Inside Children’s Healthcare of Atlanta’s 2 Million Square Foot Smart Hospital with Jeremy Meller

Speaker 0: Welcome to the Becker's Healthcare Podcast. I'm Chris Losa, your host, and I'm thrilled today to be joined by Jeremy Mellor. He's the chief information officer of Children's Healthcare of Atlanta. Jeremy, thank you for joining us today.

Speaker 1: Oh, so happy to be here, Chris.

Speaker 0: Fantastic. Well, you're here to discuss the lessons learned since the Arthur M. Blank Hospital opened in September 2024. But before we get into all that, could you please just introduce yourself and give us a little bit about your background?

Speaker 1: Sure. You bet. I'm, Jeremy Mellor, the chief information officer for Children's Healthcare of Atlanta, like you said. I've been the chief information officer here for a little over six years, and I've been with children for going on fourteen years. And so I've been with us as we move to the entire planning phase of the new hospital, really, which has been, you know, a ten plus year, journey, up into the present day. And, and it's just it's been super exciting.

Speaker 0: Yeah. Obviously, that was a massive undertaking that you guys had a couple years ago, and I'm glad it went as smoothly as it did. So now that you've been at this, like we said, since about September 2024, what would you say were the main challenges you anticipated when the hospital opened, and how those played out so far?

Speaker 1: Sure. Yeah. Well, you know, like I said, we started the planning, many years ago. I mean, from just a, you know, facility perspective, we were planning out the real estate. We were buying up properties. We were tearing down old properties and that sort of thing. And, really, we kicked off right when the pandemic started. Really was when we broke ground and we started to raise the building. But even a year or two before that, we were starting to plan, okay, what what does the patient experience need to look like? What are, what are the challenges that are present today that we wanna address? So one of the things we did to, address that was we rented out a 100,000 square foot facility, and we created what we called cardboard city. And we, had cardboard layouts, easily movable walls, that we could use to simulate different spaces, whether it be hallways, whether it be trauma rooms, whether it be operating rooms. And that allowed us to then do simulations and rehearsals in that space and say, hey. How does that work? And, I mean, certainly, that leads to all sorts of things. You can see, well, alright. You know, the that wall plug isn't where it needs to be, and that door isn't where it needs to be, and this room isn't big enough to hold the 12 people that need to be here in order to to deal with this kind of trauma or whatever it is. You know? But one of the things it did for me is as I was going through that facility, I was just struck by how much larger this, facility was gonna be than our existing facility. You know, a lot of intensive care units, pediatric intensive care units historically are, for example, open bays. And where we were going with this was we were creating, you know, individual standardized rooms for everybody, which is great from a patient experience perspective. But as you might imagine, that really blows out the size of the facility. We ended up with a 2,000,000 square foot facility, nine 19 stories. And for and, you know, so it it's absolutely ginormous. And what struck me, I guess, was the fact that it was just gonna take longer to do everything. It's gonna take longer to move around. It's gonna take longer to communicate, especially when you have to, you know, move around to communicate. So it really just reinforced for us the fact that technology had to bridge the gap in some of that. It had to allow for easier communication across distances, whether that be mobile technologies, whether that be visual cues and that sort of thing. And that's an example of something we did right from the start to meet where the organization was going and try to help it with technology. The other areas we, considered were patient engagement. We well, you know, honestly, we said, what what are the what are the other biggest challenges? One, I mean, you've got kids who are, you know, coming to the hospital. They're scared. They would really just rather be at home. Right? So how we, engage with patients and keep patients and families informed is really important. Two, we are just we are in data overload. And especially with AI and everything on the scene now, it's more important than ever to, to be able to help clinicians, you know, process massive massive amounts of information and make better, more timely decisions. So we really wanted to support the clinician from the AI and data and just, you know, complex decision making, you know, perspective as well. And so, you know, those were a a few of the and we we really wanted to save steps at the end of the day. And so how can we do things that are gonna help save time? And those were the guide the the really the big three guiding principles that led us to where we made investments across patient engagement. We made a lot of, investment in location awareness and integrated that in with the room technology, a lot of work with, device integration to drive AI. We put cameras in every room, to help with, like, real time monitoring and remote consults and virtual nursing, you know, and we layered AI into into really everything. And so I think that that's, you know, I I think we've had a lot of payback from those investments, you know, and certainly adoption. Anytime you change a process or change the way somebody works, you have to you have to think about the change management and adoption. So that's really what we spend a lot of our time doing.

