Technological advances are nothing new for caregivers, who have been saturated with new tools to "help" them for decades. But are those tools actually helping? And what can the latest innovations do to alleviate the burden caregivers face on a day-to-day basis? Dr. Heather Schmidt, System Medical Director, Healthy Work and Wellness at SSM Health, and Dr. Ann Cappellari, Chief Medical Information Officer and System Vice President at SSM Health, join the show to discuss their findings on how artificial intelligence can assist caregivers in their well-being. They discuss how technology has often added to the administrative burden caregivers face, offer insight into tools that help caregivers connect with their patients, and share how AI can help with the workforce shortages that American health care faces.
Technological advances are nothing new for caregivers, who have been saturated with new tools to "help" them for decades. But are those tools actually helping? And what can the latest innovations do to alleviate the burden caregivers face on a day-to-day basis?
Dr. Heather Schmidt, System Medical Director, Healthy Work and Wellness at SSM Health, and Dr. Ann Cappellari, Chief Medical Information Officer and System Vice President at SSM Health, join the show to discuss their findings on how artificial intelligence can assist caregivers in their well-being. They discuss how technology has often added to the administrative burden caregivers face, offer insight into tools that help caregivers connect with their patients, and share how AI can help with the workforce shortages that American health care faces.
Brian Reardon (00:08):
Welcome to Health Calls, the podcast of the Catholic Health Association of the United States. I'm your host, Brian Reardon, and with me is Josh Matejka. Hey Josh.
Josh Matejka (00:16):
Hello Brian.
Brian Reardon (00:17):
So for this episode, we're going to be talking about using AI to protect caregiver well-being, and we've got a couple of guests actually in studio today. We've got Dr. Heather Schmidt, she's System Medical director for Employee well-being at SSM Health, and joining her is Dr. Anne Cappellari. She's the Chief Medical Information Officer and System Vice president also at SSM Health. We're going to bring them in just a moment. But Josh, for this episode, obviously all season we're talking about technology, humanity, and well-being is sort of the topic of this conversation as it relates to technology. In your mind, how does, again, well-being, and we're talking about physicians, clinicians, play into our ongoing conversation around technology and humanity this season?
Josh Matejka (01:02):
Yeah, I think of two things. Whenever we have this conversation about well-being, I think about saturation and I think about connection. There is always a new technology, kind of making its way into our lives and becoming a daily part of how we operate. Whether you're a caregiver, whether you're a creative person, whether you're an administrative person, there's always new technologies to summarize things, to suggest things, and it just becomes a point where every day we're working with all of these different technologies to the point where it's saturating our everyday lives and then connection. Everybody can understand that we have social media, we have emails on our phones, we have text messages, we have phone calls. When you think about all that together, it comes back to this place where at Catholic Healthcare we want to be providing whole person care, right? Not just physical, but mental and spiritual as well.
(01:48):
And the weight of the saturation and the constant connection that we have with technology just is so heavy and it can weigh on your mental health, it can weigh on your spiritual health, and that in turn becomes part of your physical health. And that's just me speaking from my perspective. And I can't imagine how many new technologies are being thrown at caregivers, nurses, doctors, technicians, all day every day. So really this conversation we wanted it to be about how do we turn, what can be a subtractive element into something that is positive and is helping caregivers protect themselves mentally, spiritually, physically using those tools that could be negative and turning them into a positive.
Brian Reardon (02:26):
Yeah. So Heather and Ann, that's a challenge for you here of how we turn that technology and that's what we're going to talk about. So let me again reintroduce Dr. Heather Schmidt. Again. She's System medical director for employee well-being at SSM Health. And we also have Dr. Anne Cappellari, she's the Chief Medical Information Officer and System Vice President at SSM Health. Great to have you both here in the studio in St. Louis. So let me start off with you both are presenting this afternoon as we're recording this in St. Louis at the Theology and Ethics Colloquium, the CHA hosts, the topic of your presentation is about how artificial intelligence can help alleviate work stress. So I guess a logical point would be, and maybe I'll start with you Heather, is tell us a little bit about what you're going to present. If you can give us sort of the overview summary maybe as a starting point.
