January 17, 2020: Dell Medical School has fast become one of the new leaders in the healthcare space. Since its inauguration in 2016, it has earned its place among the highest rung of forward-thinking medical schools and continues to serve its growing community with cutting edge technology and patient-focussed strategies in a truly remarkable way. Today we are joined by Aaron Miri, CIO at DMS to talk about his role and how he views the intersecting challenges of strategy, architecture and innovation. He gives us a direct line to the thoughts of a CIO and his insights will be invaluable to any healthcare practitioner. We discuss his approach to a multitude of scenarios and dynamics and his attitude to the central role of a CIO, staying abreast of current and new trends in the space. Aaron shares a bunch of his go-to strategies that make the complex and evolving landscape a little more manageable as well as expanding on the University of Texas' foundational philosophy and how it permeates all that they do. For a fascinating and expertly articulated exploration of healthcare today, make sure to listen in!
Key Points From This Episode:
Aaron Miri on Strategy, Architecture, and Innovation
Episode 175: Transcript - January 17, 2020
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[0:00:04.4] BR: Welcome to This Week in Health IT Influence where we discuss the influence of technology on health, with the people who are making it happen. Today, Aaron Miri, Chief Information Officer at Dell Medical School in UT Health in Austin, Texas joins us.
My name is Bill Russel, Healthcare CIO coach and creator of This Week in Health IT, a set of podcast videos and collaboration events designed to develop the next generation of health leaders. This episode is sponsored by Health Lyrics, I coach health leaders on all things health IT. Coaching was instrumental in my success and it is the focus of my work at Health Lyrics. I’ve coached CEO’s for health systems, I’ve coached CEO’s for startups, CIO’s, CTO’s. If you want to elevate your game in 2020, visit healthlyrics.com to schedule your free conversation.
Aaron Miri and I caught up just before the holidays to record this episode. I really enjoyed the conversation, I got a lot out of it and I think you will as well.
[0:00:57.4] BR: Today I’m joined by Chief Information Officer for the Dell medical school and University of Texas Health, Austin. Aaron Miri, good morning Aaron, welcome to the show.
[0:01:05.2] AM: Good morning, thank you for you to have me.
[0:01:07.7] BR: I’m looking forward to our conversation. You know, the Dell Medical School is one of the first round up medical schools in quite some time. Give us a little background on the school itself and the UT health system.
[0:01:20.4] AM: Yeah, great question. About 2013 timeframe, the voters of Travis County decided, yeah, it’s about time we have a medical school here in this area and to work with the Texas border regions to bring in medical school here, the UT Austin. Some fantastic medical schools across the UT system, if you look at UTB or when [inaudible] is doing or South Western's doing. But Austin, being the flagship and being here in Austin did not have a medical school. Decided to come here, along with that comes a world renowned faculty and with that, the clinical enterprise as well.
Numerous clinics, multi-disciplinary clinics and of course the research angle to it. It’s been about five years now in operation, and growing very fast exceptionally well and we actually graduated the first class this May. From a healthcare delivery perspective, we just saw our 50,000th patient and accelerating rapidly, I think one thing’s for certain, the are voters here, in this area knew exactly what they were needing and they’re coming to it in droves, it’s a good thing.
[0:02:15.3] BR: Wow, when did you step into that role?
[0:02:17.4] AM: A little over a year ago now. About a year and three months or so, which in CIO year is like eight years, right?
[0:02:23.5] BR: Eight years. So the work of the architecture and that kind of stuff was under way before you got there?
[0:02:30.4] AM: It was, yeah, the building had literally just opened when I joined, the medical school component with the academic portion had been going but the clinical enterprise in research buildings had just opened up. Maybe been open six months. Things are very much just done with substantial completion, really early occupancy, starting to see the first patients, there was all about layering in the systems, layering in the processing, building the team up. Really getting this thing going on value based care.
What was interesting about UT, which is what brought me here or to some of the other opportunities I was evaluating, was that it’s 100% on value based care. The clinics are organized in a way called integrative practice units which means that they look at a care team approach versus you bound the clinic to clinic to be seen. And so, if you present, if Aaron presents in the morning. I’ll be seen by an entire team of professionals in one fell swoop.
Versus me bouncing between clinics, to figure out what’s going on with me. What we’ve seen from our patients as we’re serving net promoter score and what not, is that they love that model, they take a little longer than your normal 15 minute visit, maybe 30 minutes. But the fact that is that, you really are being completely taken care of and that’s what they want. It’s that balancing act and making sure the tech backs up and practices.
