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Hello and welcome to Trust and Transformations, Leaders Navigating Change. I am Lieve Hovem, the CEO at the DNV Accelerator, and I'm joined by Hal Wolf, President and CEO of the Healthcare Information and Management System Society, HIMSS. HIMSS is a global advisor, thought leader, and member-based society committed to reforming the global health ecosystem through the power of information and technology. More than 125,000 sector professionals, healthcare provider organizations, non-profit partners, and health service organizations around the world are members.
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Hal, welcome to the podcast. It's great to have you here. HIMSS is an amazing organization, but let's start by discussing the global transformation that drives the very existence of your organization. There's a growing school of thought among clinicians, politicians, healthcare leaders, and patients that the healthcare system around the world are broken, and that systemic change is needed for the sector to be sustainable again.
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So what do think people mean when they say that healthcare is broken?
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That’s a really good question. I think the first one is do we have a system? So I'm not sure how you break something that didn't exist before. Healthcare systems have largely been extremely isolated. It depends on the country you're in. It depends on the hospitals, if they're in a group. And there's an old adage in healthcare that says if you've seen one hospital, you've seen one hospital. So I've never really thought of us as a global system. I think there is a global health ecosystem that exists, but it's very hard to look up and say, you know, this one's broken or that one's not broken. I think the challenges are very consistent across the world. I think we're all trying to do the same things, but you know, it's not consistent. And so we have a tendency as human beings in everything we do to make things very systematic. And healthcare is one of those areas where we use a lot of magic sometimes versus science. It's a tremendous amount of human touch. So it's not terribly surprising that it's in different stages at different places where you go.
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So how can HIMSS then do a difference or what is it that you're trying to achieve?
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Well, that's a great question. HIMSS was founded back in literally 1961 at an academic institution in the United States. It's grown into a global nonprofit, as you mentioned earlier, and thank you for that warm introduction, of over 125,000 members, over 500 systems and hospital institutions, and many more of other companies that have joined.
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So what HIMSS is focused on is literally bringing the power of information and technology to bear to help reform the global health ecosystem, to get those normalities that we talked about. How do we get consistent approaches to data and information? And that's really where it started. Back in 1961, some professors had this crazy idea. Could we use information coming out of computers to look at analytics that would help the healthcare system at their academic medical institution. And then it caught on to a bunch of other academic medical institutions. So it's something that we continue to progress today. And HIMSS works with its members, its partners, with governments all around the globe, really looking at helping strategically to say, where are you on this journey? Why do you need digital health transformation in the first place, which is the starting point? And if you're on that journey, how can we support you with best practices that our members and member institutions and market suppliers that support, much like your organization, allow us to be able to contribute to the betterment of what people are trying to achieve. And so that's really the core nature of what HIMSS does.
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So how do you then help the healthcare system or organizations in healthcare to actually take a leap into the digitization journey?
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You know, so if they haven't started yet, it's a much bigger lift. I think it would be, and there are countries that are really just beginning because they haven't had the resources. For the majority of the countries in the world that have begun the process, the first question everyone starts with, what am I trying to achieve? What are the problems I'm trying to solve? And the global health ecosystem has a series of problems that are universal. I think there's you know, six or seven of them we think about all the time. We have aging populations. We have increased chronic disease that we need to manage across the board. We have geographic displacement. People have access challenges. There's a lack of information that people get a hold of. Funding systems are really different, place by place, country by country, region by region, town by town.
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And we actually have a demanding consumer who has been getting a lot of products and services through other means, through their phone, through their computer, their healthcare starting to catch up. And then finally, we have this massive workforce shortage. Most hospitals and systems around the world do not have all the manpower resources that they wish they had, the expertise. And on top of that, there's a knowledge management. So we get to the useful information that I need.
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What HIMSS does is that it helps systems wherever they start to dive in to fixing those problems, helps them with digital health solutions and strategies that they can just follow online. They have a makeup of years and years of people working it, redesigning what we call maturity models, which is if I'm starting off with full paper, I'm going to go paperless, what does that look like? And how do I use it to improve access and quality and we give people those guidelines. And then we help measure both at a system level and in some cases country level like Germany, Italy. Those are two very quick examples in the European Union where we help them understand where they are on that journey and what they need to do next in order to be successful. And it really comes from a place, from a nonprofit, of bringing that thought leadership from a membership aspect and all of these experiences around the globe to solve these unique problems that they may be having at that system, but their neighbor may not, because we are all looking at the same elephant, but it depends on, as we say, what part you're looking at a time. So that's what HIMSS does. It brings that expertise to bear.
