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Sometimes it is good to look at a problem through another set of eyes. Microsoft Veteran B.J. Moore just stepped in as CIO of Providence St. Joseph Health one of the largest not for profit health systems in the country. We capture his first impressions and perspective on the potential of technology in healthcare. 

Transcript

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 Welcome to Influence a production of this week in health it where we discuss the influence of technology on health with people who are making it happen. My name is Bill Russell. We're covering healthcare, c I o. And creator of this week in Health it a set of podcasts and videos dedicated to training the next generation of health IT leaders.

This podcast is brought to you by Health Lyrics, helping you to build agile, efficient, and effective health it. Let's talk visit health lyrics.com to schedule your free consultation today. BJ Moore recently hired ccio for Providence, St. Joseph Health joins us. Good morning, bj. Morning Bill. Thank you for having me.

Wow. That is a phenomenal jacket, . Um, and you wore it, you wore it at the Chime event And we did not run into each other. I can't, can't believe we didn't run. We didn't. I got a lot of compliments on it, so figured if I didn't know anything at the conference, I might as well be dressed in a nice, uh, sport. So good luck.

Yeah. So you, so you're, you're new in the role, you're just a couple weeks in at this point. Yep. Three weeks in. Three weeks in. So, Providence St. Joseph Health for, for those people who don't know, is, uh, fairly large, 51 hospitals, 829 clinics, uh, 119,000 caregivers, 38,000 nurses, 25,000 physicians, 2.1 million.

Covered lives in two health plans, 1.6 billion in community benefit. And, uh, Yeah, so it's, it's, you know, by any measure that's pretty big. You've been there for about three weeks, so I expect you have it all figured out. You know? Exactly. Got the lay of the land, you know exactly what you're gonna be doing.

Absolutely, totally. Have it nailed up for three weeks. An expert for sure. Um, yeah, it's obviously joking, obviously joking. Yeah, it's, yeah, it's, it's a big role and, and, uh, I, I don't know what the revenue is now, but it does cover, um, you know, Texas, California, uh, New Mexico, all the way up the, all the way up the coast, all the way even into Alaska.

That's right. It's so, it's a, it's a pretty big role. Yeah. We're over 23 billion at this point in time. I assume I can share that. If not, that'll be one of my. Early rookie mistakes you're learning? Well, it's, it's public information and, uh, you know, I was, I was at the JP Morgan conference, I heard from, uh, Venkat and he shared the numbers and, uh, and so I, I think they're out there.

So give us an idea of your background and how you, what's, what's the road? How you ended up at, uh, Providence St. Joe's. So did 26 years at Microsoft. Uh, various roles as in finance operations. So I was a marketing it, uh, last two divisions I was in, it was Windows and then the cloud and, um, the AI group, the, um, so 26 years there.

After 26 years, it was like, you know, am I gonna be there for 30 years? Was I ready for a change? And, and the question was absolutely yes. Uh, van Kat, you may know, uh, we worked together at Microsoft. And so he reached out to me and, and the timing was perfect. So, Uh, great run at Microsoft. Had a great time there.

Couldn't say enough great things about that organization. But excited to be in a new industry, excited to be in a new role, excited to, to, uh, be part of this digital transformation. Yeah, I, I find the, um, it, it's interesting when they pull you in for the interview and they go for the hard sell and the hard sell is essentially, you know, do you wanna sell software the rest of your life or do you wanna do something that's gonna make an impact on the community and the people around you?

That really resonated with them of, hey, you know what, for this period of time I'd really like to do something. Uh, you know, I know that's gonna impact the local community. Not that what Microsoft's not doing, doing doesn't impact, but just in a different way. Yeah, certainly the mission's super compelling and the melding of technology and that mission, it's just perfect for me.

Experience. You've just taken over. Here's what I'd like to do. I'd like to talk about some, you know, the number one question people are gonna ask is you, you know, can a person come in from a technology company, take over a c i o role and uh, really do the things that need to be done? And, and my premise is absolutely there's enough.

Things that are this, that are the same across, you know, the technology landscape and, uh, and Microsoft was clearly far ahead of where we're in healthcare. Right. So you've taken over this large IT shop, um, large in terms of people, systems, number of applications, uh, size of the business. Give us an idea of what, you know, the first 60 days look like for you coming in.

What are you, what are you looking to get your arms around and whatcha looking to accomplish? Yeah, the first 60 days. You know, I do have a strong technology background from Microsoft. So the first 60 days isn't really to immerse myself in the technology. Certainly need to understand what is the unique things about healthcare and the systems we use.

