Episode 7: Visionary Voices with Chris Longhurst

Larry Kaiser:
Hello and welcome to today’s episode of Visionary Voices, Optimum Healthcare IT’s conversational thought-leadership podcast that hosts digital and technology healthcare leaders to discuss IT innovation and transformation. I’m your host, Larry Kaiser, Chief Marketing Officer at Optimum Healthcare IT.

In this episode I’m speaking with the visionary physician executive Dr. Chris Longhurst. Chris is the Chief Clinical and Innovation Officer at UC San Diego Health, as well as the Executive Director of the Joan and Irwin Jacobs Center for Health Innovation. Today’s conversation will be very interesting and very informative as we focus on technology, the value of it, and a very interesting clinical study that I cannot wait to dive into. Welcome to Visionary Voices, Chris.

Chris Longhurst:
Thanks so much for having me, Larry.

Larry Kaiser:
Appreciate you joining us. So we’re going to jump right in and get things started today with a little segment we like to call Bandwidth Banter, which is our fun take on icebreakers for IT professionals where we like to have a little fun.

Since it is just about lunchtime here on the East Coast, what is your go-to burrito order, Chris?

Chris Longhurst:
Larry, thanks for the softball. I mean, I live here in California, so there’s no doubt my favorite burrito is a California burrito, and the integration of the guacamole and the fries in the burrito—it’s really a perfect burrito. But I’ll tell you, you can’t get a perfect California burrito outside of California.

Larry Kaiser:
I would have to agree with you on that one. I have dabbled in the California burrito here in Florida, when I used to live in New York, and it just doesn’t compare. I’ve had an exceptional California burrito in San Diego last year at the CHIME Fall Forum. So I definitely can agree with you on that one.

Alright, let’s call this one a second softball. What sports team has your loyalty?

Chris Longhurst:
Well, there is another softball. I grew up here in San Diego, and so I used to be a Chargers fan, but I gotta tell you, when the Chargers left town, I sort of had it with that—so I’m not an LA Chargers fan. But I married Kansas City, and so that pretty much makes me a Chiefs fan, and we’ve been watching Chiefs since long before Patrick joined the team. But it’s been an incredible seven or eight years, and we didn’t make the three-peat this last year, but we’re looking to set more records.

Larry Kaiser:
Well, it’s good to hear that you were a fan before Mahomes, which means that you’re not a bandwagon fan. As a Patriots fan, nothing made me happier than to see the Chiefs not three-peat, simply because Tom Brady and the Patriots never did that. So I was very excited when they didn’t repeat, because then I would never hear the end of it.

Chris Longhurst:
Well, my wife grew up going to Arrowhead Stadium when the Chiefs were at their worst, so definitely not a bandwagon fan—although I have to tell you that my daughter was not that interested until Taylor Swift came in the picture.

Larry Kaiser:
You know, she did a lot for football last year and brought a lot of Swifties there. I’m curious to see if this season the sale of the women’s NFL tailored apparel increases a little bit. And honestly, I’m not a Swifty myself—I’d be curious to know if she was selling any kind of Travis Kelce Chiefs gear at her tour stops up until it ended.

Chris Longhurst:
Outside of football, the sport we watch the most at home is basketball. My daughter is a terrific player in high school, and we’re following the WNBA pretty closely. We got to see Caitlin Clark’s last couple of games in college in person, and that’s done a lot for the sport of women’s basketball as well. So we’ve got the WNBA package, and we’re rooting for the Fever.

Larry Kaiser:
You know, growing up I was a huge basketball fan, and then kind of in my era—you know, I’m sure similar to yours—was the Jordans, the Birds, the Pippens, and so forth. I lost interest for so long for a pretty simple reason: nobody could hit a mid-range jumper anymore. It was either one-on-one dunks or three-point shooting. And I started watching WNBA right when it kind of first started because, you know, women have a better mid-range jumper, and Caitlin Clark’s a fantastic player. I love watching her play.

My daughter, who’s five and a half, is just now starting to get into sports, so I try to have her watch different things. We watched the WNBA games last season, and she was really getting into it. So we’ll see if she becomes a basketball player as well.

