Happy Doctors and Technology: A CMIO and Practicing Physician's POV

Phil Sobol: 

Welcome to The CereCore Podcast where we focus on the intersection of healthcare and IT, from practical conversations to strategic thought leadership. Let's unpack the decisions, challenges, and journey of those whose purpose it is to deliver technology that improves healthcare in their communities. 

Today we're pleased to welcome to The CereCore Podcast, Dr. Aaron Parker Banks, the chief medical informatics officer at St. Claire Healthcare in Morehead, Kentucky. Dr. Banks has been part of the medical staff as a family medicine physician since 2016. Today, as CMIO, he is a champion and liaison that closes gaps in technology for clinicians and helps make patient care better for all involved, and he continues to care for patients at a local St. Claire Healthcare Primary Clinic. Dr. Banks, welcome to The CereCore Podcast. 

Aaron Parker Banks: 

Thank you for having me on. 

Phil Sobol: 

Well, I barely scratched the surface in introducing you, but most people don't want to hear from me. They'd love to hear from our guests. So if you wouldn't mind, just tell us a little bit about becoming a physician and your work now at St. Claire Healthcare as the CMIO. 

Aaron Parker Banks: 

Yeah, no. Yes. I'd say, with a lot of us, it's a very hard description of how we arrived where we're at and how we've moved along. Starting now, my mom was a nurse at the local ER at West Liberty, Kentucky, and she was under an amazing family physician and he really molded me and really set the fire for family practice. And seeing him know what everybody was doing at church, while also still being able to provide good quality care, know everything that was happening with the families, could keep up from birth until death, and seeing his practice evolve and his overall commitment to the community and the health and wellness really struck a fire. 

And then, unfortunately, he passed away. After that we went through seven different physicians and it was like a revolving door and no consistency in healthcare. And whenever that happened I really wanted to be able to come back, be part of the community, be part of my heritage, my people, and provide care that hadn't been that way since Dr. Bellamy. And so it definitely pushed a big fire in my heart that I wasn't going to stop unless I reached my goals. I pushed a little hard, pushed all the way through and then went to Pikeville for medical school and then ended up staying local as one of the first residents through our AOA residency at St. Claire and one of the first graduating classes through that program. 

It was really all about training local, staying local, and making sure you're able to take care of the patients in and around the area. Because it is a different dialect and language that we utilize around here, and if you're not from here, sometimes it's very difficult to understand what people are talking about whenever they're asking for healthcare advice. So being able to bridge that gap in an area where the health literacy is at some of the lowest in the spectrum really helps re-instill that you're committed to the area. 

Phil Sobol: 

Yeah, no, that's really inspirational and just having that person that you looked up to early on and then being able to emulate and really see the impact that they had in the community and then the loss of that impact. 

Aaron Parker Banks: 

Oh, yeah. 

Phil Sobol: 

That's a spectacular story. 

Aaron Parker Banks: 

I had worked my way up to high school to become a pharmacy technician and I was the pharmacy technician on, and I remember him handing me charts and he said, "Parker, I'm done." And he had finished his charts and he said, "You go ahead and turn these in or the girls will be mad at me," and if I don't. And then he passed away. Putting that much soul and heart and into something you love so much, it really resonated on what this truly means, more than just numbers and payments and all of the stuff that has been misplaced in medicine. We've lost what medicine truly means in the nation. 

Phil Sobol: 

No, indeed. I think so much of that sometimes the finger gets pointed a little bit about technology. And so, as we talk about this, you are the CMIO there, but yet, at the same point, you also still practice medicine. So maybe give our listening audience just kind of a day in the life of Dr. Banks and how does that intersection of technology and patient care come into play? 

Aaron Parker Banks: 

It is so integral now. Technology from the moment I wake up till I go to bed. I am always on looking for new things that are coming out, AI, where it's taking us. And it's evolving just as fast as medicine. We're seeing technology advance. Because we no longer have IBM and Macs that take up a whole hallway. Now they're on your wrist. And from there to how whenever I started out, we were on paper, and integrating paper within an EHR where it was you were going to get a payment just for being able to reach the goal of getting your EHR online. 

We've seen so much of that just come to play at the same time with medicine making such advances that it's been so ingrained in me growing up with technology, because I'm still the part where Reader Rabbit was on a 7.5-inch floppy drive. And now we've advanced so far that, fortunately, I was pretty much baptized by technology, but I have to have information at the ready because every second I'm getting patient's labs are done or they've got a question or the nurse needs this. When used to it was phone call, phone call, page. 