For example, epic. Really the first 60 days is to immerse myself in the business. Um, Not gonna become a, a healthcare expert after, uh, 60 days by any stretch of the imagination. But how do I meet with administrators, healthcare givers? How do I get out in the hospitals, the healthcare system? We all understand how the business works.

Um, what are the unique things about this industry? Um, what are the unique challenges about our particular environment? Um, so I am coming in with a lot of hypotheses on how we should be organized and what technologies we can use, and what that digital transformation looks like. Really the first 60 days is about learning the business, learning about Providence, St.

Joseph Health, connecting with my peers, connecting with, with other leaders in the work. So it's really more of a business, uh, focus for the, the first 60 days, which is a technologist, isn't seem, um, you know, completely natural. But, uh, anything other than immersing myself would be premature. I can't just jump in and start making technology decisions without.

Yep. And you know, the, the, um, the good news is you probably have a hundred thousand some odd healthcare experts around you at that organization to help you. Uh, yeah. And that's kind of when people ask, you know, uh, why did Rod pick, um, you know, our c e o pick, uh, somebody from the tech industry? And that's exactly what I say.

You know, we. Healthcare experts, 119,001, would I make a big difference? Probably not. Hopefully bringing that fresh perspective from the outside. We'll be able to do, you know, a tech that, you know, journey to the cloud. Hopefully I can have an impact greater than just, you know, 119,000 plus . Yeah, and we've, we've had Rod on the show and the, the thing he, he, you, you pick up very clearly is, um, he's not afraid of the future.

He believes that the, that technology will form the foundation for where this industry's gonna go. And it will change it pretty dramatically. We're gonna see new businesses spin up. We're gonna see new ways of doing business within the traditional, uh, businesses. And we're new models for going out. And so I think he's, what he's, when I hear him talk about it, it's, we need people from outside the industry because when you look at healthcare and the experience that people have within healthcare, of their data, not following them, and no easy access to it, and it's, there's a lot of friction within the experience.

Right. And then you look at these other industries where you know, I can now do my grocery shopping while we're recording this video and have it delivered to my house this afternoon. You realize that that's just in terms of priorities, that's just wrong, that we can do our shopping that easy, but our healthcare experience is, is a challenge at this point.

Yeah. There's really a need for consumerization of healthcare, right? You've seen that in other industries. How do you make it very consumer centric and focused and something you can do on.

So, so what are you hearing? So you're out there, you know, your first three weeks. What are you hearing from, um, from the organization in terms of just, just right off the top that they're saying, Hey, you know what we need, we need this, or we need that. I, I always find that, that the first couple of days you're in that role, um, you, you, you get such a, because you don't have a lot of the baggage that goes along with it, you're able to see things through a different lens.

Well, let's just say I'm very popular the first three weeks. Um, almost everybody in the business has wanted to set up a one-on-one with me. So my calendar is, is very, very full gimme a lot of constructive feedback on what we could do better. Um, and it's everything from super tactical. It's simple as, um, how do we onboard new, um, healthcare providers and create access to our tools?

That's, that's too difficult, um, for them to come on board and. Um, it's, uh, epic or use of Epic. You know, I think we're on a good journey of, of standardizing on Epic, but how do we make that experience, um, simpler, more, you know, friendly workflow flows. Uh, so that's been a trend around analytics. How do we unlock the data that we're capturing?

That's been a big theme. I've got a lot of islands of data that are either inaccessible. Are accessible but aren't, aren't connected. And so a lot of feedback on having broader data strategy. Um, people don't articulate it this way, but I certainly take it this way. How do we simplify the operating environment?

I've learned since I came on board, we've got 4,000 applications in this environment. Hopefully there's no human being in this, in this organization that. 4,000. It's just too big a number. And so, uh, it's too complex. Uh, I need to massively simplify that. So at a macro level, those are kind of the things I'm hearing from, you know, my, my internal customers.

Um, it's, but you know, it's really these blocking tackling things I've been hearing something as simple, like I said, is application access's just issue? That shouldn't be a big issue. Yeah, I, I think I, I'm, I'm gonna go down the technology path with you. I mean, the, the great thing about the whole Epic standup and those kinds of things, I mean, you have, you have a great C M I O in, uh, Dr.

Marino. I think he, he really gets the business and he really gets the technology and how the two can come together. And, and you have Aaron there who's doing innovation. You have a lot of people that you can. Really lean on. So it's absolutely, it, it's, it's gonna be. So what I wanna sort of explore with you is you're coming from Microsoft.

