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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. Today we ask the question, what do executives need to know before they pull the trigger on mergers? Plus, we, uh, we bust some of the cybersecurity myths that are out there.

This is episode number 40. This, uh, podcast is brought to you by health lyrics. Health systems are moving into the cloud to gain agility, efficiency, and new capabilities. Work with a trusted partner that has been moving health systems to the cloud since 2010. Visit health lyrics.com to schedule your free consultation.

My name is Bill Russell, recovering, c i o, writer and advisor with the. Before I get to our guests, I wanna thank everyone, especially, uh, my guests who have made the show a success. Uh, we set a goal before we started the year to get 500 weekly downloads of the show, uh, in the first year. And so that was a, that was our big goal.

And, uh, this past week we eclipsed a thousand downloads for the week. Uh, we want to thank you for making us a part of your week, and we hope that you'll continue to share the podcast, uh, YouTube channel with your peers. Uh, today's guest is to. You're probably like the fourth chime, c i o of the year that we've had on here.

A highly decorated industry veteran, uh, Craig Richard joins us, uh, from North Carolina. Good morning, bill. Thanks for having me. You know, I assume you're in North Carolina, but every time I check social media, you seem to be in a, in like other countries or other locations. Are you in North Carolina today?

today, I'm, even though I had do have New York in my background, so I think when you, when you're a child, you know, the, the world is so large, but as you get an adult you realize it's very flat and you can. Very mobile, you know, in any places that needs you. Yeah. I think one of the posts I saw you in, were you in Asia doing some things in Asia?

I was, I, I did some work, uh, in Thailand, uh, with a very large healthcare system, a healthcare system that was, uh, had part of the system was kinda more of a community service type system. It was a 2300 bed, single facility, hospital with clinics, et cetera on it. Then they also had a private, uh, facility, which was 350 beds, which catered to the, uh, the enhance the improve those that had more of a cash payment system.

So is healthcare. So healthcare is, is pretty dramatically different. I mean, Thailand's pretty, I mean, if you've been to Bangkok, it's a pretty advanced city. I mean, or is it pretty dramatically different or pretty similar to what we have here? It's interesting, you know, when, when going into it, I had some assumptions of what I was gonna run into and, and, um, some of those assumptions were wrong.

The way I would say it is that when you look at , At the US healthcare system and how we advanced on the digital technology ways, it's much more advanced than what I observed. However, when you look at outcomes, when you look at, uh, margins, we looked at all of the, the measurable pieces that we all aspire to be.

They actually were leading in many, if not most, all of those cases. Wow. That's interesting. Well, I'm gonna do, for people who know you, I'll do a quick fly by of your accomplishments and, uh, And who you are. If, if they want to know more, uh, you, you have a website, so you have craig richard v.com. Yes, I do.

Please go and visit. Yeah, which has a ton of stuff on there. You've done, uh, advocacy work, uh, in the nation's capital. Uh, we've already mentioned in, uh, 2015, uh, John e g Jr. CIO of the year, uh, by Chime. Your, uh, 2017 leadership award, uh, for Charlotte c i o. Um, most recently you were with Carolina's Healthcare System, which is now Atrium Health.

For those who don't know, uh, roughly, I mean, that's roughly, what about an $8 billion system? Uh, is that roughly right how you measure it? It's somewhere around 6 billion in terms of the owned assets. Then we look at the managed assets. It's right around 11 billion. Okay. And, and the geography is, today is Carolinas, but obviously the name change sort of denotes that it's moving outside of North and South Carolina, I would assume.

Yeah, I think that's the intent of the name change. Uh, for my, when I was there, we had three hospitals. When I left we had 42 all in North and South Carolina. So clearly you had a , a lot of work to do while you were there. So 14 years in a row, uh, most wired designation, uh, which is awesome. You're a fellow at, uh, uh, American College of Healthcare Executives, fellow at Healthcare, uh, at hims.

Uh, chairman of Premier Member Technology Improvement Committee. You're on several boards, university of North Carolina, Charlotte Foundation, uh, board member of Care Connect. Board member of Carolina's Shared services. So, uh, not only were you able to be the c i o of a, a rapidly growing healthcare system, but you found time, uh, to give back and be a part of a lot of these, uh, uh, things that were going on in the community, which is, which is exceptional.

So, you know, one of the things we like to do with our guests is start with a pretty open-ended question. Uh, what's, you know, what's one thing or what are some things that you're working on today that you're really excited about? Well, there's probably two things I'll mention. First and foremost, I have.

Three boys and two of 'em are getting married within the next year, uh, one in two months and one in seven months. So from that standpoint, uh, like any parent that's really on top of mind for me. But secondly, professionally, um, what I've been doing for the last six, seven months is really going out and looking at different companies, different companies of different sizes.

That actually deliver across, uh, multiple industries. I looking to see a handful of really golden nugget companies that I would really be interested to be part of working with and or that when I was in the c I O seat, I would really would've appreciated people bringing those kinds of nuggets to me.

Yeah. You know, one of the things I've, I've thought about is we, we could do a, a whole show on, uh, CIOs in transition. I mean, your story, my story, and a handful of others that I've, uh, had conversations with. I know that, uh, a friend of mine just, uh, became a co c e o at a former c i o, uh, here in Southern California just became c e o.

Uh, pretty fascinating tech startup that's doing some really cool big data stuff in healthcare. And I think there's a lot of different directions CIOs have ended up going. They, they can go in that startup route. Uh, uh, Pravin from, uh, from uh, Stanford went to a startup. Uh, this gentleman, um, from Molina went to a startup.

