Humanizing Data to See the Patient as One of One

Podcast Transcript

Steph Bayer: Welcome to another episode of Studies in Empathy, a Cleveland Clinic podcast exploring empathy and patient experience. I'm your host Steph Bayer, senior director of the Office of Patient Experience here at the Cleveland Clinic in Cleveland, Ohio. I'm very pleased to have Matt Kull with me. Matt, welcome to Studies in Empathy.

Matt Kull: Thank you, I appreciate you having me.

Steph Bayer: Matt currently serves as our chief information officer at the Cleveland Clinic. He has over 20 years of experience in the healthcare industry, and prior to joining the Cleveland Clinic, Matt served as a senior vice president and chief information officer for Parkland Health and Hospital System in Dallas, Texas.

Steph Bayer: Hey, before we get into the interview, I want to apologize off the go because my interviewing of you is not going to be nearly as fun as when, about a year ago, you interviewed me. I was interviewing for this job, do you remember that interview?

Matt Kull: I do, very much, and congratulations.

Steph Bayer: Oh, thanks.

Matt Kull: We were very excited to all ensure that this is where you landed.

Steph Bayer: Thank you, and I'm thrilled to be here. But the best part of the interview was you invited a special guest, and you had your dog with you. It was my favorite job interview of my life.

Matt Kull: We have certainly seen a lot of how each other lives a little bit differently since COVID and a lot of this remote work. I think, if anything, Teams has definitely introduced ourselves to how we look in the morning and what goes on in our background.

Steph Bayer: Isn't that true? As someone who lives in the empathy space, I actually love it. It's humanizing each other and allowing us to remove some of that facade and know each other, which is really cool.

Matt Kull: It's been an interesting transition, I think my division has done really well with it, but the thing that I'm most happy about was that it really forced us to find ways to connect with one another in off time, so getting together, doing a barbecue or what have you. I think it was really important, because when you see people every single day at work, sometimes that more social aspect and connectedness, it's not front of mind, but since we've all been over video, how do we stay connected is top of everyone's mind.

Steph Bayer: Yeah, it's so true. Thank you to you and your team for allowing it, because I know it's a lot of work for you guys.

Steph Bayer: If you don't mind, get into some of the nuts and bolts of this podcast and this episode. I want to start off by just asking you, what led you to a career in IT?

Matt Kull: I've been asked this a lot of times and it's actually a really easy answer. I started my technology career in Northern California. I was a Silicon Valley technologist who found his way into one of those Y2K companies that were going to save the world from what was the inevitable destruction by the two-digit year. Looking back, I think that whole thing was a little bit overblown, we have all found, but it was an interesting experience as someone just entering their career in technology. I grew and I started consulting and then I went to work for a software company called Siebel Systems. Siebel Systems was eventually bought by Oracle, but they were really one of the first people out of the gates with a sales force automation and customer relationship management platform. While I was there, I focused primarily on oil and gas and telecommunications.

Steph Bayer: Wow.

Matt Kull: Big industry verticals. I was in Texas at this point, there was lots of those businesses in that space, but I landed one small account that they wanted me to cover, which was a small, probably a hundred million a year, in-vitro treatment pharmacy. They did IVF, multiple sclerosis and rheumatoid arthritis. That was the scope of their business and they managed chronic disease. What it opened my eyes to was really that there was a way that technology could improve outcomes. I developed a real passion for being able to impact the lives of people in a way that was really meaningful to them, especially when they were in the most sensitive areas of their life, trying to have a baby, facing chronic disease and trying to carry on a normal life or what could count for normalcy.

Matt Kull: Then it really started from there. I spent the next couple decades, up until now, primarily focused on healthcare. I've worked for some of the largest pharmaceutical distribution, pharmaceutical chronic disease management companies, and then parlaying that into the CIO role at Parkland Hospital, and now Cleveland Clinic, where I am had always hoped I would land one day.

Steph Bayer: Well, we're glad you're here.

Matt Kull: Thank you.

Steph Bayer: I also love that your background is so diverse to get here. I also did not start in healthcare and landed in healthcare. I find, for me, there is not a better mission than healthcare. You're taking the skills that you've developed and to drive it to where people need it most and what matters most, it's really an honor to do this work.

Matt Kull: It's very fulfilling and I think it becomes a part of who you are.

Steph Bayer: It does.

Matt Kull: When I was at Parkland, the thing about that hospital is it serves one of the largest underserved communities in the country. It has the busiest single site emergency department in the nation. It delivers more babies than almost any other hospital in the nation and has held the record many times. Yet, in Dallas County, there are parts of town that are incredibly, incredibly underserved. Working at a safety net hospital, it really gets into who you are, because you become the provider of last resort in a lot of ways, and to help those who are truly in need has become a real calling. I'm a technologist, but I'm applying it in a place that at least really means something to me.

Steph Bayer: That's awesome.

Steph Bayer: As a technologist, you know the Cleveland Clinic has access to just an enormous amount of data. How does the organization humanize that data?

