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Daniel Barchi - Chief Information Officer for New York-Presbyterian joins us to discuss Artificial Intelligence ethics. We also take a look at final preparation for CVS/Aetna and Daniel lays out operationalizing tele-health.

Transcript

Welcome to this week in Health It where we discuss news, information and emerging thought with leaders from across the healthcare industry. This is episode number 43. Today we make final preparations for C V S Aetnas interests into the market, and we discuss ethics in AI design. This podcast is brought to you by health lyrics.

Health systems are moving to 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, healthcare writer and advisor with previously mentioned health lyrics.

Before we get to the show, I wanted to shout out to the CIOs who are gonna be attending the Chime fall forum in San Diego. , I'm gonna be there doing one of those, , special shows like the one I did at Becker's where I sit down with, , CIOs for 10 minutes. I. Series of four questions and we just record them.

, as an audio podcast. I actually have three sets of questions. This time around the categories are going to be technology, execution, or culture. The CIO gets to pick whichever set of questions they want to discuss, and we'll go through those questions. We'll record 'em and then we'll splice 'em together for a show next week and the following week.

So, , look forward to that. If you want to be on the show, please , drop me a line at, , bill at this week in health it.com. , one last thing. , we now have an Alexa skill enabled for the podcast. You can just say, Alexa, play this podcast. , play the podcast this week in Health It. And if you enable any pod skill, you can also say, Alexa, ask any pod to play this week in health it, and it'll play that as well.

, just. Playing around with some new technology, seeing how it works out. So today's guest is a, a leader in the industry, a frequent speaker on the topic of digital transformation in healthcare, a graduate from the US Naval Academy, a marathon runner, and the CIO of New York Presbyterian, Daniel Barie.

Good morning, Daniel, and welcome to the show. Good morning, bill. Glad to be here. You know, I, , I, I, I think I keep throwing people off cuz I, we usually record on Friday mornings and this is the second week in a row that we're actually recording in, in, in an afternoon. So how are we gonna call you on it?

How are we gonna go with it? Just go with it. , well, hey, , tell us a little bit about New York Presbyterian. I mean, you guys have some very prestigious, , institutions that you serve there. Give us a little, little background on, on, , New York Presby. Sure, I'm happy to. , New York Presbyterian is a fantastic institution delivering great healthcare.

We are the University Hospital for Columbia as well as Weill Cornell. So we have two world-class medical schools that we partner with. We're an 8 billion institution with about 10, , campuses across the New York Metro region. And, , we're a leader in artificial intelligence and telemedicine. Wow. Well, I'm looking forward to getting into both of those topics on the show a little later.

So, um, one of the things we like to do to, to open it up, , open up the show is just, , a pretty open ended question and, you know, just what's, what's one of the things you're working on right now that you're excited about? I'd, , have to start with telemedicine. We really feel like our mission is to deliver outstanding care to the people of New York, but with our outstanding physicians, the broader that we can deliver that care, the better for, , our patients.

So a couple of years ago, our c o had the vision to invest heavily in telemedicine as the way to expand what we do. And we started with a couple of pilots in the 2015 time period, so that by 2016 we'd done about a thousand, , telemedicine visits.

And this year. So we're growing in many, many ways and what we're proud of is that we're reaching patients however they need that care. So for many patients, it's a ED visit, but from their home on their own phone. So they download the NYP app and they can be connected to one of our board certified ed physicians.

We have a number of kiosks in our Walgreens. We do second opinions, , nationally. We're doing a lot of care in our eds. We do more than 20,000 ed video visits every year to speed up the process. Patients can go through one door and go through a normal two, three hour ED visit, or they can do our ED express care via video with one of our physicians and via in and out in about 30 minutes.

So we feel like telemedicine is really changing the way that we're able to deliver care. It really does become a foundational technology for becoming a consumer-centric, , industry. And, , yeah. We're, we're, we're seeing it more and more. Are you guys seeing it as clearly you're doing, , second opinions and you're doing consults across the country, but are you, , seeing it as a way to reach out into new markets, get into Jersey, get into Connecticut, maybe.