So, uh, you can go the startup route, you can go back into the c i o route. Um, you know, I started a, uh, consulting practice going back out. What, what other directions do you think CIOs end up going at this point? Do you, do you have any thoughts on that? Yeah, you know, I, I do think it's, it's a, it's a very interesting piece to be.

I mean, the role that we've had, you know, the, the, the science that's behind what we've done or we've been able to accomplish, especially when healthcare, in which we've been able to do a lot of things in a very short period of time, where we look at some of the other industries. Whether it's retail or banking, others, if they've done some things over a couple of decades to get to their point, we've done things, you know, anywhere between six and 10, in some cases 12 years.

And I think we really advanced the system. So when you look at a C I O and you look at the industries, most industries all becoming technology centric, the c I O role can actually go all the way across. So I like it when people are saying the C I O is becoming the c e O or the c i o within healthcare can be the c i o within retail or banking.

I think there's so much that we can deliver back to, uh, you know, other industries or other companies. The one thing I'll say the most, and I think for all of us that have been successful in this role, the biggest thing I have been proud of, and I'm sure yourself and others, is really just the development of people.

And having the ability to learn and to deal with multiple people at different levels across the organization. You don't come in with the mindset of a technology person. You come in with the mindset of a business person to solve problems, and because of that, you know you're bringing in all the other senior executives and able to bring them around you so that you can be part of that decision making process or part of that inner circle.

Yeah, we, yeah, we've learned that when somebody goes, Hey, are you gonna do this big? Are, are you gonna do that E M R migration? You gonna bring all those things in? Our first question is, you know, usually what problem are you trying to solve? Tell me what pro you know, it's, and then, uh, and then, yeah, then it's a matter of rallying people.

It's really a, it's a leadership and a people role much more than a tech technology role at this point. Yeah. And for me, you know, sometimes that answer is, it's not, I'm gonna do it. We're gonna do it . Yeah. It's all a partnership. We're all in this together, no matter what the objective is. Yeah, absolutely.

Alright, so our show breaks down into two segments, uh, in the news, and then soundbites, uh, where I ask you a series of questions. We'll start within the news. I think the big story this week, and, uh, we try not to cover every one of these that's talked about, but this one's pretty big. It comes from the Houston Chronicle.

It's the, uh, Memorial Heron to merge with Baylor Scott and White creating the largest health system in Texas. And we know that in Texas, they like to have the largest things. And, uh, this, this is now a pretty significant, uh, well, they, they were significant health systems, uh, in and of themselves, bringing them together.

Make 'em pretty big. So let me read a couple things from this. Uh, two of the biggest hospital changes to Texas announced plans, uh, Monday for a merger that would create a mega system stretching from Dallas to Austin to Houston treating patients in more than 30 counties and employing more than 73,000 people across the state.

Uh, Memorial Hermann Health System. Houston's biggest nonprofit, uh, hospital chain in Baylor Scott and White Health. Uh, the largest in Dallas have signed a letter of intent to begin negotiations. With the goal of having a definitive agreement in place by next spring. Uh, and then it has the usual stuff, uh, growing national trend, like-minded systems, economies of scale to address, uh, growing consumer trend within, uh, healthcare.

Uh, the article actually gets a little more, a little more, uh, a little more interesting down at the bottom. And that is, you know, the, the cost of healthcare is the number one issue in America, whether it's in DC or Austin, Texas. Uh, one of the people is quoted as saying, saying, um, so taking costs outta the system will be an important part of the journey as we come together.

Actually, this was the c e o I believe of Memorial Hermann. So they actually just come straight out and say, taking costs out will be an important part. Which is actually kind of unusual for these kinds of announcements, especially this early in the process. Uh, officials said that most of the cost savings would come from, uh, sharing of expertise, collaborations, and technology.

Uh, as is usually the case. Uh, it's not clear whether the merger will lead to, uh, job cuts. Uh, that two systems combined have nearly 5,000 current job openings. So with 5,000 job openings, there might not be a need, is what they're essentially saying. Um, Actually, I, I find it interesting. Usually when mergers come out, there's, there's no talk of any, any reductions, uh, at least for, you know, a, a good period of time to have one of the CEOs come out and start talking about reductions this early as pretty interesting.

Have, have you seen, uh, first of all, have you, have you ever, have you ever done a. Have you ever done a merger that hasn't led to some aspect of restructuring or, uh, job, job, uh, you know, attrition in, in the process? Yeah. No. I mean, when you look at the cost of healthcare and you look at, especially a healthcare provider, Somewhere between 45 and 55% of all of our expenses are labor.

So from that standpoint, it just makes reasonable, whether you're doing it as a cost cutting objective, or you're doing it because of a merger and acquisition, there is gonna be some impact to your labor bottom line. But you know, it depends on how you handling it. So to me, the most important part is try not to affect people.

So the fact that they have 5,000 probably budgeted job openings means they could cut several thousand jobs. Restructure the work to process the workflow and not impact the person and still be able to achieve their budgeted expectations of reductions. So given you know that Baylor and Scott and the White have recently done this, the memorial certainly is a very well recognized and respected organization.

I gotta believe with both of them coming together with their past successes, they will have the opportunity to, you know, to make a difference. And I think part of that will be to lower the cost. The, the, the, the expense structure. The thing that happens with that though, is, Gonna do with those savings are those savings can be reinvested back into the company, do other things with it.

They can go toward bonuses, you know, to administrators and physicians and others, or they can go back to the patients or a combination of all three. And I think that's where, you know, the rubber kind of meets the road, is pending on what the outcomes are gonna look like, what is gonna be done with those to better the patient experience or the patient.

