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 All right. Welcome to this week in Health It where we discuss the news, information and emerging thought with leaders from across the healthcare industry. My name is Bill Russell. We're covering healthcare, c i o, and creator of this week in Health. It is set up podcasts and videos. Dedicated to training the next generation of health IT leaders.

This podcast is brought to you by health lyrics, looking for someone to be your personal coach in healthcare technology. Let's talk visit health lyrics.com to schedule your free consultation. Okay, so this recording's gonna be just a little different. David Benson and I just finished attending the Scottsdale Institute, uh, conference here in Phoenix, Arizona.

And we decided to go out on the golf course this afternoon and, uh, just record a few of our thoughts from the conference. Um, we also talked about his. Latest article in health system, c i o and just about anything else that comes to our mind, including the traps and bunkers and, and things that we happen to end up in.

We had a great time recording this. I, uh, apologize ahead of time. We, uh, you know, we're always pushing the envelope here, learning some new things and, uh, one of the things we learned is, Uh, not to drive the cart while we're talking and, uh, generates too much wind. We also learned to be cognizant of airplanes as they were going by, and trucks as they're going by.

Uh, but that's, uh, that's part of what we're learning here and, uh, we'll continue to strive to be better as we move forward. All right. So here we are, our first, uh, onsite podcast from a golf course with, uh, Dr. David SMA. And, uh, well welcome, welcome to Phoenix. Thank you. Thank you. I can't think of a better way to do this.

Oh, me neither. Actually, this is gonna have to become the, the normal format from now on. I'm just gonna call. CIOs and ask them to, uh, to meet me on the golf course. And, and we'll do this. Uh, so yeah, so we're at the Ian actually, uh, just finished up at the Scottsdale Institute, which was a, uh, great conference.

And, uh, we're looking forward to giving you guys some, a little bit of, uh, the insights. We're not gonna go in depth into a lot of things, but just some things that they got us thinking about and talking about. You were on a panel? I was on a panel, yeah. So, uh, looking forward to doing that. But right now we're gonna go hit a shot and then we'll come back.

We're not gonna give you a run, play by play on the, uh, call shots, but we are both pretty close to that green, so I feel pretty good about that. Um, so let's start with, uh, let's, the, the whole conference was about consumerization and, uh, digital health and those kinds of topics. Uh, let's talk, let's talk first about your panel discussion.

So, uh, just give us a little rundown of what you guys talked about. Yeah. So we, uh, were tasked with. Discussing how computer aided healthcare in the future was going to look, what we thought would be some of the most useful, uh, interventions and interventions that could be applied. And, uh, had some terrific panelists.

Um, it was great to be up there with David and, um, get a chance to hear his take from the quality, safety standpoint and then have Andrew . Have his take as a, uh, intensivist as well as a c i O and then mine as a, uh, former c I o, um, who has time to think about things. Yeah. Uh, and so moderated by Jonathan Manis.

Uh, Andrew Rosenberg, who's been a guest on the show before. And then, um, David David's last name Best, David Best, uh, was there from partners, I believe. Right? Correct. And, uh, yeah. I, I thought it was good. Good. One of the things I wanted you to talk about, 'cause you, you shared, you know, sometimes this stuff is just incremental.

We think it's, you know, digital health is this massive thing and you shared about your discharge process and it's something that really struck me as, uh, something a lot of health systems, uh, struggle with. And you guys saw significant benefits actually got written up. So yeah, talk a little bit about that.

So, uh, we instituted a physician builder program as we went live with Epic. And in the two years since we, uh, completed the GoLive, they've been working on enhancements. And one of them was directed by our hospitalist, um, builder. And she saw an opportunity to automate a lot of the data aggregation for discharge and for discharge preparedness.

What it did was it saved the nurses from having to go through screens and pull it, um, and . The physician from having to go through screens to see what was still missing. It presents it in a single format, and they're able to see what still needs to be done, whether it's med rec or uh, scheduling, um, a follow up and it cuts time.

We, uh, in the study that they did at Baptist, um, they found that it cut 40 minutes of nursing time per discharge. Um, in the initial, and it continues to have those kind of numbers, plus it reduces the time from declared ready for discharge to out the door by 15 minutes for the patient because of including the transportation folks.

