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  Today on This Week Health.

(Intro)  did we have everybody a believer at the beginning? No. Do we have more believers now? Yes. . But we have data now that we never had before that helps us tell the story that this actually is doing good things.

📍 Thanks for joining us on this keynote episode, a this week health conference show. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health, A set of channels dedicated to keeping health IT staff current and engaged. For five years, we've been making podcasts that amplify great thinking to propel healthcare forward. Special thanks to our keynote show. CDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders. Now onto our show.

(Main)  All right, here we are for another keynote episode. I'm joined with Lori Boisjoli, CIO for University of Vermont Health Network. Lori, welcome to the show.

Thank you for having me. Well, I'm looking forward to it. we were just talking it's amazing, you have sun in Vermont. Is that pretty normal in November?

No, the fact that it's 52 degrees, I can run outside, not really windy, and it's sunny is... It's a great thing. A

Crazy weather year for Vermont, for sure.

We start every keynote episode with the same question, which is give us an overview of University of Vermont Health its scope, size, mission and how you guys function.

So we're a non profit academic community hospital system. We serve over a million people living in rural communities.

in both Vermont and upstate New York. We're comprised of an academic medical center, five community hospitals, a children's hospital, a home health and hospice, and a multi specialty medical group. Employ about 2, 500 licensed physicians and other healthcare professionals, and about 14, 000 employees across the network.

Wow. It's pretty broad and pretty large. Give me an idea of what priorities would be from your role as CIO. What are some of the top priorities going into next

year? Well, always for everybody, it's always about keeping everything safe, right? From a security perspective. And making sure that we have everything we needed.

We did suffer a pretty serious cyber attack, so it's top of mind for us. And we have some pretty big investments that we've made along the way, but we haven't leveraged everything about them yet. From a financial perspective, being able to, really look at the investments we've made and take them a little bit further are probably some of the key ones.

Yeah, the having gone through those, would assume, in a lot of organizations, hear the conversation around cybersecurity is a difficult one in that it's hard to get the attention of the leadership, but after you've gone through it, I would imagine the leadership, the board, everyone's educated on what that looks like and what that feels like.

So It's more, top of mind in just about every time they come together. How are we doing? Where are we going? There's probably a lot more pull than there was push back in the day.

Absolutely true. But it wanes. So that was 2020, October, 2020, October 28th, 2020. I can tell you the times I could tell you the entire history.

But it has been three years now we still have. We run phishing, right, exercises all the time, and we had really great response to them, and real good diligence for the people that went right through the cyber attack, but as time has gone on, and admittedly, The tests are tougher, right?

They don't look, it's not just a misspelled word, right? We use technology to make them trickier, and, our people, don't do so great at those. We enroll them into education programs right away, but certainly from a funding perspective. Being able to say, I need this to keep us secure and, bringing forward what is necessary there is easier given what we went through.

These large language models are really. Fascinating to me. They're really powerful and we're talking about using them in the clinical setting and responding to notes and we're seeing studies and organizations start to push out in that area. We're seeing them take notes in meetings and identify the things, but they're also being used by attackers.

And that's the crazy thing is they are getting more sophisticated because They really don't have to work as hard, and even if English is their second language, it's not a second language for a large language model.

Yep. And we just, in the way of security, deployed the data loss protection.

module, so we can really track what people are putting in prompts from AI tools. We're starting to turn on some of the automatic blocking, based on PHI or PII, and those are, important next steps for us to just continue to keep the data and our people safe.

we met for the first time at one of the 2 29 project meetings, and there was a great discussion between you and the other academic medical center CIOs and you were sharing about the move to Agile, not just from a project management standpoint, but really from an operation standpoint.

I'd love for you to share a little bit of that. because I thought it was fascinating. And I think a lot of the other CIOs leaned in on that conversation. So

I think it spawns from, I have spent most of my career on the IT healthcare development space. IDX and Allscripts is where I grew up.

And so Lean, Agile, and using SAFE, Scaled Agile Framework were. processes that we introduced there and relied on and I saw a great value in it and became a believer. It really worked and we were able to get work done and get work done faster and build some really high performing teams. And so when I came here seven years ago we started to sprinkle a little bit in but we didn't really go all in until this past January when we launched full on Lean Agile Safe.

And, I looked and it was starting to get momentum outside of development and across different industries. So we weren't really going to be, the first, but I certainly did learn that we're the first that, that we can find that has really taken it as far as we have. And when I say we're all in, I mean all in, we have 40 plus Agile teams that includes our full infrastructure groups, and we do quarterly program increment planning, and we get all 400 plus people together for two days, and we plan out two week sprints.

We have the conversations, the teams are comp Committing to the work that they can get done and we're now three program increments in and are really seeing value in doing that upfront planning and limiting our work in progress so that we can fully deliver faster on the value.

was there a way that you stepped into this slowly or was this a no, we're going to bring it all, we're going to bring everybody up to speed did you lead with IT first or is it a full organization thing?

