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Jonathan Manis joins us to discuss digital disruption. Although he asserts, Consumer Expectation Disruption is the real driver for the changing landscape for healthcare. Are we ready, and how do we get ready? A fun discussion, hope you enjoy. 


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

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, recovering 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.

This podcast is brought to you by Health Lyrics. Need a Health IT Executive Coach. Let's talk visit health to schedule your free consultation. Shortest advertisement in all of podcasts right there. Uh, today we are joined by one of my favorite speakers and someone who has spent much of the last decade operating in and around Silicon Valley, former c i o of Sutter Health and current c i o for Christus Health.

Jonathan Manus. Good morning, John, and welcome to the show. Good morning, bill. It's great to be here. Thank you for having me. I'm excited for, uh, for our topic. You know, I not, not, not to put any pressure on you, but I've referred to you on previous podcasts as a quote machine because there, there have been times where you have spoken and I, I just take the quotes and read 'em back because they're, uh, you, you speak pretty frankly about where the industry's at and the impact that this digital transformation is having.

And that's, that's gonna be our for. So I'm forward. Yeah. It's. Topic I'm very passionate about, very near and dear to my heart, and, uh, and I'm, I'm excited to, to have that conversation with you. Well, uh, you know, before we get there, um, you know, some people may not be familiar with Christus, and I think it's one of the more interesting healthcare organizations and success stories.

And one of the things I think that's really fascinating is, you know, one of the largest health providers in Central and South America. So tell us a little bit about Christus. Yeah. Uh, Christus of course, is a Catholic health ministry. Um, we've got about, uh, 70 hospitals across five states. Um, we also have about 20 hospitals in three foreign countries in South America.

That being Chile, Columbia, and Mexico. Uh, Um, we do, um, we do about $8 billion in revenue. So a, a, a fairly large system, mostly serving, uh, rural communities, some of the underprivileged and marginalized communities across those five states. Um, we offer the full spectrum of healthcare services. So we've got clinics, hospitals, um, medical office buildings.

Uh, I would . Say, um, assisted living, nursing homes, behavioral health, uh, some outreach, um, some retail pharmacies, those kinds of, uh, of services. So the full spectrum of, of health services, um, on the IT side, uh, multiple platforms. Uh, unfortunately that's part of the work that we have to do here. Probably have every cat and dog system there is, uh, but primarily Meditech, epic, um, some Athena and Tazzie down in South America.

So, uh, I think that South American opportunity is one that was particularly attractive to me. And I'm anxious to learn, learn about the international healthcare and what we can, what we can help and assist with, and what we can learn from their, uh, from their, uh, provision of healthcare in those, in those countries.

Yeah. And I'm not gonna put you on the spot too much 'cause I know you're, you're relatively new. You, you're, what, about three months into it, or? Uh, about two months, but yes. Two months. But, you know, I've had some conversations with George and I, I know that you spent some time with, uh, George Conklin, who's the uh uh, I, I don't know what his role is today, but the former c I o, uh, who you're, uh, coming in to replace, and he spent a lot of time in South America and just gets so excited when he talks about that that opportunity and healthcare is, is, uh, different, but same.

I mean, it's, it's a, uh, each, each, uh, central and South American country is distinct in how they handle healthcare. And, uh, you guys have to be very agile in terms of, uh, in terms of how you provide services in those markets. But I. Um, that's gonna present some interesting technology challenges as you look at those different countries, but, you know, again, you're two months into it.

Maybe the next time you come on the show, we'll talk more about the differences between, uh, operating in those countries in the US. So, well, I, I would like that very much. George is still here. He's still the, the c i O. He's, uh, he's a legend in our industry. As you know. He is been a mentor and a. And, uh, you know, a really powerful speaker and, and, uh, a bright light in our industry.

I'm thrilled for the opportunity to, to help, uh, build upon his legacy and continue the, he's done at Christus on behalf of the and healthcare. That said, I, I know he has. Personally passionate about the mission in South America. Um, you know, they are in, in many ways, uh, coming through some of the same challenges that we have, uh, currently in our industry.

Plus, um, in some, some areas they're, they're a little behind. We've come through some of those challenges. So the opportunity to learn from, um, that experience and to share the learnings we've had from our experience is part of what attracted me to the position. Yeah. And, and, uh, I'm looking forward to seeing, uh, some of the things that you're gonna do down there.