Chris Longhurst:
Yeah, I agree. The women’s league is really pure basketball. It’s great to watch.

Larry Kaiser:
Yeah, I agree. I agree. Well, thank you for participating in our Bandwidth Banter—always great to have those conversations, kind of loosens the mood a little bit. But let’s jump into what we’re talking about today, which is IT and technology.

Historically, healthcare has been known to be extremely slow when it comes to adopting new technology, and you’ve been in the space for 20-plus years. Do you think that’s a fair statement?

Chris Longhurst:
I think it’s a fair statement. I think what’s important is what’s underneath it. You know, there’s a lot of criticism in healthcare for being so slow to adopt technology, but the reality is that we’re dealing with really high-risk kind of situations, and adopting technology that is not yet proven—when it could, in fact, lead to hurting patients—is the opposite of what anybody would want.

So I would say that there’s a slower adoption curve, but with good reason, which is: not only is this an industry that’s highly regulated, it’s also an industry that literally deals with life and death. And so there are spaces where you can point to very rapid adoption of things like new CT or MRI scanners, or new technology in the operating rooms that have been demonstrated to have great outcomes. But when it comes to software for managing your healthcare, the adoption has been much slower than people want. That’s partly because of the complexity of the processes and the importance of getting it right. We don’t have the luxury of breaking things fast and early.

Larry Kaiser:
So I would say that maybe—you look at COVID, and I think COVID changed a lot of things with regards to healthcare. To me it was buzzwords like telemedicine, remote care. All of a sudden everybody was shoving these systems in because of COVID. And I think what I’ve noticed from a trend after is that everybody was going back and fixing those installs or fixing that. Do you think COVID changed how quickly healthcare will adopt things in the future technology-wise, or was that a result of a necessity of a pandemic?

Chris Longhurst:
Yeah, Larry, I think that the pandemic was an aberration in terms of telehealth adoption. But you have to realize that it wasn’t the technology that was the barrier ever—it was the incentives and the policies. When those were removed and there was an incentive to actually adopt telehealth, it went way up quickly.

I remember moving tens of thousands of appointments to telehealth in those first couple of weeks. The good news was that we were in an environment with our electronic health record vendor where we were hosted. We had already been doing a fair amount of telehealth previously, and we were able to scale that up without any technology challenges. In fact, we didn’t change our technology solutions once during the pandemic—it just scaled for us. That was really a reflection of the great work that had been done for three to five years previously around getting our policies and processes in place to support telehealth at, of course, a much smaller scale.

Today we still run about 15% of all our visits as telehealth. We see some areas where adoption is much higher—mental and behavioral health is an example where people sometimes even prefer virtual visits to in-person visits. We also see certain post-operative visits and very focused urgent care visits that can be done in a telehealth environment. That’s not only convenient for patients, it’s also convenient for the health system because we don’t have check-in processes and physical space costs.

We’ve started a program called Vtalk, or Virtual Transition of Care, where our hospitalists, led by Dr. Sarah Horman, conduct a post-discharge telehealth visit to ensure that the transition home has gone effectively. That’s helped reduce our readmission rates. Everything has lined up to support a transition to telehealth as a more routine part of operations, and I think that will continue.

I do think the pandemic was an aberration, though. There have been several aberrations over time—the HITECH Act back in 2009–2010 was another one that spurred a lot of practice adoption of electronic health records. Before that, there was the Institute of Medicine report in 1999, To Err Is Human, and the follow-up Crossing the Quality Chasm in 2001, which identified health technology as one key solution for helping prevent medical errors and harm that could be mitigated with technology. We’ll see another aberration in the future, but it’s impossible to predict what that will be.

Larry Kaiser:
100%. Yeah. And I think it also depends on the organization you’re talking about or talking to, because each organization has its own policies and has gone about it in different ways. Obviously, with all the merger and acquisition activity going on in healthcare right now, and EMR conversions happening, some hospitals are very much ahead of the game, some are perfectly aligned, and some are behind the eight ball depending on where they are.

I’ll be curious to see—hopefully we never have another pandemic—but should one of those aberrations come about again, how things transpire with regards to the technological need at that time.

I appreciate your insights there.