I don't know how it would be if you didn't have it, but today with the small outage that was around the area and the world, it definitely shows you one small cog out of the wheel, you don't realize how integral it was. And I had so many physicians reaching out that it had been so long since we'd had to truly do a downtime that some of the folders weren't where they used to be and you're having to redo all of your downtime procedures to make sure they're in the same spot that it says on the procedure log. 

Phil Sobol: 

Indeed. 

Aaron Parker Banks: 

It's interesting how it does, but Monday through Thursday I'm in clinic from 8:30 until 5:00, usually mornings and evenings are tied up with meetings. Usually they'll start around 7:00 and then of the evening from 5:00 till 7:00, usually I'm still closing loops, phone calls. Then usually I'll sit down, eat, and then start looking at patient labs for the next day. Fridays are usually, I call them corporate days, where I'm in the corporate rooms and talking to everybody about updating different programs and everything that is integral to keeping the daily grind. 

Phil Sobol: 

Yep. I appreciate you sharing that and I think you bring in a unique perspective and I think so many times there's perhaps some common misconceptions just about physicians and how they view technology. Are there any that come to mind with you or really anything that you would wish that others in the healthcare technology industry really understood about the physician community? 

Aaron Parker Banks: 

Yeah. Well, we are physicians and sometimes we have our very much intricacies that can be delicate to navigate, but we expect things to be a certain way so we're able to take care of patients. And a lot of the times, whenever we're learning or we're taught, it's been the same format of HPI and physical exam and everything so ingrained in our head and through residency that any little change to that map or that workflow causes significant stress to the point that it's almost like a computer that cannot compute, cannot compute. 

Phil Sobol: 

Yep, yep. 

Aaron Parker Banks: 

One of the biggest things that has been hard to help is we still have a lot of generational gap within healthcare to where there's a lot of older physicians, there's a lot of younger physicians, and it's hard to really bring together those generational gaps when you were used to writing everything on paper and now we're expecting you to write it in a certain format that's different than the style you have always used as your dictation or your notes. And then we introduce dot text, and that is a whole new world for some people. They barely even know where sometimes the period is on a keyboard, but they can do a complete procedure without even worrying about any of that stuff. Sometimes it gets lost in translation, and what is so easy to us isn't always easy to some of those gaps. And so trying to understand what they're saying to be able to help them. 

And then whenever you have technology, trying to build it in code and source and it's hard whenever they're building it to work how we're telling them to, but they're not quite getting how it is in practice. So it's very much a delicate discussion sometimes, with some lively, colorful engagement, that really takes some delicacy to put that together whenever you've got IT and physicians sitting at the table. 

Phil Sobol: 

Understood. 

Aaron Parker Banks: 

But after understanding and being able to show people, you can maximize anything. And growing up in and around on a farm, we always complained about our tractor, but we still got the job done no matter how big the tractor was or how many discs you had on the rear end of it or whatever you were doing. You'd still complain about it, but you'd still get the job done. This day and age, sometimes that takes a second to show people that you've got the equipment you've got. Now let's maximize the equipment you've got and make it work for you. 

Phil Sobol: 

Yep. Indeed, indeed. No, I appreciate you sharing that. It's a great perspective. Having been a physician now for over a decade, you've experienced an awful lot of change, had this little thing called COVID somewhere in there that everyone had to deal with and upset the apple cart, so to speak, and then you introduce all of this technology and you can't hardly go a week or two without there being another article about physician burnout that's out there. 

Aaron Parker Banks: 

Oh, yeah. And right now the latest one saying physician burnout's down 2%. I'm like, "Probably because there was none of us left to burnout." You look, there's a 12-20% burnout rate and obviously your cohort's a lot smaller, so you're going to have less of a burnout. 

Phil Sobol: 

Yep. Very true. Exactly. Just on that topic, what are your thoughts around what leaders and organizations can do in and around that to help mitigate, in some way, shape, or form, that issue? 

Aaron Parker Banks: 

I think, and this is me, I think a lot of the times people need to utilize others to the maximum of their licenses and remember that a physician is not just the only person that can answer questions. One of the simplest ones I have is we had a sleep study order that took 15 clicks, and whenever you del down to the wide, none of it really truly needed to be the physician answering that portion of that question. And whenever you're within the order, you couldn't see all the stuff you needed to answer those. So it built up so much frustration, but whenever the lab can't see what they're seeing, the physician can't see what they're seeing, taking the second to look at all that from that instance helps reduce the amount of stress that's setting just for a sleep study. 

