Daniel Barchi - Chief Information Officer for New York-Presbyterian joins us to discuss Artificial Intelligence ethics. We also take a look at final preparation for CVS/Aetna and Daniel lays out operationalizing telehealth.
Bill Russell: 00:09 Welcome to this week in health it where we discussed news information and emerging thought with leaders from across the healthcare industry. This is episode number 43. Today. We make final preparations for cvs aetna's entrance into the market and we discuss ethics in ai design. This podcast is brought to you by health lyrics. Health systems are moving to the cloud to gain the agility, efficiency, and new capabilities work with a trusted partner that has been moving health systems to the cloud since 2010 was visit healthlyrics.com to schedule your free consultation. My name is Bill Russell, recovering healthcare cio, writer and advisor with the previously mentioned health lyrics. Before we get to the show, I wanted to shout out to the CIO who are going to be attending the chime fall forum in San Diego. I'm going to be there doing one of those special shows like the one I did at Becker's where I sit down with cios for 10 minutes.
Bill Russell: 00:58 I have a series of four questions and we just record them as an audio podcast. I actually have three sets of questions this time around. The categories are going to be technology execution or culture. The CIO gets to pick whichever set of questions they want to discuss and we'll go through those questions. We'll record them and then we'll splice them together for a show next week and the following week. So I look forward to that. If you want to be on the show, please drop me a line to a [email protected] Uh, one last thing, uh, we now have an Alexa skill enabled for the podcast. You can just say, Alexa, play this podcast, play the podcast this week in health it, and if you enable any pod skill, you can also say, Alexa, ask any pod to play this week and help it and it'll play that as well. Uh, just playing around with some new technology seeing how it works out. So today's guest is a leader in the industry, a frequent speaker on the topic of digital transformation in healthcare. A graduate from the US Naval Academy and Marathon runner and the cio of New York Presbyterian, Daniel Barchie. Good morning, Daniel, and welcome to the show.
Bill Russell: 02:06 You know, I uh, I, I think I keep throwing people off because we usually record on Friday mornings and this is the second week in a row that we're actually recording in an afternoon. So
Daniel Barchi: 02:17 I wasn't going to call you on it. I was gonna go with it
Bill Russell: 02:18 just go with it, hey, tell us a little about New York Presbyterian. I mean you guys have some very prestigious institutions that you serve there to give us a little little background on New York presby.
Daniel Barchi: 02:32 Sure. I'm happy to. New York Presbyterian is a fantastic institution and delivering great healthcare. We are the University Hospital for Columbia as well as Weill Cornell. So we have two world class medical schools that we partner with we're a eight billion dollar institution with about 10 campuses across the New York Metro region and we're a leader in artificial intelligence and telemedicine.
Bill Russell: 02:58 Well, I look forward getting into both of those topics on the show a little later. So one of the things we like to do that to open up, open up the show. It's just a pretty open ended question and you know, just what's. What's one of the things you're working on right now that you're excited about?
Daniel Barchi: 03:15 I'd have to start with telemedicine. We really feel like our mission is to deliver outstanding care to the people of New York, but with our outstanding physicians, the broader that we can deliver that care the better for our patients. So a couple of years ago our CEO Had the vision to invest heavily in telemedicine as the way to expand what we do. And we started with a couple of pilots in the 2015 time period so that by 2016 we'd done about a thousand a telemedicine visits in 2017. We did it about 10,000 this year. So we're growing in many, many ways. What we're proud of is that we're reaching patients however they need that care. So for many patients its a ed visit, but from their home on their own phone, so they download the NYP APP and they can be connected to our board certified ed physicians. We have a number of kiosks in our walgreens. We do second opinions nationally and we're doing a lot of care in our eds. We do more than 20,000 ed video visits every year to speed up the process. Patients can go through one door and go through a normal two, three hour ed visit, or they can do our ed express care via video with one of our physicians be in and out in about 30 minutes. So you feel like telemedicine is really changing the way that we're able to deliver care.
Bill Russell: 04:37 It really does become a foundational technology for becoming a consumer centric, uh, industry. Uh, and you know we're seeing it more and more. Are you guys seeing it as a, clearly you're doing second opinions and you're doing consults across the country. But are you seeing it as a way to reach out into new markets, get into Jersey, get into Connecticut? Maybe.
