Posts in category: Health

Veteran California public servant Will Lightbourne has stepped in as interim executive director of the state’s mental health commission after its previous executive director resigned following conflict of interest allegations.

Lightbourne served as head of the state’s Department of Social Services for seven years before retiring in 2018 and had already returned to service once, as interim head of the Department of Health Care Services at the height of the covid-19 pandemic. On Nov. 4, he was tapped to lead the state’s Mental Health Services Oversight and Accountability Commission after executive director Toby Ewing announced he would step down.

Documents obtained by KFF Health News showed that Ewing took a trip to the U.K. funded by Kooth, a London-based company that the state contracted to build a youth mental health app. At the same time, he was working to protect Kooth’s $271 million contract.

During a public hearing the day he announced his resignation, advocates for mental health services accused the commission of favoring the interests of corporations over those of the people it is supposed to serve.

Lightbourne, 75, is now leading the commission, an independent body charged with ensuring that funds from a millionaires tax are used appropriately by counties for mental health services. He said he’ll focus on making the commission as open as possible, as a nationwide search for the next executive director begins.

He comes to the mental health commission at a moment of change. With the passage of the Behavioral Health Services Act last year and its approval by voters this year as part of Proposition 1, the commission will be integrating 11 new members starting in January. And in July 2026, it will stop overseeing county funds for mental health innovation and will instead get its own bucket of up to $20 million a year to spend on innovation. Conversations are already underway about how to spend the funds.

Lightbourne directed social service agencies in Santa Clara, San Francisco, and Santa Cruz counties before being named director of the state social services department, where he launched an effort to move more foster children out of institutions and into family-based settings.

Lightbourne spoke to KFF Health News correspondent Molly Castle Work about his goals for state mental health services. The interview has been edited for length and clarity.

Q: You already came out of retirement once, to lead DHCS during the pandemic. How were you convinced to take this job?

A: Back when I was at DHCS, quite a bit of what is now the sort of health reconceptualization in California happened.

There’s a point where you feel a sense of paternal relationship for a lot of the initiatives. What the commission does in terms of the detailed finish work is really going to be important for this thing to work.

Q: Executive Director Toby Ewing resigned amid accusations of favoritism with the contracts. How can the public have faith that this won’t happen again?

A: I want to be very careful now, because the way you phrase the question implies that I accept the proposition, and I have no way of knowing. What I’ve always said in any setting that I’ve been in is always deal the cards face up. Just be transparent. Be open. When possible, use competitive processes.

There’s the famous three intersecting points of contracting: You can have speed, you can have quality, you can have a good price. Pick two. You can’t have three. And you know, my instinct is always to be a little bit more skeptical of urgency. I mean, there are huge human needs out there that we want to solve, but to say everything should go by the wayside because things have to happen yesterday — let’s take a beat.

Q: As the interim executive director, are there guardrails that you think need to be in place to ensure that taxpayer money is being spent wisely?

A: I don’t know that there’s anything that I am particularly worried about, but I think it’s my role to help the commission as it transitions into Prop 1, into BHSA, and into a permanent executive director — just make sure that they’ve got all the procedures that they think they need — and that we build a culture where we are sure that they are able to fully see things coming in front of them.

It’s going to be interesting that come January we’re going to add 11 commissioners. It’s a huge jump. And doing it in a way that everybody stays engaged — I don’t have an answer yet.

The value-add of this organization is that it’s got a commission of pretty damn committed people who take it very seriously and bring a lot of skill to it. And you wouldn’t want to see that lost.

Q: Our country has seen the mental health crisis spike over the past few years. Are there specific areas you want to focus on?

A: I always want to be a little careful about having one more bright idea. There is definitely initiative fatigue on the ground. People have got that glazed look. So if there are things that the commission can do to bring more resources, more players, more solutions that help, then that’s great. I just don’t want us to be piling on new ideas.

Some of the things the commission has already invested in, and I’m trying to get more familiar with this, like the early psychosis interventions — that could be a real game changer as I understand it.

