November 19, 2021: Bill and Drex discuss the latest round of in-person (yippee!) conferences. HLTH, CHIME & Healthcare 2 Healthcare. The top five themes that came up were Labor Shortage, Cybersecurity, Digital Front Door, Automation and Care Venues. As a CIO, what do you do when staff members start getting better offers elsewhere? What are the keys to staff retention? Why do some health systems handle the recovery from ransomware attacks really well and others suffer? What is happening in the world of automation and specifically clinical automation tools? And can we figure out how to adopt them very quickly? And care venues are getting smaller, more creative and more specialized. These new settings are driving CIO's to come up with new ways to do things they’ve never ever done before.
00:00:00 - Intro
00:03:20 - Will company cultures start to decay as we continue to look at each other through a screen?
00:12:50 - Digital health is about simplicity. It’s about thinking about patients as consumers and how they deal with all the other online parts of their life today.
00:14:40 - There's a significant nurse shortage coming right down the pike
00:19:30 - The 3 companies to watch in 2022 are Transcarent, Best Buy and Walmart
Bill & Drex Recap Conference Sprint: HLTH, CHIME & Healthcare 2 HealthcareBill Russell: [:
Drex DeFord: Going to the conferences and seeing each other in person and being able to sit down and have sidebar conversations as part of a presentation or something like that, it's all so valuable. The interpersonal connections that you make.
Bill Russell: Thanks for joining us on This Week in Health IT influence. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week in health IT. A channel dedicated to keeping health it staff current and engaged.
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Here we are. Conference season has come late this year, but it was a lot of fun. And today we take a look at the post-conference highlights with Drex DeFord. Drex. Welcome back to the show.
Drex DeFord: I'm always very pleased to be here. It's always a good time. And we did a little session during CHIME, which was kinda cool cause we had a lot of people drop in and out.sharing them. It's yeah. The [:
Bill Russell: The humans are back. It was good. So you weren't at the HLTH Conference. I'll do a little on the HLTH Conference. You're both at the CHIME conference and we recorded there.
We could talk about that. And then both of us went to another event. The Healthcare 2 Healthcare event. And I have a couple of insights from that as well. Plus it was just a fun event. It was good. It's getting overused, but it is good to be back together. And it makes me wonder if we, again, I keep reading articles that say, we're more productive at home or happier at home.
But I'm wondering if we're going to see our company cultures start to decay a little bit as we continue to look each other through a screen. It really was good to just see people and to, and to talk to them. And I just thought, man, that has to be missing at a lot of organizations.ther day that something like [:
The interpersonal connections that you make. And then for associations or for companies, I think that that whole connection piece is incredibly important for building culture and sort of figuring out where you're going and what the relationship with the company ultimately is going to be like. We do our best to resume, but I still think there's some missing pieces that you only get improved.ie Dimon, who is the Head of [:
I mean, they count on that revenue of those people coming in and using the dry cleaners, using the restaurants. Now economies shift and they change. So that's one aspect. The second thing he said was he talked about new employees. He talked about that very thing. He goes, it remains to be seen how good of a job we do of really training people, bringing them along. And he talks about this concept of apprenticing. And he said in the financial field, there's a lot of apprenticing that goes on that you, you learn at the elbow. That you don't learn if you are across the screen.apse. So, he might be right, [:s and they still get to live [:
Drex DeFord: This whole new world right is created in that situation. Yeah.
Bill Russell: They have that labor issue. The loss of staff and the competition for staff is getting steeper. In fact, some of, some of the health system said, we didn't normally have a lot of staff from this health system apply to our health system or go after them.
And he says, but it seems to be no holds barred at this point. I mean, there's if you're not paying your Epic staff enough, the hospital. Just around the corner and by the way, just around the corner, it could be two states over.
Drex DeFord: Just around the country. That's right. You hear these stories that you don't, they're hard to attribute, but somebody who has an Epic Analyst, who's working for their health system and then also side hustling, working for some other health system at the same time.ent. And whether it's try to [:
Bill Russell: Well, this one's in your wheel house. I think the second thing I heard over and over again is cybersecurity and privacy. Mostly cybersecurity though in this conversation. So ransomware is still top on the list. Because a couple of people said other things for number one, I said, what about cybersecurity?
And the feeling I got was, we recognized cybersecurity was an issue over a year ago. A lot of us went to our boards, got money and we're starting to .. wE're making progress. So it's not like, with the labor thing, it feels like, oh my gosh, this is right upon us now.
