A conversation between Jerry Cuomo and Claus Jensen from the Memorial Sloan Kettering Cancer Center on automation in the healthcare industry.

Covered in this chapter

• Automation in the healthcare world
• AI in the healthcare world
• A hybrid care model
• Moving to the “next normal”

The Art of Automation: Table of Contents

An industry lens

This chapter of the Art of Automation is a reduced transcript of a conversation between Jerry Cuomo and Claus Jensen, Chief Digital Officer at Memorial Sloan Kettering Cancer Center and author of four “For Dummies” books. In our first chapter of AI-powered Automation viewed through the lens of a specific industry, Claus and Jerry discuss the important role automation is playing in healthcare and why the combination of artificial intelligence (AI) and human doctors outperforms either in isolation. They also explore both good and bad examples of how AI can be used in healthcare and what innovations they expect to see in the next decade.

Jerry and Claus 

CUOMO: Welcome to the Art of Automation, a podcast that explores the application of automation in the enterprise. I like to start these podcasts with a simple definition of automation, so here it goes. Automation uses technology to automate tasks that once required humans. Simple enough, right? But, as you’ll see, the devil’s in the details, and it’s those details that we like to bring to the forefront with these podcasts.

So, let me tell you what’s in store for today. Today we’re going to take our first up-close look at automation from an industry lens; and specifically, healthcare. So, what better guest to join me for this discussion than Claus Jensen.

Claus is the Chief Digital Officer at Memorial Sloan Kettering (MSK), where he’s leading digital business transformation innovation and platform initiatives and the overall technology agenda. At MSK, Claus is focused on scaling and expanding the fight against cancer through a seamless synthesis of extraordinary people and meaningful technology — I really like that.

Before Sloan Kettering, Claus served as the CTO and head of architecture for CVS Health and Aetna. But wait, there’s more. Claus is also the author of four For Dummies books by Wiley Publishing, including Digital Transformation for Dummies, The Hybrid Cloud Journey for Dummies, and APIs for Dummies.

And with that, I’d like to welcome Claus to the Art of Automation. Welcome, Claus.

JENSEN: Thanks, Jerry.

CUOMO: Great to have you. And look, I’ve chatted with you a number of times, and I know you have so many good perspectives here, so I just want to jump right into it if you don’t mind.

JENSEN: I don’t mind at all.

CUOMO: Great.

Automation in the healthcare world

CUOMO: Claus, what do you see the role of automation being in the healthcare industry; and, why now?

JENSEN: So, the first thing to say is it won’t replace the doctors. I mean, that is sort of what you see in the boss literature, that this is going to replace everything. But it is going to make, hopefully, healthcare a better experience.

We’ve all seen the discombobulated nature of things not being connected. There’s a lot of friction in healthcare, and we have seen it very close up over the last seven months dealing with an unforeseen pandemic.

The real question becomes, how do you use automation to reduce the friction — give everyone a better experience? And not just the patient and caregiver side, but this notion of burnout on the provider side is quite real.  What burns people out is more about the meaningless stuff that you have to do because that’s just how the systems work; it’s not necessarily about the volume of work that you have to do. We all get motivated by the things that we care about and we all get slightly demotivated by red tape and stuff we have to do “just because.” So, I’d say that’s probably the biggest role of automation in healthcare.

CUOMO: So, not replacing the doctors but certainly enhancing the experience of all involved.

JENSEN: Yes.

AI in the healthcare world

CUOMO: So, Claus, could you explain the role of artificial intelligence in automation, and if you can, maybe give a couple examples?

JENSEN: So, let’s start with this debate in the industries of which is better — is the doctor better, is AI better? It’s an interesting question and actually doesn’t matter, because what we do know with certainty is that the two together are better than either in isolation. We’ve seen that.

Any time you do a study, you can debate which one is better depending on the problem, but if you put the two and combine them in the right way, it will inevitably end up with higher quality and a better experience. I’ll give you a good example and a bad example.

The good example is if you take a picture of tissue to a cryoelectron microscope. If you’ve ever seen one of those images, it looks a little blurry and you can barely discern any structure by the naked eye. But an AI model can, and it can enhance the structure, and it can highlight what the structure looks like, and I can have a human oncologist — a human physician — actually interpret. So what does it mean in the clinical sense.  That’s a great example of AI being used to enhance something we can’t see with our eye.

A not-so-good example was a hospital (wasn’t ours) that was training an AI model to try to recognize disease, and they wanted to do the best possible job so they gave this training algorithm all the images from their best piece of equipment. And it worked great in tests, and they got to production and the results didn’t make any sense.

So, what’s going on? It turned out they had trained their AI algorithm to recognize images from that piece of equipment, which happened to also be the piece of equipment they sent their most sick patients to go get diagnosis from. So, it was an unforeseen bias in the data and the way you had trained it. So, you’ve got to be careful.  If you’re not careful with how you train it and how you feed the machine learning algorithm, you’ll get an unexpected result.

A hybrid care model

CUOMO: So, Claus, you have a number of responsibilities in your role as the chief digital officer across IT, technology, business and more. What would you say is the biggest help technologically over the last couple years to bring your team together? You gave an example of computer vision; any other examples of particular technologies that you see propelling automation?