Q: How do you think funding for mental health initiatives should be prioritized?

A: Certainly the old notion of full-service partnerships is important. It means whatever takes — put a team together, wrap it around the person, address their core needs, like housing.

Don’t think that with somebody sleeping under the bus shelter that you can address their needs while they’re still sitting there, you know? Move them into a setting where they can feel safe, they have dignity, they have their personal human needs met, and also whatever therapeutic needs or medication needs or medically assisted treatment needs.

Q: What are you most looking forward to in this role?

A: Because of where I’ve been previously, I think there are some obvious connections to make. We don’t want to subordinate the commission to the other systems. It’s got to have its own thing. But just knowing who to dance with can be helpful.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

Hello. I’m Dr. Sarah Chalmers, a pulmonologist at Mayo Clinic. And I’m here to answer some of the important questions you may have about cystic fibrosis.

Just because your baby’s newborn screen came back positive does not mean that your baby has cystic fibrosis. Most babies who have a positive screening actually don’t have CF. The newborn screen looks at a substance in the blood that is elevated in cystic fibrosis, but it can be elevated in other conditions as well, even premature birth. Some states also test for a gene mutation, but even if this comes back positive, it doesn’t mean your baby has the disease. People with only one mutation are called carriers. It’s very common in the United States and one in 20 people are CF gene mutation carriers. If your baby has a positive cystic fibrosis screen, they will need to see their doctor and have a sweat chloride test to see if they do have cystic fibrosis.

CF gene mutations are actually passed from parent to children in a specific pattern called autosomal recessive. Each parent passes one CF gene to their child, and therefore each person has two CF genes. To get the disease, both genes have to have a mutation. People with one CF gene are called carriers. If a parent is a carrier, there’s a 50 percent chance they’ll pass on the gene with a mutation to their child. If both parents pass on a normal gene, or only one parent passes a gene with a mutation, the child will not have CF. If both parents pass on a gene with a mutation, then the baby will have two genes with the mutation and will likely get the disease. If both parents are CF mutation carriers, there’s a 25 percent chance that each one of their babies will be born with cystic fibrosis.

So both males and females can get cystic fibrosis. But females tend to have more symptoms, more lung infections, and they tend to start these symptoms of infections earlier in life as compared to males. No one knows for sure why this is so.

Actually, nearly 10 percent of cases of CF are diagnosed in adulthood. You’re born with cystic fibrosis, but there are several reasons why it may not be diagnosed during childhood. Prior to 2010, some states didn’t even screen for cystic fibrosis. So if you were born before 2010, you may not have received a newborn screening test for cystic fibrosis as a baby. Some gene mutations cause very mild disease and symptoms may go unnoticed until adulthood.

CF symptoms, how the disease affects the patient’s organs and how it impacts their life is very different from one person to the next. Some people have very mild disease with only one organ affected and very few symptoms, while others have more severe disease with troublesome symptoms and multiple organs that are affected. Many factors including gene mutation type determine the impact on the patient. But your cystic fibrosis care team can work with you as an individual patient to create a personalized treatment plan that meets your individual needs.

Fertility is affected in both men and women with cystic fibrosis. Women with CF have thicker cervical mucus and they may also have irregular menstrual cycles. So it may take longer for women with CF to become pregnant. But most can become pregnant, have a normal pregnancy and a normal delivery. Almost all men with CF have infertility. Men with CF make normal sperm, but the sperm canal is absent. Because they still make sperm, assisted reproductive technologies can be used to help male CF patients have biologic children. Whether your children get CF or not depends on the combination of genes passed on from you and your significant other and can range from zero chance if neither parent has a gene mutation to a near 100% chance if both parents have CF.

Always be honest with your health care team. Let us know which medications you’re taking and how often you’re doing your treatments. Write down your questions before you come to your appointment so that we can make sure that we are meeting your needs. Thanks for your time. And we wish you well.

NSW extends virtual health service to adults

Over a year since offering urgent virtual care service to children and youth statewide, the New South Wales government has come up with a similar service for adults. 