Heather Schmidt, MD (03:10):
Sure. Happy to. So basically we are going to present current state, right? Really make sure people understand what is it that our providers are facing day in and day out, much like Josh just said. That saturation piece, we call that cognitive burden, that administrative burden, the workload that we're trying to really alleviate. And so we're going to talk a little bit about that, set that current stage and make sure people really feel it. And then our goal is to really talk about what are some potential solutions to help alleviate that burden and really think about how can we be innovative and transformative while also being really cautious and making sure that we're aligning with our mission and taking care of people in a way that's going to allow them to sustainably stay in healthcare and do what they're meant to do.
Ann Cappellari, MD (04:00):
As we look at the healthcare and technology environment, it's an interesting one in that EHRs or electronic health records have come about mostly through the two thousands, and everyone thought they would be an absolutely fantastic idea except the clinicians doing medicine and building on top of that, every next technology feels often to the clinician as a burden or put upon or you are doing this to me. And the remark about saturation is a decent one because more and more vendors are in the space. As the technology gets cheaper, there is a space that is just flooding you with new shiny objects. What is so amazing and positive about this space now in the chat, GPT I'll say very generically, which I know that isn't generic, but that type of technology that we call large language models is actually revolutionizing what we can do for the clinicians in a way that they are asking for it rather than receiving it. So it really is a shift of what we can do for the clinicians and equally we have to put in the forefront the patients and their care.
Brian Reardon (05:20):
And you're both physicians, you work with physicians. So what are you hearing from your colleagues or maybe what you're experiencing yourself as far as the stress and burnout? Is it again, post covid or during COVID, obviously it was just we talked a lot about that and the tremendous amount of pressure on those providing care. From your sense, has that gotten better or is there just more that's being piled on? And can you give us maybe level set? Where is the physician at as far as just generally speaking, their stress level and their level of burnout?
Heather Schmidt, MD (05:52):
I'd venture to say we're not much better than COVID.
(05:55):
Really. There are certain things are better. The dealing with that global pandemic and the fear and uncertainty and not sure what we were doing was one whole level of burnout and often even referenced as moral injury. I think now what we're seeing is it's return to normal and it's not right. It's not normal. I mean just the rapid pace of change in healthcare, the rapid pace of change in technology that we mentioned, the expectations of patients, the frustrations of our patients not being able to be seen, not being able to get in when they need to, not having the experience that they're hoping to have because there's so many patients and there's never enough providers. There
Ann Cappellari, MD (06:44):
Was significant burnout before covid even hit. And the pressures during covid were very different. They were clinical, they were self-harm. Dangerous from a standpoint of I go into these facilities, I may catch this disease that at the beginning of people recall, most people were actually dying. Most people that came through our health facilities all across the country and all across the world before we figured things out better, there were so many deaths of nurses, of doctors, of respiratory therapists, of all the ancillary staff. And what that period to me started enacting is a higher level of workforce shortage.
(07:25):
Some were sent home because we didn't have the clinics open and they recognize the stress they were under during these situations and said, I can do differently. And I think that's the biggest, to me, the lasting touch point of covid is our workforce. People found other opportunities, saw the stress they were under. And now it's almost like that period of time we've just jumped with the same complaints about our workplace design and our workforce management and where that is now. And we're at just such a significant deficit. And in the years to come of that workforce, that puts such pressures on clinicians.
Brian Reardon (08:04):
Yeah. Now, and it's good to get again, a sort of a baseline to understand that tech saturation, the sort of hangover if you will, from covid, workforce shortages, all those issues are very real impacting those who provide care. So what I really want to get in this conversation is how do we address that and how do we leverage technology to really understand where the burnout is? How do you measure burnout? So maybe that's a good way to move the conversation. I'll start with you, Anne. Is in your approach to providing well-being programming and I guess interventions for caregivers, where do you start?
