Advanced Health Technology, Adoption, and Integration with Brian D. McBeth, MD, CPE

The integration of technology comes with risks while holding the promise of promoting quality of care. Often, quality requires a multi-disciplined approach to both implementation and use.  In this important and widely applicable episode, Mike Sacopulos and Brian D. McBeth, MD, CPE discuss not only the use of technology for healthcare but the need for humility in the implementation and use of technology.  McBeth is a contributing editor to the forthcoming book on the topic, Advanced Health Technology: Managing Risk While Tackling Barriers to Rapid Acceleration.

Brian D. McBeth, MD, CPE, an attending emergency physician, has worked in clinical medicine and hospital administration for more than 20 years. He completed the American Association of Physician Leadership’s program as a certified physician executive and is currently physician executive at O’Connor Hospital in the Health System of the County of Santa Clara, where he oversees patient safety, hospital quality programs, COVID strategy and response, as well as physician performance and professionalism.  

This transcript has been edited for clarity and length.

Mike Sacopulos: The integration of technology comes with risks while holding the promise of promoting quality of care. Often technology requires a multi-disciplined approach to both implementation and use. My guest today has taken a deep dive into the topic as a co-author on a forthcoming book. Our discussion will touch upon not only advanced health technology, but the need for humility in the adoption of technology in medicine. This is important and widely applicable information. Prepare to think about health technology, adoption, integration, and use in new ways. Next on SoundPractice.

Dr. Brian McBeth is the interim chief quality officer for the County of Santa Clara Health System. His specialty is emergency medicine. Dr. McBeth authored a chapter in the forthcoming Advanced Health Technology: Managing Risk While Tackling Barriers to Rapid Acceleration.

Brian McBeth, welcome to SoundPractice.

Brian D. McBeth, MD, CPE: Thank you so much, Mike. It's really a pleasure and an honor to be here.

Sacopulos: It goes both ways. Thank you, sir. Advanced health technology, what compelled you to become interested in this topic and write a chapter in this book?

McBeth: Well, I've always had an interest in technology and its interface with medical practice, though my background is really in quality improvement. In addition to clinical medicine, over the last 15 years, I've been working in quality, first on a departmental level and then on a hospital level and now on a health system level, with a focus on patient safety and reduction of medical errors.

I've been inspired by people like Pat Croskerry who does bias mitigation, cognitive bias mitigation work, how do we make accurate decisions at bedside with limited information. And every day in clinical practice we're challenged with lack of accessible patient information.

Being an emergency physician, especially in the days before robust EHRs, we'd struggle and often be begging medical records departments at local and distant sites to access patient data. We would often repeat testing that was recently done, and we'd make diagnoses and initiate treatment with limited information. And the situation has certainly improved, but we still have a long way to go. And medical technologies represent tools that allow physicians to be at the bedside and access patient specific data, clinical decision tools and references, and really drive care with a power that minimizes risk of error. Take diagnostic error, probably the most common and high-cost error in medicine in terms of morbidity and mortality. Advanced health technology, when it's implemented well, really empowers us with specific information to be better diagnosticians and serve patients with a fidelity and an accuracy that drives a safer approach to treatment.

Our first book Mobile Medicine, which was published last year, was the first opportunity for me to work with a diverse author team around health technology. And in this book, our contribution focused on physician culture and its evolution over the past few decades. And we highlighted the changing relationships with other healthcare providers, like nursing and administrative leadership, as well as different employment models and professional standards. And we examined how physician and hospital culture is evolving around collaborative practice and professionalism, and away from the hierarchical systems and how understanding these changes is really essential for leadership work around medical technology.

But our current book, Advanced Health Technology, the primary focus is on mitigation of risk around health technology. And our author team focuses here in our chapter on humility as a foundation for building collaborative teams and health systems around tech implementation and risk reduction from a multidisciplinary perspective. And our goal ultimately is to enable tech capabilities. And if we do that well, we can tackle the majority of overall healthcare system emerging risks. And that's fundamentally what the book is all about.

Sacopulos: Certainly couldn't have much more of an important topic. Tell me specifically, who's the target audience for Advanced Health Technology and why is the topic relevant to them?