The other day I was just doing my refills and it was 2200 clicks for just refill requests, and the number of times I had to click the mouse just in the first hour and a half that I was at work, 2200 clicks to refill medications. It's clicked in buttons to death, because now that others can see what all we've been doing forever, they want to utilize it for quality and measures, which is great for patient care, but it also adds unneeded, unwanted burden to physicians and staff. And just because you can look at the numbers sometimes, doesn't mean you always should have all the information you're wanting. Because each time you add another portion of that, there's something else that could be not looked at because of all the extra clicks and buttons. 

So sometimes I think the corporate world makes it very difficult for medicine to operate as a business whenever it is. Medicine is an art, and yes, there is within it somewhat of a standardization, but there are also those times that people that have had 30, 40 years experience know something that may not be in the exact order that it was written five years ago. 

Phil Sobol: 

Yep. Interesting. That kind of leads me into my next line of questions, and it's really kind of a follow-up to what you were just talking about. It goes to, as a CMIO, you've been involved in a number of technology implementations and projects, and obviously you've been through an Expanse project and I think getting ready to do an oncology implementation. From your perspective, as organizations go into these technology implementations, what are some of the best ways to help the clinical teams get the most out of the technology, while, at the same point, what are some of those things that they need to build into those projects to ensure that the doctors are, happy may be too strong of a term at the end, but at least satisfied? 

Aaron Parker Banks: 

Sometimes being heard is the biggest and most important thing. Whenever we originally started way back when, there was no guide for anybody coming online. I don't know if you remember the changeover that a lot of institutions had where they brought from what they had on paper into the limelight. That's what they tried to mimic. And you look back at a lot of previous builds, it was built to look like the piece of paper sitting on a desk that's that they'd had for 20 years and it wasn't truly what the system wanted. 

Phil Sobol: 

That's right. 

Aaron Parker Banks: 

One thing that has been amazing in Nathan, the CereCore team, one thing that was huge for us is, one, the guidance they gave us and the ability to say, "Hey, this is what this portion is," but they also didn't let us try to build it towards ourselves, but they would guide us to where the product kind of stood for itself. And then we built our processes off the product where you're not trying to reinvent the wheel. It took a lot of those grievances that I had. 

The last one Nathan and his team was a part of, the complaints only came from outside users. None of them were from our staff. None of them were from our staff, they were only from vendors and others. But to go live with Expanse and then with the nursing and to not have what I have seen with the original start of Meditech and complaints, we just turned it on rock and roll, they knew everything that was going to be sitting in front of them. And then we would build them towards not trying to fight the water. You're using a tool, you don't need to swim back upstream. 

So yeah, I know I'll never be able to thank the team for that portion, but having that acknowledgement of our voice being heard, but also how the product is able to be utilized in the capacity it was made. That's been my biggest, whenever I'm talking to physicians and stuff like, "Hey, I get it. I know you like what you like, but we've got this, and as we have this, we need to get you working with it. Not against it. Because you can always complain about it. Always can." but the more I've gotten physician engagement from that way, the better and the happier they've been because they're able to find their intricacies to the workflow. Like whether it's utilizing Copilot or AI or dot text or eModal, you have so many tools now at your options that you're almost like Batman and have too many tools, you don't even remember which one you got. 

Phil Sobol: 

No, that's a great point. It speaks to it. Sometimes technology gets put in for the sake of technology, I would hope, for the most part, particularly in healthcare, technology investments are specifically implemented to reap a benefit. 

Aaron Parker Banks: 

Oh, yeah. 

Phil Sobol: 

It should be to make our patient's lives better, make physician's lives better, improving patient care, safety, et cetera. So as the CMIO, as you look at these sorts of things, what's your approach to taking a look and identifying those benefits, and then making sure that that technology investment delivers? 

Aaron Parker Banks: 

That is a very good question and it is a very difficult question. A lot of the times, there are so many things that can be pedaled as making this easy or better, but sometimes, without even realizing, they're taking out maybe a stop gate or a running through on a renal profile to make sure you don't have acute kidney injury while they're on NSAIDs or they didn't have a recent fall and we've given them NSAIDs for a possible bleed and it may streamline a process that might bypass another one. So each and every one that is brought to us and me, because I do try to stay up with it as much as possible, is, one, seeing others that are using it and discussing with them and seeing if they're having any troubles, and then two, using it myself and seeing whether or not it's going to benefit. 