Daniel Barchi: 05:02 Certainly I'd say that's one of the ways we're able to do it, but it's probably more about the convenience for both for physicians and the patients in our, uh, in our region. So if you're, say from Johnstown, Pennsylvania and you come to New York Presbyterian for a liver transplant, you've probably visited a couple of times in the weeks and months leading up to that transplant. When you go home you don't want to come back again a week later for a followup visit where you might talk to your transplant surgeon and who might take a look at your incision and ask you you a couple questions about how you're doing. So for that patient, it makes a whole lot more sense that the video visit for their convenience and for the efficiency of the physician. Similarly, if you think about the patients that we serve, we are both a top class institution to whom patients come from nationally, but we also serve more
Daniel Barchi: 05:54 region than anybody else in New York with the of New York health and hospitals corporation. So there's a large population that um, you know, in many ways couldn't afford to take time off the work that we want to make outstanding care available for them or for their family members. You know, our CEO often talks about having an elderly family member for whom you have to take time off of work to get them into the city, get them up to a physician's office just for a 10 or 15 minute cardiology visit. The more that we can do for patients in their own homes, the better we're serving our patients.
Bill Russell: 06:28 That's fantastic. Alright, well show format is a pretty straightforward we do in the news where we each pick a story so that, uh, we sort of bring our own perspective and, uh, by selecting the story, we sort of bring different topics to bear every week. And in the second section is soundbites. We're, we're going to dive a little bit more into the, uh, into the telehealth strategy that you guys have been able to put out there. So, um, I'll, I'll kick us off with the first story and that's cvs had the, uh, forcing hospitals to rethink their business models. Obviously this is a, uh, it's a story from health leaders, media.com. Uh, the article actually paints with a pretty broad brush, a pretty, a single point of view that's really shared by many and that is we live in a digital age, in the digital economy.
Bill Russell: 07:16 The consumer is king. those that don't get on board and meet the needs of the consumer are going to be in trouble, is essentially the basis for the story. And I thought this would be a good time to talk about this given that cvs and Aetna is moving forward. We're almost at that, at that final day where they, uh, they come together now we know with any m and a, there's just a lot of work that goes into making the two organizations work well together. But this is, this has been a growing trend of non traditional players coming into healthcare, uh, coming with a different approaches, different models, different services trying to really get in between the health system in the, uh, in the consumer, the consumer patient and try to direct their care. And so here's what it, rather than go into the article and in depth, what I'd like to do is just pull out some of the principles that they, they say are the core of the, digital transformation of healthcare. It just go back and forth on them. And so the first principle is, you know, retail providers are, are poised to really poach walk ins and patients seeking potentially high margin procedures and directing those things. Um, is that, is that something that you guys are, uh, thinking about talking about? Is that something you see happening in the industry?
New Speaker: 08:34 I think a lot of health systems are focused on this area and certainly we're not opposed to reaching those patients we want to give patients whatever they need. If you think about the kind of care that's delivered by New York Presbyterian Medical Group or Columbia Doctors or Weill Cornell physicians we're delivering outstanding care and some primary but a lot of secondary and tertiary care. A lot of specialty care, so we certainly want to get patients in the door and deliver the care that they need and a lot of that come from convenient sources and we're covering a lot of that with our telemedicine, either through patients own phones or via our telemedicine kiosks in Walgreens but what were actually trying to do is provide all of the care that they need so I think that there's a lot of turn and prop in that front end of care, but the real care that people need for the long term is for oncology or surgery or on going urological or cardiology care that you just can't get just by focusing on the walk in kind of business now were very proud of what we've done in the walk in business. One of the stories that we share is that in one of our Walgreens and by connecting one of our physicians on the screen that physician was able to both by talking to the person looking at their blood pressure and the pluse socks, determined that they were in congestive heart failure
New Speaker: 08:34 Yeah you know what, we're, some of that didn't come through for whatever reason. So if you could actually tell that story again. So that's the story is, that would be great, for whatever reason the internet went down I'll just splice it together.