It is a exciting organization and exciting leadership team. Uh, it should be, should be a lot of fun. But today what I wanna talk to you, I wanna take you back in time. So, uh, probably one of the first times I heard you speak was that chime. Uh, maybe about two years ago, and you talked about, uh, digitization in healthcare, uh, and how it impacts the practice of medicine.

And, uh, I particularly, I took a picture of a slide and it's, uh, attributed to Cisco In 2016, I had this concept of a digital hurricane. Uh, the graphic had 12 industries. You have a, a hurricane graphic image, and you have 12. Uh, on the hurricane, uh, towards the center, meaning the, the industries that are getting the impacted the most towards the outside, the, the, uh, industries that are starting to, uh, feel the impact of, uh, digitization.

And on, on the left side of that, uh, of that chart. And, and this, this really struck me. I mean, it, it had these four things that were happen as a, an industry gets digitized. The first was, uh, it's a force that pulls everything to the center. So once you get started in the digi digitization process, there really is no going back.

It's gonna draw to the center. The second thing is industries change pretty radically. They may dissolve and. You may start to see some interesting partnerships and, uh, reformations of companies at the center. All value that will be digitized, uh, is digitized. And uh, the fourth thing when you really get close to the center is it starts to feel chaotic.

Objects are drawn to the center with, uh, increasing velocity. And again, those new partnerships, new formations, new models, uh, tend to spring up, uh, pretty, uh, pretty dramatically. And I remember when you were talking about this. Uh, it was a pretty packed house at, at Chime and the questions just kept coming.

'cause I think, you know, you, you rewind back in, I think 2017 or 2016 when you were giving this talk. People were like, oh, I, I'm not sure that's gonna impact healthcare as much. As what you're talking about. Um, but it, it, uh, I think you fast forward three years and I don't think you have many people who are questioning, uh, the impact of digital on healthcare.

Where do you think we're at today with healthcare in terms of this digital hurricane? Well, I think we've still, we're still on the outer bands and, and we're fighting it tooth and nail to, to not get towards, uh, You know, our, our digital destiny as it were. I think, um, you know, we are in many ways, a lot like, um, other industries who, who just can't seem to let go of our current model.

Um, we've got so much invested in terms of capital, uh, in facilities and brick and mortar buildings. Um, in an old. Operating model in, in an old clinical delivery model. And, and we don't know how to let it go. Um, and we are, we are doomed to failure if we can't let go of, uh, of, of the things that have made us successful for many years in order to be successful in the, in this new environment.

Uh, there's no question in my mind, um, that, uh, that, you know, I, I think about the, the millennial generations, the Gen Xers, the, the, the folks who are being born, even today, they're a very different breed of people. People wanna know, why are we on the outer band of that hurricane? And it's because we haven't had to change.

Um, and, and nowadays, uh, in, in modern life, Um, you know, there's a different expectation for service and, uh, and people wanna be serviced. There's an immediacy expectation. They wanna be serviced when, where, and how they want to receive services. And, and they frankly don't care about the convenience of the supplier.

It's all about the convenience of the customer. And, uh, and we have been very slow as an industry to realize that. It's interesting. So let's, let's step back and let's, let's take a look at, I, there's a lot of industries that have gone through this. Pick your favorite one and sort of walk us through, uh, maybe the journey that, uh, another industry has gone through that sort of started with sort of a traditional model.

And if we were to look at it today, you you'd to look back and say, well, I can't believe we once did business that way. Well, you know, um, you, you look at retail, uh, you know, you remember those early days of, uh, e shopping, right? Um, everybody was, uh, uh, banking, um, e-banking. Uh, we were afraid to put our credit card number on.

Um, uh, Uh, in the, in the computer. 'cause it wasn't gonna be safe. Um, retailers thought that, uh, this might be just a fad. Um, but the entertainment industry is a perfect example. Um, you look at Disney, uh, you know, now it's all streaming. They've started, uh, to stand up their own streaming service. S p n, uh, getting rid of, uh, talking heads, moving into the streaming business on any device, anywhere you can catch your favorite sports.

Um, you look at Netflix, for example, on the, in the entertainment industry. Um, now they have selectable content, right? This is, I don't know if you've seen the movie, um, the, uh, it was an interactive movie, um, uh, black Mirror, uh, bander Snatch, which was, uh, Allowed you to watch the movie via streaming video, but select using your smartphone or your, your remote, um, how the movie ended.