So it's patient satisfier as well as a time saver for clinicians. Yeah, and the amazing thing to me is, you know, consumerization. Really is about convenience choice. Um, it's, it's about, it's about the consumer and that was a huge consumer, uh, benefit. Yeah. I mean from a perception standpoint. Um, but we also talked about the consumer on both ends, right?

Right. The consumer, the consumer of our services as c I O is the clinician and the consumer. Being the patient. So that was a win in both directions, correct? Yeah. And from the patient standpoint, the fact that the nurses were spending less time on it, the doctor had the information. It also allowed for earlier discharges in the day, and then that 15 minute saving, um, for transport.

So it really is about a 45 to 50 minute savings for the patient. Yeah. And that's huge and great shot by your wife. She's on the green and we will, uh, come back in a couple minutes.

So David, one of the things I found interesting was there was an awful lot of, um, disagreement, which actually made this conference great. 'cause there was a lot of conversations, um, different ways of approaching budget, different ways of approaching digital in general, different concepts of digital, um, people thinking we're spending too much time on the consumer, not enough time on the clinician in our core business.

Um, but so let's, let's break some of those down. One of the things, uh, you know, some organizations have decided the future of healthcare is consumer. And so I, I did a panel, we'll see if we can drive and do this at the same time. Um, I did a panel that was, uh, chief Digital Officers, chief Consumer Officers, one c e o, um, a former Disney employee who's now working for a health system.

And, uh, and those systems are essentially saying, Hey, we're all in on consumer. The consumer experience is gonna be king. We wanna make sure we hold on. Of our, our customers. Um, but there was others who were like, you know what? We hired these kinds of people and then our D n A doesn't allow them to be successful.

It shuts 'em down. Um, I mean, did you get a, get a feel for is, are, do you think it's gonna head in one direction or another? I mean, are you feeling a consensus building or is. Just, we're gonna see what works and eventually we'll all adopt it. I, I think we're going to see, um, you know, we heard the comment about, um, two major companies not in healthcare, and the one saying, I want to be a fast second.

Yes. I think there's a lot of systems that wanna be a fast second because the investment in consumer, uh, orientation in, in digitization is significant. The change in workflow is demanding and they wanna see some success and r o i before they jump in because everyone's experiencing. The tightening margins.

The other reason is I think there's generally a lack of creativity within healthcare. We are not, um, artistic individuals, and so we don't have the ability to do the imagineering that a Disney employee can do. And our boards are highly conservative and particularly our legal counsels and digitization and consumer orientation puts you out there a bit.

Yeah, too much risk. Um, I also, uh, you know, I found it, found it interesting as we were talking to, as I was talking to the, uh, chief Digital officers, uh, just the, a bunch of 'em coming from outside of healthcare and the learning curve. And they even said the learning curve is very significant working with, uh, these health systems and

You know, they're a hundred year old companies that are, you know, their d n A is designed to, to mitigate risk and reduce risk. So, and they get the sense that a lot of the folks in those organizations are working very hard to have them fail. Yeah. Because they don't wanna be proven wrong about the way they used to do it.

Yeah. It's, it's a struggle. Number five. Okay. Well, you know, it was, uh, this is gonna sound like a choppy podcast, I'm sure. 'cause it's like, you know, we, we record something and then we hit like three or four shots, then we get some drinks, then we, uh, get back on the, uh, thing. Um, . Uh, I, I love the Scottsdale Institute because first of all, they picked such great topics and there's great people in that room.

Um, one of the things that, that struck me, and we're not gonna do justice to the, to the agenda and whatnot, but one of the things that struck me was, uh, Jerry Lewis was there, a c i o for Ascension, um, as was, uh, Marcus Shipley. Uh, c I O for Trinity. And both of them talked about, uh, the fact that their budgets, um, that they've given away a lot of their budget, uh, control.

And now, when I was c i o, I don't know if this is the same with you, I was like the Bank of St. Joe's. You know, absolutely. I had a, I had a massive budget, so every time somebody wanted money for a project or whatnot, they were coming to me and Marcus made the point of saying, you wanna get outta that business as fast as possible.

And essentially the, the budgets, yeah, we got applaud. Phenomenal shot there. Um, But they made the point of saying, you wanna get outta that business as soon as possible. Yeah. You want, uh, the governance committees, the executive committees, you really want your strategy to drive where your dollars are not the c i o holding onto the money.

It's a, it's a bad place to be. I mean, I, I assume you picked up on that. Absolutely. Absolutely. And when you're not in a full scale implementation of the integrated D h r like we were, um, I can understand that to a degree. My only concern is no one in operations, no one else. In the C-suite has an appreciation for the complexity and nuances of an IT implementation.