Speaker 0: Yeah. The the scale of this hospital is just mind blowing in a lot of ways. And clearly, as you said, you put patient experience at at the top of list and rightfully so, and you ended up with this 2,000,000 square foot facility. And so take us through again just how important it is to use technology to make sure there's less ground, you know, in the in the literal and figurative senses that your staff has to cover and how you went about getting them acclimated to that. Sure.

Speaker 1: You know, and we took a kind of a foundation from the bottom up approach, and we looked at what the available technologies are. And so I mentioned, for example, location awareness. Well, every one of our, staff members in the hospital, they wear a location badge. We call it a tech badge. And that has a number of purposes. Now one, it can help with, you if you press the buttons on the back, it will silently let security know where you're at. So if you've got a, you know, a staff to rest situation where you've got a patient or a family member, and you're you feel unsafe, that's so it's really a safety device. But we can do so much more with it. Just recently, we did some contract tracing with it. We needed to know who's in the room with a particular patient who had a particular condition. And so it can give us that data. But beyond that, you know, it allows us to integrate in with everything else that we have. And when I talked about, like, being able to save save steps, we have, for example, wall boards outside of every door, every room where if a nurse walks in, you get a halo light of a certain color. If a respiratory therapist walks in, you get a different halo light. If a physician walks in, you get a different color halo light. If there's multiple in there, it'll alternate between halo lights. So you think about that, and that's a visual cue. It isn't uncommon that, a, you know, a nurse or another physician will be like, okay, where did doctor so and so go? Or are they on the floor? And you could just look down the hall and you can see exactly where they're at in a in a in a moment's notice. And and so there's just a lot of use cases like that. When you and you enter in the room, one of our patient engagement, innovations where that we have multiple screens. So we have, you know, of course, one screen is for entertainment and videos and education and another screen that's an electronic whiteboard that certainly shows, you know, who your care team is, what your plan for the day is, etcetera. But it allows, when a clinician walks in the room, it knows that a clinician walked in the room because of that location badge. And it allows them to change it to a clinical view where they can see more detailed clinical stats. They can pull up radiology exams. They can blow them up and draw on them and share them with the patient and family, which is something that, you know, our our providers do quite often. And so it's so this is just an example of how you if when you think about the foundational technology and how you can use in innovative ways, you can do a lot more with it than you thought you could.

Speaker 0: I love all these details that you're sharing with us, Jeremy. You know? I'm sure our audience is gonna love how they'll be able to adapt these to their own facilities, at least I hope so. So you've listed so many of these wonderful features. Are there anything else that you can think of where you think of, you know what? The the clinicians, you know, any member of the SAS, like, they really love using this, and I'm so glad we added that.

Speaker 1: Yeah. I mean, it it it didn't, it didn't just stop there, of course. I mean, one of the other really big things that we did was we, we brought robots into the hospital, and these are autonomous delivery robots. We're actually, have one of the world's largest fleet of these, autonomous robots in health care. We have 90 robots, in our hospital delivering everything from meds to supplies to patient meals to medical equipment, then it'll haul trash, in dirty linens. And, and so I think that that's had a a really positive effect as well. I mean, these things run like clockwork. So, so timely, and consistent delivery of medications, and meals and supplies, the the better the more we can do with that, the the the less of the the burden that the clinician has to feel around those things. And hopefully, the whole system just works works a little bit better. So I think that was another, pretty big win as well. And then, I had mentioned the cameras. We have, we've been running and it's just been extended a virtual nursing pilot where we can handle admissions and discharges, which are, you know, generally much more standardized, and, and offload that from some of our floor nurses who are really taxed. And on some days, it can be really, really hard. And so that's something that they've found that they really, appreciate a great deal. And and having the cameras and having a a more remote, you know, virtual nurse just allows the process to be just a whole lot more efficient.