And this is the part where it helps me a little more than others, is, actively practicing, I'm able to see it in action. And whenever you're not actively in practice and you're in meetings, and yes, you know what it does, but you don't see what it does while it's working. And that's where a lot of frustration will amount to, where we're being told 20 clicks to get everything needed. You're averaging 17 minutes to room a patient and you're being told all this by somebody who's not sometimes the one in the room evaluating the patient. 

And that's where my goal has always been, is to improve the life and quality of all my team, including physicians, but also, nurses want to get home. We need to make sure that they have it easy for the people to know when to go clean the room. There's just so many parts that not even, and I love physicians because I am one, but there are so many other people that are integral to every part of the system that each and every one of them have trouble with it. So whenever I get a product, I'm not thinking of just me and how it makes me better, I'm thinking, "Well, can they get them checked in? Can they get them checked out? Are they going to be able to get their followup? Is it going to mess up anything within that downstream before I kick it on?" Because I've been a part of them changing over our email server one time and that was lively. Yes. 

Phil Sobol: 

You can do a lot. Just don't mess with my email. 

Aaron Parker Banks: 

Yeah, it don't take much to switch everything over real quick. 

Phil Sobol: 

Yep. Indeed, indeed. Well, Dr. Banks, we'd like to kind of wrap these up, and normally it's final words of wisdom. I'll give you one opportunity for that after this. But I'd love to start, as you are a practicing physician, with, what sort of advice would you have to leadership of a hospital, of a health system when it comes to dealing with the physician community, when it deals with making decisions that are going to impact that physician community in a positive manner for the future? 

Aaron Parker Banks: 

Leadership, we all have to be able to keep the lights on, but at the same, same time, each and every person that lined up as a physician took a vow to do no harm, to improve the life care of these individuals. We're all there for the same benefit. And physicians' ultimate goal is always to improve, help the patient that is there. And sometimes it's hard to not play the numbers game, but each number is somebody's mamaw, somebody's papaw, somebody's family member, and each one of those are who we're really doing this for. Sometimes whenever we're looking at numbers on a sheet, it is not the people sitting in the bed. While we still care for them and we're still needing to do everything we do and we're doing it for a reason to make sure they have lots and they're there, still yet those people who have came to us for us in a time, that is their worst time to be able to improve their life and get them back home. 

Every bit of every decision we make is, and should be, with the patient first and foremost. And physicians, we always respond well to, "This is for your patient and improving their health," and that's how we're taught with evidence-based medicine. So that helps know that all decisions are being made for the best interest of the patient and not just sometimes for the number of dollars keeping the lights on helps a lot of the times, especially whenever I'm having discussions with physicians. So that is the one thing that has been ingrained in me ever since I was little, is this is somebody's family and you're doing this to help them and to help the family. 

Phil Sobol: 

That's great advice and a great reminder for all of us that have chosen this, I guess it's an industry, but this to be our careers, so thank you for that. 

Aaron Parker Banks: 

Yeah. 

Phil Sobol: 

Well, Dr. Banks, any last parting words of wisdom for our audience today? 

Aaron Parker Banks: 

As you can tell, I got a lot of words, so I don't know that I have any particulars, but I think sometimes the biggest and strongest thing is your team and making sure that I would not have been able to do any of this while still practicing without my team at St. Claire. Between Nick, Don, Neil, CJ, Charlie, David, there's only like six or seven, and those individuals keep an entire organization afloat and keep everything going. I only give advice and help with everything I can, but they're able to keep everything going to where it makes it a little easy for me to step in and say I did something whenever I only have a good team to help me out. And that's what it has to be, is trusting your team and they will help you in making sure that you keep the patient in mind, like I said. Because whenever you've got a team approach to a patient, you see better outcomes. And it works all the way across the spectrum of healthcare. So that is my biggest parting words. 

Phil Sobol: 

Indeed. No, that's wonderful. Well, Dr. Banks, thank you so much. Thank you for your time. Thank you for all you do for the community there, and thank you for your insights on The CereCore Podcast today. 

Aaron Parker Banks: 

Well, thank you all.