[0:03:39.2] BR: Yeah, that’s a fantastic model. That’s along the same lines as you see at Mayo and Cleveland as well, right?
[0:03:46.8] AM: That’s exactly right and in fact, we’ve been in great collaborators in a lot of things like, "Hey, you know, what was some early lessons learned? What would you go back in time and change that you learn that? Bringing that to Austin as a new product, especially as a new endeavor, a new Enterprise all together, was something that the city has was adamantly stood behind.
And it’s helpful that this town is brought so you have aa very engaged audience here, you have people that are coming here to join folks like Google or Apple or others. They expect sophistication with your offerings and so it's that engagement and modality that they were looking for and it has just taken off.
[0:04:20.5] BR: Fantastic. You know Aaron, I did some research before we got on the call, you’ve given a bunch of interviews and a lot of them stem around the career. I’m going to avoid that because people can go to Health System CIO or back or they can listen to those podcast where you gave those interviews.
What I’d like to do is really get pragmatic with you and cover strategy architecture, operations and innovations. Really do an episode for other CIO’s and for healthcare practitioners. If you're up for it, are you up for it?
[0:04:49.6] AM: Let’s do it, let’s roll.
[0:04:51.0] BR: All right, let’s start with strategy, interesting environment that you’re in. What have you found to be the most effective process for setting strategy within a health system?
[0:05:00.6] AM: A couple of things, we’re talking about technology strategy, it is a process of engagement of leadership at all levels. Something with academic medicine is that you have incredibly intelligent people that are PHD MD’s or double PHD’s or you know, they wrote a book literally or they won a Nobel Peace Prize literally.
You have a number of constituents that you have to work with in setting our strategy, you can’t just be years on an island saying this is what Aaron wants to do. My first six months here really was the listening tour and really understanding, okay, what are people lines to accomplish, when we say digital transformation, what does that mean, right? What does that mean to you because that mean to you, one that mean the patients.
Those are the important dimensions that help you shape that strategy, the number two is, really participating, understanding, getting out there, talking to folks, working with the chairs, working with these intelligent leaders like I was mentioning, to make sure that they feel heard and that their wants, their needs, their considerations are taken into account. What’s good is that you are brought into an organization fresh to give your expert – technologist, you’re the expert CIO.
They expect me to course correct and say, you know what? "Doctor, researcher, that a great idea but that’s not going to jive, here’s why." "Okay, teach me." Part of that process is developing trust and last but not least, it’s communication articulating about it, right? Considerable amount of time, working people through the different nuance of the strategies and say, "How does this match a strategic vision, how does this match us delivering value based care, how does this match us in a data strategy and transformation strategy.
Once you’re able to articulate all that and you’re really listening, people feel heard, they trust you and then you’re able to execute, that’s where strategy comes together. For me, a lot of really rolling up your sleeves and hard work and not dictating from the pulpit, but getting into the mix and saying we’re going to make this together and at the end of the day, we’ll have a product presentably matches exactly what we need.
[0:06:46.9] BR: Yeah, I love that. The listening tour is a common theme for new CIO’s. I'm going to throw you a little curve here. If you’re in that CIO role for six, seven, eight, 10 years, the listening tour is pretty common when you first start off as a CIO, do you kick that of again every year, do you kick that off every three years, every five years, where you just go back out into the organization and say, "Hey, we’re going to look at it all again and see if we’re still on the same path."
[0:07:13.8] AM: You hit the nail on the head because now going into my second year here, we’re actually doing those tours right now. In fact, I routinely meet with the chairs and the departments and whatnot and talked to them on a one to one level and answer any questions and rounding it as much as I possibly can.
But formally, we kicked that process back off again because to me, a technology roadmap is only is as good as the roadmap. You have to constantly evolve it, iterate it, to make sure that it’s matching where your organizations evolving to. Part of the good tenants of a good organization is too be able to fail fast, well, if you pivot and go different direction, you got to make sure your text is right, you align to that, right? If you're not listening, you’re not communicating that, people will be like man, you’re talking about three years, we’re not doing that stuff and we got a different direction.
We have to constantly be evolving, as much as the organizations evolving. Yeah, for us, it’s annual but with constant iteration points, the entire time you're talking to people and making sure that feeds into sort of a nexus of the entire strategy and you’ll see that in the budgeting and strategic planning and all things including the technology.