Microsoft clearly has adopted the cloud in a big way and is building the cloud for many in a big way. Um, so I think people assume that you're gonna be, uh, you're gonna be sort of have a bent towards, you know, how, how is, how is cloud gonna be applied to this? 4,000 application, uh, complex, uh, environment to, to really to simplify and to automate a lot of the things that were manual before.

So give us an idea of what that, what you, what your premise might be, of what it could look like. I realize it, it'll change as you get deeper into the business, but what's, what's your premise coming in? Well, first some background on what I did at Microsoft. So, um, I was responsible for all of our commercial, um, revenue systems.

So a $70 billion business. And you asked earlier why I decided to leave Microsoft. One of the reasons is I completed our cloud journey. I was happy to say as of last October, I'd moved this $70 billion business to be a hundred percent on the cloud, not a single asset on premise. And so to play it forward to what I expected to at Providence, expect to do the similar thing, um, you know, we've got various data centers.

All 4,000 of these applications are posted. OnPrem, we haven't leveraged any of. So the journey as I see it today, you know, again, three weeks in I need to learn more is, is really getting out of that data center business, getting out of the business, hosting our own applications. And that isn't gonna just be taking these 4,000 applications we have and moving it to the cloud.

First thing that's gonna be to simplify this environment significantly. And so instead of moving 4,000 apps, maybe we move a thousand applications off premises. Into the cloud, um, you, it's gonna be using, you know, um, infrastructure as a service, probably primarily lifting and shifting these applications to the cloud.

Um, on the data front, we talked about that our data strategy is gonna have to include big data and leveraging the. Platform as a service that the cloud offerings, you know, have either Amazon or Microsoft and really have a sound data strategy around that. And then adopting software as a service. And so we've selected, um, Oracle Financials that are in the, in the cloud as our e r p.

And so we'll, in the case of E R P, we'll get away from on.

Software service model with Oracle. So what it looks like to me is, I don't know how long that journey takes, two or three years, but um, you know, we're either all infrastructure service. Platform as a service or a software as service. And this concept of hosting these applications on premises just, just turns away.

Yeah. So my old vision, my team looks at me like I'm crazy , but if I can move a $70 billion and nobody would accuse Microsoft of having a simplified business model, if I could do that already, uh, I feel at least I've got the chops to, to, to do that. So let's talk about why. So you did it for a $60 billion organization, and this is just, you know, the, the purpose of the show is to train the next generation of health IT leaders.

So I would imagine even some of your staff is listening to this going, why do we need to go to the cloud? This works, this works, but cloud models are. Are more agile, more efficient, more whatever. So give us an idea of what happened at that 70 billion organization as a result of your cloud move. Yeah, so for for one, you know, let's just start with the infrastructure itself.

It's hard to attract the kind of talent that an Amazon or Microsoft can get. You know, running those data centers, running those networks environment. We just can't compete in that space. It's just not a core competency. So just from a core competency perspective, it makes sense to move to the cloud, but you hit on the head.

It's really about agility. Uh, I'll use a Microsoft example. When I was at Microsoft, if I wanted to do new project, I'd have to to plan my hard work purchase in six months in advance, because by the time I got the order in the hardware, Um, got all the OSS installed. It was a good six months, right? How to find the space, the power in the data center.

So six months latency. And then once I got on, uh, that hardware, I'd hold onto it for dear life because, um, you know, if I gave it up, I'd have to wait another six months. So this is my dev environments, my test environments, my user acceptance requirements, my production balance, that concept completely went away when we moved to infrastructure as a service.

So if I wanted a new vm, a new virtual machine, 15 minutes after I configured it, the VM was up and running. If I wanted to create a, a development environment and run that for six hours, I could, at the end of that six hours of that dev cycle, I could either blow that environment away and not worry about what I'm gonna do with that hardware.

I could, what we call snoozing, that environment where that environment just gets written to disc. I'm no longer paying compute charges to storage of that environment. That environment can sit there for a week, two weeks, un snooze it five minutes later. I had a dev environment up and running, and I could do my development or task or my environments on these legacy environments.

You know, even if I get down to a thousand applications, we're not gonna be engineering on those environments. And so taking these legacy environments and be able to create the environments, but then just have them. Stored the disc waiting for 3, 6, 12 months before I need to touch 'em again. So it not only gives you agility, it gives you, you know, cost savings, um, security of the environments, right?

