What’s Right for the Patient the Role of Technology in Healthcare Communication

Dr. Will O’Connor:  With us today, we have the Chief Medical Information Officer from Penn State Health, Dr. Chris DeFlitch.  Chris, it is good to see you again. Welcome to the show. 

Christopher J. DeFlitch, MD: Hey, Will, thanks for having me. 

Dr. Will O’Connor: Yeah, absolutely. Thanks for taking the time. I wanted to start a little bit today, just talking about your background, give me the Dr. Chris DeFlitch origin story. How’d you decide to get into to medicine? And how’d you decide to get into emergency medicine? 

Christopher J. DeFlitch, MD:  So I wonder if you’re asking an origin story, does that mean I’m a villain or I’m an avenger? I’m a little confused about that.   

Dr. Will O’Connor: That remains to be seen. We’ll see how this goes.  

Christopher J. DeFlitch, MD: Sometimes, a little bit of both being a CMIO for 20-plus years. So, yeah. Yeah. So, I’ll give you a little background. I’m a Western Pennsylvania guy. As you can tell behind me, I’m a Steeler guy. Born, raised in Pittsburgh area. Um, I did my undergraduate, in a small school in Erie, Pennsylvania called Gannon University, where I got my degree in physics. 

Was lucky enough to join Penn State College of Medicine, for my undergraduate medical education. Never had any technology interests really other than thinking systems and, it was actually a couple credits short of a mechanical engineering degree as an undergrad too. And my mind was always sort of thinking systems, but wasn’t a technology guy. 

Ended up in the early nineties going to UMass and Worcester for my emergency medicine training. So I’m an emergency physician and for some reason, ever since I was a little kid, always wanted to be an emergency physician. I was lucky enough to be able to do that. Finished up in the academic center saying to myself, there’s no way I’m ever going into academics ever again. 

Went and worked in the community hospital, actually, the hospital I was born in, in western Pennsylvania for about a year.  

Dr. Will O’Connor:  Yeah.  

Christopher J. DeFlitch, MD: And then literally 25 years ago this month,  came back to Penn State. So I’ve been at Penn State Health and its versions. Initially, it’s just the Hershey Medical Center, but now, the larger Penn State Health for the past 25 years, done everything in emergency medicine from creating an ED without a waiting room to helping convert, from paper to electronic, most of our health systems over time, converting from Epic to Cerner and a whole bunch of other conversions over time. So, in my sort of healthcare life, I initially was practicing a lot of clinical emergency medicine. 

I still practice, I practice once a week at the Hershey Medical Center on Thursdays. So I still love taking care of patients. But my primary job here is CMIO and had actually a really fun journey in research and informatics and a fun journey in training and educating folks and, and doing some good things for our college and, you know, I think making a difference. 

Dr. Will O’Connor: Yeah. I’ve worked with you long enough to know that you are, and Penn State is definitely lucky to have someone like you. It’s very rare in a CMIO where you have the combination that you do in terms of tenure at one location and then a lot of credibility and experience both on the clinical side and the informatics side. 

They’re really lucky to have you as part of the system there.  

Christopher J. DeFlitch, MD: Yeah. Listen, anybody who’s gonna put up with me for 25 years, and you’re not my wife, God bless you. You know like most of us were so energetic and trying to get things done. And in the, as you know, in the early years of doing, physician champion things before there were even such thing as a CMIO even existed. Trying to help people understand how technology can help improve process and improve things. There were lots of promises back in the day, 20, 25 years ago about how that would happen. 

And I think, as we’ve all grown up into it, some of that has come to fruition. Some of it has just been an absolute failure. I think as we pivot and learn as to what is best for our patients and what’s best use of technologies, some things have stepped into it. Electronic records are kind of a basic expectation of everything now, whereas 20-some years ago, it was sort of the new kid on the block. 

Dr. Will O’Connor: Yeah.  

