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June 24, 2020: Welcome to this episode of the Field Report! Today’s guest is Tahir Ali, from Froedtert Health. Tahir serves as Froedtert Health’s chief technology officer of information technology, providing the leadership and vision to grow the Froedtert & MCW network further through technology acquisitions, leveraging existing technology investments and the use of technological resources. His primary areas of responsibility include the effective management of the daily operations of all technology, including the data center, telecommunications, technical services, desktop engineering, network operations, vendor management and field support. In this episode, we discuss EHR, AI and automation, and disaster recovery, and Tahir explains how Froedtert uses scalability to avoid unreliable networks through unintelligent design. We also talk about on-prem versus cloud, and Tahir gives us his argument for avoiding lock-in, and he also shares with us what he believes will be the most important projects in healthcare coming out of COVID-19. For more on the benefits of AI for both automation and security, make sure not to miss this episode of the Field Report!

Key Points From This Episode:

  • Tahir explains how Froedtert has experienced the pandemic thus far.
  • The upgrades to Froedtert’s EHR system prior to COVID to ensure scalability.
  • How AI was built into the servers for specialized EHR workloads and storage was upgraded.
  • Tahir’s experience with Hurricane Sandy, how it changed his thinking on disaster recovery.
  • How EHR systems can be automated through AI and whether PACS has AI built into it too.
  • How Froedtert uses scalability to avoid unreliable networks through unintelligent design.
  • What drives the decision for Tahir on on-prem versus cloud and why he prefers on-prem.
  • Tahir explains the value of creating abstraction layers to avoid vendor lock-in on the cloud.
  • Why Tahir considers mobile accessibility the most important thing coming out of COVID-19.
  • How Tahir believes healthcare can deliver a standardized experience within homes.
  • Seeing AI built into a number of systems going forward, and the benefits for security and automation.

This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

 Welcome to this Week in Health It where we amplify great thinking to Propel Healthcare Forward. My name is Bill Russell Healthcare, CIO, coach and creator of this Week in Health. It is set of podcasts, videos, and collaboration events dedicated to developing the next generation of health leaders. This episode and every episode since we started the C Ovid 19 series has been sponsored by Sirius Healthcare.

They reached out to me to see how we might partner during this time. And that's how we've been able to support producing so many shows. Special thanks to Sirius for supporting the show's efforts during the crisis. Uh, a couple house housekeeping items for you. I'm speaking at the Atmosphere Digital Conference for Aruba.

Which I just finished recording on the State of healthcare, the impact of Covid on Health IT and the three most important movements in IT infrastructure. As a result, uh, you're gonna have to tune in to hear that go to the Atmosphere Digital. It's a virtual conference that they're doing and that will be airing in the next two weeks.

Uh, I'm als also hosting a panel discussion on the edge, uh, with Dr. Shari from, uh, the CIO for Seattle Children's and Rick Allen. The CTO for Navient, uh, healthcare at the edge, the convergence of devices, data, patients, provider and care, uh, which you can hear at the conference. And I will also be airing it as a podcast episode.

So, uh, you'll wanna stay tuned to those two things now, onto today's show. Alright, this morning we're joined by Tahir Ali, the CTO, for M how. Good morning. Things are going well. Busy like everybody else is, but so far so good. Yeah. Thanks for taking the time. You probably have one of the better backgrounds of anybody we've had on the show so far.

I mean, that's a, that's a pretty, pretty cool mural you got back there. Oh, thank you very much. Thank you. My, my wife is in, uh, horses, so, so. Um, that's for her. Absolutely. So, you know, I want to get right to it with you. I mean, there's so, so much we're, uh, gonna get the opportunity to talk about, you know, give us an idea of how your health system experienced the pandemic thus far.

Let's just start there to get, get an idea of what, you know, what was going on at Froedter. Of course. So a, as with the entire healthcare system in the United States, the, the heroes were all the clinicians that were, you know, out there doing the, the, the, the work that they do best. What we did behind the scene, our technology team, the entire team worked really hard to make sure that we support them.

If there was a place where we wanted to get some search beds, we, we quickly deployed that if there were some technology needs, we quickly deployed them. When people wanted to quickly, uh, deploy, uh, work from home, we supported work from home. So it was a really, really great collaboration between the frontline, uh, staff and the backend technology staff to make sure it's a cohesive effort to deliver the best patient care that we can.

Yeah, we did a, we did a little bit of call to this where. Understand some of the, some of the things that you guys were able to do, and I, I asked you a lot about scaling up and you, you talked to me a little bit about a, a. A significant upgrade prior to, to Covid. What was the upgrade about? And you know, just share a little bit with our audience what the upgrade was about and what were you trying to accomplish.