So, what does an IT team need to do—or what does an organization need to do—to prioritize new technologies that are being implemented without interrupting day-to-day operations? And I’m asking this from your perspective as a physician. You’re on the technology side, but you’re also a physician—so you’ve got one foot on each side. How do you approach that? Yes, we need this new technology. I understand from the IT side what it’s going to take, but I also know from the physician side what we need.

Chris Longhurst:
Yeah, Larry, one of my early benefits was being mentored not only by the hospital’s first CMIO but also by the hospital’s chief quality officer.

Where I started my career at Stanford Children’s Health, we had a strong perspective that information technology primarily was there to support the high quality of care that we wanted to deliver to our patients.

If you think about the six elements of care quality as defined by the Institute of Medicine 25 years ago, that starts with patient safety—avoiding harm to patients from care that’s intended to help them. Effectiveness is providing services based on knowledge to those who benefit, avoiding underuse or overuse. Patient-centeredness is providing care that respects and responds to individual patient preferences, needs, and values. Timeliness is reducing waits and harmful delays. Efficiency is avoiding a waste of resources, including time, equipment, and energy. And then of course, care equity.

For those six areas, I would say any information technology project should support them. If you think about IT in revenue cycle, for example, it’s all about efficiency—automating processes to avoid wasting resources, including people resources.

At the same time, think about technologies like computerized prescriber order entry—a lot of that’s about safety and entering accurate prescriptions. Or patient portals—patients being able to schedule their appointments online—that hits multiple areas. It’s patient-centered, respecting patient preferences and their ability to schedule when they want to and need to. It’s also about timeliness and efficiency, reducing overuse of call centers and things like that.

So to your question about adopting new technologies, I really think about: What are the outcomes you’re trying to achieve? What are the problems you’re trying to solve? It’s not about the technologies or the shiny objects—even artificial intelligence. AI is not a solution; it’s a tool to help solve the problems we have in healthcare. We have to be really clear about that. Just like a Silicon Valley startup or a venture capitalist, you have to ask: What problems are we solving? And how are we making the processes better by adding automation or technology?

Larry Kaiser:
Okay, I can’t argue with that answer because it makes perfect sense to me. There’s so much to weigh on both sides of that, and I’m sure it’s a very fine line to walk and make those decisions. So thank you for that.

So my next question is one that has me intrigued. Honestly, when we started planning this podcast, I wanted you on here to talk about this because it piqued my interest. I’ll start by saying that I watch medical dramas on TV.

Chicago Med is one of my favorite shows to watch, and a couple of seasons ago they deployed what they called “the Hybrid OR” which had cameras all around the room. It would take all the different scans they inputted and create this 3D model. It had an AI assistant to help them through the surgery and make recommendations and so forth. I thought, wow, that’s super cool. I know it’s fiction, but I also know we’re not too far off from that.

Last year I saw that UC San Diego Health, along with the Innovation Institute, launched a really cool clinical study where you all were using the Apple Vision Pro in the operating room. And I thought, man, we are almost to where they’re doing this fictionally on TV.

I would love to learn more about that—what was the thought behind it? How did it go? Is it still ongoing? And where do we go from here with that? Because really, that ultimately feels like one of the first steps into getting what they’re showing and doing fictionally on TV. It completely fascinates me.

Chris Longhurst:
Yeah, absolutely, Larry. I’m happy to share—and hopefully you can link to the press release we issued—because we were the first health system in the United States to actually use the Apple Vision Pro for patient care in the operating room, specifically for minimally invasive surgery.

A lot of credit goes to Dr. Ryan Broderick, who’s a partner of ours and had this vision. Now, I want to acknowledge that augmented reality and virtual reality—whether it’s in the perioperative setting, medical education, patient education, or other areas—is not new.

So the question is, what did the Apple Vision Pro bring that was potentially new? The answer was, first of all, this was the highest-definition AR headset ever released. Some of the other competing headsets have more VGA/XGA resolution—640K or maybe even 1K—but the Apple Vision Pro is actually a 5K headset device. That’s transformative when you’re talking about viewing intraoperative images from a camera.

