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I caught up with Scott Joslyn, the CIO for UC Irvine. There is a wisdom that only comes from experience and Scott's decades of experience comes through in this conversation. I hope you enjoy.

Transcript
Bill Russell:

Today in health, it, Another one of our interviews and action. This comes from the healthcare to healthcare event, which I was a guest at from the serious health care team. It was in Montana. And I was able to sit down with a handful of CEOs. And I'm going to share those with you here shortly. My name is bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in health. It. A channel dedicated to keeping health it staff current and engaged. I hope you're enjoying these interviews and action. We were able to do these interviews at the health conference, the chime conference, and now the healthcare to healthcare event. I've really enjoyed doing them. just a reminder. We're going to get back to our normal programming where I take a new story, break it down. And talk about why it matters to health. It. We're going to be doing that as soon as the interviews are done we have done 10 from the chime conference eight from the health conference and we have five from the healthcare to health care conference so i hope you enjoy another one of these interviews all right. We're doing another interview from the healthcare to healthcare summit, a serious event that is for their clients. I'm here with Scott, Jocelyn, chief information officer and chief innovation officer. Correct. Anything else we're going to add to that anytime

Scott Joslyn:

soon. I don't want anything added to that. It's fine. The way it is

Bill Russell:

at a UCI. So you made the move from Memorial care to UCI,

Scott Joslyn:

correct? I've been at UCI health for almost two years. And another couple of.

Bill Russell:

Two years, two years in a couple of weeks. Wow. Um, so what's what's top of mind. I mean, there are two very, are they, similar systems are very different systems. They are once, once an academic medical center, once not an academic model,

Scott Joslyn:

Memorial care is a non-academic medical center, although they train residents and the likes. So, but they're not academic per se. UCI medical center is an academic medical center. It's got a school of medicine, the school of pharmacy school. The school of public health, we educate, we produce physicians and, um, residents and the like,

Bill Russell:

so do you find those two to be very distinct in terms of the requirements of the role?

Scott Joslyn:

Well, I was always told that academic medical centers are more complex than I think to some degree. It's true. Um, I found them to be somewhat more complex and at the same time, more interesting, a more diverse, I really enjoy working with the faculty chairs. It's great to know that there's a whole university, that's so much behind us, but the schools of engineering and computer science, for example, produce graduates that could be potential employees for us, but they're also doing all kinds of incredible research, whether it's cyber security, um, in particular researchers research on data. So, um, one of our faculty physicians produced a predicted model with respect to COVID the likelihood that a patient will end up on a vent for example. And so that kind of thing happens, um, alongside regular ordinary care. So I there's a lot of synergy. Um, I think it's terrific.

Bill Russell:

And you guys are, you guys are building a new building.

Scott Joslyn:

We're building a new medical center, 145 bed facility to open in four and a half. It will be on the campus of the university. So our president medical center, 420 beds soon to be four 60 is in the city of orange, which is about 10 miles north of the university campus. So four and a half years from now will be, um, two hospitals, not one. And, um, there you

Bill Russell:

are. Yeah. And you're right in the middle of a very competitive market in a competitive landscape. I love the fact that you have the innovation officer. And we actually face sort of similar challenges cause I was CIO in that same market and you have some pretty advanced, um, innovation, it capabilities around engagement around, uh, around the consumer, especially around the consumer. I think both Kaiser and Providence have arms that are really focusing on that consumer, that consumers. Um, how, how are you viewing that? How is, how is a UCI going to be able to offer your, your community, that level of, uh, experience?

Scott Joslyn:

Well, I think it's a catch up game for us in many respects, largely because Kaiser in particular, but also Providence. Um, we're early, um, Providence has their incubator and Reverend Martin, and they're just a very good organization. And they've been at it for awhile. I think the organization, they really laid things out well with Keiser. Um, I mean, just look at their thrive program, what an incredible label for something. It was just a beautiful label as a brilliant piece of marketing and they have, and they've been on epic now. They sign their contract and not August of 2003, it took a little longer than Memorial care to go live, but they've been live for decade and a half. They have lots of. And the very serious about it. Um, they have lots of people working over the innovation space and they, um, have focused on the experience of their members, not even customers, but their members. And they've done a lot to steer them, manage them, guide them, educate them. And I think they set the bar. So for, for me, I look at it as we need to be that good. Um, um, and, and in some ways maybe do things that are different that are unique to us as an academic model. But they just execute exceptionally well. So I admire them. Um, and yes, they are. They are certainly competitors. We live in a very competitive space.