Certainly, I'd say that's one of the ways we're able to do it, but it's probably more about the convenience for both the physicians and the patients in our, , in our region. So if you're, say from Johnstown, Pennsylvania and you come to New York Presbyterian for a liver transplant, you've probably visited a couple of times in the weeks and months living, leading up to that transplant.

When you go home, you don't wanna come back again a week later for a follow up visit where you might talk to your transplant surgeon who might take a look at your incision and ask you a couple questions about how you're doing. So for that patient, it makes a whole lot more sense to the video visit for their convenience and for the efficiency of the physicians.

Similarly, if you think about the patients that we serve, , we are both a top class institution to whom patients come from nationally, but we also serve.

Region than anybody else in New York with the corporation. So there's large population that, um, you know, many ways couldn't time off work, that we wanna make outstanding care available for them or for their family members. You know, our CEO often talks about having an elderly family member for whom you have to take time off of work, get them into the city, get them up to a physician's office just for a 10 or 15 minute cardiology visit.

The more of that we can do for patients in their own homes, the better we're serving our patients. That's fantastic. All right. Well, you know, our, our show format is, , is pretty straightforward. We do in the news where we each pick a story so that, , we sort of bring our own, , perspective and, , by selecting the story, we sort of bring different topics to bear, , every week.

And then the second section is sound bites, where we're gonna dive a little bit more into the, , into the telehealth strategy that you guys have been able to, , put out there. So, um, I'll, I'll kick us off with the first story, and that's CVS Aetna. Forcing hospitals to rethink their business models.

Obviously this is a, , it's a story from health leaders, , media.com. , the article actually paints with a pretty broad brush, a pretty, a single point of view that's really shared by many, and that is we live in a digital age. In the digital economy, the consumer is king. , those that don't get on board and meet the needs of the consumer are gonna be in trouble, is essentially the, the, the basis for the story.

And I, I thought this would be a good time to talk about this, given that CVS net is moving forward. We're almost at that, , at that final day. Where they, , they come together. Now we know with any m and a, there's just a lot of work that goes into making the two organizations work well together. But this is, this has been a growing trend of non-traditional players coming into healthcare, , coming with, , different approaches, different models, different services, , trying to really get in between the health system.

And the, , and the consumer, the consumer patient, and try to direct their care. And so here's what, rather than go into the article and, and in depth, what I'd like to do is just pull out some of the principles that they, they say are the, the core of the, , , digital transformation of healthcare and just go back and forth on 'em.

And, and so the first principle is, you know, retail providers are, , are poised to really poach walk-ins and patients seeking potentially high margin procedures and directing those things. , is that, is that something that you guys are, , thinking about, talking about? Is that something you see happening in the industry?

Sure. So I'd say a lot of, , different entities are competing for the walk-in or the front end kind of business. And certainly New York Presbyterian is proud of what New York Presbyterian Medical Group. Columbia Doctors and Weill Cornell Medicine are able to do in a primary care role, but we're delivering secondary and tertiary care in a way that we're focused on the long-term care of our patients no matter what they need.

We're proud of our ability to deliver to that primary care and, , you know, we do it through our telemedicine app on our N Y P app download. , we also do it through kiosks, say the kiosks that we've placed in Walgreens around the city. , one of the stories that we like to share as a young man who was out of breath, who came into one of our Walgreen kiosks, sat down, took his own pulse ox, took his own blood pressure, uploaded the information and was face to face with video with one of our ED physicians who determined very quickly that this young man was in, , congestive heart failure.

We got him to one of our emergency rooms half mile away, admitted him, took care of him for for three days and sent him home. Certainly I would say that's where we're competing with the CVS and Aetna and other places that wanna get that kinda minute clinic business. But what's important to us is the, we're able to do the in page.

Yeah. Um, You know, it, it is a, it, it is amazing to me how it seems like the market has, like you guys have been able to focus really in on convenience, access and experience as well as, , really driving such a high quality, high level of, , service that your, your, you are the, , market leader in a lot of different specialties within your market, which makes you a go-to provider.

