This Week Health

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July 24, 2020: Join our role play today with Bill as CIO and our guest Charles Boicey as CTO. Together they’ll go through the hottest issues in healthcare right now. Will they give away all their secrets? What will HHS do with our data that is different to what the CDC did? What did the CDC do wrong? With significant cuts in revenue, how can CIO’s do more with less? What should we consider when outsourcing overseas? Bill and Charles also look at cloud strategy from an R and D perspective, a data science perspective and a research perspective.

Key Points:

  • HHS versus CDC reporting [00:04:30
  • Refining the architecture of current systems to save money [00:10:00
  • Renegotiating contracts with vendors [00:12:10
  • What are some things we can do in data center ops? [00:13:10
  • Hyperconverged infrastructure [00:13:30
  • Future proofing [00:14:50]
  • What is a good cloud strategy? [00:20:30
  • The 21st Century Cures Act [00:25:30
Transcript

This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

 Welcome to this Week in Health It where we amplify great thinking to Propel Healthcare Forward. My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. This episode in every episode since we started the CVID 19 series, has been sponsored by Sirius Healthcare.

Now we're exiting in the series, and Sirius has stepped up to be the weekly sponsor for the show. Through the end of the year, special thanks to Sirius for supporting the show's efforts. During the crisis and beyond. Don't forget, we've gone to three shows a week Tuesday, we cover the News Tuesday Newsday, and we have interviews with industry influencers on Wednesday and Friday.

Uh, I am actually gonna take a week off next week. However, we have a special treat for you in that Drex to Ford frequent guest on the show. We'll be in on Tuesday to cover the the news. So we are gonna have a Tuesday News Day episode next week, and I'm looking forward to that. I will consume it as a listener just like you.

Uh, I wanna thank everyone for your support of the show. We've eclipsed a hundred thousand podcast downloads through the first six months of the year, and, uh, that is what continues to make this the fastest growing podcast in the health IT space. Thanks for sharing it with your peers, uh, to make it easier for you to share with your peers.

We've launched clip notes and, uh, I am really excited about your response to clip notes. We've gotten a, a bunch of, uh, emails from you and a. Ton of you have signed up and I really appreciate that. Uh, what is clip notes? Clip notes is quite frankly, a way for you to get a single email that condenses the entire show for you, and it gives you a, a one paragraph summary, gives you bullet points with timestamps so that you can go to your favorite parts.

And it has four, uh, one to four clips from each show, which has highlights from the show. That make it easy for you to share with your peers, to share with your staff, to share with other people within the, uh, within your organization, uh, so that you can keep them on the cutting edge of what's going on. To subscribe, there's two, two easy ways to do that.

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Uh, I am really excited for today's show. We have a special guest, Charles Boise, who I've had on the show before. Uh, Charles is one of my favorite CTOs in the industry. He has a clinical background. He is a technology genius and, uh, we do a little role playing here where I act as ACIO. He acts as ACTO and we go through all the things that we are facing as a health system today from 21st century cures to, uh, the HHS and ONC, uh, changes to, uh, cloud to, uh, cost reduction.

You name it. We try to tackle it from A-C-I-O-C-T-O conversation in my office standpoint. I hope you enjoy. Alright, today we are welcoming back, Charles Boise, the CTO for Clear Sense. Charles, welcome back to the show. Hey, bill, good to see you. You know it, it's been a while since I've had you on the show.

We've had a lot of conversations, especially through the, uh, pandemic. Uh, you've been a, uh, uh, a wise counsel for me helping me to understand some of the things that are going on. Uh, but I have a special show lined up for you. Uh, as you know, I've, I've, I've tried to hire you. Uh, on several occasions, and I've been left at the altar.

I tried to hire you when you left UCI, but you decided to go to Stony Brook. And, uh, then when you left Stony Brook once again, I was left at the altar and you went to be the CTO of Clearsense. And I think that speaks for, uh, at least to my respect for you as one of the best healthcare CTOs that I've ever come across.

So, today's show, we're gonna role play. For the first time I've hired you, I actually, I actually won . The, the, the competition. And, uh, what we're gonna do is we're gonna role play with me as the CIO, you as ACTO. And we're just gonna run through a bunch of things that are going on in healthcare right now and see how we would, I don't know, come up with solutions for 'em.

Are, are you ready for this? Hey, bill, you know what they say? Paybacks are. Uh, you know what? So, uh, I guess I'm, I'm gonna give my due, so let's go . Alright. We'll see. Uh. All right, so we're sitting in my office. Here are some of the challenges that I'm currently looking at as the CIO and the health system, so H-H-S-C-D-C reporting.

You know, this Twitter went crazy on this. The Trump administration just announced that you have to start sending your information over to HHS instead of the CDC. Um, uh, let me just, you're my CTO. So how hard is it gonna be for us to make this happen? . Well Bill, you know, really who the hell caress, whether it goes to the CDC or HHS.

