While the capabilities of the electronic health record (EHR) continue to expand, the clinician who uses the technology can sometimes be forgotten. Exciting innovations can only be successful when developers are mindful of the human at the center of the solution. New technologies that are designed to be easy to use can also be enjoyable to use, leading to increased clinician buy-in and overall patient satisfaction.
On today’s episode of In Network's Designing for Health podcast, Nordic Chief Medical Officer Craig Joseph, MD, talks with Joel Klein, MD, senior vice president and chief information officer at the University of Maryland Medical Center. They talk about his unconventional path from being an emergency room physician to running the IT department, redesigning the EHR to maximize clinician satisfaction, and low-tech solutions to optimize hospital efficiency. They also talk about how his health system was impacted by the recent CrowdStrike outage, the value of doing rounds en masse, and what an experience gradient is and how it’s used in healthcare.
Listen here:
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Want to learn more from Dr. Joseph? Order a copy of his book, Designing for Health.
Show Notes:
[00:00] Intros
[01:08] Dr. Klein’s background
[06:25] Making clinical support tools fun
[13:18] Customizing your workspace within Epic
[15:27] Rounds en masse
[21:44] The two-bin inventory management system
[27:34] Experience gradients and what healthcare can learn from aviation
[35:36] Dr. Klein’s experience with the CrowdStrike outage
[41:10] Dr. Klein’s favorite well-designed things
[45:00] Outros
Transcript:
Dr. Craig Joseph: Dr. Klein, welcome to the pod. How are you today, sir?
Dr. Joel Klein: I'm great. How are you?
Dr. Craig Joseph: I am doing well. So, tell us, just to begin, I like to figure out how you got to where you are. My understanding is that you are a practicing, still practicing emergency medicine physician, and you're involved in IT. So how does one get from a, you know, an ER doc to in charge of the IT department at a major medical institution. How does that go?
Dr. Joel Klein: It was sort of a gradual slide. It's the best way to put it. I trained at Hopkins here in Baltimore, at the other medical system, and I got hired as the night guy in a very big ER. I think they were seeing 104,000 patients a year, in one of our community hospitals, and it was great. You know, the night shift is, there's no bosses around, so you have to solve all the problems yourself. It was seven-hour shifts, which I still can't believe, we got to do. It was wonderful. Great nurses, great community, and I loved it. And then one day, the phone rang in the ER. I'll never forget this. It was an ophthalmologist in the community, and he was calling to complain about something. And the secretary didn't know what to do, so she called me over. Will you take this call? So, I don't know what this is, but I'll talk to the guy. So, he proceeded to berate me that one of my partners had given out a bottle of tetracaine for a corneal abrasion. Which, you're not supposed to do, because then you won't blink if, like, the next speck of dust gets in your eye, and you'll get another abrasion. Or at least that's what the book says. So, he was very upset about this. And so, I wrote it all down. And I went into my boss's office, my department chair, and said, you know, this happened. I got this call, and I wrote it down and I said we would look into it. And he looked back at me and said, so look into it. Go find your partner and talk to him about it. And we kind of stared at each other and I said, okay, so I did, and that was my first patient complaint. Even though it, you know, it wasn't a patient complaining. And so that that started my administrative career, about 2 or 3 years later, I was eventually elected president of the group, with a mandate to fix our incentive compensation, which was very messed up and sort of back of the envelope, you know, squint and this is how much money we'll give you. So that meant I needed data on all the things that, you know, you measure ER doctors on, like sort of doc time and throughput and all that stuff, which meant I had to go befriend all of the IT people to get that data. And this is 20 years ago, I ended up with a fair amount of access, and very little, you know, guidance on how to get that data, which meant I had to learn the underpinnings and, you know, back end of all of these terrible systems we were using back then. And it was great. All of this was really fun. And it meant I befriended all these IT people. And then, came Epic. I was the physician lead for that for our hospital. Because when you're a hospital-based doctor, you do whatever the hospital tells you to do. And, because they're your master. And that's really where it kind of started, so it grew and grew. I eventually became our CIO in 2019, I worked the first half of COVID clinically splitting shifts with my old partners. I would work 5 a.m. to 9 p.m. and then come have the rest of my day and, I would say about three years ago, it just got to be overwhelming. So as my 15-year-old son says, yeah, you just go to meetings now. So, I stopped practicing around two, three years ago.