[0:08:13.9] BR: Yeah, it was interesting, I had a pretty savvy, tech savvy board and I presented them a five year roadmap and two the people specifically pushed back on me and they were like, can you really predict what’s going to be going on in five years, I just looked at it and said, "Absolutely not." It’s moving too fast.
You know, every year, doing the listening too or figuring out where we’re going, makes a lot of sense, not only to hear from the constituents often but also the technology landscape, the innovation landscape’s changing so rapidly.
[0:08:45.5] AM: It is. What’s good though is I’m able to also bounce this off of peers. Like yourself and other people, I'll often call up and say, "Hey, you know, is blockchain a thing?" Right? We’re doing some blockchain things here, we’ve got a few brands going on but is this going to be a thing?
There’s a way to be able to work through this and use your network to help you. And then there’s of course professional services out there too, right? The [inaudible] across the world and others do department way to say, "Hey, am I totally in the wrong track here? Where’s the organization going, where’s the technology continuum going?"
That’s important, right? You’re able to sort of acid test yourself and I think a lot of leaders inadvertently get myopic in their viewed and they’re like, "I know it all, I know everything that’s going to happen." And yeah, I can predict five years from now. But the reality is, you can’t predict market as much as three, five years from now. The sooner you accept that, the easier it is for you to work it.
[0:09:36.3] BR: Yup. If I’m reading this correctly, you have a pretty high powered board. Michael Dell, Karen DeSalvo.
[0:09:41.6] AM: Just slightly high powered. No, incredibly, they’re brilliant, yeah.
[0:09:46.1] BR: Absolutely. When you approach that or when you get the chance to go into those board meetings, what kind of things are they looking for from a CIO?
[0:09:54.7] AM: Great question, a good board have excellent balance, right? One of our members, Jim Mulva, used to be the CEO of Phillips. Of course you got Michael Dell and others, they balance each other out in terms of the questions of things that they want to know about, the things they wanted to do, the things that they’re advising you on. From a perspective of technology is, really how are you helping to accelerate and get to goal and help us achieve some of the dynamics that we’re looking to achieve in market and community and what not. Also, how are you helping the University of Texas?
UT is incredibly proud. There’s an unbelievable people here. Literally people who wrote the book, are here. To the degree of it, how are we helping to continue that prestige and the things that we want to do as UT. I’m going forward t help all Texans in the community in the country. From the second interacting with them, it’s a lot of here’s what’s going on both at a project level and a strategic level, here’s what we’re hearing, here’s some of the obstacles coming at us from the market place evolving, whether it’s the federal level, state level, whatever else.
Here are the things that we want to achieve tactically, right? How can we use their help and their guidance and their mentorship and say, what should we do here? How should we interact with agents in a way? They’ve never been interacted before. The interesting thing about Austin is that the average age of my patients walking in the doors of my clinics is 31 years of age. I have over 50% commercial payers because this market is very high tech driven, right? They call Austin Silicon Hills for a reason.
You have to interact with a very sophisticated patient care demographic in a way that say was very different in Dallas or other places I came from. There’s nothing wrong with that, it just takes different kinds of input and so we have a phenomenal advisory board that tells us, "Hey, this is what we’ve seen in various other industries, think about this."
[0:11:37.0] BR: Yup, I’m going to come back to that when we talk about innovation because it’s interesting to think about when you have a tech savvy, 31-year-old average age of your patient, the kind of things that you’re thinking about am able to do.
But I want to jump into operations first and we’ll just keep moving through. From an operations standpoint, let’s start with people. Austin’s a really competitive market as you said, Silicon Hills for talent, so how do you attract and retain the top talent for your health system?
[0:12:06.8] AM: Yeah, great question. A few things, what we have found is that top talent is attracted to top talent, right? I just said earlier, I chose to come to UT because of the people that are here, on our board, on our leadership team, people like Clay Johnston who went at UCSF and now he’s our Dean. People like Martin Harris, Dr. Martin Harris who was CIO of Cleveland Clinic who is now our chief business officer.
I’m surrounded by people that are just brilliant in their field. Literally wrote the book. Martin wrote the book, I had to be a CIO 20 years and it’s amazing people around, that’s everyone. Top talent’s going to want to become the top talent, that’s number one. Number two, your mission, right? UT’s mission of the whole what starts the year mantra, really is what is the ethos of this entire university of our health system. The ability to break the norm and do different things brings out some of the best, especially young talent that is more gravitated — yeah, you get paid in maybe 30, 40, 50k more if you go work for Google, that’s great but Google's doing phenomenal things, I respect that.