Um, for so many different things, but by also doing convenience costs and experience, you're, you're really able to change the change the game. Are, are those, are, are convenience costs and experience metrics that you think, um, are, are gonna continue to, to be the key metrics? This is one of the things I talked about in the, the article as we start to become a consumer or , more of a consumer orientation that.

People are going to start to differentiate and say, I'm gonna go in this direction cuz of convenience. There's gonna be more transparency in cost. They'll choose, , a direction based on cost. And overall, when they get the kind of organizations like you're describing where , they really think through the patient experience and they say, You know, this patient's gonna drive an hour and 20 minutes to come see a physician for five minutes and they think through all the visits, and they think through what's the most effective way to do those visits with the consumer.

And really the patient as at the, , at the center of the transaction that those things are, are really gonna change the game in terms of how people choose where they're gonna go. Are you guys focused in on, on those, those metrics, convenience, cost, and experience? Convenience's, cost and experience are certainly very important to our patients and the quality of service that we deliver.

But I'd say it's quality more than anything else. , if I think of a consumer transaction, I'm always gonna wanna have a quick, easy, in and out. I don't wanna cost very much, and I want a good experience. At the end of the day, it's the quality of service that's delivered, and those metrics all drive quality.

But we're looking at longer term, um, outcomes. We're looking at mortality and morbidity statistics for our patients. We wanna make sure that we're delivering the best care that's available, and quality and the outcomes outweigh many of the other things that patients think about, and that's why we're proud of the care.

Absolutely. Yeah, we've, you know, when, um, we used to take a look at the numbers of people that would drive out of our market and they'd go up to, , the LA market to go to UCLA for oncology, or they'd go to Cedars for certain, , of their specialty areas. And quality, especially when people are, are facing a significant, , risk, , quality is a huge driver.

Um, And people are gonna seek that out. , the the other thing that we hear over and over again is, you know, hospitals that don't make this adjustment to really thinking about the consumer, putting the consumer first. They're gonna fail because they can't distinguish themselves. , it on just, you know, on, on just care alone that there's gonna be a lot of different outlets for care.

Um, so I mean, are. Do you think that's gonna happen? Do you think there are, there is going to be eventually this consumer, , move, this the ability for the consumer to actually make the decision and choose a direction. And that will start to put more pressure on health systems to be consumer centric. I think consumer centrism is really, really important because, Consumers make the choices about where they go for their care, and yet your Presbyterian has built on a foundation of quality for many years.

And through our partners, Weill Cornell and Columbia, and our history dating back to 1771, we've been focused on the long-term development of care, the research of outstanding delivery of care, and then the ways to deliver that care in unique ways that contribute to the outcome of patients. I think that being consumer focused is something that you can do with intensity over a couple of years and build a lot of consumer-centric, , focus.

And yet if you don't have the quality statistics to back it up, the history of care and the infrastructure for delivering care. Day in and day out, it's, it's not sustainable. I think that we've done a nice job of putting the tools in place to make it easier for patients to get our care, our telemedicine, our artificial intelligence tools, our, , ability to schedule appointments really easily through Columbia or New York Presbyterian Medical Group for while Cornell, but it's the long term quality of what the care we deliver.

That's more important than any event. Yeah, absolutely. I, and I'm just reminded of the old adage, you know, it's, , you, you, the number one thing in a, in a restaurant is the food. So the product for us is, is quality healthcare at its highest level. And, , at the end of the day, you can put all the, the digital tools around it.

You can put, , you can and you should make the experience better for the patient. There should be more convenience, the cost should be, , competitive and, , , affordable. All those things are important, but at the end of the day, , when people seek out a health system, a provider, , what they wanna make sure is that they're gonna get the best care they can possibly get.

And that's, that's what we bring, , to the market. And it will continue to be, , those that can deliver at that highest level that are gonna succeed. , well I'm absolutely story. So you been talking a lot about your. Stuff in ai. I'd love to. So you picked out a story on ai. I'd love, love to talk about it.

