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we just really have to look at technology with an even more critical eye than perhaps we have historically. Understanding the value and potential ROI are decision points but, they really haven't always been as emphasized as they are now.

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week.

Today's episode is sponsored by Quantum Health, Gordian, Doctor First, Gozio Health, Artisight, Zscaler, Nuance, CDW, and Airwaves

Now, let's jump right into the episode.   (Main) All right, it's Keynote. And today we're joined by Craig Kwiatkowski with Cedar Sinai. Craig, welcome back to the show. Thanks, Bill. Great to be here. How long has it been? How long have you been in the chair of the

Officially about two years coming up, I think, next month and I guess maybe unofficially close to three years Sort of as the interim role leading up to the formal appointment.

But

at Cedars for a while before that, right?

Yeah. I've been at Cedars 15 years now. And so, the last three of which has been in the CIO seat and then I guess what, three or four years before that was in the. Vice President over really our application portfolio and then a number of number of other roles

prior to that.

All right, so you're now a seasoned veteran. I'm going to throw out the easy questions. We're going to go straight for the harder

questions. All right, I'll sit up straight in my chair then.

Yeah, take a little sip of the of the coffee that's there and keep going.

All right let's look back at 23. Let's start there. What are some of most significant technology initiatives at Cedars how have they impacted patient care in 2023?

Yeah, thanks, Bill. I think the biggest thing, at least in terms of a significant achievement for the organization in terms of breadth and depth Of impact across our campus, touching literally every single one of our nearly 17, 000 employees was installation of a new ERP platform.

And like most organizations, we've spent the better part of the last, what, 10, 15 years digitizing medical records and building out, advanced clinical tools. to some degree that came at the expense of less focus on our administrative areas quite candidly, or the back office as we sometimes call it.

And so these functions, finance, supply chain, HR, payroll, grants management, scheduling, timekeeping, critical to the operation of an organization such as us, and really any complicated organization. I think they really haven't gotten their due until more recently, and so. I guess they're not always sexy topics.

Who wants to talk about chart of accounts, or invoice routing, or approval hierarchies, or supply chain match exceptions? But I guess, particularly in healthcare those topics don't really compare against other clinical kind of delivery topics that are tend to be more visible.

But, we just had an obligation to fix those things and bring them current. We've been using outdated legacy systems for far too long, I'm really happy to share that we went live over the holidays. Big bang for all of those tools I mentioned. What risks being a little bit of a nail biter when you have payroll and supply chain involved.

We have to continue to feed the hospital with supply chain and even though there's always a work around there, you can just pick up the phone and place an order. But with payroll in particular, we didn't have as much margin for error. And so, we absolutely need to pay our folks and do it correctly.

And so we tested the heck out of everything. And we had a great outcome. and I think what's interesting, Bill, is I do find it fascinating that of all the absolutely incredible things we've done with technology over the years, some of which have unimaginable complexity. Yeah, I think back to the infusion pump integration we did as an example, where 1, 000th of a milliliter could be the difference between the right medication dose and an error that can cause patient harm.

Yeah, it turns out there's a lot of complexities in payroll, too. And as I said, we tested the heck out of it, ran, I can't remember how many payroll parallel cycles, and it was it was a good outcome. And I guess I should add before I stop rambling, this is well beyond a technology initiative.

This was really a business transformation project. It was an opportunity for us to take a fresh look at the people in the process components. Which is probably 80, 90 percent of really what we needed to focus on. And again, I'm really happy that we've moved it forward and given our.

Our staff a contemporary tool that they deserve.

It's interesting. We just had a 229 project meeting, a bunch of CIOs in the room, and one of the partners grabbed me afterwards and said it, it struck me that really only half the time did we talk about technology. Like the other half of the time, we were talking about a lot of really intricate healthcare kind of things, supply chain kind of things and whatnot.

