Advancing Health Podcast

00:00:00:00 - 00:00:13:14
Tom Haederle
Welcome to Advancing Health. Coming up on today's episode, a look at the immense value that peer support specialists provide in many health care settings.

00:00:13:16 - 00:00:39:16
Rebecca Chickey
I'm Rebecca Chickey, the vice president of Behavioral Health and Trustee Services at the American Hospital Association, and it is my honor today to be joined by Zelia Baugh, the senior vice president of behavioral health at JPS Health Network, and Melanie Cooper, a peer support specialist at JPS Health Network. We are going to speak today about the incredible value and role of peer support specialists.

00:00:39:18 - 00:00:56:13
Rebecca Chickey
And so, Zelia, I'm going to turn to you first. I want the listeners to have an understanding of what JPS Health is. What's your footprint? What type of organization hospital health system are you? Give them a little bit of background so they'll have some context.

00:00:56:15 - 00:01:30:18
Zelia Baugh
Thank you Rebecca, and we appreciate you having this on this podcast to share the great works that peer support specialists do for us. JPS Health Network is a safety net hospital located in Fort Worth, Texas. And we are in Tarrant County, which is one of the fastest growing counties in the country. We are a Level One trauma center, a Level Four maternal care center, and we have a large community health presence as well as large residency programs.

00:01:30:18 - 00:01:36:08
Zelia Baugh
We are a learning institution. And then we have a very large behavioral health division.

00:01:36:10 - 00:01:57:01
Rebecca Chickey
So JPS Health, as you and I have talked about, has made a strategic investment in hiring peer support specialists. For the listeners, can you first of all tell them what a peer support specialist is, you know, from the broad perspective, and then also, what was your plan and actually why you went down this journey.

00:01:57:01 - 00:02:01:12
Rebecca Chickey
And then we'll hear from Melanie, who's going to bring all of that to life.

00:02:01:15 - 00:02:33:09
Zelia Baugh
Absolutely. So in JPS we do employ peer support specialist. We, have 14 peer support specialists here in behavioral health. And a peer support specialist is a person that has lived experience with either mental illness or substance use disorders or both. And we utilize our peer support specialists in all areas of our division. So we have peer support specialists in our inpatient psych units.

00:02:33:11 - 00:03:09:12
Zelia Baugh
We have peer support specialists in our outpatient clinics. And we have peer support specialists in our psychiatric emergency center. And they provide different functions in each area. They do groups. They do individuals. They meet with all new patients that are admitted to our inpatient units to help answer their questions about what's going on. The group routines, the unit routines, also to get to know the patients so that they can help them navigate once they are discharged from our inpatient program.

00:03:09:15 - 00:03:39:04
Zelia Baugh
They also provide navigation for resources out in the community beyond what JPS has to offer. They help our patients get access to social determinants of health like housing, food, medicine, transportation. All those typical barriers are patients face in trying to get help. They help direct our patients towards those resources to be able to be successful once they discharge.

00:03:39:06 - 00:04:12:26
Zelia Baugh
They also are a huge part of our transition coordinator program. And that program is where we have licensed, as well as peer support specialists contacting all patients discharged from our psych emergency center and our inpatient program in order to help them navigate once they're out in the community and help get them to treatment. So if they have an outpatient appointment with us or someone else and they don't have a RA, we will help get them a RA if they can't pay for their medications.

00:04:12:28 - 00:04:42:12
Zelia Baugh
Our peer support specialists are able to set up for them to get a medication voucher, to have their medicines paid for, and if they need help with job force training. Our peer support specialists know how to set them up for that with resources here in our county. And that program, as a result of our peer support specialists and licensed clinicians, is very intensive with specific touch points throughout a six month to a one year time frame with all of those patients.

00:04:42:15 - 00:05:17:20
Zelia Baugh
Last year, our behavioral health inpatient readmission rate was 5.03%. It is primarily due to the wonderful navigation work and touchpoints and supportive services once our patients leave the inpatient setting. Because the one thing our peer support specialists do with our patients that just I love, the first thing they see is hope when they come in because there's someone right in front of them with lived experience that's in recovery now, and they're helping people.

00:05:17:22 - 00:05:41:18
Rebecca Chickey
That is just such a breadth and depth of offerings that the peer support specialists can do. And so I'm wondering, does the state of Texas, I realize you're in Texas and probably they're 50 different flavors of what peer support specialists are required to do in terms of training, in terms of certification. But what are the specifics for the state of Texas in terms of certification

00:05:41:18 - 00:05:46:22
Rebecca Chickey
and what does JPS look for when you're hiring a peer support specialist?

00:05:46:24 - 00:06:26:28
Zelia Baugh
So the state of Texas has a certified, peer support recovery certification. We love to hire folks that are already certified as a peer support specialist, but if they don't have that certification, we help pay for their training to end to get to that certification. And what we look for in a peer support specialist is someone that has a track record of their recovery, so to speak, and someone that has a great personality. Because you can teach the task to anybody, but you can't teach the people stuff.

00:06:27:00 - 00:06:42:00
Zelia Baugh
The people stuff, really in the personality and attitude is the first thing we look for. And the second thing is their depth of recovery. And the third thing would be certification. And if they don't have it, we get it for them.

00:06:42:02 - 00:07:06:12
Rebecca Chickey
Well, since I had the honor of meeting Melanie before we started recording this podcast, that's a nice transition because she definitely has the heart and the personality. So Melanie, I'm going to turn to you now. Zelia mentioned some of the tasks and the work that you do, which is quite broad. Just kind of describe the life of a peer support specialist as you've lived it at JPS.

00:07:06:14 - 00:07:30:19
Melanie Cooper
Sure. Thank you, Rebecca, and thank you, Zelia for the wonderful introduction. So life as a peer support specialist - we stay pretty busy here. We have as Zelia mentioned, four of our inpatient units, as well as our local commitment alternative unit, which is our long term. They have state beds. We have peer support specialists on every unit.

00:07:30:24 - 00:07:51:24
Melanie Cooper
There's sometimes there's two of us. It just kind of depends on the units. We meet the patients where they're at. So we have what's called an interdisciplinary interview. And we go in and we find out not necessarily what may be brought them here, but challenges they have. What barriers do they have? What are their goals? Learning about them

00:07:51:24 - 00:08:23:06
Melanie Cooper
as a person that they are. Who they are, what they love to do. And we also help with the risk of readmission. Like Zelia also stated, we also do a readmission survey. And this is when a patient comes in within 30 days or less of their last inpatient stay here at JPS. And we find out, you know, what's something differently that they like to work on? How can they stay out of the hospital? Making sure they have those wellness tools, setting up that crisis planning.

00:08:23:08 - 00:08:51:02
Melanie Cooper
You know, it's basically what they want in their own recovery. We also share our recovery stories. We have peer support specialists in our wonderful psychiatric emergency center here at JPS. And I love we share our stories there. We share our stories on all the inpatient units, and we rotate so all the patients get to hear our wonderful recovery stories, how we walk a life in wellness, what we do to stay well.