Sometimes, they want to be something that’s a lot more than just like that. Something about you giving back to the community that you’re able to give back in a way that builds something. Number three, how often do you really how often do you really get a chance to start something new in a tier one, R1 academic world-renowned university, that never happens, right?
I mean, you got the Harvards and the Stanfords and others out there that are just literally amazing. How often has this happened? What I found that a lot of talent that is leaving their established places to come here, they’re attracted to that, they’re like, Hey, I get to learn from the best, I got to be a longhorn which is hook them red cyan.
And then last but not least, I get to build something new which is again, a resume bullet that you really can’t offer a lot of people. Those things tend to attract the best and retain talent that could be and probably is being solicited by the Googles, and again nothing wrong with them, what do you actually want to do with them?
[0:13:58.6] BR: For our listeners on the coast, the UT, "What starts here, impacts the world," is that what the phrase is?
[0:14:04.1] AM: That’s exactly right. Every dimension of this entire system, university, our health system component of it, you can see it, it literally seeps to the people that are here. I want to do things differently, I am going to break the classical change that have come, held up university or the organizations down, we’re going to invent the new thing, right? We’re going to teach the next generation students, it’s amazing. Everybody here believes that with a resounding fashion, they owe a lot of it, president — others just really drive themselves.
[0:14:37.1] BR: You know, I think the answer’s obvious based on the answer but – my next question was, how do you keep the people trained and motivated as a leader. I think the motivation is obvious, you’re doing something that you believe is going to impact healthcare, the community of the world but how do you keep them trained, I mean, again, the technology’s changing pretty rapidly. What’s your expectation of them and what do you do to help them?
[0:14:59.9] AM: Yeah, great question. A lot of credit to our major partners like the Microsofts of the world and others, if you collaborate with those major partners in a way and build technologies, right? We sit down and we walk through, okay these are the components of let’s say dev ops all right, I have a dev ops team, which is really your classical build application, develop something net new in Amazon or Google or Azure, whatever.
Execute it to do something that something of the shelf can’t be done, right? Value based, you find a lot of it. We’re going to be creating a lot of custom application to fill the void that traditionally can’t do. How do you keep your dev ops team up to date when every single day, you’re hearing about a new widget that Amazon’s coming out with, Microsoft is doing and so I partnered with them.
I'm like — look, I’m never going to be able to stay ahead of the curb classically but if I partner with them and say, "Look, this is what we’re doing for my technology road map, help me get better," they want to, right? They want to learn too. I just got back from mountain view, not too long ago where I was talking to some of these Google product managers and they are like, "Aaron, we’re all about health but we’re looking to learn as well, we don’t know it all."
"We plan to have a cool platform with most of them. We don’t’ know how to implement the solutions, that’s for you to decide, we want to sit beside with you to build that." Great, right? "You teach my guys how to use Google's GCP and let’s partner together," right?
To the degree of it, if you do those partnerships the right way with the right people, you’re training your team, you’re forwarding their careers and forwarding the institute’s best interests and you’re helping out your partners which will be there for you when invariably you have a rainy day. It really is that two way street, you know? Big part of the job of CIO is communication.
[0:16:34.7] BR: Yeah, you now have a board member who is with Google, I guess.
[0:16:39.3] AM: Yes, Karen is with Google, Google Cloud. Yes, that’s great.
[0:16:41.7] BR: Pretty big move, pretty exciting. You know, one of the questions I get, we poll our listeners pretty often, we try to be a listener directed kind of podcast and one of the common questions I get from leaders is around budgeting. Whenever I get a leader, I try to ask some sort of budgeting question to get the how people are thinking about it.
You have a new entity, you’re standing up a lot of things, eventually, all that build will become run. You’ll have to keep it running on a day in, day out basis but you’re going to have to continue to innovate. So what percentage of your budget are you trying to allocate to each of those, build, run, innovation?
[0:17:17.6] AM: Yeah, traditionally, the best kind of splits there is sort of a 30, 30, 30 and 10 What do you need to deal with? That never happens, right? Usually, the way it happens is you have either a 60, 30 10 or a 70, 20, 10 or something to that effect, right? You’re running more than you're able to build.
What’s great about UT is that the focus on innovation is never going to be overlooked in terms of for running better, right? Do we run, operations? Yes, absolutely. Do I have an efficiency metric I need to meet and make sure it will blow the budget and do various supporting every month? Absolutely. Am I cutting my innovation budget to build that things? No.
