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Eric Yablonka swings by to discuss Architecture. The sexy topics of innovation and disruption aren't possible without the right architecture. The right architecture allows for rapid development and data sharing, the wrong architecture leads to nothing but anguish. 


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 Welcome to this Week in Health, it influence where we discuss the influence of technology on health with people who are making it happen. My name is Bill Russell. We're covering healthcare, c i o, and creator of this week in Health. It a set of podcasts and videos dedicated to developing the next generation of health IT leaders.

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Or, uh, subscribe to our newsletter on the website. Alright, let's get to it. So today we're joined by Eric Yolana, c i o of Stanford Healthcare, and former c i o of, uh, university of Chicago Medicine. Good morning, Eric. And, uh, thanks for coming on the show. Morning Bill. Thanks for having me. You know, and I have to apologize a couple episodes back.

I mispronounced your name as Eric Lansky because my, my next door neighbor across the street has, uh, has that last name. So I, let's just start with an apology right up front. It's never happened before, but it's okay. Thank you, . Everybody always gets your name right? Well that's, um, so how, how long have you been, uh, how long have you been at Stanford?

It's been a little over a year and a half. Uh, and a big change. I was at University of Chicago for 16 years and, uh, both institutions are unbelievably great organization, so I've. Yeah. So, so many great things about, you know, about both those institutions, but Stanford, you know, you have amazing, really smart people, so many innovative minds, proximity to Silicon Valley.

I mean, what, what would you highlight as sort of maybe the most interesting thing about working in that, that, uh, ecosystem that is, that is that area and, and that university? Well, it is a very unique environment in that respect. Uh, it shares. All the, um, aspects of other academic medical centers, but the fact that it is located in Silicon Valley and, uh, it's, uh, as an organization had an, has a history of, uh, intellectual property development and advances primarily in technology, makes it a very rich environment to work in.

So are, are people knocking on your door perpetually saying, Hey, I've got this really cool idea. Can you help me? Uh, that would be one way to put it. Uh, it, they come from every direction. I mean, just a very quick vignette. Uh, I had a student who was, I think he was a junior. I happened to be on an athletic scholarship.

He sent me an email, introduced himself. He said, I, I really am interested in a career in healthcare. It, can I come and speak to you? And I was like, absolutely. I'm happy to meet with students. So he came to see me and he was wearing his athletic gear and seemed like a super smart guy. And it essentially, he came and pitched me a so,

Lots of people with lots of really good ideas. Everybody's very, very bright, uh, very motivated, and, um, uh, really believe that, uh, technology can have an influence in both healthcare and in academics. Yeah, that's, that's exciting. So we, we met at the Scottsdale Institute meeting, uh, earlier this year. And, uh, since you're the last person from that group to, to, to come on the show, 'cause you've had a pretty busy schedule.

Um, I'm gonna give you the topic that nobody, nobody else really wanted to discuss, but I think it, it fits pretty well with where you're at and that is, you know, how do you, how do you prepare for the innovation conversations? How do you prepare health it for those things? We have, uh, this whole idea of tech debt is now sort of entering our, uh, conversation in health.

It. And, uh, we had a brief conversation at the Scottsdale Institute, how, how important architecture is, uh, in order to, uh, enable innovation to be able to respond, uh, to those kind of things. So you get the really sexy topic of, uh, health IT architecture. So looking forward to that. Are, are you excited about the topic?

I'm up for it. Let's go. Bill . I, uh, you know, everybody wants to talk about innovation. Everybody wants to talk about things, but you know, the next couple of weeks I'm gonna have, I'm gonna have architecture and, uh, security. So, um, I find every time I talk about security, the number of listeners goes down by about.

By about 10, 10 to 15%. 'cause no one wants to talk about security. Uh, so we'll see what happens. So let's talk about, let's talk about architecture and, and tech debt and those kind of things. So, um, one of the things that struck me is you were actually going out and looking for, uh, hiring an architect to put in place, uh, what's the need for architecture within health it, and why do you, why do you see that role as as important?