00:08:51:09 - 00:09:19:03
Melanie Cooper
Challenges. Barriers. Things that we're still going through because we know recovery is ongoing. It's a journey. It's something that you just don't get to forget about one day. It's something that you have to work on every single day is working on that self. In our psychiatric emergency center, we have peer support specialists that work with the discharges. Those are the discharges that are going home as well as discharges that may be coming to our inpatient unit.

00:09:19:06 - 00:09:41:09
Melanie Cooper
With that being said, the discharges going home, we make sure they're equipped with those resources, those things like Zelia mentioned in the community, making sure if they're discharging to a shelter, making sure, you know, they have, a ride for that, making sure there's some sort of warm handoff for that, making sure they have a safe discharge plan, a place to go. For those coming inpatient,

00:09:41:09 - 00:10:00:12
Melanie Cooper
we talk a little bit about the experience of what to expect next. What's it going to be like? We talked a little bit about their treatment team. They're going to have a peer support specialist. They're going to have a social worker assigned to them. They're going to have groups during the day. We do lead the groups on the inpatient units as well.

00:10:00:12 - 00:10:25:12
Melanie Cooper
They're all recovery focused, recovery driven. And that's what I love about it. And this gives patients the idea of maybe to try some own ideas of what they might want to do for their own wellness, their own recovery. We also meet with the discharges, people that come in to the hospital right before they discharge. We usually meet with them 24 to 40 hours prior to their discharge date.

00:10:25:18 - 00:10:48:02
Melanie Cooper
We make sure we're working. We're collaborating with the social worker, the doctor, making sure they have all the tools they need in their wellness toolbox to make sure they're well equipped to go home, making sure they have that crisis planning set. Not only our contact numbers, but our 988 numbers, 911, making sure they know they can come back to the psychiatric emergency center.

00:10:48:02 - 00:11:13:10
Melanie Cooper
This is what we're here for. So we do as well treatment team. So this is where we collectively work as a team. This is where the peer support specialist is involved. The social worker, the doctor, the residents, the psychiatrist, the nurse, and of course, their lovely peer support specialists. And we meet with them to basically find out how they feel like they're progressing in treatment.

00:11:13:13 - 00:11:43:09
Melanie Cooper
If there's any type of medication management, you know, how are the medications working for you if they're taking medications. Because everybody's journey is different. We don't push recovery on anyone. It's what they want. We don't talk about you should take medications. It's what works best for you because we believe that person individually knows what's best for them. We also help build that bridge where there's sometimes that gap between the social worker and the doctor and the nurse.

00:11:43:09 - 00:11:50:22
Melanie Cooper
So we are constantly rebuilding that and making sure we're all meeting at that one place, and that's meeting the patient's needs.

00:11:50:24 - 00:12:10:25
Rebecca Chickey
You just summarized what was in my head. Sometimes I think organizations are concerned that if they bring peer support specialists on, it may compete with some of the work the existing staff have. And you said the word more than once, and that is collaboration. And another way to say collaboration is we work in a team.

00:12:10:27 - 00:12:34:01
Rebecca Chickey
Thank you. Melanie, first of all, for the work that you do and the joy and the hope that you bring to individuals lives. Zelia, I'm going to ask you for the people that are listening, that are on the fence, that are thinking about, should we go on this journey to hire a peer support specialist or at least begin looking into is that right for our organization?

00:12:34:04 - 00:12:39:03
Rebecca Chickey
What sort of call to action would you have or what guidance would you provide them?

00:12:39:05 - 00:13:02:00
Zelia Baugh
Every institution needs to look at meeting your patients where they are. And whether you have behavioral health in your health system or not, you can still utilize peer support specialists in your medical emergency center. You can utilize them in your case management office and doing follow up phone calls and navigation for those patients that are going to come to your health system.

00:13:02:03 - 00:13:36:22
Zelia Baugh
You may not have behavioral health officially in your health system, but you have behavioral health patients in your health system. And many times, those are the patients that are coming back in less than 30 days. And what can be done to try to stop that revolving door, to give a patient the best chance for recovery? Peer support specialists are an untapped resource that I think is well overdue in all hospital settings, whether it's somebody that is a cancer survivor, heart attack survivor or whatever.

00:13:36:25 - 00:13:43:25
Zelia Baugh
These people have life experience and hope to share to help people where they are.

00:13:43:27 - 00:14:11:14
Rebecca Chickey
That's beautiful, inspirational, and I hope just by listening to this podcast, it will become actionable for our hospitals and health systems. So thanks to both of you today, again for the work you do day in, day out at JPS. And thank you so much for your willingness to, share your time and expertise with us and inspire others and also teach others about this valuable role on the behavioral health team.

00:14:11:16 - 00:14:13:03
Zelia Baugh
Thank you for having us.

00:14:13:06 - 00:14:14:17
Melanie Cooper
Thank you.

00:14:14:20 - 00:14:23:00
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:02 - 00:00:15:03
Tom Haederle
Welcome to Advancing Health. In today's podcast, a discussion with CommonSpirit Health about creating a care delivery system that is responsive to the needs of patients and communities.

00:00:15:05 - 00:00:37:06
Julia Resnick
Hi everyone. I'm Julia Resnick, senior director of health outcomes and care transformation at the American Hospital Association, and welcome to Advancing Health. I'm really excited to be here with my friend and colleague, Ji Im. She's the system's senior director of community and population health for Common Spirit Health. And she's really an incredible champion in this space. And just really excited to jump into this conversation.

00:00:37:10 - 00:00:38:27
Julia Resnick
So Ji, thanks for being here.

00:00:39:02 - 00:00:40:10
Ji Im
Of course.

00:00:40:13 - 00:00:49:09
Julia Resnick
So to get started, I would love some background on the work that you do about your health care system and the communities that you serve. Can you talk a little bit about that?

00:00:49:12 - 00:01:11:13
Ji Im
Absolutely. And thanks for having me here. So at CommonSpirit, my role lives between the clinical world and the community. And it's about seeing beyond the hospital walls and collaborating with an array of partners who have the mission and aligned values to improve health and well-being. To give a little bit of a background about CommonSpirit:

00:01:11:15 - 00:01:42:09
Ji Im
I've been here at this organization for 11 years. And I believe that our organization exists to heal, not just treat, especially in moments of hardship and vulnerability. And we have around more or less 140 hospitals, more than 2,300 care sites across 24 states and deliver more than 20 million patient encounters annually. And so I'm one of the 160,000 employees.

00:01:42:11 - 00:02:10:18
Ji Im
And collectively as a hospital, nonprofit hospital system, we provide more than $5 billion in community benefit. It's something that I'm extremely proud of. You know my role here, Julia, you know that it's been about co-creating solutions centered in community. We have initiatives that connect people to the services that they need, not just medical care, but could be housing support, food, transportation, family resources.