Yeah. As the story goes on, um, towards the bottom, they, they cover so many healthcare. Economists disagree on the notion that hospital mergers lead to better, more efficient care for patients. Uh, uh. Vivian Ho, a health economics professor from Rice's Baker Institute of Public Policy said she worries the proposed merger could have the opposite effect.

She pointed to research showing increase in healthcare costs, and then they have four or five other, um, corroborating kind of statements around, uh, that it hasn't led to better outcomes or lower costs, uh, in the communities that they've served. Um, Why do you think so many mergers haven't led to, um, either better outcomes or lower costs in the community?

Is it, uh, you know, is it because we're not, uh, taking those savings and passing them on, uh, to the, uh, to the community? Or is it, uh, is it less competition in those markets? I mean, what, what do you think? What do you, it I think that's very, um, Valid point statements. The concern when you have something of this size coming in, I think it, you know, to me most of it has to do with the art of the deal.

You know, it has to do with what is the deal that is being done and what are the realistic expectations. In many cases, they may overcommit and under deliver, even though that delivery might be better than what the previous, uh, environment was. If you commit X but you don't achieve it, It looks like, like it's a failure.

So for me, I think it's really kind of trying to find the right balance of commitment of delivery. Delivery and making sure that you know that the community and the patients and the providers all, you know, experience some type of improvement. And when you look at change management, having been through several mergers, acquisitions, partnerships slash management agreements, Over the last two decades, it's really all about establishing the correct expectations and then realizing those expectations.

And in many cases, you know, your goal is to overachieve, you know what you've already committed to. So as long as you go into it, I think with a realistic understanding of what you want to try to get out of it, ensure that it's measurable, ensure that you can track against it. And the other part is we're in a very ever changing environment.

So as we start to shift and move things from volume to value, It's not an experiment where today when they make this announcement three years or five years later, when they measure it, it's not like the environment's the same environment. So there could be all different kinds of aspects that may impact what those results would be and how some people may interpret those results.

It could have been a lot worse. Maybe it could have been a lot better. So to me it's just gotta measuring, monitoring, ensuring that you're doing the right, that the board in these cases, you know, they're all community based. So from that standpoint, What they wanna do is measure the benefits back to the community.

And those are, you know, you can measure that in multiple different ways. And then change management's a big piece too. I think that's probably one of the underlying, uh, um, assumptions that people don't take as seriously. What they should is the change management that happens. So if you want to have a more efficient system, more effective system, that means something's gonna change.

And in many cases, as you know, bill, that means people are gonna have to change. People are really hard to change. You've got two organizations, highly respected, you, highly decorated, coming together. They're both gonna have best practices, but the reality is there's only gonna be one best practice. So it's not gonna be multiple.

So as you start to bring in different service lines together, they different corporate areas together, they're all gonna have to agree as to what the next best practice going be. It could be neither of the. They've been practicing, but actually there's a third outcome now by taking the best of both worlds and putting it together, I think that's the utopia that we're all looking for.

Yeah. So here, here's the good news. The good news is that Matt Chambers, uh, has been, he's, he's got the merit badge on m and a. 'cause. The Baylor Scott and White, uh, merger was something that he was, uh, present for. So you said it before, which means he'll have an appreciation for the complexity. Of, of org change management and all the things that you're talking about.

Uh, I know that Memorial Hermann was doing a search for a C I O earlier this year, so, uh, it's not really clear to me whether they ever filled that position. So let's, I'm gonna shift this towards healthcare it now and just focus in on that. And we're gonna give Matt some free consulting. Not that he's asked for it, but we'll give it to him anyway.

Um, what do you think, what do you think Matt needs to do now? They haven't even, they haven't even gotten to a definitive agreement yet. Um, what do you think Matt needs to do over the next six months or so, uh, to ensure the best outcome for the merger from, uh, you know, for both organizations? Well, this is the most important piece of the relationship, you know, is to understand each organization and what a combined organization might look like and.

You see it all across the country where sometimes they're, they do have a letter of intent to come together, but they don't make it. 'cause as they start to peel back the onion, they start seeing that there are things that maybe they had expected or unexpected. Things start to show up on either organization and we try to bring it together.

Either it's a cultural problem, it's a financial problem, it's a clinical expertise, whatever those things are, start to peel that back and you see some that are successful. You see some that have gone on in, you know, for a couple of years, several years before making a decision. I think this is the most important piece is to truly be a very open, transparent, you know, in this due diligence phase where all each organization is, is really exposing themselves to each other.

But that is the opportunity to make sure that you thoroughly understand what you're getting into, so that hopefully in the, when the spring comes around, you have a defined, definitive agreement and objectives of what you want to get accomplished, and the realistic expectations that you can either achieve or overachieve those, those expectations.

So these next six months or so I think are gonna be critical that everybody is open, transparent. There's nothing that's being hidden or forgotten about, but that you really know what you're getting into. Just like any marriage, you know, between a husband and a wife or any other relationship, you know, you've got to really understand the other party coming into it if you really wanna get outcome.

So is there a common mistake that CIOs make in m and a activity, do you think? Yeah, I do. You know, I, um, I can't say that it's, it's always a mistake, but I think there's an assumption that running on a single system or a single set of systems is the best way to go. So whether you are talking about the e emr, whether you're talking about um, you know, corporate areas with e r P systems or et cetera, I think there's a, a, uh, a natural tendency to say we're all upon the same one.

It's gonna be a better and more effective, more efficient. I think what happens is both systems, in this case or in any other case, have made huge investments in it over the years. And so just to throw away that investment and merge it together, that's a big cultural issue. That's a big financial issue. I think you've got to thoroughly understand which of the priorities that need to come together first.