Ann Cappellari, MD (08:39):
Once again, I'm a clinician. I'm trained in emergency medicine. I work in informatics, which is a specialty that is like a translator between the tech and the clinicians. And so there's someone who needs to go a little deeper. I am not an app developer, don't have an interest in doing That's okay. We don't want to get into too much in any of that. It jargon here. So the approach with the newer technologies, with these generative technologies, with chat GPT, copilot and perplexity, and there are just a whole host of them. There's this idea of large language models and it is using language to create outputs, billions and billions of data, of language pieces that may have come from Reddit and may have come from the Grey's Anatomy textbook. So there's always that intertwined. But you talk about technology saturation historically in the digital age, which rolled through healthcare prior to this artificial intelligence age, we looked at it as these tech companies bringing a solution and we try to find a problem to f it their solution. And for these newer language models, the problem is their documentation burden that many clinicians are putting off till 10 11 at night. More care given through email or texting type technology rather than in-person visits.
Brian Reardon (10:07):
Patient portals.
Ann Cappellari, MD (10:08):
Exactly. The patient portal, which is excellent. But there are different philosophies about that patient portal. We can talk, I won't digress too much there, but that is another thorn in the side. But the documentation burden is real constant and often putting off clinicians to do work at 10 and 11 o'clock at night and the generation as an aid to create clinical notes is one of the biggest asks that our clinicians have for us in that we have been starting to deliver over the past couple of years. And that has been an absolute instant mental burden relief.
Brian Reardon (10:48):
And it's great to hear that that is being used by physician. We talked about that I think in the first episode for this season about that ambient conversation, picking that up and then converting it to notes. So that's great to hear how that's helping physicians. And Heather, I don't know if you want to add anything more to that,
Heather Schmidt, MD (11:03):
Just personally I will tell you that the other piece is that inbox burden and this idea of trying to provide care in a way that aligns with our training and aligns with how we learned to give and deliver high quality safe care and then recognizing that we're human and it's really difficult to keep up with it all. There's somewhat of a hesitancy, and you can probably speak to this more. Some people don't want to give that up. There is, even with technology, much like any other change, adopting that new technology is also a bit of a challenge. So there is some reluctance in doing that. I just read this article this week about a physician sharing that part of her emotional healing with dealing with difficult patient outcomes and difficult patient diagnoses. And that care is through that reflective writing of doing her note. And I thought it was an interesting perspective because to me it's like no brainer. If I could have a tool that's a listening to the conversation, I can sit and look and engage with my patient in the room and it could be doing all of the part of medicine. I don't like the documentation. For me, it's just give it to me, sign me up yesterday. But there is that piece that some of us actually deal with that heaviness of caring for patients through that reflective writing of doing our note.
(12:36):
It's an outlet. It's an outlet, and we have to keep that in mind too. So that's where it's not a mandatory thing that we would make everybody do, but I think that having those people that are willing to try and that are willing to say, you know what? This is worth me letting go of control a little bit to be able to make sure I can do this for longer and that I can close my charts on time and come home and spend time with my family or exercise or sleep and take care of myself is I think just something we have to continue to move forward with.
Brian Reardon (13:10):
And Heather, you've been involved with the CHA well-being task force, and one of the things that I thought found interesting in your presentation was applying technology to really understanding stress and burnout levels. A lot of times that's done right through a survey, you get sort of subjective information about where burnout's occurring, how bad it is. So can you tell us a little bit about the tools that you're using at SSM to really gauge the level of stress and burnout among your caregivers?
Heather Schmidt, MD (13:39):
And I first want to just preface that we are early in this work, so it is very innovative, I would say even cutting edge. But the idea of really understanding that subjective feedback is so important. So those well-being surveys are so important because they give us the voice of those that are answering the survey. Unfortunately though response rates in any type of survey seem to be dwindling. And so what we know is there is a non-response bias to these surveys that if people are not answering it, they're already in trouble. They're either disengaged, they're burnt out, they have a foot out the door, but we are not really capturing their voice effectively. So being able to really also recognize what are those objective variables? There's years and years of research at industrial and human factors engineering. We know what defines good work. We also know what are those data variables that we know impact well-being at work. So those what we're calling work determinants of well-being.