00:02:10:20 - 00:02:47:24
Ji Im
And these are the things that drive as much as 80% of health outcomes. So if we want to improve health, we can't ignore them. And I also want to mention not just the work that we do, the what we do, building community networks or leveraging community health workers, or supporting the transition to community via navigation that I know we're going to talk a lot about, but how we do the work, the how really alongside community building trust, recognizing that we play a role, but we are not the solvers of everything.

00:02:47:26 - 00:02:59:06
Ji Im
We do not have the solutions for everything. We do that in partnerships with others. I think that we're going to have a little bit of fun talking about, you know, digging deep into some of these issues that I just talked about.

00:02:59:09 - 00:03:20:26
Julia Resnick
And I think that connectivity piece is so important and is really going to be a thread throughout our conversation that health isn't just what happens in the clinic or in hospitals or an inpatient spaces. It's not just what happens in the community, but it's how all of those pieces connect together to make it more seamless for people as they navigate these really vulnerable times in their life.

00:03:20:28 - 00:03:38:08
Julia Resnick
I want to hear more of your thoughts about, you know, that whole health care ecosystem. That we all know it's complex and it's hard to navigate. So when you're working with patients and communities, how are you thinking about that ecosystem and how to simplify it and make it more fluid?

00:03:38:11 - 00:04:16:18
Ji Im
So when we're thinking about designing or building or redesigning an ecosystem, it really shouldn't feel like a system to the person. Whatever we're designing and building, people should feel a whole lot less of the cognitive and emotional load. The mental burden of having to figure things out, figuring out the next step, figuring out the options, figuring out what to covered, what's not, where to go, who to go to, who's who, what's in network, what's out in that work, how to override denials?

00:04:16:18 - 00:04:46:05
Ji Im
What is a denial? Why did it get denied? So much to figure out. It's not just for the patient, for the person, for the caregivers. It's not just about figuring out the medical burden. Right? It's about figuring out life. So much can change because of that. So we have to remember that this is also when people have the least energy and the least mental bandwidth to spare.

00:04:46:07 - 00:05:21:07
Ji Im
And having a system that just seamlessly works for them. You know, the concept, the topic of navigation. It's not just about helping people get to an appointment or coordinating care. Navigation is really about removing that invisible cognitive tax that people feel in the moment, and the moment that they start engaging with the health care system. We have to recognize that navigators, they absorb some of that.

00:05:21:09 - 00:06:12:08
Ji Im
You know, personally, I felt so much friction in this health care system as a patient. And the goal of designing or building a navigation system that really works, an ecosystem that really works. It's not just about adding and building things and doing more. It's really about removing that friction that people feel and that people experience. And because when friction is removed, I have to believe that people get more of that mental bandwidth back to actually care for themselves, to do what's important for them, their families, their loved ones, and it gives them something back that matters most to them so that they're not expending that energy figuring things out.

00:06:12:10 - 00:06:34:26
Julia Resnick
Yeah, I think that like that person centeredness of it - just it really resonates with me and that, you know, when you become a patient, it's the scariest time in your life, whether it's for yourself or a loved one. So to have a more fluid support system around you that's not just your family and friends, but the medical system that you're working in, would be invaluable.

00:06:34:28 - 00:06:46:03
Julia Resnick
And you mentioned in there your personal experience as a patient. Can you talk more about that and how it's influenced your perspective on how to navigate the health care system and advocacy for patients?

00:06:46:06 - 00:07:19:12
Ji Im
Two years ago, I was diagnosed with lung cancer. And, a total shock, disbelief, numbness, fear for the unknown when it meant for my family what it meant, especially my husband and two daughters. And even though I spent almost 20 years working in hospitals and health systems, trained in public health, pursuing a doctorate in public health, I felt completely lost.

00:07:19:15 - 00:07:58:00
Ji Im
I mean, Julia, I've studied the system, but I felt like I was dropped into a foreign world and what I experience and quite frankly, still experience are those cracks. You know, one hoop after another, another hurdle. And it doesn't surprise me when it's hard. But I will say all those things, all these feelings that I have, every person I've met from doctors and nurses, from call center people, pharmacists, adjudication people...they want to genuinely help.

00:07:58:03 - 00:08:06:17
Ji Im
They really do. People want to help. Everyone in this health care system, they go into it because they want to help people.

00:08:06:19 - 00:08:27:24
Julia Resnick
Yeah. I think what you're speaking to over and over again is like that power of human connection. And you know this about me and that I had cancer 20 years ago. And you're talking about this, and I'm thinking back to my list of heroes. Those people that made the worst six months of my life made me feel cared for and brought joy and laughter and helped hold my hand through.

00:08:27:24 - 00:08:49:18
Julia Resnick
And that when we're in this, we all need someone to hold our hand and help us. So as you're thinking about that care delivery ecosystem and care navigation, like what would a truly patient centered model look like and how can we start forging that path to have better coordinated care for patients?

00:08:49:21 - 00:09:16:21
Ji Im
So much of and it will be a constant message when I talk about, which is we have to consistently work hard around removing that friction. How do we all, each of us, do our jobs so that we're extending ourselves to the next space? Our extension goes until somebody else is there to extend back and build that connection.

00:09:16:24 - 00:09:47:17
Ji Im
We need people to feel and experience, not just having written in a paper, written in a protocol. How do we incorporate as we're designing the system, incorporate the expertise of the community, expertise of those with lived experiences. And, you know, I think about, like for me, I love to message my doctors. I tell them all my symptoms, all my side effects, everything through a message.

00:09:47:20 - 00:09:55:09
Ji Im
But I know that for my parents, they want to be there in person. They want to talk to a human.

00:09:55:12 - 00:10:01:24
Julia Resnick
The system as it is now. Do you see it? What mechanisms do you think we have in place already that we can build upon?

00:10:01:26 - 00:10:26:00
Ji Im
Oh, we have so much. We have people who realize that, hey, I know this is my job, but I'm going to do more because I know that my job isn't enough. Yes, I can make a referral, but I know that you could get lost. So I'm going to follow up. I know that medical care isn't the only thing that you're navigating.

00:10:26:03 - 00:11:06:03
Ji Im
So I'm going to make a connection, a warm transition to somebody in the community who understands and who can guide you and who can accompany you in that journey after you leave these clinical settings. So these are things where it's not just doing the job, it's to say, well, is this enough? Is this what's going to achieve the greater outcome that we all want, which is for people to access and afford quality care the way they want?

00:11:06:05 - 00:11:34:18
Ji Im
Because there's a bit of like respect for humans in that. It's to say that it's not you who can't figure out how to access the care. It's not because you don't know. It's because the system isn't working for you. And we have to do better. We have to do more than just what is written in protocols and procedures and processes, and to say, actually, let me think.

00:11:34:20 - 00:12:11:22
Ji Im
Let me not just read my script, but let me think if you're going to get what you need. And I think that that's really important. And we have so much of that already. I see hospitals and health systems and many health care actors putting more thought, money and resources into not just navigation, but creating more of a seamless experience where people feel cared for, where people feel that kindness, where people feel respected and dignified.

