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March 10, 2020: Healthcare needs a digital foundation. But what exactly does this mean, and how do we implement one? Is it a one-size-fits-all approach or is it necessary to take an organization-specific view to implement this key feature in digital healthcare. In today’s episode, Bill talks with Vik Nagjee of Sirius, Chris Logan of Scripps, and Clark Kegley of VMware, about creating digital foundations. The healthcare industry has always had a ‘sit back and wait’ attitude, the industry has often chosen to create applications and platforms themselves because of the sense that only they could understand the consumer. However, the tide is changing and shifts are happening at the top where healthcare is learning from other industries, like B2C and retail, about how to treat consumers. It is important to create a service-oriented approach and to leverage the strengths of other industries to best serve consumers. Vik walks us through what a digital foundation entails. He sheds light on the five features of a digital foundation which include infrastructure, consistent operations, experience, increased productivity, and intrinsic security. We learn that digital foundations are about agility, and being able to adapt to an ever-changing landscape. This evolution, however, will not happen overnight. Digital healthcare professionals face the dilemma of keeping the lights on while addressing innovation needs that move the needle forward, often within constrained budgets and resistance to change. We also discuss hypothetical use cases, where Chris and Clark present a picture of what solutions might look like, and Vik shares how he would advise a CIO wanting to implement some changes. This is an exciting conversation, and we look forward to seeing the changes continue to unfold. Be sure to tune in today!

Key Points From This Episode:

  • Find out about what’s happening on the frontlines in light of the coronavirus and COVID-19.
  • Digital foundation: What it is, why it’s important, and what’s happening in the space now.
  • The role that the clinician and the CISO play in the digital foundation.
  • Learn about what VMware is doing to cater to the consumerization of healthcare.
  • Insights into what healthcare systems will find doing a gap analysis and how to fill them.
  • Why Clark’s role entails him explaining the ‘what’ to partners about the digital foundations.
  • An overview of the five elements that make up the digital foundation.
  • Find out how foundational applications make it difficult for digital changes to happen quickly.
  • The dichotomy between innovation and continuing to run legacy applications.
  • Two important pieces organizations need to keep in mind when implementing new EMRs.
  • An empirical study: How the ideas of a new digital foundation would work in practice.
  • How application development would happen with VMware’s extensive stack.
  • The actionable steps Vik would give to a CIO who wants to lay a solid digital foundation.
Transcript

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

 Welcome to this week, health events where we amplify great thinking with interviews from the floor. There is no floor this week, but that's not going to stop us. Special thanks to our channel sponsors, Starbridge Advisors, health Ly Scale and Healthcare, VMware Pro Talent advisors for choosing to invest.

In our show, my name is Bill Russell Healthcare, CIO coach, creator of this week in health, IT set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. I was scheduled to host a series of round table discussions at HIMSS 2020. And, uh, these guests were generous enough to find time in their recently completely vacated schedule, uh, to go ahead with this discussion.

And I'm really excited that we're gonna do, do this. Uh, the discussion is on a digital foundation for healthcare, delivering outcomes as a service. Uh, our panel is, uh, former guest of the show, Vic Naji. With, uh, with Sirius, and, uh, and well, I'll just introduce everybody. That's Vic Naji. We have Clark Kegley, assistant VP of IS at Scripps in San Diego.

And, uh, Chris Logan Healthcare strategy from VMware. Uh, good afternoon gentlemen. Uh, welcome to the panel discussion. Good afternoon, bill. Yeah, we, we were just talking at, at, you know, a panel discussion. We're at least able to, to look at each other, so we, we will be testing out these new digital. Uh, a digital round table as we go.

And, uh, you guys have assured me that this is gonna be real easy 'cause you guys have worked together before, so I'm looking forward to this. Alright, so this is a timely discussion. We're gonna talk about a digital foundation for healthcare and, uh, really what a digital foundation for healthcare is about, is about agility, and it's being able to adapt to a changing landscape, which, uh, if nothing else this week and this last month.

We really do have a, uh, changing landscape in healthcare. So, Clark, let's start with you. I mean, what's, what's going on on the front lines right now, uh, in terms of, you know, just how you are, uh, trying to adapt to the, the events as they're starting to unfold? I think California has a state of an emergency in effect right now.

So how are, how are things sort of progressing on the front lines? You know, it, it's a great question, bill, and, and I think it's indicative of the industry challenges that we're all going through. So you think about the Coronavirus and Covid 19 and, and scripts being, uh, activated by, uh, both the county and the state to help along with other healthcare organizations.

You know, it becomes that great exercise that you have every now and again where you can really test your ability to respond to issues.

We have good plans in place to deal with this kind of stuff, but the part that I think is more so interesting around what we're doing is what the industry challenges are presenting for all of us and part of the reason why you had seated the panel today. So, you know, I believe that our industry, um, has long been the type of watch, wait, and see.

Uh, kind of perspective. So other, uh, industries like finance and manufacturing and, and industries outside of healthcare, leveraging technologies from Apple and Google and Microsoft and others. For a very long time, our industry was just kinda watch that and see what happens and we can't do that anymore.

So I think what we're doing in partnership with people like Chris and Vic and other organizations is we're trying very hard. To move to the forefront of being able to make changes. And one big, uh, cultural difference that I would describe, uh, for healthcare organizations is in the past, our industry has always had a perspective of if we don't create it, it can't be right.

