system is truly patient-centered. If we only say it, but we don't actually make it happen in those ways that I just described a second ago, then I think that we've fallen short.

Josh: And so, Lydia, a question for you. I think I remember reading that actually beyond Canada, you're now leading Connected Enterprise for Health for KPMG globally, if I'm not mistaken.

Lydia: Yeah.

Josh: And even before that, you mentioned earlier how you've been doing work both in the U.S. and in Canada. And we are as well. And so, I mean, one of the challenges I've noticed between improving care or using digital to improve care has been that in the U.S., there are some more incentive models to actually drive adoption of digital. Maybe that's been meaningful use incentives for EHRs, or more recently value-based care incentives to use tech to improve outcomes. And I've seen in Canada where we all want these things as well, but because we're, you know, primarily a fee-for-service system still, a lot of folks see the value of going digital to improve outcomes and patient experience but then there aren't as many incentives to do so. So, I was wondering, have you been noticing that as well from your perspective? And then I guess, what can Canada do to drive adoption, if we don't have incentives? Or do we need incentives going forward?

Lydia: I think there's a couple of things that we can do. I do think there are opportunities for aligned incentives. So, let's talk about Ontario health teams for a second, right? OHTs are eventually going to be in a circumstance, I think, where they'll be able to pull the funding for delivery of care against whatever the specific goals are, right, whether it's population health management, improving chronic diseases, and so on. So, okay, so if we then create very specific patient-centered goals around what that funding is supposed to deliver, then how do we engineer and actually orchestrate all of the internal clinical workflows, the service delivery model, and so on to actually deliver on those goals? And so, that, to me, is a perfect opportunity, Josh, where we could actually incentivize the right behaviors to deliver on those patient-centered goals.

Now, if we just deliver the funding and say that that funding is only driven by, I don't know, “create some integrations between system X to system Y”, you're going to get exactly what you pay for, right? So, I think that we have to set it up right from the get-go and then really focus our energies in those OHT models around the alignment that I talked about. I think that even if you don't have the OHT funding incentive, let's say, as a precursor, you can, as a health system leader, create a strategy that's very deliberate around whatever those patient-centered goals might be and then do it, right? And if you don't actually deliver them on patients, we'll see that and they'll know that. And if you hold yourself accountable, then it will actually drive results. I remember a long time ago at UHN, UHN was really one of the first hospitals I think in the country to actually publish our customer Sat(isfaction) results on our website. And everybody was all freaked out when it first started happening.

We're like, "We can't possibly put that online if they're less than stellar," right, because we're only a stellar organization. I mean, it was just sort of ingrained in our culture. But we were like, "No, this is about transparency. And this is about driving to improvement. The only way we're going to get better is if we post publicly what our current results were." And sure enough, that's exactly what happened. And patients actually specifically called us and said, "You know, good for you guys for actually coming clean on stuff and identifying where you had opportunities to improve." Anyway, so I think that you can do things to actually make a difference to be public about it. But you have to kind of have the courage to do that too and put the processes behind it.

Josh: I love the idea of being more transparent about outcomes and experience and all that in the industry. I hope more and more folks end up doing that. I did want to actually follow up on this topic a little bit. So, we've seen in healthcare historically that, again, we do need, I don't know, reimbursement incentives often to drive behaviors. Even for technology, in the U.S. they have these remote patient monitoring CPT codes to adopt remote monitoring. And then Canada now, there's finally... let's call it virtual visit billing codes and all that that drive adoption. I was wondering, when you think about the long term, do you expect there to always need to be billing codes for all of these items including for using technology?

Because my thing has always been we can always create new billing codes, but then we're always gonna be behind the curve on the next wave of technology and innovation. Whereas, if we just set the right incentives, then the health system will pull the right innovations that it needs, whether it's technology-based or not. And so, I've always been pushing for: forget the billing codes, focus on the right value-based care, other incentives, and then you'll pull the right innovation out of there. But I feel it's so hard to get people to agree on what the right outcomes are, so we always default to just creating billing codes after the fact. Do you think we can get to a point we don't need billing codes for every little thing or...?