Drex DeFord: There's an urgency issue. This is a brand new urgency that is an urgency that we've had for a while so that you know that shininess or whatever is starting to wear off a little bit on cybersecurity because they're making some progress now. Yeah.uld seem to me that some are [:
Drex DeFord: Yeah, I don't disagree. There's a very wide range of maturity when it comes to cybersecurity and healthcare. And I think those were, who were on the top of the game have continued to make good progress and have continued to incrementally improve. I think those who are at the bottom of the game in many cases we're still stuck there or in some cases of kind of leapfrog and there's just everything in between organizations who still think of their cybersecurity team as cost centers and are really working hard to just straight up just control costs. And then the, just the transition of the staff from one organization to another can sort of overnight change the attitude of that organization when it comes to cybersecurity.
So a lot of variation in the world of healthcare cyber right now.
Bill Russell: Is the CISO role moving around or is it still predominantly under the CIO? Are we seeing it move out or is it, where is it? Where's it at these days?h, I think it depends on the [:of the board, or is it more [:
Drex DeFord: Yeah, I, again, I think the answer to all of those is yes. I think the CISO is definitely getting more face time with the board. They're probably getting more FaceTime with their CIO and their compliance folks. And then maybe even the CEO or the executive cabinet, if they're not part of the executive cabinet today, we've seen people pulled into that executive cabinet positions. So they sit at the same table with the CIO in some cases. Progress for sure.
Bill Russell: Yeah. Definitely more visibility. The third thing is all things digital and I realized this is a huge category. So let me, let me bring it down a little bit. Because it was digital front doors, obviously, with an emphasis on decomposing MyChart and putting it back together with an emphasis on experience.e decided moving forward, we [:
We needed more flexibility. So what we did is, you know, My Chart has this licensing model where you can break it apart and put it back together inside your wrapper, however you want to do it. And so they are doing that. They're breaking it apart. And the emphasis again is on experience. How do we make it easier for people to diagnose COVID? A symptom checker via chat bot, schedule appointments, do telehealth. In sImple methodologies. Right? So we saw tele-health fail in a lot of cases because technology connection wasn't able to be made. And they're saying, look, we're baking it into a single digital front end that is simple on this end and simple on the clinician side. And we're going to make it as simple as we possibly can to make sure that that never happens again. So a lot of, a lot of digital initiatives around experience and around telehealth obviously.t. A lot of it was, is about [:t of cases, it's no longer a [:
So I'm okay with people. Renaming it. Digital front door seems to be the most common terminology being used. I'm open for something better than that to be honest with you.
Drex DeFord: That's the new buzz term of the day, I would say from CHIME that I got, I heard more people talking about digital front doors than anything else.
Bill Russell: Yeah. It's interesting. Well, let me give you my fourth one, and that is automation. And automation being driven by doing more with less but also I thought, automation in general is a, is a hot topic. But also clinical automation is something that is bubbling right here, right behind the ear, your right ear.nurses working in the field [:
Clearly we're still doing the same stuff around speech to text and the nuances and the augmetics and all those. But we're also doing the we saw a really cool clinical automation tool at the Healthcare 2 Healthcare event. And just about every CIO in the room, he was either going to look at it or had looked at it because it is, I think it is one of those top of mind things.
Now, when we hear automation, a lot of times we just go straight to, the administrative functions and we're a little afraid to go to the clinical side, but I think we're going to see this new batch of clinical automation tools. And we are going to try to figure out how to adopt those very quickly because, because of the problem that exists.can not have everything that [:
Bill Russell: Yeah. We did a Today show on clinical automation. Interesting show. If you get a chance to go out and listen to it. The company was Artisight. Worth listening to, even if you're not interested in Artisight, the whole idea of clinical automation should be something that's brewing right here.g on around. And it feels to [:
Drex DeFord: No, I think you've hit most of the ones that I would think about. I mean, I think the labor, you had that as number one. And I would say that is the one that I probably have heard, but it's tied to almost like everything on your list. There's some version of labor that is also the reason that we're doing this, or we can't hire enough cyber security pros or whatever it is. The labor component is pervasive in all of these topics.e three companies. So at the [:
Drex DeFord: Manels. They're called manels.on. And then they, they just [:
We were not able to do that this year somewhat from travel policies. But another reason a significant number of women have left the workforce because of the burden that the pandemic has put on them. They essentially have decided to take care of the family or family home. Other priorities have risen above what they were doing.
And that was the first time I heard it. I ended up hearing it two more times that that had happened. I'm going to, I'm going to look for an article, see if there's somebody I can talk to about that topic, but that, that's one of the things that really jumped off the page at me. That was right in the opening keynote that that came out. One of the things I did at that conference was companies to watch.