So there's selectable content that's responsive to the needs of the individual watcher, um, almost to a virtual reality, uh, sense. And I think that's, The difference, right? These industries, um, are are almost game-like in many ways. They, uh, they provide that access anywhere, anytime, anyhow, you wanna see it.

And I think that's the key. And it's not about digital so much, bill, as I really think it's about, um, It, it's about being responsive to the customer. Um, looking for an exceptional customer experience, not a standard customer experience. Banking is a, is is a good industry to, to, to, to look at. Um, used to go during banking hours, right?

You used to take your check and get it cashed. You used to go to the, to the bank to get it deposited. Now all those tellers are becoming. Baristas at, at Starbucks, because we don't need to go to the bank anymore. We do everything through Venmo or take a picture of a, of a check, or we just tap and go in, in terms of, uh, of the banking industry, retail banking is, is, as we know, it is in a very steady decline.

Citi banks are closing up, uh, their, their, uh, their outlets or branches almost everywhere, and we're able to do that because they digitized, and more importantly, they're being responsive to the needs. Of the customer, how can we make it more convenient, more responsive to their desires? Yes. And that's something that healthcare just has not yet done.

So when we digitize things, we make it, uh, a lot more portable, a lot more accessible. And, uh, you know, last week on the show I shared about, uh, Walmart's new model for their employees. Where at one point the, uh, the telehealth, uh, copay was $40. They now have gotten it down to $4. It's a huge satisfier. Um, it helps them to really streamline the process.

They can actually do primary care physicians, a a bunch of the primary care physician stuff through that. And one of the things that's happening today is we're not going to our primary care physician. Uh, the millennials aren't. And I, and I am, I'm not either, but you know, I go to the urgent care and I go to urgent care 'cause it's convenient, I can get there.

And, uh, the, but the reality is that the next generation's looking for that next thing. We're missing out on, on the benefits of primary care because we're not figuring out a way to really offer it through, uh, through, uh, virtual visits and, um, and video. Um, because it would be better if instead of going to the urgent care, every time I started my journey with a primary care doc who could say, Hey, you know, Thanks for this call.

'cause it's 15 minutes. It's eight minutes, it's 10 minutes, right? Um, it's convenient, it's accessible. So that's what digital enables us to do. Um, but, but Bill, you've said so many important things right there in, in that, uh, in that little segment. Um, you know, number one is, is. The new generations and, and I'm talking about those generations that follow the greatest and the, and the, uh, the baby boomers.

Um, what the, the, the once sacrosanct relationship between a physician and his patients has become commoditized. I'm, I'm sorry to say that if you have an MD. Behind your name. My children will wanna see you if they have a health issue. They don't, they don't need a longstanding relationship with a, with a physician.

They just wanna see a, a doctor who's qualified to see 'em and treat them when, where, and how they wanna be treated. Um, And going back to your, your, your thought about primary care. You know, every one of the health systems that you and I know or can name across the country, they're doing telehealth, they're doing umit, but they're strapping those things on to an old system model.

Trying to do them in addition to doing things that we've always done and bolting on those, those, uh, those services to the old chassis is never going to work. And it's not going to work because we can't really do it, um, at the same price point as the new entrance into this market or doing it because we have these big hospitals and bricks and for offer for $40 or four.

But we're not getting the contribution margins and we need in order to pay for those, that big infrastructure and those large hospitals that we have, they don't have those things. So that $40 for them is a very different $40 than it's for us. And that is a very risky proposition if you look at the overall environment.

But is that a natural, so bolting it onto the chassis, is that just a natural evolution? I mean, when you saw . Uh, you know, DVDs were being delivered, that whatnot. You could go to Walmart and you could buy a D V D and it would say it includes digital download. And so that was sort of a, uh, let's say, you know, an evolutionary step to what we are today, which is everything's completely digital and I'm not sure many people are.

I, I can't find my DV D v D player anymore. Right. So is bolting it on sort of, you know, so New York, Presby one of the things and, uh, hospital for Special Surgery and others, they, they do a lot of special surgeries and what they're trying to do is, is. They, they look at the areas where, you know, people have to take long visits from New Jersey and whatever into New York, and they're saying, Hey, look, we can make this better.