The second piece of it is just some remarkable technology, and credit to the Apple team for how they made this augmented reality device work in terms of minimizing potential delays and lag that contribute to motion sickness. This is actually a device that can be worn for a longer period of time than most devices, where people tend to get motion sickness from the lag. That makes it not a good long-term solution. So for those reasons, we thought it was worth trialing.

Ryan really deserves the credit for figuring out how to hook this up. He developed bespoke software that allowed us to stream from our camera systems as well as our radiology systems and other sources. The Jacobs Center for Health Innovation, as you said, was at the table helping support him. I was actually in the room for the very first surgery—which, of course, was done under IRB with patient consent.

There was a backup option and it was easy to take the headset off, but the entire procedure was completed in the same or less time as it would have been with the traditional approach.

So what benefit is it bringing? To understand that, you have to understand how these minimally invasive surgeons are operating. In the conventional approach, you might have two trocars in your hand and the patient in front of you—but where’s the screen? You’ve got one screen, hard left at 9 o’clock, so your entire operating field is in front of you and yet your head is cranked to the left. Potentially you’ve got radiology images to the right at 3 o’clock. Occasionally you’re looking down at your surgical field.

It turns out for that reason, minimally invasive surgeons have some of the highest rates of ergonomic injuries and occupational health hazards. Our goal with bringing this to bear was to be able to overlay those images so you have a high-resolution screen with your operating field visible in front of you, with radiology or other imaging in front of you as well.

Bottom line—it worked. It worked great. We’ve done over 60 cases now and we’re about to publish our case series. It’s gotten the attention not only of our partners who make these cameras and operating equipment but also Apple itself, and it’s even been mentioned in an Apple earnings call.

We’re glad Apple’s committed to this long term. And yes, there’s a lot of criticism of the device. I’ve worn it myself for entertainment and other purposes. Is it too heavy? Yes. Is it too bulky and too much trouble—you have to set up the eye tracking and can’t easily share it? Of course that’s true. It’s also the worst it’s ever going to be.

This is first-generation technology and every subsequent iteration is going to get smaller, lighter, and better. I absolutely believe that 10–12 years from now you’re going to have not only surgeons but consumers wearing Ray-Ban-like glasses with AR projections on top—lightweight, able to augment your daily life, and perhaps even replace the device we’re all looking down at all the time. It sounds like an episode of Black Mirror, but I think it’s coming quickly. It’s really important that we’re helping to research the way forward from a healthcare standpoint.

That’s also why we did this under IRB as a clinical research study—so that we could rigorously evaluate the outcomes and share with others who didn’t have the same resources. Our lessons learned are that it’s great for surgeons, it doesn’t seem to be any slower in terms of use, and it may actually be better for patients as well. We’re still researching that and we’re publishing this data so others can learn from our experience.

Ultimately, even though these devices today are too expensive for most consumers—at $3,500 a pop—in the operating room environment that’s not a significant expense. In fact, if you had a dozen surgeons who are each going to use their own pair of glasses to avoid ergonomic injuries, you’re probably going to find a financial ROI off that.

Larry Kaiser:
I think it’s beyond fascinating. Do you see it going beyond your non-invasive work at some point? I read last week—one of the Apple scoopers said they’re working on a 2.0 version that’s much lighter. Do you need that lighter or newer version for use outside of minimally invasive cases—like open-heart surgery or hernia repair? I’m not a surgeon, so I’m not sure what’s considered non-invasive versus other, but let’s use cardiac as an example. Does the technology need to improve before it moves into the non-minimally-invasive world?

Chris Longhurst:
It’s a long answer to a short question. First, minimally invasive surgeries—hernia repairs, etc.—are often very rapid, sometimes under an hour, so it’s not hard to wear the headset for the entire procedure. We’re seeing other surgical specialties adopt it today; ophthalmology is a great example—at our Shiley Eye Center, Dr. Tommy Korn has been trying this in various eye surgeries.

For longer surgeries—cardiac, neurosurgery—the real question is: what problems does it help solve? For stereotactic neurosurgery, for instance, how do you overlay high-resolution imaging so you’re operating at exactly the right point? I absolutely think these tools can help with that, and we’re beginning to investigate. These are long cases, so would lighter devices help? Almost undoubtedly. But do we need to wait? Not necessarily. It’s not the entire surgery that needs the overlay.