Dr. Craig Joseph: Yeah, it's a good story. And it sounds like you ran towards the things that most of us run away from, talking with your peers about quality or lack thereof, trying to get discreet information so that you can make good management decisions. Those are things that precious few people are interested in doing. So good on you, is this a personality defect of some sort? How would you diagnose this?
Dr. Joel Klein: Probably. I don't know. I'm a pretty introverted person. And so, the thought of how am I going to do X? All right. I'll just sit in my basement and figure it out. I mean, that's a fun day of work for me. It's funny, I took a computer science class my second semester senior year of college. And, I mean, you know, that's when everything was decided, and it was kind of irrelevant. But I loved it. And I remember being so angry that I had not done this earlier. I mean, who knows what would have happened? I mean, to be clear, I have had a great ride, and I've loved every minute of my career. But you just wonder, you know, I guess all of us have an aptitude for lots of different things.
Dr. Craig Joseph: Yeah, that's fair. Let's get into it. You know, we like to talk about healthcare and human-centered design and kind of thinking intentionally about how we get folks to do the right thing and make it easy to do that. One thing that that you've done and that I think you've kind of published about on LinkedIn or in other places is, modifying some clinical decision support tools to make them fun. And normally, when people think of what Epic calls best practice advisories or what angry physicians call pop ups, we don't think of those as fun. They're not associated with anything, that you generally like. So, what did you do? How did this progress? Where did it come from? And what kind of feedback did you get when you first started it?
Dr. Joel Klein: Right. So, this started with my wife, we were working together in our kitchen, and she says, hey, you got to come see this. So, I come over and they use some sort of task management software or something in her firm, and she goes, watch this, I'm going to make up a task, and then I'm going to check off that. I completed it. So, she does. And this unicorn comes bounding across her screen with a big bright rainbow coming out of its butt. And I just looked, staring back at her like, that's kind of dumb. And she says, no, it's not, I love it. Look at my unicorn. That's my reward for doing my task. And I just stared at her and she's like, you don't like it? And I'm like, well, so I started thinking about it and it struck me that if that's all it takes, then, I mean, to hell with that. I mean, we can work with that. So, I went back to work and said, guys, listen, pick something that beats down, let's start with the nurses. You know, something that they have to do that they often don't quite get right. And I think it was some sort of intake assessment or something. And if they do it completely, then let's give them a picture of a unicorn that says you did it great. And I got the same looks as, what do you want to do that for. That's kind of dumb. And so anyway, we did it. And the nurses loved it just like my wife did. And so, I kind of thought, all right, well, small victory. Next thing I know, my boss who grew up in finance, he was the CIO at the time. He calls me, I think I was working clinically, and so I was very distracted. But it was him, so I answered, and he gets right to the point and says, so I understand that you put a unicorn in our multi-million dollar, professional, you know, thing. And I said, yeah, let me tell you, the unicorn and this task and it's great, and the nurses, and he cuts me off. I cannot believe you; he was furious with me. He wanted it out within 30 minutes. He was so angry that I had, you know, the frivolity that did not belong in the serious business of medicine. He was not a clinical person. And I thought he was kidding. And it took me another 10 seconds to figure out that he wasn't kidding. So anyway, long story short, we took it out and I waited, you know, six months, but eventually kind of peeled him off the ceiling and got him to see that this was free happiness. This was easy to do. It didn't cost anything. And it was fun. And so he just kind of glared at me. And so we put the unicorn back, and then we started doing Buddy the Blood Drop and Colin the Colon and all these ridiculous creatures that, you know, had to do with the blood administration and the success of the collecting prep and all the things that we keep trying to get people to do completely. And that led to our system standard around decision support, which is that it has to have a picture. It has to have some kind of image. It can be a photograph or a drawing or a doodle, but it has to be related to whatever it is that we're trying to get people to do. So, for instance, the one that recommends a, what's it called? Not hospice, but the folks that manage symptoms at the end of life.
Dr. Craig Joseph: Palliative care.