Daniel Barchi: 10:26 Sure. So I'd say a lot of different entities are competing for the walking in or the front end kind of business and certainly New York Presbyterian is proud of what New York Presbyterian medical group, Columbia doctors and Weill Cornell medicine are able to do in a primary care role, but we're delivering secondary and tertiary care in a way that we're focused on the longterm care of our patients, no matter what they need. We're proud of our ability to deliver that primary care and we do it through our telemedicine NYP APP download. We also do it through kiosks, the kiosks that we've placed in walgreens around the city. One of the stories that we like to share is a young man who was out of breath that came into one of our walgreen kiosks, sat down, took his own pulse ops took his own blood pressure, uploaded the information and was face to face with video with one of our ed physicians who determined very quickly that this young man was in congestive heart failure. We got him to one of our emergency rooms half mile away, admitted him took care of for three days and sent him home. Certainly I would say that's where we're competing with cvs and Edna other places that want to get that kind of minute clinic business, but what's important to us is that we're able to do the intake.
Bill Russell: 11:48 Yeah,
Bill Russell: 11:53 it is amazing to me how it seems like the market has, like you guys have been able to focus really in on convenience access and experience as well as a really driving such a high quality, high level of service that your, you are the market leader in a lot of different specialties within your market which makes you a, goto provider, um, for so many different things. But by also doing convenience costs and experience, you're, you're really able to change the change the game, are those are convenience costs and experience metrics that you think are going to continue to be the key metrics this is one of the things I talked about in the article as we start to become a consumer or a more of a consumer orientation, that people are going to start to differentiate and say, I'm going to go in this direction because of convenience.
Bill Russell: 12:50 There's going to be more transparency and costs. They'll choose a direction based on cost and overall when they get the kind of organizations like you're describing where they really think through the patient experience and they say, you know, this patient's going to drive an hour and 20 minutes to come see a physician for five minutes and they think through all the visits and they think through what's the most effective way to do those visits with the consumer. And really the patient has at the, uh, at the center of the transaction that those things are really going to change the game in terms of how people choose where they're going to go. Are you guys focused in, on, on those, those metrics? Convenience, cost and experience,
Daniel Barchi: 13:34 convenience, cost and experience are certainly very important to our patients and the quality of service that we deliver.
Daniel Barchi: 13:42 But I'd say it's quality more than anything else. If I think of a consumer transaction, I'm always gonna want to have a quick, easy in and out, I don't want it to cost too much and I want a good experience, but at the end of the day, it's the quality of service that's delivered. And those metrics all drive quality, but we're looking at longer term outcomes. We're looking at mortality and morbidity statistics for our patients. We want to make sure that we're delivering the best care that's available and quality and the outcomes outweigh many of the other things that patients think about. And that's why we're proud of the care we deliver.
Bill Russell: 14:16 Absolutely. Yeah. We've, we used to take a look at the numbers of people that would drive out of our market and they'd go up to, uh, the La Market to go to ucla for oncology or they'd go to cedars for certain of their specialty areas and quality, especially when people are facing a significant risk, quality is a huge driver and people are going to seek that out. The other thing that we hear over and over again is, you know, hospitals that don't make this adjustment to really thinking about the consumer putting the consumer first. They're going to fail because they can't distinguish themselves, uh, on just, you know, on, on just care alone that this can be a lot of different outlets for care. Um, so I mean, are, do you think that's going to happen? Do you think there are, there is going to be eventually this consumer, move this, the ability for the consumer to actually make the decision and choose a direction and that will start to put more pressure on health systems to be consumer centric.
