Mayo Clinic CIO Cris Ross delves into the transformative evolution of healthcare, from the pioneering days of Minute Clinic to the forefront of digital innovation at Mayo. With keen insights drawn from personal experience as a cancer survivor and healthcare leader, Ross explores the imperative shift from process-centric to patient-centric care delivery. He reveals groundbreaking advancements in AI technology, highlighting Mayo's collaborations with industry giants like Google to revolutionize patient-clinician interactions. Ross's vision for the future of healthcare promises a paradigm shift towards seamless integration, personalized care, and empowered patient experiences.
Cris Ross, CIO, Mayo Clinic
Megan Antonelli, CEO, HealthIMPACT
Cris Ross - Digital Talks
[00:00:30] Megan Antonelli: Welcome to another episode of Health Impacts Live Digital Health Talks. I am here today with my friend Cris Ross, CIO of Mayo Clinic.
Cris really needs no introduction to our audience. He has been a frequent guest over the years, and our friendship predates health impact to his early years at MinuteClinic. Back then, in, I don't know, 2008, 10? Retail clinics were a novel concept, and MinuteClinic was one of the first. Healthcare's sort of recent, and some might even say fast paced for healthcare, the digital evolution has ushered in Lots of technologies like telemedicine and remote monitoring and apps and wearables that are changing those service models to meet patient expectations.
And as a result, the long accepted primary care model based healthcare is changing. So I'm so happy to have you here, Cris. Thanks for joining. And I wanted to talk a little bit about, that model that's changing how. Organizations like Mayo Clinic are responding to it. And of course, the evolution that you've seen coming from Minute Clinic, and now at Mayo.
So thanks again for being here, and we can start with that.
[00:01:41] Cris Ross: Thanks, Megan. I only work for clinics that start with the letter M. Thanks. Yeah. Minute clinic was really interesting. I was there from 2006 to 2010 and it's kind of go, go years when it went from, 40 to 500 to then a thousand clinics, look, it was really founded on two kind of big ideas.
One idea was healthcare needs to be convenient when people need it. And that there was a number of kind of acute. Minor conditions that needed medical attention, but could be treated, pretty easily. And it was a lot of pediatrics, right? It was pink eye, ear infections, sore throat, that kind of thing.
Where going to an emergency room is the wrong idea. Urgent cares were usually backed up. And the idea was put it really, really close to where people shop and live and create a great patient centered experience. That was number one. Number two was taking advantage of mid levels. And at the time it was a lot of nurse practitioners and P.
A. S were coming into the field and they have the ability to practice with some autonomy. In some cases, all autonomy for a certain range of diseases. And and there was a advantage in being able to use mid level, which have an economic advantage. They're not paid as much as doctors. So the combo of the two is what was attractive and CBS bought us and then really grow us.
[00:03:14] Megan Antonelli: Yeah, it's crazy to think. And back then, I mean, there was so much conversation around, what would it do? It would move the medical home and, and, the medical home was really just. Getting traction in and of itself at that point. But then also the challenges around, just the challenges around interoperability.
And I know that you guys worked on that then. And of course, we're still seeing that now. So with the proliferation of new systems where people are going, going to specialty providers online, right. For whether it's weight management or menopause, lots of women's health, it's interesting how the specialty providers are often by demographic, and how, are we seeing some of the need for that integration happen now?
And, and, sort of, what are you, what are you thinking in terms of what we will see in the coming years as a result of that?
[00:04:06] Cris Ross: Well, I don't want to say that interoperability is a solved problem, but it is a massively improved problem. I recently gave a talk, that was intended to be somewhat humorous, describing kind of the Paleolithic era, the Stone Tool era, Bronze Age, Iron Age, and so on.
When I started at, minute clinic. I was an idiot. We were trying to integrate with other health care groups, and the idea was send a visit summary to the patient's medical home. We did that in the form of a letter, and we were running a couple of clinics in a couple cities. It was pretty easy to create a directory of doctors and mail letters.
Well, I was not going to happen at scale, so I thought, Okay, this should be easy. I'll find a way to send those message electronically and discovered that there was nothing there. So we did some pioneering work. We put some basic medical records into a format, the continuity of care record into an XML document rendered as a a soap note, and we are ready to send it.
So we kind of had the envelope, right? We sort of had the contents, right? We were using clinical coding the right kind of way, but there was no network with which to transmit it at all. So we tried to do something kind of on the side with sure scripts that had some limited traction. I then went to share scripts later to try and push that forward in the error of directed exchange that came out as the form of meaningful use, blah, blah, blah, blah.
That's history, but it's a good reminder that, 15 years ago, we literally had nothing and we were dealing with do it yourself stuff. And now, you look at the ONC records and data and what, 91%, 90 percent of. Clinics and hospitals are connected to one of the two big data exchanges.
And now Tefco, is really going to keep moving that along and the 21st century cures and so on. So, when I look at the records that come into Mayo clinic today, now we're talking about the quality of the record and the conciseness of the record. And boy, there's a lot of computer generated text.
And can we get rid of that? And how do we make sure we don't have duplicates? It's the refinement that we're trying to do now. Yeah,
[00:06:23] Megan Antonelli: it's amazing to think of the, just the progress I mean, and I, when we used to sort of complain of the slow pace it has, it's, it's moved quickly and there's been a lot, a lot of progress made in terms of just the implementation in particular, you know, just the access to the information that patients can get.