Dr. Joel Klein: Palliative care. Right. So those folks. Right. So, there's things that could trigger a consult. And so, there's a picture, of a patient with the hands of their family kind of on their shoulder. So, some of it is actually very, very serious. But you look right at it and you're like, oh, I know what I'm supposed to do here. And sometimes it gets a little edgy. So, during COVID, when, you know, to remind people to get the COVID test for even non-COVID related admissions, we had the picture, the famous picture of Anthony Fauci, you know, covering his eyes at the famous bleach press conference. And there were some people that complained that that was too political. So, we just had a picture of Fauci himself smiling, although I thought the person was pretty funny, but yeah, we think that that has been a small victory here, of really trying to ... we don't want people to read a paragraph of what, you know, we're looking for them to do. We want them to just glance at it and immediately react and say, yep, got it. And so that's what it does.
Dr. Craig Joseph: Well, it saves time. But that, that quote, and by the way, I'm going to write a book now called Free Happiness.
Dr. Joel Klein: That's right. One smile a day. If we can do one smile a day, I mean, if you round in any hospital and go down to the ER, you know, is a great place to do it, especially during COVID. I mean, yes, it's an amazing profession. Amazing job. You're really denting the universe down there. But it's really hard. And, you know, you walk around with a basket of chocolate that works too. But if you get, you know, this unicorn with a big sign that says, yay, Joel or yay, Craig. I mean, hey, that's, you know, free happiness.
Dr. Craig Joseph: Yeah, I know, I love it. And so, I think you're getting multiple benefits, right? You're getting that free happiness, that little jolt of an endorphin. This is not just checking a box for the sake of checking a box. But you're also to your point. Hey, if I see a picture of Fauci, I know what I'm supposed to do. Like, I don't have to read any of those, any of that text. And so, it's actually going to make this task faster because I can very quickly identify it.
Dr. Joel Klein: And, you know, Epic does something similar by allowing you to customize your workspace. So there's those famous, you know, pictures where the cow is getting beamed into the UFO or, you know, all these, I mean, they're cutesy little ways that you can decorate your background, but, you know, the safety feature is that you don't walk up to somebody else's workstation and you don't accidentally use, you know, another person's login. So there really is a practical purpose behind just the, oh look at that ridiculous cow.
Dr. Craig Joseph: Yeah. And certainly, there was a lot of pushback, I remember from CIOs like yourself, actually, when some of that personalization was being introduced. Saying that, well, it's harder now for us to support, because when a user calls in and says they're stuck at this one area, it might look a little different for nurse A and then nurse B and that makes, the helpdesk people a little bit more nervous, but clearly the benefits are worth it.
Dr. Joel Klein: Yeah. Well, so I will admit it's possible that our, you know, entry-level employee, I didn't get Buddy the Blood Drop. Like, what does that mean? What team does that go to? I suppose, but I think it has more to do with culture and acceptance, and what do you mean? Smiling? There can't be any smiling here. We've tried to do other visual things. So, when you log in to most of our applications in our organization, you get this splash screen that is art from our employees. So, we have employees either paint something or take a picture of something. It could be, you know, a photo of sculptures they've done. It could be, you know, during cherry blossom season, we had an amazing picture, down, you know, since we're so close to DC, of the cherry blossoms, and it's cool. And we acknowledge, you know, we put their name on the work of art and it's another way for us to recognize employees. And it also, again, I know I'm in the right application because that's the one with cherry blossoms.
Dr. Craig Joseph: Well, you were mentioning rounding. You were saying that if you ever go rounding, and that's where apparently people take care of other people. This is what we're talking about. I seem to recall that that's part of what happens at hospitals and doctor's offices. So, you've written about a rounding party, where you take a bunch of clinical and non-clinical folks and walk around. So, tell me, how does that work? What do you learn and how do you make it? How do you get some of these administrators who, like you are maybe not super excited about meeting new people and going to strange places and by strange places I clearly mean the emergency room and the PACU.
