Digital Innovations in Healthcare: A Conversation with the Chief Information and Digital Officer at Emory Healthcare (ft. Dr. Alistair Erskine)

Ed (00:00.952)
Hey, it's Ed Marx. Welcome to Digital Voices. Thank you for listening. I know you have a lot of choices out there. There's such great content. I listen to tons of different podcasts. You've taken the time to be with us and I'm super, super thankful. And we'll make great use of your time because today you're gonna hear from Dr. Alistair Erskine. Alistair, welcome to Digital Voices.

Alistair Erskine MD MBA (00:24.334)
Thank you, Ed. Happy to be here.

Ed (00:27.224)
I know we've, we've like known each other and, and talk throughout the years. I didn't even go back to try to figure out how long ago we may have met, but we've both been around a little while and I'm glad we're able to connect on this forum because I, you're a fantastic leader. I know quite a bit about you and I'm just super excited to have you as a guest and we'll talk about it. Yes. And I didn't want to admit that long, but.

Alistair Erskine MD MBA (00:47.982)
Well, thanks, Ed. It's been at least a couple of decades. So.

Ed (00:55.544)
Yeah, we'll learn a little bit about Emory, what you're doing, a transformation, and you just have a fascinating, and we'll get into it, some of the things that you've done along the way, along your journey. So I'm super, super excited about getting into that. But the first thing we always ask Alistair is, what are the songs on your playlist?

Alistair Erskine MD MBA (01:14.126)
songs of my players. So there's some things I'll be happy to talk about and some things I'll have to confess. You know, I'm a big fan of the Beatles. The Beatles takes me back to where I grew up in England and France and in Spain. But my mom loved the Beatles. And so that's always been, and then ABBA is another group that I'm really fond of.


Alistair Erskine MD MBA (01:42.51)
And of course, I'll listen to Mozart and those kinds of things. But my sweet pleasure, I gotta confess, is Britney Spears and Christina Aguilera. I just love both of those singers. I think they have great music. So, you know, much to the chagrin of my kids who look at my playlist sometimes, you know, I'll have those songs on there too.

Ed (02:05.976)
No, that's great. Aguilera in particular, like she has the most amazing voice. I don't think people realize, they just kind of blow her off like as a pop singer or whatever, but she has legit voice.

Alistair Erskine MD MBA (02:17.422)
Totally agree. It's unbelievable, in fact, what she can do with that voice. It's just, it's stunning. Yeah.

Ed (02:21.368)
Yeah, I love listening to her non -pop things. It's just awesome. So on ABBA, have you been back to London and gone to the virtual ABBA concert?

Alistair Erskine MD MBA (02:33.454)
No, I haven't yet. And it's that whole history of that band, how it came together, how it became popular, how it then eventually fizzled because of various different, it's such a classic story of sort of like human history, right? But I haven't had a chance to, I look forward to doing that.

Ed (02:54.328)
Yeah, like the song, Winner Takes It All. I mean, the emotion and as you know, because you're a big ABBA person like I am, that was like raw. That was like really going on. And it's quite fascinating. So my sisters, I don't want to confess my age, but I will be turning 60 and two of my sisters that we've done ABBA things together, they are going to take me for my 60th birthday to that London show. And...

Alistair Erskine MD MBA (03:18.478)
nice.

Ed (03:20.824)
I don't know if I could really do it, but I did commit to it. We're going to dress up like we do when we've done these ABBA shows. We're going to dress up like ABBA. So it's going to be quite interesting. I'll send you a picture.

Alistair Erskine MD MBA (03:29.902)
like platform shoes and the whole thing.

Ed (03:35.608)
What about your life message or mantra? Alistair, is there words that you live by?

Alistair Erskine MD MBA (03:43.47)
So there are, I mean, the one that I always focus on, especially in my work and my practice is, you know, the end goal is just reduce human suffering. But, you know, love my wife and kids, you know, be grateful, help others. That's pretty much why I became a doctor. That's pretty much why I got sucked into the world of initially informatics and then technology and digital, just to try to extend the reach.

of how to have some people who live on this planet who are just not endowed with health or economic prosperity and thinking about what, I feel very, very lucky in every single aspect of my life. And so how can we extend that to others in as scalable a way as possible?