Because at the end of what we do as a human. And while that's certainly true, our outcomes are different. We can leverage the experience that other organizations have brought to bear in things like video conferencing, like we're doing right now. Um, and those kinds of technologies that are desperately needed in healthcare.

So our perspective on it is we're gonna partner extensively with others and we're gonna learn from other industries and we're gonna leverage what they do well versus trying to create it ourselves. Fantastic. So what we're gonna, we're we're gonna do three things. We're gonna talk about what a digital foundation is.

Uh, why a digital foundation is necessary and, and how it really helps us to, uh, in healthcare to really adapt to the changing landscape. You know, we're sort of talking about coronavirus, but really we are right in the midst of a significant changing landscape around the consumer and around, um, just a, a new entrance into the market and a whole change in that landscape.

And then we're gonna, we we're gonna come back to real life stories of how data and applications are being used to deliver. New experiences on top of this digital foundation. So Vic, I'm gonna, I'm gonna go to you to talk a little bit about the digital foundation, and then I'm gonna, um, I'm gonna go to Chris and talk about, um, talk about VMware a little bit.

Um, but Vic, set it up for us a little bit. So talk about the digital foundation, what is it and, uh, and, and what are you seeing out there? Yeah, sure. Uh, thanks. Thanks for taking time again today, guys. Um, digital foundation, right? So before we start and go into the what, like, let's talk a little bit about the why and why is it so relevant right now.

Um, so if you actually look at a lot of the leading healthcare organizations and Scripps is one of them too. Um. You're starting to see a shift at the top. Uh, and the top is basically starting to say, just as Clark mentioned, we're we're, we're in the position of learning from other industries. Now we're starting to embrace a lot of learnings from B two C, a lot of the retail businesses, what can they teach us?

And the fundamental thing that they teach us is like, look, we need to focus, uh, our attentions on, uh, on the consumer. And, you know, in healthcare, we really haven't previously done a very good job at defining. We, we say patient, right? So the patient is somebody that comes in and gets treated and then we get money for that and then off they go.

Um, changing that into sort of the consumer and starting to treat the patient and their. Family and all of the rest of our, our IT team and our, uh, uh, the rest of the providers in the organization as constituents and consumers of things that are needed to run their daily lives. I think that's the big thrust that we're seeing here.

So what that's doing is that that's, that's reframing what CIOs are really looking at, right? So they now have the classic Gartner bimodal challenge. One is like, I gotta keep. My lights on, I gotta keep things running the way that they are would not compromise high level of, uh, availability, high level of performance.

And then the second is I've got these, these, these folks coming in and as chief physical officers, as chief experience officers that have come from retail and are saying, Hey, we need new ways to engage our constituents and we need new ways to keep them engaged and we need, we need good ways to keep them coming back for services to our organization.

So that's the whole consumerization. Those require a net type of applications of, of actually. Your information and soliciting feedback and, and bringing them into the fold. So how does the CIO straddle both, uh, the providing of the, the frameworks for keeping the lights on as well as this net new way of consumerizing uh, healthcare.

And so that's our premise of saying, you know, you need a, a strong, solid digital, clinical, or digital foundation that. Allows you to do all of those things and keep moving forward. Yeah. It's also the clinician and the CISO as well, isn't it, Vic? Yes, absolutely. Yeah. So, uh, the, you know, the clinician is also, you know, if you look at the, the new generation clinicians coming in, um, they're, they're very used to having things sort of their way, right?

And they're very used to having access to information when they need it, how they need it, where they need it. They're also very finely, uh, uh, attuned to the fact that the, the wealth of data and information that's out there and the wealth and, and the rate that that data and information is growing at, they don't have a capacity to be able to get their arms around it.

Similar to, you know, reading a few journals in the past and being able to make. Decent decisions. They wanna make the best decisions with all of the data that they have development. So that's one. Uh, and then the security piece is like, that's just table stakes now, that's Maslow, right? It's gotta be intrinsic to everything that you do.

You can't have it as a bolt on. It's no longer about, oh my God, look, we gotta go secure the perimeter over here, and then we'll be fine. That's not happening anymore. Yeah. So, so Chris, getting to VMware, it's, it's interesting because you guys really ushered in a. Complete fundamental change of how we did internal it probably about a decade ago within healthcare and virtualized that whole environment and then layered all the things, put automation on top of it, secured it, now have virtualized storage and network and everything else.

Um, how are you guys going to play in the next, uh, the next round of change around this digital foundation for the consumerization of healthcare? I think there's an important point that Clark made earlier is that we've always tried to do it on our own in healthcare, right? And I, I have this experience having come from the other side of the desk and into the partner world is that we always tried to build it on our own.

So we were always laggard. I. So we're starting to see an industry shift in how they're adopting technology to meet consumers' demands and needs. And I think that's important. It's an important aspect because it's not just about the clinicians that you're serving anymore. It's not just about the patients.

Also, those consumers are changing as well, the expectation of keeping talent in-house 'cause people have expectations of technology that they're using. 'cause we've consumerized technology so much. So they wanted a certain way, like Vic said earlier, also, they have a certain expectation of how they're going to do their jobs in their works.