Dr. Joel Klein: Yeah, those are strange places, but they're amazing places. So, we had this problem. I'm sure you know, a lot of us in healthcare IT have which is, you know, you're live on whatever platform you know, you’re talking about. But let's call it your EMR. And, you know, time passes and now, you know, how do we continue helping? How do we, have continuous improvement in our user’s ability to understand the system, use the system, and how do we keep, you know, meaningful feedback coming? You know, obviously there's people who are going to pick up the phone and call the helpdesk and complain about something, but there's a lot of stuff that you get from just, talking to users. And so we have an informatics team, like a lot of places. And they would kind of go around and through Brownian motion, maybe they would encounter, another employee working clinically who wasn't too busy, who could actually offer, you know, some feedback or be receptive to some training. And basically, the yield was pretty low. And we struggled with this for a long time. And finally, our informatics team said, you know what? Why don't we just posse up? We'll get like a massive, you know, bolus of informaticists and we'll have them round en masse, in force, as like a squadron, and we'll divide them up and we'll send them to, you know, blanket a department for some period of time. And so there'll be 30, 40 of these guys will all go to one hospital. They'll all meet in the cafeteria or something, and they'll have assignments, and they'll go out, you know, to areas where they specialize to try to get this feedback, what's working, what's not working, you know, let's gather the staff up and let's talk about it for a minute and have it be an event and thus was born the rounding part. And they've been unbelievably successful at both, again, trying to do a bit of training, but also getting feedback, constructive feedback that we never would have gotten any other way. Because a lot of these staff are people that don't, you know, really want to get involved in IT governance or go to meetings, stuff like that. So, it's been very, very helpful. And now what we do is we will rope in non-IT leaders at that hospital who hear we're coming, and they want in on it. And so, they'll come around with us and it gives them insight into how their teams are using the tools. And it's great for them because they get to see us trying to help as well as, you know, hearing firsthand the challenges that their own teams are having.
Dr. Craig Joseph: So, it's, it's a great idea. And it's similar to kind of, I've seen some other hospitals do this SWOT concept where they'll go in to a clinic or a particular department, but they'll do it for five days, on day one, they're watching, days two, three, and four, they're doing some training, but also doing build, you know, fixing things that are easily fixed, so that they can show progress by Friday, where they do a debrief and, and kind of get out of town.
Dr. Joel Klein: Yeah. No, I love that. Actually, the thing you have to be careful about is lighting off projects with these things inadvertently. So, you have to keep scope to a minimum, because sometimes we’ll say, well, you know, could we just interface Epic to this toaster over here and you have to be careful not to ... you have to have a little bit of ground rules around that. But, I mean, the idea of a multi-day, rounding party that. That's great.
Dr. Craig Joseph: Yeah. I think, one place I saw them, they kind of broke the needs into three different buckets. And I think probably everyone through governance has, you know, these big boulders or little rocks or whatever they call them. And so, it was the hey, these are things we can fix by Friday. These are things that are a little bit bigger, but we could probably get them done in the next 4 to 6 months. And then there's these big projects like integrating with the toaster. That certainly can be done, but we're going to have to figure out where that goes with the priorities. And as long as, like you said, as long as you set expectations, like, hey, we're not here to fix everything because some things are not broken and some things take a lot of money and time, and we can't just snap our fingers and make that happen. People understand that. And in my experience, often it's the little, tiny things that can literally be fixed in ten minutes that people are most, appreciative of. It's that documentation template that has a typo in the second paragraph and the third sentence that has two periods at the end. And it makes me crazy because I'm an anal-retentive physician or nurse, and I have to fix that every single time. And boy, if you just fix that, I don't really care about the new cardiology module like that. That's not as helpful to me in my mind as you fixing these little, tiny things.
Dr. Joel Klein: So yeah, I think the other thing that we have to think through is how do we do this in the ambulatory space? So, we have a ton of, you know, practices that are not physically co-located in our hospitals. And this solution doesn't exactly scale to those environments. Now, you can scale it down and, you know, send three people to one place, but it's not quite as geographically easy to do that, but that's I think another thing where we're thinking.
Dr. Craig Joseph: Yeah, I think that that sounds fair. One of the things that I think you saw, and maybe this was when you were rounding, was that an inventory management system that you thought was ingenious? The two-bin system?
Dr. Joel Klein: Oh, yeah.
Dr. Craig Joseph: And so I'd love just to kind of talk about that for just a few minutes. It seems very low tech. And I know I'm talking to a CIO now, but how does this low-tech system work and, and how can it go? How can it work and how can it break down.