Sure. I think it's a, it's a good question because as a vertical, uh, you know, I think historically we've thought that, um, having our core systems, whether it be electronic medical records or e r p systems or, um, those kinds of major systems, Was enough. And whatever wrapped around that, whether it was your Citrix infrastructure or your data and storage, all that stuff was pretty straightforward because you were serving these major applications.

And of course we all know we run hundreds and hundreds of other applications. Uh, but that was really the focus. And in those days, uh,

A little more simple perhaps, but as we've learned from all other industries, is that really, um, it's an ecosystem of applications that, uh, drives value and for healthcare organizations. There, there just has not been the uptake on thinking through how to. Purposefully create architectures and ecosystems that advance, uh, the organization.

It doesn't mean others don't have architects. I think a lot of people do, but it's in healthcare in general, it's not been a prevalent discipline. Uh, and particularly for smaller organizations, perhaps there really isn't even a need. If you're, you're a smaller, mid-sized healthcare delivery system, but for us, um, at a major academic medical set, uh, center with, um, many, uh, partners, clinical and academic partners in the ecosystem, our ability to interoperate with them as is even more critical and as.

Facility that will have the latest and greatest of technology. You know, we are dealing with things like the internet of things. We're, uh, looking at, uh, serving people when they're at home or off campus. We have employer-based clinics. We have over 70 locations in the Bay Area, and we have partnerships with other healthcare organizations and even just on campus when we want to interoperate for research.

To support other, uh, initiatives in the school of medicine, our ability to serve data up or to, um, lower the friction, if you will, in working together is critically important. So our thoughts there are to really architect, purposefully architect solutions that will enable those kinds of capabilities. And in doing so, also deal with the other topics that we're supposedly not gonna talk about today, which are, how do we innovate?

How do we get, uh, more agile? How do we, um, manage risk, whether it's security or other kinds of risks, but really how do we, um, how do we. Interoperability that is necessary in healthcare for 2025 not, uh, to continue computing in the 2015 model that we're Yeah. You know, it's, it's, it's uh, it, it's intelligent design around the system and I, I think when, when I talk to people outside of healthcare and I say, you know, our.

Our modest health system had 800 applications. They just sort of, they, they just sort of step back and go 800 applications. Are you kidding? And, and, but that's, that's, that's the norm. If not, um, you know, the average. And we were about a $7 billion health system. And that's the norm. And I've talked to other CIOs who are like, Hey, you know, we have, we have far more than that.

Um, so I. I had a conversation with the c i o this week and, and I think it, it talks to this whole architecture conversation, uh, because, uh, he was, he was asking me about cloud and we were talking about cloud and where it fits and, and how it would, uh, fit into his overall strategy. And, uh, it was interesting 'cause he said, well, Or how many other health systems are doing this?

And I said, you know, to be honest with you, so many health systems have so much tech debt. They're so, they're so every, we've done so many projects so quickly that they're just trying to clean things up. Uh, that, you know, some of 'em are really struggling to, to do the new things, to do the really exciting things because there's just so much, uh, there's so much cleanup.

How do you, you know, how do you stay ahead of that? How do you stay ahead of. You probably have what, 50 projects going on right now? How do you stay ahead of the, the tech debt that's just natural, that just comes as a result of doing those projects? Sure. Well, I mean, I. It's hard to avoid. Uh, I think we're all making investments and we know that those are not short term investments, so we're likely to outlive the technology lifecycle for any one of those and continue stay with.

So one of the roles of someone who focuses on architecture is really around that.

Our applications, we application duplication, overlap, and see if can ring out. And tech debt, uh, that way. We'll also really look at any kind of simplification, um, of, uh, our technology so that, uh, the complexity gets to the extent that it can, can get pulled out as well. Hopefully, again, moderating costs or allowing us to take those dollars and revest it into some other kind of technology.

There'll be a lot of focus on that. I mean, one of the things we're also doing at. Stanford as we're planning the unification of the School of medicine, um, IT group with the Stanford Healthcare IT group. And, uh, that's a good example of where two organizations have done amazing work. They've served their constituencies very well.