I'm like, yeah, I think that's the role now is to really understand those aspects of the business and integration of that, getting the data to flow, getting processes. Right across the system. That's as much a conversation they're looking to someone like you to have as it used to be, tell us about the data

center.

Yeah, absolutely. It was really I think the project can only started out with kind of a more technology focus, but we quickly really realized. Everything that you just described, which is, this is an amazing opportunity to really take a look at the way in which we run our operations and the efficiencies that we might gain and, moving from paper and, Excel spreadsheets in some cases to, real time data and information and so forth.

Mobile capabilities. Yeah, there's technology enablers there, but it's the fundamental transformation of the way people work and that was key.

One of the challenges when we went to the EHR was that some health systems, we took our clinical processes and like married them to the technology.

Like we changed them to the technology. Do you find that same thing sort of happens here or is there give and take as you're doing an ERP system? Is it a little different?

I think there's similarities. it's trying to, I think, free people's minds a little bit from thinking about How do we take our paper driven process or our more manual driven process or spreadsheet driven process and move this like for like into a new system?

And that's just not the way that we should really think about things. It's more oriented towards, a workflow orientation. What is the workflow here? What are the outcomes of this workflow? What are the requirements? And, how does this sit within the sort of construct of the confines of the technology?

And, we, I guess, have the benefit of not being the first people to do this within, these technology solutions within ERP, and so you can take a look at, what have others done to sort of incorporate these workflows into the solution? And, we leaned on that a bit.

Just what are the leading practices out there? And let's figure out why the leading practice wouldn't work for us, if there was a reason why, and then work around it. But I think it's a little bit of both.

It's so interesting. When I think of Cedars, I think of early adopter, pushing the envelope, and those kinds of things.

But in this one case, doing the ERP solution in 2023, kind of a late, adopter in terms of bringing that all under, under one solution.

Yeah, and I think it's for the reasons I said. I think, we've built I think World class capabilities in clinical related domains. And we haven't really given the time and attention to the back office that we needed.

And we had sort of dabbled in some of these areas over the years, trying to move forward with some updates to HR systems. But as we got further along, we realized, you know what, we should just do all this at once, one big swoop. Also unique for Cedars is to sort of do a Big Bang approach to a technology install.

I think, we implemented Epic probably over 7 years module by module. And this really was everything at once, as I said within the ERP platform.

So Craig, that's what you did last year or the team did last year. So that's in the past, Congratulations, that's all well and good It's like but what have you done for me lately?

Have you celebrated a

little

bit longer?

We could celebrate it. That actually is a huge accomplishment. The ERP is a significant accomplishment But I 2024 What are some of the key projects on deck for Cedars?

Yeah, I think well, there's probably some optimization to be had over in that space as well.

But I think some of the other areas that we're looking at as we move into 24 are really focusing on our people. So, how can we improve things for our patients and our caregivers and so, I guess some examples of that ambient listening and documentation. So we're, like many organizations, I think now piloting these solutions and looking for ways to take pressure off of our Physicians and other caregivers.

We're taking a look at doing some vendor selection around Remote monitoring, so virtual centers and virtual nursing to more efficiently You know, use those resources and some of those technology capabilities to identify things sooner in the room with cameras and so forth. We're expanding digital scheduling things like we have a virtual second opinion solution as well as a solution we call CS Connect.

That we've implemented last year, but are looking to grow this year as well as optimizing our access tools for self scheduling, which continues to be a journey for us. We have a home care program that we're going to be rolling out in the next few months. That's exciting to see probably a slow roll, just given some of the complexity there in our geography here in L.

A. We've got a bunch of work happening in patient flow and capacity optimization, taking a fresh look at those capabilities. We are bursting at the seams here in our physical space and need to continue to To solve for some of those challenges and I think supporting additional organizational growth.

