This Week Health

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June 20, 2023: Today's discussion hosts Drex DeFord as our guest, who sheds light on the personal and professional aspects of problem-solving and the transformative potential of adopting a cloud-first strategy in healthcare. We dive deeper into this insightful conversation with six specific questions:

  1. Can personal hobbies contribute to the cultivation of problem-solving skills useful in a professional scenario?
  2. What does a "cloud-first" strategy mean, and why is it significant for healthcare organizations?
  3. How can healthcare organizations find a balance between their typically risk-averse tendencies and the need for technological advancements such as cloud services?
  4. Can shifting non-critical operations to the cloud be a stepping stone towards wider cloud adoption?
  5. As organizations move towards a "cloud-first" strategy, how should they handle the complexities of this new architecture, particularly regarding security?
  6. From your experience, how have transitions towards cloud infrastructure and DevOps impacted operational efficiency, cost savings, and system agility?

Key Points:

  • Leveraging personal hobbies for professional growth
  • Understanding the meaning and importance of a "cloud-first" strategy
  • Striking a balance between risk aversion and tech adoption in healthcare
  • Appreciating the advantages and complexities of new cloud architectures
Transcript

 Welcome to this Weekend Health It where we discuss news, information and emerging thought with leaders from across the healthcare industry. This is episode number 22. It's Friday, June 8th. Today we talk about Apple and APIs and what healthcare it can do about the rising cost of healthcare. This podcast is brought to you by health lyrics.

Are your strategies constrained by infrastructure or are you tied in a knot of applications? We've been in your shoes. We've been moving health systems to the cloud since 2011. Find out how to leverage the cloud to new levels of efficiency and productivity. Visit health lyrics.com to schedule your free consult.

My name is Bill Russell. We're covering healthcare, cio, writer, and consultant with the previously mentioned health lyrics. Uh, before I introduce our guest today, I wanna give you guys an update on what we've been doing so. As I shared a couple episodes ago, we've reached some milestones. Um, and what we did is we got together with our sponsor and what we'd like to do is now that we have a quality show, quality content, quality guests, we'd like to get into the hands of, uh, more healthcare leaders.

Uh, we would like to, uh, get it to the staffs and, and other people within healthcare, within the healthcare industry. Uh, that's why I'm really excited to, to, uh, To give you an update on this and to announce that our sponsor has agreed to give $1,000 for every hundred new YouTube or podcast subscribers through episode 31.

And this is episode 22 to Hope Builders. Hope Builders is a organization in Orange County that provides, um, life skills and job trainings to, uh, disadvantaged youth, uh, and gives them enduring professional and, uh, personal, uh, skills. To put them on the right path. Uh, I've hired some of their graduates.

It's a great program. Their stories are inspiring, they're incredible. Uh, we'll hope that we, hope that you, uh, join us in sharing the show with your peers, your friends, uh, to maximize this op opportunity. And again, to just give you an update. We've already raised a thousand dollars over the last three weeks, but I'd like to push that number much higher.

So, uh, today's guest is a, um, Is coming back for the second time. So that's a good thing. Today's guess is, uh, the original recovering cio. If you go to recovering cio com, you'll find, uh, his website, former CIO for Scripps, um, Seattle Children's, among others. Now an independent consultant with, um, who helps providers and startups across the spectrum.

Uh, my good friend, uh, Drex de Ford is in the building. Good morning, Drex and welcome back. How are you? Uh, you know, I'm doing pretty good. How are you doing? I'm, I'm doing good. I just, uh, came off some travel yesterday, so, uh, it's nice to be home in Seattle. Yeah, I, uh, I noticed that, uh, Somebody did a, a Twitter post about the recovering CIO and gave you credit for being the first one to coin the term.

And, and, uh, it literally, you, you got the url recovering cio.com takes you to your Yeah. Your organization's website. How, I mean, yeah. How'd you, how'd you come up with that? I mean, was that after your last CIO gig or after? Cause you've done two or three. Yeah, I'm, uh, I'm absolutely sure, uh, in the, in the.

Sort of, uh, mode of, uh, plagiarism is the most sincere form of flattery, uh, thinking that I probably stole that from somebody in the past. And I don't know that I can necessarily say who, but I have had a GoDaddy account for a long time. So when I find a really cool or interesting phrase, I very often, uh, wind up grabbing the domain just to see if something happens with it.

So that's one of those domains that auto forward. Yeah, I'm, uh, data, data hippie, uh, nerd herder.com. All of those forward to my, I'm, I'm, I'm a little bit of an addict as well. I'm, I'm curious what your, your GoDaddy bill is up to annually, , I, I think I, I literally have about 15 to 20 domains that I've.

Collected over the years. I'm probably in the same boat. I probably, I have a few and I let a few go every year where I'm like, okay, that's, that one's never going anywhere. So that was a good idea back in 1998 and maybe not so much anymore. Yeah. Yeah. So, you know, one of the, hard to find good ones. Yeah. Oh, absolutely.

So one of the things I, we like to do is, uh, just give our guests a couple minutes to tell us, you know, what you're working on, what you're excited about, uh, today. So what, what's going on in your world? Yeah, I, um, So I, I just came back off of, uh, travel down to the synergistic board meeting, synergistic, of course, best in class healthcare security consulting firm based in Austin.