Daniel Barchi: 15:27 Consumer centrism is important because consumers make choices about where they go for their care and yet New York Presbyterian is built on a foundation of quality for many years and through our partners, Weill Cornell and Columbia and our history dating back at 1771, we've been focused on the long term development of care, the research of outstanding delivery of care and then ways to deliver that care in unique ways that contributes to the outcome of patients. I think that the consumer focused is something that you can do with intensity over a couple of years and build a lot of consumer centric focus. And yet if you don't have the quality statistics to back it up the history of care and the infrastructure for delivering care day in and day out, it's not sustainable. I think that we've done a nice job of putting the tools in place to make it easier for patients to get our care our telemedicine our artificial intelligence tools, our ability to schedule appointments really easily through Columbia or New York Presbyterian medical group or Cornell. But it's the long term quality of the care we deliver. That's more important than any that
Bill Russell: 16:41 I'm just reminded of the old adage, you know, it's the number one thing in a, in a restaurant is the food. So the product for us is, is quality health care at its highest level and at the end of the day you can put all the digital tools around it. You can put a, you can, and you should make the experience better for the patient. There should be more convenience. The cost should be a competitive and affordable. All those things are important. But at the end of the day, uh, when people seek out a health system, a provider, what they want to make sure is that they're going to get the best care they can possibly get. And that's, that's what we bring to the market. And it will continue to be a, those that can deliver at the highest level that are going to succeed. Uh, well I'm to, I'm going to kick it to you for your story. So you, you have, uh, you've been talking a lot about your stuff and ai I'd love to. So you've picked out a story on ai. I'd love to talk about it.
Daniel Barchi: 17:41 Sure. So over the weekend I read a piece by the Wall Street Journal's Zambia, Anna, since she interviewed the new, uh, Ethical ambassador for Microsoft, a person whose role is to focus on doing the right thing and asking the right question of Microsoft and other businesses about whether they're following appropriate ethics and protocols for intelligence and artificial intelligence. And it's something we're deeply focused on. If you think about our role as a health system or any system, quite frankly, it's delivering great care to patients and also protecting them and protecting their data. And if you think about the role that artificial intelligence plays, it's easy to get lured away by the idea that technology can do the best thing for patients. We talk within New York Presbyterian about the fourth industrial revolution, and the ID is that computer.
Daniel Barchi: 18:38 I was very careful to point out that we're the ones who determine what the future is and we're the ones who place values into the technology we use. We shouldn't assume that technology's value neutral, so this is a conversation that we're having at the highest levels to make sure that we're. We employ technology and especially artificial intelligence. We don't introduce algorithmic bias in any way and it requires constant vigilance. You know, there are tools that are out there for many health systems to use that have added more and more ai in the background until something that you might've purchased three or four years ago has ai components that are making decisions that you're not even aware of that. So this is something I think that needs to be on the minds of healthcare leaders and technology leaders, especially as ai plays a large role in what we do.
Bill Russell: 19:26 How are you going to deal with vendors so vendors are going to bring AI tools into your environment are you going to ask them? Because one of the things is transparency because these algorithms will make decisions, they process the information, they make decisions. Are you going to ask vendors to disclose their algorithms so that you have a better feel for how they're working with the data and the decisions that they're making?
Daniel Barchi: 19:53 No. Whenever we bring a new tool into a New York Presbyterian, we go through a series of steps. First of all, we need to decide with our physicians, is it the right tool, is the best one to come on the market. Then we have a technology review. We have a legal review and we have information security review to make sure that it's secure and it's going to work well and it's gonna be reproducible on a daily basis. More and more we started asking our vendors, what do we need to know about your artificial intelligence capabilities and we haven't purchased any of them, but when I talked to small companies that try to get into space, they've talked to us about their grade ai capabilities. I'll give you an example. I was talking to a small company that really wanted to play in healthcare and they said we can use our ai tool to make a decision about the appointment, so in order to slot patients appropriately, but when you really ask them what's behind it, they might be taking into account demographics that really aren't appropriate or no health system would feel appropriate making decisions on when and how patients get to their appointments. And so unless we ask those questions, we're not going to find out what's behind it. So it's on us the consumer to ask thoughtful questions about vendors, about what ai is going into their systems.
Bill Russell: 21:09 Yeah. And so there's been a lot of stories about ai bias and where it comes from and a lot of ai requires the machine, it will pick up data sets and it will learn from those data sets. And so there's been a stories around how a certain data sets will, will lead to, um, especially within, within our law enforcement and what not, certain datasets will lead to an erroneous calculation on recidivism and it will be based on, on race instead of other factors. And, uh, there's been a while, well, Microsoft's had their, uh, their social chat bot, which was learning from social media and whatnot. I think it was called Tay and uh, you know, after 24 hours it was shut down because, uh, you know, people figured out that it was learning from it and it spammed it, uh, to the point where by the end of the day it was coming back with some pretty harsh language and some pretty harsh things because it was learning from that data set. It was brought in, uh, brought into it. So, um, are there data sets, do you think in healthcare that are more, that are complete, that are more complete, that are better for a ai at this point then than say maybe a high risk, maybe higher risk because we don't have enough data or we don't have a good enough model yet for it?