I’ll give an example of that, one of the challenges that we suffered on the medical skill side, right? Let’s take away from the health enterprise and research, just talk about the medical school, you have these med students that are coming up through the ranks that are part of numerous associations and clubs and what not and then you have all these grades that need to be coalesced across universities to one system to produce sort of report card nine. Not an annual report card.
Kind of like, where are you? A progress report card. That’s hard to do because a lot of the academic systems out there are very legacy in nature and were built for traditionally classically trained medical students. We’re not the normal medical school, you like to do things that distinction programs, where you’re going for your MD, but you’re able to get a master’s in public health, right? You have these dynamics that are very different about our med school and the reason why kids are choosing to come here, how do you capture that in electronic systems?
We built a student information system, thinking of it as aa CRM for students and that we actually call limbs, arms, feet and legs, each limb is part of the journey of a medical student, right? All the way through residency and out. So it helps capture all of those things to where we are able to be like patient appointed outcome comes in students, like are they depressed? All of these dynamics that are not again traditional classical medicine we are able to build that, but it costs money to build, right?
We work actually with a third party in town so my dev ops team didn’t take the a ton of load on their shoulders but it costs dollars and so the debate was in our budgeting process paid to leave and keep doing these things. Which is the right thing to do and then we really focus on become more efficient. Everybody was like, “No, we have to keep innovating and pushing the envelope that’s what makes UT UT."
So my hope is that as time goes on and as you said we’re still relatively new in our infancy our budget is still relatively healthy because of it, is that we don’t lose that balance and perception. I don’t think we will. If I looki at some of the other UT systems like MBN or soon in South Western.
Which is world renowned, they haven’t lost that. They kept in touch with that. Now your spirit animal has always been able to open the front door. So we got to maintain that balance but as long as you are articulating and having a conversations and it matches the strategy, like we talked about in your first question, you don’t lose sight of innovation.
[0:20:02.3] BR: That’s exciting. I mean it is exciting to know that you guys are doing that kind of innovation. Is there plans to take that innovation outside of your system and I don’t know, commercialize it in anyway?
[0:20:11.5] AM: Yeah, actually that’s exactly right. So UT is very well-known for commercialization and fabulous commercialization into the year. There are because there have been numerous AMC’s that have reached out to us saying, “Hey, how did you guys do that again? Because we want to do something similar, we just don’t know how to do it.” And it’s like great.
Now, you know UT is not about like some big is to become the next Amazon or whatever. You know we’re not, we are just looking to really – I said, “Hey, if we can breakeven on this investment I am happy,” right? Make a few bucks, okay but let us just breakeven and do what is right for the community and that is why UT does this, right? So if you have something that’s hot and takes off great but that’s not what drives us. To drive the commercialization is to really help give back and again, the whole point of what’s early, what starts here, right?
So we start something that is new that is really hot and the community needs it, great. How do we get it out there, right? I am sort of an open source guy so if I can open source it I would, ignore the university, we can't all the time. But to the degree of it there is that give and take that we work through. So yes, a commercialization is absolutely on the horizon for a lot of it.
[0:21:12.3] BR: We’ll get back to our show in just a minute. As you know Health Catalyst is a new sponsor for our show and a company I am really excited to talk about. In the digital age, cloud computing is an essential part of an effective healthcare and precision medicine strategy and we’ve talked about it many times on the podcast but healthcare organizations themselves are still facing huge challenges in migrating to the cloud.
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Now back to our show.
[0:22:26.0] BR: All right let's get into architecture. So just out of curiosity, what is the responsibility for the architecture, the system architecture network, application architecture, where does that reside in your organization?
[0:22:37.3] AM: Right, my team. My teams are responsible for that. We do absolutely make sure that the users, the chairs, the clinicians, the clinicians drive, what is it that they want to see happen, right? So if we give – one of our requests is our women’s health department wants to be able to interact with their patients whether newly expecting moms or other conditions in a way that it is almost like a community forum but more engaging.
And so all right, let us partner with various folks that have done that in other industries and see what is the right technology that we can bring to bear for that is. So I have the users dictate what they want in their UF’s. What is the UF’s look and feel and what are the outcomes they expect to see? And then it is my job to know that and, "Okay, you need this, this and this piece and put it together to make this happen." But again, it starts with my team and it ends with my team.