We met in Southern California yesterday, uh, a board meeting. So I'm on the board of directors at Synergistic, which actually has been a massive. Super cool learning opportunity, uh, publicly traded company on the New York Stock Exchange. We rang the bell, uh, on the podium a couple years ago, which isn't one of those things you can really put on your list to do.

It just ha has to sort of happen to you. Um, so we've been through some m and a, we've done a bunch of stuff. I've learned a ton. Being on that board of directors. So that's been, uh, really great. Other than that, I'm working on, you know, the usual sort of stuff with health systems around strategy and planning, uh, lean operations, implementation kind of stuff.

Uh, I still do work with a lot of work with vendors. I have retainers with vendors helping with everything from sales training to product development, to, I mean, you name it, marketing. Right on down the line. I still do do some work with VCs and PE firms. Uh, from time to time. I'm, I'm thrashing through a book right now and that I don't know if it will ever actually be finished or be this always pending draft.

Document in my, in my Microsoft Word folder. But can I curse ? The, the, the name of the book is You Can't Bullshit An Old Bullshitter . So we gotta kinda gotta see how that comes out. And, uh, you know, in this spirit of space, nerd, I continue to stay plugged into, uh, NASA and SpaceX and, and all of that as we talked about last time.

So, um, love the Space Station stuff. Big, big announcement from NASA today on, uh, findings on, uh, Mars, 3 billion year old. Um, oh gosh, I didn't, I didn't, I'm sorry. I read it like a half hour before the show, like three, 3 billion year old findings of, uh, matter as well as they believe there's matter on Mars that, uh, can su support the elements would be required to support life.

Interesting, obviously, You know, if, if you and I were independently wealthy, that's where we'd be spending our time. Oh, for sure. I would definitely be a space tourist. That's no doubt. Yeah, it is. It is so much fun. Um, and you know, one of the things we don't probably talk enough about on this show is security and if, uh, if anyone wants to know why, the reason is we have a lot of CIOs, either former or current.

And, uh, most of 'em are under strict guidance from their security firms not to talk about their security posture publicly, because, you know, half the battle for somebody trying to hack in is just, you know, picking up sound bites. And so anytime we go to talk about security, uh, CIOs are a little leery to do that because you just don't wanna.

You don't wanna make it easy for somebody, so you don't want to talk about Well, you know, we have a three tier architecture and we're doing , we're doing Yeah, for sure. You give away a lot of stuff just accidentally when you talk about it, so, um, so yeah, that's probably for the best. Yeah, absolutely. So, uh, so on, I'll transition here.

So on our show we do three things. We do in the news, soundbites and, uh, social media, close in the news. We each picked story and, uh, you picked the story. Um, For the week, so I'm gonna let you go ahead and kick it off with your story. Give us a little background and, and we'll go back and forth on it. Sure.

Uh, so kind of the story of the week, um, the Worldwide Developers Conference in San Jose, the Apple Worldwide Worldwide Developers Conference in San Jose this week, uh, announced a bunch of different, uh, cool and interesting stuff as they always do. Uh, but in particular, they announced that they're making the, uh, health records API available to developers and medical researchers.

And I'm reading this from, uh, from the website or from a, uh, it's not from the Apple website. It's actually coming from, uh, health data management. Uh, thanks guys for writing this up. Um, health consumers better manage their medications, nutrition plans, and, and diagnose diseases. So, I mean, I find this really interesting because we have gone through a.

Google's tried to build a personal health record, uh, and, and basically bailed on it. Uh, Microsoft has, uh, a personal health record health vault still not used extensively in this country, but is used in other countries. And so this kind of whole new approach of how do you create a personal health record, but maybe the foundation of the record is on your phone and you control it in management.

And with the release of these APIs, the ability for other developers to be able to connect, uh, to that health records app and do other cool and interesting things that might ultimately drive you to stay more healthy and be more healthy, uh, is a really. Interesting idea. I'm concerned about a lot of things as a lot of people are always about security.

I always have security and privacy in the back, my mind. But, um, the opportunities there are are, are pretty cool. And it'll be interesting to see what, uh, health systems and vendors come up with. So around security, one of the things they noted is, uh, the health records data is encrypted, which we already know on the phone and protected with the consumer's, uh, passcode and, and the, that technology.

But they also also emphasized, and, and this was something I, I did not, uh, I knew they had would've to address. I didn't know how they were gonna do it. So, um, that the data flows directly from Apple's health kit to the third party apps and that it is not sent to the vendor servers. So it's, it's not a mechanism for.

Like a Facebook, like, you know, oh, I have access to this information now I can just suck all this data out from this patient and move it to our servers and start selling the data. That's not how this is designed. It just goes, it stays on the phone, it goes from, from health kit to that vendor's app gets used there and, uh, and obviously with cloud services and then gets, uh, you know, put right back where it was.

So that's, that's one of the things I found interesting about, uh, how they're gonna do security. Yeah, yeah, yeah. The devil's in the details. I mean, I really wanna see and understand how that, how that actually works. Um, but the idea that, uh, ultimately we're creating this system where you are in control of your data and you can release what data you want to, whoever you want, uh, is a really good.

Um, privacy strategy. I get to manage my data the way I want to manage my data, and no one else, uh, has access to it. That's ultimately what this really boils down to. Uh, I'm in. I I think that's a, I think that's good strategy. Yeah, and it looks like a lot of the rest of the industry's in, so in, in this article, John Hika, uh, guests on the show.