So you start bringing the organizations together. You would see things like your communication systems, you know, email, phone systems, et cetera. Uh, some of your video conferencing, all that coming together right off the bat. Nobody typically has a, uh, has a strong play or a preference to what they wanna use.

But you wanna be able to operate like one system. We look at things like e r P systems, to me that's probably something too that you wanna start bringing together to get the efficiencies and try to get some of the, the squeeze out of, uh, the work play. Then you get to the clinical systems, but those are very sensitive systems.

You have people who have a lot of pride and a lot of ownership of what they've done, and to put 'em all upon the same system may or may not be the right thing to do at that time. I do think as time evolves, it does become the right time once you start to. Depreciate that investment. It's down to the point to reinvest, reinvest on bringing it together.

But they have to be that right up front. I think you're probably throwing away some good dollars or yet to be realized in terms of, of their returns. And it's not a priority at this time because to bring those clinical service leaders together, you know, those are people that are, are, you know, extremely.

Um, uh, bright, uh, they're optimistic. They have a lot of characteristics that are gonna be, you know, that they have the best practice and those, it's gonna take some time to kinda work through and to show each other that type of respect. So I think those are things that probably lag a little bit farther down the road, but to me it's just, just kind of reiterate.

It's really that you have to be on one system and that's gonna achieve, it doesn't, it may actually cause more problems with change management. Things of that nature. And in many cases, because we're so immature in our market with our systems, some, it is like the baby to some of the leaders, this is what they produce.

They made this happen. Whether it was an Epic or a Cerner or Meditech or you name it, this is something that they really feel emotionally attached to. You've got to remove those emotions, that system with. A lot of motion. It's interesting that that does end up being one of the first questions that gets asked by everybody.

It gets asked by the media, it gets asked by, you know, all your clinicians, like, are we going to. Are we, you know, and, and the answer to that question is, you know, we're still working on a definitive agreement. Once the definitive agreement's in place, and we've, you know, we've, we're working towards merger, we're still not gonna be able to make that decision.

We're not gonna be able to make that decision until our clinicians are sitting in the room with their clinicians talking about all aspects of clinical care and what our, uh, desired outcomes are. And then determining, you know, what's the best system and what. What drives the best thing? So it's, it's usually not for another 12 months after the merger, unless it's a, now let's get some, I mean, if it's a merger of this size, two equals sort of coming together.

That's, that's a different animal than say, you know, a large health system acquiring a small whatever practice. That's a, that's probably a different conversation, but even then, it's not the kind of thing while you're doing negotiation that's that easy to answer whether it's gonna be the best. So yeah, and if you look at, you know, today's world and the future of the, the delivery of healthcare interoperability becomes such a key concept.

You know that the, the other providers in your market are not gonna have the same quote unquote information systems that you have in many cases. And from that standpoint, you've got to start improving your ability, your art, your science around communicating back and forth with other providers. 'cause you're gonna have that in your a c o or other types of, uh, associations that you're creating.

You're gonna have the, you're gonna have to have that core competence integrate back between multiple different vendors systems. You might as well, you might as well figure it out now. Uh, I'm gonna, I'm gonna move us to the next story and we're actually not even gonna cover the next story. We're just gonna use it as a backdrop for our conversation.

So, uh, healthcare, it has a whole section on. And, um, one of the stories they have is 10 stubborn cybersecurity myths busted. And they have some things listed there that are pretty interesting. Uh, but it got me to thinking it would be interesting to talk to another c i o about, um, you know, what they think are some cybersecurity myths that are out there, uh, and why they are myths.

So here's the challenge. What I'd like to do is go back and forth on some of the myths that we've seen in, uh, cybersecurity myths we've seen in healthcare. Uh, that are out there and just sort of bat 'em back and forth. Um, and just to give you an idea, I'll, I'll, you know, I'll start us off. Um, I was in a, I was in a meeting with our internal auditor and we, you know, we were sort of presenting our security posture and, and they were sort of commenting on it.

And a former N Ss a person was sitting there and, um, she looked, she looked at me and she said, uh, She goes, okay, I'm gonna, I'm gonna give you one thing that you need to do and it's going to change how you do all of your security. She said, assume they are already in your network. And uh, and as we started talking about it, you know that I think the myth is that you can keep 'em out.

And she said, assume they're already in your network and they might even be in with proper credentials. And she goes, so now how do you design your security? And I thought, I. Wow, that really does change things. Uh, instead of that exterior being the end all be all, now you have to look at a more comprehensive, uh, security posture where you're looking at, uh, people's activities on the wire and saying, it does that activity match what they've been doing for the last six months?

And if it doesn't, that becomes a red flag. So you're looking at behavior on the wire, you're looking at, uh, exfiltration of data. You're looking at a lot of different things than just. You know, do we have, do we have the wall built up and do we have policies in place that there's, uh, you know, sometimes with the walls built up as well as you can, and your policies in place as well as you can, they're still on the wire and you have to start looking for that activity.

So I think that's the, you know, for me, that was one of the biggest myths that was busted for me, which is, uh, you know, assume they're on the wire and assume that you can't keep 'em out. Um, . Yeah. So what's, what's a myth that you've run across? Well, you know, it it interesting, like for example, in this article, it's in healthcare IT news.

And you know, for me, when you look at, you know, cybersecurity and the whole aspects around this, this is not a healthcare issue and this is a total all industry issue. Everybody's in it together. So the fact that we advocate on behalf of the healthcare and financial services and retail, and this is one of the things like for example, the Charlotte c i o that you mentioned at the beginning.

