New Orleans-based Ochsner Health is expanding its relationship with a company called Latent that it has partnered with to develop clinical AI tools to help with specialty, infusion, and retail pharmacy prior authorizations. Healthcare Innovation recently spoke with Ochsner CIO Amy Trainor, R.N., about the pharmacy work, AI decision-making at Ochsner in general, as well as her efforts to reorganize how IT work is done at the 46-hospital nonprofit health system.
Ochsner’s prior authorization review times have been cut to four to five minutes — 75% faster than industry benchmarks, Latent said. After 18 months of rapid iteration and measuring the impact, Ochsner plans to scale Latent’s platform enterprise-wide.
Healthcare Innovation: Before we talk about this work with Latent, can you provide some background on your experience at Ochsner?
Trainor: I've been at Ochsner since their Epic transition, so early 2012. I came on board to help make that a seamless transition. I've been in multiple roles supporting our physicians and clinicians and then working through app support, then technology support. I have been the CIO now for about 15 or 16 months. I am a nurse by trade.
HCI: I don't think I've interviewed too many CIOs who were RNs. I think it's a good idea, but are you a rare breed in that sense?
Trainor: I would say we are starting to see a few more. I think as with physicians, it is really healthcare systems focusing on ease of practice, and how we use technology to make that administrative burden less for our clinicians, which includes pharmacists, which is what we are going to talk about today.
HCI: When Ochsner began working with Latent, what were some issues you were seeking to address?
Trainor: I am sure you have heard how hard it is to get particular medications approved, specifically specialty-based medications. The problem we were trying to solve is that we needed to get these authorizations done in a timely fashion to be able to serve our patients and their expectations. But we needed human resources to do that, and specifically very clinical resources to do that. We wanted to take some of that burden off. We still insert our clinical pharmacists where they need to be inserted, but we make sure that they're given the information that they need faster. We want to reduce the time it takes for the pharmacist to do that review.
Latent really was a great partner in streamlining the information. If you reduce the number of clicks, you really reduce that administrative burden. We still have that clinical eye looking at the chart and doing the authorization to make sure the right things are there, but it takes them a lot less time to get to that final spot.
This hit us in two spaces, which is keeping our patients first, but also making sure the technology we are investing in is giving our clinicians time to care. I'm sure you do a lot of articles on how many people are in the AI space. I think finding a partner or multiple partners is really important. But these guys said we want to be the best pharmacy AI vendor. And that was really important to me when I really started working with them. They want to go deep into understanding how we can help these pharmacists, vs, saying “Hey, we're an AI company. We can do everything.”
HCI: Did you start in specialty pharmacy and then expand to some other use cases from there?
Trainor: We did, because we have a huge specialty pharmacy practice. Our specialty drugs are the ones that take that rigorous review to make sure that we will get them paid for. Almost every single drug that came through there needs authorization of some sort. We started there and are expanding this to less complicated use cases. I can’t give credit enough to Debbie Simonson, who's our chief pharmacy officer. She knows the pharmacy space so well, and really just saw this as a huge opportunity to have a win for our patients, but also her pharmacists.
HCI: Does any of this involve improving interoperability or transparency with the payers, or working on partnerships with individual payers? AHIP and the payers just today came out with an announcement about a commitment to work on prior authorization issues.
Trainor: That would be great. We use Epic Payer Platform as well. We've seen some really wonderful results — with Humana, specifically — in the ability to share information seamlessly, which has drastically improved both inpatient authorization for care and in other authorizations needed for services for patients. I think anything we can do to move away from the antiquated, “I'm going to fax you this information, and you're going to look through a terrible, 150-page document that doesn't make any sense” is a step in the right direction.
It is time that the payers come to the table, and I think the technical piece should not be the limit, right? We're beyond that. What we don't want to do and we don’t want Latent to do either is have a war of bots between the payers’ AI and our AI, and let's see who wins. That's not success for the patient, for the payer, or for us as an organization.
HCI: Can I switch gears and ask you about something else? I saw this great interview with you in CIO magazine, and you were asked about shifting your IT team structure away from siloed areas of focus, such as hardware or applications, to focusing on a user experience. Can you talk about that?
Trainor: I'm very passionate about this. When you get to be a large organization — we have over 700 IT employees — you really get to be specialized. Each of those individual owns a super-specialized piece of some technology that we do. It came to me at a go-live event when I went to one of the tables to ask someone in the command center to help me with a workflow. And they said I can help you with this piece, but you need to go to that next table for another aspect and then to another table for something else. It was disappointing. I wondered how we can do this more cohesively.
With the help of our product team, we looked at how we could embed an agile framework and also really think about our experiences as just that. How can we identify the goals, and then bring the people to the table from all of those different teams?
We have a patient journey and a managed care journey. Through what we're doing with Latent, we created a journey just for pharmacy. We’re working on what that looks like for our employees as well. What does the employee experience look like? What are the apps that I as a corporate employee have to work with and engage with every day, and how do we take advantage of some of those? So it has been great. It is hard. Is a non-traditional way to run an IT department in healthcare, but it has brought some really big wins for us around transparency and visibility of work to the business.
We also look at this with a lens of metrics. If our KPIs for something didn't pan out the way we expected, do we need to pivot? And that's something we didn't have before. So that in addition to the structure of the teams has been huge, huge win. We're not fully done deploying it yet. There are new journeys that we want to create, and every day there are new problems to solve within teams. But I really do think it is the way of the future, and I'm, very proud as a leader of this department that the teams embrace the change, because it's an enormous change.
HCI: Most CIOs we're talking with today are very busy working with others in their organizations, in defining AI strategies. I'm wondering if you're spending a lot of time on that at Ochsner? Are there decisions about what to build and what to buy, or which types of AI companies to partner with, or where to focus early efforts?
Trainor: Yes. I think our governance is among the best in the country. We have a three-pronged approach. We have AI governance, and we developed our own responsible AI principles. We have our Center of Excellence, which is the group of people who are really strategically evaluating the risks, and determining the KPIs. Is this adding value to the organization? And then we have the journey teams, who will do the work. If you're putting in AI that will help the pharmacist, but you're not working on it in the pharmacist journey, then what are you doing? Do you understand the workflow?
I think that the part that got really difficult in the last six months was that our focus originally was looking at all the third-party developers, but we have refocused because all of the biggest players in the space are now doing their own AI. I think right now, we have 130 pieces of AI from an Epic perspective to review. We have Salesforce. We have ServiceNow. We have Workday. All of the big players are infusing AI in our platforms. How do we make sure we're thinking through when it makes sense to look elsewhere?
HCI: Is there a sense that the large, entrenched players are moving fast enough on AI tools?
Trainor: Six months ago I would have said no. I don't know what happened there, but it has been like a massive change. With mosst things, we're going to look at our partners first. If they don't meet our needs, we're going to look elsewhere. It is the same with AI. We want to make sure we're capturing the value of what we're spending already. In general, we're going to look internally first. I would say they are moving a little faster. Latent was a great example —Epic’s not doing this yet, but they probably will be in the next six months.
Turning on AI is a much different conversation than a color change or a new button on somebody's dashboard. We have to make sure that this is safe and follows our responsible AI principles. I would say that the ChatGPT era is the fastest-moving we've ever been able to take advantage of any public tech in my 20 years in health IT.