A, as these API tools become more widely available, smartphones will be increasingly important middleware component that enables patients to be stewards of their own data. Uh, Stan Huff, uh, chief Medical Informatics Officer at Intermountain Healthcare Scribes Apple's initiatives as exciting and pivotal given the fact that the company is supporting HL seven fire APIs.

Robert. Wrote the book. Digital Doctor, uh, is also very positive. Karen DeSalvo is very positive. Um, uh, and actually I'm gonna focus in on two of these. So Ken Mandel, uh, of smart and Smart on Fire Fame. Uh, director of Computational health informatics program at Boston Children's Hospital. Uh, someone who I had come out to California and speak to our physicians on the, uh, value of interoperability within health healthcare.

Great guy, extremely smart, observes that Apple has taken the next logical step in creating a health apps economy. And I think that's what we're all really excited about. He goes on to say, by connecting to hundreds of electronic health record systems using the Open Smart On Fire API standards, apple has committed to and advanced the interoperability of health data across vendors and organizations.

Uh, with this announcement, they are opening up the key health system data to their iOS development community, who will soon have access to blood counts and medications for apps just as they have access to calendar contacts, locations at step count. And I think he hits the nail on the head. I mean, that's, we're creating a, a health app economy.

Uh, when, when a developer used to have to develop an app, they have to decide, you know, how are they gonna interface with the ehr? We all know there's a hundred different EHRs, you know, are they going to, you know, go through a, a third party and api? Are they gonna go directly through a, uh, Uh, you know, like an app orchard or something to that effect.

And now you, you have this mechanism where they can, at least with the data they have, and now it's not great data. And that's the next thing I wanted to sort of touch on with you. Um, but they've created this health app economy. Do you think we're gonna see an explosion, uh, like just a, a huge number of apps come out on top of this?

I mean, we're talking about, uh, I think four, four or 500 hospitals at this point that have mm-hmm. connected in on record. Yeah. Do you think we're gonna see an explosion of apps on this, or is it gonna be slow? So I think what we see, what we see in the app store in a lot of. Cases when it comes to, you know, quantified and, and personal health applications, um, there are a lot of people that download them and use them once or twice and they're not sticky or they don't do the thing that person.

Kind of hope that they would do or wanted them to do. And so when it comes back to sort of average daily user count for those applications, there's lots of them, but lots of them that aren't used. Uh, so really very few of them are used. I think we'll probably go through a similar cycle with this. I think there's a couple of paths here.

Um, right. And I don't know that. Vendors are gonna maybe like this idea very much, but I think the idea of the electronic health record. On the consumer side, on the customer side, and you know, you heard me rant and rave about we really shouldn't talk about them as patients. They really are customers on the consumer side, on the customer side, I think we're gonna see this path where they're going to get better access to their records, the data in their records, and then using apps that.

We're gonna have, a lot of developers are gonna have to struggle through this to figure out what really works and what doesn't work. But ultimately they're gonna be able to see their data in different ways that works for them, uh, given that we're all individuals and we all have different ways of wanting to consume data.

Uh, sort of another version of personalized health, right? I'm gonna be able to use. Uh, an application that drives the data to me in the way that I need it, that le leads me ultimately to live a better, more healthy lifestyle. That's one path that we're gonna see. And the EHR vendors really in that scenario, are just going to be the data repository for the data.

I think there's gonna be another version of this that happens on the, on the provider side. And APIs and lots of other things like that, necessarily Apple.

Um, I'll see the same. There are lots of you. Between transplant and lab and rad. And you know, we've all gone to, or many of us have gone to, um, best of suite electronic health records. What if you could layer on top of that a bunch of applications that let you as a provider, see data and use data the way that you really wanna use it?

Um, and again, the EHR just becomes the underlying. Um, infrastructure, database infrastructure to feed those apps. Um, it's an interesting idea and I kind of, I do play around with, you know, where could this go and how could it work? And, you know, being here in Seattle, I work with a lot of, uh, a lot of startups and a lot of, um, Big thinkers,

So it's, uh, it's fun to brainstorm through this. So I don't know if there'll be an explosion of apps ultimately. Um, I think there will be, uh, probably a lot of apps and a lot of them will be left also to the, you know, to the side of the road over time as they develop and redevelop and redevelop. But, but that's the beauty.

Something like an app store or something that, Can be improved on over time. It's an iterative process. You find out the things that work, don't work and not burdened with. Giant legacy system that you've built to support it, that becomes somebody else's responsibility. Yeah. In this case, the HR vendors.

Yeah. And we, you know, will there be an explosion? Um, you know, I, I, I believe we will see an uptick, we'll see an explosion probably three years out. Um, a couple, couple of hurdles we still need to get over. One is the EHR providers do not wanna be relegated to. Data transaction or a, a transactional processing system for the health systems.

Um, they do make money out of the APIs. At least one of the major vendors makes money. Um, they, uh, you know, have gone on record and, uh, you know, normally, uh, you know, they've gone on record. At least the predominant EHR provider, their leader has gone on record is saying, you know, we need to protect. The patients from their, from themselves, essentially, we give them this information.

It's very complex. They might make the wrong decision. I, I understand the sentiment of that, that the health record is very complicated and I wouldn't know what to do with my health record. But there's a whole bunch of, uh, brokers out there that could take my health record and give me a lot of insight into, um, you know, my, my maladies or disease state or my.