Ed (04:38.2)
Yeah, I love that. That's great. Those are great words to live by. Yeah, tell us a little bit about your journey. And I'm really fascinated too about the England, France, Spain connection because obviously I know you grew up in Europe. So yeah, tell us about your journey.

Alistair Erskine MD MBA (04:53.87)
Well, so, you know, this, you know, I just as a kid, living in Europe, it's not uncommon to speak multiple languages because you go from one country to the, to the next. And, you know, you're in French speaking countries, Spanish speaking, whatever it may be. So I was born in London, and, and then ended up, immigrating to Paris when I was seven. And then, living in Spain when I was 14. And it felt like a very natural, my, my father's an archeologist.

My mother, I like to say she's a product of the 60s. So very, you know, kind of a fantastic kind of way of living full of color. And we would move on a dime. At one point, we even moved to Sri Lanka. It lasted like two weeks and we came back. But it made for a very sort of, you had to learn how to adapt. And I think early on, it helped me appreciate,

the vast different sets of cultures that are around the planet and different sets of values and learn to kind of basically appreciate and understand how people think differently across different parts and then how some things are basically core no matter where you go.

Ed (06:10.104)
Yeah, that's fascinating background and it does give you a great worldview from which to base your life upon. Yeah, let's talk about Emory Healthcare. Can you share a little bit about Emory for those who might not be familiar?

Alistair Erskine MD MBA (06:25.262)
Yeah, so Emory actually has been around for a while. And really, I would say the Emory University is really the one that was founded in the early 1800s. And I think it was a Methodist bishop who kind of started the whole thing. And actually, it wasn't, you know, Emory is known to be in Atlanta, but it didn't originate in Atlanta. It was in Oxford, Georgia, initially.

And then in the early 1900s, it moved to Atlanta. There's also been a really close relationship between Emory as a university and Coca -Cola, who has its foundation here. In fact, Pepper throughout the organization are all kinds of previous Coca -Cola giants that funded various different aspects of Emory. So we're awfully grateful for all that. And the health care side of it,

arrived later and initially Emory University Hospital was kind of the key hospital and much of that framework still exists today. And initially it was a small component of Emory University. Today it's three times larger than the Emory University campus. So clearly the growing aspect, the part that really is expanding CAGR, you know, year over year is the hospital and clinic side.

And the university carries its kind of rich tradition in terms of, you know, fostering inclusion and service to humanity and, you know, spirit of connections and so forth. But it's been interesting as a true academic medical center where you really have the humanities, you have the sort of pursuit of learning and research, then you have sort of the mixture where you have health research, and then you have sort of the delivery arm. We really do encompass the kind of

the ideal behind an academic medical center.

Ed (08:23.864)
That's great. And Alistair, do you still practice?

Alistair Erskine MD MBA (08:28.494)
So I like to say I'm an internist and a pediatrician and I also got board certified in clinical informatics. So I practice clinical informatics. I no longer round with my own patients, although every week I'm rounding in the unit with some other practice just so I can understand the workflows and the issues that come about. And we actually stream that experience to all of my Emory Digital staff.

So they can, because sometimes they're remote. So they can basically round with me. There's somebody who walks around with an iPhone on a gimbal and streams the experience to everybody else that may not be on site just so they can appreciate the round as well. It's been a really useful way to kind of bring people to the front line without actually having them be physically there.

Ed (09:18.616)
Yeah, I love it. That's a great, great use of technology. So with clinical informatics, how has it helped you as, you know, your chief digital officer and chief information officer? How has that helped you in your role?