And if you look at how many data elements are involved, you know, that's a small effort as well. So, um. You know, outside of, uh, you know, a different file format, you know, let's just, um, you know, redirect to a different, um, you know, secure fire, fire, uh, fire transport. Um, you know, as far as I'm concerned, we'll do the same ATL we'll produce the, you know, basically the same file.

We'll send it somewhere else and, you know, hopefully they do a little bit better job with it. Alright, so let me, let me get more specific. So, uh, I'm, I'm actually looking at the HHS document. They have. Uh, 32 data elements. So hospital information, which is pretty easy stuff, right? This is, a lot of this stuff is just ADT feeds and stuff right out of our TeleTracking.

So hospital information, uh, pretty straightforward. Uh, number of hospital beds, uh, inpatient hospital beds, uh, occupancy amongst those inpatient beds. ICU beds, ICU bed occupancy. Uh, total ventilators, ventilators in use. So this kind of information is this readily available for. To us, are we gonna have to do something special to pull it all together?

No, it's, it is readily available, bill, but let's, um, let's introduce what, you know, healthcare usually introduces to these types of things. Complexity. What time of day is that? Is that midnight? Is it after midnight? Is it 6:00 AM is it 8:00 PM? Um, and this is kind of the damage that we kind of do or do ourselves, right?

So, um, so yes, all those data elements are, you know, available and, uh, it's just a matter of, you know. Everybody get together, you know, nationally and, you know, decide, uh, this is gonna be, you know, 12 o'clock midnight kind of a thing, or is it six? So, um, I think kinds of things. We kind of, you know, spin on ourselves, but from a, from a data perspective, you know, we should be doing this.

Well, Charles, isn't it? We should be doing this anyhow, bill, because we really need to know from our own perspective, you know, when we're, you know, projecting out, you know, PPE and, and so forth, you know, what, um, you know, capacity, all of that. This should be, you know, part of our DNA right now. If it isn't, I'd be, you know, super, super surprised.

Well, I, that's why we hired you as the CTO, so we, we can get this to be part of our DNA, but let me let, so let me ask you this, that, that question is not an innocuous one because we, we do spin on some things, definitions of things. Um, so, uh, does it matter what time we, we take this inventory? As long as it's consistent on a daily basis.

No, I don't think so. But, um, but again, you know, I just brought that point up to show how, you know, silly we can be at, at times. Um, but no. So are you concerned at all, I, I mean this is not ACTO question, but are you concerned at all that, you know, the CDC is readily available to researchers in those, that database is, is open and the HHS database may not be open.

Is that a concern for you at all? Yeah, that's a, that's a concern. It is been a concern for, for most, um, you know, Amy had put out, you know, uh, you know, a, a letter if you will, the last couple of days. So, um, it's a concern for many. Um, it's not, it's a, so here's a concern, bill. What is HHS gonna do with it differently than the CDC did?

Is it, you know, of a benefit? Will the CDC get access to that data? I have no idea. Um, it's a interesting, what do they do wrong? You know, those types of questions, um, that I really don't have the, the answer to. Um, but, you know, from a purposes of reporting, you know, does it really matter where it goes? It all depends on what the use is gonna be with that data.

So for our purposes, redirecting it is, is, is really a pretty, pretty basic thing. Yeah, technically for us, no deal, no, you know, no issue and whatnot. But for the, you know, the country healthcare at large, um, you know, what is the difference between the CDC not having access to that? Um, and we don't know that answer versus, you know, health and human services.

Yeah. Um, alright, well let's, let's move on to some other, some other topics. We've got a tight schedule and, uh, . Alright, so, uh, we, we, we just we're coming through the pandemic. We had a significant, uh, cut in our revenue. I'm being asked to do more with less as ACIO. I'm glad we're playing this game of, uh, I I, I, I don't get to ask these questions of the CIOs I have on, but let, let's assume our health system, uh, I'm looking at a, you know, 10 to 15% cut, whereas I normally get a

Three to 5% increase every year. Um, I don't have a lot of variable costs. So, you know, outside of cutting people, which is one of the things that always sort of comes up when you're looking at a cut of the size, uh, what are some other things we can do, um, to do more with less, you know, data center operations, outsourcing overseas?

Are there other creative things I should be thinking about? . Sure. So I think the first campaign is a smile and dial campaign to your vendors. Um, you know, what can you do? Hey, look it, we've been in this for a long time, I'm gonna need some concessions and you may or may not get it. You know, going forward, even at the data center level level, I.

I'm gonna need to for the next six months, you know, decrease, you know, my spend there by X and you can tack it on at the end of that contract year, which may be two or three years out. So doing things like that, um, is, is, is essential, you know. Bill, how many, um, how many systems do you have running in your organization right now that you have on and lights on?