So it's really IT. And so we are hoping that, the value comes and is, we're the test ground. We obviously, because we touch everybody. We are dragging everybody along with us, and, they're now understanding the need to plan early, and we created these business relationship partners, which were really almost our most high level people within IT, our directors, they were inward facing, right?

And what we needed at the time to deliver Epic across the network and things like that, but now they're actually outward facing and they are our business relationship partners in the safe world. They usually call them business relationship managers, but we didn't like that manager word. It's really about the relationships.

And there are liaisons, and they take the IT speak and the operational speak and create the epics and the features that then the agile teams can distill into stories and execute against. And so as part of bringing the organization along, They are understanding that we're reaching out, helping to understand what their business priorities are, how technology might be able to assist with that, working with them for prioritization, and this is the first time ever across the health network we have had a single prioritized list.

across every one of those institutions that I had talked about. And we worked that list from top to bottom, and we can only get so much done. We're no different than any other IT shop in every, any other industry more than We have capacity for the ask scene.

So you have the relationship managers, they're outward facing they're going out and collecting the information.

Then you have story cards. You start to build out story cards on, what people are asking for so that the team can then distill it. I'm trying to get a feel for what makes this distinct. Obviously you have the sprints, the two week sprints where you're looking for results over a two week time frame.

I assume you have daily stand ups. am I catching the gist of it or am I missing some of it?

you got some of it. So it starts with an epoch. And the, epoch is something that's going to take more than one program increment or one quarter to produce. So the big rocks.

And so those are the epochs. And then you can break that work down into features which fit into a quarterly increment. Or something can be a feature by itself and you don't need an epic for it because it can be done in one quarter. And then there's some little small sort of those pebbles that could just be stories.

And so what we never really did before was look at the work, break it down, decompose it, actually get people in a room, make sure we had thought about everything, and really create sort of a... strong plan on everything that was needed, the teams, the operational portions, and that kind of thing. And so by doing that heavy lifting up front, it is allowing us to execute much faster on the back end.

And so we have, all these discovery that's happening early. And so we may take a whole quarter, and all it is about understanding what that request is more. And decomposing it and really understanding so that when we, and we do that without the Agile teams, for the most part, that is the product owners, those business relationship partners, operational leaders, understanding that.

And then, we have all that and we go into the next program increment. And we can just execute and get that done, plan it, execute it, and complete it. And so we're now running with a much higher delivery of that value because of the upfront work we're doing.

in My time working in agile teams, there's a Significant amount of focus that the teams end up with.

The two week sprints, this is what we're working on, this is what we're building. And that's one of the things in health systems that ends up being missing because they're constantly being barraged by the outside going, Oh, can you do this? Also this. And I found the other thing was feedback loops.

There's constant feedback loops. So you do it over two weeks and you look at it and go, Hey, we didn't get this done. Why didn't we get this done? Oh, We didn't really scope this well enough. Like we thought this was going to be easy. This was a lot harder than we thought. Feedback. And then the next time you do it, it gets better and better.

yEah, I know that's not a question, but I mean, that those are really valuable items. I think when people are doing, they're still doing a modified waterfall or those kinds of things they struggle with focus. They struggle with prioritization. They struggle with resource utilization.

And they appear to me to really not have those feedback loops. So the team doesn't incrementally improve over time. Are you finding those things are happening now that you're doing it across the entire organization? Yeah, so we do a

retrospective at the end of every sprint, as you mentioned.

So every two weeks, the teams themselves, and it's their safe space to talk about, what worked and what didn't work, and to try something new. And they could find that they tried something new and sit at the next retrospective and say, let's not do that again, right? But that is the fail fast kind of mentality.

And we do a retrospective at the end of a program. From increment, what could we do differently in that? And we're constantly trying to improve. Do we still have huge opportunities? We're only, sort of nine months into this. Absolutely. But really are seeing value. And I would say, did we have everybody a believer at the beginning?

No. Do we have more believers now? Yes. Do we still have some that are... Watching and waiting. Sure. But we have data now that we never had before that helps us tell the story that this actually is doing good things.

Did you bring in an outside third party to jumpstart the program?

I did not.

I brought in a resource from a previous employer that is SAFe certified, knows her stuff. And I would absolutely recommend anybody that's thinking about doing this, if you don't have the expertise. Find the expertise, whether you reach out to a third party or you hire for it. But and that person was dedicated to really getting this off the ground for us.

And it took a long time. I mean, we probably spent, I don't know, 14, 16 months preparing to do this launch.

Yeah it's amazing. And I wanted to have that conversation with you because I think there's. A lot of organizations that would benefit from that move. I want to move back to really talking about some of the priorities.