Uh,

So a lot of people are interested about bringing things together across all the industries. I'm very proud to have been part of that. When you look at cyber and next week, that's actually is our, is our next event is we have one event every quarter is about cyber and so you're gonna have the, the major banks in town, you're gonna have the major retailers in town, the major energy in town, the major healthcare systems in town, et cetera, all participating on the cyber piece.

So it's really not a healthcare IT type thing. It is a IT slash business. So when you look at, not even the cio.com, but these are the business aspects. Wall Street Journal, New York Times, you know, the types of, uh, information that that needs to be exposed to is to the board members and the senior executives.

This is a business issue of having the cybersecurity. The one thing we don't have the luxury of that we. And, you know, from a physical security attack, I don't have to put, you know, anti-missile systems around my facilities or anything. So the government protects us in certain aspects, but we look at the internet and the way that it's set up to be a global network.

The United States can't put a border around it and provide those protections. So we're kind of all in it right now on our own. So to me, I think it would be a very, uh, nice way to move forward is to actually have multiple across industry. C i o leadership, getting together to start to look at how do we fight and protect, you know, our assets, our data from cyber attacks as a unified industry as opposed to the different sectors that.

I could see that as one of the myths that we probably believe is that we need to do this ourselves. And, and as you're pointing out, we all have the problem. I remember hearing a gentleman speaking and he said, um, uh, and actually he was sort of dis in the government a little bit. He goes, you know, I. For cybersecurity.

Essentially these countries, these uh, countries that are, are stealing the data. And in this case, he used China as an example. He goes, this is the equivalent of China parking aircraft carriers off the East coast and West coast, and just, you know, attacking on a daily basis. He said, you know, the, the federal government needs to step in here.

He goes, because

on individual. Um, your individual organization, 'cause those nation attacks, those nation state attacks on your hospital or on your, um, on your organization are, you know, unlimited funding, unlimited time, unlimited , I mean, unlimited resources. So, um, you know, so how do you think we're gonna partner with the, how have you partnered with, say, the F B I, the, uh, with the federal government?

How, how have you seen them sort of take a role in this? You know, I've advocated up on Capitol Hill multiple times for multiple different topics and cyber was one of 'em. And so I represented Chime, which is a fantastic organization that you know, and I've represented Premier. And part of those discussions in talking to the federal government is they really will say, if you want us to help, Put some borders around will probably set you back about 10 years, given the different restrictions and the different things that they have in place there, and the expertise that they don't have.

So I really think it's across all industry thing. That's why, like for example, next week at the Charlotte's gonna be all the CIOs across, you know, multiple, uh, industries representing. You know, um, probably about 40 to 50 different major companies that are home based here in Charlotte will all be coming together to talk about cyber and the things that they're doing, what we're doing.

And when you say you can't do it yourself, you're a hundred percent correct. I think that's a misnomer that some of us, you know, may have had in the past. You know, I started doing cloud computing, oh, you know, maybe about 10, 12 years ago. Moving things off premise, moving things out, knowing that I did not wanna be a data center.

Centric, um, uh, company nor a service, but that was gonna be more of a utility, and it's gonna be what I do with that information that to actually make the difference. And one of the, the questions that came up was, how are you gonna have our patient data, our most precious data, you know, off campus, somewhere else being stored?

Like, you know, my response to the board at that time was, you know, you can't expect me with the budget and the investments that you're making today. A better perimeter for protection and detection when it does come in than somebody who does this as part of their core business. So actually by moving it offsite or moving it up to the cloud, in many cases, you have a higher level of security and protection by doing it that way.

And then it becomes more of a service. You still gotta have some people, you know, on, on the streets, some feet on the street in your shop. But a lot of those services, the 7 24 monitoring, all those types of pieces need to really be helped by somebody who does it as a core component of their business. And we do it as a, you know, as kind of almost like a insurance policy for our business.

It just doesn't have the amount of investment that others can, can do, you know, and, and make in the cybersecurity space. Yeah. And I think that is, that is one of the myths, right? So cloud is not secure. Well, you know, saying cloud is not secure, is like saying healthcare, it is not secure. Well, it depends on which one you're talking about.

But you know, Microsoft's cloud, Google's cloud, Amazon's cloud, uh, box is cloud. Salesforce is cloud. You know, if they get breached, that's their core business and they will have a significant, uh, hit on their revenue, their shareholders, or their share price and all. I mean, so you have to know that they're spending a ton of time and a ton of money on security and probably far more than any.

Uh, individual healthcare system is spending on security. So I agree with you. I think that's one of the myths is that cloud is not secure. Uh, there are many clouds that are much more secure than what we have. Uh, here's another myth I'm gonna throw at you, which is cybersecurity is a technology technology problem.

I don't, you know, cybersecurity has a component that's technology, but, um, You know, at the end of the day, it's, you know, 70% of all breaches are caused by individuals either, you know, clicking on something, doing something, uh, reusing their password all over the internet, uh, having it hacked that way. I know that, uh, uh, and I've shared this before, that, you know, uh, there's a c I o I know went to, uh, R s a I believe, and said, you know, we want to do an audit.

Uh, we wanna see if you can get, uh, some of our, uh, physician credentials on the black market. And it only took 'em about 48 hours to come back with some actual credentials of acting physicians that they could log into their Citrix environment, get into their E M R and start view viewing patients. And when they, you know, did the research on why that was, it's 'cause those doctors used those same credentials that they used to get into the E M R.

They used them for their banking system. They 'cause, you know, they had to remember 20 uh, things. So it remains, it re it remains a people challenge more than anything. How do you get, you know, it's Baylor Scott and White now, 70,000, uh, some odd employees with Moral Herman. How are you gonna get 70,000 people to act?