00:12:11:24 - 00:12:33:02
Ji Im
And I know that we're putting a lot more into it. The big thing here, Julia, I think, you know, again, we talk a lot about this is that we can't do that alone. This is not for a hospital to solve. This is about the entire health care industry and other sectors to help solve.

00:12:33:04 - 00:13:02:03
Julia Resnick
Absolutely. And I think what you've so beautifully illustrated is that within this ecosystem, the players are all there. They care deeply about their jobs and their patients. We just need to make for make progress in stitching it all together to make it more cohesive. So as we close out, is there anything else that you'd like to share with hospitals or any piece of advice that can help others who are in this space and are thinking about how to better meet the needs of their patients?

00:13:02:05 - 00:13:51:28
Ji Im
I do want the designers and the creators and the catalysts and the collaborators to just always keep in mind that, when we think about navigation, we need to make sure that success for navigation is not measure too narrowly. And that we're not saying, oh, navigator, you need to track appointments, you need to make sure that XYZ services resources was attained, but that they do so much more. They build trust.

00:13:52:00 - 00:14:40:08
Ji Im
They build confidence. They build agency for patients and their caregivers. And so there's so much more value that success cannot be just defined by did you do this appointment or not? The second piece is the navigation itself is so undervalued. I know we say it's important, but we have to look where resources are going. And we need to make sure that we're shifting the resources to make navigation support, whether they are community health workers or anyone else that their roles are stable, that they're defined, and that they're valued as part of the care that is being provided.

00:14:40:10 - 00:15:11:29
Ji Im
I think that that goes to my last point that I want to make, which is: navigators, they probably see so much more of the nuance that a 15 minute visit may miss, that people might not feel comfortable divulging certain things to certain people, let's say, in a medical setting. Right? In a clinical setting. But they see so much more the nuances, the small gestures.

00:15:11:29 - 00:15:23:13
Ji Im
And how do we really maximize on that information that navigators have about people to help them, to truly help them and what matters most to them?

00:15:23:15 - 00:15:47:03
Julia Resnick
Absolutely. So, Ji, just thank you so much for sharing your story with us and your insights. It's been really powerful, and I'm certain that this will give people new ideas about how they can design care to better support their patients throughout their health journey. So thank you so much. We appreciate the work that you do and wish you all the best in everything that you're going through right now.

00:15:47:05 - 00:15:49:00
Ji Im
Thank you.

00:15:49:02 - 00:15:57:12
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:00:03 - 00:00:23:09
Tom Haederle
Welcome to Advancing Health. In this first leadership dialogue podcast of the year, Dr. Marc Boom, president and CEO of Houston Methodist and the 2026 Board Chair of the American Hospital Association, speaks with a top leader at the Joint Commission about the factors that drive organizational innovation.

00:00:23:12 - 00:00:51:28
Marc Boom, M.D.
Well, greetings, everybody, and thank you so much for joining me today. I'm Dr. Marc Boom. I'm here with you today as I am privileged to start serving my term as the board chair of the American Hospital Association for 2026. This is a great honor, great privilege, and it's something I take very seriously. And I can't think of a more interesting time and an opportunity with more promise than leading the American Hospital Association's members, who work every single day to make health care better for all Americans.

00:00:52:00 - 00:01:12:03
Marc Boom, M.D.
Part of this new role is making sure we are continuously learning, and I believe these leadership dialog series are a great way to listen to and learn from others as a strategy to always seek to be better and better informed. To give a little background on me and my experience leading a hospital system since this is our first podcast.

00:01:12:06 - 00:01:36:27
Marc Boom, M.D.
I've been very fortunate to be at Houston Methodist now for 28 years, almost 29 years. I've been privileged to be CEO for the last 14 years or so. We're a very large organization, 35,000 employees, flagship Academic Medical center, the Texas Medical Center, and seven network hospitals that span throughout the greater Houston area. We have an active research institute, GME programs, etc..

00:01:36:29 - 00:01:57:27
Marc Boom, M.D.
And today, as we start this series and really wanted to focus on a foundational element, which is innovation. Because I believe this is a critical skill set for hospital leaders today. And so we're going to weave that theme throughout the year, along with a lot of other things. At Houston Methodist, innovation has been part of our DNA for a long time.

00:01:57:27 - 00:02:19:03
Marc Boom, M.D.
And we've really pushed it very hard, rethinking how we do things, being more agile in what we do, and trying technologies like virtual nursing, ambient listening in the operating rooms, wearable technologies. We have a saying at Houston Methodist when we try new technologies: we will succeed fast or we will fail fast. We also have two guiding principles for innovation.

00:02:19:06 - 00:02:41:23
Marc Boom, M.D.
The first is to obsessively focus on the needs of our patients, families and communities. That's why we are innovating. But a very close second is to make the lives of our clinicians and employees easier, so we can free them up to do what humans do best, which is actually the personal interaction in health care and what really connects them to the people we serve.

00:02:41:25 - 00:03:11:12
Marc Boom, M.D.
And I know that trying new and innovative solutions is nothing new for my guest today. I'm very pleased today to be joined by Dr. Jim Merlino, who was recently appointed a couple of months ago to serve as the chief operating officer of the Joint Commission. Prior to stepping into that new role, he served as the organization's chief innovation officer. And before that, he was the chief clinical transformation officer at the Cleveland Clinic, where he oversaw strategy, business development, safety, quality, patient experience, and continuous improvement.

00:03:11:14 - 00:03:21:04
Marc Boom, M.D.
So his experience and expertise make him a perfect guest for today's discussion. So let's welcome Dr. Jim Merlino, and let's jump on into our discussion. Jim, welcome.

00:03:21:07 - 00:03:31:25
James Merlino, M.D.
Thank you. Marc. Honored to be here. And congratulations becoming the chair of the American Hospital Association. Can't think of a better person. To be leading that organization in times like this.

00:03:31:27 - 00:03:51:16
Marc Boom, M.D.
Well, thank you very much. It's great to see here. Now, if my memory serves correctly, it's been a while, but the very first time we actually met was regarding institutional culture. So I know you think a lot about culture and you know the importance of culture, so I'd love to get your thoughts around that. How important is it when you're tackling innovation?

00:03:51:16 - 00:03:58:04
Marc Boom, M.D.
How do you use culture to drive quality safety, service, innovation. How do you do that?

00:03:58:06 - 00:04:23:00
James Merlino, M.D.
Yeah, well it is absolutely essential. And you know, when you first asked me to participate in this conversation, my initial thought was you know, I'm being questioned by a person that understands this better than I do because, you know, we first met when I was the chief experience officer for Cleveland Clinic under Toby Cosgrove, and we came to Houston Methodist to talk to you and talk to the team to learn about how you leverage culture to really build an incredible organization.

00:04:23:00 - 00:04:45:27
James Merlino, M.D.
And I remember we were touring the basement, and you showed me the floodgates and told me a story about how the hospital flooded after the hurricane and how you use that as a as a rallying point to really start to rebuild the organization. You know, I think in my career and I think you see it across the country, certainly within your organization, if you don't tackle the culture of an organization, particularly in health care, you're never going to achieve any of your goals.