Daniel Barchi: 22:39 I couldn't tell you specifically about data sets, healthcare from a clinical point of view. But I'll give two examples that I talk about and we as leaders talk about. And one is a leaders in business. So the example I often give is if you're going to choose a CEO of the next major American auto company, what would you choose if ai was going to choose that person and the only data that they have to look back on is 100 years a Caucasian males and it certainly wouldn't have produced Mary Beara who's the CEO of GM right now. So it's those kinds of things where we need to be very careful about that data that we look at. Similarly, if you look at facial recognition tools through training and the data sets that they had, they're much better recognizing lighter skin faces, than darker skin faces, and so we need to think not only about the software using, but even the tools and the cameras were using. So there are examples that are bound and how we need to be very thoughtful and very careful about how we're introducing technology into what is otherwise a very warm and welcoming healthcare environment.
Bill Russell: 23:46 Yeah, there's probably some opportunities within, um, within it itself in terms of ai, especially around security and looking at our, uh, our log files, looking at different patterns of usage and those kinds of things. I know that some previous guests have have said, you know, rather than a, we might be a little ways away on the clinical side from, from certain applications of ai until it matures, but there are, there are cases where it can really give us a leg up from an it perspective given the, just the sheer amount of data and log files and things we're processing on the security side, on the, really on the behavior side, what data's being accessed and those kinds of, really security and privacy seems to be an area that ai can be applied. Not sure if there's a question there. So let's. Oh, go ahead. Go ahead.
Daniel Barchi: 24:46 You raise a good point. A few years ago, log files were something that were interesting and might help our developers or programmers go back and look at what might have happened and maybe fix a bug, but more and more we recognize that log files are ways to gain the insights about how the systems are working and how people are interacting with them, and then later in artificial intelligence on them can recognize patterns that might indicate behavior that we don't want to see the log files that are associated with say a medication dispensing robot for instance, may tell us perhaps somebody who's getting a controlled substances out on a weekend when they're not actually on service and it's those anomalies that point out things that we might not otherwise see if we're just looking at specific moments in time. So more and more I think artificial intelligence is going to help us maybe not directly in a clinical way, but on the back office side, making finance and technology and hr and security much more efficient.
Bill Russell: 25:48 Yep, absolutely. All right, well let's. Let's jump into our soundbite section is a handful of questions. I'm just looking to go back and forth on for a couple of minutes on some of the different topics, so I've read some of the things that you've spoken, spoken about, written about, out there on the, on the Internet. I actually saw you at the Becker's conference as well, which was a great presentation. So I'm taking some of that. Just forming some questions here. So let's just jump in. So first one, and we really have to go back to that telehealth. You guys, when you were brought in, your announcement for cio was really almost like we're bringing this person in to spearhead our telehealth initiative. It was a, it was really interesting as I was reading that, that that was so much a focus. Most other cios that would get hired it would be we're bringing this person into to be our cio who's over all these things, but there was so much emphasis on telehealth. It was, it was really fascinating. So there's two aspects of, of telehealth that I'd like to ask you about. The first operationalizing telehealth and the second big data silos. So, um, so you gave us some background on, on the program and what you rolled out a. So let's dive into those two things. So the first thing,
Bill Russell: 27:12 which is, uh, which is operationalizing telehealth, it's not as much a technology challenge as it is an operational challenge, getting everyone to understand how to, how to really use, utilize this technology where it can be utilized, give us an idea of the process that you went through, how you determined the best places to put telehealth and how you brought the clinicians along. Uh, and then also how you got adoption out in the field. I guess those are the key areas for operationalizing.