Lydia: I don't know about not having billing codes because the fee codes that were established by the provinces during COVID for virtual care were set up to make sure that physicians got paid for conducting virtual visits as opposed to what historically was done in person, right? So, they needed to make sure that they provided access to services, and fee codes at the time were the way to enablement. Now, the interesting thing is coming out of the pandemic, I actually had an opportunity to facilitate a virtual care summit for the FPT, the Federal Provincial and Territorial groups that were looking at this issue. And they said, there are actually four major things that will be required to sustain virtual care going forward for Canadian healthcare… Reimbursement was only one of the four. It was an important one. And I don't think people took it off the table. They said it was one of the four. But it wasn't the only thing. The other stuff was what do we think about national licensure, because currently, and I'm talking about physicians, right, physicians are only licensed in the province that they practice in. If you create national or cross-jurisdictional licensure, can you open up the opportunity for broader use of digital services, right? So, that was the second one.

The third one was around service delivery models, so do the service delivery models actually incent the use of virtual care or not? Or do they only incent you to come in in-person because that's the only way that the whole care model actually functions? If digital isn't built into the workflow, and that'll be a theme that I'll talk about probably a little bit later too because it's a key thing around digital virtual sustainment. If it's not built into the workflow, it probably won't stick. And then finally, like, do we have the change management training and all of that and education to teach people how to actually interact in a digital world? So, there were those four themes, Joshua. And I think reimbursement is only one. But it was considered like, "Look, what we do have to pay for the things that are the right things to do, so." I don't think it's the only thing though.

Josh: Makes a lot of sense.

Alan: Yeah, I think that's totally fair. Lydia, in another panel that you were on–you actually led this panel–you're talking about changing the way we work does not necessarily equal layering on more tech. And I think it's really important, especially coming from a digital leader, given your unique focus on digital transformation in healthcare. Curious, what's brought you to that conclusion? And maybe what is your mental framework for considering whether a solution is needed within technology?

Lydia: Well, what brought me to that conclusion was that the first time...I remember this, as though it was yesterday... When we were starting to implement CPOE at UHN, I'm just gonna say it right now, we were automating current-state process, right? We weren't actually using it initially as a chance, "So, hey, let's, like, take some steps out of the process," or, "Can we smooth the communication process between physicians, nurses, and pharmacy?" So, we just put technology in place to kind of speed up the existing process. At the end of the day, people just mutinied because they said like, "This is stupid. It's so much faster if I could just work with my pen and paper," instead of having to click around the screen 30 places in order to place an order or whatever. And so, it was just so obvious that if you don't take the chance or take the opportunity, that is, to improve what you're currently doing in a manual world with technology, then what's the point? And I still think that's true.

So, we put in place order sets. We use clinical decision support to guide orders. I mean, all of those things just to get rid of the error possibility, the rework steps, that's when things started to actually take off. But if you just literally automate a bad process, you're not going to get anywhere, right? It's just gonna frustrate people because they're expecting so much more, right? So, it seems obvious, but you can't just speed up a bad process and expect that to be a good outcome.

Josh: That is so true. I think that's such a great point to highlight. If the process is bad in the first place, then layering on technology will just automate the bad process and maybe make it worse, or maybe it'll accentuate the problem so you get to the root faster afterwards. But that's a fantastic, fantastic point. One of the other topics that you've talked about in the past has been the challenge around the term "pilot-itis," particularly in health care. We do so many technology pilots in health care that often never actually get to scale past the initial pilot or study. What would you say is the root cause of pilot-itis in healthcare? And then what should the healthcare system do differently to avoid pilot-itis?

Lydia: Well, I mean, I've done a lot of pilots myself, so I put myself in the camp of pilot-itis just as much as anybody else. I think that the main thing is that pilot projects are intended to be something fast, unique, innovative, or just different than current state to try and demonstrate some improvement, right? And they're not by design kind of setup for sustainability. The challenge is that we've done it so many times that we kind of should stop and think about the energy that goes into pilots, because if 9 out of 10 pilots ends up stopping, then we should probably re-evaluate whether we should be doing pilots, right?

And I think, Joshua, the key in my mind, and I've seen this over, and over, and over again in the work that I do around virtual care now, is that if you don't plan for how this pilot...so, let's say you're implementing a new digital solution, if you don't actually build that into the clinical workflow, the pilot is going to die, right, because people get busy, things happen, and then it's like, "Oh, this thing that was cool six months ago is now just like, 'I don't have time for that.'" It's not built into the service delivery model. It's not built into what they do each and every day. And so, it will die eventually, when other things take priority versus a true sustainable, digital solution or pilot is something that you go into it thinking, "I'm going to sustain this. Therefore, I need to make sure that I'm thinking about all of those things that..." just like any other clinical intervention would require, same approach, right? But we don't do that with digital. We don't do that with virtual care enough. And so, many of the things that get put in place don't make it because they don't really build it with that sustainability long haul sort of picture in mind.