Alistair Erskine MD MBA (09:29.742)
Well, I'm not unique. There are a number of physicians that complained too much about the electronic health record back in the day. And so somebody says, well, great, why don't you fix it? And we kind of got into informatics. And that was just learning to be a double agent, a clinician who understood something about the art of the possible with the technology, and then learning to appreciate.

how technology gets deployed, project management, all those kinds of aspects that you don't necessarily think about when you're on the receiving end of the technology. And so I think in the world of informatics, the other thing that helped myself and colleagues like me is we knew how to provide a narrative that would be intelligible to the people that matter when it came to making decisions about how to.

divert funding towards maybe technology and so forth. So very quickly, the CMIOs kind of absorb more scope. You know, you start off as a CMIO, then you become a chief health information officer as you kind of expand it, then a chief clinical informatics officer, a chief digital health officer, all these various different, you know, levels of expanding scope and then kind of getting into the C -suite eventually, again, probably because of the advantage of

being a physician, being able to describe things in ways that everybody would understand so that you can convince a board to invest tens of millions of dollars in this digital brick instead of that brick and mortar.

Ed (11:07.352)
You're right. Yeah, no, I love it. But what about the corollary? So what would be some advice you might give your non clinical CIO CDO peers to better understand the clinical side?


Alistair Erskine MD MBA (12:43.95)
I would say that there's a certain lexicon that clinicians use that gets other clinicians to kind of develop a sense of confidence in terms of what's going on. And I think that it's useful, literally, if CIOs spend time rounding with other clinicians on the wards or spend half an hour in a clinic.

That goes a long way to accomplish two things, to show that that CIO cares and to also kind of learn and empathize with what it's like to be in the hurly burly of clinical care. The other thing is, again, it helps tell the story, forgetting about the technology, not worrying about like the bits and the bytes and the benefits from a technology aspect, but instead focus in purely,

on what's the experience you're trying to achieve. So we want the patient to have a certain experience. We want the care team to have a certain experience. And some of that's going to be met with technology. Some of that will be met by a different process or a way that we use the technology or some clever engineering about how things get done. But focus in less on the tech and more on the experience, I think, has been useful.

Ed (14:06.04)
Yeah, that's great sound advice. You know, when you were talking about your background, one thing we didn't bring up, and I would love to get your take on it in terms of your career, is you took a role internationally. Can you tell us a little bit about that? And would you recommend such a role, you know, that everyone would do something like that at least one time in their career?

Alistair Erskine MD MBA (14:28.526)
Yeah, so you're right. I went to Doha in Qatar in the Middle East. And really the opportunity there was to build a health care system from scratch with, I would say at the time, not a lot of limitations when it came to the budget. So it was a fascinating opportunity. And the reason that I ended up there is because I speak French and Spanish fluently, I did at the time,

I did a lot of talks about informatics in those languages and then ended up going to the Middle East as one does just doing some international consulting and then stumbled upon an opportunity where somebody called me back and said, gee, we'd like you to consider helping us build the system. And it was really an ex -pack lifestyle. So I brought my kids who were getting way too comfortable in suburbia.

America and my wife and my in -laws and we all went to the Middle East and we were there for about three years and the gaggle of people from every different part of the world that were there, Australians, Germans, French, Spanish, Canadians, Americans made for a really interesting melting pot and an important aspect of having to define, you know, what does a midwife do? Well,

depending upon where you came from, they may do all kinds of different things. And when you had to build a system, in this case, it was a Cerner system, you had to sort of define, okay, what are they gonna be able to do and what are they not gonna be able to do? And so it took a while to actually get over an agreement and consensus building. And then, because the budget wasn't as big of an issue, there tended to be a lot of purchases of big equipment, like we had five MRIs for our 400 bed hospital.

But it was hard to make the case to hire the people to run the MRIs. It was easier to acquire things where you could touch and feel it and more difficult to acquire sort of the talent to run it. So a very different set of problems and, you know, and a revolving door of people who would come and go as they would, you know, contribute and then.

Alistair Erskine MD MBA (16:51.822)
continue on to wherever they were coming from, it made for a very dynamic and somewhat chaotic, but in an interesting way, scenario with all these people from all over the planet. Really, really interesting. I would recommend it. It was fantastic for the family. My kids now are forever impressed with the need to remain internationally connected to all their friends. So that really

opened their minds. And it was, I think it was a phenomenal experience, even from a career perspective.