00:04:46:05 - 00:05:01:29
James Merlino, M.D.
It is really foundational. You still have a saying, the clinic has a saying that, you know, if you don't, it's kind of like, how do you drive safe, high quality, patient centered care? You tackle your people and you make sure that they have the tools they need, that they are coming to work engaged, they love their job,

00:05:01:29 - 00:05:22:06
James Merlino, M.D.
they're feeling satisfied. You're meeting their needs. If you don't focus on that - organizations don't focus on that - you're never going to achieve your goals. That's essential for not only the basic elements, the table stakes and health care, but if you want to create an organization, particularly in health care, that's focused on trying to do new things and innovate, you need to harvest those ideas from your people, right?

00:05:22:06 - 00:05:29:15
James Merlino, M.D.
That's where the best ideas come from. The people that work in your organization, working closely with the people you serve, your patients and families.

00:05:29:18 - 00:05:33:27
Marc Boom, M.D.
That's great. So what do you do specifically to build that culture of innovation?

00:05:33:29 - 00:05:55:26
James Merlino, M.D.
Number one, I think we have to get leaders to recognize that culture is actually something you can develop. It's not something that just exists. You can invest in your culture. You can shape your culture. You can have your leaders help to define it and to grow it and to transform it. So investing in your people and your people development is a really critical component of it. Including measuring engagement, right?

00:05:55:26 - 00:06:19:25
James Merlino, M.D.
Are you ensuring that you're understanding what's important your people's minds? The second thing is giving them opportunities. And you talked about this at Houston Methodist, right? It's not the or, it's the and. It's like we need you to deliver great care, and we want to make sure that we're listening to you to harvest the information that we need to be able to build the organization that we want to deliver that great care.

00:06:19:28 - 00:06:39:23
James Merlino, M.D.
So I think it's a component of investing in your people, recognizing that culture is something that can be shaped, it can be molded, it can be developed, it can be improved. And giving your people the tools and the opportunities to speak up, to engage in that innovative culture, to share their ideas, to share their thoughts, to provide feedback.

00:06:39:23 - 00:06:46:03
James Merlino, M.D.
Those are two essential elements that I think health care leaders across the industry need to recognize.

00:06:46:06 - 00:07:03:29
James Merlino, M.D.
I think that's spot on. I always talk about intentionality. It is intentional. Culture is something, whether you're talking about any aspect of a culture, when you are intentional about what you do, you get the culture you want. When you don't have that intentionality, you don't get the culture you want. Unless you're lucky. And so that's critically important.

00:07:03:29 - 00:07:22:02
James Merlino, M.D.
So, okay, you've got the culture and you work on the culture, you build that, you work with your people. Now, you really talking about some of the technologies and how those intersect. And some of those technologies are so exciting. Some of these are kind of scary at the same time, right? What do you see as the opportunities at the intersection between technology and health care for our future?

00:07:22:08 - 00:07:27:15
Marc Boom, M.D.
I'd love to hear the thoughts about, you know, how that interplays with the Joint Commission as well.

00:07:27:18 - 00:07:57:23
James Merlino, M.D.
Well, you know, it's interesting because I think technology has always been with us in health care in some form. If you look at the innovations of the last 100 years in medicine alone, right? There's been tremendous advances. And now in the last few decades, those advances have just been accelerating where the curve is nearly straight up. But when you think about what we have with us today in terms of artificial intelligence, machine learning, etc., the opportunity to take new technology, new ideas and apply that to what we do is really unlimited.

00:07:57:23 - 00:08:16:04
James Merlino, M.D.
I mean, you are doing it now at Houston Methodist as well as others. I recently had the opportunity to visit your flagship and look at some of the things you're doing. And I think the exciting thing about technology today is that we really have an opportunity to use those new technologies to help liberate our people. Exactly what you said, right?

00:08:16:04 - 00:08:42:28
James Merlino, M.D.
We want to get people back to the personal touch of caregiving, AI. Machine learning, I don't think I hope will never replace the human touch, the human component, but it should be able to help the human component to be able to deliver that personalized care that people need in their healing process. I think from a Joint Commission standpoint, from the perspective of AI, you and I cannot imagine what AI is going to do for health care in ten years.

00:08:42:28 - 00:09:01:00
James Merlino, M.D.
I mean, when I was in college, right, my cell phone was, you know, it's five times the size of my current computer that I'm on, right? And now think about it, right. We are walking around with very sophisticated, very powerful computers in our palms. We could have never imagined that back when we were in college or high school.

00:09:01:02 - 00:09:30:21
James Merlino, M.D.
So I don't think we can really imagine how AI is going to transform, how technology is going to transform what we have in front of us for an opportunity. Our perspective is we can't regulate AI, right? We want to unleash the power that AI and technology can bring to benefit patients, and also to benefit caregivers. Our perspective is, you know, let's provide guidance on what you should be thinking about, because, as you know, in health care, particularly in your role at the AHA, is there's the haves and the have nots.

00:09:30:21 - 00:09:49:17
James Merlino, M.D.
There are big organizations that can invest in technology and resources, like yours. And then there's small organizations. We want to make sure that we're providing guidance on what people should be thinking about. We don't want to be saying, here's what you need to do, because the last thing we want to do is stifle the innovation that people can have with this technology.

00:09:49:23 - 00:09:57:03
James Merlino, M.D.
We just want to make sure that people are thinking about what's important for their organization and to protect patients. That's kind of our thinking about this.

00:09:57:05 - 00:10:14:09
Marc Boom, M.D.
So we talked about that foundation of culture and innovation within, but some innovation comes from outside, and is how we implement and how we move quickly with it. Talk about the partnerships that need to be part of the equation when we're thinking about innovation in health care.

00:10:14:12 - 00:10:34:08
James Merlino, M.D.
I think that sometimes organizations look at what they're doing and think that the best things happen here, right? And one of the things that I learned in the various roles that I've been fortunate to have in my career is that there's a lot of great things happening out in the market, and we should take advantage of learning from others and seeing what others are doing.

00:10:34:15 - 00:11:08:27
James Merlino, M.D.
To understand whether I could apply for what we're doing, apply to what we're doing or not, right? Learn from each other, share information. That's what our opportunity is. I think that if we look too much internally only and that look to partners, then we're going to be blinded by what the potential is. And I think about organizations like ours, like the American Hospital Association, the ability for us to lever these platforms to ensure that organizations have access to information, to have access to best practices, to be able to see what others are doing is really unlimited.

00:11:08:27 - 00:11:18:12
James Merlino, M.D.
And that's our opportunity is to help those organizations get exposure to that and get access to that so that they can judge for themselves whether the think is something they can use.

00:11:18:14 - 00:11:37:03
Marc Boom, M.D.
When you're judging those, what are you really jazzed up about? What makes you excited about the future of technology and what how big do you think this impact is? Put that in, I guess in in the scope of other big innovations within health care, how what's the potential opportunity here? What are the big exciting things coming down the pike?