Josh: It reminds me of, I think, years ago, we've had some cases where we would let's say do a pilot. But on top of that, it was run as a very, very tightly controlled research study to the point where the stuff that we would normally do patients are working directly with the healthcare team and the organization wasn't allowed, it was basically the research team doing everything, and it was set up for failure from the beginning because we actually weren't able to deliver on what we normally do. And so, that actually reminds me of that and why actually now we always in the organization say, "If we're gonna do this, let's do it for real because we don't want you to be spending time on something that has a high risk of failure."

One of the other challenges that we've seen is that often research funding is used to study digital health interventions for use cases that ultimately administration in a hospital or system may not even see value financially to pay for after the study. I was wondering, is this always going to be a risk of using research funding for digital initiatives? Or what can we do to maybe close that gap?

Lydia: I don't think so. I don't think this is just a research funding issue. I think it goes more to a bigger problem. And that is that we're pretty sad in healthcare at benefits realization, generally. And the other thing too I'll say about research studies is that they usually focus much more on, like, a single dimension, right, like on patient health outcome improvement from the use of technology or some operational efficiency measure, right? But I think what we need to make sure of going into these types of studies is that we're taking a quadruple aim approach because if you want this to resonate eventually with people who are making the funding decisions in a hospital, you have to talk their language, right? And so, if you're only...I mean, it's not to say that outcomes are not important. But if you're not also looking at operational efficiency, you're not also looking at cost reduction or whatever, right, then they're not going to be as interested.

So, yes, you might get a paper out of it, patient health outcome improvement, but that doesn't mean that they're going to necessarily want to sustain this intervention. So, I think that's the thing that I would say we have to do a better job of. And like I said, I think it's a challenge. We don't do a very good job of this and we don't stick to it. So, even when we do benefits realization after something as big as like an electronic health record implementation, I've seen so many times where people put all this effort into identifying the perfect set of KPIs, then they turn the system on and they all sort of forget to follow up on the evaluation, right? It's like, "Wait, who's responsible for reducing errors associated with medications?" "I don't know. I thought you were doing that." "No, I thought you were doing it," right? So, nobody actually owns the evaluation at the end of this. And I think that we were just generally not that strong at it. And I think that we could do so much better because we actually have the data now to be able to support this. We have the tools to be able to support more robust evaluations. But I don't know why. It's kind of a cultural thing that's ingrained, and I'd like to see us change.

And so, I think, Joshua, even when you go into an organization with your company and your products and you say like, "Let's do a pilot. Let's make sure that we're doing a pilot that's actually going to resonate with all the different stakeholders that you need to make sure that this thing can stick in the organization."

Josh: Well, I'll tell you, the first thing we do now is we stop using that word.

Lydia: Call it an intervention, call it a clinical intervention...

Josh: Yeah, that's a good point.

Lydia: ...Honestly, it'll be taken more seriously than a pilot. Pilots die...

Josh: It's true. Another thing that we do is we make it clear that if we're going to do this, then we have to get broad buy-in, you know, not just from frontline stakeholders but also administrators and executives...

Lydia: IT, right?

Josh: Yeah, it has to be a team effort for sure.

Lydia: Yeah.

Alan: Yeah, engagement and a sense of ownership. I think that's so important as well, really instilling that ownership on the stakeholder. Lydia, if the pandemic has taught us one thing, it's that consumers really do enjoy having convenient digitally-enabled access to their care, and that they're capable of using it. Now that we have kind of broad adoption of vaccines and mandates and...no, sorry, the mandates are being lifted, things are going back to in-person, less from virtual, what level of adoption of digital health should we expect moving forward compared to where we were before the pandemic?