Uh, but some of the tech has grown up, grown up, if you will, side by side. And really, uh, we all know healthcare is a team sport, particularly in academic medic medicine, where we also have. As well as patient care. And so, um, our ability to then rationalize that technology now with the school of medicine is a very exciting opportunity.

And in fact, I think our faculty are very excited to know that we might be able to actually ease the burden on them with the tech debt that's out there and make it easier to work with and easier to.

Architectural discipline will be really, um, positive if we can drive some improvements in, uh, not only our cost position, but how easy it is to work in an organization such as ours. Have you been able to hire that architect or are you still. Still in the process of trying to find somebody, we're, we're in our recruitment mode.

And, um, it's really very interesting. Um, you know, I have a, a bias for someone outside of healthcare, uh, who has maybe some commercial grade type of experience. It's just a bias. Uh, but we've seen candidates who. Corporate and we've also seen, uh, people who are from healthcare but have some very advanced, um, experience.

So, um, I would say it's a, it's a great field, but to maybe some of your earlier comments, bill, I'm recruiting against Silicon Valley companies, uh, and um, the interesting going.

May think that it's a great opportunity to come, uh, to an organization like Stanford and have a big influence in the healthcare industry, uh, and do meaningful mission oriented work, uh, versus, you know, the quarterly, uh, wall Street report and. Obviously the, the relentless drive for profitability now doesn't mean, as we know, all healthcare organizations are not trying to, uh, make money.

But we also know that money goes right back to the organization and gets invested for patient care and other things, uh, versus return to shareholders. So, We do have people who seem to resonate with that idea. And I think that's actually quite exciting to think we could bring these, uh, things together, the commercial grade capabilities with the healthcare vertical and see if we can, uh, accelerate, uh, the transformation of of care at Stanford.

Yeah, so architecture, it's, uh, so architecture's interesting 'cause you can apply it to infrastructure, you could also apply it to data and uh, you know, so we've seen a lot, a lot of fed federal, uh, initiatives around data. You know, they're coming in and saying, Hey, do fire, do APIs? Um, you know, they've, they've given us models.

Uh, you have, uh, You have Tef fca, you have, uh, just other models around. Uh, I, I, I think looking at it saying, Hey, every other industry has figured out how to share their data and share it effectively. And then they, they sort of grab at this thing and say, well, it's APIs now. APIs are important in architecture, but it's, it's not the end all and be all.

I guess my question here would be, um, From a data standpoint, how do we, how do we step back? 'cause we don't own all the, we don't own all the silos within healthcare, right? So people say, well, why can't you share data? And we say, well, it's 800 applications and it's not all in a central place. And when we do bring it into a central place, 'cause eventually we, we started with.

EDWs and we're moving to more sophisticated models. But even still, when we bring all that data together, it doesn't mesh real well. And then people are like, well just share it with the patient. Uh, but this is where architecture really comes into play. Um, what, what kind of. What are you thinking in terms of being able to make that data available, um, you know, to patients, to innovators, to, uh, researchers.

Uh, how are you gonna make it easier for them to access it but still maintain this is what architecture's about maintaining the security, maintaining the controls, and maintaining the, uh, quality of the data in the product. Uh, that's a very good question. So, um, obviously, um, there's a lot of work to be done around the data and, uh, architecting that data such that you enable its use.

Um, and that will be a big focus for the person that comes to stand for. He or she will definitely be working a lot on the. And of course, you know, it's not just about how do you persist that data, as you mentioned or persist that data. It's really more how do you use it in new and, um, novel ways and drive organizational performance.

So, um, you know, Great examples are real time and predictive analytics. Probably one of the, um, big opportunities to drive organizational performance and to eliminate waste, improve asset utilization and patient, uh, experience. Uh, and so, you know, we'll be working on those kinds of things, but to your point, to actually do those kinds of things, you have to enable, um, the, or get the data to.