So they all under budget and overcommit in terms of volume of, uh, projects. And I think the CIOs got to at least be able to be in the room and have a very strong voice to control the, um, overgrowth of the projects. But that, but see, control is an interesting word. 'cause uh, what I was hearing from them was a lot of, um, giving up control and being

More the, uh, guidance, uh, educator. Um, uh, yeah. And, and so yeah, you're right. I, my word of control is kind of a misuse. It, it is guide the conversation to make sure all the aspects are con, considered, all necessary aspects are considered. That's not controlling, that is simply guiding and educating.

Absolutely. Well, let's go hit some shots.

But David, it's kind of, it's kind of cliche to talk about the role as c i o, but one of the things that struck me about that panel you had, uh, uh, also Eric, uh, Lansky, Lansky from, uh, out of Stanford, now Stanford. And, uh, Used to be Chicago. One of the things that just struck me was when, when they got done, you hadn't heard the word e h r, you hadn't really heard them talk about technology.

They were talking about business and influence and leadership and um, and leading out in, in different areas like, uh, partnerships, like driving new partnerships and, and new business models and those kind of things. And somebody made the comment of, uh, you know, they almost sounded more like CEOs. Right. To a certain extent.

And I think that's the evolution we've all been talking about of Yeah. Uh, this c i o is now the c e o of technology within the organization. Absolutely. Yeah. And having a, uh, much stronger role in developing the system strategy and having to think in terms of a more holistic model. Um, I liked when Eric was talking about convening.

Some of the clinicians and some of the department directors and was slightly surprised that others hadn't thought about doing that. And I think that's where it has the opportunity. 'cause they see who the end users are, they understand who's gaining value from the systems, and you can bring 'em together to help evolve them and improve them.

And other executives may not have that insight.

Okay, so we're gonna talk a little bit about your article, but before we do that, what do you think of the Phoenician so far you've played here before? I love the course. Love the course. I don't like the way I'm playing it, but I love the, uh, course it's actually fair. So I'm awful. This is my, uh, first time out for the year, so I'm not too hard on myself.

Um, plus playing the course for the first time. Sometimes you, uh, find water that you didn't know was there, and a couple other things. So, uh, feeling pretty good about that. So you, uh, wrote an article in Health System, c I O. Uh, was that last week or two weeks? Uh, it came out Monday came out Monday out was Monday.

Okay. And, uh, we, we pulled a couple, uh, quote pictures from it, uh, great article. And it reminds me, I think this was your quote from this morning of, you know, you can spend time up front, uh, talking to the clinicians, listening to them, um, getting their feedback, incorporating it, or you can spend a ton of time later trying to earn their trust back because you, you violated their trust.

Yeah. Recovery takes a whole lot longer than being proactive about it and. And just involving them. And you know, my other take on it is because I've seen it and I saw it. So, um, beautifully illustrated by the 216 physicians who participated in our build process. Um, and that is when you engage them, they are so positively contributory that, um, executives are amazed.

Their productivity level's high 'cause they don't have time to waste. But they'll come in there and they're gonna give you your best 'cause they don't want anything shoddy going out with their name on it. Right. So how do you, so . It's interesting, uh, one of the CEOs was sharing their process and they, they took 150 people, they put 'em, they locked him in a room, is what he said.

I doubt they locked him in a room, but they, uh, I guess they secluded him a little bit, gave 'em some time, and they said, design what healthcare's gonna look like in 10 years. And, uh, and they came back with their concepts and their ideas. I think somewhat sometimes people are afraid that if we put physicians in a room, they're gonna come back and design something that's iterative as opposed to something that's, uh, transformative, if you will.

I mean, something that's gonna, that's totally different, but that's not really the case. It's not the case when you look at some of the surgical techniques that they've pioneered and some of the thought process to get to those surgical techniques, they're thinking so outside the box. So, um, Extravagantly audaciously risk, um, avid that they come up with things that you just wouldn't do if you were being cautionary and trying to do an iterative or incremental process.

And they'll bring the same to healthcare. Yeah. But where, so where's the physician's head at with regard to digital? I mean, one of the things I always think is we did really such a bad job with the E H R just as an industry. Let's just say that. 'cause some . Did a, did a really good job. Um, but as an industry, we sort of, you know, sort of pushed it on people and it wasn't really a shovel ready project, and we had all those issues and it, it, it almost, um, and I tell people, I think that put a bad taste in physician's mouth.