We're focusing on planning for our new hospital in Marina Del Rey. And then I think really a fundamental for us moving forward is cost optimization and application rationalization. So in addition to all the, the new shiny stuff, one of the ways in which we're taking a look at, what we've got, our technical debt and applications that we need to build some muscle memory and just muscle.

around ongoing evaluation of those life cycles.

the CS Connect is interesting to me, I was around working with you guys a long time ago actually, around that platform and scheduling. I want to touch on CS Connect. So CS Connect is that built on the foundation of MyChart or is that just an instance of MyChart for you guys?

Yeah, it's not it's beyond the MyChart portal. And so CS Connect I guess we're calling it a virtual healthcare option. So, with physicians available 24 7 for urgent issues, same day appointments, and even some primary care needs. And so it's intended, I guess the genesis of it was intended to help alleviate capacity and access pressures.

In our brick and mortar location, so primary care and urgent care in particular with an emphasis as we say, on meeting patients where they are anytime day and night they need health care. This is available. And I guess it has the added benefit of making things easier for physicians and so.

We worked with K Health which was a startup of sorts that developed the AI technology that Cedars Sinai and sort of worked with them on and then co built in an app experience. And I guess maybe just to describe the workflow starts with an AI enabled chat question and answer workflow that gathers relevant health details and symptoms from a patient to assess sort of what, what they're engaging about, what's their medical concern or their need.

Patients get then sort of after they've answered a question, they get information about a potential diagnosis. There's an 80 percent chance you have a sinus infection. There's a 20 percent chance you have a cold, something else. And then they choose whether or not they'd like a real time video visit with a physician, which we encourage patients to do, either scheduled right then, or occurring right then, or scheduled into the future.

And so, if they choose a video visit, All that intake information that was gathered during the chat session is assimilated and presented to the physician on the back end. So, the physician has that information to more seamlessly sort of initiate a conversation with the patient with the benefit of all that information gathered.

We're, I guess. A few months, so it started in October into the general availability of that. And the response has really been positive so far. And so we're excited to see that continue to grow and expand. Physicians like it because it makes their job a little bit easier and having gathered all that information, we're hearing from a patient experience standpoint, the patients like it.

In that for the similar reason, they don't sort of have to repeat themselves as much because the physicians have that information. And I think the general look and feel and workflow is pretty easy to navigate. So we're proud of the app experience that's been developed. There's of course always things that, we're looking to enhance and improve upon, but again, while it's relatively early we think the early results look good.

And we're excited to continue to expand.

Is it a command center kind of model where you have. primary care physicians and critical care physicians a central location where they're handling those calls? Some of them

are, yeah, some of them are located centrally, but there's also physicians who work remotely and they, log in and Do their shift or, some portion of their shift from wherever they happen to be.

Is this available for the general public? Like, would you put this up on a billboard and anybody can get to it? Or is this the kind of thing that they need to have a login of some kind in order to access this? No,

it's available generally. Anybody can access it, via billboard initiated

Well, I just know how L.

A. traffic, you get so much time, you sit

there and read the board. Absolutely, there's a lot of time to sit and think and look at the surroundings for sure. Yeah, we were advertising broadly effectively anybody in the state of California. Could use it so whether you're local within LA or you're, in some other region anybody can use it.

You do not have to be a Cedars Sinai patient, an existing patient in order to use it. In fact, we're seeing a fair uptake of net new patients, which is a nice benefit of the solution. So whether you're a new patient or an existing patient. The workflow is similar. If you're an existing patient, there's a step in there to identity match you, basically, sort of almost like with a clear workflow, where you take a picture of your ID, and it matches you to.

An existing patient record, and then that information also gets pulled in for the physician visit. So, they have all of your background information in addition to the information you provided up front and the sort of the Q& A portion of the interaction.

Cedars has. has seen pretty significant growth over the last, five, six years.

A couple of acquisitions, a couple of strategic partnerships, and whatnot. Talk a little bit about the growth what that means from a technology project.

There's a lot more to do. I think it's the punchline, but the growth I think it started probably about a decade ago. first affiliation was with Marina Del Rey Hospital, I think, close to 10 years ago.