Proclivity to certain things that I think is valuable. Let me hit on this last one. So this is, this is, uh, from someone you probably know pretty well. Eric Topol, uh, from Scripps wrote the book, uh, the Patient Will See You Now. The Future of Medicine is, as you're in your hands, was also quoted in this maybe not as optimistic, optimistic, a little guarded.

Uh, Apple's continued effort to get patients accessibility to their medical data as laudable. Uh, says Topol. However, he adds that we are a long way from getting holistic, comprehensive data, but this is a step in the right direction. And what he's talking about is, uh, you know, the, the, the challenge with the data itself.

Intermountain's Huff, um, who's been an advocate for, uh, clinical data models and terminologies says, uh, his only concern is that there's. There's a need to further standardize the models and terminology used in fire services so that the industry ends up with true semantic interoperability across the marketplace.

And you and I have, I mean, this is why we have less hair and gray hair is, you know, you start digging into these. Various disparate EHRs. And it's not so much that the EHRs store data differently or, or those kind of things, although they do. Um, but really it is that we put it in differently. You know, we put the same, the same prescription in five different ways.

And it's really the same thing. And even when, when I talk to people about, um, AI models and are we gonna be able to apply AI models to these things, they're like, You know, that is one of the harder things to get through is that these five things are the same thing. It's this, it's a, it is a very challenging model.

So, I guess the question, the question we, on this one is, Okay. The, the Fire API is phenomenal. We're getting out the basic information from the Fire api. Um, and I imagine that will continue to progress, but as we get into some of the more complex data sets and some of the unstructured data and whatnot, um, uh, I, I would assume, I would assume that's gonna slow us down.

Do you think that's gonna slow down this, this progress? Um, Or do you actually, let me rephrase this. Okay. Do you, do you think there's gonna be a push nationally to getting to that, um, to that true, uh, clinical data model that just happens now that we're, it, it's almost like we were gonna try to get there so we can get to interoperability, but now that we're driving to interoperability, it might drive.

A standard data model across all these health systems. Do you, do you, do you see that happening or what do you think is gonna happen in this data model space? Yeah. Yeah. I, so, you know, um, I, I regularly talk to clients too about sort of analytics in general and how to approach it and, um, So I'll tell you a short little story here, and maybe it kind of ties, this ties back into this.

Um, when I, uh, went to one of my health systems, uh, as the cio, um, the, the data, the data analysts were all sort of centered in the information services department. And so when, when, um, my partners clinical or business partners wanted. Reports or, or databases or other things, they lined up outside the door and there was a long line outside the door and they would have a conversation with one of the analytics guys on my team and they would gather the requirements and they would build something in a spreadsheet and shape vigorously, give it back to the back to the partner.

Two weeks later, and by then the partner would say, you know, now that I've thought more about it, maybe there's some other stuff I would like to have in there too. Then the analyst would pull their hair out and go crazy and, and, and start over again. And we ultimately evolved that to a model where the analysts in the IS department were the folks who were, um, uh, they, they were sort of the consultants and the keepers of the data and data governance and.

Analysis of the data, uh, to the front. We gave them Tableau view or you know, something like that and happened was. Instead of saying, we're going to solve world hunger and build a data warehouse, we started off with let's find two or three really hard chronic problems that we have in the health system and figure out the 23 data elements that we need to solve that, and what's the source of truth that we wanna use for those 23 data elements from these five different systems, and let's build.

A database that pulls that data in on a regular basis, hour, hourly, quarterly, weekly, whatever it actually takes to solve the problem, and then push the data visualization tools down to the frontline folks and let them figure out what's the best way for them to consume that data.

Better, faster, cheaper, safer, easier access care for families. Sort wound through a process. Um, accidentally, but very intentionally went through a process of making decisions on that's a really important data element and we use it in lots of our decisions. So it's gonna come from that system and it's that data element.

And now we're really gonna go have conversations with the people who do the input of that data element to make sure that they understand why it's really important that. Something from the dropdown menu or that they, that they actually answer the, um, you know, the, the question or we modified the system so that it made it really easy for you to answer that question instead of bypass it.

Uh, so the things that we needed to make better business and clinical decisions drove the way that we ran the applications and the way that the personnel. Maybe there's something in that, in this larger sort of context as far as we don't have to get it all right, right away, and maybe we shouldn't even try.

Maybe what we should focus on are the data elements in our electronic health records and other systems that all taken together are the things that are the most important data elements that drive improvements in health for patients and families. Yep. I love that. I, the, um, you know, what I would say is that it, transparency changes things, right?

So you give tableau, click view to the, uh, frontline physicians who are trying to utilize the data. They get transparency into it. They look at it and they go, Hey, this data's a mess. We should talk to that medical group. We should talk to those doctors. That's right. And I think that same thing is gonna happen here.

Trans transparency of the data. Nationally, it's gonna get people to say, Hey, you know what, at least for these things, we could, we could handle, you know, cancer moonshots better if the data was, you know, better, uh, along certain lines. So I think we'll see that. Um, to close out the story, the last thing I would say to people is this, uh, You know, th this has left the barn.

Uh, get connected. Get your, first of all, get your e h r Fire, uh, uh, connectors set up. You should be done by now, actually. Um, uh, contact Apple. Get, get it involved in this. Uh, get your, get connected, get your health system connected to it. Um, you know, this horse has left the barn. If you are not on board, you could be, uh, could be left behind.