Let's talk about the patient. what kind of things are you doing at, is the organization doing, UVM doing around patient centric healthcare or making the patient journey? better, easier less friction, those kinds of things. what's the focus around the patient?

So I think certainly there's a lot of conversation around value based care and it really, Trying to shift that model and what actually I think personally jazzes me about that is it seems to give us permission to think differently because it's a different model and so you're freed from how you used to or maybe and how you do some of the things today and let's just step out of the box.

I mean, trying to figure out how to bring health care to the patient, to the people versus them coming to it. Like everybody gets their haircut, right? well, what kind of services might you be able to get? Or connections can you make in environments like that?

But really just trying to think about it very differently. We're no different than anybody else and have access problems and have people resource problems in the way of more jobs than we can possibly fill.

Yeah. Give me an idea. So from a virtual care standpoint, telehealth standpoint.

Are there technologies maybe even scheduling, are there technologies or approaches that you're putting in place to support value based care, to support the engagement with patients?

Yeah, so we are an Epic shop, so leveraging MyChart direct scheduling, we had to make a lot of scheduling changes to essentially balance out, as separate organizations that came together as a health network.

There was a lot of variability in some of those things. So there's been standardization that now allows us to, take advantage of what is there. Recognizing that many of us would rather. Take some of that scheduling or using MyChart to know where we stand put that power into people's hands is important for us, for sure.

Yeah, but it it is such a challenge. It's so interesting when I have conversations with people outside of healthcare and they say, why can't you do scheduling? I'm like, you have to understand how specialists work. You have to understand how all this stuff works together. And if you step back and look at it, it's not a simple, just put this little piece in this little spot and it works. There's a lot of operational changes. Give me an idea. It's when UVM approaches a project that requires a lot of operational change, what is your role in helping to facilitate or helping to make that happen?

So it's a lot of conversation to make sure that from an IT perspective, if we're going to make that investment of the resources, that it really is a change that is going to be followed through on the operational side. So it is understanding the value. Now everybody is in the prioritization effort and it's created great transparency so that the conversation can now be more about the operational leaders asking each other.

Is e consults more important than e referrals or upgrade to health network packs? Well, not really an upgrade because those we treat ourselves as KTLO, but maybe the deployment of some new system. And it's not really like an IT decision, never has been, but it seemed like that in the past, but now we've created that transparency.

And, a really good example is e consults. Still fairly new in the e consult world, but in October of this year, we did more e consults in the month of October than we did in all of 2022. And, that took a lot of time. Relationship building and back and forth between operations and IT to make that happen.

And what a win for patients, right? some people have to travel a long ways for an appointment because we're pretty rural. And, being able to use an e consult and know that you don't need to go to that specialist. You get that, peace of mind perhaps right away and you might not have to travel.

You know every two years when a CIO at St. Joe's would do a significant survey of the they would ask them, what are you looking for, what are you hearing, and that kind of stuff. And the first time we did it, an earful. It's just fix everything was essentially the thing.

But couple of years, better and better. We were able to focus on the things. What are you hearing from the clinicians? in your community that they would like to see happen that technology might be able to enable?

I think the big one is probably not a lot different than, what previous people you've had on, this show talk about.

And, we Spend time with class and our providers participate in the class survey and, we can see how close people are to burnout, how much pajama time they have, obviously EPIC provides some of those statistics too, but that's a real focus for us. And so I think, being able to leverage tools and technologies that make decision making easier, and That potentially, formulate most of the response back in the way of an in basket message or help with the notes or search through and do a summary.

I think those are the things that they're certainly looking for on the imaging side, being able to do that preliminary read. And it's a tough spot for us to have enough radiologists to do those reads. So where we can insert those kinds of things are certainly what we're seeing be prioritized.

IRIS towards the top.

I used to ask this question from a technology perspective, what are you looking at over the next five years? I feel like now what I should say is, what are you looking at over the next five months? It's things are rapidly moving.

What are you looking at from a, strictly a technology standpoint? Understanding that technology doesn't drive all the decisions, but just you're keeping an eye on, because... It's moving so fast and has the potential to impact the work at University of Vermont. What are some of those technologies?

Well, I think for

us, it really the two places that we're keeping the most eye on is really where the most immediate needs are, because I think we have so much of that. We're not probably as forward thinking as Maybe we should be. So it really is trying to address the throughput on the access side and the human capital that we don't have enough of.

So what can we automate? What can we skinny the time for anybody on? And so whether that's in RPA or AI or bots or self service, what are the things in any of those areas is probably the most of what we're looking at in that shorter period of time.

Have you guys made moves in virtual nursing and those kinds of things command center and those kinds of things?

So

we have not, it's still in planning and what is it going to cost us to invest in that kind of thing? We definitely having a home health and hospice, that home health side of things, and what can we do when we're in those spaces? Is a top topic, but we're also, when we do the deep dive into say hospital at home, a lot of the organizations that we've looked at that works in a fairly small radius number of miles.