We'll do the surgery and then the follow-up visits. We can do a lot of that via telehealth. And so they bolted on, they get experience, they learn, and then they expand it from there. Is is that a, is that the natural evolution for this, how we're gonna see it sort of evolve in, in healthcare? Well, it, it's interesting because I, I, I think, um, the hospital for special surgery is a, is a unique, um, a unique example in many ways, the traditional healthcare integrated delivery networks, we have been.

Frankly, we've been robbed of our business by a number of new infants. And one of those I think is, um, is the model that, that the hospital for special surgery, it's a focus factory, right? They do primarily hips and uh, and they do an exceptional job at the high quality, low cost, high volume with, uh, with the ancillary to do digital.

And I think they've done, uh, they've done remarkable work, um, for us in a traditional healthcare setting. Um, you know, We've lost in many ways, dialysis. We've lost birthing centers, we've lost cancer treatment, we've lost cosmetic surgery and ambulatory surgery. We've lost urgent care. We've lost, um, things to those, those focus factories as you pretty, uh, recently brought up.

And, and next will be primary care. Those things that used to feed our hospitals are being took away from our model. Leaving us holding the bag, as it were with these large capital intensive hospitals and, and, and, and our, uh, competition having taken from us all of the, you know, low risk, high margin services, leaving us with the high risk, low margin services.

And I'm talking specifically specific emergency department. I'm talking about complex surgery. I'm talking about I C U, and I'm talking about end of life, those things that are high risk. Low margin are the things that those new entrants don't want. And, uh, and, and we can't offer those other services at a price point that allows us to do those at, at a competitive market.

So, you know, CIOs hate, it's interesting. So I just do focus groups every now and then. Not actual focus groups, just sitting around with some CIOs, uh, having drinks, and I'm like, you know, what's, what's the buzzword you hate? And, you know, disruption is one of those things that they hate. They're like, you know, we've been talking about it for eight years, seven years, six years, and it's just not happening.

Um, And, and so they, they almost get kind of cynical towards, uh, the word disruption. Although it's happening, it's clearly happening. When you sit around CEOs and have that conversation, they are, they're feeling it, they're like, you know, you can't keep taking my, uh, low risk, high margin business and leave me with a shell of, of an old business model.

Uh, I, we've gotta figure out how to, uh, how to transform what, you know, what do you think is slowing the pace?

Uh, within healthcare, I mean, what is slowing down the pace of digital, of digital adoption? Well, I think, um, First off is demand. And I think that that's, um, that has kept us on the outer bounds. Uh, bands of that digital hurricane I talked about. And what I mean by demand is that, uh, the millennials, the Gen Xers, the, the Gen Ys, the, the, the generations that will follow, um, they really haven't had too much of an interaction with healthcare, right.

Um, they've been on their insur, their parents' insurance. Um, they, they really don't have health issues primarily as a, as a population. Um, but, but now they're coming of age, they're starting to have their own babies. Uh, they were born into a digital age. They're starting to, um, to have their first, uh, interactions with the healthcare because they're coming off their pa, their parents' insurance, starting to have their own babies, and they're maybe starting to take care of their parents or aging parents, and they're having their first interactions with the healthcare model and they're.

You have got to be kidding me. I cannot believe this is why. Or this is how we get healthcare. We do healthcare in this country. And, um, and, and that demand is coming. So the more opportunity they have to deal with the healthcare, uh, environment, the more they're gonna demand something very different from us.

And it's also why you see organizations like Google and Amazon, and. Starting to step up and say, we can do this better. Um, we can broker these healthcare services. We can, we're not gonna provide healthcare, but we're gonna show you how to do a delightful customer experience. And, and in which case, we're gonna delight your customers and they're gonna become our, that relationship's gonna be ours, not yours anymore.

Uh, traditional healthcare system. Um, you know, if you look at the Amazon model, what they want is to provide a better customer experience. They want to make it easy for individuals to, to take care of themselves, both their health and their, their, their healthcare. And then thirdly, they want a broker for services causing all of us with, uh, that provide services to bid for those services, um, based on quality and low cost and convenience for the customer.

And I'll tell you, as a customer who wouldn't want that, I personally would want that. We talk about, you talked about focus groups. Um, I'm, I'm constantly amazed by marketing teams and, and, uh, and leadership teams who wanna pull in customers and, and do a focus group. What all I I say is, what do you want?