Dr. Joel Klein: Yeah. So this is just about the dumbest, most ingenious thing in the world. I don't understand why this isn't, you know, so the idea is you're in a, in the clean utility rooms of every, you know, clinical area in the building. You know, let's say you need, I don't know, some gauze. So, you go into this room, and you find the gauze and there's a bin, and there's some gauze in the bin. But behind that bin, there's another bin with the same thing. More gauze. So, what you do is you take from the front bin and you, you know, you people come throughout the day, they take orders out of the bin. And then there comes the point where the bin is empty. And what do you do then? You train everybody. What you do is you take the empty bin, and you throw it on top of the rack of the shelving, and there's a bunch of other empty bins up there. And then you take the second bin, the one that's been hiding in the back, and you pull it forward, and then you get your gauze from that bin and you go about your day, then the supply chain dude or dude at, or people, they show up and, throughout the day and they pick up all of the empty bins that are now up on top of this shelving, and they take them downstairs and they restock them, and then they bring them back up and they become the behind bin. And so, the reason this is genius is its so low tech. It's perfect. It forces product rotation. So, you're not like constantly taking from the front and then having the stuff expire. And you have to throw it out. And it's a great way of just managing your inventory of stuff. Now there's a few things you can't do this for. So, you know, huge bulky things. It's obviously, you know, less practical. There are some clean supply rooms that I have seen that are so packed full that, you know, it's already a fire hazard and you can't really, you know, do that. But, you know, think about all these projects that you've heard of, of weighted bins and you know, that are connected via wires to some Pyxis-like, you know, crazy system where, you know, the weight of the gauze gets measured or some nonsense like that or, even worse, we're going to charge individual items to the patient. Now we don't do, you know, patient-level charging like that here. I know in some places, you know, you have to, but, just from a, how do you keep the place stocked? It just was such a great ... and so we're actually doing a project. We're calling it the California Closet Project for your stuff. And so we're literally sweeping through our whole organization, two-binning the whole place. And, and the other interesting thing that you get to do is you know, there are things in your supply closets that, I'm sorry, you just don't need them. You think you need them, but that's like the extra, you know, workout gear that you bring on your vacation. You're not going to use that. And so if you have somebody who's actually doing some, you know, even minimal time and motion study and, you know, really looking at what's being used, you can free up space, you really can. And you have to, you have to be careful because it's someone's closet and you're, you know, moving their socks and whatever. It's not yours. It's not your home. And you have to be respectful, and you have to have good governance around that. But you can make space and it can look like one of those, you know, makeover type situations. And so, it's a great, great pride, not only tangentially related to IT. I mean, obviously the ERP aspect of this does come into play a little bit, but it's a great project.
Dr. Craig Joseph: Yeah. I'm most disturbed and I feel like you see me when you are telling me not to bring that extra workout outfit on vacation.
Dr. Joel Klein: No judgment.
Dr. Craig Joseph: I know, but I do feel judged. Despite that, alright, let's move on. And let's talk about flying now, you’re not a pilot, are you?
Dr. Joel Klein: But I wish that I could be a pilot. I am, I absolutely love flying, but I am deathly afraid of heights, which is strange.
Dr. Craig Joseph: That is strange. All right. And so that's the problem with you becoming a pilot is that they generally fly in the air.
Dr. Joel Klein: True. That does seem to be the way. My wife got me a flying lesson for my birthday, and so I, you know, went in the little plane and got up there. The little plane didn't bother me, you know, that's all fine. I'm comfortable that it is a real airplane. And, the teacher says, okay, you know, fly the plane. So, I'm flying the plane. He's like, okay, turn. So, I banked the plane and, you know, the plane tilts and I look down and I just thought, that's it, I'm done. Because, you know, at some point you have to solo, you know, after maybe 30 hours, you're up there flying by yourself. You have to do that. And I just realized in that moment, there is no way I could get over, don't look down, nope, not doing it. But I do love commercial flying. Absolutely love it.
Dr. Craig Joseph: Well, I and I ask the question, because you've written a lot, on LinkedIn and other places about, things associated with aviation. And so one that you relate to healthcare which I love. And one of those was talking about the authority gradient and this concept, that is very, I guess, you know, well established and respected in the cockpit, but, not so much in healthcare. So, what is the authority gradient in aviation and how is it related to healthcare.