So when we come in and talk about digital, they, they sort of go, whoa, whoa. Slow down, take a breath. Let's, let's think this one through before we go running down the, running down the path. I, i, is that, I mean, how are they thinking about it? I, I think there's some of that. But when I talk . To them. Um, their concern is that if, if it's coming from the same people, they don't want it.

But if you bring in a chief digital officer and you're bringing in some different, um, players to work through the process, um, I think you've got a much better chance of engaging them because they love their iOS, they love their droid, and they love their apps, and they love things that work intuitively and things that work well, whether it's for themselves or for their patients.

So I, I think you've gotta change the faces. You know, as I said, I, when I left my role, I was the face . Of the painful part of Epic, there's now folks who get to be the face of the evolving, improving part of E Epic. And I thought that was important. I thought that was valuable to the organization. There was an awful lot of talk about organizational change management, right?

So that's one of the things that we did not do well and it's, it came up in my panel, my digital panel a couple times where they said, Hey, we've got these new initiatives, but we are really struggling with, uh, getting it implemented, uh, at scale across the board. And, uh, and people just . Kept driving home that the old skills, the skills we learned in doing the E H R, at least towards the end, you know, we may have screwed up in the beginning and we learned, oh, we gotta bring people along.

We gotta include them in the conversation. We've gotta, uh, co-create the solution as we go. Um, all those things we learned, those are gonna be . Critical moving forward. Absolutely. And that becomes change facilitation instead of management. Physicians hate to be managed . They like to be helped, like, like to be helped and they like to be a part of the process.

Yep. Our wives are going forward. Without us, we, we might want to hit, hit our drives. Here we go.

So Cedars Sinai presented the, the accelerator and it was really interesting and it gets me to, to thinking, um, how should we be thinking about innovation? Um, 'cause we have a lot of different models out there. We have some dcs. We have, uh, the accelerator model, which they in detail, which is very interesting.

And, uh, there's just, there's. So many different models, but you came from a, a $2 billion health system. How did you think about innovation? We, we thought of innovation as organic efforts that, um, responded creatively and uniquely to a need that we saw within the system that could be done, uh, with the personnel that we had and the systems that we had.

And so it was really more innovative use of what we already had, um, and then hopefully be able to share it. So that discharge, um, uh, process for. For the record, it's shared out. That's available in the library. It's, um, then shared out to, uh, several of our, um, friends around the country. But the thing that I liked about the Cedars idea is it could look at a wide variety rapidly and truly accelerate things.

Plus they are thinking about bringing in other groups that represent different demos, different. Um, needs than Cedar's going to experience. Right. But, you know, I think they're one of the few that has an accelerator like that. Um, but you were, you were chatting with them and I mean that's, that's sort of the conversation of how many of those should we have across the country.

Yeah. And so Ann and I had a nice chance to chat about it and. Yeah, my concern was you could spend a whole lot of money across the country if every one of us chased this. And she agreed. And we kind of settled on the idea that their thought was, and I agree that 20 across the country, um, doing different approaches to innovation, But still having the openness that Cedars does to bringing in other participants, other partners, to at least look at the OP opportunities and to bring new understanding is a good model.

That way, not everyone has to have that infrastructure. There's other things that each of us can do in our sites that can contribute. To the care of the patients across the country without having to have an innovation center. The, the thing that struck me was it, it doesn't, here's the thing that's expensive.

It's not the money. It's not the cash. That's the expense part. The expense part is the pilots and the people and the resources that you have to dedicate to it. And that's where, that's where it really burns, um, burns cycles and, you know, so, hey, you're not gonna have a lot of 'em. But there's been a lot of talk about sharing, um, you know what

What kind of sharing models do you think are gonna work and where, where have you seen sharing models where obviously through, you know, through Epic, you share some of the things that are going on? Yeah. Through, through the Epic library and the U G M and X G M E certainly share there. But, um, within, um, the state of Kentucky, there's a C M I O, uh, collaborative and, uh, Dave Dauer from Owensboro Health is the convener of that group, and there's six to eight CMIOs who participate at various times from Kentucky and Southern Indiana.