Look at how you live your life. You don't need anybody else to tell you. I can do everything I want in my life. On my iPhone, I can, I, I can communicate with people. I can manage intimate relationships. I can make dinner reservations, flight reservations, hotel reservations. I can, I can tell the proprietor of my lunch today whether it was good or bad, based on, on, uh, on what he served for me.

He can respond to it immediately. This is how we live our lives today, except for healthcare. In healthcare, we don't do it this way. You go to the Palo Alto Medical Foundation in, uh, in Palo Alto, California, one of the most progressive, advanced clinical, uh, environments in the country. And I can get Uber to take me there.

I can make that appointment online, but the first thing they're gonna do when I walk in the door is hand me a clipboard and a piece of paper. It's just, it's just barbaric. Six weeks after I get home, they're gonna send me a five page piece of paper asking me how satisfied was I with the services I re I I I received.

I will have had to make that appointment two weeks prior. Two weeks or more prior to when I arrived. That's not how people wanna live. I wanna see a doctor right now. I want to tell you whether it was good service right now. I wanna be able to pay my bill right now, and then I wanna be on my way. That's the model of the future.

If, if a health system's able to do some of those things you just rattled off, uh, in terms of, uh, overall experience, uh, do you think that's gonna create a competitive advantage for them in the markets that they serve and potentially new revenue streams and new revenue models for them? Uh, , there's no question.

Um, you know, you, you, uh, You talked about, uh, two things, digital disruption. Um, I'm one of those people who don't, don't wanna really talk about digital disruption because I don't think it's digital. I think the real disruptions are two twofold. One is, um, denial disruption, which is, I. You know, wearing a Fitbit, uh, wearing a, or ingesting a ingestible monitor or using connected devices at home, um, to maintain my health and prevent an interaction or an episode of care at a clinic or hospital, right?

Maintaining my, my, uh, my wellness in my health. Monitoring and curating my health, that's denying us the opportunity to take care of a paying patient that's very customer centric. That denial disruption denies us the opportunity to take care of a paying customer. That's one kind of disruption I. The second, and, and that's coming, I think as generations.

Um, we're not there yet. People are not good at taking care of themselves and doing the right things just yet. Um, but, uh, that self-service model is coming. You see it with things like, um, uh, I would say, uh, uh, Cologuard, you know, you can, you can do that, uh, 23 and Me, you can do that at home. Both of those tests you can take at home.

Um, Fitness, uh, uh, monitor apps, um, subscription services that offer those things. All of those things are available today. There hasn't been a huge uptake just yet. We as a population are not there. The second way that we're gonna be disrupted is delight disruption, and that's where organizations. Are customer centric and focus on the convenience, access, quality, low cost experience for their customers.

And frankly, in healthcare, we are terrible at this. So these new entrants into the market are really disrupting us by doing the exact same offering, the exact same services we do, but doing it in such a way that absolutely delights the customer. You asked for an example. Um, The, uh, I was recently at Scottsdale Institute where Ken Salmon of, um, of MedStar on the East coast spoke.

And, uh, he gave the example of his daughter, he's the c e o of the system. His daughter had a so, or scratchy, scratchy throat and, uh, and went to the urgent care to have it taken care of. And Ken said that, um, he said, well, you, you went to one of our facilities, right? And his daughter said, well, actually, there was a, an urgent care right on the corner, and it was just so convenient.

US popped in there and had a swab. It was only $30 and, and I needed it right then and right there. And he said the light bulb went on for him, that his own daughter of the, of the c e o of the, of the health system went to someplace that was more convenient for her. That's when he realized our model has got to change.

We have got to be focused on the convenience of our customers. 'cause that's where they want their healthcare. I I have a theory on what's gonna open the floodgates, by the way, that my theory is this. There's a, there's a a case before the Supreme Court in a completely different industry. I. Um, but it, it's around, uh, the selling of alcohol and wine across state lines, and it's going up to the, to the Supreme Court.

And one of the things they're, they're looking at is, is that interfering with interstate commerce? And if they get to the point, if the Supreme Court comes down on this and says, you know what, that's against interstate commerce. Um, you're now allowed to sell wine across state. Barriers across the country that will completely upset and change that industry.

Uh, you know, there's some states that have like, uh, state stores and those kind of things. They will completely change that industry. I think that same thing could be the, the catalyst. So if you have health systems that really get this consumer thing down, they really understand the experience. They really build out these experiences, and then all of a sudden those barriers from state to state come down.