Sure. So over the weekend I read a piece by the Wall Street Journals, Amy Castellano, and she, , interviewed the. Ethical ambassador for Microsoft, , a person whose role is to focus on doing the right thing and asking the right question of Microsoft and other businesses about whether they're following appropriate ethics and protocols for intelligence and artificial intelligence.

And it's something we're deeply focused on. If you think about our role as a health system or any health system, quite frankly, It's delivering great care to patients and also protecting them and protecting their data. And if you think about the role that artificial intelligence plays, it's easy to get lured away by the idea that technology can do the best thing for patients.

You know, we talk within New York Presbyterian about, um, the fourth industrial revolution and the idea that computer. Steve was very careful to point out that we're the ones to determine what the future is, and we're the ones who place values into the technology. We technology. So this is a conversation that we're having at the highest levels to make sure that we, we employ technology and especially artificial intelligence.

We don't introduce algorithmic bias in any way. And it requires constant vigilance. You know, there are tools that are out there for many health systems to use that have added more and more AI in the background until something that you might have purchased three or four years ago has AI components that are making decisions that you're not even aware about.

So this is something I think that needs to be on the minds of, , healthcare leaders and technology leaders, especially as AI plays a larger role in what we do. Yeah. How, how are you gonna deal with vendors? So vendors are gonna bring AI tools into your environment. Are, are you going to ask them? Because one of the things is transparency, cuz these algorithms, , will make decisions.

They, they process the information, they make decisions. Um, are you gonna ask vendors to disclose their, their algorithm so that you have a better feel for how they're working with the data and, and the decisions that they're making. You know, whenever we bring a new tool into a New York Presbyterian, we go through a series of steps.

First of all, we need to decide with our physicians, is it the right tool? Is it the best one that's on the market? Then we have a technology review. We have a legal review, and we have. Information security review to make sure that it's secure and it's gonna work well, and it's gonna be, um, reproducible, , on a daily basis.

More and more we've started asking our vendors, what do we need to know about your artificial intelligence capabilities? And, , we haven't purchased any of them, but when I talked to small companies that try to get into space, They've talked to us about their great AI capabilities. I'll give you an example.

I was, , talking to a small company that really wanted to play in healthcare and they said, you know, we can use our AI tool to make decisions. Appointments. So in order to slot patients appropriately, but when you really ask them what's behind it, they might be taking into account demographics that really aren't appropriate or no health system would feel appropriate, making decisions on when and how patients get, , their appointments.

And so unless we ask those questions, we're not gonna find out what's behind it. So it's on us, the consumer, to ask thoughtful questions about vendors, about what AI is going into their systems. Yeah. And so there's been a lot of stories about AI bias and where it comes from. And a lot of, a lot of AI requires the, the machine, it will pick up data sets and it will learn from those data sets.

And so there's been, , stories around how, , certain data sets will, will lead to, um, especially within, within our law enforcement and whatnot. Certain data sets will lead to an erroneous, um, , Calculation on recidivism, and it will be based on, on race instead of, , other factors. And, , there's been, , well, Microsoft's , had their, , their social chat bot, which was learning from social media and whatnot.

I think it's, it was called te and, , you know, after 24 hours it was shut down because, , you know, people figured out that it was learning from it and it spammed it, , to the point where by the end of the day it was coming back with, um, some pretty harsh language and some pretty harsh things because it was learning from that data set.

It was brought in, , brought into it. Um, are there data sets, do you think in healthcare that are, , more com , that are complete, that are more complete, that are better for, , AI at this point than, than say maybe a high risk, um, maybe higher risk because we don't have enough data or we don't have, , a good enough model yet for it?

Yeah, I couldn't tell you, , specifically about data sets, , in healthcare from a clinical point of view. But I'll give two examples that, , I talk about and we as leaders, , talk about. And one is, , leaders in business. So the example I often give is, If you were gonna choose a CEO of the next major American Auto Company, what would you choose if AI was gonna choose that person?