Point where that you can use that to enable these kinds of applications. And that's, that's a journey that's not, you know, I do a project, my data's all good, and all I have to do is just, uh, you know, fire up a couple APIs and I'm ready to go. Um, that's going to be a journey and we're gonna be working on that for a very long time.

And I would say that's, if you really look at it strategy, um, if we're also developing an IT strategic plan, data and analytics and of is absolutely top three, top two initiatives. And so, um, you know, I think the old days of, you know, let's stuff it all on the warehouse. Um, then let's build some dashboards and oh, by the way, let's extract that.

We'll send it over to the school of medicine so they can do their research. Those are all fine things to do, but we end up persisting data multiple times. We don't really have a good, uh, handle on, um, Data terms of the lineage of the data and how it's actually being used. And we actually, because of these, we leverage doesn't, um, Contemplate other areas that you've talked about.

Controls like security or privacy controls and making sure those are appropriate, but taking a purposeful view and architecture allows us to actually engineer those solutions and perhaps, uh, be a little less ad hoc about it. Regardless, those controls have to be in place. Yeah, it's interesting. It's a simple, uh, architecture diagram and how, how powerful that ends up being when you're talking to different vendors and you're like, this is where you fit and these are the things you have to supply.

Um, but let's talk about governance. So you, you brought up the word governance. I didn't bring it up. You brought it up and, uh, The, uh, interesting thing I found about governance is, uh, the number of people that are able to recommend a new application in a, uh, health system, let alone an academic medical system, is pretty significant.

And, uh, so people are constantly bringing, uh, new applications to bear with, you know, for some really cool outcomes and really cool, uh, features and those kind of things, and it's easy to get really caught up in that. But what do you do? Uh, do you have a process for vetting those applications based on their ability to share data, their ability to function well within your, um, within your architecture and their ability to be a part of maybe a complete health platform for Stanford?

Do, do you have a, a process and, and, and how do you ensure, uh, that everything sort of fits together? Yeah, that's a really good question Bill. And I think you were starting to describe the ideal state, uh, which might be a great target, uh, for us. Uh, but we're not quite there yet and I would think others are still on the journey as well.

Uh, so we do have an architectural review board today. They look at all new applications for things like interoperability. Making sure that it can fit into our infrastructure, that kind of thing. Uh, but that sort of more catching versus pitching. And here's our, here's our reference architecture, here's where we wanna be.

Here's in a very specific way.

Applications are selected that they, um, or as they're being selected, we do that analysis and make sure we understand that position. Uh, you know, we're no different than anybody else. Every single C-suite member, physician leader, or physician is either being pitched, being contacted. Day after day after day, and a lot of really good ideas out there.

Um, you know, analytics is a great example where, um, a lot of fantastic point solutions. Uh, but you know, if you bought 10 or 15 point solutions, then you think about how do you manage data across those and do your reporting across those point solutions. It feels like things could get outta control very quickly, or you could have a lot of inconsistencies in your data.

So really having a position on, um, both your, uh, architecture, your infrastructure, your interoperability, um, with a set of standards such that, you know, as you look at plugging things in, it's very clear where they stand would be a great.

A little different direction. But you know, it's interesting 'cause uh, you know, we, we had conversations with a company called ias D and I think ias d up near you guys. And, you know, their whole concept is, uh, you know, data has shape. They bring in all the data, they map it, and it has a shape, and the shape tells you, uh, certain aspects about your workflow, your process, and those kind of things.

What I found in all these projects, all these machine learning and AI projects and mapping projects is. Uh, you, you can't feed them enough data. They, they want more, they want more and more and more data. And, uh, at, at some point it's, uh, uh, you end up with data sprawl. I mean, it's, it's, it's hard to track all the places that you've, you've sent data.

Uh, are, are you finding that, that that's becoming more and more of a challenge, especially where you're at? I imagine the number of AI and machine learning projects you're getting hit with are probably pretty significant and they probably want. As much data as you can give them. Yeah, that's actually a very good point as well in that, you know, at least at Stanford, um, we have some of the best AI people in the country.