Now all of a sudden, You're gonna have a whole sorts of new entrants come into your markets and start to pick off things that, uh, that you didn't think were possible before, and then be able to say, Hey, you need a surgery? Uh, here's your plane ticket. Come on up to our facility in, you know, in. Utah, we're wherever, and, and, you know, we'll, we'll do this surgery up here and, and take care of you.

And by the way, we'll continue to provide, you know, telehealth and, and those kind of things. And the experience will be far better than it would be. And they'll have partnerships with urgent care facilities. And I, I think that's gonna be one of the biggest catalysts. I mean, do you see something like that?

Um, You know, really opening the flood gates for digital disruption or, or just disruption in general in healthcare? Uh, I would tell you, you're exactly right. And, and, um, and maybe, maybe I'm, uh, I don't know if this makes me glass half full or glass half empty, but, um, Not only do I see it coming, I, I think it's already here.

I, um, I, I kind of keep a track of some of these, uh, some of these new entrants and I'll give you some examples. Uh, I don't know if you've heard of with cove com, with Cove is, um, is uh, an organization that helps you manage, I. Migraine headaches, uh, anywhere in the country. So, um, they will write you a prescription.

They will, uh, do a FaceTime with you, uh, with a physician. If you're having a, a chronic migraine problems. Um, you don't have to see a doctor other than write there on your couch or in your bedroom. Uh, with your iPhone, your medications come in the mail. Your counseling is via iPhone. They are taking care of, of, um, of patients with, uh, with chronic migraine issues.

Dot com site. Um, heartbeat, believe it or not, heartbeat is an organization out of, uh, New York, upper New York. It's a cardiology practice, um, that is basically using digital audio files to help patients with cardiac problems, um, manage their cardio across. Across the country. So you, you put your iPhone up to your heart and there's a, a device that attaches to it and send them a cardiac, cardiac file.

Um, and, and they listen to that cardiology, uh, file, digital file and, and, and adjust your medications, help you with your exercise regime. And those cardiac patients that used to be ours are not there anymore. Um, dental, D N T L, uh, is, uh, online and remote. Um, uh, uh, dental Services SmileDirect Club. You get a package in your, in the mail, you make an imprint, you send it off, you get, uh, uh, a corrective, um, uh, prosthetic for your teeth.

Um, it's by an orthodontist or a remotely via iPhone. Um, it's all self-service and you do it yourself. And then, uh, for, uh, for a lot of people, the, uh, erectile dysfunction. Now you can get medications for those kinds of things right off of Facebook, right off of the internet. You have a remote physician that takes care of you and adjusts your medications as required, I'm told.

And, uh, and then you, uh, you um, you, you know, so here's something that used to be a clinic visit used to be revenue for us now being taken care of completely remotely. Completely responsive to the customer, need completely, um, online, um, or via digital conveyance. So I think that, you know, those used to be for us revenue streams and copays and, uh, and now they're, they're gone from us and, and the conveniences through the roof, the quality is through the roof and the patients absolutely love it.

So let, but let's, let's change the, the game here a little bit. And so I wanna talk to you about the, let's, uh, hypothetically talk about the rest of your week. So you're a C I O for a health system. We're talking about all these things that could fundamentally change the business, but. You know, probably if you're like, and you're, you're, you're, you're not on the digital scale.

You're, uh, pretty evolved in this aspect. But still about 60% of your time is gonna be spent talking about the E H R and operation systems and, uh, and, uh, consolidation and application rationalization and standardization. It's still gonna be talking about taking care of that traditional. Uh, uh, thing, I mean, is that, uh, I, I found that to still be the case.

In fact, having talked to a couple health systems and, and CEOs, you know, what are you looking for in a C I O? They say, well, you know, the first thing is they need to have epic experience. And I sit there and go, Really, you know, 'cause I, I'm talking to more and more people and it seems like, um, you know, that's almost a lower level function within the IT organization.

Somebody who can run Epic and somebody who can keep it functioning and even give it new workflows. And the c I o or even, you know, innovation officers or digital officers should really be focusing on the these models and working with strategy and. Are we still saddling the c i o with, you know, and 60% was being kind, 90 to 95% of their time is just keep operating the old model and make sure it doesn't break Well, I, I think the short answer is yes, and I think that also is, is the, the challenge for.