Lydia: Yeah, I was thinking about this actually, like, while I was in the early stages of pandemic and we were watching, like, the stats just, like, go crazy, right? I was thinking that Kaiser Permanente had set a goal for themselves that they wanted to have 50% of all of their encounters in some virtual or digital form. They exceeded that. They're over 60% now. Well, I don't know what they are now. But this is prior to the pandemic, they were already at 50%, 60% of all of their encounters being digitally enabled. And so, I think, "Okay, well, why would that be any different now?" And now, to your point, Alan, we know that patients want this. Like, they prefer it. They want the option at least to have a digital channel when it's clinically appropriate. And so I'm very disappointed to see that health systems are kind of backsliding. And I think Sacha wrote a paper, Sacha Bhatia (Chief Medical Innovation Officer at Women's College Hospital) wrote a paper that said it was like 20%, 30% now where it was like, you know, 150% or 200% of what it was before COVID.

And so, I think, again, it goes back to this point of...I mean, let's face it, every hospital that set up virtual care who didn't have it yet during the pandemic treated it like a pilot. They set it up fast. They just wanted to get it out there because they had to. But did they embed it into the workflow? No. Did they actually make it a digital add-on? Yes. And so, now that everything's kind of going back to in-person, this is the point, right? If they had embedded it into the workflow...and they still can do this. I think this is still...this is my challenge to most health systems that I work in. Like, you can still embed it into the workflow. You can still do things like think about quality, evaluation, clinical governance, all the same stuff that you would use for any clinical service or clinical intervention, right? But they haven't gone back to that. And so, I think there's lots of room in these types of initiatives going forward, like do we have clinician training on the agenda? Do we have patient awareness? Like, how are we dealing with governance? All of those key things that we do for any other service that we bring into the hospital, we should be doing the same thing for virtual care. It's not a technology add-on, it's actually part of the care delivery model, but we haven't necessarily treated it that way. And that's why we're seeing things backslide.

Josh: So, I guess one of the differences that we've noticed in the U.S. versus Canada on this topic has been how in the U.S. a lot of health systems are not only consolidating, but they're trying to grow their market share by delivering care across regions, across multiple states. And so, they have an, you know, incentive financially to deliver virtual care to patients, you know, five states away and grow their market share as an organization. Whereas in Canada, we have more of a community-based perspective on health care, you know, "This is your community. You serve the patients here." And so, in many ways, there's maybe less incentive to have broad digital reach. So, I guess I'm wondering, unless there's a mandate by the province or the country here to do more digital, does it have to come from within an organization to be motivated to make that leap forward and sustain the adoption or I guess is there anything else we can do?

Lydia: Well, I don't think it only has to come from within, although some of the key things that I've talked about a second ago like cross-jurisdictional licensure is going to be a challenge if you want to try and go across borders, right? But, I think about also what the private sector did and has done during COVID. So, if you look at Dialogue, and Maple, you know, and Babylon and stuff, like...I mean, they stood up a private pay service for convenience. There was a demographic of people that chose to use it, still use it. And I think they created almost inadvertently, like, a lot of pressure on the public system now to kind of get its act together, right? And so, I think the pressure can come from within, it can come from outside as well, Joshua. And, you know, I think that we should...like, let's examine why that happened, how we can improve the public system because of that, and I think that's okay. I think that's good. Market pressure is never a bad thing.

Josh: Competition is sometimes a good thing. It's really true. To make progress happen.

Lydia: It's really interesting.

Josh: I've seen some CIOs go from industry, let's say consulting or business, to hospital CIO, and others who spend their whole career in the hospital sector before becoming a CIO. You've kind of been on both sides of the table there. Do you think coming from industry-first shapes how people act and think as a hospital CIO or a digital leader? And if so, how is that different do you think?

Lydia: And when you say come from industry, you mean like not from the hospital, right? Like, from outside.

Josh: Yeah, like you come from consulting.

Lydia: Like consulting, or private sector, or something. So, I'll say a couple of things on this because I think there is no perfect answer to this. I think CIOs today are most successful when they really understand a business or organization. And so, that doesn't matter whether you're in a hospital or whether you work for the LCBO or you work for any other private sector company. I think that what makes a great CIO do their job well is when they actually have a really strong collaborative relationship with their peers, their C-suite peers in the organization because it's what I said in the beginning, like, you have to make sure that what you're doing from a technology perspective actually is aligned to and supports the business, right, the business being in the hospital and care delivery. And it's not the other way around.