Give or take. Marina Del Rey Hospital has about 130 beds. We're in the process of actually building a new hospital tower on that site with a plan to completion in late 2026. We affiliated with I think in sequence next affiliated with Torrance Memorial Hospital, and I think 2018 that has about 400 beds.

And then I think most recently in 2021, we affiliated with Huntington Health over in Pasadena. And that's about 600 beds. All in all, as a health system, we have about 2, 000 beds that we have oversight or access to. And then we also have a pretty significant ambulatory grown over that time period.

Dozens and dozens of primary urgent care specialty locations across LA and out into the valleys. And I think we've talked about before, Bill, we've got a number of joint ventures, Providence others. And so, all of that keeps us busy. think in November of, I guess, a year ago, November. We had a major technology assimilation with Huntington, moving their systems on to sort of our enterprise solutions, including EPIC, and I think it was 173 other application systems that we either moved over.

To enterprise solution or had a net new integration within EPIC. And so it's just a lot of technology moving pieces and parts. A lot of it is the fundamental stuff, sort of the bottom of The Maslow Hierarchy of Needs Pyramid, network, infrastructure, telecom, all of those things, and then we build upon that, of course, with more advanced capabilities.

One of

the things you get to do is be a part of a construction project. those are interesting. I've talked to a couple of CIOs that have the opportunity to do that. It's a challenging puzzle to look at the technology that's available today. And imagine, this is what is available today, but, we have to build for the next 5 to 10 to 15 to 20 years.

in this building. what's that project like?

I find it interesting and really fascinating to watch as well, particularly the project management of just standing a building up, I think is interesting and I try to sometimes compare that to the way in which we run technology projects and, man, those guys do not miss deadlines.

This thing is moving and it's on a fast moving train. But and it's fun just to watch the construction quite honestly, it's you go over there and I think it's about, we're building, I think it's a 9 or a 10 story tower and the steel's going up. It's currently about 5 stories high.

And it's just fun to watch,

do they seek out your. Thoughts and ideas, Cat6, Cat6e, Wireless. I mean, are you involved in those discussions? Yeah, I'm

not personally, of course. But folks who are closest to that within our teams, absolutely, yeah, they do work with. The architects, and, there's sort of points of no return after which, no changes can be made once, some acts of pieces of structural steel, or, walls start going up, and, if your lines are in there, great.

If they're not it's something we'd have to come back to with a change order. But, yeah, that's all part of the early planning and, I think, as you alluded to, it's a bit of future proofing and so wiring the heck out of the building so that we have, access points everywhere we could possibly need them anticipation of, not really knowing where everything's going to go in 3 years, let alone within 15 to 20 years.

And so it's sort of a fun experiment, but it should be a really beautiful building. There's still some fine tuning to do on the specific specialty programs that are going to go in there. But it should be a great space. Interestingly Marina Del Rey is I think actually the closest hospital to LAX.

So if you ever have, God forbid, a health event or an issue at LAX that's where you'd probably be going. And it'll be a really nice thing for the community in that space to have the new facility. I think the way in which we're trying to orient the technology thinking for the building.

Is really starting with overall vision for the facility, that it's intelligent, it's human centered, it's reliable, sustainable, data driven, all of those things. And from a technology standpoint it's all of what I mentioned. It's having the right infrastructure in place to future proof it.

And then it's really defining goals with our operational and service line leaders about the programs they're implementing, what they want from patient experience, staff experience, efficiency. There's well being opportunities for Providers and caregivers. There's capacity and flow considerations That we need to take into account.

And then we're trying to tie those goals. There's work groups and sort of other Governance in place to potential solutions and making bets on some solutions that have, in some cases, some maturity to do or maturing to do. So, for example the smart room, sort of, of the future. What does that mean?