I think that's right. And I know we've talked about this before, too, in terms of your experience as, a cancer survivor as a patient who went through the system and to go through the system, not only as a patient, but a, a leader of, the most amazing healthcare system in the world and, and to go into that, but to see.
The inadequacies of what gets communicated. And I think you've mentioned kind of, we're talking now about kind of this, there's multiple digital front doors that people are going to go through because they have multiple providers and it's it, multiple places of entry and then, but when you then get in there and you are treated, you tend to have one, one door that, that you exit from, just by the nature of that and how we handle patients there.
Is not always the best way. And I think you've talked about that, but I'd love to hear you, sort of talk about as now you're luckily a couple years from that experience and what you learned. And then, of course, what you've implemented or focused on, how did that change your efforts at at Mayo?
[00:07:46] Cris Ross: Yeah, so the thing that I noticed being a patient and I, I went through cancer twice. So the first time was just after we implemented our EHR. And my focus was, how's the EHR doing? And I could find lots of ways in which we weren't optimized and. We still live with how do we make doctors and other clinicians feel like the electronic tools work for them and patients and not the other way around.
Maybe by the 2nd time around, I was noticing things like, we have a really good digital front door at Mayo, but we have a really terrible digital backdoor. And I don't mean to disparage my colleagues. We're just not good at it. We don't provide survivorship support or aftercare or support for caregivers.
And we're getting better at it, especially in things like our hospital at home. But one adjacent thing that I've been sort of focusing on recently, Megan, that might be useful is sitting back and thinking about the limited times, mail's a great system, places where I ran into things that were suboptimal.
And for most part, it was where we and others have focused so much on quality improvement for really good reasons, and therefore, to improve quality, you have to improve processes. So we've got these perfect processes. That are getting safer and safer and better and better, but they don't connect with each other.
And so you get this disjointed experience. And it's because now we're at the point where we need to say, hooray, we've done a good job at processes, but we need to pivot towards delivering health care as. Integrated services and products from a patient centric view, which means challenging some of the processes that we put in place that have kept us safe or help us make margin or whatever those things might be.
So, if I'm on a crusade, it would be to think about how can we move from process centric to patient centric and patient centric in the form of creating products and services that they want to consume.
[00:09:50] Megan Antonelli: Yeah, which is not easy.
[00:09:52] Cris Ross: No, but you got me on my soapbox there. So,
[00:09:54] Megan Antonelli: no, I like it. Well, that's, that's what we want to hear about is, is what what you're focused on.
And, and I think, and it it's that, it's the Holy grail right? Is to, to really give patients what they need when they need it in, in what they're looking for. And of course, that. And that applies to all patients and the changing demographic and the needs of them. So, we talked a little bit about history.
We talked about where you're focused on now. And I know you've, you've spent and done so much in the AI space with, with Mayo share with our audience and the little time we have left, just a little bit about, where things are going with, Large language models, how you guys are responding, what you think that's going to do.
And really, what are the implications for patient centered care within AI? And what are some of those opportunities?
[00:10:41] Cris Ross: Yeah, we could talk about that for a long time. So, there's the before chat GPT and after chat GPT era, and then the kind of OG era, we're doing lots of algorithm development that was super cool.
And that continues, it's just not quite as sexy, and it doesn't get the headlines that Gen AI does. Gen AI is an unbelievably powerful set of technologies. That's the culmination of a lot of things brought together. So we have a major partnership with Google. We have partnerships with others around model building and other kinds of things.
We're going to do a whole mix of build, buy, integrate and move forward. There's a lot of things that we're working on that will be inpatient care that have to go through an FDA software as a medical device process and other helper tools like voice that are in a different space. And I think that 5 years from now, the interaction of clinicians with the electronic health record will be very different, and it will be increasing amounts of voice.
And less typing and clicking, and I think our clinicians will be extremely happy with that future, but it depends on the voice technologies being reliable enough for us. Did can we bake them into the workflow and so on. But. Those kinds of ways that we change the way that the doctors and patients interact is super cool.
It's going to be an accretion of a lot of little AI, and I like to talk about little AI. But we're also going to do some big AI. Diagnostic tools, treatment tools, and so on. So I'm super excited about this. I wish I was 30 years younger. The future is unbelievable. Holy smokes.
[00:12:29] Megan Antonelli: Yeah, it is. It is amazing to have seen and I, as we've watched this sort of evolution of innovation and implementation and adoption around health care technology, what we've seen in the last 3 years, and, amidst the pandemic and then in the time from it.
Has been amazing, and it and it will it will change. I mean, a lot of the things that we wanted for so long, changed overnight, in terms of access to, sort of telemedicine and virtual care and things like that. And certainly not with no work. I know it wasn't that easy, but to some, it seemed that easy.
So, but the future is bright and I like that. So will we see you? I will see you at hymns. I hope
[00:13:12] Cris Ross: I'll be there.
[00:13:14] Megan Antonelli: Fabulous. Well, I look forward to it. And thank you so much for joining us. It's wonderful to see you and we'll see you soon.
[00:13:20] Cris Ross: Megan. Anytime.
[00:13:22] Megan Antonelli: Thanks.