McBeth: Our book is written for hospital leaders and executives who implement and oversee health technologies for their hospitals and healthcare systems. We've written it for hospital and medical leadership, our CMOs, our CMIOs, our CIOs, our CEOs, our chief security officers, chief quality officers like myself, also chiefs of medical staff, department heads, and other executives and hospital leaders involved in implementation of technologies and their oversight in healthcare settings.

The book is important because it brings together experts from a wide variety of fields, the top minds in law, cybersecurity, risk, medicine, human capital, psychology, to name a few areas, to provide perspective, experience and knowledge that can guide leaders to implementing health tech systems that will foster partnership and collaboration between administration, tech departments and medical staff while mitigating institutional risk.

Sacopulos: Excellent. My next question: why is the book and technology important for the promoting quality in medicine and how is it ultimately tied to patient safety?

McBeth: Well, that's a great question, Mike, and we wouldn't want to imply or assume that more technology means better quality, right? Going back to clinical diagnosis, providers' decisions around diagnosis and treatment for patients are based on patient data, which must be accurate, timely, and accessible to be of value. Safety is compromised by lack of information or delayed information, and clinicians are often frustrated when they're forced to provide care that is compromised by operating without complete understanding of a patient's past medical history or medications or allergies, for example.

So, health technology has the ability to transform patient care at the bedside in an acute or an ambulatory setting by being a bridge to more complete patient specific information that will drive safer decisions. And in other important domains like population health for example, mobile medical technologies have potential to affect chronic disease management in a variety of settings, including the home, providing clinicians with more accurate real-time data that can improve timeliness of interventions and the finer calibration of patient care, potentially reducing ED visits and hospitalizations and cost.

However, access to patient data with improved efficiency and quality will only be achieved if we can assure security of the data. And cybersecurity threats, identity theft, compromise of health system databases are unfortunately a daily reality now, with increasingly sophisticated attacks coming from domestic and international origins. Healthcare and physician leadership needs to partner with the technology and security experts who understand these risks and are able to leverage our frankly not unlimited resources to protect patient data and mitigate these risks.

One recent example from just last month was a highly publicized ransomware attack on one of the largest nonprofit U.S. hospital chains where the system had to take down their EHR and scheduling system resulting in the need to return to paper charting, reschedule appointments, divert ambulances, at least per the public reports. And it's really an international problem. The NHS in the UK has suffered attacks, many systems all over this country. I worked in Israel for six months in 2020-2021, and there were cyber-attacks that shut down clinics and other services and led to delays there in patient care and access. It's really a worldwide problem.

Sacopulos: Certainly that's a downside. And since you've brought it up, it occurs to me we should maybe touch on something here that while technology is absolutely necessary, there is a criticism out there that it can somehow dehumanize medicine and that technology interferes or interrupts with the physician-patient relationship. Is this a concern of yours? Did it influence at all your work or this book, those type of thoughts?

McBeth: Yeah, absolutely. I mean that's a concern I think for clinicians and administrators across the board. We hear from patients and there have been not a few reports of the challenges of patient perception of the providers being tied up with their computers instead of interacting directly with patients. And I think this has been brought to the fore by patient perspective and advocacy groups.

But also on a provider level, there is a component of wellness that is important in our medical care and that patient interaction is critically important. And physicians and other providers frankly report that time engagement with technology can pull them away from the more satisfying aspects of the care and connection with patients.

It often comes down to charting requirements and administrative requirements. There's certainly been efforts around wellness and recognition of that to reduce the documentation burden. And technology can do this. I mean, we sometimes point the finger that it's the problem, but it also can be part of the solution if we use it in smart ways to again foster the relationships between people. And this is some of what the book is about too, a humble kind of approach to integration of those technologies.

Sacopulos: Well, I think that that brings us to your specific chapter in the book and it's entitled, “Humility as Core Value for the Adoption of Technology in Medicine: Building a Foundation for Communication and Collaboration”. How does humility play a critical role in implementing health technology, team building, and ultimately organizational success and quality?