[0:23:24.8] BR: Yeah, I don’t know about you but I used to hate when HIMSS came to Vegas and the reason I hated when HIMSS came to Vegas is because it was close to my system. We got more people actually went to it because we had a problem and so before I got it you know we are a 100 year old [inaudible] company and before I got there, there wasn’t a lot of governance.
So if a doctor saw a really cool thing they brought it in and IT really didn’t say no a lot. And so you end up with a eight, 900 applications strewn across the organization and it sort of like sending out your contractor to Home Depot and just saying, “Hey, just buy stuff for a house.” And they all show up at the house and go, “All right, let’s build a house.” And it took me a while. It actually took me about six months of a lot of education amongst leadership team to get them to realize, “Hey architecture is a thing. We wouldn’t build a building this way. And we shouldn’t build our IT systems this way because if we do, we are not going to be agile. We are not going to be able to be responsive."
And quite frankly, I was brought in after a lot of outages. I’m like, “And this is what happens from a complexity standpoint.” How are you going to keep that from happening there? So you are early on, which is great. But how do you keep it from being that way 10 years from now that you are constantly bringing in new stuff and all of a sudden the architecture gets out of control?
[0:24:41.5] AM: Yes, so going back to what I said earlier about trust. We have phenomenally brilliant people and I am not saying that’s going right where you have those discussions and debates. But it is a positive awareness with saying it to people and it is not that Dr. Joe or Dr. Jane wants XYZ tools. I don’t believe you are going to find many clinicians like that. It is not that they wanted a widget for widget’s sake. There is something that they are able to do today in their course of care for a patient. That’s causing them to want to look at something, right?
Yeah there is ways of being innovative and new and flashy and I get all of that. But for the most part, clinicians are very practical people. They actually want to solve the problems. They just want to do it faster, right? They want to do it easier, they want less burn on the patients. We are seeing their rigmarole of having to go through garbage. They’re like, “Look, this thing cut in waste,” right? "I haven’t been able to do that apparently and this may do it," right?
So a lot of times it is helping them validate what will validate that you are right. "You have this gap today and it may not be buying widget A, but using this thing with widget B all differently, have you thought about that? "No, I never thought about that. Okay that's where trust comes in, right? And you only get that from all of the things that we’re talking to and so a lot of time I spend, which is, “Hey Aaron, I found this thing or heard about this thing and you tell me what you think."
Now that is great, right? It costs a lot of money and we can look at it but you also have this other thing, which you could use there. Have you thought about it? “Oh really?” Yeah, you have it right there, let’s try it. I will be there on Monday morning, we'll show you how to do it together. We’ll figure it and now then we are comparing and we’ll look at this other one. That is what it takes. That is really what it takes.
[0:26:10.9] BR: So UT Austin, you’re in Austin so and heck, your things called the Dell Medical School. So you got Dell VMware, you are talking cloud, edge computing, hyper convergence. I mean it is all right there. How are you viewing those emerging technologies at the medical center?
[0:26:28.5] AM: Yeah, so great question. There is – I think it’s healthcare in general. There is a dichotomy in terms of the way that some of the classical health applications are run, versus if you look at the micro services industry and those things are being built up, if you look at containerization, which is not going away because it is now old to do. But if you look at things like Kubernetes and others and Docker, you typically don’t see electronic medical record leveraging Kubernetes.
You’re just not going to see them, right? So there is this ebb and take in terms of what you can and can’t do. There is also some constraints in the real world like your financial systems. You may have an ERP that wasn’t built for a medical store health system you’re having to work through. Okay, that is what I am doing right now and things like that that you have to do while you also innovate and do things like the cloud and really leverage the whole internet of medical things with all of those dimensions.
You know it’s funny, I don’t think healthcare is used to rapid innovation cycles. So AGILE is a difficult thing to ingest here. It is really more of a waterfall kind of model. Now I believe in AGILE, I think that is where we have to get to but I don’t believe that the continuum is built for that yet. So there is that kind of half point that most health systems are at. Again, I have the benefit of being able to play through some of these issues right now.
I am more of a Greenfield, which is a luxury. But the realities of a healthcare apps are in the healthcare apps, right? A lot of them are on Internet Explorer. A lot of them are still dependent on Windows XP, whether you hate this thing or not it is true, right? I just got back from Chime. At Chime I can’t tell you how many of my college were like, “Oh yeah, we just now gone to migration in Windows 10,” I’m like, "Really?"