Christopher J. DeFlitch, MD:  I think, again, we talked philosophically, but I think, there’s that practicality in the business as CMIO, but there’s also the importance in education and training. So as a professor in the College of Medicine and a center founder and a center called CHOT, where we study healthcare delivery science and how does technology impact the practice of medicine? How does, how to processes and people adjustments impact the use of technology? What’s the right role for people? It’s been really fascinating to mentor literally over a hundred students, PhDs, MDs, master’s students in healthcare delivery science, and really start developing that thinking about not just technology itself, but the use of technology and the people and processes around it, and how it impacts, our family members as we care for them. 

Dr. Will O’Connor: Talk to me a little bit more about the technology piece. And I know, we’ve talked before about electronic medical records and I think that one’s been well discussed. Talk to me more specifically around communication technology and how you’re communicating and collaborating across your organization. 

Christopher J. DeFlitch, MD: I think that’s key. I mean, anytime anybody’s been through some sort of quality review of cases or how systems are affected, communications is sort of the number one thing on the list. It’s been very fascinating over the years to watch this happen where without, technologies, people actually talked with each other. They would pick up the phone and ask for something and there was that sort of human interaction. I think more and more, there’s technology intermediaries in there that are helpful and hurtful in some ways. So, people communicate through electronic records in ways, whether they’re inboxes or message centers, or whatever each vendor calls them. 

It’s really about that communication. But it’s an email, right, effectively. And it’s not really synchronous and you don’t know, is there a response or not a response? I’m an old-school guy and I still pick up the phone and talk to people whenever I have a question. But more and more we’ve been involved with more advancing technologies like texting and like, enhanced video, interactions both with patients and providers in regards to telehealth. 

And so I think that there are platforms and opportunities for quality communications bi-directional. I think that’s the key. In both the video space and in the texting space. Again, I’m still a big fan of picking up the phone and talking with somebody or talking with two or three people at the same time, so that we’re all collaborating and I’m talking especially in the setting of clinical care that, we can get everybody on the same page. 

So we’re taking care of the patient in the same way. I mean, anecdotally, one of my family members, extended family members, got sick, over this past weekend and, with a quick conference conversation went from a family that was completely freaking out about what turned out to be truly a life-threatening situation, to talking them through it, to having the conversation about what our next steps in care. 

And then as we moved on, texting back and forth to, keep that communication, back and forth, up to now then surviving this past weekend and going to a longer-term rehabilitation facility to finish out their convalescence. I think, you know, 20 years ago that didn’t exist. 

I would have had to get in a car and drive to Pittsburgh, which is a good four hours away. It’s become expected in, I think, my kids’, level of communication that, their primary, desire is for quick snippets and for texting back and forth and, you know, we’ve been, partnered with TigerConnect here for a few years now. 

And while I think it started off as, how the heck do we use this and where does it make sense? And you always get these early adopters in any conversion. We’re now to the point where we’re looking at the numbers a little bit, 2 million plus texts a month, that is essential to the communication strategies in three of our six hospitals. 

And the other three, are converting very rapidly to the point where by the end of this fiscal year,  it’ll be our primary texting platform.  

Dr. Will O’Connor: That’s a lot of messages a month that are going back and forth. Any sense as you have observed over time and worked at Penn State and used the technology yourself? What’s gotten better? What’s improved?  

Christopher J. DeFlitch, MD: Connectivity is improved. The importance of the bi-directional nature I think is really important. Pagers is that sort of long-standing 1980s technology that people hold onto that say, oh, I’ve always used it this way. And then, once they realize that they don’t have to carry around that device and they already have a smartphone in their pocket previously, and they understand that the application can do what that device did is sort of the ah-ha moment for most of them. I’m continually surprised that in some areas they’re so, so important to hold onto something that’s tangible like a beeper, for some people, like a local network phone as opposed to a smart device, that the mentality shift from the device doing it to the application doing it is a little bit hard for some people to understand.  