In a way that's not going to, uh, jeopardize your security position or your security posture. Uh, and that still remains the biggest problem with insecurity, I believe. Yeah, and I think part of that bill, I didn't respond. Now with that is, you know, we look at, in some cases, I think there's also an understanding, or at least a feeling that in many cases consumers are a little bit numb to the cybersecurity.

Number one, they don't understand it. Number two, we've probably all been breached, you know, a handful of times or so in the last several years, whether it's the target breach or the Facebook, I mean, you name it. I've got several different, you know, monitoring services free of charge on me because I've been breached so many times and they offer that out there.

And so when that does happen, you need to take advantage of it. Getting back to your core question about the company, I, I think it is a people problem, but a technology solution. And, and by the solution standpoint, you know, it is the people that are doing this. And when you go through, you know, we all do the education, we all do the fake phishing.

We all, you know, did all those things. And when you look at, even when you tell the department or the division, I'm coming at you next month, you know, with a. You had, you see marginal improvement, people are still clicking on those phishing attacks and, and jumping into, you know, places that they really shouldn't be jumping into.

And I think it's for us, you know, it's still the continuous to try to manage, monitor, uh, detect, contain when it does occur. 'cause you're right, every system, every. System has been breached. If you have not been breached, you just don't know it, right? That's the, I think the underlying fact you have been breached.

So once that does happen, just like your question, you know that somebody posed to you, what if, just assume they're already in your spot. You have to contain it. You have to contain it. So it doesn't spread. Then you have to remove it. You have to figure out how they went in and try to plug that hole again, because, uh, know in.

Is when you look at today's internet population, you know, globally, it's billion in.

The potential number of victims for cyber attacks. So you talk about the cyber criminals, you know, they're just kind of salivating, like my number of potential attacks will go up by 50% of of victims over the next five years. That's a huge growth. That still, you know, isn't even the total population yet.

So from that standpoint, I think they see it as the, the pots keep getting bigger and that's where I think as an individual company or an individual industry, there's only so much that we can do, I think, to step it up a notch and do things that are across all industry. I. We're trying to do here in Charlotte, if you could bump it up in other major cities and have those cities come together, I think you would see over a period of time, possibly everybody, you know, working together on this.

Because to me, you know, this is not a competitive component of, you know, any type of business you don't wish this upon. You know, your your worst competitor. Yeah. This is not something that you play with. We all wanna play in a very safe environment and have everybody's data be protected. Whether it's yourself, your competitor across the street, or somebody across the country.

So it's for all of us to come together, and that's gonna be, I think with the leadership, the boards, the CEOs coming together and start to link things in. So when you look at some of the mergers, that's probably, you know, one of the advantages that goes undetected is at least we look at the merger we talked about at the beginning.

The one thing that we'll say is those are two very large organizations that now will be able to share best practices among each other about how to better protect. The assets and the data that they're privileged to keep on behalf of their patients. And so they will end up having, at the end of the game, a much better protection in place than what they currently have in each individual organization.

Yep. Well, I'm gonna move us along. This is the, this is the part where you're gonna end up doing a majority of the talking. I'm gonna, uh, the soundbite section, I'm gonna to us out five different questions, uh, short answers, one to three minute answers. If you go longer, I'm not gonna stop you, but, uh, but generally one to three minute answers on these.

Uh, thanks. We're gonna focus in on innovation. Uh, the first time I met you was at a, um, Dreamforce event, and, uh, I think we were the only two healthcare CIOs at the event, and we happened to sit at a table. Uh, uh, talking to some people about how healthcare could benefit from c r m and, and, uh, you know, I, I think it was pretty forward thinking back then and I was kind of surprised to even see any other healthcare CIOs.

I think there's more, I think Dreamforce is actually going on this week, or, or, yeah, I think it's going on this week. There's probably more healthcare CIOs there now than there were before. So, uh, alright, so five questions. One to three minute answers. Let's start, uh, question number one. What industries do you look to for inspiration for innovation within healthcare?

Great question. Um, my, under my answer would be all. I think there's a lot of nuggets that they gain from all industries. So when you look at the energy sector, there's things that they do to try to limit the use of energy. And so from that standpoint, we're trying to limit the use of healthcare. I. So, you know, those are both two very precious resources.

So I think there's things we can learn from them. Retail obviously on how to brand, how to get things out there, banking services, all that stuff kind of brings things into, uh, a patient's hands or a consumer's hands. Putting things, you know, in, in your pocket. I think all those different industries are all things that we can learn from.

We never within healthcare had to, or very rarely had to focus much on. People came to us because their doctors told them to come to us. Or people picked those doctors 'cause they were part of the payer plans, then they were in-network versus auto network. You don't have, I don't have an in-network bank.

I don't have an in-network, you know, retail shop. I can go to wherever I want. And I think now that we've we're continued to move, although I believe at a slower pace, expectations. Uh, in terms of, you know, consumer directed and, and high deductible plans, people do have choice to go in and out of network for the best value of their dollar that they're pulling out of their wallet.

So from that standpoint, I think there's all those different sectors you gotta learn from, and I don't think there's any specific one that would lead all of them. I do believe they all have advantages where they, you know, moved ahead. And that's where I think when you look at like the Charlotte c i o association, you know, when we started coming together a half a dozen years ago or so, more informally, Part of what we realized was 80 to 85% of all the work that we do was the same.