We don't have a lot of people in a short number of miles from even here in Burlington at the Academic Medical Center. So it really is, how can we think about some of those things probably a little bit differently than what people have been super successful with thus far.

It's still a logistics challenge, isn't it?

I mean, you still need to get people out to it. I know we're calling it home health, and when people hear that, they envision, all this technology just communicating back and forth and someone popping up on a screen and everything's good. But at the end of it, I had a conversation with Mayo about their home health, and they have to send people out to make sure that the home is a proper environment for the acuity that they're putting the person.

There was just a whole host of things. At the end of the day, they have to draw a circle around a certain geography and say... This is as far as we can reach given the amount of, personal interaction that we still have to have, even in a home health environment.

Yeah. And I didn't even realize what the experiences are of some of our home health.

Whether it is the patient themselves, the dog another family member, they are, out in potentially some remote places and encountering things that I had really, and it makes sense, but things I hadn't really been aware of.

yeah, is amazing. I used to have a national service organization and from time to time we had clients say, Oh, we're going to roll these things out and we're going to go to people's homes because that's where the people are working.

And the first couple of times that, that happened just all these crazy stories happened. And I was like, all right, we need to protect our employees. We need to protect, we have liability. We had all these things I didn't really think about when we went into these deals. And so subsequent deals, it was like.

Hey, this is more complex than it sounds just going into somebody's home. from safety to liability to I don't know. There's just a whole host of things. It's, it is really challenging. Give me an idea as you progress forward, as you're looking at.

The coming year and you now have Agile in place and you're getting things. you've talked about access. You've talked about the clinicians, talked about the patient experience. How much are you, how much do you feel like you're going to be able to accomplish? Or how much will be reactionary and how much will be proactive in terms of addressing some of those challenges?

So I think we'll have a mix of both. We'll never do as much as... We want to do and I think we're probably in line with most other organizations in that about 70 percent of our resources are really about run the business and keep the lights on, so it only frees up some small capacity of these, more.

Big, impactful changes. So the I think it will come down to those priorities and it will be those things that do what we talked about in the way of automation or freeze up those or have significant ROI from a financial perspective. That will be, again, where we can leverage the remaining resources that we have.

Final question. I'd love to hear from you. Obviously, a female leader at a prestigious academic medical center. Love to hear from you on what it takes for women to progress and to succeed in healthcare and healthcare IT.

So I actually haven't felt like I've had to do anything different.

And I will admit that. People see things differently, and I actually had someone interview me for a graduate paper that they were working on and, asked me how hard it was to sit at, a table where I might be the only female, as I progressed up, and I didn't really ever think about it differently.

I've even had women say to me coming out of a meeting, Can you believe they said that? Or whatever it is. And it's just, I think some people are really attuned to it and some people aren't. And so I admit that I'm not that way. And so I think that's probably helped me to not feel like I was different.

Definitely like very athletic sports through college. And, so all of those things are probably just what's innate within you. But my, certainly recommendation is that We do need female leaders at the table. We do bring a different perspective often in any kind of position. And that balance of, different ideas is important to move any organization forward.

I love hiring college athletes. college athletes to me are amazing because They had to get through school, which was hard, and they had to compete at a college level. And I don't care if it's, a small school or whatever, there's still a commitment to whatever that sport is.

And to me, that shows so much. It shows a drive, it shows the ability to juggle things. to really get things done and to stay focused on whatever's in front of you at the time and get all that stuff done. I would imagine has that been your experience? I mean, that college athletes tend to be really good hires and good at at really focusing and getting things done.

Yeah, I think that in military. And I think back to my college years, right? I'm old, so there were no laptop computers, right? I had, I was a computer science major, I had to go to the lab and, show up and do my stuff. At the computer lab, and I was on buses to games and practice and, so it was often, pretty late at night that, you were doing those things, but it's what you needed to do to get the school

part done.

Just out of curiosity, what was your first computer? At home? Yeah, first one you owned. I don't even

remember. Some big box, some big tower.

They were so big! They used to take up you'd put them on your desk and be like, oh, I guess, I guess that's it. The computer goes on your desk. Try to describe that to people now and they just look at you like they have no idea what you're talking about.

Lori, I want to do... I wasn't around for punch cards, though. I'm sorry, you did work on punch

cards? No, I said that predates me. I'm not the punch card

person. My first computer class in college, we used punch cards. And they replaced it the year after and we were all like, thank God, that was the most frustrating thing whoever programmed things, like the people who put the people in space and whatever on those computers, their patience and their ability is, it's just beyond me because

That was a frustrating year of classes working with punch cards. I'm glad we don't have to do that anymore. Laurie, I want to thank you for your time. Always great to catch up and look forward to catching up with you again next year.

Thank you. Take care.

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