JENSEN: I think there are three, and they’re tied to three vectors of change around us. There is the whole move to a hybrid care model — so the emergence of not just audio/video telemedicine tools but perhaps more importantly, our ability to stay in touch in a near real‑time fashion when you’re not necessarily in our facility. I can send people home with devices and I can get real‑time telemetry into my offices and basically take care of them as if they were in my hospital.

The second one is we’ve gotten new tools and technologies to understand data semantically and actually try to make sense out of a very rich data set that we have historically not been able to make sense out of, partially because a lot of it is written notes from physicians, and they don’t necessarily speak in structured data — they’re not supposed to — to tell a story about what happened with the patient.

And then the third one — and that’s actually where I think we will see the biggest wow factor if you sort of look ahead — is much of the healthcare system is focused on disease, and we know how to take care of disease. But the real question is, how do we help people that haven’t gotten sick yet? And that’s not a problem that you can scale with people and physical resources, because there are too many humans in the world and you can’t call everyone every day. But you could build a digital platform that allowed people to get guidance and knowledge in a pre-disease stage, and then you can integrate in humans with specialized experiences and skills when you need it. But, by and large, this is a primarily digital relationship that helps you with all of your needs logistically and practically and knowledge-wise around some particular disease.

And we haven’t seen that yet — not really. But I think we finally have the technology to build it; and if we could, this will be a lot smarter than Google and a lot more useful than any static library you can go read in a book, because it will be personal, it will be meaningful, it will be about you.

Moving to the “next normal”

CUOMO: So, Claus, when you think about moving forward in 2021, all eyes are going to be on industries and how we move forward, get people back to work and optimize our overall surroundings. What’s your view on how we get back to our new normal?

JENSEN: It’s a great question, and I don’t even know whether I think that the new normal is the right term. I sometimes talk about the “next normal” because, in some ways, it’s about reinventing what does normal even look like. True transformation is almost inevitably based on both optimization and creation. You need to optimize some of the stuff you have to free up resources to create new things, and we talked a little bit about some of the new things I would like to bring in to the world of cancer.

Usually, when you talk about optimization, people tend to say, how can you do more with less, right? So, if I give you less of the resources that you have today, can you do more with the same — with a smaller amount of resources — and get the same piece of work done?

I actually think that’s the wrong question. I think the right question is, how do we do more with more? And here’s one — because as we get more capabilities in terms of digital and intelligent technology, we have more tools in the toolkit. There are more problems we can solve; and as we solve more problems, we can actually make some of the existing problems smaller.

I’ll give you a simple example. If you can teach people how to manage risk earlier in the lifecycle, you get less need for some of the heavy lifting that comes further downstream when they get sick. It’s a simple example that’s related to population health management, but it’s the same principle.

When you have got more tools in your toolbox, I think we should look for doing more things with more tools — hence, getting to a better outcome — rather than just asking ourselves, can we do the same things with less resources. That’s an uninteresting question.

CUOMO: Claus, we spoke earlier this year — I think I’m going to guess it was around January — and you made a statement which I’ve got to admit, when I heard it, I didn’t think of it too much, but when I took the role in automation I thought back right away to you.

Before the pandemic, even, you had said that 2020 increasingly will benefit from automation across the enterprise, but in 2021 it’s going to be a really big deal. And I’m paraphrasing what you said, but you kind of like foreshadowed the importance of automation. And jeez, like look what’s happened in between. I don’t know that it’s a year that any one of us expected.

So, can you pinpoint one or two particular areas where you feel excited about automation making everyday life for you, your staff, your patients, people yet to be diagnosed, as you said, better.

JENSEN: Well, we talked about a lot of them already. If I were to pick one, it is the ability to have a seamlessly orchestrated process all the way from identification of, I need to meet with someone, I need to go through a whole bunch of tests; and ultimately, ends up with it a disposition after the visit. In the old world, this was a very cumbersome process. It involved a lot of people and a lot of paper.

In the world we now live in, you can imagine a CRM-type tool, and it will allow you to do lightweight orchestration of the process. You can plug in people that are not clinicians. You can orchestrate the logistics, and, ultimately, all you have to do as a patient or as a physician is do your part of that process instead of having to worry about all the red tape.

In some ways, this is the most low hanging fruit but also the most profound change for any of us who live in the healthcare environment, because all of a sudden, we just have to worry about our part.

Learn more

Make sure you check out The Art of Automation podcast, especially Episode 3 from which this chapter came.

Check out the other chapters in the ongoing series, The Art of Automation:

The Art of Automation: Landing Page

• Foreword: The Business of Automation
• Chapter 1: Introduction to the Art of Automation
• Chapter 2: Automation with Robotic Process Automation (RPA)
• Chapter 3: Automation with Intelligent Document Processing
• Chapter 4: Automation and APIs
• Chapter 5: Automation with AIOps
• Chapter 6: Automation in Healthcare
• Chapter 7: Automation in Insurance
• Chapter 8: Automation and the Weather
• Chapter 9: Automation at Sea
• Chapter 10: Automation in Retail
• Chapter 11: Automation and Process Mining
• Chapter 12: Automation of Yesterday, Today and Tomorrow
• Chapter 13: Automation and Observability
• Chapter 14: Automation and Digital Employees
• Chapter 15: Automation in Financial Services
• Prependix: The Art Behind the Art of Automation