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So basically you help them assess where they are, help them understand where they're going and then bring them along on that journey?
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Yes, and show them where the gaps are. And then they need to figure out how to solve for those gaps themselves. We don't actually come in and say, okay, do it this way. Because that to us actually creates a bit of a conflict of interest. What we're most focused on is showing where the gaps are. And then there are many great organizations that are out in the world that can help them, you know, how to achieve those strategic goals.
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It's very interesting because you did mention initially that HIMSS was founded in 1961, right? And at that time, a lot of the technologies that are available today weren't even existing. So how do you think, I mean, first of all, how has HIMSS developed along with the digital development and also what do you think is the next kind of digital breakthrough that will affect the healthcare system the most?
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Well, I think we'd like to believe and our members believe that we've been fortunately ahead of the curve. So we've been working very hard to always make sure we understand what's happening now, but more importantly, what's next. And what are those dependencies, HIMSS is sort of synonymous, not only with helping people assess where they are, but leading the discussions around interoperability, the exchange of data on a consistent basis, developing workforce, educating people to understand the technology and more importantly its implementation and its use, and how to bring people process and technology together in order to achieve outcomes that you normally wouldn't have. So, HIMSS is trying and always wants to be a little ahead of the curve but not so far ahead of the curve that someone says, well, that's interesting but we'll never get there. But in answer your question, which is the tough one, which is, you know, what's coming in the future. I'm reminded of a conversation I had with a physician leader 15 years ago. And she looked at me and said, what I really want is a place on my laptop or my desk computer that I can ask it any question I want. And it'll give me the answer. It'll go and look at the data that we have and it'll look outside and look at the knowledge management and tell me what the best recommended solutions are. That's what I want.
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And now we can actually see the contours of that happening, can't we? Yeah.
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You can, I mean, and my reaction at the time was, I can't do that. We don't have the technology. Even if I took all the computers of the world and lined them up, I couldn't do what you just asked. So the big technology shift is one, I think we're, we realized in the last pandemic, obviously, that we didn't have enough information at our fingertips. It was taking too long to compile data, to bring together the ability for us to share information just in time. And I always use just in time versus real time, because real time is kind of a myth. But just in time information, we have to prioritize it. And now, of course, here comes AI, here comes the machine learning, which really is a necessity as a tool. And what we're working on very hard and we realize is that we need a helping hand extended to health systems to understand what do they need to do to be prepared to utilize these new tools and capabilities? But this is a significant game changer. It's a game changer in terms of health equity. It's a game changer in terms of quality. It's a game changer in terms of operational outcome. So this is an extremely important frontier, and we're right in the middle of it. We're very pleased to be so and we hope to be a part of the guidance of it as well and as a resource.
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Well, Hal, you travel a lot and you meet a lot of very central people that are taking very important decisions and are really driving the progress in healthcare and the digitization of the industry. And in your encounter of all these great people around the world, how would you categorize the pace of the adaptation of the technology in the healthcare system compared to other industries that you might also get an insight to on your journeys?
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Yeah, that's a good, interesting question. When I first came into healthcare, a little over 20 years ago, I came from the innovation side of the entertainment industry and the telecom industry. So we were creating video on demand. I was very fortunate to be a part of some advanced teams and some advanced thought. And the gentleman who recruited me over, who I had worked with just a little bit in telecom, said I need to warn you if you come over that the organization you're coming into is 10 years behind healthcare and you need to understand that healthcare is 10 years behind every other industry that's out there. Because we had just begun the process of putting in electronic medical records, right? Well, we're still catching up on electronic medical records. So I think healthcare overall is in three layers.
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We still have systems that are paper-based. Nothing has changed much since 1900. Technology is better, our understanding is better, but the way that we utilize information and use it to our advantage in the treatment of care hasn't changed a lot. We have healthcare systems that are far more advanced. They use cutting-edge technology, but they're still not end-to-end digital transformation, not there. And we have about five or six percent of the healthcare systems totally digital.
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way advanced, live off of information. So all three layers we have to work with to pass down best practices and figure out how to get everyone at the bottom to the top and for the top to continue to innovate in a fast way. So if we look at the utilization of it, I think there are just some really great examples of where information, technology, and data is being utilized at a very high level. An example is Samsung Medical Center in Seoul, South Korea, it’s phenomenal what they've been able to do, right? You can look at different places in the US, you can look at different places in Europe, but there's just some places that are exemplary. And that's five, six, seven percent maybe of the systems that really are at the top of their game, the rest we’re pulling along. So I'd say we still trail the commonalities of the rest of the world and the use of it at least 10 years. And it's accelerating and it's getting better, but we still have a way to go in healthcare and that's okay. We understand that.