The thing that a professional CIO from, let's say, private sector might bring, they might bring extremely strong technology skills. Because they have had an opportunity to do cool stuff with a lot more resources, they might be, I'll say, might bring a more modern mindset from a technology perspective than we might see what currently exists in many hospitals today. And so, if they've been experienced, let's say, in doing a bunch of stuff in the cloud, and then they come to a hospital, they can bring that expertise and that experience. However, if they don't understand the culture and the way the place works in a hospital, public sector, or healthcare environment, they're only going to be limited, or they'll be limited in their success, right? So, I think you kind of need both. Now that I'm sort of able to step out and work not just in Canada, across different provinces, but also work globally, I can see what leading practice really looks like. And I can bring that experience to my clients in hospitals. And I really understand their business because I used to be one, right? I used to be one of the CIOs in the hospital. So, I think you kind of need both. That's sort of the ideal circumstance. And I don't know that one or the other is necessarily better. But I think it's kind of a combination of, you know, do you have like an understanding of what good technology really looks like, modern technology looks like in the context of what you can afford in a public sector arena? But also, do you really understand healthcare because I think you need both?

Alan: Yeah, I think that last point is so important, understanding the processes that are already set in the healthcare and understanding the system and how to work with different stakeholders. I think there's this misconception that CIOs have just technical ability. And you've spoken in the past about, you know, while yes, the technical skill is certainly important, there's also softer skills like change management, and adoption improvement, and process improvement skills that are equally important as a digital leader today. Why do you think that is?

Lydia: So, listen, I'm an N=1 person, right? So, I've had one experience as a CIO. But I do think that you have to have a base understanding of technology. But look, I'll say I wasn't a technologist when I joined UHN. I mean, I learned about technology, but I wasn't a computer science background. Like, I haven't coded. I mean, I was a project manager in a very glorified sense, right? I understood though what was required to surround myself with. So, whatever gaps that I had in my own understanding of technology, I made sure that I had really solid people around me in my team that did understand that element. The CIO has to be strategic. And I think the CIO has to be a leader. But the CIO doesn't have to know everything, right? It's like any leader. You don't have to know everything that your team knows, but you got to make sure everybody fills all the gaps, right? So, the other thing too, and it kind of goes to my earlier comments around collaborating with your peers in an organization, I think that emotional intelligence, humility, political savvy, negotiation skills, those are all really critical, and not just to being a CIO, I think to being any leader. But particularly because for IT, you have to negotiate across the organization a lot, right? Everything that you do theoretically kind of impacts the whole enterprise. So, you got to know how the rest of the organization really works so you can understand how you can actually help, right? And so, I think those kind of skill sets, Alan, are key underpinnings of the stuff we traditionally call change management, process improvement, governance, etc., all those things that you need to really transform an organization.

Josh: You know, with digital transformation right now in healthcare, we're seeing the evolution and the implementation of new roles. So, I mean, CIO was the big IT digital role for many years now. We're seeing the VP or chief digital officer. I've even seen now roles are chief digital and information officer and innovation officer. Can you help unpack at least how you view, you know, what does the CIO going forward focus on versus a chief digital officer? Where is there overlap? How do they work together? I know, I think it's still kind of evolving in terms of [inaudible]

Lydia: Yeah, I think so too. I think so too. I think it's also just there's a bit of like, I don't know, marketing in some of these titles, meaning like...okay, so a very good friend of mine is a Chief Digital Officer, how is that different than a CIO? I think she would admit that she basically still has a CIO portfolio job description. But the spin on the title for chief digital officer is that you understand...I think the interpretation is that you understand how digital really impacts the user, right? Like, so you have to bring a UX kind of perspective. You have to understand human factors. So, it's not just a hardcore put servers in a data center, you know what I mean? Like, you actually have to understand how people interact with technology. That's kind of the emphasis on the digital versus an information officer who's got to be really good at data management, data governance, all that kind of hardcore sort of data hygiene stuff. And then a CTO is somebody who really manages, like, the infrastructure and truly, like, the network and all of that, right? So, I think you need all of that stuff kind of put together. What you call it, I think, is again, it depends on maybe the sort of the strategic spin of an organization, right?

Alan: Yeah, I think so.

Lydia: The thing that I think is different though, Joshua, than probably was the case maybe 10, 15 years ago is this element of UX, because I think it wasn't until I'd say probably in the last decade really that we really understand, like, what the heck is a patient journey map? Okay, like, we used to kind of pay lip service on that stuff. I think it is core. It is now core. And so, if you don't really understand sort of customer experience, user experience and how to actually design for that, I think then you're kind of not modern, do you what I mean? That is new. I would say that's relatively new to most sort of traditional CIO roles.

