>> Welcome to this IBM Watson Health "Client Conversation." We're probing the dynamics of the relationships between IBM and its clients. And we're going to look back, we're going to explore the present situation and we're going to discuss the future state of healthcare. My name is Dave Vellante from theCUBE and with me are Dr. David Huelsman, who is a radiologist at TriHealth, which is a provider of healthcare in hospitals and John Kritzman who is with of course IBM Watson Health. Gentlemen welcome. Thanks so much for coming on. >> Thank you. >> Yeah, thanks for having us. >> Doctor let me say you're welcome. Let me start with you. As an analyst and a TV host in the tech industry, we often focus so much on the shiny new toy, the new widget, the new software. But when I talk to practitioners, almost to a person, they tell me that the relationship and trust are probably the most important elements of their success, in terms of a vendor relationship. And over the last year, we've relied on both personal and professional relationships to get us through some of the most challenging times any of us have ever seen. So, Dr. Huelsman, let me ask you, and thinking about the challenges you faced in 2020, what does partnership mean to you and how would you describe the relationship with IBM? >> Well, it is exactly the reason why when we started our journey on this enterprise imaging project at TriHealth, that we very early on made the decision We only wanted one vendor. We didn't want to do it piecemeal, like say get a vendor neutral archive from one organization, and the radiology viewer from another. We wanted to partner with the chosen vendor and develop that long-term relationship, where we learn from each other and we mutually benefit each other, in sort of not just have a transactional relationship, but that we share the same values. We share the same vision. And that's what stood out to us is Watson Health imagings vision, mirrored TriHealth's in what we were trying to achieve with our enterprise imaging project. >> You know, let me follow up with that if I could. A lot of times you hear the phrase, "Single throat to choke" and it's kind of a pejorative, right? It's a really negative term. And the way you just described that Dr. Huelsman is you were looking for a partnership. Yeah, sure. Maybe it was more manageable and maybe it was a sort of Singletree, but it was really about the partnership, going forward in a shared vision and really shared ownership of the outcome. Is that a fair characterization? >> Yeah, how about more positive is "One hand to shake." >> Wow, yeah, I love it. (chuckles) One hand to shake. I'm going to steal that line. That's good. I like it. Keep it positive. Okay, John, when you think about the past 12 months and I know you have history with TriHealth, and more recently have rejoined the account, but how would you kind of characterize that relationship and particularly anything you can add about the challenges of the 2020? What stands out to you? >> Yeah, I think going back to your one hand to shake or one vendor to hug all that's not allowed during COVID, but we're excited to be back working with you, I am in particular. And at the beginning of this sales process and RFP when you guys were looking for that vendor partner, we did talk to you about the journey, the journey with AI that we already had mature products on the vendor neutral archive side and all the product pieces that you were looking for. And I know you've recently went live over the last year and you've been working through, crawling through and learning to walk and starting to run, hopefully. And at some point we'll get to the end of the marathon, where you'll have all the AI pieces that you're looking for. But this journey has been eyeopening for all of us, from using consultants in the beginning, to developing different team members to help make you successful. So I think I've been tracking this from the outside looking in, and I'm happy to be back, more working direct with you this year to help ensure your longterm success. >> Yeah, that's great John. You have some history there. I'm going to probe that a little bit. So doctor, you talked about this enterprise imaging project. I presume that's part of, that's one of the vectors of this journey that you're on. What are you trying to accomplish in the sort of near term and midterm in 2021? John mentioned AI, is there a data element to this? Are there other, maybe more important pressing things? What are your main goals for 2021? >> Sure. Well, where we are, where we've started, the first step was getting all of our imaging stored consistently in the same place and in the same way. We had like many health system, as you grow, you acquire facilities, you acquire physician practices and they all have their own small packs system, different ways of storing the data. And so it becomes very unwieldy to be a large organization and try to provide a consistent manner of your physicians interacting with the data, with the imaging in the same way. And so it was a very large dissatisfier in our EMR to, oh if you wanted to see cardiovascular imaging, it's this tab. If you wanted to see radiology, it was this tab. If you wanted to see that, oh you got to go to the media tab. And so our big goal is, okay, let's get the enterprise archive. And so the Watson enterprise archive is to get all of our imaging stored in the same place, in the same way. And so that then our referring physicians and now with our patients as well, that you can view all the imaging, access it the same way and have the same tools. And so that's the initial step. And we're not even complete with that first step, that's where COVID and sort of diverting resources, but it's there, it's that foundation, it's there. And so currently we have the radiology, cardiology, orthopedics and just recently OB-GYN, all of those departments have their images stored on our Watson Enterprise Archive. So the ultimate goal was then any