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Yeah, and I think we understand that because it goes without saying really that healthcare is a safety critical sector and that it is central to national critical infrastructure. And it's also an incredibly complex sector and operating very large and intricate value chains, multiple stakeholders all the way from governments to clinicians and to society at large. So it is understandable that given all this risk and complexity, to what extent do you think that trust has been an inhibitor to the adaptation of the scaling of the digital technology in healthcare?
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I don't know. I mean, without trust, first of all, nothing happens. There's nothing really more personal than your individual health. So a patient, a citizen, they want to believe that the person who's across from them is the best doctor, nurse, clinician in the world. They want to believe that, they really do, because they're rightfully so extremely concerned about what's the alternative to that. So trust is everything. And that means that the clinician has to have trust that the new systems around them are also worthy in order to support them with their patient, with the citizen who's there. So where does that come from and why is there pushback sometimes? I think it's a realization that we don't know what we used to know as a practicing clinician. That a new generation's coming up with different tool sets that actually may have more knowledge at their fingertips without experience, and I may have in my knowledge with experience. And let me explain that.
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If I go back to the 1970s, there were four major journals around the world that were producing somewhere around 400 printed peer review articles a year, and they showed up at your doorstep through the mail. And if you were a very diligent physician or clinician and you read a article a day, you could fundamentally keep up with the advancements of healthcare in general. Amazing.
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This year, there'll be over 10,000 peer review articles that are written and published. So without a robust knowledge management system behind you, there is no way for any individual physician, no matter how talented they are, unless they're just completely micro specialized to keep up with the information that's going on all around them within their specialty. And even if you're micro specialized, there's advancements in technology and pharmaceuticals and information that's just happening all about. So this dependency and this need to appropriately trust and verify trust, the information and suggestions coming from machine learning or AI knowledge management is critical to delivering the best possible care to the individual. That individual will trust it if the physician leader does and the physician leader is critical, clinical leaders in helping us usher in this new age. And I would argue that it's critical for them to do so because as we talked earlier about the workforce shortage, this lends itself to something that I think we just need to get our arms around, which is that we're going through a new scope of practice change. So if we go back just 15, 10 years ago in most countries, most places, we went through a scope of practice change where we shifted the burden that physicians had to nurse practitioners who were more than capable of taking it on, given their expertise, but the physician really didn't need to do anymore because we have higher needs for their skills set due to demand. Now we've reached this point where we need to take the scope of practice and take it to a third entity, which is digital health, AI, machine learning. Let's move other things off the plate of the humans who are always going to be desperately needed for the encounter of working one-to-one with people, operations, all of that. We need the humans there, but let's use digital transformation for where we don’t.
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It sounds like an almost overwhelming transition listening to you, Hal. What do you think that the sector needs to do then to earn trust in technology quicker than we have done so far and also to be prepared for the future?
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Yeah, education, and it really will take leadership. I think nothing, it's not about the technology, Liv. I mean, we have all the technology we need and it's coming very fast. This is about change management, it's about adoption. And by the way, that is the hardest thing that exists for every single human on the face of the earth. Machiavelli wrote about it in the late 1500s and he made the note that the change agent has as his adversary two groups. One, everyone who did well under the old system and everyone who's lukewarm about the new. So in classic change management, about 25% of your people are going to be like, best thing that's ever happened, this is great, let's go get them. 25% are going to be like, hell no, won't go, I refuse to do this, you're insane.
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And really the battle is about the 50% that sits in the middle. We need to bring them along. We need to educate them. And this is where AI and machine learning and other new components have to have levels of transparency that are clear. But I don't want to get too wrapped up in one size fits all. AI really has three different layers, right? One are the devices, like the ring that I'm wearing here. It's a blood pressure ring. It's measuring my blood pressure. You've seen it before. It's telling me how I'm doing. Doing great, by the way. The other one are all the operational stuff that we're building applications for that do predictive modeling on supply chain, capacity planning, resource utilization. Those are happening just in time. And then where we have to be particularly careful is, of course, in the clinical decision support realm of AI, where it's making suggestions.