I think this is, uh, This is not a trend that's gonna fail and, and come back. I think this is a trend that it might move slower than we think, but it's, it's, uh, it's going to, it's gonna move. So I, I agree. I think it's definitely gonna move and I, and it, it may be a little slower and a little more cautionary.

I mean, I think Apple's learned a lot from the other, uh, tech vendors who have said, oh, hey, we're gonna solve healthcare, and then they get into healthcare and then, you know, A year later or two with their tail between their le their legs, they leave saying, oh man, super complicated. I no idea what was, uh, actually, uh, happening in healthcare.

They'd been a little more cautious in their approach. Um, but you're right, this is, uh, The barn is out the door. Uh, the, the, the horse is out the, out of the barn door, as you say, horses out. So, uh, we're, we're on our way. That's, that's the analogy we're looking for. Not that anyone understands what the horse is out of the barn means anymore, but we'll keep using it.

Um, okay, so here's my story. So, uh, yeah, the headline is, you'll Be Shocked at the Price of Healthcare for a Family of Four. Uh, it's from an MSN article. I think it was published yesterday. Here's a couple things from it. Healthcare costs have been increasing at the lowest rate in the past two decades. The result, the total cost of a typical family of four insured by the most common health plan offered by employers will average $28,166 this year, according to the, uh, Milliman, uh, medical index.

The estimate includes average cost of health insurance paid by the employer, uh, employers and employee, as well as deductibles and out-of-pocket expenses. Despite the significant expense for many households and employers, the slower rate of growth is good. News says Scott Welts, a principal at the Consulting actuary, uh, in Brookfield, office of Milliman.

Um, my first question to you is, uh, does that number surprise you? $28,166 a year. For a typical family of four, is anything surprising about that? Um, you know, I, I think it's only surprising in that, you know, when you see the number and you think about the amount of money that the average American makes, uh, even at this point where we're at full employment, man, that's.

It, it, uh, it is, it's shocking. Um, it's, uh, in some ways it's kind of horrifying, uh, that it costs this much, which signals to me there's still a massive amount of waste in healthcare. There's still a lot of consolidation to be done. Uh, we, we don't, uh, we don't operate well. Um, and, and Yout say that in every case, uh, when it comes to healthcare, but.

Man, this is a huge amount of, I mean, ultimately people are making decisions right? About are we gonna pay the rent? Are we gonna buy food, or are we gonna pay our healthcare premium? I mean, these are hard choices that most of the country are facing right now. Yeah, and you know, I've, I've seen this from a lot of different angles.

Obviously CIO for health system, um, had, you know, 600 and some odd employees, uh, reporting into me. So I saw it from their perspective and from the health system p and l perspective. I now have also seen this from my perspective. So one of the things that they note in this is that, uh, the total costs, uh, includes the premiums paid by the employers.

And I think that the, you know, over the last two years was the first time I've had three consulting practices. The first two were just Bill Russell, Inc. This one I've actually hired, uh, hired a team. So I have, I have employees, we have insurance. So I went out and had to, you know, buy insurance and get it all set up and that kinda stuff that was eyeopening to me that it was, it was really eyeopening how, um, I thought we'd be able to go online, select, you know, sort of like the Geico experience.

That's, that's just not the case. I ended up with filling out, this almost looked like identical forms for three different carriers. One for dental, one for, uh, medical, uh, vision was a different one. And, uh, you know, I'm working with a broker. I'm like, can you do this stuff online? They're like, well, you know, in a couple years we'll be able to do this.

Right. And I'm looking, I'm looking at that and I'm going, all right. Well, that I, I could see the waste is right in front of me. I mean, I'm sitting here with, you know, 15 to 18 pieces of paper I have to fill out. There's the waste in of itself. Yeah. Then you talk, just knowing what we know about billing, uh, the average, uh, medical bill has to be sent out, uh, or generated 12 times before it actually gets paid.

Well name another industry that we generate a bill 12 times before we get paid. It just, yeah, it, it doesn't exist. So there's still so much, uh, so much to do. I wanna trans transition this to really our, our listeners on this show. Um, you know, health systems are continue to be under pressure for cost reductions.

It remains one of the largest sources of cost. Um, you know, what are some strategies that you've done to, uh, contain or reduce it costs in the past, and what do you, what do you think the CIO should be doing now? Uh, you know, so for me that was, um, every time I came into a CIO job, it was a turnaround thing, which I mean, may just be obvious, right?

There are times that you wind up in a new CIO job where, The previous CIO had simply decided to retire, or they've been recruited away to another place. Very often though, it's a, it's a different situation. You have to come in and, and fix a lot of stuff. Often that also ties back to cost pressures. So for me, um, when I went to Seattle Children's, it was.

I mean, for me, part of the reason I went was Lean and Toyota Production Systems. It was a cultural way of making decisions about how they were gonna prioritize the work they were gonna do, but also driving that sort of take waste out every day, one second at a time kind of approach. Uh, that really did allow the organization to become more efficient.

And more cost effective kind of one drop at a time. So, so, so practice. I'm a huge fan of Lean and so practicing Lean. How do, so like our health system did it system-wide, but if, if, if a CIO's in a health system that's not doing lean, how do they get started? Where, where would you direct them? Yeah. So there's a.

A couple of things that every place that I go that like these are just two of the things you can do, uh, and, and take some waste out of the process at the same time. One of them is to do a daily huddle, um, and, and, and maybe do a daily huddle and do away with the weekly or the every other week, uh, staff meeting that you have.