Only where you're paying maintenance on the, um, software. You're paying, um, you're paying for the electricity, you're paying for the, you know, the footprint. What are the, what systems could you, um, you know, archive and turn off with giving them access and so forth that they can then, um, you know, realize, you know, that benefit that could be several hundred thousand dollars, you know, annually, um, from a, you know, a personnel perspective.

Um, you know, what could you, you know, potentially, you know, outsource how much, um. How much of the work that your team is doing that, you know, could be, you know, potentially, you know, um, you know, done, you know, offshore. Um, and you know, when you talk about offshore, uh, yes, you have skilled work. Yes, you have, um, a lower cost, but is the work that they're doing and is your organization, uh, um, at a point where, you know.

Somebody, you know, external can, you know, access your data if that's the kind of, you know, development work that they're going to be doing. I, I want to come back to, um, offshore outsourcing because you, you've done a fair amount of that and healthcare that has a, uh, interesting, uh, there's, there's some interesting challenges with that.

But first I wanna come back to something you said earlier, which is, uh, shutting off those systems that are just sitting there with lights on . And, uh, you know that this is one of the things that you and I actually did work on. Uh, you were with a vendor and, and I, uh, was ACIO. And when we were moving to the cloud, we inventoried all of our systems and found out that a, a good 10% of them were not being used by anyone.

I mean, no one in the organization was using them anymore. And I think, you know, people think well, application rationalization, that takes a long time and you gotta think through and you gotta do all these things. But at the end of the day, there is a, there's low hanging fruit at almost every organization of systems that are just sitting there doing nothing.

Has, has that been your experience? . Yeah, a absolutely. And you know, you talk about, and, and many times, uh, if, if the, you know, from the vendor situation, it hasn't been centralized, you could have, um, various departments using, uh, various applications and believe it or not, paying. You know, various rates for those, um, you know, departmental applications that actually still, um, that still exists.

So, um, so both? Yeah, both Bill, it's, you know, it's very much like, you know, back in the day when, um, you know, orthopedic surgeons would be dealing with a vendor and each surgeon would be charged a different price for the same, um. You know, for the same, um, implant, if you will. Um, so yeah, there's, there's a bunch we can do from, from just the software that we're using, whether it be, you know, renegotiating contracts, um, you know, finding out, you know, if departments are, you know, doing things on their own.

And then yes, you know, what's out there that's, that, that isn't being used, that we can, you know, turn off and just. Be done with it. Well, I'm, I'm a huge proponent in planning ahead, so I, I hate when you get asked, Hey, you need to cut 15% this year if you haven't been planning for it. And so almost every year I go to my team and say, Hey, can we, can we figure out how we're gonna cut 5% next year and give them a full 12 months to think about those things?

Um, so in that vein, talk to me about data center operations. 'cause one of the things that's always shocked me when I talk to you, . Is, uh, how re-architecting a platform gives you the ability to really cut down on the number of people that that needs to, uh, support a significantly large set of, uh, servers and, and storage and, and equipment.

So, you know, what are some things we can do in, in data center ops? Sure. So it's a, it's a combination of, um, of, you know, basically, you know, hardware, um, as well as a combination of a different skillset, if you will, as well as, um, a monitoring, you know, monitoring everything. Um, and I'll kind of get into that in, in a bit.

So, uh. Uh, you know, we're gonna kind of, we unfortunately gotta get into the tech bill. There's no way I'm gonna be able to, um, no, I won't. To get away from that. I welcome it. Let's, let's do it. Yeah. So, um, you know, bringing on, uh, what's called a, a hyper-converged infrastructure, and that is, you know, the ability to actually, from a storage perspective and from a compute perspective, actually use that which is needed.

Um, and, um, from a source perspective in particular to be able to scale out as needed with . Uh, low cost commodity, um, commodity, um, equipment. Um, even the introduction of, you know, low cost, you know, um, SSDs and so forth. So you're really distributing from a storage perspective and you're using what you need no more than that, but you're architected as such that, um, you kind of keep yourself, um, future proof and that you can expand upon that.

And even the introduction on the, on the compute side to be able to scale, you know, on CPUs on, um. On ram. And if you're now into a, a data science rich environment, uh, GPU introduction, um, that's at the base bare metal level. And if you think of, uh, hyperconverged, uh, on top of that, we're now. And I'm not gonna mention vendor names, but you know, now we have the ability to, in the same environment, uh, bare metal servers, um, virtual machines, which everybody's familiar with, as we move more into a containerized environment and our client and our vendors are moving that way.

Uh, and then even far further advance. For, um, you know, a serverless environment. So this sets us up for two, two potentials. Uh, one is I talked about, you know, future proofing as emerging technologies come in, this is the environment for them and let's go, you know, if you want to go into it now, we can. Uh, you mentioned earlier this sets us up for a hybrid, uh, for potential of a.

And if you want to go there, we'll go there. But this is really setting you up for that, uh, eventuality. So everything is is software based. It's software defined. We are, uh, we can actually write code. We can actually have it not be written code that. The, the, the amount of volume or the, the load on the server will kick in additional processes and those kind of things if the software's written to take advantage of those kind of things.