And what does it look like in 3 to 5 years? And so we have a smart room focus group. Getting into the minutia of workstation design, door displays, digital whiteboards entertainment options, environmental controls, all the stuff that, you can imagine needs to be in the room. And it's fun.

It's one of the more fun areas that I think our teams are super excited about. It's cool, sort of, cutting edge tech. We're actually even we're building a patient room simulation, a wet lab of sorts to sort of write in one of the available offices across the hall from me here.

And so we have a test area to pilot these things internally and test them out before we actually deploy it in new physical space. And so, that's been fun. And there's a lot of opportunities there to fiddle with new technology and toys and we've also got some groups looking at command center and remote monitoring solutions.

Where are those going to be stationed within the organization? Similar to what you asked earlier what would that look like to have a centralized pool of resources? For virtual sitters, for virtual nursing, telemedicine, all of that. We've got groups focused on wayfinding and situational awareness and sensing solutions.

That are really what we're going to begin to see in the next few years. There's mobile work groups, digital signage. So, again, We're just trying to organize everything into the right swim lanes and areas to partner with the right operational resources to make the right choices.

So the choices and the bets we think are going to come true within 3 years and then set ourselves up for success, in years 5, 10, 15 from an infrastructure standpoint.

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  📍 that's the fun thing. I think I'm going to move to the less sexy topic, which is operational excellence and those kind of things.

One of the things that is a conversation that keeps coming up over and over again is application rationalization. I'm sure Cedars doesn't have this problem, but a lot of health systems have. A lot of applications that have grown over time. And that's not even counting the instances of those applications.

You could have multiple instances of those same applications. What is your approach? how does Cedars approach first of all, the philosophy around bringing new applications into the environment and then Rationalizing those some applications out of the environment.

Yeah, it's a great question, Bill, and it's something I think we're beginning to build a program around not just application rationalization, but more of a lifecycle approach.

And, candidly, we haven't really had this historically. I think, even the words application rationalization, when you say those words to people outside of IT, they tend to look at you with a little sort of a confused face, not really understanding what that means. And so, I think we're finding it involves some explanation and education to counterparts around the organization, tying together the concepts of platforms of enterprise solutions and technical debt.

And I think, as I mentioned earlier, we did a bunch of this just sort of I don't know, hate to say, but organically, it happened as a consequence of the affiliation we did with affiliation work we did with Huntington moving 170 some systems and sort of rationalizing those against our baseline of enterprise solutions.

And that was a bolus of work and now we're going back to look at our baseline. And so the way in which we're trying to do that is take a look at what systems we have. Where do we have overlap? What's adoption like in some cases for systems that have been around for a while? Are they being used?

Are they being used in a way that, matches the expected use and the value proposition for those solutions? What risks exist with those solutions that haven't been evaluated in a while? How hard are they to maintain and support and so forth? So there's a number of sort of factors that are going into the calculus of taking a look at a short list of applications to start with and then growing from there.

And in some cases, it's looking at bolt on systems that Epic Now has a module for that didn't exist previously. And so, epic continues to, of course build upon their platform. And there's ways in which we can take advantage of that to move away from decisions that we had made years ago, based on the then available technology.

And so a subjective, I guess, as the process may be. We're leaning in as best we can to a scoring matrix organized around again, as you said, Bill, this isn't particularly sexy scoring matrix, that's fascinating around some of the factors I mentioned to sort of risk stratify and help us make decisions together.

Our plan is to take findings and recommendations through. Stakeholder and governance groups and discuss, how we approach those identified opportunities. I'm excited to see how it evolves. And it ties to the other part of your question, how do you make decisions on these things to begin with?

Again not particularly sexy, but, some cases it's RFIs and solution identification, ideally looking for solutions. That solve a problem, not the reverse. And so we partner with stakeholders to to help us through those decision making processes and hopefully make the right choices with consideration given to all of the many tools we already have in place.