Josh: And to your point, I guess, two years ago, the focus even from a UI/UX point of view, if at all, was on the clinician or administrative user. And now it's extended to the patient...

Lydia: Patient.

Josh: ...which is another huge leap forward. And so, needing another person or two to help lead that makes a lot of sense for small organizations.

Lydia: And let's face it, it's a massive portfolio. If you have customer, patient, you have data, you have a technology, right, you've managed all the applications, or you manage a SaaS environment with cloud providers, like, that's huge. It's gigantic. So, to break it apart a little bit, it's a move to preserve sanity I think more than anything, and also to sort of put the emphasis in the right place, right?

Alan: That's fair.

Dr. Liu: Yeah.

Alan: Lydia, you've shared in the past your personal journey regarding being a woman in STEM or in healthcare, especially on thoughts about equity and health care. And I've heard you personally on your team try to maintain a 50/50 ratio of men to women who are on the team, provided they have all the skill necessary when you hire. What else can leaders do to better understand some of the biases that they carry?

Lydia: Well, I'll tell you what I do. I don't know that this is necessarily the only answer, the right answer. But I do a couple of things. One is I try to get to know my team members. I want to understand kind of what their values are, like what's really motivating them, what are the cultural norms that they kind of grew up with, because they do help. I think that that helps you kind of understand where somebody is coming from. In addition to the 50/50 ratio that we do strive for, and actually my team, I haven't double-checked today, but we are pretty close to that, we also try to strive for diversity, like ethnic diversity as well. And ethnic can be where you got your education, where you grew up. It could be a variety of things, right, because we want people who think differently because we think that makes a better team. So, it's both gender, as well as just sort of diversity in the broadest sense.

So, I want to get to know my people because I only can be a good leader for them and with them, if I feel like I know them. The second thing I try to really do is create a safe space for people so that they can challenge each other's thinking, obviously, in a professional way, right? But, to ask people what they think is probably one of the most important questions and to allow them the safe space to be able to answer it without feeling like they're gonna get in trouble if they say the wrong thing is really what I'm trying to do with my team. So, I think those things there are loosely what I try to do.

Josh: I think that’s a really great point. I think when we talk about diversity, we often forget the importance of diversity of thought as well. And then to your point, I think it is really important that people can disagree and have healthy debate and to realize there are multiple perspectives on things that are okay to have. I really love that. I don't think we've heard about that often enough. So, I really appreciate you sharing that. As the Chair of the HIMSS Americas Board of Advisors, and in your role at digital health globally at KPMG, you're exposed to probably so many fascinating patient-facing innovations, whether it's digital patient engagement or chatbots for triaging patient services, etc. What are patient-facing digital innovations that you are most excited about at this point in time?

Lydia: So, I'll tell you the coolest thing that I personally experienced, and then I'll tell you about a couple of things that I just read about recently that I'm just like, "Whoa." So, I mean, the first one was using augmented reality headsets. So, these are like those HoloLens headsets to actually show people what a hospital physical space could look like, so like a clinic patient room, or a lab, or, an operating room, and to have people going through the hospital campus redevelopment process. Like, board members, executive team members, clinicians, strap on the headsets and actually walk through a physical space and realize like, "Oh, that beds too close to the console on the side," or, "I can't get a code blue cart into that room, because by the time you got all the people sitting around the patient bed, there's no room for the actual equipment." So, like, that was mind-blowing, not because of the technology but because of what it enabled people to think and see differently than walking around a cardboard cutout or drawing something on a 2D picture, you know.

So, that was mind-blowing in terms of the impact that it had on people's ability to kind of engage in a process that before they had been like, "Leave that to the architects and the IT guys. I don't really care," right? They were like, "Whoa, we want to do this." And now, this particular hospital that we did this for, they're thinking about using the headsets for their foundation to actually have donors, like, walk through the space.

Alan: Oh, cool.

Lydia: You know what I mean? Okay, so that was cool. And that was something that I personally experienced on a project a couple of years ago. Two things I read about that I was, like, a little bit blown away. So, I don't know if you guys heard at Toronto General, I think it was last year, they used drones to transport solid organs from one campus to the other.

Alan: Yeah. Wow.