And they're sharing ideas. They're sharing ideas that, um, they have found to be beneficial to the physicians, beneficial to the patients, beneficial to the nursing, um, physician relationships because none of us want to have to invent the wheel by ourselves. Right. You know, it's interesting to me, I listened to somebody, somebody set up at a mic and said, what, we don't have a lot of good examples of machine learning or, or ai.

And I thought, well, I really wish you'd listened to the podcast. 'cause we've had about a dozen of them that people come on. And I was, I was thinking of, uh, Routing all their faxes through Amazon Web Services, having the machine learning look at it, identifying the consent forms and then just using fire to check the box.

We got the consent form for this person and now you've taken a process that is where it was very manual and very whatever, it's just doing simple N L P on a form and using fire to check back in. And I thought, you know, that's the kind of thing that would not be that hard to implement across many systems, systems, many sites.

Um, so I don't know. It's probably something we should all be spending some mind time on of. Uh, how do we facilitate more sharing of those kinds of things? Because most of us don't view each other as competitors. Obviously in a market you do, but outside not really. Yeah. Yeah. How do we more intentionally share on a regular basis to make sure that we're not missing opportunities?

Yep. Absolutely. Alright, well I, I talked about your shot into the bunker. I gotta talk about your shot here. Nice, nice drive and thank you and good luck on the next one. Thank you.

All right, so we're gonna close this up. This will probably be one of the most disjointed podcasts in enjoyable for us. Uh, yeah, absolutely. And we, we clearly didn't cover everything. There was a great c e o panel, um, and there was, uh, I mean, there was just a bunch of great conversations outside of it, but what I wanted to do is catch up with you on.

So the last time we talked, you were working on a wood project for your, uh, grandson, and it was the Titanic. How far along are we on the, uh, wooden, wooden, uh, replica? The Titanic? I have, I have the steerage, um, deck below decks. I have the crew quarters below decks, and I've got the main deck in place. Now I have to build the three levels above main deck, and then the captain's

Um, area and the stern, uh, area with the, um, lifeboat. So lot to go, but I'm getting told by a five and a half year old that I messed up. 'cause I don't have an engine, I don't have a, uh, propeller shaft and my bilge is not right at, at some point he's gonna get older and you're gonna tell that story. He's gonna go, I can't believe I did that to you.

That's, that is so funny. But in the meantime, we were building two, uh, Airbus three eighties out of walnut and, uh, have all the wings and tail, uh, components. Just have to do the landing trucks. And then I, uh, built a, uh, B two stealth bomber because the fourth grandson just really didn't wanna be like the others.

Got it. And, uh, are, are, I assume you're like, you're like whittling those things, right? Yeah. I mean that's, yeah. Using, um, rasper and surf forms and sometimes Grindr, golly, it, it does amaze me as we sit around with the CIOs, the different hobbies that people have and. Whatnot. Not all of 'em are golfers. A couple of 'em are golfers, but Yeah, well, the boys all got their own surf forms, and so they're learning how to shape wood with a surf form now.

Gosh, it's fun. Well, that's great. That's amazing. Any, anything else you would add at this point? You know, I, I just so appreciate the opportunity to be in the president of the CEOs, CIOs, CMIOs and . CNIs and get the wisdom from that many people in a short period of time, but in such a relaxed and condensed setting.

And I just encourage anyone, when you have an opportunity to get in that kind of a gathering, don't pass it up. Don't think you're too busy. You're going to really regret it. Your organization's gonna be harmed by you not doing it. Yeah. These, um, I, I, I agree with you a thousand percent. When, when these, when these settings, the smaller they are,

I mean, when you look at who's going and the smaller they are, that's the, the value just increases. Absolutely. Even if it's only 10 CIOs, you know, you're gonna have one-on-one conversations. You're gonna talk, uh, very tactically and, and get, get to talk about things you want to. And I watched three of the CIOs find new partners to work with.

So six people got linked up in meaningful ways that will benefit their organizations. Absolutely. Well, we're gonna sign off on number 10, so we don't have any excuses for our back nine, but, uh, thanks again for coming on the show. Appreciate it as always. Thank you. Thank you again for listening and, uh, once again, just sorry for some of the production challenges that we had.

Hope you, uh, got some good content out of this. I really enjoyed recording the, uh, the show with David. It's always fun to get together with him and take a look at the industry and what and the things that are going on. This show is a production of this week in Health It. For more great content, you can check out the website at this week@healthit.com or the YouTube channel at this week@healthit.com.

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