imaging, including not just what you typically think of radiology, but endoscopy and arthroscopy and those sort of images, or wound care images, in that any image, any picture in our organization will be stored on the archive. So that then when we have everything on that archive, it's easier to access consistently with the same tools. But it's also one of the large pieces of partnering with with Watson Health Imaging, is the whole cognitive solutions and AI piece. Is that, well now we're storing all the data in a consistent manner, you can access it in a consistent manner, well then we hope to analyze it in a consistent manner and to use machine learning, and the various protocols and algorithms that Watson Health Imaging develops, to employ those and to provide better care. >> Excellent, thank you for that. John, I wonder if you could add to that? I mean, you've probably heard this story before from other clients, as well as TriHealth, I call it EMR chaos. What can you add to this conversation? I'm particularly interested in what IBM Watson Health brings to the table. >> Sure, we've continued to work with TriHealth. And like we said earlier, you do have to walk before you can run. So a lot of this solution being put in place, was getting that archive stood up and getting all the images transferred out of the legacy systems. And I think that we're nearly done with that process. Doing some find audits, able to turn off some of the legacy systems. So the data is there for the easier to do modalities first, the radiology, the cardiology, the OB, as Dr. Huelsman mentioned and the ortho. And now it's really getting to the exciting point of really optimizing everything and then starting to bring in other ologies from the health system, trying to get everything in that single EMR view. So there was a lot of activity going on last year with optimizing the system, trying to fine tune hanging protocols, make the workflow for everybody, so that the systems are efficient. And I think we will continue on that road this year. We'll continue down further with other pieces of the solution that were not implemented yet. So there's some deeper image sharing pieces that are available. There are some pieces with mobile device image capture and video capture that can be deployed. So we look forward to working in 2021 on some of those areas, as well as the increased AI solutions. >> So Dr. Huelsman I wonder if you could double click on that. I mean if you're talking to IBM, what are the priorities that you have? What do you, what do you really need from Watson Health to get there? >> So I spoke with Daniel early last week, and sort of described it as now we have the foundation, we sort of have the skeleton and now it's time to put meat on the bones. And so what we're excited about is the upcoming patient synopsis would be the first piece of AI cognitive solutions that Watson Health Imaging provides. And it's sort of that partnership of we're not expecting it to be perfect, but is it better than we have today? There is no perfect solution, but does it improve our current workflow? And so we'll be very interested of when we go live with patients synopsis of does this help? Is this better than what we have today? And the focus then becomes partnering with Watson Health Imaging is how do we make it better for ourselves? How do we make it better for you? I think we're a large health organization and typically we're not an academic or heavy research institution, but we take care of a lot of patients. And if we can work together, I think we'll find solutions. It's really that triple aim of how to provide better care, at cheaper costs, with a better experience. And that's what we're all after. And what's your version of patient, the current version of patients synopsis, and okay does it work for us? Well, even if it does, how do we make it better? Or if it doesn't, how do we make it work? And I think if we work together, make it work for TriHealth, you can make it work at all your community-based health organizations. >> Yeah. So, John that brings me to, Dr. Huelsman mentioned a couple of things in terms of the outcomes. Lower costs, better patient experience, et cetera. I mean, generally for clients, how do you measure success? And then specifically with regard to TriHealth, what's that like? What's that part of the partnership? >> Yes, specifically with TriHealth, the measure of success will be when Dr. Huelsman is able to call and be a super reference for us, and have these tools working to his satisfaction. And when he's been able to give us great input from the customer side, to help improve the science side of it. So today he's able to launch his epic EMR in context and he has to dig through the data, looking for those valuable nuggets and with using natural language processing, when he has patients synopsis, that will all be done for him. He'll be able to pull up the study, a CT of the head for instance and he'll be able to get those nuggets of information using natural language processing that Watson services and get the valuable insights without spending five or 10 minutes interrogating the EMR. So we look forward to those benefits for him, from the data analytics side, but then we also look forward to in the future, delivering other AI for the imaging side, to help him find the slices of interest and the defects that are in that particular study. So whether that's with our partner AI solutions or as we bring care advisers to market. So we look forward to his input on those also. >> Can you comment on that Dr. Huelsman? I would imagine that you would be really looking forward to that vision that John just laid out, as well as other practitioners in your organization. Maybe you could talk about that, is that sort of within your reach? What can you tell us? >> Well, absolutely. That was sort of the shared vision and relationship that we hope for and sort of have that shared outlook is we have all this data, how do we analyze it to improve, provide