Dr. Joel Klein: Yeah. So, I think all of us who have spent time in the clinical space recognize this phenomenon. And you know, people have ranks in hospitals, right? I mean, within doctors, there are, you know, medical students and interns and residents and fellows and attendings. And, you know, it's, there's a pecking order. And then you layer in all the other staff and, you know, they're all part of the team. But the breakdown happens when that team becomes communicatively dysfunctional. So in other words, when people stop having the sense of safety that they can say something that they're seeing. So when a nurse kind of comes up to, the doctor and you see they are really scared, they're going to get their head taken off, by, you know, asking their question or reporting something that the doctor is going to find insignificant. But the nurse doesn't know that. Right. That's how bad things happen when we don't deal with that. And so what's in aviation? They've really, come to have a really structured way of talking about this, in a cockpit situation. So you've got far fewer people, obviously. So it's a less complex environment, but you'll have, you know, a captain with, say, 20,000 hours and a first officer who might have, say, 700 hours. And so that's a really high experience gradient, which will translate to an authority gradient. And there have been so many accidents where that first officer is, is watching the captain do something really stupid and is afraid to say something. And so the way a lot of airlines do it, as part of what they call crew resource management and are trained to do this, is it the first flight of the day of a team working together? They will brief. What do we see as our threats, you know, to the today's operation. And it's the responsibility of both crews to say, well we do have a big authority gradient today. So as your captain, I'm going to remember, that I need to put that aside and make sure I'm asking you what you think throughout the day. And the copilot will say, and I will remember that I, too, am a member of the crew, and I'm going to remember to speak up, even if I think, you know, even if I'm, I'm concerned that my point might be trivial or if I might be wrong, I'm going to make sure that I say something. So they have that explicit conversation. I don't think I've ever been in an operating room where anybody talked like that. Certainly, I've never been in an ER where anybody talked like that, and that's what's missing. And, you know, culturally we’ve got to deal with that. And, you know, we're a long way from that. It happens in IT where you have a junior analyst who is afraid to tell me something or afraid to tell their boss something because it's, you know, the scary boss. And that's how things happen. So it's something, it's probably applicable to any work environment, but certainly one where safety and, you know, one wrong move and there's a big impact, you know, come into play.
Dr. Craig Joseph: Yeah. I mean, it's a big deal. I've never really thought about it, you're right. There's a pecking order that's so obvious to physicians. At the bottom is medical students actually third-year medical students. And at the top. At the top is the attending. And even attendings have pecking orders.
Dr. Joel Klein: Right. I mean, think about when the dean shows up to do his one week, you know, of actually practicing. Think anybody's going to tell him, sir. I think you overlooked this? You can, but, you know, it's a lot harder to do that. And again, it's being explicit. It's a routine that we're going to acknowledge this risk, acknowledge this threat. It's part of our job too. And that takes all the mystery and all the apprehension out of it. And it's just part of what we do here.
Dr. Craig Joseph: Yeah. Well, the word that I keep coming back to is intentionality. You're intentionally bringing this up, and like you said, both the senior person and the junior person, the senior person acknowledging, boy, I do have a lot more experience, than you do‚ And it might have been different yesterday where they might have been much closer, in which case that authority gradient is not is as dangerous. And boy, yeah, not saying things can be, very bad for everyone involved. From the doctor to the nurse to the patient, that's for sure.
Dr. Joel Klein: Or even from the clinical space to IT. So, you know, last night was our quarterly upgrade here, our Epic quarterly upgrade. I'm sure there's something, you know, broken. And so, for clinicians like, well, I'm not going to report it because who cares? Or I'm not going to report it because what do I know? Well, we can't fix it.
Dr. Craig Joseph: Yeah. And I think a lot of that is also that, you know, acknowledging it is kind of adding transparency to it to say, yeah, I understand you might be scared and if you say something. I'm not going to belittle you. At least I hope that's the case. I once, I wrote about this in my book. I took my daughter to the child neurology clinic, at the University Center where I used to live because she was getting headaches all the time. And of course, I was concerned, and, they had just installed Epic at this place.