So I mean there is a lot of those things out of the real day to day of healthcare. So will we get there in terms of true virtualization, true bring your own device, true those kinds of things you want to do? Probably, will we here at UT get to it faster than others? Most likely, but I am still constrained by the things that healthcare constrained by. Until the vendor community can get together and rally around, “Hey, we are going to become truly micro services enabled with API calls going everywhere and the data is affordable,” it is going to be tough.
[0:28:32.4] BR: Yeah but simple things like you talked about Windows 10 and you know somebody is getting ready to do a Windows 10 migration across the board. One of the things I found and I am not knocking other organizations, just one of the things I found is that people don’t think about the next migration while they are doing this migration.
If you are doing this migration, shouldn't you be planning for – it would feel to me it makes sense to go, “Hey, you know what? This is an arduous process. It took us a long time, we should probably put the foundation in so that when Windows 15 comes out, you know we are doing it in days not years and it is not costing millions. It is costing hundreds of thousands.”
[0:29:11.8] AM: You would think so. I think though that just like what we are talking about earlier with value based care and traditional medicine being very episodic, so too has technology organizations become episodic, right? I believe in this principle called 'shadow of the leader' and what I mean by that is the business leads IT tends to follow and a lot of traditional healthcare institutions. So with that it is episodic. “Oh it’s Windows 10 today,” right?
Then it is Windows 15 or whatever it is in the future. So you are not really thinking two steps ahead as in the health system doesn’t normally do that. Because it is episodic, it's people serviced, right? So you have to change the ethos in the organization for technology teams to be thinking about that. So what you say is very logical and I totally agree with you. But I think that is a difficult proposition when you truly are living day to day, month to month in terms of what’s being thrown at you, what curveballs are being thrown at you.
I personally believe also that your question is exactly the reason why you are seeing the rise of chief digital officer and chief transformation officer. Because a lot of CEO’s and boards are being frustrated with, “Why can’t we move forward? Why do we stop doing this episodic things?” Why are we just talking about Windows 10? No one cares about that. How does it help with my mission?" So the thought is, “Oh I am bringing a new chief or officer to help.” That is not going to change, right?
Because to change a culture it takes more than one or two people to change an entire body of people. That is why good leaders are good leaders they are able to move the whole ship like we have here at UT.
[0:30:35.5] BR: So I have a couple of questions around innovation and this helps and that is going to go along with I’d be remiss if I didn’t talk to you about innovation. So everybody wants to talk about digital innovation. They want to talk about transformation as well. Where are you seeing the most movement in terms of digital transformation in your health system?
[0:30:51.4] AM: Yeah, so a couple of things. Number one was the way we interact with our patients. So I will give you a specific example. We build all of our care models off of patient afforded outcomes and a patient afford an outcome are structured series of basic questions and Q&A to be able to diagnose the patient before they present it to say, “Are you depressed?” Yeah, you may have ham pain but are you depressed because of it?
You no longer play racket ball because of it, right? If you have other conditions that are core morbidities that you just don’t know of. And so the PRO aspect traditionally has been very survey-based in terms of like literally questions and answer check-check-check when you present. There is this giant form and there is structured like PHQ or data or com PRO’s or [inaudible] and so that is a very worrying dynamic.
Yet if we built our practice models around it, it’s important. So our patients are telling us we just don’t want to take these survey on this things, right? We are saying we need a clinical decision for it off the data and do something. So I partnered with a startup out of North Carolina to build the conversion across any modalities responsive whether you are on your mobile device, your laptop, whether you want to do it on traditional paper, when you have fill on an iPad, when you present.
So that we can do these dynamically and increase our participation rates so that what we are building in terms of our patient’s team, our team make up makes sense for every morning. And so it works. Our patients are telling us we like this, it is easy. It is a couple of clicks or a text message versus this long piece of paper I had to fill out and it was engaging. So to answer your question, we are seeing around the patient engagement perspective. We have been listening, being responsive if we are adding solutions to them that they want to interact with you on.
Versus just giving them, “Well you have to take this. Too bad. Deal with it.” A patient will do that because they are sick and they are being told they shall do it, they will do it. They are not going to be happy with it. So the question you are going to ask yourself is, do you want a happy and healthy patient or do you just want a good quality outcome to check that box? So that is what we are seeing in that level of digital revolution.
[0:32:43.8] BR: So from an IT perspective or a digital transformation perspective, you focus on the patient, you focus on the clinician and the clinician experience, you focus on the student and then the system itself. I mean there is innovation RPA and whatnot around, how do you determine where are you going to spend the money or the time, the limited resources in terms of innovation?