You know, there's a, there's very few that actually, uh, of the things that we had, uh, performed as a c I O that actually was different in a bank versus a energy. Sector versus the healthcare sector. And so once we found that, you know, we're not that quote unquote special that we always thought we were, it was really great to be able to share things back and forth and to use some of the techniques that they've used and bring that on to, you know, in the healthcare industry.

Yeah. So that's great advice. So, uh, if you're a healthcare IT person, develop those relationships outside the industry and, uh, You know, you might, you might learn, uh, some things and they might learn some things from you. So it's, it's great to have those relationships. Uh, second, uh, second question. What core technologies do you think need to be in place for health systems to become really a digital business or a digital platform for business?

I think what you have to do is you really have to empower the patient, uh, the patient slash consumer. I'm gonna use that interchangeable because to me it is interchangeable. Uh, the patient actually has made a commitment to come to your organization. But the next time, next week, they are a consumer again, making choice.

So to me, you gotta be able to put the information to make those decisions in their hands. When most of us do, you know, transfer money to our children or somebody else, I need to pay a bill. Uh, we pull out our phone and we make the payments that way. You wanna purchase something, you're sitting there in your car, driving along in the passenger seat, and somebody says, Hey, you know, we need X.

You pull out your phone, you buy that hat, you buy that piece of thing, and you want healthcare. I don't think it's become a habit yet. That phone and you deliver service, it's see. Probably some alignment with banking, where banking had big banks, where we had hospitals, then you had branches, and we had urgent care centers and physician practices, and then we had, you know, uh, uh, urgent care centers and, and they had kiosk machines.

You, you, you, you see a lot of things that are happening that way and now I think it's mostly, you know, in your pocket. So for me, I think the, uh, the number one thing is, is to be able to. Go to the patient where they want you to be at versus having the patient come to you. And that's going back to 10 years ago.

We all got into telemedicine and every article now that I read recently kind of continues to show the amount of savings that is occurring, not only in terms of that actual cost for that visit. But also over the re the repeat and the recurring afterwards. I read something this past week that talked about if somebody had a virtual visit versus a visit with their primary care physician, there is less likelihood that that patient will show back up again for any kind of healthcare service within the next three weeks.

But if you do it to a to primary care, they're gonna wanna follow up visit. So from that standpoint, you know, you start seeing the costs going up. When you start doing it the old fashioned legacy way and the new way of having it in your pocket and you're kind of one and done and he or she needs to reach you.

Most of us typically have our phone in our pockets at all times. Anyway, you can access that information real time. Yeah, there's some interesting skills. Uh, uh, third question. So I'm gonna, I'm gonna look at, I, I, I'll narrow it down to three areas. Three areas. I'd like to get your thoughts on innovation possibilities for each.

So, Um, let's start with the clinician experience. So what are some opportunities for innovation in the, in the way, in the clinician experience today? Yeah, I think there's two things. I think one is, uh, patient generated data. Let the patient do the work. You know, let him or her submit, you know, online or submit via, you know, uh, the web, the information that they're gathering.

So if you're monitoring somebody's, um, vitals, you know, let 'em take the vitals at home, let 'em step on that Bluetooth scale. 'em, do the things that they needed and have that information be imported back into, you know, the, uh, the m r for you to look at. So I think putting that workload upon the patient, you know, most of us, if you look at banking again, you know that you wrote checks in the past or you went to the bank to get cash.

Well now all that stuff happens to me. So let me do the work. I do those clerk and those teller activities myself and I wanna do it myself. So lemme do that work for you. And I think on the other side you hear a lot of the interaction with the E M R and the point and clicks and some people measure satisfaction as a very highly correlated with the amount of clicks that they have to use on their, on their mouse.

Well, voice technology has certainly advanced. Use the voice to interact with the system just like you use it for Alexa today. You know, I saw where you can pay bills, you know, using the voice, you can schedule appointments using the voice. Alexa can read back their results back to you. And if you're in exam room talking to a patient and you wanna see their most, Let your voice be the input into the system to allow it to navigate for you so you can bring that information up versus turning your back on the patient, clicking up here, clicking down here, pulling things back up.

I think the voice will alleviate some of the frustration that people have, uh, with the providers have with interact with E M R. So, uh, second area, uh, innovation possibilities around the, uh, consumer patient. I have those listed as two separate, but since you brought 'em together as consumer patient experience, uh, what's, uh, I mean, this is probably the most talk talked about area.

What's, what's some of your thoughts on innovation possibilities for consumer patients? Yeah. And, and this, uh, this will be innovative for healthcare but not innovative for other industries. And you're starting to see it to come out recently, Walgreens, and now it's a couple marketplace. I mean, you really have gonna have out.

Quality, be open, be transparent. Don't fight that. Don't keep it enclosed. Don't keep it as a protection for you within your healthcare system. If you're not proud of your reviews or you're not proud of your costs, you're not proud of, then fix it. Fix that problem. But I think as a consumer, and you know, next time I wanna make a decision, I want to see.

All the possibilities. Just like when I purchased a product or a service. If I wanna go to a hotel, I can pick any hotel in that city. I can see what the cost is for that night. I can see what the quality reviews are, you know, for that hotel. I can read the comments that people made about it. I can look to see if I have any other kind of points or things that I've earned that allow me discounts or other types of benefits before I make that decision.

When you look at healthcare, You typically go in blind with most, if not all that information. And so I think the marketplace is gonna be a big piece for consumers. And I think the healthcare system that says, Hey, we're very high quality, we have reasonable costs, I'm a great value, I'm gonna go out there and be able to compete online, open, transparent with other providers.

And we look at the, you know, especially the telehealth type services, those borders around them. You know, those are gonna be very soon disrupted, broken out, and you'll be able to see your providers across, you know, multiple states. And so from that standpoint, if I'm in California, I don't have to buy a product from California.