Yeah, that's correct. So, um, workloads in a containerized environment as they increase, you know, multiple containers are, are, are spun up. You know the exact, you're exactly right. It's, it goes, it gets away from how we used to do things where, okay, we reach capacity, now we gotta throw that out and get a bigger box, right?

And then we reach capacity. Now we gotta get a bigger box. It keeps it keep, it prevents that, you know, every three years from having to just rip and replace. Yeah. It's, uh, what, what do you say to the, you know, I, I, I'm gonna get a lot of pushback from our technical team. I just hired you. That technical team's gonna say, look, we have too much legacy

And if you're running legacy, you gotta run it on old architecture. Is that the case? No, it's not the case. Um, you know, and it's very interesting that you said that there is a lot of remedies within that hyper-converged infrastructure where we can actually bring that, bring that into, into that environment.

Is it a, is it a cakewalk? Absolutely not. But it's, you know, it's something that can be done. It's, and it's essential. Alright, I'm gonna come back to cloud. Let's, let's talk about, let's talk a little bit about overseas. Sure. And, uh, working with overseas resources. So, um, you know, you have some experience there.

I have some experience there. Let's start with, um, you know, what are some of the considerations when health systems outsource overseas? I. Just flat out that question, what are some considerations we need to talk about? Sure. So you have to have, um, you know, some representation in the states. Um, you have to, um, you know, really understand, you know, what that workforce looks like.

You know, what were the universities that workforce came out of? Um. Which is, which is Es essential. Um, and let's, you know, you can outsource to Ukraine, you can outsource to, you know, Spain, Dominican Republic. Uh, my potent, my outsourcing, you know, uh, you know, country of choice as you know, is, is India and it's not.

As most people think because of the, uh, cost perspective, and there absolutely is cost per um, savings. Uh, it's the fact that it is very, very difficult to get into those top-notch schools. Um, it takes, it takes, uh, you know, pretty much, uh, you know, from a very young age, you know, to get into those. That is your goal.

You've gotten into that. Those schools. And as a result, um, you're a, you're a hot commodity, and those are the folks that I go after. Um, I know those universities, I recruit from those universities, and as a result, I have the, the best of the, of the best from a architectural perspective all the way down to, you know, you know, hands-on coding.

So it's, it. So it sounds like you're pretty hands-on, I mean, you are actually recruiting these people. Uh, do you spend time in India as well? Well, I used to up until, you know, what's going on now, um, where I'd go, you know, at least, um, at least three times a year, if not, if not four. Uh, but, you know, that is, that is a group that's, you know, that those teams, and again, bill, I'll go back.

I've, I've been, I've had a team since 2007, so, um, this has been, you know, 13 years for me, um, with, you know, excellent, you know, results and success, you know. You've got, you know, we're, we're on Zoom right now, so, you know, you've got a whole bunch of technology that, uh, assists in that. Um, from a monitoring perspective, cost savings, perspective 24 7 monitoring.

Um, I have, you know, done in India development, I. Absolutely, depending on the organization, there may be some restrictions on what they're able to, you know, be involved with as far as, you know, data access and whatnot. But that can be mitigated as well with, um, de-identified obs, obfuscated data sets and so forth.

Yeah, it's, uh, you know, it's interesting 'cause a lot of CIOs, like I was, I was, uh, challenged with, uh, follow the Sun's support e essentially seven by 24 coverage. 'cause the hospital never closes. And so you could either try to do that in the States, which is extremely hard, or you could literally get seven by 24 with just the states and India.

For the most part, when we're, when we're going, it's not somebody looking at, um, you know, Zabbix or Grafana or some of these monitoring, uh, software. It's actually people in there, you know, doing maintenance as well. So if you think about what your, your networking team, what your, um. Your engineering team are doing, you know, you know, during the, you know, 40 hours that they're working and now you can extend that to, you know, additional 40 in those off hours.

And your, your systems are, are pretty much, um, maintained. And kind of going back to that, you know, bringing in that, you know, hyperconvergence so forth, um, and you know, software defined networks and the rest of it, yes, it's a higher skillset, but um, it takes less people. To maintain that as long as they're at that skillset level.

Yeah. I wanna be clear, we're not recommending that organizations do this, although we have both done it, which I think speaks to Oh yeah. We're just talking about it. Yeah, I get it. Yeah. Um, 21st Century Cures, well, uh, let's, you know what, let's go, let's go to cloud, then we'll come back to 21st Century Cures, uh, cloud and DevOps.

Um, you know, let's just start with the, the flat out question. What is a cloud strategy? . Yeah. What is a cloud strategy? . Um, so , I'll give you my definition of it. Um, it's not a choice. And what I, what I mean by that is you have your own on-prem Cloud, you could have a private cloud located somewhere else, you know, in a coated environment.