So I, I think from a VMware perspective is that we, we've got, we've got the secret sauce, right? So we've done some very slick things over the past few years, and if you look at our history where we started, people still consider VMware just a virtualization company, right? Well, we do so much more than just virtualization in your data center.

Now we're extending that virtualization. Not only into storage, into networking, but also into security. Now where security is inherent in the platform, it's just ingrained into it's intrinsic, so to speak. Right? And we're changing how people do their work, which is very critical. 'cause people have an expectation of how they're going to do their work.

What the consumer doesn't care about is what it takes to get their application anymore. They have the expectation that the application's just going to be presented to them in the form and fashion that they see fit, and they're gonna have an experience time and time again. Where VMware plays in that space is we're making the lives of the IT departments, those providing this type of service.

As simple as humanly possible by giving them the opportunity to take advantage of consistency within the infrastructure. So whether that's to compute the networking, the storage, and then changing how they're operating. No longer are you constrained or bound to the four walls of your data center where you can now start to look at workloads and move those workloads where you see fit from an operational standpoint.

Important point here when we start to talk about healthcare and healthcare delivery. Bill, as you know. Being that CIO from, uh, you know, just a few years ago, is that, are the applications ready for that kind of movement in this world? So we're looking at it from the lens of how can we not only change the infrastructure, which is providing that service, but how are we now addressing the application and that portfolio so you have that seamless experience while securing that entire ecosystem in one fell swoop.

It's definitely not an easy task, but it's a task that we're definitely up to because we value how the providers are using technology. We wanna see better outcomes to those patients that are being seen in the clinics or wherever they want to be seen, and we want to use technology as a differentiator to.

Take away the bounds for how healthcare is being delivered. So VMware is going to play a very critical, important role in that because we see care not just at the bedside anymore, but care has gotta be a part of everybody's lives on a day-to-day basis as we're taking care of populations. Yeah. I like to come back to this, to this word, uh, agility.

And Clark, I'm gonna, I'm gonna come back to you. The, it's interesting to. Well, at one point my, my team was talking about how they'd automated all this stuff on top of our infrastructure internally, and this is back in the old days. I said, you know what would be really interesting is if I could say, Hey, Alexa, you know, provisioned me some servers and those kind of things.

Well, on Monday, so that was like a Friday on Monday, I came back in, they said, okay, we're ready to demo. I'm like, demo what? Like we're ready to demo you talking to Alexa and it provisioning. You know, for, uh, you know, servers or whatever you want it to provision. And I was sitting there going, what? You know, I, I, so few projects in healthcare happened that quickly that I was sort of taken aback, but that's really what we're talking about.

You know, when the new entrant. Comes into your market when, when the, uh, CVS or the Walgreens comes in and, and starts offering services different or Amazon care or whatever, uh, or, or Coronavirus hits. And all of a sudden now you need to be doing, uh, massive telehealth that you weren't able to do before.

You're gonna have to be able to spin up things that you weren't doing before. So, Clark, give us an idea of. You know, how you, how most of these things start with a gap analysis and most sure. You know, so help and help us to understand most health systems. Uh, some health systems are gonna be starting really at, at the ground floor, and some are gonna be pretty advanced.

But what, what are they gonna find when they do the gap analysis? What are the most important things they need to put in place? So, um, you know, we're, we're doing this video conference Bill. It's a great statement and a great set of questions you make, but we're doing this video conference because one of the biggest healthcare it shows in the country, if not the world HIMSS National, got canceled this week.

Right. And one of the benefits of going to conferences like that for me is we get a chance to connect with colleagues and other health systems around the country. And we all discovered that many of us are experiencing the same kinds of challenges. There are other health systems that'll be a little bit ahead in some areas.

In another area, scripts may be ahead, but I think it's indicative of the real culture shift that has to happen. And, and Vic, I think, uh, touched on it, it starts at the top, but it must, uh, really, really disseminate down into the depths of the people that do this work. So part of my job is articulating technology for people that really don't want hear about technology, don't care technology.

Demoing our, um, enterprise architecture strategic plan, which is a graphic that we've done in one sheet, one side only, which is one way to explain the what, not the how. That's part of the culture shift that healthcare organizations need to go through. And a group of managers asked me, they said, Clark, what's your vision?

What is your vision? For enterprise architecture at Scripps today. So again, back to that perspective of culture change and how you get folks in that space to understand it. So what I did is I held up my, this is my smartphone, and I said, in every aspect of your life, you can run your life from this, but your healthcare.

And we intend to change that and we're not there yet, but we're well on our way. And I think it is that notion of blow up what we have traditionally done in healthcare and then apply principles like speed to market. Which are very foreign in a lot of healthcare organizations, agility. Certainly many of us adopt Agile principles.

But have we really embraced and endorsed and reinforced from the very top that we must deliver goods and services based on the needs of our customers, not based on the needs of us. Which causes us to go much faster than we have. And then again, as we approach that really smart people in healthcare IT approach that, don't feel the need to try and create everything yourself.

We talked about that earlier, right? There are lots of great companies that are willing to partner with us to help us learn from that. But if you don't have that down to the absolute frontline level so that everybody understands where we're trying to go, uh, you're gonna fail. And it'll be the initiative of the.

Uh, plague Healthcare as an industry and. Vic knows this. Chris knows this because it's actually over my shoulder right here. Partially, uh, my laminated strap plan that we walk around and I can tell that story in about three minutes to anybody that is willing to listen. And those that aren't willing to listen sometimes, but everybody understands what it is we're trying to accomplish and why Now, what's interesting about it, bill, is as you think about the real creativity that exists in healthcare IT shops today, part of my job is to explain via partners what.

The collaborative nature is to let turn the team loose on the how, and that's actually really energizing and it's a lot of fun to watch. Certainly our teams here at Scri just get super creative and go after it. Alright, so here's what we're gonna do, Vic. I'm gonna, I'm gonna ask you to talk about the digital foundation, some of the elements of the, the digital foundation.

Then we're gonna get really pragmatic and I'm gonna come back to you guys and here's the example I'm gonna give you. So today, 21st Century Cures final rule goes into place. Which means that, uh, essentially what the ONC is pushing towards is that the data becomes an asset that is used for health. So no health system can really control the data anymore.

No EHR provider can, can control the data anymore. It has to be freely accessible to the patient in order to manage their care and in order to provide the best care, uh, possible. So all of a sudden we've taken this data and we've freed this data. This is a, a seminal event within healthcare. So now we have all this data that's going to be not only our data from the provider side, but also from the payer side, also has to be made available as part of 21st Century Cures.

So we've just created this, this new ecosystem that is going to, uh, that that is going to really put a lot of data at play. And, uh, and a lot of really smart people are gonna come up with solutions and say, Hey, you know what we can do now, now that we have the complete longitudinal record? And now that we have this, we're gonna be able to do some things.

So we're gonna, from a pragmatic standpoint, I'm gonna ask all three of you to talk about, you know, what kind of solutions and, and really the how. So how would we go from where we're at today to launching some new solutions? But first I wanna go to Vek Vek. What, talk about the digital foundation. What are some of the elements of the digital foundation?

Sure. Uh, sounds like you've been busy today reading the 1700 something pages, that came out, but that's okay. I, I read the bullet points, but go ahead. Yeah, I was doing that too all day, but No, just kidding. Uh, there's, uh, you know, fundamentally, I, I think that there's, there's some amount of agreement on, on some of these, uh, different.

Categories that I'm gonna mention. Um, I'm sure that there's folks, you know, Chris might want to add some, uh, Clark might wanna add some, but I think fundamentally there's five different areas that I consider when I'm thinking about a, uh, digital foundation. And, you know, I put clinical in parentheses because we're talking about this in the healthcare space.

I think it's true of any digital foundation, but there's, there's five and, and Chris, some of these will sound familiar to you, right? So one is around infrastructure, so consistent infrastructure and. I'll talk a little bit about each of these and then we can dive into your questions. You gotta make sure that in order to do this bimodal thing right, that we talked about where you gotta keep the lights on, you gotta make sure that your services are running no matter what, unquestioned, high performance, high availability, and that you have the freedom and flexibility to be able to grow and, uh, and shrink as needed.

So be elastic as needed. Uh, I think you need to have that level of consistency. In, in your operations, but then also in, in terms of your, uh, your infrastructure very specifically. It, they need, it just needs to work. Just needs to be there. You need to be able to rinse and repeat, grow as you need, et cetera.

So that's the first piece. Second pillar is around operations. And I kind of touched on this previously, so again, consistent operations. So consistency in terms of being able to say, I have, uh, you know, I, I'm gonna start embracing the future world of, uh, service based. Uh, uh, a delivery, right? So I have a, uh, a service catalog and I have the ability to be able to go through and provide these services.

Now we're very far away from being able to do that, but just conceptually, those are the kinds of things that we could probably take and apply to have a really good, solid digital foundation. So that was the second piece, consistent operations. Um, the third one that I like to add, that I like to think of here is around, um, uh, experience.

So if you actually say. One of the pillars of my digital foundation is consistent experience. Then you can sort of peel apart and say, okay, who are my constituents? Who am I trying to provide these experiences to? Is it just my patients? Is it my patients and their families? Is it my patients' families and caregivers?

Is it all of the above plus the IT staff? Is it all of the above? Plus the executive staff of the, of the organization? Is it all of that plus the community members? Right. The answer really is, is that it. Somewhat depends, but I think that the right answer is every, everybody like the, the whole shoot and match.

Right. And this will kind of come back to the, the ruling that you mentioned here in just a second. Um, and then the last two element, and, and Chris touched on this a little bit before, and I, I've been thinking quite a bit about this and, and Chris might wanna touch on this a little bit more, is like this whole concept around productivity, right?

So a, a, a, a core tenant of the digital foundation ought to be increased productivity. The increased productivity is for your, your staff, but then also for folks that are trying to use the, the services that you're trying to provide them as an IT organization. So it's not only onboarding, so somebody comes on and, and you're, you're able to get them off to the races very quickly.

But it also about like taking the friction out of everything that you're doing on a daily basis. Productivity. Like, just think about all of the millions and millions of dollars that companies like Microsoft has spent. In terms of recasting, very slowly over time, reshaping what the overall operating system experience is for the user, but then also for the provisioner of those services, right?

So you're like Windows 10 is like completely off this, you know, off the, the beaten path, if you will, of, of original operating systems. Um, so that's, so that's the fourth piece. And then the last piece. Which again is like Maslow, right? You gotta have it. It's intrinsic security. You can't have a digital foundation and bolt on security.

I said that previously. I'm gonna repeat that again. It's gotta be built in at all of the layers. You know, one of the things that I'll mention here, like that kind of ties this together. This is. This is not really new stuff. This is stuff that we all kind of been saying for a long time. I think what's new is that we're starting to see that there's not much runway left before we all have to start moving the direction of adopting this.

I think that's the, that's the differentiator. And there's drivers for that. Right? So why would you change their behaviors? You'd change their behaviors if there's either a carrot or a stick or in some cases both. Right? So in this particular case, you have the situation where you have. You know, these, these, these digital enthusiasts, enthusiasts coming in.

All of these folks that, from that, that are consumer first, right? Coming in from B two C, you've got all of these next generation providers coming in that are like, look, I need access to a vast majority of data and information to make the best decisions possible, and there's no way that I'm gonna be able to keep up with all this stuff.

And then you have the consumers that are like, I just want to treat this like my Starbucks app or my Target app, or whatever it is. It doesn't matter what it is, right? So that's, that's one sort of carrot and stick, if you will. I think the other one is like, as you mentioned previously, bill, like right now is very timely, right?

So there's two things that are being talked about quite a bit. Uh, so, uh, telehealth and remote work, right? So these are the two things that a lot of organizations are talking about right now. What are those needs? They need a lot of stuff, but fundamentally they need a framework and a platform that you can actually expand and contract when you need.

This is elastic, right? You grow when you need, you shrink when you don't. Um, very different from what we've done in the past. And the last item I'll mention is that the reason why it's so hard to embrace this, even if we conceptually and academically say, yes, we understand this is a digital platform or foundation, and we've talked about it for a long time, and now we have a carrot in the stick.

Why aren't we doing something very rapidly around this? Because it's really hard to do. It's really, really hard to do because we have these applications that are foundational. They used to call legacy, can't call them Legacy anymore. Call them foundational, foundational applications that keep us sort of very grounded, that require us to have a certain amount of, yeah, doing things a certain way, some specific platforms, some specific delivery mechanisms.

That's a very big portion of the keep the lights on day two operational pieces. That's why I see that there's this dichotomy that exists today around this digital foundation thing and how do we actually operationalize it and make it real. So I'll, I'll pause there and then hand it off to back to you, bill, and then we can take it from there.

Yeah. You've given us a lot to talk about, uh, Chris. I, I want to, uh. I really don't want to frame this 'cause if, if there's stuff you want to add to that, I want to hear it. But one of the things I do want to push on is just ask you, you know, uh, when I talk to CIOs today, there's a lot of 'em that are still struggling with that 95% of their investment every year is still going towards the old.

Keeping it running and, uh, maintaining the old environment, uh, is that changing? And, and because if, if you, if you're still spending 95% on the old, you don't have the money to invest in getting the digital foundation, right? So is that changing and, and what things are we seeing to, to change that? So I see a blend, um, as I have conversations across the country with a lot of different CIOs and a lot of folks that run technology shops, it's definitely a blend.

And I, and I think it's a cultural phenomenon that people are still wanna hold on to the past. Um, they wanna hold on to that application that they've had for so long. But, you know, if you look at it on the flip side of, of, of, of the other side of the coin, the flip side is that. Nobody has the money from a healthcare perspective to go out and reinvest in brand new technologies.

Right? So the reimbursement rates, they're, they're not what they thought they were going to be. You don't have deep pockets anymore. You're looking at shared risk through the care continuum. There's a lot of other business drivers that are causing folks to continue to keep on with, I'll say legacy because it is legacy that legacy technologies, those applications and infrastructures, 'cause they do their job.

Right. So it's really tough to pry that application away from somebody when it does its job and it's actually bringing money back into the organization. So it's kind of a mixed bag where some folks are definitely well ahead of the curve and they wanna use innovation to really drive how they're changing the dynamics, uh, and the shifting dynamics of patient care.

And then other folks are just, we just can't, . Afford the innovation. 'cause we're stuck in that rutt of keeping those lights on. So we try to always encourage folks to have a blended approach to it, right? You're not gonna change exactly what you're doing overnight. This is going to take time, and you can't drink from the fire hose when it comes to dealing with a new digital foundation.

One, because you may not have the skillsets necessary to do that. I always lean on people and process first before technology technology's great, but if I don't have those other two foundational elements in place, technology does absolutely nothing for me. So changing overnights not gonna happen. So it's going to be a slower draw across this period of time.

As we look at how innovation's creeping into organizations, I think where the rubber's starting to meet the road, and I think where Clark hit the nail on the head perfectly is that down.

The changing consumer dynamic is in healthcare and how technology's really going to drive that. So we're having a much, much more deeper conversation about how we take organizations from where they were 10 years ago to start to think about 10 years in the future and laying out roadmaps for them. And I think that's where Vick's definition and how we laid out those five key points of a digital foundation are very spot on right now.

I could get into the blocking and tackling of each of those, but I don't. The theoretical lens that he put at it. It's all those pieces that are necessary to start to move an organization forward. And what I would say to people is that you don't have to do all of them together. Right? You can take a balanced approach to getting to that point, which will in time, free up that capital.

So you're not working on just keeping the lights on, but you're also addressing some of those innovation needs within your organization and moving the needle forward for your organization. Yeah. Absolutely. Uh, you know, Clark, one of the things, the , we call it the A word on the show, and that's architecture and.

It's, uh, it's something when I, the reason I call it the a word is 'cause when I throw it out, people sometimes gloss over. They're like, oh, he is talking about architecture again. But I found it to be a fundamental part of the conversation when, when I'm sitting there and people are saying, Hey, you need to reduce your costs.

And I go, okay, I'm gonna reduce my costs. And let me tell you how we do it. In it, we, we standardize, we consolidate, we, you know, and what does that mean? Well, it means we can't have, you know, this many. Uh, cardiology PAC systems and we can't have this many radiology PAC systems and we can't have this many.

Now we focused in on the EHR and for some reason that conversation has gone real well, and a lot of people have gotten to a single EHR or moving towards a single EHR, but it doesn't seem to have permeated the entire organization. And I'm not sure how we move the needle forward without addressing the stuff that's in our closet.

You know, it's a, it's a great comment that you make, bill, and I think the thing that we have to keep in mind, uh, particularly around the EMR conversation. Is the easy part in many respects, is going to a new EMR and getting it implemented. Beyond the implementation piece, you've got two or three things that an organization really needs to think about.

Certainly, one is that workflow dynamic that you have in your acute and ambulatory spaces, right? So how many organizations go to a new EMR. Try and pigeonhole that EMR into the old workflows that they used before they got the EMR. That is not a good approach. So organizations have to be really forward thinking about taking the, all the, the capabilities of that EMR in really looking at each individual workflow and saying, how am I going to do things differently, leveraging the tools that I've got in my shiny new EMR.

Positive patient outcomes to be more efficient and all those things that we all talked about. That's number one. Number two is that application rationalization conversation that happens after you implement the EMR. So most large healthcare organizations approach it the same way we say as part of our justification for getting the budget to be able to implement a new EMR, no matter who you're buying from.

I'm gonna be able to get rid of this percentage of applications. They're gonna go away because I'm gonna have a consolidated set of functionality capabilities that are gonna replace those applications. But I do agree with Chris. The word legacy still exists in healthcare. So what happens beyond that, and I'll give you an example.

It's Scripps. We had a portfolio of a. About 1100 apps all in before going to our, our brand span and new EMR. There's still a list of applications somewhere in the low eight hundreds that we're now jumping into and saying, okay, there's two criteria around that. Does the current EMR have that capability today?

It. There's not a strong argument for keeping that application here. And then the second one, if we're willing to be honest and look internally, look at our own application stack. Do we already own three of these? Do own four of these. So if you own several and it's not in the, um. The functionality is not your EMR.

You still have an opportunity there to reduce and to save some costs. And then once you begin to do those, uh, very painful set of discussions, there's maintenance costs for the hardware. There's hardware you probably don't need anymore. There's space in a data center you may not need anymore. And all of those things get rolled together to tell the story about how you can further reduce.

I would say not in a simplistic way. The M in is the easy part. It's all the stuff afterwards that gets really, really hard. Alright guys, here's so rubber meets the road. I'm gonna give you an application. So I'm a physician in, in a health system that you're working with. I come in and go, okay guys, here's how this is gonna play out.

And by the way, I do believe this is a real application. So 21st Century Cures freeze all this data. Here's what I want our health system to do. I want us to create a, a service where people are able to aggregate their entire health record. They're able to have scripts or fill in the blank client. And, uh, and essentially they're gonna send us their entire medical record.

And we're gonna, we're gonna provide including their, their, uh, Fitbit data and their Apple, you know, data and all that stuff. And we are going to actually use our clinical expertise. We're gonna have a call center and a digital foundation for this, where we're gonna use our expertise. We're gonna scan these records, look for any anomalies, and we're gonna provide either a report back.

A television, not a televisit, but a but, but a conference call like this to have a conversation with the person about their health and those kind of things. We're not necessarily gonna do telehealth across, 'cause there's still state guidelines and those kind of things, but we're gonna provide this consultation for people around their medical record or a second opinion kind of thing.

And we're gonna stand this up as a result of 21st Century Cures. Alright, we're talking about this digital foundation. How are we gonna make this happen? Who wants to go first?

Well, I think I'm happy to go first. I'd love to go first as an old guy, bill, um, because I have some strong opinions about this. Um, first of all, in, in our industry we produce a whole lot of data that is not news to anybody on this call or anybody in our industry. I think the sweet spot for us. Is data with context is information, and we need to produce way more information than we do, and the use cases and the consumers of that information are very different than they were even a few years ago.

So we would all certainly identify providers, executives. Others working in the clinical process, uh, that they need specific data that helps them understand. But if you think about aggregating all the data built to your earlier points, that is a very good thing for patients and for those that take care of patients.

And then creating the right kind of context, depending on who you are. So an executive may say, I wanna know what it costs to do a particular. Procedure on an annual basis and drill down into that and see if we're actually competitive in the market or not. And individuals going to want to see all the things relative to their specific, um, ailments, any chronic diseases, those kinds of things.

And AC o's gonna wanna see much, uh, broader data. Data, data across a population and so on. And if you can't quickly get to a point where you can provide the right context for the consumer of that data, then all you're doing is producing, to Vick's earlier point, a massive amount of structured unstructured data that no one individual could possibly consume and make clinical decisions with.

Hey Chris, I'm gonna, I'm gonna put you on the spot and I'm gonna take off the, the handcuffs here 'cause I know, I know you're trying not to talk about VMware, but you guys have a pretty extensive stack. If I wanted to develop this kind of application and, and roll this out and scale this, um, you know, talk to us about how we would do this on the VMware stack.

Sure, of course I can do that. Um, yes. And I have , you guys don't tend to talk about yourselves. I have to pull it outta you. Yeah. So I, I think it starts again, if you, if you look at the foundation for the digital aspects right? And what we can do in this new world of, uh, a multi-cloud environment. So, and what I mean when I say this, how can I extend workloads into a public cloud provider?

How have you taken the tenets of, of what I need within my own data center to extend those workloads, to take advantage of the microservices that are on the backend, right? So that's one aspect of it, because you can't be expected to do everything in your house at a hundred percent. It's just not, not a capability, not a possibility.

Now, if I wanna develop the. Class applications, I'm gonna find what I do best as a system, right? So I'm gonna go back to, to what Clark was saying earlier. Again, I'm not gonna try to boil the ocean, but we're gonna find out what we do best. That's the data points that we're concerned with. That's the data that we're gonna take in to provide the best clinical outcome to a patient market.

That service. Now, I can create those applications using, uh, you know, a whole bevy of. Theories about how applications are created. I'm gonna try to stand them up in a containerized environment though, so I can have agility with how that application moves, and then what other services I can take advantage of within that application.

Now, from a VMware perspective, the simplification of actually creating those applications in those containers and manage them alongside of. That's our sweet spot, right? That's what we're doing today. That's what the future beholds for us. So being able to manage with consistent operations, make it reliable, extensible, scalable, and having that agility in place to manage that environment seamlessly through one pane of glass.

That's the dream. That's, that's where we want organizations to get to, to show that it's not complex to manage the technology. Through that single pane of glass and giving them the flexibility and extensibility and scalability to be able to move business lines and services to meet that consumer demand, right?

Because nobody's gonna build an application to do a whole bunch of stuff if it doesn't solve the consumer's demand. So being able to scale that out beyond the walls of your hospital into a multi-cloud environment. One for cost measures, but two, just for simplifying your operations and extending out your workflow.

Force as we're competing for talent, right? But what's most important in that regard is that ensuring that you have those other core tenets around that workload as it's moving, so that intrinsic security, so that it follows the workload so that you're ensuring that you're protecting that data or that patient's privacy, and ensuring that in that consent model, as they're giving you their data, they feel comfortable with the fact that you're, that you're.

In control of that data at all given points of time, you're preventing it from breach or minimizing the impact of that breach, but two, bringing it back down to the end point to make it much more usable. So that's that end user storying component, right? Because the last thing we wanna do is force feed a whole bevy of data onto a clinician to try to make a decision.

But at the same time, we have to have the patient engaged with their care. They have to want to care about it. So ensuring that we're creating those applications, one that are usable, not just for the clinicians, but also for that patient as they're providing that data back in and that it is being consumed in a normalized manner.

So where we come into play, there again, it's, it's that building that foundation of managing that IT environment. Giving you the tools necessary to build those applications as you see fit in a containerized world, managing it all through a single pane of glass, while taking into consideration the core tenets of automation, orchestration, operations, and eventually, hopefully service requests and ticketing on top of all of that to drive how agile and digital foundations can be consumed across that continuum of care.

I love that by the way. I mean the multi-cloud, uh, I mean, designing the application so you can run across any cloud, I think is going to be critical. I think when you select a specific stack, you could get locked in, uh, containerized, being able to move it. If you're gonna scale nationally, you need to be able to do that.

Vic, guess what? I'm gonna give you the last word and, and, but I'm gonna change the question on you, which is, uh, you're coming in to consult with me, CIO and I'm telling you, Hey, digital foundation, I, I, I listen to the podcast. I get it. I understand. I need to be more agile. I need layers of abstraction into the cloud.

I need more security around everything that we're doing. Help me to get from here to there. What, what, what are you gonna do for me? What are, what's step one through? Five in the process. Yeah. Way to put me on the spot right there, . Thanks. Uh, and, and then also you're taking away from the big a, you bring up the A word, which is my kind of like thing that I've built my whole career on and you switch it on me at the last second.

That's fine. . Um, no, but, but thanks, uh, thanks for that question. I think that that's a really important question and here's why. Right? So I, I, I kind of get sick and tired of. Talking with, uh, CIOs, CTOs, et cetera, and they're like so jaded by the fact that when they, when they ask somebody to come in and say, Hey, can you help me with X?

The whoever comes in best interest at heart, et cetera, says, okay, here's how you get to the, the end spot. Right? Here's where you are. Here's where you get to the end spot. Good luck. See you later. Right? You can't do that. And you know, Chris mentioned this earlier, is like the beauty of the digital foundation, if you actually structure it correctly, is that you don't have to bite all of it off at one spot, at one shot.

It's like, you know, you, you, you figure out and articulate. So this is how I would do it. Figure out and articulate where you are as an organization. What is the most important thing for you right now for whatever is most important for you right now? So, for example, if you're like a Kaiser, uh, or, or you know, another very large healthcare organization that has just recently made big investments in figuring out how to consumerize by adapting and adopting B two C, like, uh, engagement methodologies, right?

Applications, gamification, et cetera, et cetera. Well then maybe your big focus right now is around saying, how do I get to a platform and a foundation that allows me to embrace digital as quickly as possible? And when I say digital, I mean, you know, mostly mobile type applications. Um, accessing from any, any operating systems or Android, iOS, uh, I need to be able to manage them.

Some of these devices are managed, some are not managed, so there's that component associated with it. That's on. So you take your business goals and. This digital foundation and say, okay, which ones of these do you like is the biggest hitter for you? Uh, in some cases it's going to be more around the journey of the, you know, the, the consistent infrastructure piece I think extends out.

And Chris Chris's, uh, explanation was really, really good. I really enjoyed it. Not gonna hear me say that much about Chris, but I did enjoy that one. . Um, I've seen him hit a golf ball. It's not pretty . You haven't seen me hit a golf ball. It's even less pretty than that . Um, but, uh, but yeah, so the, so, so the, so the, the, the in the consistent infrastructure.

Like changing your mind in terms of saying, okay, now I am thinking about stuff outside of my four wall walls. Is the only way you're gonna get forward. That's the only way you're gonna do it. And this whole next generation preva data application building something to make, you know, to, to start getting some really, really good gold from them.

Bear Hills is the only way to do it, is to actually be able to adopt and adapt. Compute and microservices from places outside of your walls completely. Absolutely. 100% agree. There's a couple of different, there's a couple of steps before that as to why folks are really looking at leveraging services from places outside of their walls, right?

So one is, and Clark touched on this, right, so the thousand 1200 applications rationalizing down to 800. Now further rationalizing out. There's still some lifecycle associated with that, right? And then there's two pieces, right? So there's the application and the software associated with them, users that are consuming that.

But then there's the infrastructure that the dang thing has to run on. And so if you can actually break those two things apart and say, okay, while I figure out this rationalization piece and figure out, you know, what my users want, can I actually take and liberate out some of the actual infrastructure that the stuff runs on?

So again, expanding out to to other areas. So. Long story short, come in, have a conversation, sit down and say, okay, here's what the foundation looks like. Here are the elements of it. What are your business priorities, Mr. And Mrs CIO, what are you focused on right now? And then let's pick the one or two areas and just like dive deep into those, solve those back out.

Go to the next one. That's how I would do it. Absolutely. And you know what I, I, I appreciate that answer. One of the things I did as ACIO is I just, I came in and talked you, you talked experiences earlier. And I just talked about outcomes. I said, all right, you know, I want to get to no more than two racks in every hospital.

And they just looked at me like I was insane. And I'm like, uh, I don't think I am insane. I think you can get to two racks in every hospital. I. And get out of the data center and the expensive floor space that we're taking. I'm not gonna tell you how, I'm just gonna tell you I know it's possible, and I knew it was possible with hyperconvergence and things that were going on.

I knew it was possible. So, um, and then I would say things like, all right, I want to be able to, uh, you know, we need to be able to reduce our IT operating costs by 2% a year, uh, for the next five years, reduce it by 10%. And of course they would say it's not possible, and then they'd come back and go, oh, you know what?

If we do this and we do this and we do this, we're gonna be able to do that. And I think the same thing holds true here on the digital foundation. It's pushing the team to say, um, all right, we need to be able to, to scale up this rapidly, provide this level of service, provide these kinds of tools, and, uh, let's, let's just open up the creativity of a, an organization like Scripps.

See what we can't do for our community, our local community, but also, you know, the whole state of California and even beyond, to open up some new markets. It would be really fascinating. Anybody want the last word before I, before I close out? Yeah. I, I would just say on your comments, bill, those were those really hit home, uh, for us at Scripps.

Uh, there needs to be a fanaticism around weeding out transactional work and automation. Um, because no healthcare organization, no healthcare it shop that I know is gonna get a, a large number of FTEs. Added to their current staff. So the only way they're going to be able to create capacity is to actually create capacity.

And those are two important steps to creating some capacity to release that creativity that you were just describing. And it's, it's actually really, really fun to be part of and watch. So that's it, Clark. It's the last word in the show. So gentlemen, thank you. This is, uh, this is a lot of fun. I hope we get to do this again.

Uh, this space continues to move so rapidly. I think, uh, we. We, uh, definitely will be talking about this for the next year and, and, uh, look forward to some really good use cases coming outta this. So, uh, thanks again for your time. Thanks, bill. Thanks Bill. I really wanna thank these three for, uh, joining me on the panel discussion.

I think it's such a great and timely, uh, topic and discussion. Uh, we wanna thank our founding channel sponsors who make this content possible Health Lyric scaling healthcare. Starbridge advisors, VMware, and Pro Talent Advisors. If you wanna be a part of our mission to develop health leaders, go to this week, health.com/sponsor for more information.

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