The new VirtualAdult service will provide urgent care via video conferencing for common illnesses or injuries, such as coughs and colds or flu, respiratory symptoms, vomiting and diarrhoea, and rashes. 

Following its launch this month, December, in Sydney, it is planned for statewide expansion by the end of 2025. The service is part of several initiatives introduced to relieve pressure on overwhelmed emergency departments across NSW. 

Digital pharmacy ordering now live in Victoria

Compounding pharmacy Slade Health, part of cancer care provider Icon Group, has digitised its ordering system for public hospitals in Victoria.

It recently integrated the digital medications management system, Charm Evolution by Magentus, with its in-house software, to automate information flow. 

In a media release, Slade Health says public health facilities and hospitals can now order through this digital system, doing away with manual entry. The system also provides the pharmacy with near real-time visibility into orders, updates, and cancellations. 

This integration makes Victoria the second state in Australia after Queensland to fully digitise ordering for hospital pharmacies. 

Royal Melbourne Hospital beefs up digital transformation

Royal Melbourne Hospital has sought support from digital health accelerator ANDHealth for its digital transformation. 

It made the organisation its “innovation partner,” helping keep updated and providing expert advice on new and emerging technologies.

The hospital has also become ANDHealths’ first core hospital system partner, providing insights into clinician and staff demand and needs from technology.

We spend much of our midwinter in joyous celebrations – of Christmas, of New Year, with friends and family, good food, good drink and bright fires blazing in our hearths, But beyond that firelight, there are lingering shadows: we might associate Christmas with parties, love and general jolliness, but for millennia it was a time when the world was turned on its head, when hideous creatures rampaged through the streets, when the dead returned, when chaos reigned. Associated with all these horrors are a host of unsettling celebrations and rituals – there’s plenty to pick from, but here are my own top 10.

Elect a Lord of Misrule

If you’re finding your Christmas parties lacking a certain something, why not elect a Lord of Misrule to lead you in wild and chaotic revels. A practice that originated with the Roman festivals of Saturnalia about 2,000 years ago, where mock kings were elected by friends to issue ridiculous commands, which included everything from dancing naked to shouting insulting lies, it spread to medieval Christmas celebrations. By the early modern period, the puritan pamphleteer Philip Stubbs was complaining that the Lords of Misrule brought “devilry, whoredom, drunkenness, pride and whatnot” to Christmas celebrations, and while he wasn’t entirely unbiased in his condemnation we have many accounts of riots, smashed windows, and even a manslaughter charge brought against a Lord of Misrule in England after his Christmas games went awry. Less likely to recommend because manslaughter charges probably aren’t what anyone wants for Christmas.

Watch the solstice at Stonehenge

There are many ancient monuments across Europe that are aligned with the midwinter sun, so marking the moment of the longest night was clearly a popular practice a few millennia ago. It seems to have died out fairly early on: by the time Christmas was arriving on the scene, most of these monuments had been long abandoned. But if you feel like reviving it, you can head to Stonehenge for 21 December, where there are two choices – the first is to go for the solstice sunrise, when English Heritage lets you stand in the middle of the stone circle and experience the joy of the sun rising at the end of its longest night. But Stonehenge was actually aligned to midwinter sunset, not the sunrise. You can’t get into the centre of the stones for the solstice evening, but you can still see the sun set through the main stone archway from some distance away. To modern sensibilities at least, there’s something extraordinarily melancholy about bidding the sun farewell rather than welcoming it, and watching as its last rays – caught by the huge, uncanny stones – slip below the horizon before the longest, darkest night of the year.