Uh, our radiology people are amazing, and we have other faculty members, some of which will be working directly with in inside of it are just. Industry leaders. Leaders. And it is true that, you know, uh, for machine learning models and um, other data science applications, it's all about large, large, large, um, data, um, stores.

And that's why more and more you're, you're seeing multicenter, uh, Or collaborations certainly on oncology research and other areas. I mean, the government expects us to partner with others, uh, as well as do our own research. So, um, another reason why we're going where we're going is to really enable that kind of work.

Um, we do provide data to the.

Our privacy, um, policies. Uh, but often that's not enough. And they do partner with other schools, uh, to see if they can put those data sets to run the models. Uh, and of course, you know, that's not a onetime thing either. You actually have to have a continuous capability, uh, for. Ml, you have to have a continuous capability.

That's how these things learn. And so we're gonna be putting together an approach to, we're a little ways away from that, but we have to put a together that will be a high area of focus at Stanford Medicine over the next uh, years. All right, so let's, we'll take the last couple minutes and talk about innovation.

So I won't, I won't just pigeonhole you into this, uh, architecture. So you have a lot of innovative partners, uh, in that area. Um, Let, let's start with this question. Let's, let's put you on the spot and say, you know, you're gonna leave Stanford, you're gonna do an, uh, a health startup. Um, uh, where do you see sort of a current underserved area that you might be able to incubate something new or, uh, you know, if somebody uses your idea, we'll give you credit in the future, but I'm, I'm just curious if there's, if there's an area you wish there was more innovation talk or, or you, you see an opportunity.

Uh, well, you know, I, I, for some reason I, I'm pretty close to, uh, the security space. I, I, I've met a lot of people, particularly Israeli companies that have come out with amazing IP around the security space. I, that's very interesting to me. Plus, um, quite frankly, very, Big challenges to solve for. So, um, whether it's, you know, automating threat detection and response or some of the analytics around that, um, I really, I would find that to be a pretty juicy topic to work on.

I think analytics is another area. Um, but really from an enterprise play we've seen big.

There's a better way to think about that. And, um, while everybody again has niche solutions, I just wonder if there's a better enterprise play and that's not, you know, the data warehouse project, if you'll, but really thinking about how do we stream data, how do we deal with the internet of things, um, and how do we, um, Enable that data to drive, uh, organizational performance in the moment or as it's coming versus, you know, what happened last week, last month.

I think those are all really good topics and there's investors around all of it today. So, um, I'm sure though we'll see lots of advances. So what, what, what do you tell the, uh, student who walks into your office and says, I've got this great idea. I need to work with the health system. Because a lot of 'em don't recognize the complexity of working with the health system.

One of the things I always tell people is, um, you know, be, be aware of the sales cycle within healthcare. That alone can, can kill a great idea and a great startup. Uh, one of the things that you would, you would tell a, a young entrepreneur who's, who's gonna rely on doing business with health systems? Uh, well, yeah, I've been on the board of a startup company and, uh, it's very interesting when you see it on the inside, uh, as a C I O when you see the inside of sales cycles and forecasting a business and then actually what happens on the ground.

So for the young student, I would say, you know, definitely, uh, Be patient and, uh, persistent. Persistent in the ex to the extent that, you know, understand that there are long sales cycles. That decision making isn't always clear, uh, from the buyer perspective, but also prove value. You have to be able to prove value and differentiate yourself from the 20 other people have contacted the people you're talking to, you know, this week.

And I think that's a big challenge. How do you, uh, really get through the clutter? All the, um, opportunities in healthcare. But you know, for some organizations it just takes a couple dots on the map and all of a sudden you, you have some traction and you can take off or you can attract further investment to allow you to scale.

And so, um, you know, it'll be a different world in five or 10 years in healthcare. Uh, and I think.

But you know, they have to have something super special. Things in healthcare tend to go a little slow. At Stanford, we talk about being value focused, digitally driven, and uniquely Stanford. Those three areas are, are what we're, are aiming to, and in that context, just, just even for our own employees over time.