And the only data they have to look back on is hundred years of, , Caucasian males. And it certainly wouldn't produce Mary Barra, who's the c GM right now. So it's those kind of things where we need to be very careful about the data that we look at. Similarly, if you look at facial recognition tools, um, through training and the dataset that they have, they're much better recognizing lighter skin faces than darker skin faces.

And so we need to think not only about the software we're using, but even the tools and cameras we're using. So there are examples that are bound and how we need to be very thoughtful and very careful about how we're introducing technology into what is otherwise a very warm and welcoming healthcare environment.

Yeah, I, there there's probably some opportunities within, um, within it itself in terms of ai, especially around, , security. And looking at our, , our log files, looking at, , different patterns of usage and those kind of things. I know that some previous guests have have said, you know, rather than, , we might be a little ways away on the clinical side from, from certain applications of AI until it matures, but.

There are, , there are cases where it can really give us a, a leg up. Um, from an IT perspective, given the, just the sheer amount of, of data and log files and things we're, we're processing on the security side, on the, , really on the behavior side, what data is being accessed. And those guys really, security and privacy seems to be an area that AI could be applied.

Not sure there's a question there. So let's let's you raise, you raise . Oh, go ahead. Go ahead. You raise, you raise a good point. , a few years ago, log files were something that were interesting and might help our, , developers, our programmers go back and look at what might have happened and maybe fix a bug.

But more and more we recognized that log files are ways to gain insights about how systems are working. And how people are interacting with them. And then layering artificial intelligence on them can recognize patterns that might indicate behavior that we don't wanna see. The log files that are associated with, say, a, , medication dispensing robot, for instance, might tell us perhaps somebody is getting, , controlled substances out on a weekend when they're not actually on service.

And it's those anomalies that point out things that we might not otherwise see if we're just looking at specific moments in time. So more and more I think artificial intelligence is gonna help us, maybe not directly in a clinical way, but on the back office side, making finance and technology in HR and security much more efficient.

Absolutely. All right, well, let's, let's jump into our, so our soundbite section is, , handful of questions. Um, just looking to go back and forth on, , for a couple of minutes on, on some of the different topics. I, so I, I've read some of the things that you've, , spoken, ab, , spoken about, , written about, um, Out there, , on the, on the internet.

I actually saw you at the, , Becker's conference as well, which was a great presentation. So I'm taking some of that and just forming some questions here. So, you know, first let, let's just jump in. So, first one, , and we really have to go back to that telehealth cuz you guys, , when you were brought in your announcement for CIO was really, , almost like we're bringing this person in to spearhead our telehealth initiative.

It was, , It was really, , interesting as I was reading that, that that was so much a, a focus. Most other CIOs that would get hired, it would be we're bringing this person in to be our cio who's over all these things. But there was so much emphasis on telehealth. It was, it was really fascinating. So, , there's two aspects of, of telehealth that I, I'd like to ask you about.

The first operationalizing telehealth and the second being data silos. So, um, So you gave us some background on, on the, , program and what you rolled out. , so let's just dive into those two things. So the first thing, which is, , which is operationalizing telehealth, it's, it's, , it's not as much a technology challenge.

As it is an operational challenge, getting everyone to understand how to, how to really use, utilize this technology where it can be utilized. Give us an idea of the process that you went through, how you determined the best places to, , put telehealth and then how you brought the clinicians along, , and, and then also how you got adoption out in the field.

I guess those are the key areas for operationalizing. Telemedicine has been around for a while. You know, Michael Creighton wrote in his book, five Patients in 1969 about a use of telemedicine at Boston Logan Airport, , for a patient who landed, who was having, , chest pain, and they used, , telemedicine to connect that patient to, , Massachusetts General Hospital.

So this is going on 50 years now. So it's not really the technology that's developed that far, it's how we use it. And certainly the technology is more ubiquitous now, but it's really the use cases. And so the way at New York Presbyterian that we've been able to maximize our ability to use telemedicine is in thinking about those use cases that might best.

And then try them out. So we've done a lot of fast failure. So our, , chair of emergency medicine, , Dr. Rahul Sharma at Weill Cornell said, I'd like to use telemedicine in the emergency department. And we said, great. Let's put together a small trial. We tried it with 10 patients. It went really well. We tried it with 20 patients.