So we're not at the very least, we're not adding or duplicating solutions that aren't fully optimized. Yeah, I

I used to explain this to people by saying, have you ever moved from one home to another? And they'd say, yes. And I'd be like, you know, when you went to move and you're like, we probably don't need this anymore.

We probably don't need this anymore, whatever. I'm like, that's rationalization. The and invariably somebody would say to me, are we going to a smaller data center? It's like, no, we're going to a less complex, the boxes. Complexity and attack vectors, like we need to reduce complexity within the environment.

We need to reduce the number of attack vectors in the environment. Therefore, anytime we can reduce those things, it's like moving into a new house. And so if we can reduce applications and those kinds of things, it reduces integration points and whatnot. I just throw that out. Every now and then I feel like.

Sharing things that have

worked to explain these things to me. Clean out the basement, right? Yeah, clean out the basement. And, the time we're in healthcare blends well to this, quite candidly. But a challenging time with enormous financial pressures. Really, I think the last couple of years in particular was really macro and micro forces.

Applying lots of pressure to us and our operating margins, not unlike other hospitals across the country. I think we've all sort of struggled through this. And, we have the good fortune culturally and organizationally of viewing technology as an enabler. And part of the solution to tackle some of our financial challenges again, gains in efficiency, productivity, workforce, the like.

And, I think we just really have to look at technology with an even more critical eye than perhaps we have historically. Understanding the value and potential ROI are decision points but, they really haven't always been as emphasized as they are now. And so, it's something that we're focusing on and something I think we need to continue to build discipline around.

Craig, we haven't talked about AI, and every conversation I have now talks about AI. And I interviewed Chris Ross this morning with Mayo and we were talking about AI and just the velocity of it. it's like upon us, like every day somebody's coming in saying, Hey, we can apply it to supply chain.

We can apply it to coding and billing. We can apply it to these, some of these clinical care settings the velocity of it to me. is really incredible. How is Cedars approaching AI? What are some areas where you're currently using AI or projecting to use AI?

Yeah. Thanks. We made it what, 30 minutes, give or take.

I know. Well done. Without focusing on it. it's interesting and I think everything you said I'm certainly feeling as well. And watching TV the other day, there was a commercial for a washer dryer, now with AI. I don't know, I think it's probably still just telling us that, the sheets are dry, but, there's certainly an advertising spin to it.

We've been using AI for years mainly in the category of rules based and machine learning. We've deployed lots and lots of predictive analytics solutions. Readmission risk, surge prediction, census, patient deterioration, length of stay, identifying heart failure, risk of cardiac arrest, predicting whether mom's going to deliver by a C section.

the list goes on and on. I think it's really the generative AI explosion that's really just raised the public consciousness around this. The reality though is we're still working on similar problems, whether it's a generative AI solution or whether it's, a rules based machine learning or some other just programmed algorithm.

There are problems around capacity, flow, monitoring and alerting progression of care, readmission risk and some of the administrative functions you mentioned, how do we better automate supply chain, staffing, scheduling, financial solutions to predict either to process claims or to predict denials prior auth and so forth.

And so, I think, we're leaning into generative AI solutions where it makes sense. We're continuing to use machine learning and other predictive tools to build upon what we already have available. I think some of the areas that we're focusing on, as I mentioned, for 24, feeling pretty bullish about ambient documentation tools.

It feels like those tools are, previously, I guess, in some cases, called, a digital scribe with the generative tools overlaid on top of that now. We feel like those are in a place where they're finally ready for prime time. And so we're piloting a few of those vendors to understand what technology may be best suited to our workflows and, primary care and specialty and whether there's any differentiators there that we should be paying attention to.

So excited to see what that looks like. And maybe even applying those solutions beyond the physician. How can we help nurses navigate flow sheets and care plans with some of these tools? And, hopefully spend more time looking at the patient and focusing on the patient and less behind the glowing computer screen.

