Former Razorback and current President of Mercy NWA visits host Cindy Moehring in this incredible new episode of the BIS podcast. Listen to their conversation as the two discuss the implementations of technology in medicine, the incredible life saving technology behind many medical decisions, and the ethical implications of new biotech.
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Cindy M. 0:03
Hi, everyone. I'm Cindy Moehring, the Founder and Executive Chair of the Business
Integrity Leadership Initiative at the Sam M. Walton College of Business, and this
is The BIS, the Business Integrity School podcast. Here we talk about applying ethics,
integrity and courageous leadership in business, education, and most importantly,
your life today. I've had nearly 30 years of real world experience as a senior executive,
so if you're looking for practical tips from a business pro who's been there, then
this is the podcast for you. Welcome. Let's get started.
Hi everybody, and welcome back to another episode of The BIS, The Business Integrity School. And in this season of the BIS, we are talking all about tech ethics. And today we are going to be delving into the field of tech ethics as it relates to medicine and the medical field. And for that wonderful conversation, we have a very special guest with us today, Eric Pianalto. Hi, Eric, how are you?
Eric Pianalto 1:06
Cindy, it's great to be with you today. I'm doing great, hope you are as well.
Cindy M. 1:10
I am. So for those of you who don't know, let me just tell you a little bit about
Eric. Eric was named the president of Mercy Hospital of Northwest Arkansas back in
2013. And he still serves in that capacity today. And we are lucky to have him in
that role. He's a northwest Arkansas native. So the name Pianalto, if you live in
Northwest Arkansas, may be familiar to many of you. He's been with Mercy hospital
system since 1994 in a number of different roles, which has really equipped him well
for the role that he's in now leading all of Mercy Hospital in Northwest Arkansas.
Prior to being president, he was doing roles like chief operating officer for regional
operations in Arkansas and Oklahoma. And like I said, that two decades of work has
given him a very balanced view of healthcare prepared him for the role he's in now.
And when we talk about the role he's in now and the challenges, we're going to jump
right into what some of those challenges are, because we're still dealing with COVID,
which means Eric is still dealing with COVID. So Eric, thanks again for being here
today. And before we jump into COVID, I always think it's great for the audience to
just get to know you a little bit. So can you just share with us kind of, how did
you find your way to Mercy and, and stayed there for over two decades and end up running,
running the whole system in Northwest Arkansas? Tell us a little bit about your journey.
Eric Pianalto 2:33
Thank you, Cindy. You know, of course, it started at the University of Arkansas. But
yes, I'm at University of Arkansas grad. I initially was in manufacturing. So while
I was in college, and, and shortly after college, I worked in manufacturing and got
to cut my teeth and leadership in manufacturing, and healthcare kind of found me.
And it was a job that allowed me to get back to Northwest Arkansas at the time. And
I thought it would be a stopover until my next leadership job in manufacturing. But
I found a heart and a passion for it. It was something where I could, without a science
background, have an impact on people, and really fine tune my skills and my learnings
to have an impact on communities. You know, I think the greatest advice I got along
the way, was from my guy familiar to many of us, Mike Dude. Who, who once told me,
and I've heard him speak on this topic as well, Treat every job as if it's the best
job you've ever had, snd always assume that you're going to get fired doing it. If
you look at my career in Mercy, I would say that's, that's pretty accurate. I'm curious,
inquisitive. Like to have an impact, where I can. I didn't aspire to this role, you
know, just was part of my journey, and was an opportunity again, to serve in the community
and, and have an impact and really love what I do.
Cindy M. 4:11
Wow, that's fantastic. And you're having quite an impact. And Mercy is, of course,
really growing in this area and has been just so important with COVID still dealing
with it, you know, almost two years on and there are a number of issues, before we
get into specifically tech ethics issues, that surround COVID and implicates sort
of all leadership issues and ethical issues and kind of. How do you manage your responsibilities
in the right way? And I'm wondering if you can just share with us a little bit about
that journey. I've read the paper and heard about things like rationing care at times.