And so the way I think we’ve seen it, you’re gonna have your early adopters. They’re gonna gravitate to it no matter what. You’re gonna have the people who really understand how to improve processes and the use of technology, they’re gonna gravitate it to it because the technology’s really easy to use. 

And if you leverage the roles and the teams and all that, the capabilities that are associated with it, you can improve some specific things. But then you got this sort of, last third in the laggards, which is kind of where we’re at in our organization is to say, how do we get the rest of the organization moved towards that and it’s a different transformation technique, and back to the old guy CMIO thing, right? Our first foray into informatics and CMIO worlds were converting electronic records. Then we talked about optimization of those records. I think nowadays, you know, your more advanced CMIOs are at the executive table so they are talking about how do we improve the outcomes of our patients? 

How do we improve the gaps in care? How do we leverage the technology to improve the opportunities for care we have across our organization? And again, communication technologies are key to that. Video technologies are key to that. Ease of use of the electronic record and other peripherals are key to that. 

And as we mature, as an industry and as more and more of the Technologists understand the importance of the informatics piece of it, and as the clinicians and business folks understand the importance of the informatics to be able to enable them to do all those things that you’ll see the really development of informatics that some of us had vision for more than a few years ago. 

Dr. Will O’Connor: We talked about how convenient this technology is, how clinicians are happy with it, how it’s definitely made their lives easier. Talk to me a little bit about some of the clinical and perhaps operational improvements that you’ve seen.  

Christopher J. DeFlitch, MD: I wish everybody was happy with it. They’re not, people are not, generically, people don’t like change. 

Some folks are. Some are, come and kicking and screaming. That’s a reality. But most people understand once they use the technology, like, oh geez, why didn’t I do this before?  

Dr. Will O‘Connor: Yeah.  

Christopher J. DeFlitch, MD: It was just that change management and resistance to change. I think we’ve tried to use the technology to enhance the experience and I, focus in on the quality and safety aspects of things more than, that includes experience of the providers. So, actually, in our community, the facility, radiology, interpretations, and actually laboratory results, we set up different roles within both the community, radiology services, and the different laboratory services that instead of it coming from Dr. Smith or Nancy Jones, it’s coming from Critical Lab Results Hospital A.  

Dr. Will O‘Connor: Yeah.  

Christopher J. DeFlitch, MD: It’s coming from Critical Radiology Results Community. And so when I see that text, it puts it in context for me. It’s still Nancy, Nancy Jones and Dr. Smith that’s sending it ultimately, but that’s not what I see as receiving it. 

So all of a sudden without really doing anything, I’m looking at a text with a completely different context than I would’ve before.  

Dr. Will O‘Connor: Yeah.  

Christopher J. DeFlitch, MD: Imagine you got that in a beeper, right? It would say, one, two, three, four, five, call me or something like that. So all of a sudden I’ve got four or five minutes of work as opposed to I can look at this and I can see I’m like, oh yeah, that’s for real and I gotta do something with it. 

Or you look at it and say, ah, no, I knew about that already and I can just bypass it. I mean, that’s a second, as opposed to minutes conversation. And it makes the patient care, I think, a little bit more effective and it makes me as a physician more efficient.  

Dr. Will O’Connor: You talked a little bit earlier about your role as a CMIO and being very much connected to the executives in your organization and part of the executive, and have worked with other folks and other CMIOs, and I’m sure you have as well, where that’s not the case. They’re really more part of the IT team. How have you made that connection? 

And what are the things that you track and that you think about and perhaps the metrics that you drive to as a CMIO that makes you important and relevant at that senior executive level? 

Christopher J. DeFlitch, MD:  I do report through IT. So I report to the CIO, Cletus Earl. I think part of that is our leadership team at Penn State Health with Cletus and the other folks that he’s brought in with Chief Applications Officer, Chief Technology Officer, Chief Data Officer. 