I can buy it anywhere in the United States and have it be delivered. And that's gonna same I think's gonna happen with healthcare. You're gonna have that openness, that transparency, when we make these decisions. And it's gonna be a demand from the system. I mean the, from the consumer. They need to be able to, Well informed decisions, and I think that's gonna be a driver for us as that marketplace.

Alright, well let's, let's jump to the fourth que fourth question is, uh, how do you engage the consumer patient when identifying innovative, uh, innovation opportunities? So, uh, I know that some health systems have, uh, uh, patient panels that they bring in and some, uh, will, uh, include.

Of patients in their innovation, um, uh, sort of identifying the opportunities and, uh, checking the progress of, of different, uh, especially mobile technologies and those kind of things. How do you, how do you engage the consumer patient in your innovation opportunities? Yeah, I, I think those are all great ways of doing it.

You know, the one thing that you don't wanna do is you don't wanna take something that hasn't been tested yet. And, and, uh, beyond like a proof of concept and bring that out to the market to be exposed is that will look, you know, that will not be a good representation. So for me, going through what I call it is kinda like a dimmer switch.

You know, you kinda get the idea, you turn it on, you start to get feedback, you keep fine tuning it, keep turning it up. But you can take that dimmer switch and once you're ready to roll, you can flip it all the way on high. So that's not an issue. The issue is how do you get from the current starting point to high, and I think in a methodical yet fast way, because whatever is innovative today for you.

Tomorrow, somebody else is gonna match it. You gotta be onto the next thing. So once you get something there, you get it rolling. You gotta be thinking three to five years ahead of, of what I want to be delivering. Then when the healthcare system or the physician market or whatever, you know, whatever area that you're working in is ready to take advantage of it, you've already moved on to something else.

It's up to cha them to change their processes, to take advantage of it, to modify the people, to be able to take advantage of it, and to bring all that together. So from a technology perspective, you've gotta be, you know, several years out in advance. But when you look at your market and you look at your healthcare system, it's gonna be up to them to accelerate and bring that down.

So, You look at anything with the consumer, you know, you only kind of get one shot. You know, once you kind of mess something up with somebody, they can move on to the next one, next provider. So from that standpoint, I think you gotta be careful, but boy, you gotta be focused and you gotta be fast. Yeah. So the, the last question you, you could eventually be with one of these innovation partners.

So the last question is, what do you look for in a vendor partner that is bringing, uh, innovation into your health system? Are there certain characteristics you're looking for? Um, You what, what looking for from them? I think to me, uh, probably first and foremost, it's, it's kind of having a, a shared vision, a shared culture, you know, people that have the same type of relationship that you want to have together.

So from that standpoint, you know, bringing people in who are good, quote unquote fit within the organization, I think is extremely important. And equally important to me is shared risk. This isn't all upside for them and you know, just downside for you, if it doesn't work, this is a shared, you know, we're both gonna win together.

We both aren't. I'm for. I want to be part of whatever that is. I want to be part of that solution. If we can make it so that it's actually an advantage to our healthcare system, let me help you be part of something else. When you look at things of that nature, you know, sometimes people go back and they look at how they can, you know, kind of almost like quote unquote, take advantage of those relationships.

I don't like to see it that way because it's to your advantage that that partner is successful. So it's not squeezing everything out of them. Put all the risk upon their back. They don't make it too bad. There'll be another one tomorrow. I think this is something, if you do your due diligence, that you're gonna be working together.

When you have these kind of stumbling blocks, that that part of your culture and part of what you want to get accomplished is that you are gonna be flexible enough, be able to change enough, modify enough to continue to advance, you know, whatever cause that you're working on. So to me, has to be a good fit.

A shared risk with you. Absolutely. Well, Craig, thanks for coming on the show. Uh, is there a good way for people to follow you on social media or other things? Yeah, sure. I mean, I actually think Craig Richville is the, uh, I don't think I'm the only one in the world that actually has that name, . So, so from that standpoint, you know, when you look@craigrichville.com or any of my social media, whether it's on LinkedIn or whether you're looking at, um, uh, Um, Twitter or anything of that nature, probably LinkedIn and the craig rich com is the best way to take a look at me and to, to see some of the things that we're doing.

And I'm totally open to engaging open discussions. So if anybody has any questions, comments, thoughts, and just wanna kind of brainstorm on some stuff, like in this case, bill with you, this has been so enjoyable and that. The information that you bring back to all of us is, is fantastic. So I, I certainly, uh, wanna applaud you for what you've done over this past year and certainly to be able to double your goal.

That's, uh, we all gotta wanna strive to do things of that nature, so congratulations on that. But certainly if anybody has any questions, thoughts, comments, wanna anything off, we send you a LinkedIn. Uh, Craig richfield.com, you know, uh, go to that and go ahead and contact me and be more than happy to get back with you.

And that's the one thing that I will say. I've never ignored a message in my life. I have always replied back. Now the reply might not be the answer you're looking for , but I've always replied back, so please feel free to reach out. Yeah. And having been a c i o and having, uh, reached out to CIOs, that's no small.

Task, uh, with the number of people, uh, and communications you have to deal with every day, so, awesome. Uh, you can follow me on Twitter at the patient cio, uh, the health lyrics website for my writing. Uh, don't forget the show's Twitter. Uh, this week in h i t check out the, um, the website this week, health it.com, and the videos.

Health it com slash video. We'll take you over to our YouTube channel. Uh, please come back every Friday for more news information and commentary from industry influencers. That's all for now.

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