I don't know if we ever reached that point here and, but I just want the audience
to understand a little bit about what are some of the things that you in this 100
year, you know, pandemic situation that you've never had to execute before and other
hospital systems too, but that you found yourself having to contemplate this time
that touched on kind of ethics and leadership.
Eric Pianalto 5:13
I would have never dreamed that, as part of my role, I would be part of 100 year,
pandemic, and, and dealing with an ever changing, unpredictable situation. And, you
know, throughout, there's been shortages of lots of different things that have driven
lots of, lots of decisions. There were supply chain issues, you might remember, dealing
with personal protective equipment, and how we deployed that limited resource, how
we acquired it. You know, a lot of, there were a lot of scams out there to acquire,
personal protective equiptment. But so, you know, a lot of ethics involved in that
as well, Cindy. Just looking at supply chain, how we deploy various pieces of equipment
and at the bedside or in different care settings to protect our workforce. Then you
had testing shortages, you know. So, again, we had to use a very limited resource,
to figure out what the best use of testing was in what it really meant to have a confirmed
test. And then, you know, what were the decisions that followed that? So you had,
you know, a couple of early, early issues. And then, you know, as we really got into
the pandemic, in the height of the pandemic, we had already prepared for this. It's
the idea of crisis standards of care. And in that situation, it's almost about like
being a field hospital in the in a battlefield where you have, you know, people that
are injured, and you're having to triage them upfront to use the very limited resource
that you have on the battlefield. So since we were dealing with floods of people all
over the world who were seeking medical care, we developed these crisis standards
of care, in the event that we would ever need them to really look at survivability
to look at how we apply limited resources to a population. And those are very, very
difficult discussions. You know, involving a number of the best and brightest physicians
that we have throughout our health system. Ethicists, nurses, pastoral care, and some
family members actually. So developed the criteria that would help us triage people
at the front door and determine the treatment plan, say for limited resource like
ventilators. Ventilators, how do we make a decision about who gets the ventilator?
And thankfully, we never had to enact crisis standard of care here in Northwest Arkansas,
but across the world, some people did so. So lots of ethical decision making lots
of parts of decision making through that.
Cindy M. 8:11
Yeah, things again, because it hasn't happened in 100 years that you, we, as a society
only envision that happening as kind of part of a war, right? Where you're rationing
care and treating injured on the battlefield. And, you know, to deploy that in the
hospital setting. And in the healthcare setting, I'm sure was just mind bending at
time. So you're even sitting down and having that conversation about setting up the
parameters. And then recognizing we may reach the case. Hopefully, we don't, but we
may reach the point where we have to actually deploy this and knowing that other hospital
systems did is just, it's pretty incredible. And something that not many people will
live through. And you're right. I'm glad to know that you had some ethicists at the
table, and involved in a lot of those decisions. I think, though that position in
particular is really important when it comes to medical ethics, because things are
always evolving in that field. So wow, well, congratulations to you and getting through
it. So far.
Eric Pianalto 9:09
We have a great team of people here who, their, their passion is also taking care
of people. So it's, it's very rewarding to watch some of the best and brightest people
in the field do everything within their knowledge base and and with their technical
skills to, to help the people who most need us. So.
Cindy M. 9:34
So let's now move from those ethical decisions about COVID. And let's talk about tech
ethics in in particular, and how, how it looks when you're using it responsibly, let's
say in health care. And so the first thing that I just wonder about is the use of
technology in healthcare, and doesn't, when you inject technology into something that,
you know, to this point we've kind of grown up with with it just being one to one,
it's a very personal relationship you have, you know, when you go see your doctor,
and when you go, you know, you talk to your physician assistant or you talk to the
nurse. And, and there's a lot of judgment calls they have to make right in that situation.
And so what I wonder about is that, does the injection of technology, maybe through
telemedicine or other things? Does that help? Or does that hurt? Do we see the error
rate from humans go down when you rely on technology and health care?