(14:43):
And those can actually be captured through objective data. We are already measuring. So things in our EHR, even our EHR does have a nice platform for us to be able to look at and what providers are struggling with work after work or pajama time. How long are they spending in their inbox? How long are they spending with doing chart review? But also what about in the H knowing and understanding demographics? Are people taking time off? Are they actually working through their lunch? Are they overlapping appointments? Are they double booked? And what does their weekend look like? Are they logging in when they shouldn't be? Right? So there's these ideas of being able to capture these objective data variables and then use predictive analytics and machine learning to really give us an idea of what is that risk? What is their overall workplace look like? What are those drivers that are impacting them individually?
(15:42):
We know that healthy providers are productive providers. We go into medicine to see patients. That's what we're here for. And so what are those other factors that are kind of inhibiting me and that ability to be productive and what are ways that we can more proactively identify those and then address them. And so like I said, we're really early in this work, but the idea is that this particular tool would allow anyone that's looking to do a well-being intervention to monitor this. It could also just be any other initiative or any other new rollout of a program or a policy that we can see how is this ultimately impacting well-being and risk of turnover. Physician heal
Ann Cappellari, MD (16:29):
Thyself is one of the age old adas, shall I say adages that we hear about that you are not taking care of yourself as a clinician. And I just want to emphasize that the work Heather is doing is new, but it is also mandatory. Once you reach a point of burnout, you do not have that insight to come to someone to say, I am burnt out. You just do not. Amen. So that is just the first step in recognizing that we do need these objective tools and that it is critical. And I would equally even say for a chief of medicine to be trained to counsel their burnt out colleagues when chances are they have some medium level of burnout themselves
(17:24):
Is also something that Heather and her work and me alongside try to tackle to say, we are identifying this. We're not just giving your name to someone else. We're actually going to put you in a program of wellness with these steps to help do action to remediate, not to put it off at someone else, but so it is the analytics behind it, gathering the data, churn the analytics through this innovative database to understand and then have a good program design as how you react when you find the people who you feel likely need a lot of help.
Brian Reardon (17:59):
And I would suspect that physicians probably react pretty positively to data, right? Because they are scientifically minded. So if you can give them data analytics, how are they responding to that?
Heather Schmidt, MD (18:10):
I think that there are some that are receptive. I also think the thing to keep in mind is that always has to come to inform a conversation, right?
(18:18):
So yes, you have to make sure you have some data, but I think that ultimately that data doesn't define who that provider is as a person. Ultimately, they could have a million other things going on at home or they could have things going, but it really has to be relationship based. And we need to continue to make sure that our leaders feel equipped to have these conversations. Much like Ann was saying, it's not just the providers that are burning out. Our leaders are also burning out. So how do we make sure they feel supported, that they have the information they need, but also maybe those skills and resources that they need as well. But even I think higher level, what I'm hopeful for with this tool is that it doesn't necessarily have to be an individual intervention. This has to be what trends are we seeing?
(19:02):
How are we identifying these things that we can actually change the work in medicine? We have clinical frameworks, we have evidence-based guidelines. We do things because we know it works, right? But unfortunately, as more and more burdens and challenges and financial pressures continue to escalate in healthcare, each and every person working in healthcare, every leader we all have our work to do. And if we're not keeping in mind that end user, that physician, that clinician, that nurse or the team member that's nonclinical, if we're not paying attention to how every one of our initiatives, every one of our guidelines or challenges are impacting that person, then we're causing harm. And so this has actually been recently identified as administrative harm. It's really been defined. We know it's playing a role. It continues to create a divide between hospital administration and the practicing providers. And we need to collaborate and come together so that we can understand what is it that's actually working, how do we maybe staff differently? How do we standardize with guardrails but still allow some flexibility? And so that's what I'm really hopeful for with this particular tool. And I will add to
Ann Cappellari, MD (20:20):
That, that as we try to identify struggling physicians through this database, the reaction also is why are you looking at me?
Brian Reardon (20:34):
Interesting.
Ann Cappellari, MD (20:35):
Why are you metricking me?