McBeth: Our chapter presents the argument that humility is a core value for integration of this technology in healthcare settings as I was alluding to. And we approach it first by a discussion around the differences between intellectual humility, relational humility, and organizational humility.

I'll be brief here, but intellectual humility is championed by the work of Duke psychologist Mark Leary, and really is a recognition that things you believe in might in fact be wrong, or another way to say that is an awareness of one's own cognitive fallibility. And in many ways this concept underpins so much of our working quality around accountability, transparency, for example, certainly at the bedside with patients in a role as a diagnostician where we must remain humble and aware of a broad differential diagnosis, we must avoid overconfidence and certain cognitive biases that have been well described like anchoring and diagnostic momentum. And these things can lead us astray as we're working on diagnosis.

But also in system context as physicians or technologists or administrators, there's a multitude of perspectives and expertise. And it benefits one to consider this with any new project or strategy.

So secondly, relational humility represents an individual's intuitive empathy and perspective, both on an intrapersonal level or one's accurate view of self, but also interpersonal in terms of being other-oriented rather than self-focused. And this will shape communication and our ability to build human relationships. And in terms of collaborative work and team building, relational humility drives our ability to connect and work with diverse individuals and perspectives.

And lastly, organizational humility, we talk about in the chapter representing the extent to which leaders and vision really prioritize and value humility and build it into policy, reporting structures, communication and engagement strategies, wellness, which was mentioned earlier among other areas.

In the chapter, we don't attempt to tackle the breadth or depth of what has been written about humility in an academic or philosophical discourse, but we do try to approach our more practical and systems-based discussion here from a perspective of human fallibility.

And generally speaking, I think this also informs what most of us see as a reasonable, compassionate, and effective approach to healthcare quality, in that if we approach it proactively with educational and systems improvement and frankly compassionate support when medical error occurs for providers rather than certainly the other end of the spectrum, which many of us have seen, more of a retrospective and overly critical or even punitive and worse case analysis fueled by hindsight and outcome bias, which is not what we want to do.

We also get into humility and physician identity in the chapter. We make the argument that technology and access to information and AI and et cetera, has driven the patient-physician relationship in a direction that supports engaged and shared understanding, ideally with a physician sharing wisdom and experience around healthcare rather than a paternalistic or prescriptive directive around treatment.

And ultimately for physicians to thrive in the future, we make the argument that the traditional analytic mindset that we learn in medical school will need to be complemented by a synthetic mindset. And by a synthetic mindset what we're talking about is one that incorporates different disciplines, seeing the connections between them and acknowledges and incorporates alternative perspectives.

Our chapter's broken down into different parts where we explore the role of humility and medical and technical education, how this has evolved, especially over the last 20 years with increasing access to information as I just mentioned, and how this could drive changes in physician identity and relationship to patients.

In the second part, we explore intellectual and relational humility as foundational for communication and collaboration in the healthcare settings.

In the third section, we explore specifically how technologists and care providers interact and the integration of humility for team building and successful project implementation.

In the fourth, we tackle risk mitigation around health technology, and also examine organizational humility as applied to systems-based thinking for healthcare organizations.

And lastly, we use humility as a use case for tech implementation through the lens of the different perspectives of physician champions, technologists, and then executive leaders.

Sacopulos: In Advanced Health Technology and really your prior book, Mobile Medicine, you've taken a multidisciplinary academic approach. And I'm interested if you're able to provide detail on why this collaborative approach and multitude of perspectives is important for understanding and I guess ultimately driving success of technology and implementation and risk mitigation in healthcare?

McBeth: It's a very good question and really one of the foundational themes of both books that we've been discussing that ultimately this comes from the leadership of our chief editor, Sherri Douville, and the way she assembled the team from diverse backgrounds. And as already mentioned there, it's a number of leaders. So, in this book, 23 different authors with different backgrounds from everything from engineering to computer science, law, cybersecurity, data privacy, communication, medicine obviously, psychology.

When a hospital or health system is considering rollout of a technology product or platform, one really needs the perspective of a multidisciplinary team simply because the complexity of the issues are beyond the expertise of any one individual or department. And personally, this project was so much fun and rewarding because it was an amazing opportunity to learn outside of my medical and administrative training, the chance frankly to get exposure to bright and dynamic minds and fields where I have very little knowledge.