Eric Pianalto 10:34
Yes, absolutely. So there are many great uses of technology in healthcare, I would
say healthcare was slow to adopt technology. The reliance historically, for the last
100 years has been on the human brain really, to absorb a lot of information, retain
that knowledge, look at a set of circumstances in determining a treatment plan. When
you do that, you have a lot of great outcomes, but you also bring in an error rate
because we're relying on humans and their their ability to recall the right information
at the right time for the right treatment. And as recent as 2010, only 5% of helpless
across the country even had electronic medical records. So we're relying on a paper,
flipping through a paper, paper record to determine, you know, what was going on with
the patient. And then using their mind mostly for the treatment plan. And the estimate
in the US is about 250,000 people die annually of medical errors resulting medically
or third leading cause of death in the United States. So you know, technology and
the adoption of technology in the healthcare field. Some, some easy wins, there are
drug interactions. So suddenly, when we have your complete medical record in electronic
format, and we go to prescribe a medicine, for you, it's searching in the background
to make sure Cindy is not allergic to that medication. Saves lots of lives, saves
lots of sustained treatment or potential treatment. Another one that it allows us
to do suddenly, when we're gathering all the information while you're having a hospital
stay, is to look for a condition called sepsis. Sepsis, about 160,000 people across
the country will acquire sepsis while during a hospital stay. And once you get it,
it's very difficult to treat and can result in disability or death at a at a pretty
high rate. And so, by the use of technology, and artificial intelligence, we can run
screens in the background for things that are going on with your health status in
the moment that are predictors of that this person may develop sepsis rapidly. And
we can take early interventions and we're able actually to detect it before the patient
even knows they're getting sicker, detect it before the human eye will detect it so.
So it pops up an alert, allows us to take interventions much faster and prevent serious
illness and death as a result of sepsis. So lots of great uses of technology. You
mentioned telemedicine, highly utilized throughout the US. Neurology as a specialty
is very limited across the country. Not a lot of new people graduating in the specialty
of neurology that treat strokes and many other conditions, nervous conditions, as
well. And we can apply the technology to bring it to the bedside through telemedicine
with a set of instruments at the bedside where a nurse can utilize the instruments
at the bedside for a remote neurologist to make a diagnosis. And, and put a treatment
plan in place. And sometimes that's clot busting drug. I mean, you may be in small
town, Arkansas, where there's not a neurologist for 150 miles. You're having a stroke,
we can deploy this technology, we can administer medication within 30 to 45 minutes
that'll save your life and save, make your outcome much better in the end, so great
uses of technology.
Cindy M. 14:36
Yeah, I mean, that sounds like you're extending a very limited resource to a broad
swath of the population so that they can actually you know, take advantage of it which
is which is great. But in that example, or just in like your basic telemedicine example,
which I will say took us a long time to warm up to but COVID kind of forced us all
to get there, right. Just talk to your doctor over the phone and we'll see what they,
if they can help over the phone. So it probably helped us leapfrog over some of that
resistance, which is a good thing. But do you think the neurologist or the doctors,
that it can increase their chances of missing something when they're not face to face
with a patient in the room?
Eric Pianalto 15:16
Certainly, it has its limitations. There, there is no doubt that using technology
remotely doesn't give you every piece of information that you would have in a face
to face visit or being able to touch the patient or really look into their eyes or
look for signs and symptoms. So you know, I think the best use of it is for, you know,
minor conditions, sinus infection, ear infections, at least at the primary care level.
But even then, again, it has limitations where I don't think it will ever replace
one to one care. And in the case of telling neurology or remote surgery, as a possibility,
you're going to have a human interaction in the room in those situations helping augment
the, you know, that setting so that they can intervene, or they can provide additional
information. Because the human body is a very complicated organism. Not everybody
reacts the same way to certain treatments. We know that standard care, and protocols
will, will produce evidence based medicine that produces good results about 80 to
85% of the time, there's about 15 to 20% of the time that the human body doesn't react
the same. And we need to apply a different treatment based on what we're seeing in
the moment. So. So I think it's a combination that we will continue to see, even when
we're applying remote care, augmented by somebody.