Heather Schmidt, MD (20:37):
Yes, it can be.
Ann Cappellari, MD (20:38):
And the mental health stigma, which is a million times better with the younger generation than it ever was with my gen generation. It still is like a scarlet letter. And so you are identifying that physician or the provider and saying, you're burnt out, which to them is, I'm weak, I have a mental health problem. Absolutely. You are going to look at my work suspiciously. And so there's that whole other battle to fight to have them accept that they're in a place that they could use resources and that will be actually incredibly difficult.
Brian Reardon (21:18):
Interesting. Josh, as we're wrapping up here, I want to bring you back in anything you want to comment or ask.
Josh Matejka (21:23):
Yeah, thanks Brian. And thank you, Dr. Cappellari and Dr. Schmidt. I am fascinated by the downstream implications of these types of tools. Obviously the implication is that a caregiver who's not taking care of themselves is not only not taking care of themselves, but that can impact the care that they're giving to their patients and the communities that those patients live in. What kind of potential is there for these types of models, these types of predictive tools to measure what kind of impact, how caregivers who are taking better care of themselves, what kind of impact they have on the communities? Because it would make sense to me that if caregivers are taking good care of themselves and are in a better place mentally and physically, that their patients are going to get better care and those patients are going to start taking better care of themselves, which enables them to take better care of their families and their communities. Do these tools have potential to measure what kind of impact that could have on a larger scale?
Brian Reardon (22:18):
Like health outcomes?
Ann Cappellari, MD (22:19):
And that is the exact result we want.
Heather Schmidt, MD (22:21):
Amen. I was going to say this is population health. I want this.
Ann Cappellari, MD (22:24):
Yes. And that to measure that patient impact, it will take a long time in large cohorts, but it would be through secondary kind of leading indicators. Like are they refilling their medications? Are they regularly attending their appointments? Are they staying out of inpatient mental health admissions now because they've been managing their depression better? And is their diabetes being managed better because you are able to counsel them and have that sacred patient physician and provider relationship. And that is what we have been missing and devaluing in my opinion, just to give the time to do that. And that is also what we're trying to do in these initiatives.
Heather Schmidt, MD (23:13):
Yes, we were just talking about this last night. Do I have time to say this? Sure. We were talking about Whole Person Care and how when we think about Whole Person Care, that relationship is at the center. You have to have trust, you have to be able to communicate freely, you need to be able to share your concerns. And that's a difficult relationship to establish when you have no time, when you have seven minutes to address 15 different health complaints. So how do we actually redesign care? How do we bring it back to that relationship? And I am very hopeful that when we can start thinking about the way we do our work differently, the way we're measuring these outcomes, the way that we're really able to resource differently, that we can hopefully get back to that.
Brian Reardon (23:56):
And this conversation, I think has been hopeful because we think of technology is sort of coming in and dominating and being this sort of impersonal thing. And what you both shared with us over the last 20 plus minutes is how this technology can actually make our caregivers more human address some of the concerns and issues they're dealing with. So I really appreciate your insights and this gives me hope that, again, as we're talking this season about technology and humanity, the humanity piece came through really loud and clear. So I thank you both for sharing your insights and spending time with us.
Heather Schmidt, MD (24:29):
Yeah, thank you. Thank you so much for having us. Yes, thank you.
Brian Reardon (24:32):
And again, that was Dr. Heather Schmidt. She's System Medical Director for Employee well-being at SSM Health and Dr. Anne Cappellari, she's Chief Medical Information Officer and System Vice President at SSM Health. I'm Brian Reardon, your host, and this has been another episode of Health Calls, the podcast of the Catholic Health Association Health Calls. Executive Producer you heard is Josh Matejka. We had additional production support from Yvonne Stroder and this episode was engineered here in St. Louis by Brian Hartmann. At Clayton Studios. You can find Health Calls on all of your favorite podcast apps and services, as well as on our website, chha usa.org/podcast. We'll also have other material on that page related to this issue. And if you enjoy the show, we always ask that, give us that five star rating. It really helps us and share your feedback. We'd love to hear from you. As always, thanks for listening.