And so, I'm watching the nurse who is rooming my daughter, and she goes to the reason for visits section, and, she types in other because you have to choose, there's a list of things, then other. And then she has a free text box right next to it. And she types in the word headache. And I watch her do this and, you know, my daughter's pleading with me to not say anything, of course,
Dr. Joel Klein: But you can't help yourself.
Dr. Craig Joseph: I cannot help myself.
Dr. Joel Klein: I would have the same reaction. I cannot believe they put other when headache is in the list.
Dr. Craig Joseph: Well, no, headache was not in the list.
Dr. Joel Klein: The category list? That’s terrible.
Dr. Craig Joseph: I swear it was not in the category list. Now we're talking, you know, on the inside here category list, it was not in the category list. So, I said to the nurse, I'm like, I just have a question. Do you see a lot of kids with headaches here in the child neurology clinic? And I already knew the answer to that question. She said, why, yes, we do. I said, but I noticed that you didn't have a pre-selected choice. There was no headache there. You had actually to type select other and then type it in and she goes, yeah, and I said, did you tell anyone about this? And she said, no, I just do this. And so, we have to make it kind of, again, I don't know, maybe that's a little bit of the authority gradient, maybe that's a little bit of well, I did tell someone once about something and I submitted a ticket and that was it. And I never heard about it, and it never got fixed. And so, after that happens once or twice, or my friends tell me about that. It's done. I'm not going to tell you that anymore. And that's information that boy, again an easy fix and it makes you look a lot better. Cool. All right. Well let's see. Moving on. Recently, and I think you're aware of this, there was a third party called CrowdStrike that makes some cyber protection technology. You've heard of them?
Dr. Joel Klein: I have heard of them.
Dr. Craig Joseph: Yes. And I believe you're a customer of theirs.
Dr. Joel Klein: That's possible.
Dr. Craig Joseph: And you've written about your experience when they had a little bit of a technical snafu, and you related it to: how to know that you have the right partner. And so, can you kind of tell us, hey, what happened? And how did it work out? And did you have a right partner and how do you make sure that, how do you judge that? And then how do you apply that to, to future partners?
Dr. Joel Klein: So that was such an interesting incident for us, as it was, I know for lots of organizations, healthcare and not healthcare. But I think to really get at the, at your question, you know, we ended up on the phone with our CrowdStrike person with, I would say 30 minutes of that incident starting. So, at two in the morning eastern time, they actually got on the phone with us after we had, you know, suddenly figured out what the problem was. And later in the day, there were probably 7 or 8 third-party systems that were just as affected as we were by CrowdStrike, where, you know, they were down and they weren't going to come back, you know, anytime soon. And in contrast to CrowdStrike’s communicability with us. You know, they got on the phone with us and told us what to do. These guys wouldn't even answer all these other vendors where they just wouldn’t answer the phone. They pointed us to their website where they were going to post updates. And the update is we will let you know when we have an update. Just no stonewalling, nothing. And you know, just compare those two reactions. Now I will be clear what CrowdStrike did was not good. And they have, I think, started to disclose a little of what happened. And that's good too. But I will just tell you, as, somebody in my role, it matters a great deal when I know I can get somebody on the phone where I know somebody will be straight with me about what happened. And, I don't have to sit around and wonder, you know, how am I going to get out of this? We've had a couple of third-party issues, you know, in the last few years, and it's just so interesting to see the difference in how organizations handle things. I mean, the whole topic of how you communicate during a cyber incident is, is really complicated. And, you know, you get into you can't say too much, and, you know, the, the discoverability of what you're saying and so forth. But I will just tell you, in the heat of the moment, it makes a big, big difference to me. And, that that was one of the things that stood out to me in that whole incident.
Dr. Craig Joseph: And so how do you do you bring that lesson back to your entire IT department? you know, because there are also kind of sometimes delivering answers to their clinical or operational counterparts.