00:11:37:06 - 00:12:06:10
James Merlino, M.D.
I think it's unlimited. I mean, again, going back to my comment earlier about what's our imagination to be able to say what it looks like in ten years, I don't think we can imagine that. Right? I think that it is limited by only our imagination, what we think we can bring to it. When you consider the advances in technology and the advances in disease treatment, just in my medical career alone. When I was a medical student, right, think about it - half the medicine wards were filled with people dying of AIDS.

00:12:06:12 - 00:12:29:16
James Merlino, M.D.
Today, HIV is a chronic medical condition and people are treating it with basically no detectable virus in their blood. And AIDS is nearly nonexistent in the United States. I mean, that's an amazing technological leap in terms of treatment in medicine. And I think the limit for what technology, whether it's science or AI or other things, can bring to medicine?

00:12:29:19 - 00:12:35:19
James Merlino, M.D.
There's no limit, right? I can't imagine the ability of what it's going to bring to the field.

00:12:35:21 - 00:12:52:02
Marc Boom, M.D.
Is there any particular challenge problem that you come across with the Joint Commission? You look into so many hospitals, as you mentioned, from really the entire spectrum of size that you wish technology could be brought to bear to fix first?

00:12:52:05 - 00:13:21:08
James Merlino, M.D.
For me, and this is a personal perspective, it's a little bit about what you touched on earlier, right? It's how you lift the burden from caregivers? You know, in some ways, technology has created a burden. I think about the electronic medical record. My wife is the chief medical informatics officer for the Cleveland Clinic. And her and the team spent a lot of effort helping physicians understand how to use the EMR as a tool in their workflow to deliver better care and reduce burden.

00:13:21:15 - 00:13:47:11
James Merlino, M.D.
Right. But if you look at the rollout of the electronic health record across the United States, across the world, when it started, what we did was we took the technology and we put it on top of bad processes. And now you had two things that weren't working well together. It was only after you think about how you get it to work more closely, how you evolve your workflows to get it to work more efficiently, to get it to work in a way that benefits caregivers and patients.

00:13:47:13 - 00:14:15:25
James Merlino, M.D.
I think that as we roll out new technologies, we look at new opportunities, we have to be mindful of how is it going to impact the caregivers, right? Ensuring that the promise of reduction of burden is reality and is going to impact them in a way that benefits their delivery of care and ultimately benefits patients. But I think that is what's really most important for me is how do you get to lift the burden for caregivers and ultimately improve the delivery of the care that they're doing.

00:14:15:27 - 00:14:39:14
Marc Boom, M.D.
I think that's spot on. That's why that was the second of our sort of philosophical aims with technology, because we all know burnout is a very real thing. We all know many of the things that cause burnout are - as our chief physician executive calls it - the pebbles in the shoe, they're the irritating things that just kind of get at you and over time just even get worse and worse, as if it was a pebble in a shoe.

00:14:39:15 - 00:15:01:00
Marc Boom, M.D.
Yet technology can take so much of that away. And when you put the patient at the center and you think about that one on one relationship or those close personal relationships, I'm a primary care physician, so that's important to me as well. I think technology has the dramatic potential that enable it. The other thing I'd probably throw in there, and I'd love to hear your thoughts about that.

00:15:01:03 - 00:15:19:08
Marc Boom, M.D.
I think one of the big challenges we face in health care, if not maybe the biggest existential question is affordability. For me, it's the big A right now. To be honest, I'm not sure much of technology has ever really improved affordability and health care, but I think we're on the cusp where that could happen. Do you agree with that?

00:15:19:09 - 00:15:27:28
Marc Boom, M.D.
Is that something plausible that we could actually help end some of the cost curve, make health care more affordable by implementing technology appropriately?

00:15:28:00 - 00:15:50:00
James Merlino, M.D.
I agree, and I think it's true. And particularly if you consider access issues. When you look across the country, you know, you have tremendous opportunities to improve access in rural health, for instance. And I think technology is a way to extend that delivery of care into communities, into areas that don't have the resources that you see in the big cities and urban areas with big systems.

00:15:50:03 - 00:16:03:27
James Merlino, M.D.
And, you know, we should be thinking about how we use technology to extend in those areas. Coming back to the issue of adoption, you know, I think that the pebble in the shoe analogy is a great line. I'm going to steal that.

00:16:03:27 - 00:16:07:15
Marc Boom, M.D.
Steal away. I stole it from our chief physician executive. So it's just breaking down the chain here.

00:16:07:17 - 00:16:28:26
James Merlino, M.D.
But think about it. If we're going to be successful at implementing technology, we should look to the challenges we've had in the past with technology implementation, right? and ensure that as we're leveraging new technologies, particularly AI, we're using our people, our physicians, our nurses, other professionals and health care to really help us understand how to apply it appropriately.

00:16:29:02 - 00:16:49:06
James Merlino, M.D.
Right? Because I think sometimes we lose track of that. Right? People are sitting in the ivory tower. They want to implement something that seems really exciting and really new, but we have to remember that we're giving this to the people that are delivering the care. We want to make sure that we're levering them to help us understand not only the best uses for it, but actually how to implement it.

00:16:49:08 - 00:17:08:04
Marc Boom, M.D.
Well, that's great. Thank you, Joe. I mean, this is exactly why I asked you and I'm so thankful that you agreed to be the first guest this year on this series is because I know you understand the inner workings of this and obviously have had a huge impact in your career at the Cleveland Clinic and now a huge impact across so many hospitals with the Joint Commission.

00:17:08:04 - 00:17:17:22
Marc Boom, M.D.
So thank you very much. Very insightful conversation. I enjoyed it a great deal, and thank you for everything you do in service of humanity through your through your roles.

00:17:17:24 - 00:17:25:18
James Merlino, M.D.
Well, thank you very much for having me. And I appreciate the conversation and look forward to the great things you're going to do at the American Hospital Association.

00:17:25:20 - 00:17:36:05
Marc Boom, M.D.
Thanks so much. Well, everybody, thank you so much. I hope you enjoyed this as much as I did. And thanks for taking your time to listen. We'll be back next month for another Leadership Dialog conversation.

00:17:36:08 - 00:17:43:14
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever

00:17:43:14 - 00:17:44:18
Tom Haederle
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00:00:00:08 - 00:00:17:06
Tom Haederle
Welcome to Advancing Health. Today, we learn from the experts how physical security is a necessary component of cyber security, and why they have added the misuse of AI by bad actors to the list of cyber threats facing health care providers.

00:00:17:09 - 00:00:47:01
John Riggi
Hello everybody. My name is John Riggi. I'm national advisor for Cybersecurity and Risk at the American Hospital Association. So pleased to be joined by my good friend today, Larry Pierce, who is the director of cybersecurity, information security officer for Atlantic Health. And folks, believe it or not, Larry has been at the same organization, Atlantic Health, for almost 40 years in various forms of information technology and cybersecurity,

00:00:47:02 - 00:01:10:13
John Riggi
really as the field evolved. So, Larry, so good to have you here today, especially as cyber threats of all types are increasing dramatically. Third party risk is a major issue that we're facing. In fact, quite frankly, it is the most prominent source of all cyber risk that we face in health care. AI is everywhere and on everything.