Everybody shows up. You've got 20. 25 minutes, 15 minutes, whatever it turns out to be, and you literally go through a process of having a conversation about what are we doing today? What are the roadblocks for getting those things done? How do we overcome them? There's usually a list of things that are, uh, ongoing, pending, challenging issues that you can talk about.

You can talk about a safety. Item or something like that. But you, the, the beauty of this is that you understand every day where you're at today, instead of having a conversation once a week where somebody has been saving up stuff for a week and they're mad and frustrated and you know, then they barf all over the table.

And that's not good for anybody. So doing daily huddles and really understanding where you're at every day, where the issues are. You know, every day, every morning so that you can work them, uh, makes a, a, a great amount of sense, not just for the cio, but their direct reports, their managers and directors should be doing daily, daily huddles with their teams too.

The other one is going to gbo, you know, going to the place where the work is done, whether that means the CIO or the directors or the managers going actually out operations and how to understand. Delivery of, uh, healthcare IT solutions makes it easier or harder for those partners to deliver great care to our patients and families.

Or sometimes it comes down to me sitting down with three analysts in. One of the areas of the department and talking about some process that they're, that they're working on. It was not unusual for me to go in and sit down and, and pick out one particular thing and talk to an analyst on one day who drew out a diagram of how that process worked, and then go back the next day and talk to the next analyst.

About the same process. Who drew out a diagram on how the process worked and then getting the two or three of them together and showing them the diagrams and having them have the revelation of, man, there's no why. Why are we doing this three different ways? We should just agree on one way and then we can all do it and then I can go on vacation and you won't call me.

Cause there's some weird thing that I'm doing that we are not doing as a team. And when you develop that culture, ultimately you can drive that thinking. Down into the organization and this idea of I'm unique and special to the health system, and the reason that I'm valuable is that I know stuff that nobody else knows starts to change, to creating good standard work that allows everybody to be more effective than they've ever been before is the reason that.

You know, lean to me is a, it is a big deal and I understand it's kind of magical, uh, for a lot of people. Um, I know sometimes it's, uh, kind of a, you know, just a management term that people use, but it's a real cultural approach and it can really make a difference in how your employees engage in your health system.

It can make a real difference in saving money. It can make a real difference in how well you care for patients and. Obviously I'm a fan. I've lived in Japan. I lived in Japan for three and a half years. I've been back since to, you know, meet with Yamaha and Toyota, and so yeah, I've drank the Kool-Aid. I'm, I'm that guy.

Yeah, it's, it, it's good stuff. So our, our organization had lean methodology across the board and, uh, you know, drove out millions in waste and, and cost and improved safety. Uh, in it, we took a sort of a modified lean slash agile. You know, visible management, uh, standup huddles, those kinds of things. All of our major projects had standup and visual.

So every one of our walls within our IT building visual, yeah. Had something I could just walk by and look at and say, Hey, I've got a question. What's going on? And because you're doing daily standups, you know, it's not hard to find somebody who knows what's going on. And yeah, we talked about that this morning.

Here's, here's what's going on. Um, and I'll tell you the other thing that just, here's, I'll give. IT organizations, one thing they can implement. Which is when we sat down, we had 120 projects going, and I decided I'm gonna bring all my, uh, my direct reports into a room. And every one of the project managers was gonna come in and they just had to tell us, you know, give us an idea of, of how the project originated, what problem is it trying to solve?

Does the problem still exist today? And, uh, you know where you're at and what do you need for management to be successful? And the first meeting almost took a day and a half, all 120 projects to go through 'em. But when we were done, we cut out like 20 projects. Cause the problem that existed at one point did not exist anymore.

And yeah, we still had it resources allocated to it. We were still, you know, generating documents, doing all sorts of stuff, and it was, it, it was nuts. And we just like, and that's, you know, it's just lean, it's, it's, it is logic. It's not necessarily lean per se, but it's just logic to say. Hey, you know what?

Let's continue to ask the question of do we still need to be doing this work in this way with the, uh, changes that have happened? So, yeah. Yeah. One of the things in Lean is the five whys. You know, you ask for anything that's going on, you ask why five times, and you'll probably really get to the root problem after the fifth answer.

Um, this idea of, you know, Being able to see into your organization and understand what healthcare organizations, it's what I do. Don't have great governance processes when it comes to deciding what projects they're going to do and what they're not gonna do. They don't actively kinda draw a line and say, we're going to do the things above the line.

And all of those things have business or clinical sponsors. These aren't is projects, they're. Clinical projects or business projects and the things below the line, we have as a group decided that we're not gonna do, so we're gonna actively not do those. And that means that our business and clinical leaders aren't gonna have little black operations where they try to do those projects either.

And if they do, they get in trouble for. We're trying to do that. So, um, that, you know, having good governance processes, understanding where all your contracts are, uh, do, do you actually have all of your contracts, most of the places I go into and have that conversation, uh, it turns out that some significant number of contracts were signed by.

CIO two CIOs ago, and they don't actually have the contract anymore. Somewhere in a file. They just start paying the bill. Right? So going through the, that legacy stuff, all the m a stuff that's going on right now, right? You wind up with, uh, even when it's not an m and a thing, you wind up with a multi.

Three applications that I'll do almost the same thing. So this application rationalization effort that I know you work on too. And you know, let's pick one app and kill off the other two and save a lot of money and drive a lot of standard work and improve the data that we collect. Right? So it has a whole bunch of secondary, tertiary, um, Positive impacts.