Bill Russell:

Do you break that experience down and say, okay, we're going to work on this aspect of the experience that the basics, the blocking and tackling, if you will, the, the communication between the clinician and the patient, the communication around the scheduling, the communication around a procedure. I mean, how do you, how do you break it down by. Pretty big challenge, right? Experience means a lot of things.

Scott Joslyn:

You, you need to, to break it apart into the pieces and tackle the ones that matter to us from an operational standpoint, but more importantly, the ones that matter to the patient and access is a problem. Getting an appointment is a problem. Communicate with your providers, the problem. So all of those represent an area of activity, even, um, consents or video visits or a remote patient. But first and foremost, it is, um, to have a consistent picture for all the various doors that UCI health represents virtually. So to speak, whether it's get an appointment, find out something I have cancer. Um, I'd like to get a consult, whatever that is is to put those together into a series of capabilities that we put inside our website. And the challenge is one to get them done. Secondly, To array them in such a way that it's a somewhat seamless experience. And I have tried, and we are starting to crest the issue of, for example, we only want you to be a stranger once I want to remember you just the way United remembers me or fidelity remembers me, or for that matter, the water company remembers me. When I come back, we don't do that. Good a job at healthcare, but we also have lots and lots of doors. So I think that's first and foremost, As part of the experience thing is like, we remember you, we value your time. We don't want you to have to repeat yourself. And I'll set in set aside intake forms. Those are pain in the neck as well. You have to fill this out multiple times. We need to solve those problems. That bothers patients experience matters and drives our clinicians nuts.

Bill Russell:

Yeah. I, I do want to talk about your first hundred days, but I also want to talk about the new facility because from time to time, I run into people that are doing new facilities. And the biggest challenge with the new facility is it's new on the day it was opened, but how do you keep it fresh? You know, how do you, how do you plan for what it needs to be? You're going to have it done in four and a half years. How do you plan for what it needs to be 10 years from now, or even 15 years from now? And is that even possible? And, and what's, what's your thought process going

Scott Joslyn:

into that? Well, it, um, I think first, the first thing is to recognize. And you may recall on my presentation this morning, one of my fears is how do we avoid building a new old hospital? We have to think outside the box and are there ways that we can keep it competitive, so to speak. And I don't mean so much competitive with others, but on par with all the new capabilities that are there, we can't rebuild the facility in room sizes will be room sizes, but we know there'll be. But what's in the patient room and how the patient room functions is going to evolve over time. So I don't know other than to one, be aware to have awareness. Secondly, we know that being situationally aware, loaded with sensors, um, and having the ability to run essentially as sort of a factory and all of its various lines. And to watch that factory perform, to look for bottlenecks, cure bottlenecks, and maximize our. For the sake of maximizing the amount of care we can provide. The second part of that is are there pieces of equipment, even something as mundane as a bed that we might think of as a service? Could I have my monitoring from GE or one of the other companies be, um, not just a one-time or periodic capital purchase with follow-on depreciation? Could it be. Something like a subscription or a service now that may have a price premium, that's all to be negotiated. But the idea is, is to keep pace with Phillips or Spacelabs or one of the other monitoring companies so that we are using relatively new equipment all the time on a continuous basis. So maybe the facilities will look different, but by and large, you know, patient will be a patient room, but we want. The technology in those rooms fresh. Um, and I think a lot of it's now going to be behind the scenes and virtual. So it's less physical, it's more virtual.