People who aspire to the c I O role. This is, this is not a technology role bill. This is, this is a leadership role. This is being able to communicate the vision and then being able to lay out the, the progress and steps that an organization or an industry needs to take in order to get to that. And, um, I think it's critically important that my peers, myself, and others, Take on that mantle of leadership and step up to this challenge.

Our organizations are struggling with it every single day. They're hiring chief innovation officers, chief transformation officers, chief digital experience officers, chief patient engagement officers. They're all struggling with how do we harness this and, and it's out there. We don't need innovation officers.

All these innovations exist. They just don't exist in healthcare. These things are what retail and service industries have been doing for years and years. I, I use the example, um, and you may have heard it, that I drive past a Chili's restaurant on my way home from work every day. And as I go past on my g p s in my, in my car, I.

It pops up and says two for one margaritas, it's happy hour, join us. But yet, when I drive past the clinic, it never pops up and says, have you had your flu shot this season? We don't think that way. Those, that, that would be innovative in our industry. It's not innovative. It's taking something that already exists in the retail or service sectors sector and adopting it into the healthcare industry.

My, the lady who cuts my hair, no comments, please, um, sends, says, Your appointment is, is tomorrow, press one to confirm after I have my haircut. Hey, thank you for your business. Uh, you're scheduled three weeks out. I'll send you another reminder. We don't think that way. The lady who, who does, um, the, the, the, the business that does my, my dry cleaning, they will tell me that, um, your, your order is ready for pickup.

Swing by and, and pick up my, my dry cleaning. Thank you for your business. We don't think that way. Pizzas now they'll tell you, Hey, you know, Uh, you know, Tom has put your pizza into the oven. Larry's getting ready to bring it to you. I've got a countdown clock on my, on my monitor that tells me when my pizza's gonna arrive.

Yet my wife with her mammogram results sits anxiously by waiting for the, the, uh, mailman to come and, and, and see if her results are gonna be in there, uh, today, or maybe it'll be tomorrow. We can do all of those things in the retail and service industries, but we can't do 'em in the healthcare. It's not about innovation, it's about adoption.

So, uh, yeah, I won't comment on your hair if you don't comment on my hair. So, um, the, the question becomes how do you go beyond the, you know, every c i o has in their bag of tricks to pull out the Netflix slide? You know, Netflix didn't do this or the Kodak slide, and we, but how do you go from talking about it to.

Doing it. You know, there's a huge difference in Silicon Valley has, uh, you know, DevOps versus what we have as traditional it. They have, um, you know, a, a team-based model. We have a hierarchy still within it. They do agile, we do waterfall, they do fail fast. We do never fail, is more our mantra. So, um, You know, from a, from a culture standpoint and a technology standpoint, how do we go beyond the slide?

How do we go beyond the, the, uh, uh, almost cliche slide of Netflix and Kodak? And we need to change as an industry to go, alright, here are the things we need to put in place. Yeah. And, and, and it ties into what you asked before, and I, I maybe cleverly avoided the question, which is, um, you know, how do you, how do you enable this?

What do you really do? Um, and, and there's a utility function we have to, to, to provide to our organizations. The, the systems that they run on need to be responsive, need to be, uh, high performance, need to be up all the time in order to, to do those things. But, but Bill, those are transaction systems. And, and as a customer, I don't give a.

Whether you have Epic, Cerner, Meditech, or, or, or whatever, you're not gonna get a single additional paying customer because you're on Cerner or because you're on Epic. It doesn't work that way. People don't care about your transactional system. Keep it up, keep it running, make it responsive to your clinicians, but don't think that that's gonna be a, a differentiator in, in the marketplace.

What I see as the c i o role for what you just described, is to throw open the shutters, unlock the door. Let in some light, let in some people from, from, uh, who wanna partner with us, from retail and the service sectors. We have been a very closed industry. 'cause we were, we were something different. Those innovators, those millennials, those uh, those populations that want something different from healthcare, I.

They wanna help us. There's an altruistic attraction about people who are called to work in healthcare. Um, and, and people would like to give us a couple of their years of time and, and talent. They want help us. Um, so why do we keep them at arms length? We need to embrace them. We need to embrace. Things like, uh, the agile methodology, we need to understand that we are going to fail, not on the transactional side of things, but on, on whether or not, uh, you know, the pop-up, um, notification about, uh, about you getting a, a flu shot.