We work very closely as a team together. So it’s really that unified approach. And it’s not just I at the table as sort of the technical clinical voice,  

Dr. Will O’Connor: right? 

Christopher J. DeFlitch, MD: I’ve had roles as physician leaderships in a couple of different locations. So the folks that are the Chief Medical Officers or the VPMAs of the different organizations  

Dr. Will O’Connor: Mm-hmm. 

Christopher J. DeFlitch, MD: I sit with them, as part of their forum. I sit with the Chief Nursing Officers as part of their forum and with the Senior Executives in regards to that. It’s, not rare. Some of the guys will pick up the phone and say, Hey Chris, we’ve got somebody who’s in the emergency department over here. Can you come help me?  

They know I’m an emergency physician. I’ve been doing it for 25 years. I’ve taken care of more people than I, care to say. And so that’s that. There’s a level of personal trust there and they know I’m in it for the right reasons. I mean, I very rarely talk about technology for the sake of technology cuz that’s not why we do things. 

Dr. Will O’Connor: Mm-hmm. 

Christopher J. DeFlitch, MD: There are some cases where old pen and paper or pick up the phone and talk to somebody is much better than any intermediary technology. I always say that healthcare is about, people taking care of people. It’s about the physician and patient in space and time. And that can happen in the ED, that can happen virtually now with really good telehealth, that can happen with phone calls. 

But you can’t lose that personal touch. So, I think that one of the reasons I’ve been lucky enough to have that conversation is, I put in my time. There’s part of that. I’ve been successful with the help of my team and others, over a period of time. And they know it’s about the right thing to do for the patient for me. 

No matter what I say or what I do, it’s about the right thing to do for the patient. I won’t go into great detail, but when we first selected our EMR vendor, literally in the early nineties, I was on the search committee as this young buck who wasn’t afraid to share his opinion. And when we did the round table and they asked, okay, what vendor you want to go to? 

I said, well, vendor A has a much better user interface and I think would make more sense if we’re only focusing in on our docs. But vendor B at this point in the development made a lot more sense for our entire organization because they had some stuff that the nurse could use. They had stuff where I could get results back to me as a physician. 

Maybe my user interface as a physician wasn’t quite as good as the other one.  

Dr. Will O’Connor: Oh yeah. 

Christopher J. DeFlitch, MD: But it was about how we together can take care of patients and, to me, that theme of doing the right thing by our patients, doing the right thing by our system has always carried me forward. So anytime there’s hard decisions or anytime there’s sort of what’s the right thing to do, I think about what’s the process, how does it affect the people and would this be good for my dad or my cousin or my extended family member who was just ill. 

And so that’s sort of my norm. I think people appreciate the honesty cuz there’s times when I’ll say it might be unpopular, but I don’t think we should go in that direction because while it may enhance one part of our organization, it probably is not the best bang for the buck for another area. 

Ultimately, like anything else, like any, personal or business activity, it’s all about relationships. Right? And, and how do you help each other out? I know it’s a long-winded answer, but I think over time, I’ve been able to understand the technology enough to speak to the technologists. 

Obviously, I’m a physician and a clinician, so I can speak to the clinical folks, fairly easily. I’ve learned a lot of financial information. So when we’re talking about finances, we can help translate that for the folks who are very focused in on the finance. A lot of times we use informaticists or translators between the clinician and the IT folks or the business and the finance. 

This, and because we’re clinicians, we always have that sort of, I think true north. That moral compass. It says, it’s really about the patients and how do we get folks to the point where it’s about the patients. So I think it’s one of the reasons I stay at Penn State Health and have been there for such a long period of time is cause I think we have the people here that care about that stuff. 

Dr. Will O’Connor: Yeah. 

Christopher J. DeFlitch, MD:  While there have been, people come and people go, people come in with different perspectives and, I think we’re seeing a lot of people who care about the right things to do. And I’m kind of lucky enough to work with folks.   