Ed (17:28.028)
Yeah, yeah, I would think that would be the case. You know, I had a little bit of a taste of that when I was at Cleveland Clinic and we had a facility in Abu Dhabi, but not like I was living there or anything like that or London. So yeah, if I if I could have a redo, I would definitely pick up an international assignment somewhere along the way. And for all the reasons you cited and the fact that you could take your family and get them ingrained and that experience. I mean, that's that's priceless. Just totally priceless. All right, we better move on. I want to talk about transformation. So

I know you're doing a lot of transformation at Emory. Can you share one or two things that you're doing that you're particularly proud of?

Alistair Erskine MD MBA (18:05.39)
Yeah, so I think the one I'm the most excited about right now is what we're doing in the ambient listening space. We were pretty early on doing a kind of full in commitment. You know, an ambient listening, you walk into the clinic as a doctor, you have a dialogue with a patient, that dialogue is converted into a transcript, which then is converted automatically into the clinical note.

And after you leave the office, you can take a quick look at the clinical note that is generated, make some adjustments, and then that finishes your documentation. It has several advantages in the fact that what's documented is actually what happened in the clinic office, less copy and paste that moves forward. The second thing is the notes tend to be a bit more comprehensive because the computer has...

the wherewithal and the time to include everything as opposed to if you're rushed trying to write your note. And then clinicians have been happy about the fact that not spending as much time at night trying to finish up their work because they're spending less time on documentation. So, and then there's an additional benefit of the fact that by capturing this stuff automatically, the level of code that you can build ends up being higher.

because a lot of clinicians practice defensive coding as opposed to coding exactly what happened in the office. So all these advantages were hypotheses initially. We embedded the tool into our electronic health record, initially interfaced. And so it was a bit awkward to go to an application to be able to use it. Now fully integrated and we're just seeing.

impressive adoption. So I think in terms of what's the impact in changing the experience of a patient coming in and not having the doctor distracted by the computer or the experience of the care team, you know, in this case, the physician not having to write the notes late at night, all the while being able to sustain the health, the financial health of the organization. That's been a real win.

Ed (20:19.256)
Yeah, it and like you pointed out, you're it's a double whammy, a double good whammy in that you're addressing both the clinician team experience and the patient experience, everyone wins in that scenario. So sometimes our investments, you know, are, are helpful to one or the other, which are fine. But it's nice when you make an investment like that, and it actually helps everyone. And plus it helps it helps the CFO experience as well, like you were saying.

Alistair Erskine MD MBA (20:43.086)
Correct. I mean, you know, it's rare. Unfortunately, it's rare to find solutions that hit all three, you know, patient care team and finance. And then to have an adoption where you literally have physicians, you know, there's only a few times in my career I've had physicians break into tears about something that they've had pent up frustration about that finally gets, you know, released with some technology. And this is one of them.

Ed (20:52.568)
Yeah.

Alistair Erskine MD MBA (21:12.686)
I've had people describe how it's changed their marriage, how it's changed their life at home. I mean, they really have a visceral reaction to it. So that's incredibly gratifying to see that with a piece of technology, you can actually impact people's personal lives like that.

Ed (21:31.352)
Yeah, no, that's that's tremendous that that I don't know it makes me makes me happy You know since I work in the industry when you when you hear the stories of the things actually working, you know Anything else especially along the side lines of patient experience or what other things are you doing for patient experience?

Alistair Erskine MD MBA (21:40.526)
Yeah.

Alistair Erskine MD MBA (21:50.478)
So we're doing the traditional stuff, which is making sure that patients can book their appointments online. I'll say the pickup on that has been disappointing, meaning even if you put most of your inventory online, people really prefer, or at least are accustomed to calling a contact center and so forth. We've done things around wayfinding, where make it easy for people from the parking lot to go to the clinic and so forth.

because a lot of these buildings weren't built with the end in mind and it's difficult to navigate. Again, the pick up on that has been, I would say dismal in terms of the number of people who actually use it. But I think the real experience that I think is of concern is what happens in the emergency department, which is everybody tends to agree is a place you never want a patient in.

because it's, you know, the emergency department has to deal with whatever comes in the door. People have emergencies and sometimes they can stay there for, you know, long periods of time. We have a particular piece of software called vital .io that we've had incredible success with. What it does is it basically sits on top of our electronic health record, pulls data out of it and exposes that data in intelligible ways that, you know, somebody with a fifth grade education could understand.

about here's what your wait time can be, here's what your lab just came back and what it means, here's your x -ray results converted into intelligible English from what the x -ray documentation shows. And by the way, if you want to share this experience you're having right now with your family members, it lets you send that along so that everybody else stays in touch with the lab that came back, the x -ray that came back, the diagnosis that came back, and so forth.