Dr. Joel Klein: Yeah. So absolutely. And the lesson is get up there and own it. So I have stood up many times in front of our, you know, CEOs, CFOs, even, you know, board meetings. And, you know, when we made a mistake or when something happened that we could have stopped or there was and it doesn't matter, just get up there and own it and deal with it. And because it's not going to go away and when you start bobbing and weaving and making up some, you know, the best is when people start using the passive voice, like, an error was introduced into the system, like it just rained out of the sky and we don't know where it came from. Don't do that. I mean, you can say we have an analyst, this is what they did. This is what they were thinking when they did it. And obviously we've spoken with them, but this is what happened. And, you know, you in healthcare, there's this whole legacy of blame. I mean, that's the whole M&M story. When you get up and, you know, this parade of horribles, I mean, that's it was intended, I think, to be, you know, how do we make, a teachable moment out of, you know, a terrible situation. But I think for the organization that's dealing with that situation, the other part of it that gets lost is that we made a mistake. And I know families, they respond very differently when you do that, when you say, okay, this is what happened. There's a whole conversation around an I'm sorry program in the malpractice space where you acknowledge something and apologize for it that day instead of, you know, letting something...So there's so many ways this applies. We saw it in how the airlines reacted to this crisis and the different responses. So, I just, I have tried to lead by just being honest, don't, you know, go too far. But say what happened in plain English and own it.
Dr. Craig Joseph: Love it. Well, this is a this is a great conversation. I really enjoyed it. we love to end our, our talks by asking the same question, which is, is there anything that's so well-designed in your life that it brings you joy and happiness every time you use it? And sometimes people talk about technology and sometimes they don't. So are there 1 or 2 things and they're so well-designed. You love them.
Dr. Joel Klein: The first thing that comes to mind, and it's going to sound like I'm some kind of violent person, but I'm not, is I have a ten-inch Henkel's chef's knife that I have had for a very, very long time. It is, I think it's a Twinstar. I don't know if they make them anymore. it's a German knife. And, when I bought it, you could either get the one that has the two rivets or the smooth handle. And if you were a serious chef, you got the rivets, because that was like, the classic way. But the one I have, it's a very smooth, flowy handle. And, when I hold that thing, I mean, it's going to sound corny to say it's like an extension of my hand, obviously it's a knife and not an extension of my hand, but it just feels great. And, if I go and sharpen it on my sharpening gadget, it, you know, you can just go to town with that thing. And it just feels great. And you don't get your hand as tired from holding it all day like I used to. I had a job as a prep cook in a fancy restaurant when I was in med school. And, yeah, there's pictures of me making mashed potatoes in a chef outfit that are pretty funny out there somewhere. But you know, when you have to chop vegetables for an hour or 2 or 3, having a good knife, it makes all the difference. So that's, that's my answer, my chef's knife.
Dr. Craig Joseph: Oh, that that is exciting. I have to say, I would not have predicted that what I was going to predict based on your writings was a cherry pitter.
Dr. Joel Klein: Oh, the cherry pitter! Yes. So, so every summer when it's cherry season, you know, it's cherry season because the price of the cherries goes from like, 6.99 a pound to 4.99. And then there's like a week where they're 2.99 and you just should buy all the cherries you can, but then you have to pit them. I mean, I guess you could just eat them, but that's not as satisfying. So, everyone has their little OXO stupid little cherry pitter where the little, you know, spiky thing breaks, you know, after 5 pounds of cherries, I found this German, just luxury, $30 item on Amazon, and you can literally stamp out the pits of a pound of cherries in five minutes flat with this thing. And it is just fantastic. I just put it away for the season. It is a fantastic device that is true. That's a toss-up between that in the knife.
Dr. Craig Joseph: All right. Fair enough. Yeah, you put a picture on LinkedIn, and we'll try to find that, put a link in the show notes of you next to this machine and, I don't know. I know there are some kitchen gurus who don't like devices that do one thing. But, boy, when you find one that does just this thing and it does it better than everything else.
Dr. Joel Klein: So, Alton Brown is wrong about that.
Dr. Craig Joseph: Alright, you got the reference.
Dr. Joel Klein: Perfectly fine to have a single-use item and you know, you don't want a giant library of them because you'll run out of room in your drawer. But, you know, for something that truly meets the need and an important need. Yeah, get the get the right tool.
Dr. Craig Joseph: Awesome. Well, Dr. Joel Klein, it has been a pleasure. Thank you so much. Really appreciated your time and look forward to more of your LinkedIn posts.
Dr. Joel Klein: I'll keep them coming. Thanks so much.