Bill Russell:

Uh, the thing I liked about your presentation this morning is you have so many years under you. Somebody who walked into what you walked into probably would be a little overwhelmed. And you're just looking at it going. I've seen a lot of this before. I know what it looks like to build a building. I know that I know the challenges and the ramification. Um, but it was interesting how you touched on so many different things you touched on, uh, on innovation, innovation framework, you touched on, uh, labor, labor challenges, how you're doing that you touched on, uh, not only the facility. Yeah. We're building silly, but we're also keeping an eye on hospitals and we're advancing in hospital at home. And those kinds of things, just keeping an eye on those companies and what's going on. Um, you know, you, you were active in the conference. Around clinical innovation as well, clinical automation as well. Um, do you think there's something that comes with having done this for so many years? Is it your clinical background or is it just having done this for so many years, you're able to, to not get overwhelmed by it because there is a lot going on. It's funny. Every time I ask a CIO what's top of mind, I get different answers every day. It's kind of amazing. Well,

Scott Joslyn:

it's hard to pick one thing. Um, I think he experienced really bad. Long ago I practiced pharmacy. I know what the physicians do. I can generally speak their language. A degree in business helps to understand marketing or for that matter, even micro economics, some of the theories behind outsourcing, for example, um, and then, you know, having programmed and does some things like that. I have some vague recollection of technology and frankly, that's probably one of my weakest spots, but there's good people to do that. But I think it's just years of experience. And as I cited in the presentation this morning, I grew up in a period of time where there was self-development followed by best of breed systems, followed by monolithic systems, such as epic. And now in the current period, which has almost like another big sea change to where the EHR is obviously critically important. Its footprint has expanded. It's helped. Organize the various departmental systems into a single thing. And it's no longer complete in that. So much of the data lives outside of the HR. So not to subvert it, but it's to surround it. And it almost looks to some degree like best of breed again. Um, I actually think it's two things going on, right. As I use the phrase, creative assembly, it is going out and picking partners and others to augment my EHR, to be more complete across multiple venues of care, including things outside the facility. And I think the other thing is happening. It's not like best of breed at all, but super aggregation. It is. And the aggregation relates to data. All of these things that we're putting in place to generate data and to generate signals. And the interesting thing about being part of an academic medical center is the ability to inject. The signals and scale and begin to look for signals in the noise. So that's a by-product of having these systems is that we're generating data, um, about our operational environment to, for example, do a better job at predicting readmission. Every readmission costs us, or basically I'm sorry. Every 0.1% improvement in readmission is about a four or $500,000 impact to our bottom line in our interest. Economically is in our interest for the sake of the patient. You know, we don't want them coming back, coming back as an error. That's why it is the way it is and regulation. So I, remote monitoring program, for example, or our mobile urgent care is to have people go home safely and don't allow them to decompensate and attempt the problem immediately. It's in their interest, it's in our interest.

Bill Russell:

So you were one of the early adopters of epic. Kudos for that. I guess my question is in this best of breed world, what's the, what's the move. Now that a CIO is making that you're maybe 10 years from now, I'm interviewing them going. You were the first one to make the move there or whatever. What's that, what's that thing that you're looking at going? Is it, is it these data aggregation platforms? Is it, is it, um, you know, the, the, uh, computer vision? I mean, what, what is it that you're looking at going? This could, this could fundamentally. Change some things, how we, how we practice healthcare.

Scott Joslyn:

Um, well I think it's in the area of AI and with that almost by definition, data aggregation or AI operates and does well when it's able to see a bunch of data. Now we've heard in the presentation today, the, depending on how you approach AI, it doesn't always take billions and billions of records. It depends on how you do it, but I think it's AI and. Along with that, what we've heard. And from gardener, for example, in the real-time health system, isn't an environment that's situationally aware. What does that mean? There's sensors and it's not, we're trying to spy on people. It is more about what's going on. What can the computer tell us about the activities in the medical center? What's the patient doing? Are they turning off in enough? Do they present a false. Um, what does that tell us about the care and can we optimize it, but it's the changes going on? I think in the area of automation, which along with it means computer vision, um, are decided, for example,

Bill Russell:

I know it's getting loud around us.