And I don't have the really small ones. I did talk to a bunch of the small startups because it's just fun to see, Hey, what are you doing? That kind of stuff. But that the three companies I think to watch, and this isn't going to be a surprise to anyone. Transcarent is one of them. So Glenn Tullman's company is very impressive to me what they're doing.I didn't interview with him [:
And they are partnering with health systems around the country. And the benefit that they offer is essentially we will pay for surgeries before they happen. Think about that. Think about the AR and whatever that just went away because you're getting, getting paid upfront. So that's an interesting partnering opportunity.s right now, because they've [:
And they could be your last mile for getting into the home, setting them up correctly. Those things. It's not as easy as what people think to put people in the home. There's liability associated with that. I used to manage people that had to go into the home. There's some goofy stories that go along with that harassment that goes along with that. So You gotta be careful and Best Buy already has that whole,
Drex DeFord: It's a complicated environment. If you can buy that as a service, why would you try to build it yourself? Right. I think that's probably the model. Like nobody wants to get into that business. That's not, look l et's just pay these guys to go in and put in the technology to take care of patients at home for whatever it is, where we're sending with them home.e've been in healthcare since:healthcare. I mean, but we, [:
In fact, in their presentation, they really believe they are going to be one of the solutions to healthcare in rural America. And I'm not sure I disagree. I mean, again, I think it's a good partnering opportunity. It could be a good referral network for an academic medical center to say, look, we will do telehealth visits to those Walmart locations for complex cases or, or escalations.
And we can have conversations and make some recommendations. I'm not a clinician but it would appear to me that they're everywhere. And they're near populations and they're not going to be hiring specialists. They're going to be doing primary care for the most part.t's really close. It's not a [:
And there's Walmart grocery store components now and everything else. It makes sense to me. Go to the place where people already go and add this more expensive health care component and, and people are going to take you up on it. And so I'm with you. The other thing about something like Walmart or even Best Buy is they try things out and then if it doesn't work, they stop doing it and they try something else.eck act cycle and figure out [:
Bill Russell: One of the fun things was again, the conversations you have in the hallways and stuff like that. There was a picture that was floating around of David Feinberg now CEO of Cerner and Judy, Judy Faulkner. So they did, they did a selfie and and it got posted around social media and people had some fun with it and whatnot. And it led to a bunch of discussions on, what do you think that's about and what not?
I mean, do you, I mean, when you saw that picture, I just thought fun moment. I think David, Feinberg's trying to say, Hey look, we're both, we have similar goals, which is to make healthcare easier for the clinician and to provide the best care that they possibly can in the communities that they serve. And I think that was his intention. Did you read anything else into that?wants to make a guess about, [:
Bill Russell: Judy was very visible at the CHIME conference. She was out and about sitting around talking to people. Again, it's hard to not like judy Faulkner. If you, if you've run into her at all, it's hard not to like her. Cause I was actually interviewing somebody and it was a female leader for a company and she was just saying, man, I would really like to meet her. And I'm like, she'll talk to you. Let's walk over there and talk overto her.. I mean, that's who she is. [:
Drex DeFord: I might very well pile on whatever your answer is. Let's hear it.
Bill Russell: So I was sitting there and I'm not the first one who has said this I'm sure. But it's. Epic should be a platform. It shouldn't be an EHR. And what it requires is a change of thinking. Instead of focusing so much on the hospital workflow, they should really try to figure out how to enable the world to innovate on top of Epic.oh, that's what app orchard [:
And that's, that's what a platform is. A platform is essentially, Hey, the components are available for you, the entrepreneur, the, the, the I dunno, the thinkers, even the clinicians to say, I'm going to tinker with this. I'm going to see, and I know there's physician builders and those kind of things, but again it's not a platform it's not easily accessible APIs common language that I can tap into it.spects to make sure you sure [:
Man, if we unleashed a community to really go to town on top of that, I think it would do great things for healthcare. That was my answer to that question. I don't think it was any better than anybody else's I just, that's, when I look at their market share and I look at their position, I think they could really benefit from a change in culture that says we have to build it.
Drex DeFord: Yeah, I think it's, so it's interesting. You and I have been doing this for a really long time. And I remember when we first started building things that were electronic health records, that we didn't really call electronic health records.
We have best of breed systems. So we bought a lab system from one vendor and we bought an emergency department system from another vendor and we bought a transplant system.
Bill Russell: Those were the days weren't they.
Drex DeFord: Best of breed, best of breed. We try to strap them together through an interface engine.data element that says first [:e things. But we let lots of [:
We let lots of companies who build really awesome specialized systems for particular kinds of clinicians ride that backbone. Ride that platform. And it's a situation where ultimately you could make everyone more efficient, more effective, happier with their experience, interacting with the EHR because they would be interacting with the EHR through some gateway that they really love through some application that they're really, really comfortable with because it was built for them.
So I'm kind of with ya. I think it's just a matter of time until we finish making that whole circle. And whoever decides to jump on that first, whoever leans into that first, maybe the next EHR company that has a different name, but.ls and financials at Atrium. [:
There was somebody else I heard who, who actually, there was a handful of people as we were sort of doing the introductions that would say things like, yeah during the pandemic, we also did an Epic go live and I thought that, so they're still, they're still winning deals. Plus the M and A activity.