That's one less environment for somebody to hack into or, or, you know, exploit. Um, so, you know, infrastructure as a service, there's just so many, um, variables. Now one thing we should address, and Microsoft's not gonna like me saying this, if you just take your existing on premises environment left and shift it to the cloud, you are actually gonna pay more money than if you were on on premises.

So you can't just take your existing practices and the way you manage hardware, move to the cloud. You know, you, you have to adopt new things. Um, so auto scaling, you know, on low load periods, maybe at night you're down to just one or two dms to run a workload during the day. During , maybe that expense, it's like seven, eight.

So it's nice to have the loss 60 and like I said, your Devon test environments, they don't have to be up and running, just pauses you. That's just a simple example. The.

It looks like you're trying to jump in, but I'll let you jump in here. So, no, I, you know, I, I, having, having gone through this a little bit and, uh, you know, I think some of the pushback will be, and, and, and by the way, I agree with you a thousand percent, some of the pushback will be around, hey, 4,000 applications.

Um, You're gonna have things, uh, literally you're gonna have things that require dongles and to client server to, um, all the way up to cloud native applications. You're gonna have a few, uh, startups that have done cloud native applications. That would be great if there was cloud native alternatives to all these applications.

So it will be multiple strategies, won't it? I mean, there's not gonna be like a one strategy fits all to get it all to the cloud, I would imagine. No, it's not one size fit all. And some of the feedback I've got is, hey, some of these applications run on NT four. You know, some of 'em are on a Windows xp.

Some of these companies don't exist anymore. And you know, we can't get rid of them. And you know, as a C I O I'm thinking, gosh, if we've got an app right on nt, like it can't be secure. Like Microsoft no longer support that operating

of, um, You know, the difficulty of moving that to the cloud because maybe it isn't cloud ready. I'm looking at through a different lens in this case to say, boy, this is a huge security risk. What do we do? You get that out of our environment altogether. You know, it's part of that, simplifying that environment.

Hopefully it's one of those 3000 I can get rid of, you know, is there an alternative? Is there some consolidation we can do that's needs to be done? You know, as a C I O I can't just have a, a Windows NT uh, machine sitting in an environment that's just, um, you know, at a high risk.

Yeah, NT and xp, I mean, there's not a lot of XP workstations, but there's an awful lot of XP clinical devices still out there that need to be secured. So let's, let's jump over to the data side. 'cause one of the benefits of cloud is, uh, the whole data and innovation side. So your innovation team does, uh, a lot of really interesting and cool things up at Providence.

Um, I'm still trying to, trying to get the, the team to come on the show, so I'll keep sending the emails, but they, uh, but they, they're hungry for data. They need data. Um, they're, they're getting data from consumers that they wanna move into your environment and they're, um, They're also taking, uh, information from the clinical environment, uh, applying intelligence to that and helping people to live healthier lives across the board.

So what does your strategy look like To, to give them the, the, the data and the tools they need in order to start building out those, those consumer level experiences in building new experiences for the, uh, for the West coast. So my three weeks, I haven't been able to dive into it, so it's more of a, a kind of a cookie cutter answer, but I can give you that, that answer, which is, um, as I mentioned earlier, our data's locked up in the silos of data, uh, SQL based, uh, legacy database, uh, like legacy databases.

So we need to have a data warehousing strategy where we move this data to the cloud and really a big data, data model, right? Soon as you start taking all. Clinical data and the E H R data now consumer data, you know, IoT the medical device data, right? Just kind of use traditional analytic tools aren't work anymore.

And so I know we're gonna have to have a big data strategy, a big data strategy's gotta be cloud-based. Um, and then you can, you know, have. Analytic tools that everybody's used, but now you can start putting these more advanced analytic tools on top of it, like machine, another artificial intelligence type type of coaches.

So I know what the pattern looks like, I know what we need to move towards. I did it at Microsoft, but you know, like I said, my first two months is really learning the business. I haven't really deep dived into what our data infrastructure looks like. Locked up in servers or. Yeah, I remember, yeah. As a c I O I remember when they came in and said, Hey, we have, and they counted the number of SQL databases and it was an exorbitant number, uh, you know, almost, um, almost close to a thousand different, uh, data stores.

And you're sitting there going, you know, um, you know, gimme the characteristics of those. And they broke it down. And it turned out that like, uh, Of that number, 90% had a, uh, something called a patient. So patient data in it. And you realize, my gosh, we capture patient data in almost 4,000 of those systems, maybe 3000 of 'em have a record called patient.

And they're not tied together in any way at this point. Not tied together in any way. And then also over time, people have taken existing data and duplicated it.