Yeah, we're, we're gonna do a whole show on m and a at some point. I went through one of the largest m and a's, uh, in, uh, healthcare. Obviously the two organizations come together, formed a 22 some odd billion dollar health system, so eventually we'll get there, but, I'm actually running over already. So here's what we're gonna do.

The second Oh, okay. Second part of the show is, uh, we call soundbites. I'm gonna give you five questions. You get one to three minutes to answer. Um, and you know, I'll cut you off if it goes too long. We'll start with the, okay. The easy one. So, uh, kids are graduating from college, so if you had a kid going to college today, what's the major you would tell them to focus on If they were interested in healthcare it?

Yeah. Um, Man, you know, analytics, I think, um, it, it doesn't matter, uh, healthcare or not. I just think the idea that, um, whether you're going to be an actual data analyst, uh, professionally, or you're going to be a business operator or a clinical operator in the front lines, You need to understand data and data analytics.

And not just that, but also um, you know, data visualization. I'm a big fan of Edward Tuffy. Uh, I read and reread his stuff all the time. You know, a picture is worth a thousand words. If you can out how to show data in the right way, you can convince people to do the right thing. You know, over and over and over again.

Um, there's some, uh, there's some other companies that I work with that do some really awesome, uh, data visualization. Arcadia Health Solutions in Boston has a, a whole page on their website, a data gallery that has some amazing data visualization. So that idea of. Whatever it is, however you get into it, whether it's a major or a minor, you really need to understand data and, and how it works and, and at least the fundamentals of sort of database design and how you take that data and make it work for you.

Yep. And that's, that's just the result that, that's digital, right? The exhausted digital. It is. It's just the world that we're in now. Right. You, you ha you have to know it and understand it. And it almost doesn't matter what job you're doing, you have to know, you have to have a sound fundamental understanding of that, of that capability.

Yep. So the raging role debate for healthcare technology leadership. So you have a c I, some health systems have a c. Chief Digital Officer, cdo, right? I have a cio, chief innovation officer, and so on. Um, I guess my question is, who's the voice of the future for healthcare? Who is setting the course for the next 10 years of, of that group?

Or who do you think should be. Um, I think if I understand the question right, for me, the question is more of a question about where do you try to draw whatever the gray line is between strategy and tactics, right? So when it comes to job titles, if you're a chief information officer and you really focus on strategy and you have a really strong chief technology officer that keeps the trains running on time, And does it efficiently and manages the, you know, the budget really well and all those, then it doesn't matter.

You can call it chief Information Systems. There are strategic, strategic chief information officers who try to be strategic, but because the daily operations have regular challenges, they get sucked into the tactical side of the house on a regular basis, and that can cause. Some significant frustration for your executive peers.

Cause the only thing you seem to be working on is that XYZ that isn't working well today. So those health systems go out and hire chief digital officers or chief innovation officers to think strategically and not meet, be mired in daily tactical operations. So I don't know that necessarily makes a difference.

Purple doesn't really matter what the title. Where and how you draw the line between strategy and and tactics. And then when it comes to strategy, really being involved with your business and clinical partners, uh, developing new, better creative, innovative ways to deliver care. Great care to patients and families and, and that isn't just a technology issue, that's a people in process and business and alliances and partnerships with other organizations.

All that gets wrapped into it. I think those are the people who are ultimately gonna help drive healthcare in the right direction in the future. Yeah, I'll close that out by saying I think the leader of the digital strategy within the health system is the c e o and, uh, no exception. So yeah, that's right.

So, uh, what are one or two technologies that you're keeping an eye on right now that could be disruptive to healthcare? Um, and, you know, let's just say the timeline is the next, uh, five years. Yeah. Um, so I mean, I. Because of many of the things that I write about and post about on Twitter, I have to say artificial intelligence.

But artificial intelligence is one of those things that I think by the time we, uh, develop that thing that was artificial intelligence, by the time we get to it, we call it something else. So AI is always just out of reach. So, and we have Siri and we have Alexa, we have self-driving cars and all those things.

At one point we would've described artificial intelligence.

They're just a thing that we have and a thing that we use. And I think we see the same thing in healthcare when it comes to, you know, digital radiology and, you know, a whole, whole bunch of other stuff. Uh, that's not artificial intelligence now. That's just a thing that we use. I think general artificial intelligence is a, is a long ways off, although there's a lot of people doing a lot of cool stuff in labs around the world, but, Don't talk about what they're doing.

Uh, so I could be wrong with that, but, um, but I think AI ultimately could be and will be one of those things that will over time incrementally continue to allow us to use our time and our brains to work on the really hard stuff. Because the stuff that can be automated or, uh, put into an artificial intelligence bucket.

We're going to continue to march down that road. So AI is one. I, I agree with you. I think AI and IoT are probably, for me are one and two, being able to monitor wherever they're at. I'm gonna just keep going cause we're Yeah. Running a little over here, so out of time. Okay. Uh, so the health IT job landscape continues to change.

Uh, what do you tell the frontline staff about how to stay current with their skills? How can they, what, what should they be doing to stay current? Yeah, I, you know, a few things. I mean, one is, um, If you can go to conferences, go to conferences, and talk to your peers, that personal connection to other people building that network.