You've got Google, you've got Azure, um, you've got AWS. Whole ecosystem is a cloud. Does that make sense to you? You're not making a choice. You're, you're in a cloud environment now, whether you know it or not. Um, and because of, you know, how we are doing things now from an API perspective, um, if I wanna run a workload in, in Google BigQuery, then I will run a, a, a workload in Google BigQuery.

If from a storage perspective, I wanna store all my data on-prem, great. If there's some tools within AWS that I want to, um, to bring on. You know, in work in my environment, I can do that as well. So I can move workloads around as I need. Is it, is it all or none? No, it absolutely isn't. And I think this is something that we'll see, um, you know, evolve as time evolves where I'm not making a decision to shut down my data center and move to, let's say, AWS I'm gonna do everything in AWS no, there's interconnectivity between all those cloud vendors.

Um, and I've used them and they're fast, so it's. It's a, we are in a cloud environment, you know, and are we gonna best utilize it? And from ACIO perspective, what I would say a cloud strategy is, it is, uh, you getting the most agility and efficiency for your organization, providing the, the most capabilities to your organization, right?

So, um, you know, the reason we talk about cloud at all is because cloud gives you the agility, the efficiency, and the capabilities, right? We can spin things up. Uh, overnight that we used to have to plan six months for and order servers and put 'em in your data center. Um, and so the cloud, the cloud as a, as a model for how to build out your, your infrastructure in order to, to serve the, uh, the capabilities and the, the applications, uh, and even smaller the services that you're going to be

Uh, providing, uh, it, it is just, it, it, it is now, uh, table stakes. And so when I talk about a cloud strategy, I'm talking about . You know, how are you thinking about public, private, uh, hybrid cloud? How are you thinking about, um, you know, uh, cloud, uh, apps and how do they integrate? How are you doing an I identity and and access management as the perimeter around your cloud strategy?

It's, it's, you have to be able to answer those questions as ACIO and ACTO. Mm-Hmm, for your organization. 'cause if you don't answer 'em. then, then it, it's just a, uh, you know, it is just another one of those hype words that gets used over and over. Yeah. We're in the cloud, we use Workday, and you're like, uh, uh, okay.

That, that is a, a cloud application, but what is your cloud strategy? Anyway, you and I have. Gone round round. Yeah. And if you, if you think about it, bill, from an RD perspective, you're absolutely right. I need to, um, you know, do this. And I will say, from a data science perspective and from a a research perspective, I can spin up an environment, do the work that I need to do, and then collapse it, and then I'm, you know, on my way and I can deploy that model within my environment if I have some heavy, you know, uh, heavy workload that's, you know, gonna use heavy, you know, GPU, just to, you know, do the, you know.

You know, build out the model, then, you know, I can do that in another environment and then deploy in my environment. Well, it's, uh, you know, so you and I have actually talked about this and I've consulted with some organizations on this that are, are saying, Hey, you know, healthcare in an AWS cloud or in an Azure cloud, how do we ensure hipaa, how do we ensure the, uh, security levels and the, uh, you know, the, the things that were normally

Um, identified as required for, for hipaa. Like we, some people think that HIPAA requires us to, to point to a server and say the data is on that server, but in a cloud environment, we don't do that really much anymore. So how do we, how do we ensure that, uh, a level of, uh, compliance to those, uh, security frameworks?

Sure. So if we're going outside of our, um, if our we're going outside of our private cloud, then we, you know, we have to, you know, assure that, um, hitrust, you know, SOC two, there's a couple ISOs thrown in there, not just, you know, uh, hipaa. So, you know, if you're, whether, you know, it doesn't matter what the environment is, um, you have to be able to not only, you know, build that out.

Or have the insurances and get that, you know, get those certs and whatnot, those compliances, and then you have to be able to demonstrate it. And, you know, ongoing. Because, because it's, it, again, it is, it is healthcare data. Right. And you know, one of the things you put me on too is I used to, I used to get all worked up and I'm gonna have to do all those things, but there are companies out there that build wrappers just for healthcare.

Oh. To, uh, make a work. All right, let's hit 21st Century Cures. That is right around the corner. We have a data blocking. Uh, challenge that we have to, uh, overcome. What are some of the ways that we can make sure that we're ready to share the entire patient record digitally with the patient? Well, you would have to ask me that one, didn't you?

Is it, is this a hard one to answer? This is, this is, well, you know, you know, think about it, bill. This is what we've been trying to do since, you know, from, you know, from day one. Um, you know, we have all kinds of standards and you know, that really is the issue. We have all kinds of standards, right? Um. You know, we have some definitions.

We've gotta, you know, we've gotta adhere to 'em. You know, we have, we have some successes with, you know, health information, information exchanges. You know, some states have done very well, you know, others have done, you know, very poorly. Um, you know, it's out there, we've gotta do it. Um, you know, how much should we rely on our, um.