Drex DeFord: Exactly. The community connect stuff still continues to put Epic in more places than it's ever been before.
Bill Russell: That's the other thing I would say is there's a point of diminishing returns. We've seen this in some other industries specifically the ERP, the SAP's, the Oracles and the others.e they'll just keep breaking [:
And so you have to force them back to a foundation build and we'll see what happens. So I think we'll close with this. What conversation? Just pick one conversation. I know you had a lot of conversations. I'll give you mine first. So you can think about it. We had a lot of conversations over the last three and a half weeks.
One of the ones that jumped out at me was a conversation with Doug King, who was the CIO at Northwestern. Northwestern medicine. Yes. And the reason it jumped out at me is we started talking about culture and what he was doing on this labor issue. And he realized probably about two and a half years ago that, you, you can't win without a great team.
And so he put together programs for internships from college students from master's programs. He even went all the way down to high school students having summer I don't know what they were called. They weren't fellowships. I don't know what they were, but they came in for like a couple of months.s. Underserved areas. And so [:
And he goes, generally I can win in a certain market and that kind of stuff. He goes but at some point you got to start developing. You have to have a farm team, right?
Drex DeFord: This is our pipeline.
Bill Russell: And it started to come to fruition and I asked them, what's the biggest difference? And he said, it's new blood. It's the thing I call beautiful ignorance. They just, they, they come into healthcare and they go, well, why don't we do this? And people are like, nah, you can't do that. And they're like, well, if we did this and this, we could probably do this. And you go well, crap that's probably right.
Drex DeFord: Totally could do that.man, more systems need to do [:
And they're smart. My entire team, I've got five people on my team now. And my entire team is young people who are, they're just, they're smart, they're hungry and they're creative and that's, sometimes that's what you need. You need to bring some of those people into health IT. So that, that was, that was one of the more interesting conversations for me. How about you?
Drex DeFord: That's great. I I was sitting here thinking about it. One was with William Walders and just the idea that when you talk to people like William, he is both long in the tooth and a new guy at the same time. Right. He's been in the military for, for several years.ill kind of a relatively new [:
They become the Chief Information Officer and it doesn't take very long until the Chief Operating Officer or the CEO starts looking at them and saying, why don't you you've turned that around. Maybe you should also take supply chain or maybe you should also take radiology.
Bill Russell: You're really good at contracts. Hey, we do contracts over here too.ology or hasn't lived in the [:
And they go in and are able to sort of make some changes like that. So hearing him kind of tell a supply chain story for me was like very refreshing and it's not a thing that is completely unique. I'm starting to hear it more and more and more. I'm hearing CISOs moving into the CIO job. So there's, there's more of that kind of movement that's going on.
And I think it's because those jobs by their nature involve those leaders having, like you said, their fingers in lots of pies. They have to know what's happening everywhere in the organization to make their job work.
Bill Russell: Yeah. So William Walders doing COO type work, you have Chad Brisendine at St. Luke's University health system who actually took a, I think he took over radiology. He actually has a a line of and. BJ Moore took over real estate at Providence. That's no small role.estate or something. So man, [:
Bill Russell: We actually sat around one night and we were trying to think of all the clinicians that have become CIO's. The number's pretty big now. It's getting, it's big and getting bigger. And we're sort of speculating it's you think that's because the EHR is such a big part of the role and clinical operations, that the knowledge of clinical operations is so important that that's why that's happening.
Drex DeFord: Hmm.
Bill Russell: That's what we were sort of speculating around that.
Drex DeFord: I think that's, that's probably part of it. I would be interested to see what are the numbers when it comes to the CEO job which felt for a long time in my career, those CEOs were always MDs. And then over time, more administrators started to move into that position.alytic study for somebody to [:
Bill Russell: Well, I'll tell you what I'm looking forward to getting back to the news. I've done interviews for the last three and a half weeks. The good news is you are going to be continuing on in this role next year. So I am looking forward to that because I really enjoy our conversations and I think I've heard from people that they really enjoy when the two of us sort of banter back and forth about things. They like when we disagree, which I don't know we can probably, if we get back into the news stories, I'm sure we'll find some places we can disagree again.
Drex DeFord: Oh yeah, for sure. Now your wife told me her mother really enjoys when we disagree on the air about something that is like her favorite part of the whole This Week in Health IT.lly this. Cause she's one of [:
Yeah. So, Hey Drex, thanks again for your time. Really appreciate it.
Drex DeFord: Anytime. Good to see ya. I'll see you in person again sometime soon.
Bill Russell: Yeah. Looking forward to it.istening. That's all for now.[: