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 Welcome to this Week in Health It where we discuss the news, information and emerging thought with leaders from across the healthcare industry. This is episode number 46. Today we're finishing up our three-part series from the Chime Fall Forum. I hope you had the opportunity to listen to the other two.

One was on culture and it was a phenomenal episode In the other. On technology. And so we did a deep dive with two very technically minded, uh, CIOs and associate CIOs. Uh, our industry has so many wonderful people for this episode I'm about to share with you. I got the opportunity to sit down with Bill Spooner, who's one of those truly special people that has contributed so much to our industry.

Bill was honored with the Legacy Award at the Chime fall forum, and I was honored to be able to sit down with him to discuss everything from the o opioid epidemic to preparing for retirement. I had a great time recording it, and I, I, I'm really excited to share it with you.

So Elder statesman for healthcare it, bill Spooner has, uh, decided to join us. You don't mind going by elder statement statesman at this point. You're doing a lot of work. Some, some people say, geez, . I'm not, I'm not gonna say that. So you're doing, you're doing a lot of, a lot of different things, but you, you were honored by Chime.

You're doing a lot of work for Chime. What, what, what kind of things are you working on these days? Well, lemme talk about Chime for a minute. Okay. Um, you know, I, I've known Ned Kaki for 30 years. I knew Tim when he was a little kid, and that got me really motivated about the opioid issue. And so I spent a lot of time in that in, in the past year or in the mor, every week I.

The more I learn, the more I realize I learned. So I need to learn. And, and it's kind of frightening because I, I don't know what the end to it is. Yeah. But I think we, we have to deal with it. And so I've really got, I've spent a lot of time on that. Um, so you, so you're on the opioid task force? Task force.

Yes. Yes, absolutely. And just trying to make things better. That was a, an amazing video this morning that, uh, I know it was Ed who was the other, Christie Kinler from Adventist Health System, Florida. And they both shared very personal stories of how Yeah. And they worked tear Jerkers. There's just no question.

It really was. Uh, and it's just, so, I, I am, I admire both of them so much for being willing to stand up and talk about it. And I, I remember the first time that Ed came to the task force meeting, it was really tough. I mean, he, he wasn't able to talk that much. I mean, what was, you lose your child. Yeah. Well, I, I thought it was interesting at the beginning of that when they said, uh, everyone who's been impacted in some way by the opioid epidemic, raise your hand.

And there was a, a significant number of hands that went up in that room. So I, it, it touches a lot of lives. When we had our first task force meeting back in January in DC. I can't, there are probably 50 people there perhaps. And we, we broke off into groups and we started out by telling our story. And, you know, I feel fortunate that I had less to tell than others, but almost everybody had a family or friend event, a brother a, a child that they've been contending with forever.

And it's like, this is this, I, I never appreciated just how many of us are being touched by it. So, uh, if I'm a health system, c i o, I can, I, what, what would I get from the Chime task force? How, how would you guys help? What, what we're trying to do is to put together, well, we'll, calling a playbook. Yes. To begin with.

To give people, to give CIOs some, um, tools to help them engage in the efforts in their own organization. You know, most organizations are doing something, but for those that aren't, we're, we're creating a playbook that talks about how to kick off the problem Stewardship committee, . Provider education.

We're also trying to get into the, to the, uh, details of where we can apply better information. Whether it's building dashboards, about prescribing patterns by your doctors, the whole issue of the state, uh, databases, pd, DMPs, as they call them. Yeah. Um, very, very difficult to integrate with and, and in many states it's basically a web lookup, so the provider has to go through all these extra steps of going into some portal, which discourages them from wanting to do it, and different rules state by state.

So we're trying to put together some information to help and we're trying to exert some influence. We've had some influence on the legislative side in terms of this recent opioid act that was passed. But there's, but we also didn't make it in some, in terms of trying to, uh, uh, make available, I think they call it Jesse's law, so that the, the substance abuse information can be, can be made available to the providers.

So we're trying to influence it in a number of ways. We've had some successes. We still have a lot of room to go to, to go, and I think people are now, uh, recognize this, but chimes on Capitol Hill, I mean, we're having conversations. Oh yes. And. And, and influencing and we feel that we are influencing some of the things that we've, that we've promoted have ended up in the legislation.

Obviously we weren't the only organization to promote that, but, but it really all adds up. And one thing, and I think somebody said that this morning, we are being asked for our opinion, so that helps. It seemed unlikely. It seems kind of unusual for a bunch of it people to be so involved in this thing, which is a, you know, a severe medical crisis.

But it's just too important not to, and there are ways that we hope that we can get information to the table. Well, it's, you know, the very first episode I did of this was back in January. It was following the JP Morgan conference, and they have the non-profit track where all the CEOs get up. With their COOs and others and talk about, you know, their performance of their organization.

They're talking to bond holders, so they're talking about their performance and that kinda stuff. And one of the things I, I took as a, uh, takeaway from that conference was healthcare has mobilized on this opioid epidemic. The CEOs are sitting up there saying, this is a priority. This is what we're doing.

It was, uh, Geisinger, it was dignity. It was, I mean, they, uh, Intermountain, yes. They were all sitting there going. No, and this is not something we're competing on. This is something that we're sharing. So you know, we're gonna, this is, this is, this is a problem. We can minimize, solve might be a strong word, but this, we can minimize the impact.

We're still gonna prescribe opioids. Hopefully we'll get to a point where there's non-addictive opioids. That would be, I guess, the silver bullet. That would be perfect. You know, the, the real challenge as I see it, is that we each have our, our target. We know that, that American healthcare has prescribed opioid drugs more than than European countries.

Even with the reductions we've had, I, I saw some data recently said, we're still twice as much as in Europe, right? But, Wow, that's not the whole problem. How do we, how do we get engaged with communities? And some organizations do it, some organizations need to, so an addicted person shows up trying to shop in the emergency room and you don't prescribe them if they go out on the street and buy heroin and it's laced with fentanyl and kill themselves.

That really didn't, wasn't a very good solution. And it's so, it's like how do you bring the community together? I'm participating also in the opioid task force from my local health system back in northeast Tennessee. And. I, I've attended a couple meetings now, and it's really interesting because I see a whole bunch of silos, but the, the really interesting thing that I saw at the, in the most recent meeting was a couple of new players and I see them seeking out, they had a, a woman who represented a couple or three community drug stores, so, you know, we need you at the table too.

And then we had another woman from the university who is trying to do community outreach. And because this is, because this is kind of a, what you call the Bible belt, You know, churches have a role in it and there's a person who is engaging the religious leaders to participate in, in outreach to, to families that need help and it to really solve the drug problem more than just reducing prescribing in the hospital setting.

It really needs to be a community. Effort. And that's gonna take a long time. That's gonna take a long time. One of the things that I think it was Ann Weer brought up while she was on the show, and, and I'd never really thought about this, she goes, HCAP hcaps contributes to the opioid epidemic. I'm like, well, you're gonna have to explain that to me.

She goes, well, think about it. Uh, manage, manage pain. That's right. It's a checkbox. And, and then the doctors look at it and go, well, you know what? I just . Did a knee replacement, this person's not gonna wanna come back in. They have to come back in physically. You have to be looking at the person in order to prescribe an opioid.

So they go, Hey, you know what? It's gonna be hard for you to get in here. So they over-prescribe. That's exactly right. I was just talking with that this afternoon. Said the same thing. And, and another, another physician say, and, and, and I don't get paid for another office visit for them to, to renew their prescription.

Yeah. So I'll just prescribe 30 days and then they use it for five days and, and somebody steals the other 25. You know? Right. It's, it's there, it's there for your, your kid or somebody else. But the other thing, the other thing she said is, you know, some people, they, she said they, uh, had done some, um, uh, consumer, uh, questions and, and were talking to this one lady and they said, uh, you took all 30 days of your prescription.

It's like, were, were you in pain? She goes, well, no, I wasn't in pain, but my doctor prescribed it. So I, I took it for 30 days. and you're like, oh wow, we really need, there's so many aspects of this closing. All those gaps you talked about, including the community as well as just education across the board.

Well, and going back to the beginning, I dunno if you're following this, but going back to the beginning, a lot of this started because some Grand Boston I, in one of the prestigious Boston hospitals, wrote a letter to the New England Journal of Medicine. They had had been tracking, um, patients that had been prescribed opioids in the, in the house, and very, very low percentage became addicted.

So, hey, apparently they're not addicted, and this got published. The drug companies latched on it as part of their marketing material. Joint commission was complicit because that was, that's how pain became in the fifth. Right? Wow. And so hospitals were incented to make sure that patients were comfortable.

One thing I've been wondering about, I forgot to ask this question, is you used to be able to get those little devices where you, where you, uh, shot your own, uh, medication whenever you, whenever you hurt. Yeah. I, I, I need to find out if, if that, if we're starting to remove those, That's interesting. Well, so you're, I, I, I, so, I, I hate to, so I spent a lot of time on that.

I was gonna say, I, I'd hate to say you're retired 'cause it sounds like you're working pretty hard. A little bit. A little bit. And, uh, it's great. So this, this conference is in San Diego. You served at Sharp for. For a long time. I mean, well, I, I was at Sharp for, I was in San Diego for 32 years. 32 years, and I was at Sharp all that time.

Wow. And I was a, I was c i o of the last 18 years. And so I know I've got a lot of friends here and, uh, it was good to come out and see some of 'em, anyone who lasts that long. I have to ask this question. So. Um, and I, I almost always get the same answer, but CIOs don't generally last 30 years, so I What do you attribute that to?

I remember, I, I, I came to Sharp as the c f O of their second hospital, and I moved to it back in the eighties, but, so I've had multiple roles over that period of time. Right. But I have to tell you, as 18 years as a C F O C I O, I had a great boss and he, he's gonna retire this next year. A wonderful guy.

Yeah. And he, he's a real team builder. Mike? Mike. Uh, Mike Murphy. Murphy. Yeah. I can't say enough good about it. And, uh, the, the team that we were able to assemble was good. Me, I just couldn't ask more about, say more about them. We were, we were lucky to be able to build a really great team in it, and they deserve all the credit for everything that we got.

That we were able to accomplish. It's a great place to be. That's, that's interesting. 'cause it's the same answer every time I ask somebody who has longevity, I say, what's your longevity? I say, I came in as part of a great team. We were, we're more like a bunch of friends who worked really hard together to do great things in the community.

Absolutely. Absolutely. And, you know, and it, and it wasn't necessarily that way to begin with. Oh yeah. It's hard work. And, you know, we, we, we. We learned to work together in some cases and we learned, you know, we were, these are all okay people. Yeah. And you just couldn't ask. I, and the interesting thing is I spent so long here, it's been, I've been, I've done a little bit of advisory work in consulting since then.

And so, you know, I realize and I appreciate there's other way, the other things, the other ways of doing things. People have different preferences in different communities. I don't find any of it that I think is anything, um, Superior to what we did, and I just, yeah, I, I'm amazed at what we were able to accomplish and what I've seen elsewhere.

The team makes a huge difference. So, um, we had fun together, we worked hard together. Well, it, it, so there are, there's a bunch of CIOs who have had it, who are former CIOs who are out there looking. What would you tell A C I O who's out there looking, who's interviewing with the ci, c e O? What, what should they be looking for in that team?

I mean, it's Is there any aspects, is there any cultural or, well, you really do have to try to understand the dynamics and how they work together. Yeah, yeah. Do they, I. Did, did they just work together or, you know, do they really try to, to respect one another and, uh, do things in the community together? Yeah, I, I remember, uh, talking with some folks, uh, I think it was after I left Sharp and I was describing that we had, you know, some benefits, some events together where we actually, the whole executive team, We, it was at a party and they said, magazine gift team doesn't even talk to one another much to have a party.

It's so you try, you have to try to understand that, oh, it's offended. I'm sure you go through the, the roots of, well, what's, what, what, well, how will you decide whether I'm successful after three months, six months in a year? Obviously you have to go through of that, but it's to try to understand the style and the culture of the organization is interesting.

So I I, I agree with that, but part of me is like, you're sitting across from the c e o and the answer is, would you want to have this person over for, for dinner? I mean, you know, 'cause people hiring their own image. If you're interviewing with the CEO, E O. And they've built out a team. You're getting sort of a glimpse into the team, what the lord, because that's, and it's how, how does this person fit within that team?

Yeah, it's, that's, are you, are you a team player or are you, are you grabbing for glory? So how, um, how do you think it has changed healthcare? It has changed since you've, since you've retired, do you think? Well, I, I can tell I change. In terms of a few things, when when I left Sharp I was, I said to myself, great.

I will never in my life think about cybersecurity that scares the daylights out of me. Well, about a year ago, I was invited to join the, uh, risk, what is essentially the risk and compliance committee of a large health system, and one of their focal areas is cybersecurity and they got a huge initiative underway.

So like I went through a fast. Fresher course in my, in through, uh, a day long. I went through a day long forum and I started reading. It's like, oh my God, I gotta catch up with this stuff. That's a big change. I know that the information security staff at Sharp has doubled since I left there, and they probably would like to have.

Um, I think it, it appears that we're making progress in terms of bringing in some of, some more innovation. Um, people say they're doing it, I'm not sure how much they're doing it, and I'm chairing the most wired program and I see some of the results. And gee, there's a lot of people are doing some things.

There things you're doing, there's more telehealth, et cetera, and, and so I think people are having some fun with that, how widely it's been being deployed. It's kind of hard to tell at this point, but clearly moving in the right direction. Um, I, I, you know, we keep talking about c i o 2.0, 3.0, I, I, I'm not really a big one.

Which one are we on now? Are we on 3.0 already? I don't know, maybe 3.14. I may need an upgrade, but. That's right. I made an upgrade. I, I, I don't really buy into that. I think it's all, we've always had the same responsibility. I'm glad I that we, I don't hear any too many CIOs anymore worried that they're not at the table because I think all CIOs are at the table and, and I think that they have been for a while.

Um, the one thing that make the, that I do worry about is that I still see the cost of healthcare going up and Yeah, and, and I don't fault the IT people for it. I think that it has become a huge part of our economy and, you know, there's all the bright and shiny object syndrome and people are trying to try those things.

And when you talk with organizations, you'll find that . We, we haven't reaped the benefits and some of them we haven't reaped because perhaps the system didn't work quite like we thought that it did, and partly because we didn't take the effort to implement it in a way that can be used. But the cost of healthcare is still going up, right.

And. That's not okay. I, you, you see lots of examples about how we're getting, uh, quality improvements, access improvements and, you know, hitting the patient safety issues. Yet we're, we're not tackling the increasing cost and I think. Yeah, that's gotta happen. Yeah, it's interesting. Um, it's interesting.

Younger people like you who have to pay off the national debt sooner or later would appreciate it. the, uh, think about cost reduction. I think it's interesting is when it, people hear that they sort of cringe. 'cause they hear that and they hear, you know, staff reduction. But at the end of the day, if you're doing it right with a, I mean, you have the, you have the short term lens and you have a long term lens.

If you're looking long term and you're saying, Hey, if we do our IT systems this way, we're gonna be able to do it at less cost in three years or five years. Yes. And then you, if you're having that kind of perspective, then you can retrain these people to do other things instead of, you know, being addressed in, in certain lots of organizations who view it as IT staff reduction.

That's, we can cut the cost of it, but that's not the Oh, yeah. That, that, that's, uh, That, that's bad thinking. It's how do I cut the cost of healthcare? How, how can I, how can I help the, the caregivers do it more effectively and more productively? Yes. You brought, you brought up cybersecurity cybersecurity's.

Um, we, we don't talk about cybersecurity much on the, on the podcast. And the reason we don't is not, 'cause it's not a huge issue. It's because most CIOs can't talk about it. Because you're not allowed to reveal your posture and Absolutely. And all those things. Absolutely. Uh, but I can talk to you about it.

'cause you're not , you're not, and I'm not at this point. But, uh, but the, the thing which just struck me about cybersecurity is you really have to pay, you have to educate that board. So people like you. There's probably a ton of. Board positions that would love someone like you. 'cause you have to educate the board on, uh, what you can actually do.

So we had a scale, we had eight pillars and zero to five scale. Mm-hmm. and, uh, you know, and the board, when I first went in with, with our chief security officer said, well, we wanna be five across the board. We said, okay, do you understand what five across the board is gonna cost? Is like just an astronomical number.

Mm-hmm. , they just look at it as like, look. Cybersecurity is a, a series of trade-offs of where, where do you wanna make sure that you are as secure as you possibly can be? And what other areas can you, you know, make me take a little risk? Because if China says we're gonna hack into that health system, it's really hard to say.

You know, we're gonna put up the same kind of barriers that, uh, you know, the US government does or somebody else. I mean, how do, um, what, you're sitting on a board now. Yes. So, um, what, what's the best way to, to sort of get the right funding, get the right message out there? Get, I mean, I, I assume it has to start at the board level.

Well, it does, you know, the unfortunate thing so that, uh, so a lot of organizations get their funding after they've had a breach. Yes. And that's not what you want to do. Probably true. And, um, I was lucky at Sharp that we got a, we got a few dedicated security people when HIPAA came out and we realized, you know, we gotta do some stuff here.

And then we, we sort of learned over time today, um, if you're, if you're not really addressing it seriously, you've got a big catch up to do. Yeah. The one thing that is good, that I'm really positive about is, Five years ago, um, I don't think I, I, I probably could spell nist, but I didn't understand it today.

You've got a decent framework in nist. You've got, and you've got High Trust, which some people support and they've all, they've all got reasonable scale, so they should measure yourself against them. We all, we've brought in and had an annual review from an outside firm where they did general assessments, but it wasn't really as

Structured as it could be. And, and you could, and it wasn't as measuring you against the rest of the world other than in a kind of a subjected manner, uh, by the, by the consultant who said, well, you're about this compared to everybody else that we consult with. Right. I think using. Having something like a NIST or a High Trusts gives you a lot better targets to shoot for and, and so that you can know, know the gaps.

But even with that, you still have to be able to have somebody do the assessment and be be willing to suck it up once you're, let them hear and see how you're doing. Yeah. And the NIST framework was the framework we used to come up with our pillars and our model. Mm-hmm. , um, I don't think people know this, but there's, there's a NIST framework for cloud computing.

It's also the framework we used back in 2000, and it was available back in 2010. So this framework we used in 2010 for the health system I was at is the NIST framework. Great set of material to . To, to dig into If CIOs aren't digging into that, that's, that's phenomenous. Well, and I think it varies, but I, I think most of them are today.

Yeah. I was over at, well, at least the security people definitely are. Well, that's for sure. And, uh, I was, I walked over to see some former colleagues over at the, uh, he, and they had. A conference earlier and there's a room full in, in this, in the security one. Yeah. I, a lot of people are looking for education and that's important.

So I, you know, I'll probably close with this question and, and the question is, um, let's see, I'll probably about 15 years away from retirement, so what's your coaching to people who are getting close to retirement? CIOs are getting close to retirement. Do you have any, any words of wisdom?

Here's the thing, I don't think people can grasp. CIOs are listening to this sort of get it and everyone who's in healthcare sort of gets it. But when, uh, when I left the last health system I was at, I was at a point where I was getting about 250 emails a day. I, who knows how many phone calls, texts, and, you know, and at least one emergency a month where you're responding.

I mean, so the pace is, is crazy. When you retire, that pace goes. Down pretty quickly, doesn't it? I'm still getting a lot of emails, A lot of it's, a lot of it's stuff that I just didn delete with. You know, I, I think there's a couple things. One, I think many of, we all worked too long, and I see too, I've see too many people who are, who, who, who retire and then their, their health doesn't, doesn't allow to do the things they want to do.

Yep. So it, it tells you to do some realistic financial. Planning so that you really know when you could retire. I probably could have retired sooner than I did, but I was cautious. I am cautious. Yeah. And so, yeah, I, you know, that's important. But then the other thing is to be thinking about what you're gonna do after retirement, because all of a sudden you've got a lot of time on your hands.

Yeah. And I'll say I didn't do a good job of that. I, and, and so I did a lot of work for the first three. This was wonderful, and I'm still continuing to do it. But you have to be thinking about how you wanna spend the time, whether you're gonna travel. Okay, where am I gonna travel? I mean, let's plan it.

Make sure that you and your spouse, you have a spouse or someone in agreement. Yeah. Make sure that, uh, that, uh, you, you've reached an agreement about how much you wanna be under each other's. Yeah. How much you wanna be together, how much time you wanna be together, all of a sudden, oh golly. My dad retired from three M and I love my dad, but the amazing thing to me was he's, he told me the story the year he was getting ready to retire.

Three m sends out a counselor to their upcoming retirees and they, they do this little thing where they sit across from you and they say, okay, what's your plan for retirement? And if you say things like, I'm gonna do stuff to my house, they say, okay, that's one year. And then they say, well, we're gonna travel.

They say, okay, how much are you gonna travel? How much money do you have? And they're like, you know, any, any redoing your house, traveling. It's like all these things cost money. And then the other thing people, so do you have enough money? And then the second thing is you overestimate. Do you think, oh, I'm gonna work on my house for the next five years?

Well, unless you have a farm in acreage, that's not gonna happen. Yeah. Your house is done in a year. Well, you know, there's a couple things. One, um, . Like I did when I did my financial planning, the planner forced us to put in a travel budget. Yeah, that's make sure that you got the money there and that you're going to, that you're gonna spend it.

You have to do that. You go crazy. But then the other thing is, all of us . Are pretty talented professionals. We've got a lot to give and so think about what else you can do. I have a friend who's who retired and unfortunately has a lot more money than I do, I think, but uh, you know, he's gotten involved in his community non-for-profit organization and helping the elderly and bringing some leadership to them in terms of their fundraising and in some of their community mission.

And that's, that's just a really good example, but there's something that we all feel strongly about different things. Everybody feels strongly about something. Figure out how you can get back. Yeah. Some people do it. You're, you're still gonna work, you just don't get paid anymore. Yeah. Some of it do, do it through churches, some of it do through, through community clubs, some of it do through various other not-for-profits.

Absolutely. And I'm sure some of it do it. You know, I, in my Kiwanis back in Jonesboro, Tennessee, there, uh, there's a group of people who just go in . to the elementary schools, the new reading program to help the teachers out so the kids learn to read better. Yeah. And you know, all of that, those things are important.

It's just a question of what you, what you are, are inclined to do. Yeah. I don't think people realize, but Kiwanis is still out there, Rotary's still out there, and Rotary doing some great work on, I mean they've always on polio and, and other things. Oh yeah. Lions and, and there are some clubs that I'd never heard of until I moved to the East Ton and Ton and I still dunno what they do, but they're very, very active.

Yeah. A lot of great stuff. Well, bill, as always a pleasure. I really appreciate it. We will definitely have to do this next conference. This is a lot of fun. Great, great talk. Thank you. Wow. I really wanna thank Bill Spooner for coming on the show. I learned something every time I sit down with him and I, I hope you really enjoy the show.

As always, you can uh, pick up more episodes on the website this week in health it.com. You can follow a show on Twitter at this week in h i t. You can follow me on Twitter at the patient cio and you can follow my writings on the health lyrics website as well. And, uh, please come back every Friday for more news information and commentary from industry influencers.

That's all for now.

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