Crown a St Lucy

The night of St Lucy is 13 December. She was a young Christian girl who, according to legend, was martyred in Syracuse in the 4th century AD. Every year, across the Nordic countries, young girls are crowned as Lucy in eerily beautiful ceremonies, by having a wreath of lit candles placed on their heads. But make sure all your work is put away for her celebration, and remember to leave out food offerings for her overnight, because there’s another side to Lucy. She’s not just a good, Christian girl but also a rampaging witch who flies across the sky on 13 December leading a cavalcade of the dead – and she has no hesitation in murdering or cursing those who don’t honour her properly. Sadly, people don’t tend to leave out food for her much any more (in previous centuries the dining table would have been set ready and waiting for her). Bonus points for this celebration as it comes with its own saffron-spiced, raisin-studded bun, the “luciapullat”.

Go on a year walk

This involves going out in the pre-dawn darkness of Christmas Eve, without talking to anyone, without looking into any fires, and without eating anything. If you fancy a year walk, stroll far enough away from any houses so you wouldn’t be able to hear a cockerel crow, and then head to your local church and sit and wait by the graveyard. According to a Swedish tradition, attested in numerous folk tales (archived in the Swedish Folklore Archive, if you happen to speak Swedish and want to know more), you’ll see shadowy enactments of any burials that will happen in the coming year. And if that doesn’t work, you can try peeping through the keyhole of the church door, to see the premonition of a service in a year’s time – anyone missing from their pew will be dead before the year is out. Though be warned, there are dangers in all of this – the folklore tells that monsters, madness and death threaten those who go on year walks. And, perhaps more to the point, who really wants to get up that early on Christmas Eve?

Go guising

From late antiquity across Europe, Christmas – and especially 1 January – was a time when you dressed as a monster and ran house-to-house demanding food, drink and money – a practice called guising. The UK seems to have come to the practice fairly late – it was only in the early modern period that British sources start mentioning everyone running door-to-door dressed as horrible creatures. You might think that sounds quite close to trick-or-treating, and you’d be right – but it was a Christmas tradition first, and a Halloween one second. There are plenty of excellent guising monsters to pick from if you’re thinking of dressing up this year– from the Skekars of Shetland, Orkney and the Faroes who dress in , antlered straw costumes, to the Klaubaufs of Matrei in Austria who look like fur-clad demons and drag people into the street to throw them in the snow.

Participate in a pwnco

Do you want to spend Christmas in a poetry contest with a skeletal horse? Then the pwnco is the dark ritual for you. Normally found in Wales, the Mari Lwyd is a horse skull, often stuck with tinsel, with baubles in its eyes, held on a stick by a performer who hides under a sheet. The Mari is recorded from the 18th century in Wales, and is a guising monster with a twist, visiting houses (often led by a gang of supporters), demanding entry, food and drink – but if the residents want the ghostly horse and its retinue gone, they have to outwit them in a rhyming battle of insults, or “pwnco”. If your rhyming is good enough, the horse will leave you be. The practice declined in the late 19th century and, while you can still find it across Wales, it tends to be a formulaic call and response between the monster and its reluctant hosts. Bumped up the list for the joyous surrealism.

Go wassailing

If you wanted to do something else with a skeletal horse, you could always take it to an orchard. In the new year in the UK there are plenty of wassails, a winter tradition where people gather in orchards to wish good health to the apple trees in the coming year, drinking cider and pouring it on the trees’ roots, hanging toast from the branches for birds, and often shouting loudly and banging pans to drive away evil spirits. The Chepstow Wassail and the Blackthorn Ritualistic Folk Wassail at Newton Court both have all the elements you could want: a glass of cider, a good bonfire and horse monsters.

Watch a mummers’ play

On Boxing Day, across the UK, there are numerous performances of mummers’ plays – strange, formulaic little plays that involve bizarre costumes (the mummers of the Cotswold village of Marshfield dress entirely in torn strips of paper), often revolve around the murder and resurrection of one of the central characters and normally include a devil, who begs for money after the performance. Father Christmas can show up, too, but he tends to be wielding a sword, and is a far cry from his cheery, Santa-based self. Most of the plays we see today were based on ones written in the 17th century, but they all come with eerie strangeness.