Daniel Barchi: 27:47 Telemedicine has been around for awhile. You know, Michael Criton wrote in his book five patients in 1969, about the use of telemedicine at Boston Logan Airport for a patient who landed who was having chest pain and they used a telemedicine to connect that patient to Massachusetts General Hospital. So this is going on 50 years now. So it's not really the technology that's developed that far. It's how we use it. And certainly the technology is more ubiquitous now, but it's really the use cases. And so the way at New York Presbyterian that we've been able to maximize our ability to use telemedicine is in thinking about those use cases that might best fit what's available and then try them out. So we've done a lot of fast failure. So our chair of emergency medicine, Dr Rahul Sharma at Weill Cornell said, I'd like to use telemedicine in the emergency department. And we said, great, let's put together a small trial. We tried it with 10 patients. It went really well. We tried it with 20 patients really well. We bumped it up to 50, we got feedback, we tweaked it, and now we're more than 20,000 patients in the using it. We found it much more efficient. Similarly we found that trying it in nursing homes was very good because we're able to prevent patients from coming in in the middle of the night who could otherwise stay in a nursing home, but it doesn't scale really well. It's really challenging to get the nursing homes that might only use it once a week or even once a month to use it with any frequency and use it really well. So in some areas we found that it, we've really taken to it and other areas not so well. So our ability to get to 100,000 visits a year is predicated on the idea that we found 12 to 15 use cases that work.
Bill Russell: 29:38 Wow. Are you using a lot of specialty equipment or are you just basically using a pretty basic set of tools on both sides of the equation?
Daniel Barchi: 29:55 The fact that we've been able to maximize our success in telemedicine is based on our ability to be nimble. So we've used many different tools for different areas. So our ability to do second opinions nationally is in partnership with a company called grand rounds. Our ability to do telemedicine psychiatric evaluations in our emergency department is based on our ability to use our own cisco equipment internally. So nothing special. Uh, we've partnered with American well to be able to do our telemedicine visits via kiosks and on our phones. And in other cases we've just used our own networks. So there's no one tool or technology. It's the ability to use the right tool at the right time and be thoughtful about it.
Bill Russell: 30:40 That's awesome. So with that being said, you know, telehealth has a tendency to create data silos. If it's, if, if you're not thinking through integration from the get go, you're going to end up with a secondary scheduling platforms, uh, potentially other documentation repositories that are out there. How were you able to avoid that pitfall?
Daniel Barchi: 31:04 The ability to avoid data silos ties back to something that you discussed earlier. In many ways, telemedicine can be a point of entry for a healthcare system and then there's follow on care that goes very, very deep. So for second opinions, for instance, when a patient in Oklahoma has a really bad diagnosis and they need to contact one of our world class physicians, that first set of interactions is all focused on that patient and the discreet information that they give themselves, give us about themselves and that specific condition. After we've follow up with care. Then we go deep and they're part of our ecosystem and they're part of our electronic medical record. And then we ingest more and more of that information, but for that first second opinion, and we're okay with only dealing with the information that they provide. Similarly, when the patients who's downloaded our NYP APP and has a video visit with our emergency department, say from their couch or their apartment when they have an acute pain in their lower right abdomen for that first visit, our ed physicians is able to determine if that's indigestion or if it might be appendicitis. Three times in the past four months, we've been able to diagnose appendicitis through our video app and then brought that patient in for that first visit. We just want to know how are you feeling a pressure abdomen. Tell us about your care. Just a little bit of background. You don't really care for going deeper into their background. We just need to know what's happening in that moment, once they've come into our hospital for follow up care once if we diagnosed that appendicitis. Then we go deep and import their record, so I'd say it's almost two tiers of data and as long as we get what we need at the right time, we're able to deliver that care.
Bill Russell: 32:52 Interesting. So you talked about agility and being responsive It seems to be a core tenant of how you're, how you're thinking through the technology at a, at New York Presbyterian, so the velocity of change is going to continue to increase in healthcare. What are some of the foundational elements that you want to make sure are in place at your organization to ensure that you remain agile and responsive moving forward?
Daniel Barchi: 33:21 Well, it's interesting you ask about the foundational elements about being responsive and being agile because so when using anything I think about our core tenants, about how we behave, so we have a ethics, we have a credo and more than anything we're committed to high quality care and maintaining the integrity of the data that our patients share with us and delivering great care. When we talked about employing more and more technology, telemedicine or artificial intelligence, we created a series of technical ethics that we follow. So more and more we've created a list that's growing larger about the things that we will and won't do with data behaviors that we want to follow it and to make sure that we're employing technology appropriately. So while there's the clinical care and that hasn't changed in the past 200 years as it relates to what we think about our patients and how we treat them with respect and dignity, the technology is constantly changing. So we need to keep a list of things that we know are appropriate to do with data and how we treat patients through technology and we need to keep that up to date.