Sources of truth that data's been transformed. Um, you know, people were empowered. Empowerment, good benefit then gives you multiple sources of truth. Um, that isn't helpful when you actually try to, to do . So, so what are some other practices, uh, maybe not technologies, but what are some other practices, um, you know, maybe around DevOps, those kind of things that you're, you're thinking, um, you might bring with you or some other practices that you've seen, uh, outside of the industry that you think might be applicable.

In healthcare, um, I can speak to, you know, what I'm seeing here, um, at Providence St. Joseph Health. So we need to move to more modern combined engineering, right? We're still doing, we still have a, a central P M O organization and it's separate dev, kind of configure organization, separate QA organization, you know, dev and tests really need to be combined and a combined dev function.

Need to move away from a P M O type function where I've got generic PMs and move to really dedicated, uh, pm teams that have deep subject matter expertise that really can add a lot of business value to our initiative. And then more advanced, it'll be later in the process of be moving to, to DevOps versus the separate, you know, support teams that really exist outside of engineering.

So certainly need to modernize that workforce from an engineering perspective. And then again, speaking to our environment, it doesn't look like we've got a really strategic outsourcing, uh, function where we've looked at things and said, you know, do we have the core competencies? Are we the experts? Can we have others run that as a service on behalf?

You know, do it at a cheaper or higher, higher effectiveness level. And then, you know, offshore, we don't have any, uh, any teams in, in India. So whether it's 24 by seven support, coverage, um, report writing, uh, application configuration, number of things, we've can levering offshore team four. So I know, hopefully my team doesn't listen to this.

I've been pretty

town halls. I've.

In industry.

Struggling, you know, from a margin perspective. And we haven't, you know, done things from either an engineering practice or from a a staff perspective really optimize . Yeah. And you know, that's one of the reasons we started this show was so, you know, so that health IT organizations would have their staff listen to it.

And we, and I have, have had some, uh, CIOs say, you know, my, I'm having my direct reports listen to it. We're conversations around it just because. We'll talk about R p A, we'll talk about machine learning. We'll, we'll bring in experts around these things and hopefully it staff will recognize that, you know, the job they were doing yesterday is not gonna be the job.

Definitely not gonna be the job they're doing five years from now. Um, but it might not be the same job they're doing a year from now. And we, we just have to get used to the fact that including the c i o role, the job is gonna change every six to 12 what's on, what new technologies are. You know, we talked to, uh, oh, I forget who we talked to.

We, you know, they, they talked about artificial intelligence is now writing code, actually writing code and applications. I'm sitting there going, well, that can't make developers happy, but it's something you want to get out there. So developers realize, Hey, I, I may have to change my skillset. Yeah, and I hope I've got a workforce that's excited about that.

I mean, these, these, you know, we're doing a lot of things that require a lot of manual effort. Um, that to me, wouldn't be very rewarding. And the goal is to retrain folks and, and do these more advanced workloads that I think are mentally more stimulating and. Have a bigger impact, right? In a single eight hour day.

I think you can have a bigger positive impact with these modern tools, modern practices, modern uh, tech AI is a good example of that on the shoot. Yeah, absolutely. Well, you know, uh, thanks for coming on the show. I think, you know, it would be great to check back with you maybe towards, uh, towards the end of this year, see how.

You get your, get your feet under you and you come in and go, Hey, I learned a few things about healthcare . Remember what we talked about this? This has changed a little bit how we thought about it. It'll be, it'll be interesting to see, to just catch up on your journey as it goes forward. It, it will be, and I know I'll probably look back and say, oh, I was a little naive to think that.

But frankly, I think that's the, the value of having to come in as well. Right. Um, I'm not maybe limited based on 30 years. This is the way we've done with healthcare. Hopefully I'm bring a fresh approach, a fresh perspective, you know, if I'm only right 51% of the time, you know, that's still, uh, success and I think we can, uh, transform and new feed quicker with.

Yep. And that's what I appreciate. I appreciate you coming on the show. Um,

You know, why can't we do things this way in healthcare? And I think that's, that's what the new perspective gives you is the ability to say, I think we could do it a different way. And there's probably a lot of things we should be doing a little different. So. Well, thanks for having me on the show, bill. I really appreciate it.

And, uh, Hope to connect in a couple months. Absolutely. So, uh, this shows production of this week in Health It. For more great content, check out the website at www this weekend health it com or the YouTube channel at this week in health it.com/video. Thanks for listening. That's all for now.

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