Sure. So, you know, as, as you know, and I think, I think Covid is, is going to be a paradigm shift where we do business differently. With the same token, we were a little lucky. We started doing our upgrade on EHR hardware a little earlier to make sure that the scalability is in place. Uh, in order to do that scalability and upgrade, we upgrade the backend storage to the fastest storage possible that that is currently available, NVM, and then a very, very fast interconnect.

Frontend servers. So our capacity, uh, we used to run between 75 to 80%. Now we are down to 20 to 25%. Now we are at a place where we can scale for next three to five years without any issues, any kind of different variance that comes our way. We are really ready. To, to take that head on and have that scalability put in.

One thing that is extremely, extremely important, we got the new servers that have AI built in for specialized EHR workloads. So we are ahead of the curve in order to make sure that if there's any peaks that come our way, we can smoothly have that, that scalability built in. So we're seeing AI come all the way down into the architecture, into the, into the core architecture.

Absolutely. So, so this AI is especially made for, uh, uh, special workloads. It is customized to a particular workload, and if you use that logic of, of artificial intelligence, you can deliver much better, uh, performance with a lower resources. So it's, it's, it's very specialized artificial intelligence built in.

So, uh, what what'd you end up doing on the storage side and on the compute? And you also, you also changed the channels as well, right? Absolutely. So we, we upgrade the, the backend to, like I said, NBME Ram, the front end runs our power power nines that has the AI built in. And of course, the interconnect were upgraded to 32 gig times.

We have eight or, or 10 different strands. So it's, it's smoking fast. I don't think you can do any faster than that. So, so you're ready to scale? I mean, did, and I assume that the pandemic sort of put a bit of, you know, load. Really see how it was gonna perform. And I, I assume it, I assume it did fine.

Absolutely. So, so, uh, of course, as, as we build more surge beds, the, the resources were getting consumed, but with this technology in place, we had no issues. Well, how do you, so you worked in New York City during Hurricane Sandy. And you shared some of those stories with me and, and they're fascinating and I think that fundamentally changes how you think about, uh, architecture and disaster recovery.

How, how are, you know, a lot of people are looking at the cloud, they're looking at different things. How are you thinking, you know, you have this new model in place. How are you doing disaster recovery for this? Sure. So I think with with Sandy, I, you know, it really changed who I am. One thing that is very, very important is making a extremely cohesive disaster recovery.

What does that mean? Making sure that you look at all the peripherals that. Inject into your EHR, your packs, any business line that you want to do, disaster recovery and highly available, uh, solution, highly available solution. You wanna make sure that you pull all the pieces that build that ecosystem.

That's number one. Number two is make sure that it's auto failover. Once a disaster happens, there is no time for people to pick up the call. Their family. Um, in Sandy, people had their homes under, uh, underwater. So you can't ask 16 people to come meet you in some kind of data center remotely. Get to your data center and do the steps that are required to move from one side to another.

It needs to be seamless. It needs to be automated, and it needs to be orchestrated. Now, fast forward seven to 10 years. Now the technology's in place where you can automate and orchestrate a lot of different things through RPA and other automation tools where you can say, if this doesn't work here, automatically move it here.

So that is a true disaster recovery for technologists where it's a zero touch are, are we able to do, I know we systems yet.

I don't know the legacy aspect of the EHR at this point. Sure. So EHR by themselves are now built at at ha. So they do have the integration of saying, you can run it here or you can run it here. They have come a long way. Now you have to decide all the peripherals around them. Even having active directory, fully redundant across two data centers.

Very important. Your active directory doesn't work. Nobody can log into your EHR, so you have to do some due diligence on looking at different things. Some could be more than one, and you can have a farm. The other one could that does not work in farm. You can have one side bring everything down and automate everything that I would do in a keyboard through an orchestration tool.

And they do exist currently. So when you stood up your new environment, did you, did you essentially say, Hey, we're just getting two of them. We're putting one here. Is that, so we've got two and two. So now we have two in one place. Completely highly available within the data center. Then we have two more highly available within the data center.

So at any time we can mo move back and forth without any problems. And of course it's, there's, there, there is some currently intervention required for humans. But we are getting to a place where we completely automated. Could be everywhere. I, you know, I like talking to CTOs. It, it's interesting art. The conversation we had before we're like, in completely different direction.

But that's, that's what happens when I, when I talk to you guys, uh, the, because I love it. So give, gimme an idea of some of the, you talked about some of the design principles, but this whole idea of architecture, you know, we, we didn't adhere to it for so many years in healthcare, and it got us into trouble.