Bill Russell: 34:33 Yeah. So you've been, you've been the CIO now at I think three different health organizations, so to tell us what you try to do in the first 90 to 120 days as the cio, uh, in a new organization, what are your, what are your priorities as you're, as you're starting to get your feet on the ground?
Daniel Barchi: 34:53 I think that healthcare it is all about people. In fact it's 80 percent people. It's 15 percent process and it's really only about five percent technology. So understanding the people and understanding the processes of any institution are more important than anything else. I've always tried to create a long term technology strategy and making sure that we're up to date we're putting the right operating and capital plans in place and longterm strategies for working ourselves into a good technology spot, but understanding what the values of the people are, what's important, what people need in order to get their job done are` more important than anything. So anytime that I've joined an institution and especially as I've joined the New York Presbyterian, I've gotten to know the leaders and members of the IT team the chairs the chiefs, the physicians, the nurses, and understand what's working well and what's not working well. So to answer your question, I'd say it's about getting to know the people and that's more than important than anything else.
Bill Russell: 35:55 Yeah and that doesn't change for the first 90, 120 days or Two, three, four years. It's relationships and you driving. And you being able to develop those relationships and support the people around you.
Daniel Barchi: 36:09 Absolutely.
Bill Russell: 36:10 So I, I read a bunch of stuff on the Internet in preparation. Um, and you, you appear to be a big fan of history. You made, you made reference to a Lincoln, Grant, the Wright brothers, Alexander Fleming and you even studied the history of the Chrysler building, as you know, at that you referred to in a story which I found interesting. First of all were, you know, where does that come from? It just the love of history. And I think the second thing is, um, you know, what lessons are you drawing on right now in terms of inspiration for being a cio in healthcare in 2018?
Daniel Barchi: 36:48 I'm interested in history because I look at what we do at your Presbyterian as a small part of a continuation of work that men and women have done for more than 200 years now. And in any great institution like this, we are standing on the shoulders of giants who went before us. And so the foundations that they put into place are important to recognize. And whether you look at your local history in your town or village or you look at a national or global history, we can look back to fantastic people who are inspirational, what they did and learn a lot of lessons from them. So I think when I look at history, I try to see what challenges people faced and what lessons I might draw from them. Now thinking about going forward, I think that we want to invest our time and our energy and our resources in a way to create a foundation more and more as we've run into a problem.
Daniel Barchi: 37:41 I've thought not, oh, what do we need to do this week? But if we could really change things, how would we want this to look five years from now? How would we want it to look 20 years from now? And if that's where we want to end up five or 20 years from now. What changes do we need to put in place right now that will get us on that right kaleidoscope to get there. Even if it's hard, it's worth doing, but there's no point in putting in a quick fix and then two years going in and do the hard work.
Bill Russell: 38:10 Daniel, I really appreciate you coming on the show. I know I know a great show when I hear one, when I am A. I want to take notes so I'm looking forward to going back and listening to this show and writing some things down because it, it's, uh, your, your wealth of experience or background and just your, your thinking and how you break things down I think was really helpful for me. So, um, is, is there a way that people can follow you? I know you're speaking it at Socal HIMMS event are there some other ways people can follow you?
Daniel Barchi: 38:46 Sure. Well I've written a couple articles and posting them on Linkedin and I'm on twitter @DanielJBarchi, so I'm more and more. I've tried to share a lot of the great work that's happening in New York Presbyterian and then highlight a lot of what our peers are doing nationally because quite frankly I feel like unless we're all working together, the challenges of developing technology in healthcare are immense and more and more I learned from my peers. And so, uh, I try to share as much as I've learned from them with other people as well.
Bill Russell: 39:15 Absolutely. It's one of the things I love about this industry. Awesome. So you can follow, you can follow me @thepatientscio the show @thisweekinHIT, uh, the website thisweekinhealthIt.com. And you can get to the youtube [email protected]/video. And that's all for this week. So please come back every Friday for more news, information and commentary from industry influencers.