To drill down just for a moment on my chapter co-author team, I had the honor to work with Brittany Partridge, who's a tech expert and clinical communications coordinator for UC San Diego Health. And she has incredible insight in understanding physician perspective and effective ways for engagement of physicians to drive collaboration around healthcare technology.

Dr. Arthur Douville, another co-author, has decades of healthcare leadership experience in a variety of executive and physician leadership roles and a deep understanding of physician culture and systems-based approach to quality improvement. And I've had the honor to write with him on several manuscripts in chapters now and learn each time from his thoughtful imbalanced approach.

And my final co-author was Dr. Felix Ankel, who is a professor of Emergency Medicine at the University of Minnesota, who has been a friend and colleague and mentor for decades. And simply an inspiration with his experience and wisdom around the evolution of medical education and its history and systems-based thinking, physician wellness among other areas.

So, I learned during our writing process how integral the input from these different areas are, as well as the other chapter authors, to technology implementation and adoption, hearing about the pitfalls and organizational risk when the administrations rush forward based on a strategy that has not been considered with a multidisciplinary perspective.

And the appeal of this book, Advanced Health Technology as a text, is that it distills these perspectives and experience in an organized and articulate manner that provides a practical and accessible foundation for healthcare leaders with a variety of backgrounds.

Sacopulos: Brian, as you know, this is the podcast of the American Association for Physician Leadership. And I'm interested, how was the AAPL a critical resource for your professional leadership development and what do you see as the opportunity for the organization to embrace and support physician education around technology in the healthcare setting?

McBeth: Yeah, thank you for asking. And Mike, I really can't say enough about AAPL and the appreciation I have for its leadership and quality educational courses. I've been a member for six years and from the beginning with pursuit and completion of my CPE credential, I've recognized the importance of the organization's professional support and its excellence in leadership education.

The work I did for the Capstone Project around physician disruptive behavior several years ago, which we presented and ultimately published, was the seed for our deeper exploration of changing physician culture in our first book chapter and its relation to medical technology. And AAPL really provided the educational foundation and context to begin to explore this field in an academic way, as well as gave me the practical tools and confidence to be able to operate day to day in our medical staff leadership at C-Suite, especially in sensitive areas like physician culture, accountability, transparency, disruptive behavior.

For me to try to go it alone or try to figure out how to serve as a physician executive over the last several years without the educational program provided by AAPL simply would've been untenable.

I do think that the organization has a unique opportunity to continue to develop educational resources for physicians around technology, and I'm very grateful for this chance to join you today on SoundPractice, and I've been an admirer of your work for years, Mike.

Sacopulos: Well, thank you.

McBeth: Yeah. I'm thinking of the interviews you've done with national leaders like Dr. Peter Angood and Dr. Anthony Fauci, and I frankly look forward to every episode you put out. So, we'd love to explore other ways to bring educational content around health technology to AAPL, especially as related to physician culture and leadership. And our next book on cybersecurity for the physician leader is already being planned.

Sacopulos: Excellent. Well, we look forward to that book and a discussion of it when it comes out. Certainly, it's very necessary. Dr. McBeth, we are almost out of time, but I am sure that there are audience members here that are interested in your book. How can they get a copy of it?

McBeth: Yeah, thanks for asking. Our publisher is Taylor & Francis, one of the top publishers in academic and medical professional education, and people can find it on their website, Taylor & Francis, or through Amazon through pre-order, and it will be out this winter and we can certainly share the links for that as well.

Sacopulos: And we will make sure that there is a link in the show notes. Dr. Brian McBeth, thank you so much for being on SoundPractice.

McBeth: It was really a pleasure. I appreciate the time and the opportunity to share our thoughts with you. Thanks so much, Mike.

Sacopulos: My thanks to Dr. Brian McBeth. His book is Advanced Health Technology: Managing Risk While Tackling Barriers to Rapid Acceleration . I recommend this book to you.

My thanks also to the American Association for Physician Leadership for making this podcast possible. Please join me next time on SoundPractice. We release a new episode every other Wednesday.

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