That's been a very clever way to augment and improve the otherwise challenging experience in the emergency department. We're now taking that into the inpatient experience and then doing something beyond that, which is wrapping it around even when patients are go looking for a provider. Today we just send them to a provider list and they have to kind of see through all that. Tomorrow,

Alistair Erskine MD MBA (24:17.966)
It's a much clever way where we're going to propose two or three providers that take that patient's insurance that are available, that are close to their home, that are essentially pre -selected. So a much smaller list for them to go through and that are the kind of provider they need. So sometimes patients don't know they need an electrophysiologist for some heart issue, but the electronic health record knows. And so the tool kind of actually comes to the electronic health record, identifies what is the exact specialist that they need.

and then matches them to location, you know, payer and availability and proposes that to the patient. I think that's pretty clever.

Ed (24:53.88)
Yeah, that is really cool. You know, let me make a comment on something you said, and then I want to get your your angle on it. So you're talking about we're sort of talking about portals and the the dismal uptake on on various aspects of them, even though they're so fantastic. And we've seen something like that with telemedicine as well, right? We because the pandemic we we, you know, went up to 80 % of virtual visits. And then since the pandemic has waned, you know, everyone's back down to, you know, five, let's just say under 10%, for sure.

Alistair Erskine MD MBA (25:09.678)
It's too close.

Ed (25:24.152)
And, but you know, from a tech point of view and everything, and a patient experience, you would think that the uptake would be, you know, at least 50%, right? Cause of the convenience factor, just like with the portals. What, what's your take on why some of these tools haven't really seen the utilization we might've thought.

Alistair Erskine MD MBA (25:44.718)
Yeah, no, you're right. I was surprised post -pandemic that the virtual care numbers dropped as precipitously as they did. And I think a lot of the industry was surprised because they had invested heavily into the telehealth companies and then the price of those stocks then ended up going down once it didn't manifest as a sustained adoption. I think that at the end of the day,

First of all, there's a lot of uncertainty around how it will continue to be paid. And so that makes health systems then divest a bit out of that environment. Because the same thing is true about hospital at home. Today, the idea that you can take care of a patient, 20 % of the patients that get admitted to the hospital could be managed at their home.

if we have the logistics to be able to take care of them. There's some organizations like Master and O 'Brigham and others who have done a great job. They have a like 60 bed virtual bed system where those patients who would normally be admitted to the hospital are now being taken care of at home. And then they get discharged from the home and it's actually Best Buy that comes and sets up the equipment and then takes the equipment away with the geek squad. But.

you would expect that to be broadly adopted across the whole country. What patient doesn't want to be taken care of at home instead of sitting in the emergency department of hospital. But again, legislation hasn't gotten to the point. These things are being done by waiver as opposed to hard -coded legislation. So there's so much uncertainty to make that investment. It doesn't make sense now. There's probably less than 5 % of hospitals that have hospital at home programs. If that were to change as...

something will happen in December of this year in terms of will that get extended another five years or what, that will probably have a big impact. So I guess the answer to your question is how it gets paid has an impact. The other thing is patients like to see and talk to their doctor in person. And there are certain things that you would want to do that you could do. It's the same thing about online scheduling.

Ed (27:43.896)
Yeah.

Ed (27:49.272)
Yeah.

Alistair Erskine MD MBA (27:57.294)
You want to have a voice on the other end. Some people, digital natives are perfectly happy doing this, but the kind of patient demographic that tends to require healthcare today is not the kind that is digitally native.