EHR vendors. You know, I, I don't know, but, um, and I'm probably giving you some really crappy answers and, you know, I, I don't mean to, but it does have to be more of a, an organized, you know, effort, if you will, and not a organization by organization trying to, you know, kind of figure this out, right? So a lot of us are gonna rely on our EHR, uh, provider to, to, to meet this needs, but at, at the end of the day.

Um, here's, here's, I think what we're required to do is if somebody requests access to their patient, re uh, record digitally, we have to provide it. Now, typically what that, what that's gonna look like is, um, somebody's gonna go out and write an app. They're gonna sign up people, and those people are gonna make requests through that app to our health system for their record.

So that they can provide their service to that, to that patient. And we're gonna see probably a proliferation of these digital health type, uh, type, uh, companies, uh, come, come to the fore and they're gonna hire clinicians who are gonna help us to figure out care plans. Or you fill, fill in the blank. I'm not really sure how that's gonna happen.

I could even see the insurance companies, uh Yep. Making these requests as well. Um. . So I, we have a lot of mechanisms to share this, right? I mean, all I have to do is put this through a standard fire server and, and put it out there. But not all the, the data elements are really built out in fire yet, are they?

No they're not. And you know, are all of the ontologies properly applied? You know, um, and is that, you know, is that something that we need to, you know, be concerned with? And, you know, the, the accuracy, the completeness, you know, those are, you know, all questions that, you know, we've gotta answer and we don't really have, you know, all that much time to do it.

You know, you know, right now somebody comes and asks us for. You know, the record, we're able to, you know, we're able to accommodate that. Um, but, you know, from a longitudinal perspective, and, you know, thinking of other entities that are involved here, you know, we've got, we've got a considerable amount of work to do.

Um, if I, you know, if I'm a, if I. You know, go to several different organizations, you know, that, you know, compounds. How do I get a, how do I personally get a longitudinal record, you know, through, you know, having visited several, you know, several different healthcare organizations. So, uh, so you, you're now counseling me as the CIO.

Are you saying I should get behind efforts that should ask for a delay? Are you saying that I need to stand up a team to that really delves into this, uh, you know, which, which direction should I be going, or both? Yeah, I'm, you know, I'm saying that Bill, from your, um, from your HR perspective, you better have your ear to the, you know, what the vendor is doing and, um, you know, really pay close attention and, you know, what's the heads up from, you know, from your vendor of what you're gonna have to do versus, you know, what they're gonna be able to do to, um, you know, help you meet those, you know, requirements.

And, you know, hopefully it isn't a, you know, complete. You know, download of, you know, all the data elements and then you having, having the, the onus of, you know, processing that and then put in, you know, at the end product is the product that, you know, gets distributed because that's a considerable amount of work and hopefully they're able to, you know, do that within, within that environment.

Now, now Charles, you have been with companies as CTO of companies that have consumed whole data sets. Uh, on, on the patient. I mean, how, how ugly is that? How hard is that? If you and I were gonna go out and start a new company and we were gonna write a patient app and, and they said, look, we're just gonna give you a raw dump of the file.

Could we make sense of it? Yeah, we can make sense of, from a, from a, you know, an EHR dump if you will, um, you know, taking that and running it through a, you know, pipeline. Some of the obstacles that we're gonna run into are, you know, what I call ontological right sizing. So, you know, assurance that, you know, the various ontologies are correctly applied, um, assurance that, um, that is actually the patient that.

It's stated. So the whole EMPI needs to be part of that, you know, processing, if you will. And then from a, um, from an output, you know, the, the assurance that the output is actually, you know, formatted in the form that is expected for ingestion into the next, um, you know, the next application or, you know, is suitable for, you know, distribution at that point.

So are you coaching me to ask for a delay? Should I get on that bandwagon of people who are saying, look, we need more time. I, I'm, I'm not one for, you know, asking for more time. I'm one for, you know, getting to work and, you know, start working on, you know, what's gonna be required. And that's just, you know, beating up everybody and their brother to get as much information, you know, as you can to best position yourself.

Yeah. And that's the problem with that crowd, to be honest with you. And if somebody's in that crowd, . Uh, on the sh uh, that's listening to the show, I apologize. But, you know, the problem with that crowd is it, it's hard to distinguish between the people who are saying, look, we've looked at this, we need a little bit more time, but we're gonna make progress and we're gonna get there.

And the people who say we need more time, and then when you get to the end of that block of time, they're saying, Hey, we need more time. And they're gonna keep doing that for the next decade. Right? So there's those clumps of people in that, and that's, that's why I. I, I like you struggle to get in that crowd of saying, Hey, give me some more time.

I wanna make as much progress as we possibly can, uh, given the time that we do have, see what we can actually do to be, uh, compliant. That's sort of how I think about it. Yeah, you've got the, you know, that whole, you know, thing that cloud hanging over all of this, you know, that competitive advantage, you know, cloud, you know, if, if data's easily exchangeable and and so forth, does, you know, does from an organizational perspective, does that make me less competitive?