It went really well. We bumped it up to 50. We got feedback, we tweaked it. Now we're more than 20,000 patients and using it, we found it's much more efficient. Similarly, we found that trying it in nursing homes was very good because we're able to prevent, um, patients from coming in in the middle of the night who could otherwise.

Stay in their nursing home, but it doesn't scale really well. It's really challenging to get, , nursing homes that might only use it once a week or even once a month to use it with any frequency and use it really well. So in some areas we've found that it, we've really taken to it in other areas, not so well.

So our ability to get to 100,000 visits a year is predicated on the idea that we found 12 to 15 cases that work very well.

The, um, the, are, are you using a lot of specialty equipment or are you just basically using a, , a pretty basic set of tools on both sides of, of the equation? The fact that we've been able to maximize our success in telemedicine is based on our ability to be nimble. So we've used many different tools for different areas, so our ability to do second opinions nationally.

Is in partnership with a company called Grand Rounds. Our ability to do telemedicine, , psychiatric evaluations in our emergency department is based on our ability to use our own Cisco equipment internally. So nothing special. , we've partnered with American well to be able to do our telemedicine visits via kiosks and on our phones, and in other cases we've just used our own network.

So there's no one tool or technology, it's the ability to use the right tool at the right. And be thoughtful about it. That's awesome. So, , with that being said, you know, um, telehealth has a tendency to create data silos if it's, if, if you're not thinking through integration from the get go, you can end up with, , secondary scheduling platforms, , potentially, , other documentation repositories that are out there.

How are you able to avoid that pitfall? , the ability to avoid data silos ties back to something that, , you discussed earlier. In many ways, telemedicine can be a point of entry for a healthcare system. Then there's follow on care that goes very, very deep. So for second opinions, for instance, when a patient in Oklahoma has a really bad diagnosis and they need to contact one of our world class physicians, that first set of interactions is all focused on that patient and the discreet information that they give themselves give us about themselves and that specific condition.

, after we. Follow up with care, then we go deep and they're part of our ecosystem and they're part of our electronic medical record. And then we ingest more and more of that information. But for that first second opinion encounter, we're okay with only dealing with the information that they provide.

Similarly, when one of the, the patients who's downloaded our N Y P app and has a video visit with our emergency department, say from their couch or their apartment, , when they have an acute pain in their lower right abdomen, For that first visit, our ED physician is able to determine if that's indigestion or if it might be, um, appendicitis.

Three times in the past four months, we've been able to diagnose appendicitis through our video app and then brought that patient in for that first visit. We just wanna know how are you feeling? , you know, pressure, abdomen, tell us about your care. , just a little bit of background. We don't really care for going deeper into their background.

We just need to know what's. Once they've come into our, , hospital for follow on care, if we've diagnosed that appendicitis, then we go deep and import their records. So I'd say it's almost two tiers of data, and as long as we get what we need at the right time, we're able to deliver that care.

Interesting. So, um, you've talked about agility and being responsive. Um, it seems to be a, a core tenant of how you're. , how you're thinking through the technology at, , at New York Presbyterian. So the velocity of change is gonna continue to increase in healthcare. What are some of the foundational elements that you wanna make sure are in place at your organization to ensure that you, , remain agile and responsive, , moving forward?

Well, it's interesting you ask about the foundational elements about being responsive and being agile because, so, We using all anything, I think about our core tenets, about how we behave. So we have, , ethics, we have acc, credo, and, , more than anything we're committed to high quality care and maintaining the integrity of the data that our patients share with us and delivering great care.

When we talked about employing more and more technology, be it telemedicine or artificial intelligence, we created a series of technical, um, ethics that we follow. So more and more we've created a list that's growing larger about the things that we will and won't do with data. Um, Behaviors that we wanna follow to make sure that we're employing technology appropriately.

So while there's the clinical care, and that hasn't changed in the past 200 years, in, in, , as it relates to what we think about our patients and how we treat them with respect and dignity, the technology is constantly changing. So we need to keep a list of things that we know are appropriate to do with data and how we treat patients through technology, and we need to keep that up to date.