better care cheaper? And there's no way to do that without you harnessing technology. And IBM has been on the cutting edge of technology for my lifetime. And so it's very exciting to have a partnership with WHI and IBM. There's a history, there's a depth. And so how do we work together to advance, because we want the same things. What impressed me was sure, radiology and AI has been in the news and been hyped and some think over-hyped, and what have you. Everyone's after that Holy grail. But it's that sense of you have the engineers that you talk to, but there is an understanding that don't design the system for the engineers, design it for the end user. Design it for the radiologist. Talk to the end user, because it can be the greatest tool in the world, but I can tell you as a radiologist, if it interrupts my workflow, if it interrupts my search pattern for looking at images, it doesn't help me and radiologists won't use it. And so just having a great algorithm won't help. It is how do you present it to the end user? How do I access it? How can I easily toggle on and off, or do I have to minimize and maximize, and log into a different system. We talked earlier is one throat to choke, or one vendor to hug, we only want one interface. Radiologists and users just want to look at their... They have the radiology viewer, they have their PACS, we look at it all day and you don't want to minimize that and bring up something else, you want to keep interacting with what you're used to. And the mouse buttons do the same thing, it's a mouse click away. And that's what the people at Watson Health Imaging that we've interacted with, they get it. They understand that's what a radiologist would want. They want to continue interacting with their PACS, not with a third vendor or another program or something else. >> I love that. That ton of outside in thinking, starting with the radiologist, back to the engineer, not the reverse. I think that's something that IBM, and I've been watching IBM for a long time, it's something that IBM has brought to the table with its deep industry expertise. I maybe have some other questions, but John I wanted to give you an opportunity. Is there anything that you would like to ask Dr. Huelsman that maybe I haven't touched on yet? >> Yeah. Being back on your account this year, what do you see as a success? What would you count as a success at the end of 2021, if we can deliver this year for you? >> The success would be say, at the end of the year, we've got the heavy hitters, all stored on the archive. Do we pick up all the little, we've got the low hanging fruit, now can we go after the line placement imaging and the arthroscopy and dioscomy, and all those smaller volume in pickups, that we truly get all of our imaging stored on that archive. And then the even larger piece is then do we start using the data on the archive with some cognitive solution? I would love to successfully implement, whether it's patient synopsis or one of the care advisors, that we start using sort of the analytics, the machine learning, some AI component that we successfully implement and maybe share good ideas with you. And sure we intend to go live with patient synopsis next month. I would love it by the end of the year, if the version that we're using patients synopsis and we find it helpful. And the version we use is better than what we went live with next month, because of feedback that we're able to give you. >> Great we looked forward to working with you on that. I guess, personally, with the pandemic in 2020, what have you become, I guess in 2020 that maybe you weren't a year ago before the pandemic, just out of curiosity? >> I'm not sure if we're anything different. A mantra that we've used in the department of radiology at TriHealth for a decade, "Improved service become more adaptable." And we're a service industry, so of course we want to improve service, but be adaptable, become more adaptable. And COVID certainly emphasize that need to be adaptable, to be flexible and the better tools we have. It was great early in the COVID when we had the shutdowns, we found ourselves, we have way more radiologists than we had studies that needed interpreted. So we were flexible all often and be home more. Well, the referring physicians don't know like, well is Dr. Huelsman working today? We don't expect them to look up our schedules. If I get a page that, Hey, can you take a look at this? It was great that at that time I didn't have a home workstation, but I had iConnect access. Before there was no way for me to access the images without getting on a VPN and logging on, it takes 10, 15 minutes before I'm able. Instead I could answer the phone, and I'm not going to say, "Oh, I'm sorry, I'm not at the hospital day, call this number someone else will help you." I have my iPad, go to ica.trihealth.com logged on, I'm looking at the images two minutes later. And so the ease of use, the flexibility, it helped us become adaptable. And I anticipate with we're upgrading the radiology viewer and the iConnect access next month as well, to try to educate our referring physicians, of sort of the image sharing capabilities within that next version of our viewer. Because telehealth has become like everywhere else. It's become much more important at TriHealth during this pandemic. And I think it will be a very big satisfier for both referring physicians and patients, that those image sharing capabilities, to be able to look at the same image, see the annotation that either the radiologist or the referring physician, oncologist, whoever is wanting to share images with the patient and the patient's family, to have multiple parties on at the same time. It will be very good. >> With the new tools that you have for working from home with your full workstation, are you as efficient reading at home? >> Yes. >> And having full access to the PACS as in-house? >> Absolutely. >> That's great to hear. Have you been able to take advantage of