We ended up with thousands of systems, you know, si silos of data. We ended up with, you know, essentially unreliable networks because. Because we allowed things to just sort of go without a, a, an intelligent design, if you will, of the overall architecture. What are some things you look at from a design principle standpoint to make sure that that's not happening at at, at.

Sure. So, so the key now is, is more scalability across your different application, your different tiers. How, how do you do that? Uh, uh, a normal day, people are sitting at ho at work and they're just working and there's a internet traffic. Um, two months later, COVID happened. Nobody's sitting at work and all the traffic is coming from home, their internet traffic.

How do you become that agile? A lot of new technology out there are very software driven, so you have to take a look at certain places where you can say, I can define my bandwidth. I can define my resources on the fly. I don't have to wait for somebody to, to, to give me a piece of hardware to add my, my resources or add scalability to what I already have.

I. If you do a scalable solution and have that scalability through software, you can switch very quickly. So if you wanted the SD WAN and you said, I, I'm not using this clinic, I'm gonna shut this off and open it up here, you can migrate that, that scale there, that resources across to all VPNs if you VPN is not in use because, uh, it's a Monday morning and everybody's working.

You can migrate that to all traffic that goes to internet, so I think having a great scalable solution. With a layer of software that can migrate your workloads accordingly will be the solution moving forward. Yeah, and that leads into my next question, which is, uh, we were in New York together last year for a, for a meeting and, uh, there was a pretty dynamic conversation about on-prem versus Cloud Cloud and, and it was interesting to me because there's so much hype around the cloud.

And there is a lot of practical applications for the cloud, but, but you were sitting there going not for everything and, and you were, and, and it was interesting to see that, that conversation, you know, what drives a decision for, for you in one direction or or another on-prem versus cloud? Of course. So again, this, this is my personal opinion, every healthcare has their, their own ways of doing different things.

What, what I believe is. Cloud is a great place to, to have a scalable solution. So if you want to migrate something to the cloud and you want that scale and you want that resources, you, that agility on demand, you can definitely go to the cloud. But remember. Cloud was really sexy five years ago because data analytics has not matured.

Once data analytics has matured, people started thinking, oh, I put this application on that cloud, that application on that cloud. Now I have to pull all my data back so I can get rich analytics. So you have to be extremely careful where you put your data in your application and in your business. Are you going to do analytics?

Are you going to mix and match that analytics with something that you have on-Prem? If that's gonna happen, then you have to pull all the data back and mix it with your on-prem data and have a richer data analytics. And if you want to move forward with predictive analytics. You gotta be very close to the data.

The minute data changes, you gotta capture that change and see how that, that analytics change tomorrow day after tomorrow. Hourly. So predictive analytics, can't it, it's, it's a, it's a newspaper, so you gotta decide what you want. Yeah. It, it, it, I mean, where that conversation ended up going was just you have to understand the benefits of both.

You know, and one of the things that we ended up talking about there was the, the need for an abstraction layer at the, you know, we have abstraction layers between compute storage and, and the software now so that we can, you know, we can move those virtual environments all over and that is really powerful.

But now we need an abstraction layer at the cloud layer, so the multi-cloud essentially. And we end up talking about how important that is, because you don't want vendor lock in. Absolutely know people move this data in. What's, I mean, I, I read some of these contracts. People move the data in, then all sudden, like really cool analytics we're gonna.

Almost double the amount to get the data out as it cost us to put it in. Absolutely. Absolutely. So now, now you have data in four D or five different places. So you are absolutely right. Having, having a a, a, a great, great layer where you can, you can containerize your workloads and swing between your cloud, somebody else's cloud migrate.

Now the, the, the cloud providers are also getting really, really clever and they said, Hey, . Our cloud has this special one thing that no other cloud, so you, you can containerize your workload, but still you will be dependent on a particular feature that only one cloud has. So they are trying to keep you, but as a technologist, you have to be clever enough to make sure that they don't lock you.

Yeah, absolutely. All right. I wanna get down to where the rubber meets the road, you know? So, two things I wanna talk about, patient experience and caregiver experience. These are, you know, this is the service that comes out of all this really great architecture that we create as you consider the patient experience.

Let's start there. What projects do you consider the the most important right now, coming outta Covid? Sure. So, so I think not, not even just Covid itself, but, but I personally think that we will become more and more mobile. If you look at yourself, your home, your kids, your family members. Maybe five, seven years ago there was at least one PC in the house.

Today there are more, uh, iPads than, and, and tablets than, than even laptops. So we used to have a desktop, then it became laptop. Now it's just a handheld, and I was looking at a couple of commercials that says, oh, your, your next handheld is going to be faster than your computer. So, so as we migrate. We have to realize that our consumers and our clients and our patients have also part of that migration.