Attend a krampus run

Every December, across Switzerland, southern Germany and Austria (and Whitby, if you’d prefer something a little closer to home), there are “krampus runs”, where performers dress in terrifying masks, huge horns (often more than 1m high) and costumes made of bulky pelts and rampage through the streets. Krampuses are punishers of the wicked – especially wicked children – and are led by the proto-Santa himself, St Nicholas – his dark antithesis, punishing the bad rather than rewarding the good.

Read ghost stories

The Victorian era saw the decline of the more nightmarish traditions, with the growing popularity of a family Christmas, spent at home with your loved ones and not drunkenly running through the streets in a horrible mask. But the darkness of Christmas endured in ghost stories, with Victorian writers, from MR James to Charles Dickens, penning horrific tales specifically for the season (including a Christmas Carol, with all of its ghostly visitations). Not only did they tie in nicely to the Victorian obsession with spiritualism, they allowed the darker side of Christmas to be embraced. Personal favourites include Henry James’s The Turn of the Screw (which even has a framing device of being a tale told on Christmas Eve), and MR James’s Whistle and I’ll Come to You My Lad (along with its fabulous 1968 BBC adaptation). Nothing is more Christmassy than a terrifying ghost story and a mug of mulled wine.

The Dead of Winter – The Demons, Witches and Ghosts of Christmas by Sarah Clegg is out now at £14.99 (Granta). Buy it for £13.49 from guardianbookshop.com

The 24-hour news cycle is just as important to medicine as it is to politics, finance, or sports. At MedPage Today, new information is posted daily, but keeping up can be a challenge. As an aid for our readers, and for a little amusement, here is a 10-question quiz based on the news of the week. Topics include the benefits of short bursts of daily activity, chocolate consumption and diabetes risk, and chronic traumatic encephalopathy (CTE) in ice hockey players. After taking the quiz, scroll down in your browser window to find the correct answers and explanations, as well as links to the original articles.

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Ingredients

1. 1 pound extra-lean ground beef
2. 1/2 cup chopped onion
3. 2 large tomatoes, chopped (or 2 cups canned, unsalted chopped tomatoes)
4. 4 cups canned, unsalted kidney beans, rinsed and drained
5. 1 cup chopped celery
6. 1 1/2 tablespoons chili powder or to taste
7. Water, as desired
8. 2 tablespoons cornmeal
9. Jalapeno peppers, seeded and chopped, as desired (not included in nutrition analysis)

Directions

In a soup pot, add the ground beef and onion. Over medium heat, saute until the meat is browned and the onion is see-through. Drain well.

Add the tomatoes, kidney beans, celery and chili powder to the ground beef mixture. Cover and cook for 10 minutes, stirring often. Uncover and add water to desired consistency. Stir in cornmeal. Cook at least 10 minutes more to let the flavors blend.

Ladle into warmed bowls and garnish with jalapeno peppers, if desired. Serve right away.

Editor’s Note: This is part two of our two-part interview with Dr. Karandeep Singh. To read part one, click here.

Yesterday in our new series of articles, Chief AI Officers in Healthcare, we spoke with Dr. Karandeep Singh, Chief Health AI Officer and associate CMIO for inpatient care at UC San Diego Health. 

He described how accountability for all AI in a health system must lie with the Chief AI Officer, and how to hold this hot new position, executives must have skills that encompass clinical and artificial intelligence – though there need not be a balance.

Today we talk more with the physician AI chief about where and how UC San Diego Health is finding success with artificial intelligence. We dissect one AI project that has shown clinical ROI – and get some tips for executives seeking to become Chief AI Officers at their own organizations. 

Q. Please talk at a high level about where and how UC San Diego Health is using artificial intelligence today.

A. We’re using it today largely in two different broad classes of use. One of those is predictive AI, and one is generative AI.

Predictive AI is where we use AI to estimate the risk of having a bad outcome, usually, and where we design and implement interventions to try to prevent that outcome. That’s something we currently have widely in use for sepsis in all of our emergency rooms across UC San Diego Health. It’s something we’re in the process of deploying across our inpatient and ICU beds, as well.