Speaker 0: Jeremy, tell us more about these robots in particular. So how one, how do you think or how have you seen patients reacting to them? I mean, is this something the kids enjoy seeing all these robots, you know, floating around the hospital? I mean, I've I've seen some of these at work in in hotels without bringing your towels and things like that. But, obviously, you have 90 throughout this entire facility. That's that's an enormous sleep in my mind. So, yeah, what's been the reaction to to these robots?

Speaker 1: You bet. Well, I mean, many of the robots are just back of house robots. You would never actually see them. They, we have 12 elevators that are just for our robots. Wow. Okay. And so there's a and there are depots on every floor, and there are hallways, etcetera, that the robots use that are a little bit outside of the patient care areas. And that's where a lot of the bulk supplies move. Where the patients may see the robots are where they're delivering, you know, medications and foods and sometimes, select supplies. And, and those robots are all wrapped in, in, you know, a skin of some sort. They may look like a look like, an ambulance driving along with a couple of kids at the driver's wheel. They may look like, they may have our our dog our dogs on them or whatever else. And so I I think what we found is that the kids are are are amused by the robots. But, I mean, it it's a great question because anytime you're introducing anything new, you have to adapt to it. And, and so there's a fair amount of training just for our staff on, okay, when a robot's coming down the hall, what's it gonna do and what what should you do if a robot is, you know, going some play if you feel like it's going some play or you need it to stop, how do you get it to stop? And, and and those sorts of things as well.

Speaker 0: I imagine there are a lot of fun things you can do with the robots at Halloween as well. I'm I'm rather Right. Yeah. Thanks thanks for all of this, Jeremy. This is wonderful. Next thing I wanna ask you though, is now that you have been at this for a little over a year and a half as we've said, do you have any advice that you would give to other hospitals, health systems that now you've seen all this cutting edge technology, you've been able to apply it, you know. What what don't you tell someone who who wants to pick your brain about this?

Speaker 1: Sure. Yeah. I mean and I'm not gonna pretend that we got everything right. I mean, there were some things that we invested in and we thought were gonna be a big deal and weren't a big deal. So Okay. An example of that is, on our mobile clinical phones that all the nurses have, you can, for example, see waveforms, off the monitor in the room, which is a great thing. And we thought that we'd noticed that the utilization of that wasn't exactly what we thought it would be. And we thought, is something wrong? Is something broke? Is this an educational opportunity? Well, you know, it comes to comes to be that, you know, the, the data that came along with it, the text alerts, for example, giving you information about it really pre precluded the need there to have the actual waveform on the phone. Now it does have some utility, but for a lot of people, it didn't. So that's an example of something we thought was gonna be big, which didn't turn out to be big. And so I think you have to, one, acknowledge that there may be some of that. But if you, you know, start with, you know, what are your, you know, grounding and guiding principles? For us, it was saving steps, supporting better decisions, and improving the patient experience. It was those three. And so that was the framework that we thought about what our, needs were gonna be. Then we said, look. Let's again, let's look at the foundation of everything that we have. There's a lot of you know, everyone's talking about AI. But the thing is AI needs data, right, in order for to do anything with, especially in a clinical setting. And, and that data needs to represent reality. And so it's a representation of reality that the computer can use to do things like understand, is this a patient who's deteriorating? Is this a patient maybe who has an infection that we're not recognizing, etcetera? And so and that's a hard it turns out that that's a really hard thing to do. But, but you have to have the foundational things in place. So for us, we thought about having all we have thousands of medical devices with all of this data, whether it be monitors, pumps, etcetera, getting all that data into the system and building it from the ground up so we had all of it. That was one. Two was dislocation data. I mean, just the the amount these are all data points and they're all signals. You know, how much activity there is going around around a patient is actually an indicator that could be used to understand, is this a patient that, you know, really should be, should be, you know, paid attention to? And, and things like camera, even even the the visual. And there's a whole, you know, you know, emerging field around visual AI. And can you use, visual to really understand better whether it's, you know, the the relative motion of the patient today compared to yesterday. And all of those things, it can help you understand what's really going on. So that was another one. Then we another thing I would probably pass on is that now when we opened, we had we had we had staffed, I wanna say, like, a three week technology command center, and we shut that down probably after a week. And we had, I wanna say, about 25% of the issues and incidents that we had expected to have. Like, you know, so we were like, okay, we're gonna plan on this. It turned out that we had about 20% more issues than we have on a standard day, which was just remarkable. And I and I credit the real hard work with preparation and simulations. We had, simulations that we that the clinical teams ran, and then we also ran technology focused, simulations. And we treated them less like training, but more as a means for how we could discover and learn where issues are, where things weren't gonna work, or whatever. And we caught a number of major issues with those simulations. And I really credit that to allowing us to have as smooth of a implementation as we have. And then finally, I would just wrap up by saying, expect to have adoption of lips, like I said. Expect to have challenges. Changing human behavior is just hard. You know, some technology will work better than others. It'll be more important than others, and it will some of that will surprise you.