00:01:10:14 - 00:01:36:20
John Riggi
So we'll talk a little bit about that as well. Unfortunately, the risks that we as hospitals and health systems face and our patients face are not just the virtual threats. Unfortunately, there's been a dramatic rise in physical threats and attacks and violence against hospitals and health systems. And there is a nexus, a connection between the physical threats and the cyber threats.

00:01:36:22 - 00:01:48:10
John Riggi
From your perspective, Larry, having dealing with a very busy organization, a busy emergency department - how do you feel that the physical threats and the cyber threats intersect?

00:01:48:12 - 00:02:07:12
Larry Pierce
I think in many cases, you know, with the exception of when you're dealing with nation state threat actors who, you know, like the state thousands and thousands and thousands of miles away from you, there are a lot of things to your point that we need to be concerned about. It seems like there's an uptick in physical violence within in health care organizations.

00:02:07:15 - 00:02:33:03
Larry Pierce
You know, when you talk about physical security, we're looking at things that, you know, the intersection with cybersecurity would be an unsecured laptop, right? that may not be encrypted for one reason or another. That's really security 101 is ensuring that your mobile devices that are within the organization are always encrypted. So in the event that they walk out of the org or they're stolen, that they really turn into a brick.

00:02:33:06 - 00:02:56:27
Larry Pierce
But there are some vendor supplied systems that we have out there that may not employ the same technology. So data centers and server environments within the main hospital, we don't have a lot of data centers that are in the hospital anymore, but your server rooms and network closets, there could be a lot of damage caused in those areas if somebody happened to go in there with nefarious purpose

00:02:57:00 - 00:03:16:20
Larry Pierce
they weren't meant to be in there. That could cause us a lot of hardship. We rely on the security cameras that we have throughout the hospital system right now in physical security monitoring those. In the event that something happened, we can always go back to those and look and see what's happening. So operational technology is something we take very seriously here.

00:03:16:20 - 00:03:35:15
Larry Pierce
It's something that we work closely with our partners in emergency management, physical security and even law enforcement at the local, county, state and federal level. So up to including the FBI, Homeland Security, prosecutor's offices, local law enforcement.

00:03:35:18 - 00:04:03:18
John Riggi
You know, when I think about this, the intersection of physical threats and cyber security, you know, we always talk about ransomware attacks as being a threat to patient safety and really a threat to life crime. And I would venture and proffer that a ransomware attack in itself could be viewed as a violent crime. We tell the federal government all the time, if you do something that puts people in physical harm, risk of physical harm, then that's a violent crime.

00:04:03:23 - 00:04:22:20
John Riggi
So that's one of the one of the things we're pushing the government to understand as well. And they do. They do, quite frankly, as you know, with the FBI. So let's, let's talk back about here on the health care landscape and a little bit about what everybody else is talking about, AI. right? So talking about cyber, we've talked about physical threats, AI, everything.

00:04:22:27 - 00:04:41:10
John Riggi
So is AI is evolving and widespread implementation we have in health care happening quickly, really quickly. This has a lot of risks and rewards as we know. What do you see from your perspective, the emerging risks of this widespread and perhaps overly optimistic adoption of AI in health care?

00:04:41:12 - 00:05:00:19
Larry Pierce
AI is obviously not going to become it has to become a game changer for health care and many other industries. Contrary to what some people that you know aren't in the technology field that I speak with on a regular basis outside of work or even inside of work, and they ask me, you know, AI thing that's going on right now, is it here to stay?

00:05:00:19 - 00:05:25:14
Larry Pierce
Is it just a fad that's going to kind of come and go? My answer it's been very, very consistent with that. AI is here to stay. Depending on how you use it, whether we're leveraging it internally for protective technologies or whether we're using it to better patient outcomes. Those are some of the things that we are doing internally.

00:05:25:16 - 00:05:50:12
Larry Pierce
But I think in using AI in an ethical manner, we need to ensure that we are taking a very cautious approach with that. I don't think has demonstrated quite yet that it can take the place of a human to make a medical diagnosis, for example. We're not that far along. I'm not saying we may not get there at some point, but I don't think I was ever

00:05:50:12 - 00:06:11:21
Larry Pierce
billed - and I would I would argue this point, you know, unless I'm convinced otherwise years from now - not necessarily made to take the place of a human in every case. Is it going to limit some jobs? Absolutely. But, you know, in the health care space, we are seeing more and more platforms that are coming in. And I'm not just talking about security technologies.

00:06:11:22 - 00:06:38:03
Larry Pierce
These are third party systems that we're employing that are either incumbent systems that we've had here for a while that are starting to adopt more AI technology, and companies that are AI centric and completely involved with AI, and we're bringing them on board as well. So for us, again, very cautious approach, and we have a very rigid onboarding process for these AI technologies.

00:06:38:03 - 00:06:59:05
Larry Pierce
So it all starts with the governance process. And is there a need for it? Do we have the dollars? Because health care is getting squeezed quite a bit right now. From a monetary perspective, we're not getting the same reimbursements that we had once before. We're spending a lot more money than we ever had to before. These fancy AI technologies and everything else, they come with a price tag.

00:06:59:07 - 00:07:23:21
Larry Pierce
So in adopting these, we need to make sure that we're doing it ethically, responsibly. So we have a an AI committee that partners with - and it's not just the most important thing - it just fits in with everything else very nicely. So we do a full architecture and design. We do an assessment. We do a complete comprehensive cybersecurity review.

00:07:23:23 - 00:07:42:21
Larry Pierce
It all comes down to risk. And I'm not the final say when it comes to that. There are, you know, executive leaders within the org that will either accept risk or not accept the risk. But they are certainly informed when that comes along. We also have our team members or employees that are using AI right now.

00:07:42:23 - 00:08:14:20
Larry Pierce
Beyond just the medical side of the house, AI is being used to craft more business friendly emails. It's being used to develop algorithms associated with a better presentation. So we don't want, you know, an AI platform such as OpenAI, ChatGPT, Gemini. It should be able to have the ability to ingest spreadsheets that are our proprietary information, may contain, you know, many, many elements of PHI, PII.

00:08:14:22 - 00:08:36:03
Larry Pierce
We don't want to put that into their learning module because they all give you the caveat if you look at their privacy statements and policies, they could use this information almost indefinitely to train their models. Well, if their information is to be compromised and we've got over 500 records in there that were put in to come up with something, it's going to cause a breach situation for us that we don't want.

00:08:36:05 - 00:08:58:27
Larry Pierce
We've employed, you know, our content filtering, our DLP technologies are all trained at this point to significantly restrict what people can do with AI to prevent them from getting themselves in trouble. More importantly, from landing Atlantic Health in the news because of something that was an unintended consequence.

00:08:59:00 - 00:09:29:07
John Riggi
So again, AI is here to stay. It's an almost everything we use. It's not necessarily new technology coming into the organization. There are a lot of existing programs, of course, like Microsoft and Google that add AI features. So that governance council that you spoke about is extremely important, not only to assess new AI technology coming into the organization, but to identify instances where it is now been added to existing software and technology within organizations.