This is something we implemented as early as 2018. It’s something we have rolled out in a really careful way. It was designed by colleagues of mine at UC San Diego Health. One of the key things that differentiates this from some other work that’s been done in this space is that in the process of rolling it out, they actually designed a study to put on top of that rollout to see whether or not the use of this model linked to an intervention that largely alerts our nursing staff is actually helping patients or not.

What the team found is that this model is saving about 50 lives across two ERs in our health system every year. It’s beneficial to people, and we’re keeping a really close eye on it and looking for further opportunities to improve. So that’s one example of where we’re using predictive AI.

Another one is predictive AI for forecasting purposes. I already highlighted in yesterday’s interview one of the use cases by our Mission Control, where we’re using a model to forecast our emergency department boarding patients. And that helps us figure out what things we need to do when we anticipate we’re going to have a busy day tomorrow in two days or in three days, and something that we’re still designing some of the workflows around. We have some workflows already implemented in progress.

So, the other broad category of use cases is generative AI. We’re using some of the capabilities within our electronic health record that allow generative AI capabilities. One example of that is when a patient sends a message to their primary care doctor, the doctor has the option to reply in the usual way where they type out the entire response, or they can see a preview of an AI draft response and can decide if they want to use it or not as a starting point, and then edit that response and send that one along.

If the clinician opts to do that, we append a message at the bottom that lets patients know this message was partially automatically generated so they know there was some process of drafting that message involved that wasn’t just the clinician being involved. That’s an example of one where we found that, surprisingly, it actually increases the amount of time it takes to reply to messages.

But the feedback we’ve gotten is that it is less of a burden to reply to a message when you have a little bit of boilerplate text to start with than to start with just a blank slate. That’s one that we’re still refining, and that’s an example of one that’s integrated into our EHR.

There are other ones where we have built them in-house. In some cases, it’s work that was done in my academic lab, but in a lot of cases, it was work done by colleagues of mine that we’re now looking to implement as part of the Jacob Center for Health and Health Innovation. One example of that is we have a generative AI tool that can read patient notes and abstract quality measures.

Quality measurement abstraction is something usually very time-consuming. The main implication of that is it takes a lot of people to do it. But more importantly, we’re only able to review a really small subset of people’s charts just because it’s so time-consuming. So, we never get to reviewing most charts in the electronic health record.

What we’ve found so far is we can get more than 90% accuracy using generative AI to do some of these chart reviews and abstractions of quality measures where we say, did they meet this quality measure or not? There’s still some room for improvement still there. But the other critical thing is we can review a lot more cases.

So, we’re not limited to a small number per month because we can run this on hundreds of patients, thousands of patients. It really gives us a more holistic view into our quality of care beyond what we could even achieve currently, despite throwing a lot of resources and a lot of time at trying to do this well.

Those are the two broad categories: predictive AI and generative AI. We’ve got a lot of other work, a lot of other use cases in progress or already implemented.

Q. This story is about what it’s like to be a Chief AI Officer in healthcare, and you’ve discussed a number of projects you’ve got going. For this next question, could you pick one project and talk about how you, as the Chief Health AI Officer, oversaw the project, what your role was?

A. I can talk about our Mission Control Forecasting Model. This was something already implemented in an initial version when I got here to UC San Diego Health. I’ve been here for 10 months now. Some of the things I’m working on are on the runway, and some are just starting to be implemented.

My role in this model, though, is that while it was working somewhat well, there were clear days where the model would predict that we’re going to have a not-so-busy day tomorrow. Tomorrow would roll around, and it was much busier than what the model was saying it was supposed to be.

Anytime you have a model that’s doing forecasting, where it is predicting tomorrow’s information using today, and it’s really far off, the people who are using that tool start to lose faith in it – as I would, too. When this happened, I think once or twice, I said, “We can’t just tweak things now. We have to go back and look at what are the things the model is assuming as to what information it’s using to figure out why tomorrow’s prediction is not accurate.”

