DIGITAL DISRUPTION IN HEALTHCARE: INSIGHTS FROM A CLINICIAN IN A TECHNOLOGY COMPANY

Photo by Luca Bravo on Unsplash

An insightful article in NEJM Catalyst was published on March 1, 2023, by Karen DeSalvo, Chief Health Officer at Google, and Michael Howell, Chief Clinical Officer at Google. Having spent the last 10+ years as an pharmacist and clinician at multiple health systems (e.g. Mayo Clinic, University of Utah Health, Sarasota Memorial Health Care System), the article made me spend some time today to reflect on my own foray into a technology company just 10 months ago. In short, I am grateful for the path that Karen and Michael undoubtedly paved for other clinicians to venture into this industry.

In this article, I'd like to share my own experience as a health data architect/clinician at Verily, an Alphabet Inc. company and how it relates to the 6 lessons laid out by Karen and Michael. You can read the full #NEJM article here.

BACKGROUND

I spent the last 7 years at Mayo Clinic as an informatics pharmacist and was part of the Plummer Project team that implemented Epic as our single, integrated electronic health record (EHR) across our hospitals and health systems. I was primarily focused on infectious diseases (i.e. Antimicrobial Stewardship and Infection Control). As the project began to ramp down in 2019, I embarked on new adventures part time. In 2020, I completed my MPH and year-long internship at the Office of the National Coordinator for Health Information Technology (ONC).

Shortly thereafter, the cumulation of my clinical, public health, and federal policy experiences really began to make me ponder about the opportunities to disrupt healthcare from more of a technology perspective. I spent a few months researching what that may look like and ultimately accepted a new role as a Health Data Architect at Verily in April 2022.

IDENTITY

A common theme among the lessons in the NEJM Catalyst article is the need to truly define what our roles should be as clinicians within a technology company. What makes this particularly challenging is the fact that, as described in Lesson 4, a "clinician" is a new function for technology teams.

In the last 10 months, I can't tell you how many times I've been asked to describe my role and subsequently struggled to find the words to articulate what exactly I do as a health data architect. Should I continue saying that I'm also an informatics pharmacist? Or perhaps I should use clinician or subject matter expert since I'm no longer strictly focused on pharmacy. Honestly, I've probably given a different introduction to everyone I've conversed with in the last 10 months, but I think it's finally coming around.

Hi, I'm Brian. I'm a health data architect, but a pharmacist by training. I have a little over a decade of experience, in which, 3 years were in direct patient care and the last 7 were in pharmacy informatics.

Yeah, I know. It still needs some more work. Let me get back to you on that in the future.

EMPATHY

Many years ago, I recall working late one evening and being extremely frustrated at the newly implemented EHR. I was in the central pharmacy trying to verify some medication orders for my patients and could not get the order to complete because it wouldn't route to the correct dispensable medication. I was thinking to myself, "It's a basic furosemide order, how did the informatics folks make this so difficult for us to simply do our jobs?!". That ultimately became one of the motivating factors that influenced me to pursue pharmacy informatics.

Well, I did and realized that it's not that simple.

Over the next few years, I began to appreciate the complexity that occurs at the intersection of healthcare and technology as I was immersed in the configuration of my hospital's EHRs. Constraints showed up in many forms - technical, business, regulations, you name it. You'd think I'd learn from that experience, but I had similar frustrations with healthcare policy given the rapid adoption of EHRs during the Meaningful Use Era.

Then I interned at the Office of the National Coordinator for Health Information Technology (ONC) when the 21st Century Cures Act was being finalized. At last, I had the opportunity to inform health IT policy via the ONC's Cures Act, but quickly realized that, again, it's not that simple. It was a different set of constraints, but constraints that made me understand why things weren't always black and white.

All that to say, I couldn't agree more with Lesson 3: Recruit for Talent - but not only for clinical expertise. As clinicians working in tech, we truly should seek to also understand the constraints that go beyond traditional patient care: product, technical and business. Personally, it took many years for me to get the memo, but I think empathy can go a long way here.

CAREER PROGRESSION

My career planning was much simpler when I was a pharmacist as I had an idea of what roles I could work towards. Be it a staff pharmacist, a pharmacy specialist for a given service line, a clinical coordinator, or perhaps a pharmacy manager or director. These days, it's not really clear. I've had this discussion with a few colleagues over the last few months and I think, as humans, we all want to feel as though we're progressing.

On that note, I'm reassured by the fact that lesson 5 puts an emphasis on further defining what the job ladders and performance reviews look like for clinicians that work in tech. I also think we can borrow some ideas from our fellow engineers as well. Especially when it comes to tech levels (e.g. L3, L4, L5) and the option to continue down the individual contributor (IC) path as a L6+ vs. only moving up by way of becoming a manager. Lastly, I feel quite fortunate to have many clinician role models at Verily such as Erich S. Huang, MD, PhD, Vindell Washington, & Vivian S. Lee, MD, PhD, MBA. Of course, I also greatly admire the work of Karen DeSalvo and Michael Howell as they've grown the clinical team at Google, which, I'm sure indirectly gave me the opportunity to have Cían Hughes as one of my formal mentors.

SYNERGY

When two very different industries intersect, it can be difficult to identify the best ways to collaborate. Lesson 4 describes the ways in which clinicians interact with teams and goes into depth about the level of engagement. That is, usually it starts off with ad hoc advising, but eventually (and hopefully) continues to progress through consultation, collaboration, and eventually co-creation & leadership. I had hopefully in parenthesis because I think this is only possible when there is rapport between the individuals and teams.

I typically strive for rapport in two ways: domain knowledge and empathy. The former usually manifests as classes or certifications in computer science when working with engineers and getting my BCPS and CEs when working with pharmacists and other clinicians. The latter is usually through a lot of listening, being kind, and showing others that you acknowledge their challenges. They say relationships are the key to a successful life. It also applies to our careers. I'm extremely grateful for the help and patience that many of my fellow engineers have given me and I hope to continue collaborating and co-creating amazing products with them. You all know who you are.

COMPASSION

The primary value at Mayo Clinic is: the needs of the patient come first. As clinicians, this is how we rationalize our decision making. This hasn't always come easy for me as I was a very shy, soft-spoken pharmacy student at the University of Florida. That was until my 4th year APPE rotations at Mayo Clinic Jacksonville and the PGY-2 Critical Care Pharmacy Resident told me something that has stuck with me ever since:

Brian, I know it can be hard to speak up sometimes. But remember this, whenever you come across a situation where you think something you know may impact a patient, you must speak up. It might be scary, but we have a duty to our patients to provide the best pharmaceutical care we can.

I've spoken my mind ever since.

I'm not always right and I've actually been wrong quite a few times. Of course, I make certain to let others know when I have a knowledge gap, but I'll never hesitate to say something if I think a decision may impact a patient down the road. I think this aligns quite nicely with Lesson 2: Develop, communicate, and act on a consistent set of clinical values. These core values should form the basis of our decisions in tech as they have in the hospitals and health systems we used to practice in.

CONCLUDING THOUGHTS

I truly think disruption and transformation in healthcare doesn't happen in a (clinical) vacuum. Rather, it takes a village - as Abinash Virk used to say whenever our Antimicrobial Stewardship team at Mayo Clinic accomplished an important milestone or project. As of right now, I think technology is an enticing path to making healthcare better for everyone and I am excited for a future when clinicians in tech are no longer the exception, but rather the norm.