Scott Joslyn:

That's right. Um, they're working on a new chip that actually can smell now. Humans can smell pseudomonas and dogs can smell. Um, and so what else can be, it's another sense beyond envision or in the case of artist's side hearing, which we've seen at epic to be able to automatically do the note with through NLP. Now you have the idea of even being able to smell in the environment. So I think it is the, um, the absorption of that data for the sake of operations, intervention and improved. And then I think it's the collection of that data over time that allow us to find new insights. Um, there's all kinds of debate in the literature about sepsis, for example, what's the best algorithm for that. And there's some debates among the HR vendors as to whether they have something better than somebody else. But nevertheless, there are things that are possible. And I remember my days, a pharmacy that changes a shift, a nurse would say, who'd been on all night. I'm in my patient's going to crash. What do you mean? Well, the chances are they're going to code she, or he couldn't really tell you why it was the 15 or 20 years of experience they had. They could see something. Now the computer can see that often in the physiological monitors, temperature, pulse, and respiration, respiration changes that are very subtle collectively together that are seen by instruments. Can now do those kinds of things. A nurse used to be able to quote, see that it was her. We're now intuitions move to a new level. Some of the other stuff is now done by Peter.

Bill Russell:

Yeah. You're you're I mean, I'll close with this. I mean, the, the amazing thing is how long you've been a CIO? Um, I know, you know, I did it for, I guess I was there for about six and a half years or so six years, six and a half as a interim. And then as a full-time it takes a toll. I mean, I, when I sort of stepped out. Uh, there was a period of time where I'm going back to almost where I started with you, which is, um, how do you coach CEOs today to say, look, I know it feels like the weight of the world is on you because you have to look at supply chain. You have to look at administrative, you have flooding clinical, you have to keep these systems running your cybersecurity of all these things. How do, how do you balance it? Cause you, you know, you're not overweight. Like a lot of us, you're not. Um, and you're and you, uh, you know, she stepped out of one CIO role stepped into another CIO role and it looks like you're ready to go.

Scott Joslyn:

Well, first of all, I don't think I'm any more overburdened than certainly our CEO is or our CFO. Um, but it's, it's how you, I guess, confront the burden if you will. I, some days. I can't believe I get paid to do what I'm doing. I really like this work and I've done it for a long time, perhaps longer than I should. And it's, there's a whole new crop people that are incredibly bright. Many people in my position now are physicians. So they've got the clinical experience, the diagnostic experience, everything that goes with it. Um, and many of them started out perhaps as an undergrad in engineering. But you know, if you really like your work, it, it, it, it, I don't find it burdening to me. I just think it's fast. I also like to create, um, and I was fortunate to have good leadership at my old place and in my new place. Um, and I got new experiences. I mean, I, over, I was asked to oversee research. I was asked to oversee master planning. Um, I was an advisor to, for a short period and I said, I wanted to be on the venture capital board. And I helped put our VC board together at Memorial care with Cedar Sinai and summation health ventures. And we just now put together a term sheet, um, to do that kind of work inside UC health. So we're, um, I think it's, it's, it's allowing yourself to not be confined your role, take care of the basics. You know, as I said this morning, the CIO though always wants to be at the strategy table or whatever, you know, you don't get there until, you know, the email works and the servers don't go down and your cybersecurity programs in place, you needed to get the basics done. That's your job one. But as you get things under control and you build things, then the chance to create. And I think in my environment, I'm I was asked by the C E O to look at innovation as well, because we need to do it. I like to do it. It suits me. Um, and, but more importantly, the organization needs it. So it's all, it's all applying technology and just new ways. Yep.

Bill Russell:

Scott, thanks for the time. It sounds like the session is starting, so we'll get back

Scott Joslyn:

up there. That's great. Thanks.

Bill Russell:

Don't forget to check back as we have more of these interviews coming to you, that's all for today. If you know of someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week, health.com or wherever you listen to podcasts, apple, Google, overcast, Spotify, Stitcher, you get the picture. We are everywhere. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health. VMware Hill-Rom Starbridge advisors, McAfee and Aruba networks. Thanks for listening. That's all for now.

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