Speaker 0: Jeremy, so you mentioned these simulations, and I I imagine a lot of that goes back to the cardboard city that you mentioned. So that's when you went into this whole project, I mean, certainly, you can computers can do a lot of things. You can say, okay. Tell me this. Right? And give it some input, and it can do some simulations on its own. But how how much it should be put into percentage. Like, what what did you learn from the practical simulations at Cardboard City compared to other means?

Speaker 1: Yeah. I mean, I I it was a learning process the entire way, Chris. I mean, the, you know, it started with just, okay, the Cardboard City from a technology perspective really helped us understand where we would have to interact with staff visually. Where we're gonna have the space to mount the monitors and TVs and screens and, you know, just some of those very tactical physical things? Yeah. As we got into the project and we you know, some of these things were relatively new. You know? When we first started, we were we were wondering, do we need to we need to plan for, self driving cars? We need to have a special self driving car drop off, you know, spot at the hospital because we didn't know how big that would be yet. Right? And some things but on the other hand, we didn't we didn't see AI adopt, you know, you know, happening as fast as it did either. And so you're gonna get those things wrong. Some things move we call it the jagged frontier in IT where, you know, some of the things move faster than you thought and other things just don't. And so, you know, having an iterative process, I think, is what's most important. You're you're, you know, you're you're developing a a theory for what you think is gonna work. You're trying to find some way to test whether or not that will work, whether it's through a simulation or other means, you know, and then you're adjusting.

Speaker 0: Yeah. Certainly, I'd like to be able to say, yeah. We saw all of this coming. Not quite possible or practical, but you guys you know, you do the best you can. Right? So I I look forward to the next you know, hopefully, we'll be able to talk to you in another year and a half, two years, and you can and give us more, another breakdown of what's happening. So as you look to the whatever time period that is most practical for you down in Atlanta. So what's most exciting to you about where technology is headed and just health care is headed?

Speaker 1: Well, certainly. And I'm sure everyone is thinking about AI, what its potential is, what its, capacity is to help help us solve access challenges, improve outcomes, you know, find efficiencies and improve the patient experience. But I think that even there, we have to we have to be realistic, and we have to understand where we're at in everything. You know, there was this thing in 1987, called the, the productivity paradox.

Speaker 0: K.

Speaker 1: And, you know, PCs had been around for going on ten years, and everyone was wondering where is the productivity gain because they weren't seeing it in the numbers. Now, that eventually came. That came in the nineteen nineties, but what they ended up finding out was that it wasn't until roles changed. It wasn't until you know, I mean, pre computer, they would have, for example, a secretarial pool. And the first thing they did is replace the typewriter with a PC, and it turns out that did absolutely nothing for productivity. Right? It was it was, you know, rethinking the entire thing. We don't need to have secretarial pools, and we don't need to have proofreaders, and we don't need to have some of those things, because, because the technology can can change the entire process. And so I'm sure that there's gonna be a fair amount of that. And coming with that, of course, there's a lot of, you know, concern about the human impact on AI as well as cybersecurity. And I think that we just you know, if we have a human led, approach, I think, you know, if we do it correctly, I think we can hopefully see some real improvements in quality, speed, and patient experience.

Speaker 0: I think we are all looking forward to that. I'm sure all of your colleagues and peers would echo that as well, Jeremy. Thank you so much for coming on the podcast today and sharing all your candid insights about things that did not work, more importantly, things that did and that you're looking forward to to tackling in the future.

Speaker 1: Wonderful. Yep. It has been great. Thanks so much, Chris.