Is it, is it targeted? Right? Is it worded right? That's where we need to be doing our innovations and our, and our, and investing in, not in the transactional. Uh, infrastructure. That said, I would also tell you that if all of our money in it is being dumped into 20 year old, um, legacy transaction systems and not res, more responsive to the marketplace, then, then this is, this is a dying.

We're in a dying spot. The, the future is an operating expense, not a capital cost to be depreciated over 15 or 20 years. Um, The world moves at a different clock speed, and we've gotta pick up the pace in order to be more responsive to those who are paying the bills. The insur, clearly we're failing.

Insurance companies, uh, large organizations are, are saying they can do it better, and they're partnering to do just that. The Googles, the Amazons, the Microsofts of the world are saying it can be done better. We want a piece of this. You know, almost 20% of the G D P spend on healthcare, these costs are unsustainable.

We can do it better. It's not, uh, it's not impossible. We just need to let go of what we've been doing so long in order to do something different. Yeah, it's really interesting. You know what, we, we've actually, uh, we've come to the end of our time. I could talk to you for another, uh, 45 minutes. Um, uh, you know, I think the last, if I could throw out one more question, it's, um, You know, you, you just took on this new role.

Uh, and, uh, I, I, I think the, the question, because we have a lot of different viewers, I know that we have some college and university students watching and whatnot. Um, what, what type of advice would you give to an aspiring c i o somebody who's in college just coming out, who's saying, I wanna get on that path to be somebody who's, uh, you know, mapping out the future of the business and how technology's gonna support that.

What, what, what would you say to. Well, like you, I, um, I wish we had more time. I could speak, uh, talk to you about this bill for another hour or two to tell you the truth. Um, what I would say to those who aspire to this position, I would tell you that, um, There's not a better job in the world. Uh, this is absolutely the place to be.

If you wanna make a difference, if you wanna make an impact on society, and, and, and you want, you wanna be a leader, this is the place to do it. Our industry needs leadership now more than ever before, and what you need to do is be decisive. Take the initiative, be bold, be aggressive, you know? By fitting in, you get to these positions by standing out, speak up, be heard, you know, take the initiative.

Um, if that's what you want, and you aspire to be a leadership to make a difference, there's not a better job in the world. Yeah, absolutely. Well, we'll, you know, we'll give you a little bit more time in the chair there, and then we'll have to have you back and, uh, we'll, we'll finish this conversation up.

Love to hear some of the things that you're, you're able to do once you get your feet on the ground. You have a great market there. I mean, you're, you're in Dallas, Texas. You should be able to hire some. Really good talent, I would imagine, uh, from that market. It, it was probably pretty hard to, I mean, it was great to be in Silicon Valley 'cause there was so much talent, but it's probably pretty hard to hire that talent 'cause the, you know, you didn't have stock options to give them and, and the kind of salaries they were getting from, from there.

You might have a little bit more of a fighting chance in Dallas, I would imagine. Right. You know, it's a good, it's a good thought. And, and I know we don't have time, but I would love to talk to you about it. Uh, you know, Healthcare has become stayed. My, my incentive program used to be on, on how I kept turnover low.

Um, you know, keep a, a one, two, 3%, uh, turnover rate. The truth is, with these new generations, they wanna give you a two or three years and then they wanna move on to something else. But they wanna give you their best two or three years, learn and contribute the best they can. And we should have a, a 12 or 15%.

Turnover rate and celebrate those folks for coming in, doing good work and then moving on. And uh, and maybe that's a topic for another time. Absolutely. Well, John, thank you very much. Um, yeah. Do you, I mean, do you write, you have a full-time job? Do you write a lot or do you have a way that people can follow you if you are putting stuff out there?

Um, I, I will get that to you, bill. There's been a, I've written a couple of articles for, uh, for Becker's. I've done that on occasion. One is, uh, Healthcare needs to stop, uh, dodging, denying and delaying their digital destiny. Um, and then the second one is, um, let's stop talking about digital disruption. I would encourage you and, and your, uh, viewers to take a look.

'cause I think, uh, a lot of what we've been talking about today, um, you'll find in those articles, but I will get you my contact information if you'd be interested. That, that would, that would be great. Um, thanks again for coming on the show. This show is a production of this week in Health It. For more great content, check out the website this week in health or the YouTube channel at this week in health

Thanks for listening. That's all for now.

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