Q&A: Prioritizing Health Equity with Emory Healthcare’s Chief Transformation Officer

HEALTHTECH: What would you say were the top three lessons you learned during the first year in your new role?

ENEANYA: It's been a great year. For lesson one, as someone coming from a different part of the U.S., ingraining yourself and getting to know the people and the culture of the organization that you’re in, that’s important to determine the change readiness of an organization. You can't necessarily apply your previous experiences as a one-size-fits-all to your new role. So, really learning about Emory Healthcare, learning about Atlanta, learning about the history of Georgia, the political climate — that was an important lesson.

The second lesson is that change is exciting. There's a lot of trepidation with change, and part of being effective with change management and transformation is really garnering excitement. If you are exuding any type of apprehension, that will spread like wildfire.

The third lesson that continues to be pervasive in my career is that health equity is poorly understood. You have to meet people where they're at. You have to start with the basic foundation and concepts of health equity before you can make initiatives, otherwise people won't understand what you're doing, and they might have a visceral response to what you're doing because of the misinformation around health equity.

HEALTHTECH: How do you balance patient and clinician expectations for health equity?

ENEANYA: Education is all around; it's 360 degrees. Even patients are not aware that, for instance, 80% of factors that drive clinical outcomes happen outside of the walls of a healthcare institution. They may be struggling with some social factors, such as their housing or access to insurance or even violence inside or outside of their homes, and they have no idea that that's going to link to their clinical outcomes. You have to educate people about what that means and how they are deserving of the highest quality care, regardless of who they are.

That education has to be a starting point, because people may not be feeling worthy or they may be feeling embarrassed about their situation. I think building that trust with the patient is critically important when you're treating that patient and making sure that they have the best outcome for them.

Clinicians should also receive education about how to act appropriately when a patient has a bad outcome. Leveling premature judgments on patients can reverse any trust that is built when you're trying to develop these relationships. Educating patients and clinicians about why there are health inequities can better foster an empathetic environment and help draw from different resources that can help meet patient needs.

DISCOVER: How is Patient Room ‘Next’ an evolution of care delivery?

HEALTHTECH: How is Emory Healthcare approaching AI advancements? What is being implemented now? What will be implemented in the future?

ENEANYA: Having clinical algorithms that can take any administrative or cognitive burden off the table so that clinicians can focus on the patient and return that TLC touch to the clinical encounter should be a goal for bringing on these technologies.

At Emory, we have, for instance, an ambient listening software for the clinical encounter, so that instead of typing at the computer or writing down notes, clinicians can just have conversations with patients as the AI tool listens in the background and transcribes notes. It takes away that administrative burden that clinicians have at the end of the day called “pajama time,” where they're trying to finish their notes to meet compliance and regulatory standards. We've seen a decrease in pajama time and increased clinician satisfaction.

It would be great to leverage that technology to do even more for the patient. For example, what if, when a patient is nervous during the clinical encounter and they miss key things or they need to share information with a caregiver, they could receive a voice note so they could listen to that important information on their own time again? These are some of the technologies that we are considering and talking about to really optimize care.

In general, algorithms are not new to patient care. We have equations that are built into, for instance, lab values that help direct care. There's one in nephrology that is well known called eGFR, and it’s a way to quickly assess how well a patient's kidneys are doing. There are many algorithms like that.

Going forward, the lesson that needs to be learned — and this is drawn from my experience with racialized algorithms and nephrology — is that you can't bake social constructs into biological tools because that widens long-standing inequities. Race does not dictate biology. It's really an amalgamation of all the social constructs that occur in someone's life. Using race to predict an individual biological outcome is wrong.

We had to take that on in nephrology, taking out race as a factor from an eGFR calculator, because that calculator affected transplants for Black patients. So, that’s a major lesson: When you’re going to add a variable like a social construct, but really any type of variable, you must ask yourself, why? Why is this variable in there? How does this benefit the patient? What are the downsides to putting this in there?

I think, historically, a lot of AI tools and algorithms are focused on precision and quickness, but how much clinical relevance are they really adding? If you examine the math, inspect these variables, taking some of them out actually does not affect a model’s statistical accuracy at all.

At Emory, we have a Committee for Responsible AI to review these algorithms as they're being built, to iterate on them. That’s the whole goal, that we iterate on them and change as the population changes, and we make sure that we are covering our bases when it comes to the risk of using these tools.

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HEALTHTECH: How can healthcare organizations continue to keep innovation at the forefront amid budget constraints and workforce concerns?

ENEANYA: For me, thinking outside of the box is fun. If you keep doing the same things but you’re seeing the same outcomes and nothing is really changing, it’s time to go back to the drawing board and ask, how can we make this easier for people, whether it's clinicians or patients? How can we have better outcomes for clinicians, with their well-being, so that they can work at the top of their license, and for patient satisfaction? Where are you being wasteful? How can you be more efficient? How can innovation and transformation contribute to efficiency?

HEALTHTECH: What do you expect will be the top healthcare technology focus areas in 2025?

ENEANYA: In a Forbes article I contributed to in late 2023 predicting healthcare trends, I talk about social media as a powerful tool. Other industries have seen the impact of social media, and I think healthcare has been a bit divorced from that. I mentioned using videos and maybe having atypical partnerships with social media platforms for patients and their families to give feedback about their experiences.

When someone is really excited or upset about their healthcare, they go on TikTok or Instagram, and they make a video. You get to see their emotions. That can translate into business outcomes for an organization depending on which way the video goes. So why not preempt that and empower patients to share those videos as direct feedback?

There would have to be a lot of thinking through how to make sure patients provide proper consent and that they’re not penalized or receive retribution for sharing their experiences. But I think there's a power in capturing emotion — the power of the anecdote. I see video platforms becoming the next way we capture patient satisfaction and improve our understanding of their experiences in the future.

More immediately, I think a major continuing trend is addressing clinician well-being. High levels of clinician burnout remain. There’s an exodus from the healthcare field. How can technology bring the joy back into caring for the patient? How can technology support clinicians? I think a big fear is that technology will replace personnel, but I don’t think that will happen; it doesn’t have to be an either/or situation. Ambient listening is a great tool, for instance, and I think there'll be many other tools to reduce that administrative burden and cognitive load. Having the investment from key leadership will really push that forward.