What did we do here? I sat down with our data scientist. We went through that model line by line looking at code. And what that helped us do is figure out key things we thought were in the model, but actually weren’t because they had gotten removed previously because it was found to not be helpful.

So, we said, “Well, why was it not helpful?” We did a bunch of digging and looked at some of those predictors and found that some of those were not helpful because they were actually capturing the wrong information. Based on the description of the predictor, it was capturing something different than what the code was actually doing.

Doing that over the course of about three to five months, we went from version 2 of our model, which was implemented when I first got here, to version 5.1 of the model, which went live last month. What’s happened as a result of that? Our predictions today are substantially better than our predictions were in January and February. And what that does is help us start to rely on the model to do workflows.

When the model is not accurate, there’s not a lot of appetite toward linking any workflow around it. But when the model gets more accurate, people start to realize the model actually says tomorrow is going to be a busy day, and it turns out it is a busy day, or it says it’s not going to be and it turns out not to be busy. That now lets us think about all kinds of things we could do to make our healthcare and access to care a bit more efficient.

What are my activities there? Figuring out with the co-directors of our Center for Health Innovation, our data scientists, some of our PhD students, what is happening on the data side, what’s happening in our AI modeling code side, what’s happening in our processes for how we go live with new versions of models and our version control, and then making sure as we upload those new models, that gets communicated out to our Mission Control staff so they’re in the loop on when to expect the model to change and what is actually changing.

So, we develop model cards we distribute, then we make sure that information is communicated out to a broader set of health leaders at our Health AI Committee, which is our AI governing committee for the health system. So really, it’s soup to nuts being involved in everything from how we’re pulling data all the way to how it’s being used clinically by the health system.

None of that is stuff I can do alone. As you notice, each of those steps requires me to have some level of partnership, some level of someone who has domain knowledge and expertise. But what I have to do is make sure when a clinician notices a problem, we can think about and brainstorm what in the upstream processes might be creating that problem so we can fix it.

Q. Please offer a couple of tips for executives looking to become a chief AI officer for a hospital or health system.

A. One tip is you really need to understand two different worlds and understand how they connect. If you look online, there is a lot of chatter and discussion about AI. There’s a lot of excitement about AI. There’s a lot of people just sharing their experience of AI, and all of that is good information to capture.

It’s also important to read papers in the space of AI and understand some real limitations. When someone says, “We need to make sure we monitor this model because it might cause problems,” you should know roughly what kinds of problems it could cause, what are key historical examples of problems caused by health AI, because you’re essentially going to be the AI domain expert for the organization.

One of the key things is, it’s a bit difficult to pivot from being a healthcare administrator leader into a Chief Health AI Officer unless you already have a substantial amount of health AI knowledge or are willing to engage in that world and get that knowledge and build the community.

Similarly, there are challenges to people who know the health AI side really well, but don’t speak the language of healthcare, don’t speak the language of medicine, can’t translate that into a way that can be digestible by the rest of healthcare leadership.

Depending on which of those two worlds you’re coming from, how you’re going to need to develop to be able to serve in that role, is going to be a little bit different. If you’re coming to healthcare already, then you’ve really got to make sure you have domain expertise in AI that is going to translate to making sure that when you say you’re accountable, you actually are accountable.

And on the AI side, you need to understand how the healthcare system works so as you’re working with health leaders, you’re not just translating and giving them your excitement about a specific method, but you’re saying, “With this new method, here’s the thing you need to do today that you can’t do, that we could do. Here’s how much we would need to invest, and here’s what that return on investment would be if we were to invest in this capability.”

There’s really a number of different skill sets you have to have, but there, I think, thankfully, are a lot of different ways in which you can have a strength in one area and not necessarily across the entire spectrum.

That’s where different health systems will take slightly different approaches to how they look at this role. Other companies, like payers, are going to look at this role a little bit differently. That’s okay. You shouldn’t hire this role simply because you feel like you’re missing out. You should hire this role because you already are using AI or you want to use it, and you want to make sure someone at the end of the day is going to be accountable to how you use it and how you don’t use it.

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