Yeah. So you've been, , you've been the CIO now at, um, I think three different health organizations. So tell us what you try to do in the first 90 to 120 days as the cio, , in a, in a new organization. What are your, what are your priorities as you're, as you're starting to get your feet on the ground? I think the healthcare, it is all about people.

In fact, it's 80% people, it's 15% process, and it's really only about 5% technology. So understanding the people and understanding the processes of any institution are more important than anything else. I've always tried to create a long-term technology strategy and making sure that we're up to date, we're putting the right operating and capital plans in place, and long term strategies for working ourselves into a good technology spot.

But understanding what the values of the people are, what's important, what people need in order to get their job done, or more important than anything. So anytime that I've joined an institution, and especially as I've joined a New York Presbyterian, I've gotten to know the leaders, the members of the IT team, the chairs, the chiefs, the physicians, the nurses, and understand what's working well and what's not working well.

So, to answer your question, I'd say it's about getting to know the people and that's more than important than anything else. Yeah. And that doesn't change for, for the first 90, 120 days or 2, 3, 4 years, it's. Relationships that, , and, and, and you driving and you being able to develop those relationships and, and, , support the people around you.

Absolutely. So, I, I, I read a bunch of stuff on the internet and, , preparation. Um, you, you appear to be a big fan of history. You made, you made reference to, um, Lincoln Grant, the Wright Brothers, Alexander Fleming, , And you even studied the history of the Chrysler building, , as you know, at that you, , referred to in a story, which I, I found interesting.

, first of all, where, you know, where does that come from, that just the, the love of history. And I think the second thing is, um, you know, what lessons are you drawing on right now in, in terms of inspiration for being a CIO in healthcare in, in 2018? I'm interested in history because, , I look at what we do at New York Presbyterian as a small part of a continuation of work that men and women have done for more than 200 years now.

And in any great institution like this, we are standing on the shoulders of giants who went before us. And so the foundations that they put into place are important to recognize. And whether you look at your local history in your town or village, or you look at a national or global history, we can look back to fantastic people who are inspirational in what they did and learn a lot of lessons from them.

So I think when I look at history, I try to see what challenges people faced and what lessons I might draw from them. Now, thinking about going forward, I think that we wanna invest our time and our energy and our resources in a way that create a foundation. More and more as we've run into a problem, I've thought not, oh, what do we need to do this week?

But if we could really change things, how would we want this to look five years from now? How would we want it to look at 20 years from now? And if that's where we wanna end up five or 20 years from now, what changes do we need to put in place right now that will get us on that right glide slope to get there?

Even if it's hard, it's worth doing, but there's no point in putting in a quick fix and then two years going in and do the hard work later. That's interesting. That's great. I, you know, Daniel, I really appreciate you coming on the show. I, um, I know, I know a great show. When I hear one, when I am, , I, I, I want to take notes.

So I, I'm looking forward to going back and, and listening to this show and, and writing some things down. Um, because it, it's, , your, your wealth of experience, your background and, , just your, your thinking and how you, , break things down I think was really helpful. For me. So, um, is, is there a way that people can follow you?

I know you're, you're speaking at, at SoCal , HIMS event. Are, are there some other ways people can follow you?

Sure. Well, I've written a couple articles and posted them on LinkedIn and, , I'm on Twitter at Daniel j Barchi. So, , more and more I've tried to share a lot of the great work that's happening in New York Presbyterian and then highlight a lot of what our peers are doing nationally, because quite frankly, I feel like.

Unless we're all working together, the challenges of developing technology and healthcare are immense. And more and more I learn from my peers. And so, , I try to share as much as.

It's one of the things I love about this industry. Um, awesome. So you can follow, , you can follow me at the patient cio, , the show on this week, , this week in ht , the website this week in health it.com. And you can get to the YouTube channel at this week in health it.com/video. And, , that's all for this week.

So please come back every Friday for more news information and commentary. From industry influencers. That's all for now.

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