How can you give them everything that they need that they have at home? Same exactly. When they come to our, uh, brick and mortar, or if there's a virtual visit involved, the key is providing them a layer of network or a wifi that is so robust that they can be anywhere. It has a better bandwidth and throughput than in their own home.

If we can provision that across our entire network, I think that will be a great, great win. In order to do that, you have to make sure your, your cabling is up to par. You have to make sure that your access points are top of the line, and you wanna make sure your networks behind the those IDFs or MDFs are solid.

And lastly, your throughput and your bandwidth. To the internet. If you can manage those things and provision great, great SSID through the wifi, I think that'd be a great, great win. Now, let's say you stay at home and you wanna do a virtual visit. Nobody likes to do any kind of video that is grainy or that has an issue.

That also cleans that up on the, the physician side or a clinician side. So what we are trying to do is make sure that it seamless where. For, for your, your, uh, wifi, anywhere you go. That's, that's where we are starting, of course, moving forward with getting more features inside. With five G providing handheld, you can bring your own device.

Uh, uh, a patient can come in and, and still get all the capability that we can provide them through freighted. That's gonna be next, next five G wave that's coming out way. Yeah. You think there's gonna be more home-based type solutions where you're, I mean obviously we're, uh, you and I talked about the density.

The density in the, in the clinic room is getting pretty significant with, you know, Bluetooth, low energy wifi, I mean, you, you name it. I mean five GI mean the density of. In those locations, we could also see the same thing happen at home with the, you know, medical centered home really taking off as a result of this.

How are you thinking about extending your, you know, so you thought through architecture for the last decade of, within the hospital system, now we have to think through architecture really in people's homes. How, how are. Sure. So I think, you know, we can never, and it's, I think it's going to be more and more challenging how you, you figure out the last mile.

So it's going to be tough. I can dictate what you have in your house. I can dictate what type of seller service you have when you go home. That's gonna be tough for us to really dictate. That is also changing. Now when the five G comes, the cellular service in your home is going to be as fast as some of the wifis that are there, wifi themselves are getting better and better.

Getting a gig in your houses not really unheard of. A lot of people have that. What you have to do is make sure the analytics is built in. You can provide the insight to your clients and your patients if the experience is not great. How do we do that today? We are looking at certain tools where we can say, Hey Bill, we were having that, that virtual visit.

We saw that there was some graininess. We understand and we can also tell you or show you that, that how the bandwidth. Played a part in, in how your experience was. So I think knowing how the experience is going to be delivered is the key to moving forward with better, better delivery. I think that's where we have to, because you can never provide the last mile to patient's home, and I think we have to figure out how to mitigate that, at least having the sense of where the problem is, is a first step.

Yeah, absolutely. Well, it's interesting. I, I, I love the conversation. I never, I don't know why it's, it's just the, the, the idea of having systems that have AI built into them, I would assume it's gonna go from one end to the other. We might, we might see that go all the way from the home network into the computer.

It's gonna be sort of layered into the entire fabric moving forward. It. Interesting. I guess you're, you're using the M Power nine is, is, has that built in? We're see that in the, probably in the Cisco products, the, the network and, and even, even other network products all the way out. Absolutely, and, and, and more and more companies.

So they, they're starting with, with very customized workloads, very one-off scenarios, and they're checking those scenarios. Even, even the, the facial recognition, the, the, the network understanding now things exist for, for security, where there's AI built in where they can say, Hey, this just doesn't feel right.

I won't do anything. But at least I'm gonna tell you that this particular, uh, traffic doesn't feel right. So there's a lot of things that are going on that will move the technologists away from touching the keyboard, but we will be doing more important things throughout the day than a lot of repetitive things.

So I think all around it'd be a win-win. Well, thanks, thanks again for sharing your, uh, experience, your time, uh, and time with us. You know, I think at, at some point I'm gonna want to have you and the CIO come on. 'cause she, she was in New York City with you during Sandy, right? Absolutely, yes. That, that story, I mean, when you were telling it, it's the kind of thing that nightmares, you know, CIOs have nightmares about for, for years.

Following. But I think it's such a great story in terms of just understanding what can go wrong and actually just about everything did go wrong in that story. It's, it's really amazing. Absolutely. Absolutely. So love to have you back on to talk about that. Thanks again for your time. I really appreciate it.

My pleasure. Thank you so much for having. That's all for this week. Special thanks to our sponsors, VMware Starbridge Advisors, Galen Healthcare Health lyrics, Sirius Healthcare and Pro Talent Advisors for choosing to invest in developing the next generation of health leaders. If you wanna support the fastest growing podcast in the health IT space, most of you can see this now without me even finishing it.

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