using any of the collaboration tools within iConnect, to collaborate with a referring physician, where he can see your pointer and you can see his, or is that something we need to get working? >> Hopefully if you ask me that a year from now, the answer will be yes. >> So does that exit a radiologist? Does that help a radiologist communicate with a referring physician? Or do you feel that that's going to be a- >> Absolutely. We still have our old school physicians that we love who come to the reading room, who come to the department of radiology and go over studies together. But it's dwindling, it's becoming fewer and fewer as certain individuals retire. And it's just different. But the more direct interaction we can have with referring physicians, the better information they can give us. And the more we're interacting directly, the better we are. And so I get it, they're busy, they don't want to, they may not be at the hospital. They're seeing patients at an outpatient clinic and a radiologist isn't even there, that's where that technology piece. This is how we live. We're an instantaneous society. We live through our phone and so great it's like a FaceTime capability. If you want to maintain those personal relationships, we're learning we can't rely on the orthopedist or whomever, whatever referring physician to stop by our reading room, our department. We need to make ourselves available to them and make it convenient. >> That market that you working in Cincinnati, we have a luxury of having quite a few customers with our iConnect solutions. There's been some talk between the multiple parties, of potentially being able to look across the other sites and using that common tool, but being able to query the other archives. Is that something that you'd in favor of supporting and think would add value so that the clinicians can see the longitudinal record? >> Yes And we already have that ability of we can view care everywhere in our EMR. So we don't have the images right away, but we can see other reports. Again, it's not convenient. It's not a click away, but it's two, three, four clicks away. But if I see, if it's one of my search patterns of I just worked the overnight shift last week and then you get something through the ER and there's no comparisons, and it's an abnormal chest CT. Well, I look in Care Everywhere. Oh, they had a chest CT at a different place in the city a year ago, and I can see the report. And so then at that time I can request, and it can take an hour or so, but look back and the images will be accessible to me. But so how do we improve on that? Is to make the images, that I don't have to wait an hour for the images. If we have image sharing among your organizations that can be much quicker, would be a big win. >> As you read in your new environment, do you swivel your chair and still read out of any other specialty systems, for any types of studies today? >> No, and that was a huge win. We used to have a separate viewing system for mammography and we were caught like there were dedicated viewing stations. And so even though we're a system, the radiologist working at this hospital, had to read the mammograms taken at that hospital. And one at the other hospital could only read the ones taken at that hospital. And you couldn't share the workload if it was heavy at one site and light at the other. Well, now it's all viewed through the radiology viewer if you merge PACS, in not just general radiology, but impressed. It has been so much better world that the workflow is so much better, that we can share the work list and be much more efficient. >> Do you feel that in your, your new world, that you're able to have less cherry picking between the group, I guess? Do you feel like there's less infighting or that the exams are being split up evenly through the work list? Or are you guys using some sort of assignment? >> No. And I'm curious with our next version of PACS, the next version of merge packs of 008. I forget which particular >> John: 008. >> It's 008, yeah. I know there's the feature of a smart work list to distribute the exams. Currently, we just have one. It's better than what we have before. It's one large list. We've subdivided, teased out some things that not all of the radiologist read of like MSK and cardiac and it makes it more convenient. But currently it is the radiologist choose what study they're going to open next. To me how I personally attack the list is I don't look at the list. Some radiologists can spend more time choosing what they're going to read next than they do reading. (chuckles) And so if you don't even look, and so the feature I love is just I don't want to take my eyes off my main viewer. And I don't want to swivel my chair. I don't want to turn my head to look at the list, I want everything right in front of me. And so currently the way you can use it is I never look at the list. I just use the keyboard shortcuts of, okay, well I'm done with that study. I mark it, there's one button I click on my mouse that marks it dictated, closes it and brings up the next study on the list. >> Hey guys, I got to jump in. We're running up against the clock, but John if you've got any final thoughts or Dr. Huelsman, please. >> Sure. Dr. Huelsman, I guess any homework for me? What are the top two or three things I can help you with in 2021 to be successful? >> Keep us informed of what you're working on, of what's available now. What's coming next, and how soon is it available? And you let us see those things? And we'll give you a feedback of hey, this is great. And we'll try to identify things, if you haven't thought of them, hey, this would be very helpful. >> Gents, great conversation. Gosh we could go on for another 45 minutes. And John you really have a great knowledge of the industry. And Dr. Huelsman, thanks so much for coming on. Appreciate it. >> Thank you. >> You're welcome >> And thanks for spending some time with us. 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