That the, you know, the folks down the street, you know, may, you know, have some insights into, you know, how I handle my operations. You know, clinically, financially and operational. And then if you look at it from a national perspective, you know what organizations are doing, you know, better than than others.

So, um, I think there's a lot of worry there. And even on the vendor side, are, are you familiar with U-S-C-D-I at this point? I. No, I'm not. Okay. All right. We'll talk about that later. Um, uh, but I think that provi provides some of the framework that we need to, uh, make sense of the data. Uh, all right. So you're, you're my CTO.

Um, give me an idea of how you think of build versus buy. Uh, you know, are you, uh, do you favor one versus the other? It, it all depends on the, the skillset that you have incumbent and understanding. Um, so let's say, um, let's say I want to build out a, I'm gonna build out a, you know, a big data platform. You know, why are you gonna build out that big data platform?

Understanding the, the why of it, um, really understanding what you want to do, and you know, why. Do you need to do it versus, um, you know, you know, working with a vendor to, to do that. And I'll tell you where it gets really complicated, bill, and it, it has to do with data science as well as the skill level that it takes to build these systems out and build 'em out properly.

Um, many, many times, bill, if you don't know the skill skillset that's required, you're gonna make some mistakes in the hiring, even if you use somebody. To, to bring people in. You're still gonna make those mistakes. Um, and those mistakes can be costly in. From a, from a time perspective. So if I bring in a, an architect, I bring in an engineer, I bring in a team that's going to, um, not only architect out, but also, you know, do the, the, the purchasing, the, the rack and stack and then the build out.

And somewhere during that process, I realize that I probably brought the wrong people in. Now I've architected a solution that probably isn't the best. And now I'm in a, in a bit of a bind and I see it the same with bringing in, you know, data scientists as well, uh, where organizations really don't know.

Um, you know, what type of individual, what they're actually gonna be doing. It just sounds really good to let's bring one in and they bring one in and they find out, you know, later down the road that they really brought in, you know, the wrong individuals. So I think, um, from the perspective of, of personnel, um, I think there's, you know, some considerations if you have the proper team, um, I think you, you, you're, you're, you're in a good spot.

If you don't, you know, probably not. And, and the most important part, bill. That, that I always talk about is we learned from Covid that the need for data and what we have to do with data is increasing exponentially. And the technology needs to follow that same type of exponential, um, growth. And it's a time perspective.

Um, so if I'm gonna build something out, I'm gonna build a team six months. Eight months. Uh, a couple team members weren't quite what I thought. Now I'm into eight to nine months. I still don't have anything. I got the architecture now. I've got all the equipment. I've done the racking and stacking. We're at the end of year one.

Now I'm starting to, you know, build it, build all this out, and now I'm getting into the six month. I still don't have any data. So we're getting into 18 months and I'm really not getting a whole lot of use. And you know, I'm probably gonna get realized, you know, use in 18 to 24 months. And oh my gosh, guess what?

Um, we didn't do so well under our revenue targets and we just became an m and a target, and now we've been acquired. And, um, what do you know? That organization already had a data platform and you know, now we're in trouble. Um, so yeah, so the, the build versus buy, if you can do it, if you can do it quick and you've got the right people by, by all means, if you need to get going, um, you know, I would really consider the.

The, the buy this is, uh, you know, it's, it's interesting you and I think the same, uh, around these things because, uh, uh, but we also, we also understand the value of teams. So we build out the teams. And so when I go from organization to organization, uh, I still have teams that I can call on that can do different things like develop applications, develop websites.

Um, you and your team can, can stand up a, a big data, data, data science team. Uh, almost overnight. And you, you, you keep those and you build those out, um, so that, that you have that value that you, you know, that whatever you do next, you can stand that stuff Very, stand it up very quickly. Yeah. You just go onto the next challenge, right?

Yep. and, and you still have the tool set with you. Todd, last thing, talk to me about digital front door. Build your own utilize component of the EHR provider utilize best of digital kind of approach. How, how are you thinking about digital front door? Bill, you're gonna, um, I want to, I want to hear your definition of digital front door first.

Digital front door is how we digitally engage with our, uh, patient community actually beyond the patient community. How we . Uh, how we interact with our community to deliver health, right? So it's everything from easing the friction, uh, to interacting with our health systems. So, uh, you know, digital appointments, digital scheduling, digital, um, uh, visits, um, to, um, uh, you know, to coalescing the information around all the

Uh, devices that we put in the home. So the, you know, the, the patient-Centered Medical Home, which has now evolved into really a, a digital care platform that's delivered out of the home. But we coalesce all that information into that. Uh, it becomes the, the gateway, if you will, for sure. Uh, for more touch points.

We are, uh, engaged with that patient with our community. On an ongoing basis to be their, um, their resource for health at all times. And, you know, bill, as your CTOI needed that definition first, right? Yeah. Okay. Um, so, um, that's a, that's a big one. Um, first of all, I say let's go look at organizations that outside of healthcare that have done this really well.