Ed (28:12.152)
Yeah, I think that's that's gonna be it. Yeah, for sure the financing and then as the generations change over, I think we'll see further adoption. It just didn't happen as fast as some of us thought. This is this is amazing conversation. I there's so much more I want to talk about it. I've kind of bumped out that our time is coming to an end. Let me ask one around leadership and then and then we'll close out. What is the one piece of advice that you would give to aspiring CIO? So, you know, a lot of our listeners are

are people earlier in their career than you and I. And, you know, looking back and all of your experience working with other leaders and growing leaders, what's one thing you would tell them to do to think about as they grow?

Alistair Erskine MD MBA (28:53.71)
I think, you know, it's funny you should say that because, you know, you think of a CIO and you immediately think about technology and electronic health records and genitive AI and, you know, those kinds of things. I think my, the biggest job I have as a CIO is, is managing the hundreds of people that, that I'm responsible for in the organization. And so much more about, to your point, leadership, but how do you manage a team? How do you inspire people to work at their best?

How do you make sure that you communicate with them, you know, how they're each connected to purpose? You know, how what they're doing is having an impact in saving lives. It's kind of connecting those dots and making sure that people understand what the vision is, what are the possible is, what can be accomplished. It's so much more about that to me than it is about necessarily all the clever technology. Of course, that's an important part of it.

But so to aspiring CIOs, it's much more, I would say, get to the point where you come to identify your own leadership signature. Are you going to have monthly town halls? Are you going to have skip meetings where you're not only talking to your direct reports once a week, but you're talking to their direct reports once a month? Are you going to meet with every single person that's new to your organization every week to find out who they are and to make sure they understand what the vision of the organization is? Do you?

Ed (30:13.016)
Yeah.

Alistair Erskine MD MBA (30:22.414)
You create meetings once a week with 12 people in your organization that don't know each other just to have lunch and talk about nothing to do with work. Do you round on the units on a regular basis and make sure that you can model the behavior to your customer, the clinician, the administrator, the teacher, the researcher, so that people know how then to interact with the customer when they're doing it. I think those are the important aspects.

Ed (30:49.4)
that's gold. That's some great, great advice. This has been fascinating. First, you know, just you're a fascinating individual, your background and the way that you were raised. We talk a lot about songs on the playlist, which we have our own digital voices playlist. So people can, we'll put it in the show notes. So there is a digital voices playlist. We'll add your music to that. And I loved your whole mission and mantra, you know, about reducing human suffering and how you and your family operate by being grateful and really helping others.

Alistair Erskine MD MBA (31:08.718)
Nice.

Ed (31:19.192)
And then we hit a bunch on Emory and career and things you're doing for transformation and then the final one on leadership. So we covered a lot, but is there something we missed or anything you want to double down on? I'll give you the last word.

Alistair Erskine MD MBA (31:33.614)
So I think that there is a, you know, taking a step back and looking at the entire healthcare, people complain about, you know, how the healthcare system is complicated and so forth. There is one theme that I think is important to keep in mind. We have to protect the delivery system, how at the point of care we're delivering healthcare. And if you look at the macroeconomics, you know, a hospital and health system is currently,

working with insurance companies, working with pharmaceutical companies, and you see kind of a shift of profit and a shift of resources more towards a way I would say from the delivery side. And the problem is in certain cases, especially critical access hospitals, that puts an enormous strain and that has a really negative impact on delivering care to the more vulnerable populations. So I think...

Part of what I feel is really important to do is, you know, you have vendors come to the health system to ask to sell a piece of software. We want some of those vendors to go upstream to the pharmaceutical company, to the insurance company, to make the payment so that we can deliver it at the point of care. I think that is an overall, something that's not in alignment and something which impacts our ability to live out of care, which is what everybody ultimately wants.

So part of what I'm trying to do is rebalance that portfolio and make sure that we still can keep it intact, the delivery aspect, while partnering more closely with insurance company and with pharma and biotech to make sure we can get that to happen.

Ed (33:18.584)
Yeah, Alistair, that's great insights and I agree with you completely. You're an amazing individual. I listen to you talk and your philosophy and the things that you're doing makes me want to go down to Emory and be on your team. Thank you for being part of Digital Voices.

Alistair Erskine MD MBA (33:34.958)
Thanks so much Ed, I really appreciate the kind words.

Ed (33:37.912)
Hey, that wraps up another edition of Digital Voices. Thanks for listening.