There are companies today doing stereotactic neurosurgery with other AR devices like HoloLens. Will a higher-resolution headset make that better? Almost certainly. Is it too heavy right now? Yes—but it’s the worst it’s ever going to be. I’m excited for what’s coming, and I’m excited that the Jacobs Center gets to partner with our surgeons at UC San Diego to drive this forward.

Larry Kaiser:
It’s very exciting. As someone who likes to be on the leading edge with personal tech, I didn’t shell out $3,500 for the headset—but I’d definitely check it out if the cost comes down. I love how technology like this is working its way into healthcare and surgery—it’s innovative and advanced. Feels like we’re inching toward The Jetsons. I’m looking forward to seeing results from the study and reading about it—it’s all fascinating.

Chris Longhurst:
Thanks for asking about it, Larry—and one correction: The Jetsons released in the 1960s. We’re definitely still catching up! Headsets, combined with augmented AI, will be mind-blowing. And there’s a lot of other technology first envisioned in The Jetsons and other sci-fi that we’ll apply in the OR and in care delivery.

Larry Kaiser:
I agree. And for the record, Apple missed an opportunity with Apple Watch not letting Michael Knight call KITT on it. The tech is coming! Before we sign off—anything else you want to share with our viewers about technology or anything we touched on today?

Chris Longhurst:
It’s hard to close any health-tech podcast without AI. I’m very bullish on generative AI and the chance to unlock value in unstructured data we haven’t been able to access. One example: we had a traditional ML approach to identify sepsis in the ED. It worked really well—we published a 20% drop in ED sepsis mortality last year.

What happens when you add generative AI? It depends on the workflow. In the ED, adding GenAI didn’t help—our ED doctors often write notes after discharge or admission, so there wasn’t much text substrate to improve prediction.

In contrast, for post-operative sepsis prediction, we couldn’t get there with discrete data alone. When we added GenAI, it pushed us over the line—because surgeons and proceduralists immediately dictate/type notes after procedures, and ICU teams write accept notes right away. That text was very helpful for risk stratification. We’re now deploying this in an A/B test to see if it saves lives like our ED model.

It’s a great example: GenAI can solve some problems and not others—you have to understand workflow and context for algorithms to matter. Outcomes are what matter. I’m tired of hearing only about algorithms; we need real-world outcomes with real patients and clinicians. That’s our focus at the Jacobs Center—impacting outcomes.

Larry Kaiser:
That’s exciting. AI is everywhere—at ViVE and HIMSS, in countless blogs. It’s a buzzword, with so many models. I’m excited to see where it goes—and a little scared of how it gets there. Skynet became self-aware, right? You see models with personalities. But the meaningful outcomes you’re seeing are fantastic, and credit to your docs. I’m looking forward to what’s next.

Chris Longhurst:
I was at an AI summit recently—there’s one every week—and I liked their framework for AI in healthcare in three areas:

1. Operational use: efficiency and cost reduction.

2. Clinician use: better diagnosis, outcomes, quality.

3. Patient-facing use: empowering patients directly.

Operational will adopt first—lower risk. The caution: don’t use AI to solve the wrong problems or as a band-aid. With EHRs, we sometimes paved the cow paths—hardening bad processes. Let’s not repeat that with AI. Classic example: insurers using AI to review claims vs. hospitals using AI to submit claims. Let’s fix underlying problems, not just layer AI on top.

There are places AI can transform call centers or business processes—but we should also improve those processes themselves. For clinician-facing AI, we must measure outcomes (like the sepsis example) and prove benefit—like a new drug—before broad adoption and payment.

For patient-facing AI, there’s huge opportunity to systematically empower patients—remote monitoring, inter-visit care, automated care loops. Many companies are emerging, but like clinician AI, we need to measure, show it works, then adopt and scale.

Larry Kaiser:
I couldn’t agree more. I’m glad we included AI in this conversation. That concludes our discussion on Visionary Voices. Thank you to my guest, Dr. Chris Longhurst, for joining me and sharing his insights. And to our audience—thanks for tuning in to Visionary Voices, powered by Optimum Healthcare IT. Remember: the future of healthcare IT starts with your vision. We’ll catch you next time.