Cindy M. 17:03
Now, that helps me get my head around it a little bit. Yeah, that's kind of interesting.
So even if it is a remote surgeon, where you know, they've shown that and you like,
see, just like they're maneuvering the robots arms, and they're in the room, and maybe
they've got those cool Oculus Two glasses on for the virtual reality, or whatever
it is, you know, it just seems so much like science fiction when you, when you think
about it. But when you can imagine that there's somebody in the room, so it's more
of an assisted, right, use of technology, it's not just kind of hands off. I think
that certainly makes it feel a little more responsible and might help that, you know,
the general public warm up to it a bit more, because, you know, going from complete
one on one interaction to you know, having a robot do surgery on you is feels like,
I don't know, if I'm comfortable with that, like, what if something goes south, you
know. So that's, that's a good, that's a good, I like that visual on that thought
about, it's an assist, that's good.
Eric Pianalto 17:58
Surgery, you know, if if something were to happen during surgery, where an artery
gets nicked, or I mean, those are complications of surgery. Well, there's a surgeon
at the bedside who will immediately take over in a moment and, and apply the appropriate
intervention. But it allows us to really spread the best and the brightest all over
the world, that potential exists to reach rural areas, to reach even smaller urban
areas where you have a gap and certain types of care, or there's only five surgeons
in the world that have the capability to perform this procedure. I mean, it's, the
opportunities are endless.
Cindy M. 18:43
They really are and, you know, marrying them up with a human in the room or a surgeon
in the room feels very responsible from a kind of use of technology perspective. So
that's great. So I mentioned sci fi, and I want to, I want to hit on that in a minute.
It's kind of science fiction, but to kind of set the stage a bit. Let's talk about
one more type of technology, biotech. I hear that often in the medical field, what
is that? And what are some of the risks associated with it when you are talking about
ethical use of technology in medicine?
Eric Pianalto 19:16
Yeah, there's, you know, a lot of, a lot of uses for biotechnology, a lot of research
going on. You know, if you, if you dial back to 2006 to 2010, the mapping of the genome,
the mapping of your DNA was beginning to happen and lots and lots of ethical issues
raised during that time, lots of research done on biotech and the use of that. Is
it good, is it bad? How will it be applied? What happens if somebody uses it for,
in inappropriate ways, uses your DNA against you. Let's talk about the positives first.
What we see today out of that research is incredibly targeted cancer care. That's
one of the very first research arms that was used for the data, as a result of the
DNA research is to understand your DNA, how cancer is attacking your body. Even apply
a very specific treatment to your DNA that's targeted and doesn't create ancillary
damage. So if you think about most cancers historically, have been treated with radiation
or chemo, have extreme side effects, and are targeted to an area not to the specific
point of cancer. So you have other damage going on to your body, when you take, you
know, high ends of chemo, or you're blasting radiation to an area. Now you're damaging
other cells in your body and, and can potentially have lots of side effects. As cancer
treatment is continuing to develop, they're able to target your DNA to a specific
spot with very little if any ancillary effect to other parts of device, so incredible,
incredible uses of bio, the biotech industry. You know, we also have, I mean, people
have wearables on their arms today, actually an FDA approved wearable, that will give
you a medical grade EKG. And you can transmit it to a doctor to look at your EKG to
see if you just happen to have a racing heart or do I have something like heart attack
going on, and I need to see immediate treatment. So you know, lots of again, opportunity
in the biotech industry to impact people's health care, intervene much faster, yeah.
And in save lives, ultimately,
Cindy M. 22:06
That early intervention is fabulous. And it kind of starts to push on the edge of,
you know, proactive health care and and not all just being, you know, kind of defensive
and waiting until you get sick, but getting in front of it. And, you know, thinking
about what can we do to be more preventative and making it easier and more accessible.
And I like that view of technology. That's, that's really interesting. So it is fun
to think about, but it also does make me wonder a bit if some of these advancements
make the use of technology and medicine available more to those who have the economic
means to afford them, perhaps, then those who don't, which that in and of itself could
be an ethical issue, right? It's certainly a moral issue. How do you how do you think
we go about as a society kind of addressing, addressing that issue?