Lydia: Now, that's just from the Toronto General to the Toronto Western or wherever it was going. But the point is that it's completely transforming the way we typically think of people like, you know, getting their coolers and getting on an airplane or a helicopter. So, that to me was a bit mind-blowing because it's like, wow, it took sort of things like transplant to a whole new level, where access is a very different issue. The other thing I just read about last week was actually that the NIH just funded a study where they've created this digital twin of a human. So, I can't remember exactly all the parties that were part of it. I think Amazon was actually maybe one of the companies. There was a couple of centers. And they're going to use this digital twin to run sleep apnea clinical trials. It's cool that it's for sleep apnea first. But that's just the beginning, right? They're thinking about creating a fully-humanized digital twin. And you could kind of think about this as like being an example of an individual person, right, that you could run studies again. So, anyway, I just thought kind of blew my mind because just think about the possibilities of that, right? So, yeah, those were two things that I thought were really cool.

Josh: And so, ideas that you could basically almost study individual, like, patient [inaudible]...

Lydia: The effects, right?

Alan: You can run simulations.

Lydia: You can run simulations. You can test stuff on them before you actually test them on a real person.

Alan: Risk-free, yeah.

Lydia: Risk-free, you're not actually doing something to the human. So, it creates a whole other question around like ethics, approvals, you know what I mean? Anyway, it's pretty crazy, really interesting stuff.

Josh: It was really cool.

Alan: Yeah. Last question that we have, Lydia, this is actually...we had a previous episode recorded with Duska Kennedy, who you know quite well. She's the chief digital over at North York General. And she was asking what do you prefer more, consulting or working in the hospital?

Josh: If you're answer is not consulting, we'll just scrap the… (laughter)

Lydia: Well, it is consulting. But it's only because I have 20 plus years of hospital experience. And I think I'm a better consultant for it. The one thing I will say is I prefer working on projects over operations. Don't get me wrong, I loved learning about operations. But I think it's a very tough job to be a CIO these days, like when you're going from ransomware attacks, to system outages, to tight budgets, moving at pace. Like, it's really hard to balance all of the bouncing balls. And in consulting too, I mean, my job, I'm very privileged because I get to work with some really cool people globally, basically, people like me across KPMG worldwide. And so, I get to see firsthand, you know, leading practices and health systems around the world. That's pretty amazing. I didn't get that opportunity when I was working in the hospital sector. So, if I did want to do that stuff, it would take a lot more energy to be able to do that. Right now, it's part of my job. So, I got to say consulting today.

Josh: I'm curious, Lydia, have you ever seen hospital executives do let's call it, a temporary tour of duty with a consulting firm to go around the world and learn best practices for a year, with the intention of coming back to the public sector?

Lydia: I have. I have. Actually, we hosted one of those individuals a couple of years ago. So, I haven't seen a program like that in Canada. But this was a program actually in Australia. And so, my colleague in the Sydney practice who I worked very closely with said, "Hey, we're hosting this intern," they called her an intern. She was like a hospital CEO or something and from, I think, one of the children's hospitals there. And she was doing this, like, two-year-long fellowship that she had applied for and gotten funded by some public entity there. And so, she got to pick where she wanted to spend her two years. So, one summer, she basically spent with KPMG in Canada, and she worked with our digital health practice. And we just basically took her on all of our engagements with us, obviously, with permission of our clients.

So, she got to learn about consulting. And we had her go to internal meetings so she could learn about the business, as well as project work. And then, I think after us, I can't remember where she went, I think she went down to, like, someplace in the States, in Boston. And she got to pick. And so, I thought it was a brilliant, brilliant idea. And, you know, all of the positions were private sector though, right? So, she purposely was picking private sector organizations to work for so she could kind of bring that private sector mentality back to her job when she went back. Do we have something like that in Canada? If not, we should, because it's cool.

Josh: Yeah, I haven't heard of it. It strikes me that, you know, a lot of folks who want to go into hospital administration, let's say, do an MBA and then go to hospital administration. Why not do a tour of duty with KPMG instead for a year or two?

Lydia: Sign me up. Do it. Let's do it. Honestly... we actually had a really interesting conversation with a physician who's in, I don't know, like, whatever year you get off, like, don't you get to take a year off or a term off or something like that for...kind of practicum?

Josh: Not typically. I think you can negotiate one.