00:09:29:10 - 00:09:53:28
John Riggi
Just saw another report this week that corrupted data, PDFs and emails which are already in networks, are then consumed by AI, legitimately looking for responses or answers to questions, queries submitted to it, but it unwittingly sucks in malicious data and perhaps malware that's already within, present and within the environment and produces it as part of its response.

00:09:54:00 - 00:09:58:06
John Riggi
So really, lots of complications and dealing with AI as we go forward.

00:09:58:10 - 00:10:17:17
Larry Pierce
Threat actors are leveraging AI right now, which is something that we continue to try keeping up with. There's a lot of security technologies that are evolving that are coming up with protections for that, which is great. But one of the things I'll bring up, and it's pretty common, I think a lot of people have heard of it: What are, you know, what is your biggest concern with AI?

00:10:17:20 - 00:10:42:18
Larry Pierce
More sophisticated and realistic phishing emails that are coming in. The telltale signs of a phishing email coming in and there's a lot of email securities out there and other cyber technologies that do a very good job at looking at, you know, what we equate to millions or tens of millions of emails every month to come in, and we have to block the most malicious emails that come in are all the malicious emails that come into the organization.

00:10:42:20 - 00:11:04:25
Larry Pierce
They're using these emails to come up with verbiage that we would normally point to as this is a yellow flag or a red flag. It's not there anymore. Look at the deepfakes that are coming out right now that AI is doing. They are very, very realistic. The other phishings that AI is being used for. It started out as general phishing emails.

00:11:04:25 - 00:11:37:29
Larry Pierce
that went to an audience of a thousand or more people. And just like, if 1 or 2 people click on it, it was worthwhile for the threat actor. Then it evolved to spear phishing. Very targeted going to one person. Now you've got smishing, you've got phishing, you've got quishing. We're seeing all of that internally here. And there's a lot of technologies that really aren't from an educational perspective or detective perspective, able to really latch on to these and be able to prevent them from getting to the people that may get hooked on.

00:11:38:02 - 00:11:59:27
John Riggi
All great points about the ubiquitous use of AI in hospitals and health systems. I totally agree it's only going to accelerate. And again, lots of good will come from it. But we also have to think of AI representing a type of third party risk. We know in health care, third party risk is the major source of cyber risk that we are exposed to.

00:12:00:00 - 00:12:21:29
John Riggi
The data holds that change health care are increasing reliance on outside third party technology, service providers and supply chain. So AI again, is a major third party risk included in all the other third party risks. So as a growing concern, how does Atlantic Health approach third party risk management?

00:12:22:01 - 00:12:44:03
Larry Pierce
So third party risk is, you know, it's near and dear to me because if I look at our application portfolio and understand that we have 750 or so applications that are currently in use at Atlantic, whenever we're going to onboard a new technology or review an incumbent vendor that's been here for a while, we have that same rigid process in place.

00:12:44:03 - 00:13:01:25
Larry Pierce
So it starts with governance and is there truly a need for it? Financially, do we have the money for that? Is it budgeted? Is there going to be a return on investment or not? I mean, why do we need the product is what it comes down to. Then we need to go to the nuts and bolts of what does the assessment look like for this?

00:13:01:25 - 00:13:25:23
Larry Pierce
We do a full architecture and design for everything. A full security review. As I believe I mentioned before, we have an RFI process that we send to the third party. It's about 150 questions that they have to answer in there that allows our teams to be able to determine whether this is something that meets our minimum baseline security controls.

00:13:25:25 - 00:13:45:12
Larry Pierce
So as we look at a lot of these products that we're evaluating now, let me rewind 10 or 15 years ago. We had a lot of on prem data centers, so whether it was within one of your own facilities or it was a co-location. Everything was basically on prem to a certain extent. So we had control physical control of all the security associated with that.

00:13:45:14 - 00:14:15:01
Larry Pierce
That was on us. As we evolve and migrate to third parties, which is, you know, that is the trend, it's moving in that direction. It has been moving there. A lot of companies are already 80, 90% of the way there at this point. We are, I would say, shedding some of that responsibility. But with that comes the fact that we are now relying on the security posture of that third party that we are entrusting with what may be our crown jewels.

00:14:15:03 - 00:14:25:18
Larry Pierce
And for us in the health care world, that is our PHI, the protected health information of our patients, which is central to what we do as a business.

00:14:25:21 - 00:14:47:06
John Riggi
This mass migration to the cloud has been very good economically and for business processes, but it's created a different type of risk. We've talked a lot about AI and cyber threats and physical threats, operational technology. What do you see in the next year? Couple of years? The trends in cybersecurity and health care and potential threats?

00:14:47:08 - 00:15:07:25
Larry Pierce
I think a lot of the same threats that you see today, they're going to remain. You know, the phishing emails, the other ishings that we talked about. I think they're going to continue to evolve. They're going to be more sophisticated, more believable. The nefarious threat actors that we all deal with, unfortunately, too often are going to build their capabilities on these.

00:15:07:25 - 00:15:33:16
Larry Pierce
They're going to be tougher for technology companies. And that's what it's always been. And, you know, we are trying to stay one step ahead of our adversaries. And it just seems like unfortunately, it's the other way around. They're staying one step ahead of us in many cases. There needs to be a level of vigilance within your organization. You need to continue to be mindful and ensure that your third parties and your own people continue to watch the shop.

00:15:33:18 - 00:15:53:24
Larry Pierce
When I started my career, PCs weren't even part of the landscape here at Atlantic. So you look at how far we've evolved. I think we'll be having an entirely different conversation five years from now. We'll be talking about things that I won't even say were top of mind, things that weren't even in our minds today that they're going to change.

00:15:53:27 - 00:16:23:21
Larry Pierce
I'm hoping that security technologies will continue to evolve, that they're going to get better, more comprehensive. And I'm hoping that there is, you know, work done by the federal government and other areas of the world to make it more difficult for these threat actors to do what they do to, you know, there are greater consequences for them. Most of these people right now, we can't go after them, unfortunately, when they cause us millions and millions of dollars of heartache because of something.

00:16:23:29 - 00:16:41:04
Larry Pierce
So I'm hoping that you get better with legislation and some of the strong work that you're doing, you know, with your counterparts. We're going to become more and more reliant on technology. And I'm just hoping we have the right technical safeguards in place to prevent some of the attacks.

00:16:41:06 - 00:17:01:17
John Riggi
Thank you, Larry. Very well said. And thank you for your service in helping defend health care networks, your patients in the communities that you serve. I also want to thank all our viewers for what you do every day to defend networks, care for patients and serve your communities. This has been John Rigi from the American Hospital Association, national advisor for Cybersecurity and Risk.

00:17:01:17 - 00:17:09:19
John Riggi
If you'd like to learn more about cybersecurity and risk, please visit our website at aha.org/cybersecurity.

00:17:09:21 - 00:17:18:02
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.