Matt Kull: The way that we're approaching this is there's information about our patients that can help us treat them better, that can help us to create an experience that is exactly the experience they need, where they are. I think it's one of the most empathetic things that this organization or any other healthcare facility could do, is to meet patients exactly where they are, on their terms, in a way that enables them to get the care they need without creating hardship or other types of inconvenience in their life.

Matt Kull: I think back to one of our last State of the Clinics, when Dr. Mihaljevic kicked off and said, "We're going to improve access," because when you're a single working parent, taking time off to get to the doctor is tough, not getting an appointment on a day that you're off or a time that's convenient for you, that's really hard and it creates undue burden and barrier to care that many people need. I think by using the information that we have and by informing ourselves with preferences and specifics about each of our individual patients, we're able to meet them where they are.

Matt Kull: Then there's another side to that, where we can take this data, as well as our research insights and start to create therapies and treatments and interventions that become more proactive, where we can know more about you and intervene in your health before it's at a catastrophic level. We can make sure that preventative medicine is occurring, we can make sure that screenings are occurring. We can take all of those elements of information that we have to drive insights into what makes me, me and you, you and why one therapy might be appropriate for me but not for someone else.

Matt Kull: I think when we really take a look at the vast amount of data we have and the human interactions that come from that information, not only do we make a more convenient and personalized experience, but we're also treating you as one of one. It's less about your condition or disease and more about you. That's what all of this data ultimately will get us to. It's been a long journey and we have a long way still to go, but I believe that humanization is going to occur when we really can deliver on the promise of precision medicine, taking the data and making it you.

Steph Bayer: Yeah, and that's really how to humanize, exactly. That's a really brilliant concept. You just said though, meeting patients where they are and being proactive are important concepts to make sure that we get to that humanization. One of the bigger areas of IT right now, and maybe gives people a little discomfort at times, would be the remote monitoring, because there's some question about should we be concerned that you're receiving care in a less personalized or less empathetic way if you're receiving it in a remote space. What's your belief on that? Can you talk to me about remote monitoring?

Matt Kull: Certainly. For my own self, I would say that being at home is more comfortable than being in a hospital room. There's no more personal space in my life than my home. If we can deliver our standard of care based on the level of acuity of that patient and need of that patient and we can make them more comfortable by having them recover in home or having them monitor in home, then we need to evaluate that. But I can tell you that any hospital at home or remote monitoring that we've thought about doing, it had to achieve parity in the standard of care that they would receive on premise. We wouldn't send someone home who was requiring potential immediate intervention if we were worried about someone coding or otherwise. It's important from the perspective of we absolutely will not lower the standard of care, remote monitoring is not for every patient and every condition, but for the ones that we can create the ability to go home and recover at home and monitor in a way that's safe, I think we make a much more personal experience and a better path to recovery.

Matt Kull: If you look at what we've done through COVID, early in the pandemic, when ICUs were 100% full and we were overflowing into other areas of the hospital, we developed, here at Cleveland Clinic, with Epic, a monitoring program at home for COVID patients. It was driven by a mobile app or a website. You would take your temperature and your respiratory rate and your blood gases, and if we saw change, there would be an immediate outreach to have that person come in, but that condition didn't have an almost immediacy of, "I have to be there." We had a little bit of window, we could make it safe. What that did was allow us to decant the ICUs for people who may have been in there, who may have been in our emergency departments, so that we can treat and focus the face-to-face energy on those patients that were the most critical, that were at the highest level of side effect or symptom from the disease.

Matt Kull: I would say that, first off, we will not lower the standard of care for anyone who is being monitored at home, but more so, that being able to be at home with your family, your children, in a safe way, I think creates a better experience than being in a hospital room.

Steph Bayer: What I really like about your answer too is it triggered for me, as I'm listening, that not only are we making it more empathetic and more compassionate and more personal for the person being monitored at home, but for those patients in the crowded ICU and those caregivers that have so many patients to take care of in our in-house environment, we're relieving some of that stress a bit by making sure that we're targeting the interventions to those that need it most. Boy, if technology is not driving empathy with that, I don't know what it is. That's awesome.

Matt Kull: It's been a very fun space to be in.

Steph Bayer: Yeah.

Steph Bayer: In your role though, you do know that patients give us a tremendous amount of trust to provide their data to us. How do we honor that trust and control for the data and the right protections that we need to also leverage the technology?

Matt Kull: We look at data, our patients' information, as the most personal and private information any human can have. This is really at the source of what makes you you, and in some cases, some very sensitive information about conditions that you have to be, and our patients have to be, respected to share with others on their own terms. It's not for us to decide that. But what is important is how we protect that information.

Matt Kull: We have a number of preventative measures across our hospital for the use of data. First, sharing data has an incredibly high threshold that has to meet the continuum of care or quality and safety or research type initiatives. Research initiatives, our patients are, one, provided an opportunity to consent before their data is used in research. Then that data, across the board, goes through an independent review body to make sure that it's an appropriate study, to make sure that we're using it ethically.