Eric Pianalto 23:00
Yeah, you know, it's something certainly as a as a health system, we look, look and
seek to impact our entire community, not just those that can afford certain treatments.
And certainly, some of those are only available to the wealthy. People who wear the
wearables on their arm, there's, you know, there's a limited piece of society that
can afford those. But where I use the example of tele-neurology, we can make that
available to, you know, a poor portion of Africa, or a small rural town in Arkansas,
or in any other part of the world. So, you know, I think with all types of technology,
whether it be the wearables, or whether it be the advancements of tele-neurology,
and other applications and specialties, the price points will continue to come down.
There'll be more affordable, more available. And you could also create in certain
areas, you know, pods of places where people could go to seek that technology as well,
where you house appropriate devices, maybe you don't have availability to immediate
care, but we have a place that you can go connect via virtual medicine to somebody
put on the devices and, and, and help render treatment at bedside. Very important
subject. I appreciate you bringing it up. I think there are ways we can deal with
it. Some will exploit it, certainly for profit reasons. But I think most people that
have gone into healthcare went into it with the right heart, the right passion to
to care for the person not, not based on their socioeconomic status.
Cindy M. 24:53
Yeah, yeah. I think that's certainly a very laudable goal. And one of the reasons
why I have so much respect for everyone who's in the medical field. Well, Eric, this
has been a fabulous conversation. I've really enjoyed having a few minutes to just
let you share your wealth of information and wisdom and experiences that you've lived
these last few years and the experiences that you see on the horizon with technology.
It's been great. I always like to ask my guests one last question. If somebody wants
to go deeper in this space and learn more about responsible use of tech in the medical
field, do you have any good resources, you might point him to like a book, or maybe
a documentary or a good podcast series or something?
Eric Pianalto 25:36
Yeah, you know, a couple of podcasts come to mind. One of them is by our good friend,
Cindy Moehring. And there's an article on the Business College website on AI and ethical
use of AI. So I might point you to that blog that Cindy did. Because I think the principles
in that article are, are the same across all technologies and use of technologies
in an ethical way. There's a few TED Talks out there on biotech ethics and how they
come together by even using robots and AI to treat at the, at the point of care. without
human intervention and the ethical dilemmas around that. So I think the TED Talks
out there that that might be of interest. I talked a little bit about the bad use
of some of these, some of this research and findings particularly the likes of DNA.
I like to point people to the new Bond movie, Cindy. I won't be the spoiler, I'm not
gonna give you a spoiler alert here. But some fascinating things in that movie around
biotech and how it can be used poorly, and against our moral code or society's norms.
So I might encourage you, it's, it would be thought provoking to think about it in
that way, as well.
Cindy M. 27:06
Oh, yeah. Oftentimes, sci fi is a peek into the future in many ways. So you know,
and I haven't seen that movie yet. So now I have even more reason to want to go see
that movie. I'll try to do that over the holidays that are coming up here. So. Well,
Eric, this has been great. And I also want to say thank you for being a member of
my external advisory board as well for the Business Integrity Leadership Initiative,
and for giving back to your alma mater, and the university in that way. We are a better
board. And we are focusing on things at the right level, in large part because you're
a part of it. So thank you.
Eric Pianalto 27:41
I was honored to be asked and I'm honored to serve. It's a, you put together a great
group of people that that I'm learning from every day. So thank you for the invitation.
Cindy M. 27:50
Well, you're welcome. All right, we will leave it there and thanks again, Eric. Really
appreciated the conversation.
Eric Pianalto 27:56
Thank you, Cindy.
Cindy M. 27:57
Okay, bye.
Thanks for listening to today's episode of the biz the business integrity school. You can find us on YouTube, Google, SoundCloud, iTunes or wherever you find your podcasts. Be sure to subscribe and rate us and you can find us by searching the BIS. That's one word, t h e b i s which stands for the Business Integrity School. Tune in next time for more practical tips from a pro.