Lydia: So, she negotiated like a whole term off. And so, we're going to probably bring her on. It's obviously a short-term gig. But she just is really interested in learning. But then we started thinking like, "Hey, if that works, why don't we just leave an opening on a rotational basis and bring any other grad students, right?" So, anyway, we're gonna check it out this year and see. I'll let you know.

Josh: It's a great idea.

Lydia: Yeah.

Alan: Yeah, awesome. Well, Lydia, we're gonna shift over to what we call the fast five lightning round. It's basically five questions to get to know you better for our audience.

Lydia: Okay.

Alan: Question one, what is your favorite book or book you've gifted the most?

Lydia: Okay, so I'm actually reading two books right now. So, one of them is called "Educated" by Tara Westover. If you haven't read it, it's a great book. It's basically a nature versus nurture book. But this woman who came from very poor South is like an Oxford or Cambridge student, right? So, anyway, really cool. And that was recommended to me by some friends at the Canadian Medical Association. They all read it, so I'm like, "Okay, all right." And it's good. The other book that I'm a little embarrassed to admit, it's called "Outlander." It's this series of books by Diana Gabaldon. And it's historical fiction, and it's fantasy, and it's like [inaudible 00:45:36]...

Josh: Is there a Netflix show?

Lydia: Yes.

Josh: Okay.

Lydia: Yeah, there's a whole series of these things. And I've been reading them for, like, decades.

Alan: That's awesome, yeah.

Lydia: Those are the ones I gift the most.

Alan: Nice. Question two, how has an apparent failure set you up for greater success?

Lydia: Yeah, I won't say when this was but a long time ago in one of my first jobs, I was being lazy. In one of my first jobs I was asked to analyze something and go study something. And I was lazy. I didn't do my homework. And I got totally called out by my boss in front of my entire team. That was many, many, many years ago. And I guess my lesson for everyone who's ever been close to that situation is do your homework, be prepared, and don't let yourself get in that situation. So, I've always tried to be prepared.

Josh: But then you never forget it.

Lydia: You never forget it. Oh, my God, it was mortifying, so yes.

Alan: That's great. Josh does that to me on a weekly basis with our podcast guests. So, I know your pain. That's good. Question three, would you rather have super strength, super speed, or the ability to read people's minds?

Lydia: Okay, definitely I never want to be able to read people's minds. That's just like way too scary to know what people are actually thinking. I'd wanna have super strength. Especially as I get older, I feel like my knees, my hips, like nothing quite works the way it's supposed to. So, I want super strength.

Alan: Yeah, I'm in the same boat. Question four, what is something in healthcare you believe that others might find insane?

Lydia: Okay, so I have two things. One is...I'll never forget this. I was at a presentation. This is years ago. So, it's probably already happened. But they were talking about growing organs from stem cells. Like, "What? That is so crazy, right? You won't need solid organ donors anymore in the future?" Like, that blew my mind. The other thing that others might find insane is our public sector procurement process, so.

Josh: You don't say.

Lydia: I'll just leave it at that.

Alan: Yup, totally fair. Last question that we have, Lydia, this is a pandemic lockdown-related question, what is one hobby or activity you've gotten into since the beginning of the pandemic?

Lydia: So, I did get a spinning bike. It is not the big brand. It's a different one. But I do have the app. Anyway, so I've been pretty addicted to that.

Alan: Nice.

Lydia: I've lost 20 pounds.

Alan: Wow, congrats… If you were planning on losing 20 pounds...

Lydia: I wasn't planning on losing 20 pounds. It just happened, so. Anyway.

Alan: It's awesome.

Lydia: Yeah, so go out and get exercise.

Alan: Amazing. I love that, great message to end on. Well, Lydia, thank you so much for coming on the show today and sharing your wisdom. You carry a ton of wisdom with you from your decades of experience on both sides, the private sector and the public sector, kind of bringing them together, really being a transformational leader in digital health and health care globally at this point. So, thank you so much for sharing the time with us today on the show.

Lydia: Thanks, guys. That was fun. Thank you and I appreciate the opportunity to talk to you today.

Alan: Amazing. Just to end off for our listeners, you can find Lydia on Twitter, @lydialeetoronto, that's L-Y-D-I-A-L-E-E Toronto. And that's a wrap for "The Digital Patient" hosted by SeamlessMD. Follow us on Twitter @seamlessmd. And if you like the podcast and want to learn more, visit www.seamless.md. Thank you.