[0:33:05.7] AM: Great question. So we have a good project team that we put together. With regards to the PMO to being able to catalog and gather all of these requests across the entire system. So each of our divisions we call them missions here. Each of our missions will have their catalog and their suite of requests for innovation. “I want to do this. I want to build this. I want to go here.” All of its great ideas, right? And to your point, you have finite level of resources and time that you can spend.
So part of it was a transparency exercise, let’s surface all of these things so that people can see that yes, you were heard, we cataloged it and then I work with the solution teams exactly, what are the priorities, right? We can do 10 things and we have a list of a 100. So you tell me what the 10 are then we’ll go forward. Here is my recommendations but I am one piece of the pie, right? I may be able to put the LEGO pieces together but you tell me do you want to assemble a dinosaur or do you want to assemble a McDonalds in LEGO blocks? So it is that partnership.
Years ago, I had a mentor who’s told me that you know ITT has the options and that is exactly what it is. We tee up, here are the options and what our recommendations are. Here are the absolute flaming dumpster fire you want to have away. You don’t want to cross HIPAA. You don’t want to cross these things but other than that, let’s have some fun but this is what we are constrained to and most people understand that.
I think you see a lot of resistance when you can’t articulate. If you can’t talk in language where your end user and your clinicians and others then can understand you, they’re be like, “You know the heck with you. You don’t understand me, what good are you?” That’s the whole no inclination to that. Your career is over as CIO or as CIO. So you got to be able to talk to people and you got to be able to start to set up in a way that makes sense and then also being able to deliver something.
[0:34:39.0] BR: All right, here is my final question. It is more of a fun question for me, which is if you left your current role and you and I, we were going to do a startup what area would you choose to do your startup? What area would you chose to innovate in?
[0:34:52.3] AM: I think this is a big need right now in the community. So for anybody out there trying to figure out what to go build, maybe you and I go do this together on the side or something. I think we are missing in [inaudible] precision medicine, which is truly extracting what is value, how do you manage your value? How do you actually measure community impact? What is that, right? Is it faster meals on wheels? Is it getting in front of food deserts?
Is it getting in front of people with conditions with what they present? I mean you see these wild things in the media and whatever like, “We achieve value,” yeah, what is it? There is a New York Time article a couple of weeks ago. I don’t remember the exact day but it was a Sunday. I want to say about three weeks ago and actually send this question, what is value? What do you measure it with? How do you measure value? How do you measure impact?
That’s right, I think there is a way to create a startup that you take multiple dimensions and you are able then to start saying extract okay, this is really what your return on value was and how you helped the community and more importantly then you can link that back to the payers and others and go, "Look, this is what you are getting for the dollars," right? Whole systems have a difficult time communicating with payers saying, “Hey we are going to change some feet per service from episodic to value based.”
They’re like, “Great, tell us what that means. I will get that back to you.” Right? So there needs to be something in a community that helps connect this thing to be able to comment definition set. I give a lot of credit to the office of National Coordinator and HHS and others trying to do that and it is difficult. Because it means different things to different people. So how do you create a common set of criteria that helps measure this and maybe it is looking at social media to go, “Aaron stopped posting about pizza, now start posting about broccoli on Twitter.”
I don’t know, what is that common definition of community can rally around and much like some of the early electronic health records pioneers then were saying, “We are going to create an EMR and we are going to go along and at the end of it all we are going to have something that we all look alike and feel alike.” That is what is going to happen here at some point. We have to have common definitions that we all align to.
[0:36:44.2] BR: Well don’t be surprised if somebody flags you down at HIMSS and says, “Hey I heard about that and here is what we are doing.” It will be exciting.
[0:36:51.3] AM: Yeah, no problem at all. Would love talk to them about it.
[0:36:53.5] BR: Aaron, thanks for coming on the show. I really enjoyed our time together. Is there a way where people can follow you on social media and other ways?
[0:37:00.3] AM: Absolutely. So I am a big social media guy. So LinkedIn, please look me up @aaronmiri on Twitter. It is my name, nothing original there. Aaron Miri all one word, I am happy to reach out or just email me. Again, I am a public institution, so my email address is public, everything is public. So reach out and I’d be happy to answer.
[0:37:15.1] BR: Fantastic.
[END OF INTERVIEW]
[0:37:16.1] BR: I really want to thank Aaron for taking the time to join us this week. He is so articulate and I think a good picture of what a CIO of the future looks like. It is someone who really knows technology and knows the business and the industry that they are operating in, which is this case is healthcare.
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