Matt Kull: More importantly, we have end-to-end audits on patient information that occur outside of the technology team or the clinical teams by an independent internal team that strictly audits who is using, who is accessing, who is looking at patient data. We have very clear rules around who can and cannot engage with patient information. There has to be a part of the continuum of care to have that access. We're not able to look at our own patient information, our family members can't look at our own information or their family members' information. We put this level of rigor around all of this, because we want to have this heightened level of care, regardless of who you are.

Matt Kull: We also have, in more sensitive situations, whether it's somebody who has been injured during a crime or specific people of interest, there are protections that we put in place where there's literally big warning screens that says your activity is being tracked, if you enter this record, understand it will be scrutinized. It is a lot of internal effort and a lot of work to keep this as secure and private as we do, but that's the level of respect and regard that we have for people's most sensitive and personal information.

Steph Bayer: I'm glad we do, thank you.

Steph Bayer: You once said that it's up to a business leader to make sure that the digital tools are used for the good of all. How do organizations prevent data from being weaponized without creating bureaucracy that limits innovation that gets in the way of our ability to create?

Matt Kull: I appreciate you bringing this up. Just to give our listeners full context, this was an article that had to do with the utilization of data and artificial intelligence. This is an area that many technology and data science leaders are talking about right now, because we have to create equitable outcomes in the usage of artificial intelligence or machine learning or data science to create decision support.

Matt Kull: One of the most critical factors is that we're not allowing programmers or the people who are modeling this data to let their own biases be part of the decision criteria. We have a very strong ethical review process that goes through all of these algorithms and compares that to population data to ensure that we're getting the right decision support, recommendations, and outputs. What we don't want to see happen is we don't want to create a process by which we're trying to reduce medical errors, but we find out that medical errors for Caucasian females went down, but Hispanic males showed no improvement. That can very easily just be a part of how the algorithms are trained and how the machine learning is doing its self-learning.

Matt Kull: It's critically important for an enormity of reasons, but most importantly, to create equity in the way that we treat our patients. It's very important that these review happen, that the reviews are validated before we put things into production environments. We run these in the backgrounds as simulations for a long time before we put any kind of digital AI directly into our systems to look for just these very things, because as you said, it has to be good for all of us. It can't just be good for a few, especially when we're talking about the health and wellness of our society.

Steph Bayer: I love knowing that, I wasn't aware of that before. There's such inequity incumbent in healthcare that to be able to use machine learning to level some of the playing fields and how we approach things, I think is fantastic. Thank you for thinking that way too.

Steph Bayer: How does Cleveland Clinic leverage technology to promote patient experience and empathy amongst caregivers?

Matt Kull: I'm really glad you asked that. As I mentioned earlier about creating better access for our patients, we have started one of the most important initiatives of Cleveland's modern time, and that is a program that's called Access. This program is specifically designed to promote patient experience, to make getting care easier, and to reduce the burden on our caregivers to be way finders. We want to have the processes in the digital domain obfuscate the complexity of our physical domain. In doing this, in leveraging this technology, we will implement chatbots that help our patients find what they need in our health library, to give them the information about their conditions, but also have warning sensors that if certain comments are added or questions are asked, the ability to escalate from the chatbot to a live agent or to a potential virtual visit, all seamlessly in that same patient encounter. Those encounters should be efficient and we should see patients receive the care that they want over the channel that they want, whether it's in person or virtual, at a time that is convenient for them.

Matt Kull: It's really critical also that patients feel as though their engagement with us is seamless. What I mean by seamlessness is that if they have to go get a flu shot and they need to get their prescription refilled and they need to be seen for their heart condition, the experience should be one cohesive experience to get to that care, as opposed to having to make multiple calls and follow-ups. We're really driving to bring that experience to our patients through this program. As I say said earlier, meeting our patients exactly where they are and how they want to be met is probably one of the most empathetic things we can do.

Steph Bayer: I'm going to ask one more question. I'm curious, because we covered a lot, from access and caregiver ease to protecting the patients and the trust they instill with us, how do you prioritize? Do you have a North Star or a guiding principle? I'm just looking for a cheat sheet to say how do you know what needs to be most important?

Matt Kull: Certainly, quality and safety always comes first, 100% of the time. Then for everything else that we're implementing or projects that are on our roadmap, it is really the single question that I think guides this entire organization, and that is patients first. What is the most beneficial thing that we can do next for our patients, and then what's the next most important thing, and the next most important thing? That's how we drive our prioritization, because if we're putting patients, first picking what's most important is a very, very easy thing.

Steph Bayer: I'm glad I asked that.

Steph Bayer: Well, thank you for your time today. I'm really grateful that we got to talk about this important topic. I don't think we always think of technology and empathy in a happy marriage, and you've helped reframe that for us.

Matt Kull: Terrific, it was really a pleasure being here with you. I enjoyed this conversation very much.

Steph Bayer: I did too, thanks.

Steph Bayer: This concludes the Studies in Empathy podcast. You can find additional podcast episodes on our website at my.clevelandclinic.org\podcasts. Subscribe to Studies in Empathy podcasts on iTunes, Google Play, SoundCloud, Stitcher, or wherever you get your podcasts. Thank you for listening, join us again soon.