I mean, we live in a world now where it isn't what, you know, it's that you have access to lots and lots of different people and things that can help you figure out those problems really quickly. Uh, so whether it's conferences or YouTube, I think there's a go out and get a certification, you know? Thing that also is, is really important, staying on top of it.

I think there's other things too, like follow bill on Twitter and uh, listen to the show, and play the show for your staff. Uh, those are all things that kinda from a big industry perspective, um, helps people stay in touch. And then I would say the other thing is don't, uh, It's not all about work. So go figure out other things that you like to do that you're interested in that helps keep your mind tuned up to think in the way that ultimately helps you, uh, at work.

So for me, I mean, whether that's old cars or hiking or, um, you know, those are, those are things that I do that cause me to think about how am I gonna fix this problem with. Something that I can't just go to the store and buy. I have to, I have to sort of figure it out with the stuff that I have in this bucket.

Right. Or in my backpack. Yeah. Um, that, that's good. That's a good model to drive improvement in your thinking processes around how do you solve problems at work? Yep. Absolutely. And then, uh, you know, last question. We hear a lot of leaders talking about cloud first strategy. Um, what, what does a cloud first strategy mean and why should a health system be thinking cloud first strategy?

Um, you know, like everything, uh, cloud, cloud isn't a silver bullet. I mean, it's a new way to get services that we may have provided to ourselves and our data centers. Um, We're really risk averse in general in healthcare, so I think you have to look at what you willing to. Let's move to the cloud and find a way of, uh, working through that strategy at a pace that's right for you personally.

I think you should hurry up. I think, you know, we're, we're kind of definitely in the. Go on too slow mode right now, but whether it's a software as a service provider or putting your backups into the cloud, or giving your research guys and ladies access to cloud services to support scaling up and scaling down research projects without buying the infrastructure, you know, you know, for your own data center, for your own property, all of those are good.

Maybe not business critical or clinical critical operations. Um, if you kind of wanna get started and figure out how to move, but I think it's mostly about moving. And then the other part is, and I go back to security and, and all of this, um, this is a new complicated architecture, right? You, you don't have this all in your data center now.

So make sure that as you're thinking through this, think about what's your architecture gonna look like and how.

All of that is still important even as you move to the cloud. Yeah, absolutely. I, I, so I, I mean, I would disagree with you a little bit on that one. Okay. We're just, we're just different in terms of our, maybe our risk posture. You know, in 2011, I brought box, you know, Dropbox equivalent box into the house system, and it enabled things that were not possible prior to that.

There was nothing Microsoft offered in 2011 that even remotely got close. Um, to the amount of collaboration that happened in a secure, auditable environment. That's one aspect. When we moved to cloud infrastructure, we went from two to three weeks to provision to server to two minutes. When we went to DevOps, we went from 35 people running our DevOps, our running our infrastructure to five.

I mean, there's a ton of. Cost savings and, and things, uh, a bunch of agility that you can get to. Bunch of things that, that's why I built this. I, I built the company that I started around this cloud infrastructures. Cause um, I think, I think the number one thing holding back healthcare is this thing called architecture.

And I think we've allowed our ourselves to, um, you know, just a decade of this change, this change, this change without an architect looking at all of them. And so we've ended up with this mess. Instead of saying, we're gonna purpose build this environment to be agile, nimble, cost effective and efficient.

And because we've done that, we've, uh, and we still think that that's the norm. We are way behind o other industries and we don't understand why we can't move faster. And I think the cloud is the first step to, uh, for sure. And I, I mean, I, I'm, I am with you there. I, um, I mean not, not to do a commercial for you, but I think this is a great opportunity now, health, this would be the second commercial you've done for me.

I appreciate it, . This would be a great opportunity for health systems to actually leapfrog. Um, a lot of the challenges that they have today, right? They, they can, they can, they could get over it. If they were willing to go in a big way, they could leave a lot of the burdensome legacy. This is how we do things in the past.

But it is a very scary thing for a lot of folks. But I think. If you sit down and talk to somebody like you and you really understand what you're doing and what the process can be and how, what's the timeline and what's it really gonna cost and what's it really gonna save? The scary part goes away, and it really becomes just a way to execute a very large project that ultimately saves you money, makes you way more efficient, makes you much more secure, makes you much more agile.

All don't disagree with you. I think it's. Our legacy of being risk averse, um, just keeps us from talking about something really different, even though it's probably less risky than what so people know. We don't pay our guests for this show, but I, I really. I, I really appreciate you saying that. So Drex, thanks for coming on the show.

Tell people the best way to follow you. Uh, you can, uh, follow me on Twitter at Drex Ford. Um, and of course connect with me on LinkedIn, uh, and send me an email anytime. Drex drex.io. Awesome. You're giving out your email address. That's, that's impressive for sure. I'll give you a phone number too if you want.

Uh, . Easy enough to find. Easy enough to find. We're, we're getting a lot of downloads for this podcast now. I, I'm not sure We wanna give it . Uh, maybe, uh, follow me on Twitter patients, uh, at the patient cio. Um, the show this week in ht, uh, website this week@healthit.com. Um, and if you want to see the videos, we're now to, uh, over 150 videos, uh, this week in health it.com/video.

Uh, once we get more followers, we'll get an actual, uh, vanity URL for our YouTube channel as well. Don't forget to, uh, share this with, with as many people as you, you can. We'd love to, uh, raise more money for Hope Builders. Uh, and please come back every Friday for more news commentary, uh, and information from industry influencers.

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