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It's taking all that knowledge management. Because it can only answer based upon the knowledge of the question and the resources that it can pull from. So you have to look at everything judiciously. But again, I would argue the resources that some algorithm is pulling from is deeper than the resources any human can pull from just because of consumption of all this new info. So we're in a whole different place. You're right. I mean it's a significant change management time. If you don't like change, this is absolutely the wrong ecosystem for you to be in.
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So change management and leadership and looking forward then what qualities must modern healthcare leadership display as a navigator transformation?
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Yeah, this is a really good question because leadership is everything, I think about it's about embracing change, first of all. You have to be able to embrace change. Don't look at it as a mugger in the dark alley. I mean, change is really the critical element behind it. You need to understand the ecosystem that you're changing into. I mean, that is probably one of the most important components of it.
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What is the app global ecosystem? Where is it coming from? What is my patient seeing? Most physicians will tell you that they spend half their time in an encounter explaining to a patient that the research they did was wrong and that they have self-diagnosed and almost half the people that walk in have self-diagnosed and of them, two thirds of them have already come up with the prescription drug they should be getting and what it is. And literally in the encounter half the time of a physician is undoing that, right? And this is a big issue. So how to utilize the information around it. And then this whole idea of team versus individual. You have to recognize as a physician leader, it's about the team. And it's not just about the four walls, it's about recognizing outside in. That what happens at home is as important as what happens in the walls. All around what you're doing and how you're doing it.
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And then the last thing a great leader has to understand is they're surrounded by younger people who are coming in that may know more than they do. And that is the opposite of the way we taught medical schools for years and years and years. You learn, you practice, innovation came at a relatively slow pace. You learn from the person who innovated and it's passed on physically. Now we have this entire ecosystem that’s passing on mentally and passing on knowledge management and bringing data there that you just can't even imagine that you had at your fingertips just 10 years ago. So it's all about leadership and embracing that change. And without it, systems will be stuck because that 25% who never moves, they're not going to move, but you’ve got win that 50% in the middle and you have to be able to explain it and be confident in it.
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I agree and you describe it so well and so lively, Hal. So if you don't mind, can I ask you a personal question? Knowing you a little bit and seeing how much you travel around and how engaged you are, where do you get your energy from?
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That's a really good question. I think one of my bosses once said, Hal, you have a childlike interest in the world. Not childish, childlike. So I'm always fascinated by why things happen the way that they do. I'm always excited by what I can learn today versus what I knew yesterday. And frankly, when you get a chance to influence and make just a small difference from time to time, it's very energizing. So that's what gets me up in the morning.
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I notice that you also have a very active use of humour in your meetings with people. What is it that inspires you? Do you have leaders that have inspired you during your careers?
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Yeah, absolutely. I've been very fortunate in my life to have some very important people that influenced it. One was a congressman who I knew for many, many years. He worked in the House of Representatives in the U.S. for over 40 years representing the 3rd District in Jacksonville, Florida. And he was my surrogate grandfather. He started the Ethics Committee in Congress. He was just an amazing individual, had a huge influence on me. In healthcare, George Halverson, who was the CEO of Kaiser Permanente, was a huge influence on me because George was a significant change agent, highly respectful of where people came from, but could paint a wonderful vision about what was moving forward, right? And then when you go back and you look historically, there's many phrases that I picked up from time to time that have always made me, you know, sort of think about what that looks like and who I look for. One is a recent guy who is Franklin Delano Roosevelt who said during World War II, we have nothing to fear but fear itself. And, you know, I think we all, health care is very risk-averse appropriately, but we have to be simply afraid of the fear. We have to find a way forward. And Thomas Jefferson, drawing on U.S. history as well. But he wrote something a long time ago that said, today we are farmers, so our sons may be poets. And so the work that we do today is really about freeing up the creativity and the capabilities of the next generation. And I think that's extraordinarily important.
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And then the last thing, not to bore you, but I've always kept this above my desk and it's simply a lyrics from a song. And it says, every day I wake up just the same, waiting for something new. And every night I have myself to blame for the dreams that haven't come true. So those are the things I draw on on a daily basis. Everyone has their own, but you know, and just remember laughter is the best medicine. So yes, I do try to find something to chuckle about every single day. And if I can't, I just look in the mirror and that usually does it.
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Well, thank you very much, Hal. It was great talking to you. Thank you for participating on this podcast. Looking forward to seeing you again.
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Well, thank you for having me. Same here. Hope it's soon.
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You've been listening to Trust and transformations - leaders navigating change, a DNV podcast. Head to DNV.com to hear more episodes of Trust and transformations or subscribe on your favourite podcast platform so you'll never miss an episode. Thanks for listening.
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