Dr. Will O’Connor: Yeah, and I think that really resonated with me when I visited was, everyone was driven by exactly what you just said, is ultimately what’s the right thing to do for the patient. And that’s really comes through at, at Penn State. 

Christopher J. DeFlitch, MD: Yeah. And it’s, and will, it’s hard stuff, right? I mean, the healthcare environment’s tough, right? Getting access to the right care, being able to contact somebody in a way that that is value added for everybody involved. 

It’s just getting harder and harder and harder I think. We learned a lot through Covid, but there was a, you know, it was just an absolutely horrendous time for everyone involved in the pandemic. But there have been a few things like telehealth, like, ace, like near synchronous communication technologies and texting and, video, chat that have had got us through it. 

And now, folks who may have been more resistant to that use of technology, are now saying, oh geez, well why not this? I mean, we’re, yeah, we opened up two new hospitals, literally brand new hospitals in the last, little over a year. And we have people that are willing and able to think a little bit differently because you’re in a new physical plant. 

And working with some of the cardiologists to truly have a hybrid visit where the only time the patient is spending time, face-to-face is a physical exam with a physician. Everything else is being done either, asynchronously or synchronously on video. 

Dr. Will O’Connor:  Mm-hmm. 

Christopher J. DeFlitch, MD: so there’s no reason why we can’t do that in many locations. 

There’s no reason why in many locations we can’t completely virtualize it and, have the patients in their home. I think, I’m talking a lot here, but one of the things that we’re really looking into, is some people call it social determinants of health. I call it social indicators of health, cuz I don’t think it’s a predetermined activity. 

I think there’s opportunities for folks to intervene, where there’s the needs of populations and as more and more mature with the secondary data aggregation and connection to other industries and other resources. I think we as health systems have the obligation to be able to make those connections between patients and groups of need with organizations that can actually improve their long-term life and outcomes. 

That’s not necessarily your traditional, transactional, clinical visit, like an ED visit or a surgery or something like that, but that longitudinal care that actually improves the lives of a family, that is, facilitated by Penn State Health. I think there’s a lot of opportunity there. 

So, I think what we’re gonna see, at least from us in the next coming times and probably from others is, how do we work for our communities that we serve.  

Yeah.  

And how do we use these technologies that are now ubiquitous, whether they’re, Tiger Connect or telehealth visits or EMRs, or whatnot in a way that improves, the lifespan and outcomes of families in our region. 

And I think it’s part of the obligation we have from what we’ve learned over 20-plus years of doing this stuff. But also what companies like Tiger Connect are willing and able to do with us to be able to say, yeah, yeah, we’ve done some really good things in healthcare and communications have been enhanced and the ease of technology use has been, the burden has been decreased. 

But what about everybody else? What about those, the people who maybe do have a smartphone but don’t have a ride to the doctor or have food insecurities or maybe they live in an area where the safety of the waters is not quite where it should be? How can we leverage these technologies, leverage our expertise in healthcare delivery science to be able to improve their lives? 

And I think as we think about things, we allow ourselves to think about those things, coming into the future. I think we, people are obligated to make a difference there. And I think this next generation of our employees, things like that automatically is a very important. Social connection to how they purchase, to how they use technologies to do this. 

And it’s really the right thing to do. So as people have been around doing it and can tie into that, that great thought of the next generation coming up and how do we bring that together to help people in need. Yeah. Yeah.  

Dr. Will O’Connor: Well, Chris, really appreciate you joining us today. You’ve been so generous with your time. 

Thank you so much for sharing your perspective. It was great to see you again. We’ll have to have you back on here sometime soon.  

Christopher J. DeFlitch, MD: Yeah, that sounds good, Will. Thanks. Thanks for having me. Thanks for allowing, uh, you know, Penn State Health and myself to have the swarm to be able to talk about some things that are important to us.