Together where people who have good ideas can come to us and we can process those in a, in a quick reinforce.

Not only for our internal capability, trying to take away all the friction of how do you bring an idea to fruition, but we're also doing that so we can line up with outside organizations and be easier to work with. Uh, Stanford's a big place and there's lots of, um, touch points in these kinds of engagements, and we wanna make sure that it's, um, it's understandable and we don't, we're efficient about it because there's gonna be a lot of work in that area.

Have you, have you guys stood up? I know that like Cedars has an accelerator and, and Providence has sort of a vc, not a sort of, but they have like a VC arm and then, you know, others have set up these diff different innovation models. Are, are you just more ad hoc because you have so much innovation around you, or do you guys have something formal in place?

No, I think you know, yes and yes. Um, but I think now we're moving to sort of 2.0 generation 2.0 of some of that. We're building an incubator. We've established an industry relations group that will really help us. We work with Google, apple, Amazon, Microsoft. I mean, we're working with a lot of big companies.

We're difficult to work with only because of our bureaucracy or our process.

Purposeful, we're doing purposeful work on trying to smooth that out and make it a good experience, not only for our people internally and give them guidance on how to work together, but also for third parties who wanna engage with us. Do you think any of the direct, this is the last question by the way.

I, I, I wanna respect your time here. We're, we're almost at the 30 minute mark. So do you think any of these direct to patient, direct to consumer, Models are going to work. We see more and more of these, uh, health centers of excellence. We see, uh, telehealth plays and, uh, Walmart's doing a play now. C v s is doing a play Now.

Do you think any of these, uh, they're not really end rounds 'cause they're, they're using care providers, but they're, they're starting to hire care providers outside of the traditional hospital and standing those up. Are, are concerned about any of those or are any of those going potentially. Um, you know, make it harder to, to orchestrate that entire patient experience.

Yeah, well, yes, of course. And every market is different. Um, and, uh, you know, there's no doubt the retail side of healthcare delivery, whether it's Walmart or c v s, is gonna have an impact. Otherwise, they wouldn't be investing the kinds of monies that they, they plan to invest in our investing. So,

It's hard for me to forecast what that will mean, but obviously for the healthcare provider, um, the hospitals and the large physician groups and physician networks, uh, that's something to keep a keen eye on. And then I think, uh, for the consumer, that might actually be a really good thing. Yeah, it really depends, I tell you, you know.

For some that won't work at all. They need a higher touch or a more comprehensive view. But for others, um, that might be just what, um, the doctor ordered if I can be. So, um, I, I think it's really, um, it's happened in other industries and healthcare's no different. Uh, more and more the cost side of healthcare will come under greater scrutiny than it already has, and it's gotta be better solutions for it.

So whether we work on it within our healthcare system, which we will or, um, patients choose alternative providers, uh, which some will, it'll be very interesting. Uh, And of course ultimately to your, how do we tie it all together? So is is addressed will be very, very interesting. Another reason why get architect together and ecosystems inter.

Well, nothing, uh, nothing makes us talk about healthcare costs more than an election cycle. And, uh, we're heading there and I'm sure there's gonna be a lot of talk about the cost of healthcare. Uh, you know, Eric, thanks for taking the time. Great conversation. Um, any, anything you wanna leave our listeners with?

No, I would just say, um, you know, we're all, all of us who work in healthcare, it are just so privileged to serve our patients. Um, it's really meaningful work and now is the time for us to really set, help, set the agenda for healthcare. It, uh, there's so much capability and so much opportunity. Um, I know my colleagues and I are really excited about being in the place, in the space.

So thank you very much. Yeah. And I'm excited that you're in the place you're at. Uh, so that's all for this week. Please come back every Friday for more great interviews with influencers. And don't forget, every Tuesday we look at the news, which is impacting health. It. This shows a production of this week in Health It for more great content, you can check out our website url.

This, uh, www., uh, or the YouTube channel at this week, Thanks for listening. That's all for now.


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