So who's done this type of thing really well, um, especially in, in the, the world of Covid. I. Um, who needed people in their doors, you know, to keep the revenue up and, you know, keep, you know, going, you know, you know, you talk about Uberization is, is a word. Um, you know, what can we learn and we should learn from, you know, those in, in retail logistics, um, and how they've engaged and kept people engaged from a front door perspective.

So, um, it's great to have a bot on your website. But what's the bot actually doing? Is the bot bringing somebody to a destination? Um, so if I log in and I'm looking to make an appointment, can that bot bring me through, um, all the way to an end point? And did you buy all the, by the way, have self-scheduling?

Did you have all those components in place? So what I'm getting at is you really have to think this thing from end to end and not miss any of those component pieces. Um. It's, it's really critical that, um, and we all have call centers now. Um, not sure why healthcare's in the call center business, but we are in the call center business since we made that decision.

Um, you know, let's take care of it. Uh, we have, um, you know, bots that can help us through that. For call deflection. We have, um, uh. Intelligent agents that can handle a lot of those calls. Are we using 'em in healthcare? Absolutely not. We also have, um, uh, artificial intelligence that can monitor those calls and score those calls so that we again, bring the level of, um, you know, the, the level, level of, you know, customer care, you know, to, to its highest.

We're not utilizing any of that stuff. So first of all, I say when they land on our site, let's get 'em to where they need, um, secondary to that. From a, you know, device. In the home perspective, we did pretty damn good over the last several months, um, with doing telemedicine and all kinds of weird ass, you know, you know, crazy kinds of ways, you know, utilizing Zoom, utilizing, you know, all of these different, you know, tech.

We responded pretty good with that. So, um, you know, expanding that, professionalizing that a little bit. A little bit more, more. And then from monitoring and so forth from the home, again, it has to be purposeful. You know, I as a clinician do not wanna log into my EMR and see, you know, 1500, um, blood sugars from, you know, my 1500 diabetic patients.

You know, that needs to be meaningful. My team needs to be known, needs to know that, you know, one of my patients, uh, is, you know, uh. Is is a little wonky in their, their blood sugar and I need to, you know, take care of that. Or from a blood pressure perspective, I don't wanna see all that stuff, but I need to be aware.

So we, we need to make it really smart and we need to make it, um, simple for the, the patient population. Um, I. Plugging stuff in and getting connectivity and all that kind of stuff, you know, really has to be an excellent, excellent experience. Otherwise, you know, we've got a problem. And another I, the last thing I'm gonna say about this, this call center business is.

You know, when you get somebody on the line, you better, um, know where, who they are, where they are, where in proximity they need to be, um, you know, for whatever the prider. And you better get 'em to that location and not be sending them all over the place, you know, over, you know, several miles and whatnot.

And one of the things that I've seen that just is extremely, um. Frustrating is I'll do a telemedicine visit, but when all this is over, I'm gonna be followed up. Oh, I'm not gonna see that person because they're, you know, 30 miles away from me. Why didn't you connect me with somebody that I can, you know, follow up with after this is all over?

So we gotta think about it from like a, you know, really from a marketing retail. Look what everybody else is doing and bring that into, into healthcare. And from a call center perspective, there is a lot of work we need to do. , you know, it says you just gave away all of our secrets. Uh, when you and I get together, we'd like to, uh, you know, the one question we bat around is where do you think the, the best entrepreneurial ideas?

And when we, whenever we focus on healthcare, I think people will be shocked, some of the areas we come up with. 'cause you know, we have experience, fairly deep experience in a lot of different areas, but you and I agree. That the one area that if you and I ever got together, we could revolutionize in healthcare.

It, it is the call center across the board. It doesn't matter what they're doing, we can change it completely. And, and the other one is, why the heck are we spending so much time and energy on, on recovery, on bill collection? There's, there's far better ways to take care of that. Why are we doing that? Yeah.

Yeah. And, but even if we were doing it, we're, we're not using the right analytics. We're not using the right tools. We're not using the right, yeah. Who's likely to pay, you know, you know, data science project on, you know, who's likely to pay data science project on, you know, what's the best, you know, methodology for delivering care.

I mean, there's a lot of stuff you can't give away. All of our secrets here. That's . Charles, thanks. I really appreciate you, uh, coming on the show. I think there's a . Fair amount of soundbites and things for, uh, for people to take away, and I'm looking forward already looking forward to our next conversation.

Cool. I, you know, I really appreciate being here and um, bill, welcome to Florida . Thanks. Thanks. It's rained all, it's rained all day today, so tha thanks. Thanks for the welcome. That's all for this week. Special thanks to our sponsors, VMware Starbridge Advisors, . Galen Healthcare Health lyrics, Sirius Healthcare and Pro Talent Advisors for choosing to invest in developing the next generation of health leaders.

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