Ep. 149: Global Health, Local Impact: Rethinking Care Through Innovation

Anne Snowdon, PhD, Chief Scientific Research Officer, Healthcare Information and Management Systems Society (HIMSS), joins us to discuss how information, innovation and digital technology are transforming health care worldwide. From AI tools that support early-career clinicians to cross-border collaboration on system design, this conversation explores how digital health is improving outcomes, addressing workforce shortages and advancing a shift from disease management to whole child health.

Guest: 
Anne Snowdon, PhD, Chief Scientific Research Officer, Healthcare Information and Management Systems Society (HIMSS)

Host/Producer: Carol Vassar

Views expressed by guests do not necessarily reflect the views of the host or management.

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Transcript

Announcer:

Welcome to Well Beyond Medicine, the world's top-ranked children's health podcast produced by Nemours Children's Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.

Carol Vassar, podcast host/producer:

Each week, we'll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor's office. I'm your host, Carol Vassar. And now that you're here, let's go.

MUSIC:

Let's go, oh, oh.

Well beyond medicine.

Carol Vassar, podcast host/producer:

Today we're talking global healthcare innovation with Dr. Anne Snowdon, a pediatric nurse, a professor at the University of Windsor, Ontario in Canada, and Chief Scientific Research Officer at HIMSS, the Healthcare Information and Management Systems Society.

I met Dr. Snowdon at South by Southwest, where she was part of a panel discussing how U.S. healthcare trends are both shaping and being shaped by systems around the world. Today we'll explore that, plus how digital tools like AI can support care teams, improve outcomes, and help families meet real health goals.

So, what is HIMSS, and what role does it play in all this? Here's Dr. Anne Snowdon.

Anne Snowdon, Ph.D., HIMSS:

HIMSS is a global network. I think it's well over 100,000 members around the world, and its central mission and vision is to ensure global health systems can enable every human everywhere to achieve their health potential. It's a very significant mission-vision, but given they mobilize so many leaders, clinicians, patients, global health system, decision-makers, it's an inspiring mission-vision that we all work very closely together to advance. And I don't think I need to explain why that matters today with the many global health challenges we are all hoping to overcome, really.

Carol Vassar, podcast host/producer:

It definitely matters in having digitally-forward healthcare systems, is going to inform where we go moving forward as a global society. I met you at South by Southwest, and you were talking about how the U.S. shapes global health systems.

I would love to hear your perspective on that and what the current impact of the U.S. is on global health systems, and reverse that a little bit and talk about how other nations' global digital health systems are impacting the things that the U.S. does.

Anne Snowdon, Ph.D., HIMSS:

So, I think it's certainly fair to say the U.S. is a very large power in the world, right? And it's known for advancing very significant innovations across many business sectors. Healthcare is one, and it's certainly an important one.

I think for many years it has been the country many others look to, to figure out, "What's happening in the U.S. we should be thinking about and learning from?" So I think it has been, in the past, leading many innovative tools, technologies, advances in health system. I'm in Canada. We are deeply integrated, of course, with the U.S.

So, many innovations in Canada find themselves in the U.S. actually because the channel to scalability is so significant, and that's been a very long-standing, I think, view of global health systems. Now in the world with many, many, many things going on, I shared this at South by Southwest, I think many countries are looking and thinking, "Who else can we learn from?"

Uncertainty, of course, is one of the drivers of looking beyond, and I am a believer that's a good thing. There are multiple and different approaches to learning from country to country, health system to health system, and that's a really important role that the HIMSS network is playing. It is bringing leaders from many health systems together to learn from each other. And what we see in one part of the world hasn't even been contemplated in another part of the world.

So, really, in this global environment we all live in, if ever there was a time for a global network to build relationships and help everyone learn from each other, what works, what doesn't work, particularly in advancing health systems, this is the time. And one of the reasons I say that is the sustainability of our health systems.

Canada and the U.S. share a rather challenging distinction of being the most expensive health systems in the world per capita. When you look at the dollars spent per person in our respective countries, we spend a great deal of money. And when we compare with other countries, the outcomes we're achieving are not as impressive as they should be. Right?

So although I think U.S. has been a country we all look to for what's the latest, what they're achieving, AI is a good example, this is a time where we need that system lens to figure out, how do we achieve very significant outcomes for our populations, but do so at a cost that is sustainable? Right now, I'm not sure it is in either Canada or the U.S. Our European colleagues do much better, actually, in terms of what they're spending and the outcomes they're achieving.

So really, for me, it's about that learning network. No one's figured it out. No one's perfect. Everyone would like to be.

Carol Vassar, podcast host/producer:

Hopefull,y they will be.

Anne Snowdon, Ph.D., HIMSS:

Yeah, but if ever this is a time for us to learn from each other and to really understand the differences in context, what the drivers are, how to achieve that goal of every person, everywhere being able to achieve their health potential, this is the time.

Carol Vassar, podcast host/producer:

You travel across the world. You see how different healthcare systems work, what kinds of digital innovations they are making, and you've kind of, in your comments just now, carved out Canada and the U.S. as being expensive with lower healthcare outcomes.

What can the U.S. and Canada, in your estimation, learn from other healthcare systems, employing some of the digital innovations that you have seen that can really help, maybe lower those costs and raise those healthcare outcomes?

Anne Snowdon, Ph.D., HIMSS:

That's a really good question. And I pay a lot of attention to the patterns that we see, because I think you can learn from the pattern, but it's never a silver bullet. You can't just take, "Oh, that's a great idea. Let me drop it into the U.S. or Canada or both, and all will be good." There's a translation and a transformation that has to happen. But here's a pattern that's interesting, perhaps.

So, artificial intelligence is a whole suite of technologies that we are hearing an awful lot about these days. All good, right? It holds great promise. Promise. The reality of where and how have health systems embedded and scaled it across entire health systems anywhere in the world? Not very often. I'm not seeing it. But the hope and the compelling mandate to do so, of course, is there.

One of the patterns I'm seeing very interestingly is in the Asia-Pacific countries. They've taken a very different approach to implementing artificial intelligence than what I'm seeing in North America. Now, is this an absolutely representative sample? As a researcher, I would say no, Carol, but some interesting signals.

So what I see in North America is the use of AI technologies like ambient listening. As a nurse, I can go in and talk to a patient, and this tool can help me document that discussion and conversation and the decisions that I might make with a patient, right? And it's designed to make that work environment for our clinicians much easier, smoother, and much greater free uptime for patients. All good. Right?

When I go to the Asia-Pacific countries like South Korea, Australia, Taiwan, they're using it quite differently. They're designing and developing AI technologies that help clinicians inform their decisions with patients. So here's an example of an algorithm that says, "Okay, for this particular patient who has cardiac disease, the risk of doing cardiac surgery is," I'm making this up, "27%. The risk versus the risk of putting in a stent through cardiac catheterization is 47%."

That's a very interesting and different approach to helping clinicians and patients make the decision that's best for them. And that AI tool then is able to very nicely support the emerging young clinician who hasn't seen 10,000 patients like that, maybe has seen 10 or 20. And that tool is now supporting and enabling the young clinicians, young nurses, young, not in age but young in terms of expertise, in giving them the confidence that, "Yes, here's a best evidence, best data for this particular patient, and these are the key items you should be considering in making a decision."

So that's supporting not so much the quality of work environment, it's supporting and giving those insights to clinicians who may not have the experience those senior physicians or nurses might have, and it builds confidence, and it just might support retaining them. So, same sets of technologies, two very different applications.

So my thought is we need to learn from the pattern. What are the outcomes? What is it achieving for those young clinicians? Another example is an algorithm tool that I've created for nurses. The majority of hospital nurses today have less than three years' experience because so many of our senior experienced nurses, through COVID and since COVID, have decided that was more than they wanted to continue doing.

So if you have a whole cohort of younger nurses who haven't seen wounds, can't easily classify them and know exactly what care to provide for those patients with those wounds, the app does it for them. Take a picture, it stages it, it tells you what kinds of dressings, what kinds of cleaning solutions, therapies that you should use, and how often, so that you have the value of experience, but it's in the palm of your hand. I don't have to go find a wound care nurse that's covering an entire hospital who's really busy, right?

So that's an AI technology that's more common in those countries than I see in North America. Now, does that mean they don't exist? Not at all, because Anne Snowdon doesn't visit every hospital, but I pay attention to the pattern. How do we learn from those patterns, ask those questions? What can those AI tools achieve, and what does success look like, and how do you know if you get there?

And that's really where HIMSS plays a role in terms of measuring, what are you achieving, for whom? How do you know you're achieving the outcomes for your particular patient populations and the very specific and unique groups within those populations? And that's, I think, what the real opportunity here is in terms of that learning.

Carol Vassar, podcast host/producer:

And you addressed many of the workforce issues that I was going to ask about, but I want to talk about another workforce issue, maybe take this one step beyond: workforce shortages. They're not unique in the U.S.; they are really worldwide.

Can IT, can AI be used to alleviate shortages? And as you addressed, you've already talked about supporting the current and future healthcare workforce, but what about alleviating the actual shortages?

Anne Snowdon, Ph.D., HIMSS:

It's an exceptionally complex driver of shortages. We have a global nursing shortage and likely a physician shortage as well. That is not going to change anytime soon. You can't simply throw several billion dollars to train the next generation and get yourself out of that shortage. We can't train our way out of it. The numbers are too large. We don't have the faculties even to teach as quickly as we need them.

So the question then is, so where and how does technology play a role? Technologies can play very important roles in automating systems. So right now, if I want to go and book an appointment with my physician, I may or may not have a digital tool to do that. So many are still on the phone, and maybe leaving a message, assuming they answer their phones.

So there are ways that I think technologies play an important role in creating digital environments that automate those processes, seamlessly enable patients to connect to their provider teams. And probably the most important one from a nursing perspective, from my point of view is how could digital technologies help people help themselves manage your health and care?

We have a very large percentage of population in North America and actually many countries with chronic health conditions, diabetes, heart disease, you know, COPD, all of those. Those are things that have to be managed every day. So my question is, is there not an important role for these digital tools and technologies to help Anne Snowdon manage her health and care so that we help her stay well, and she doesn't need the emergency room, she doesn't need that primary care physician visit every three weeks to make sure her sugars are on track? We can automate that work. And more importantly, give those patients the tools, the insights, the health literacy if you will, to make informed decisions that are actionable and drive towards their personal health goals.

So I think that's not a common finding. When I'm working with a lot of organizations, it's aspirational. They say, "You know, Anne, we want to get there." But in my mind, if you've got a workforce shortage, if you can't suddenly manufacture workforce, which I don't believe we can, then how about looking at the other side of that balance and helping people stay well, particularly our highest-risk populations? And use those digital tools and technologies to connect meaningfully to their provider teams, to help them do that safely, based on evidence, not what your mothers, brothers, sisters, uncles, aunts told you-

Carol Vassar, podcast host/producer:

With Dr. Google.

Anne Snowdon, Ph.D., HIMSS:

Right? Wouldn't that be a change? And so I think it's complex, but you have to go at it from multiple perspectives, helping people help themselves stay well, helping them meaningfully connect to their providers when and where they do need that insight and support, and supporting and enabling our clinicians to work much more seamlessly, easily, if you will, in digital work environments that are of very high quality.

So I think that's where the global workforce, and maybe that's the silver lining. Maybe it helps us stop and think much more quickly, and effectively think about creating those environments every nurse and every physician wants to work in, and making it easy for them to provide the incredible care that they are so talented at delivering.

Carol Vassar, podcast host/producer:

And some of the comments that you've made kind of allude to something we're trying to do here in the U.S., and I know Nemours has been working on it. We call it Whole Child Health, and that is kind of pointing the ship away from fee-for-service and more toward value-based care, or what we call here at Nemours, paying for health.

Do you think, especially from the pediatric perspective, because if we start with kids, in a generation or two, we'll have a much healthier population? Do you think there's a role for digital technology, AI, now to help turn that ship towards a value-based or pay-for-health model, which seems to have, we've been stuck here for decades trying to get there, but maybe we're here, and can AI help?

Anne Snowdon, Ph.D., HIMSS:

Well, I don't think it's a technology problem. I think the technologies have been there for a while. I think it is much more, we are a very disease management health system. Kids have never fit into that disease management health system.

As a pediatric nurse, we make the system work because it's not just that little one, it's his or her parents or the grandparents and the extended family. It's a family you are working with, and supporting, and enabling. So I believe digital tools and technologies have much to offer.

Value-based care certainly is a term that has multiple meanings, but in my world, how do those digital technologies help this little one and his or her family achieve their health goals, not the ones I tell them they need to achieve? How do we help them help themselves? And it's about health goals, but the driver of that is, how does it get reimbursed?

So if we're only reimbursing for a diagnosis, and this little one certainly has a diagnosis, but the goal is not the diagnosis. The goal is, let's help him get to school. No reimbursement to help him get to school. There's a reimbursement for a clinic visit to review his medications for his illness. So I think it's multiple layers, and digital tools absolutely can get us there because it can drive those outcomes towards those health goals that that family decides on with their provider team.

So my goal is to get the little one to school because he hasn't been in school for eight months. That's a great goal. It's not a reimbursable goal. So how do we help the system shift toward health outcomes, health goals that are defined, can be tracked and measured, of course, but done so seamlessly with those digital tools so that you don't need 17 clinic visits between April 15th and September 4th when they all go back to school.

So it's about the reimbursement systems. It is moving towards a proactive approach. How do we keep people healthy and well? And how do we reimburse for that? Meaning, how do we incentivize them? Because right now, the more diagnoses, the more you get reimbursed.

So I think it's a layered approach that technology is not your problem. Technology was there, I'd say five years ago, maybe 10, probably 10 actually. It's being able to create a system that supports and drives it and incentivizes it. And it's not something I see very often. For example, what are the outcomes health systems should be held accountable for that keeps people well? That's a good question.

Carol Vassar, podcast host/producer:

That's a very good question and an unanswered question, or at least inconsistently.

Anne Snowdon, Ph.D., HIMSS:

Yeah, because I mean, there are some, like, okay, we can decrease our readmission rates. Okay, but a readmission rate's tied to an admission. So okay, that's a slice. That's one. How do you keep that person from ever needing to be admitted? I mean, apart from the urgent accidents and trauma and the things that just need to ... They happen. And yes, you can prevent some of them, but it's not like with chronic conditions, we have best practices pathways.

How do we help people stay well and meet their goals and get reimbursed or incentivized, because if you don't, it's called follow the money, Carol. Doesn't happen.

Carol Vassar, podcast host/producer:

You're right. You're absolutely right.

Anne Snowdon, Ph.D., HIMSS:

Just doesn't happen.

Carol Vassar, podcast host/producer:

I want to talk about you brought up the example in talking about pediatrics that getting the child to school, maybe transporting them to school, is not reimbursable. How do we work in a cross-sector collaborative kind of way to make sure that we move digital health forward, especially in the role of pediatrics?

You're a pediatric nurse, and how does HIMSS work to kind of facilitate that, so that there are partnerships and meaningful partnerships between governments, health systems, and the private sector, and the nonprofit sector as well?

Anne Snowdon, Ph.D., HIMSS:

Yeah, it's a big question. Having spent about 15 years in research studying how does innovation happen in health systems, there are some things we're pretty clear, work and don't work. We are very clear, this is a multi-discipline, multi-sector challenge. Pediatrics is a great example. It's never just going to be that hospital clinic that helps that little one get to school. It's the clinic with their expertise around his or her diagnosis. It's the school. It's the family's social support network. It's the challenges at school and in the community that enable that little one to have the very wonderful, healthy growth and development, the access to healthy foods, all those things.

It's a team sport, is my point. And we tend to work in our organizational silos because that's how we're structured. And in the U.S., it's very much structured that way because it's driven by revenues. In Canada, it's not driven by revenues because there's really no such thing. It's a tax-based system, but we still stick to our silos.

So it's not just about reimbursements and revenue. It's about how do you create the conditions that wrap around that community, that group of, that population, in this case, it's children and families with specific health challenges or goals or needs? How do you wrap the team around them, and move them, and support them to be able to achieve the health goals that are meaningful to them?

So in Canada, we have very large Indigenous communities and populations. They have very specific, very culturally-based health goals. How do we help them achieve and support them to achieve their unique health goals that are very different from an inner city community, different again from rural?

So we have to be much more, I used to say one-size-fits-one. It's not one-size-fits-all. There's no clinical pathway that's going to work exactly for every one of those kids at that hospital clinic. There's probably 30 different versions of it. So, how do we create the infrastructure and the systems that help those little ones achieve those goals, or help those families in those unique populations move towards their health and wellness goals in a way that's equitable and ethical?

In a disease management system where we've been for many years, actually a few decades, we tend to prescribe. "You're diagnosed with X. You should take Q, R, and T in terms of therapy. Off you go and you'll be fine." That prescription doesn't work for everybody. There's no drug that works for absolutely every patient who needs it. There's no therapy that works, there's no surgery that works. So we need to move to that more personalized system.

That's where technologies, those digital tools, AI, in particular, can tell you, and has. And I've seen it. Those are the Asia-Pacific countries, and Taiwan was most recently. Based on everything in that that we know about that particular patient can create that risk score. A clinician, a nurse position's never going to spend time looking at 10 years of a health history and calculating somehow, magically that same risk score, but an AI tool can do that.

So I think there's a real intersection here between those impressive technologies that, by the way, they are evolving faster than any of us can even understand, almost, right? But having it focused very specifically on what does this population need most and how do we know that? And defining success is a way to say that, and measuring your progress towards success.

And if it's not reaching your goal's pivot, be agile and move differently. But that takes a team. It's never just going to be that nurse or that physician. It's that multidisciplinary team. And it's usually, often in communities, multiple and different organizations that all create the conditions for people to thrive and achieve their quality-of-life goals. And everyone has that opportunity, and that's really the equity piece of it.

Carol Vassar, podcast host/producer:

And it sounds to me like integration of both people and technology is really key here, as you outlined. I want to ask one other question about integration. And I know the promise in 2010 when the HITECH Act here in the U.S. was first coming to be, and electronic health records were coming to be, was the secure exchange of those healthcare records between providers, between providers in other states. And I'm wondering where we stand both in the U.S. and Canada on that kind of exchange and integration, but also globally?

If I'm in London and I accidentally break my leg, the people in London, in the emergency room, are they going to be able to have access to my records here in the U.S? Are we at that point? Are we headed to that point? Is that integration happening?

Anne Snowdon, Ph.D., HIMSS:

Yeah, I'd like to say that it is. I haven't seen it. It doesn't mean it doesn't exist. But the HITECH Act was, I would say, an incredibly impressive legislation that really did drive global insights and actionable next step. And it was primarily my understanding that it is heavily focused on hospitals to adopt electronic medical records.

One of the challenges there was it didn't specify that by adopting that EMR technology, you have to advance your interoperability flow of data to all of those relevant community agencies, people, processes to make that dream come alive. And that says, if I go skiing in Vail, Colorado and break my femur, somebody can access my health record from Ontario.

I have not seen that to date. There has been wonderful progress on interoperability. We have a tool called the Digital Health Index, actually, that has tracked and measured over the last three or four years impressive progress on the flow of data across systems and populations. But whether it actually comes right down to whether Carol, who has an accident in England and needs that record from Connecticut, I haven't seen it.

The technology's there, policies, processes, even those questions that seem simple but aren't, who owns what data, and how does consent to flow data from point A to point B happen? Still working, but it's not a technology problem. It's a challenge around ethics, consent, or data ownership, data standards, and all the many tools.

But if we can get there, and I know jurisdictions are. We just mapped an entire public health digital capacity in the state of Missouri's public health system just to help that state understand, where do we have that flow of data, that interoperability, those analytics we need to inform decisions and where don't we? So, those kinds of approaches.

I'm seeing the progress in terms of, how do we get there? What tools can we use to measure where we are today to understand where we need to get to tomorrow? So I would say it's a stay tuned. I am not sure I can tell you exactly when you should expect to see it, but there are cities, I know, where in Canada, for sure, if I happen to be in an emergency room at one hospital and I'm referred to the hospital across the street, I actually have to carry my chart over there. So it's-

Carol Vassar, podcast host/producer:

Really?

Anne Snowdon, Ph.D., HIMSS:

Yeah. Well, and probably the same in the U.S., although I haven't checked it lately. But if you're a hospital system owned by, I don't know, one company or one organization, and you're not affiliated with people across the street, I'm not sure that data flows really simply either, unless it's flowing through a patient in a portal and that patient takes that data to that next organization.

So it's not there yet, but it's not a technology problem. It's got a lot of complexity and drivers around it in terms of policy, frameworks, consent, data ownership standards.

Carol Vassar, podcast host/producer:

Hopefully, a future state.

Anne Snowdon, Ph.D., HIMSS:

It absolutely would solve many, many challenges, and we are making progress. I'm about to publish a paper on some significant improvements in interoperability globally, but we're not quite there.

Carol Vassar, podcast host/producer:

Pediatric Nurse Dr. Anne Snowdon is the Chief Scientific Research Officer at HIMSS.

MUSIC:

Well beyond medicine.

Carol Vassar, podcast host/producer:

Thanks so much to Dr. Snowdon for joining us for this episode of the podcast, and thank you for listening. Looking for more insights on children's health? Well, look no further than our website nemourswellbeyond.org, where you can find previous episodes of the podcast, subscribe to it, get our monthly E-newsletter, and leave a voicemail with your idea or ideas about future podcast episodes. That's nemourswellbeyond.org.

You can also subscribe to the podcast on your favorite podcast app or visit the Nemours YouTube channel to hear and see each episode. Our production team is growing. Thank you to this week's team, including Cheryl Munn, Susan Masucci, Lauren Teta, Sebastian Riella, Steve Savino, Brit Moore, and Alex Wall.

Join us next time when a patient advocate and storyteller joins us to share her powerful personal story with Crohn's disease, and what every parent should know about Crohn's disease and IBD in children. I'm Carol Vassar. Until then, remember, we can change children's health for good, well beyond medicine.

MUSIC:

Let's go, oh, oh.

Well beyond medicine.