We're also moving forward with as I mentioned, the remote monitoring and the virtual solutions perhaps some centralization of admin and discharge workflows. We're supporting the native solutions that Epic is rolling out, in basket drafts which I think now they're calling augmented response technology, ART chart summaries and other technologies that Epic and some of the other big vendors are doing, Oracle and the like.

We're piloting Copilot. We're piloting Microsoft Copilot. And that's been fun. I'm one of the pilot users, so it's been fun to sort of be in the feedback loop So do

you have it responding to emails now for you?

yes, although nothing is automated, I think, in the category of that.

Nothing is fully automated, so much so that I can't look at it before anything goes out, I think. I guess that Chris

was saying to me, sometimes he gets these really lengthy emails, like it's just a long chain. And he's able to say, summarize the top five points and it goes boom.

And then he's able to go, oh, okay, I know what this is about. And he's able

to respond to it. I think it does a few things really well. What you just described, it does fairly well. So, I could be. Looped into an email thread that has been going on for five days, and they say, I've been Craig for such and such.

And I can click summarize, and it does a decent job of summarizing sort of the essence of the email and, a handful of bullet points. I think that it does really well. The other thing it does really well is although, with some perhaps risk that we need to sort it through it captures if you record a meeting it will do either a transcription and or a meeting note summary.

There's sort of a general notes and there's an AI notes. The AI notes are really great. They summarize things beautifully and then you can actually click on a segment of the note if you recorded the meeting and it will take you back to the portion of the meeting recording where that happened and you can sort of replay.

And you know the risk I mentioned is I think we need to sort of understand what that means from data retention. In terms of email responses it works reasonably well. It's interesting it it, you can either have a generator response and you can accept or reject or I think it's like three options.

You can also have it as, like, an advisor or a coach, where, like, you're writing an email, and then you can ask it for input. It'll say, well, I think that tone is a little abrupt, or it's too directive. You should have a better introduction. And so it's. It has a way to sort of, educate you, I guess.

what I was really hopeful about with Copilot that I think, it has some maturing to do, is I was hopeful, and again, maybe it was just, too much of an imagination on my part, that it could mostly create A PowerPoint for me and with, take this Word document and create a PowerPoint and it does it but, it doesn't quite do it with a lot of extra, massaging and editing.

So, I think all of that's going to mature in time. I think this is a great start. The tool is really great, I think, out of the gate and it'll be exciting to see how it continues to evolve, but it's been fun to experiment with, for sure. Well,

Microsoft's not a sponsor of the of the show, so I will say this.

I hear a lot of pilot conversation. I don't hear deployment conversation, and I think it's, we're getting to the point, and I'm not going to ask you to comment on this because I'm not going to get you in trouble. But I think we're getting to the point where, these cloud things are killing us, 20 per user per month at a time.

And we've got to be careful when we're implementing these tools to ensure that we're going to get the ROI on these tools. That's why I think we're there. Let me give you a closing question. And that is talk to me about balancing innovation, because we talked about innovation. And. All the other, the day to day stuff that goes on.

How do you balance that? How do you keep your team focused on the thing they need to be focused on at

the right time?

Gosh, that's a great question. I'm, I don't know if I have a crisp answer. I think I think part of it it's intertwined. It's not binary or, one or the other.

I think innovation can happen even in all the little ways that the day to day continues to sort of happen and be served. All the things that people do as part of the routine, I think we have to ask ourselves periodically. Why are we doing it this way? Isn't there an easier way to do it?

Couldn't I speed this up by fill in the blank, or do I even need to do this at all? You might call that innovating. And so, I think there's a lot of ways that innovation can happen within the minutiae of the day to day. And that would again, be in the, the category of the care and feeding and again, the lower levels of our sort of our hierarchy of needs as an organization.

But then, there's the innovation that builds upon all the foundational pieces and, some of what we've talked about today. All of the work we've done over the past 10 to 15 years to build out robust EHRs now overlaid with these generative tools it's really, I think a time of great potential to finally take advantage of the amalgamation and the way in which we've pulled all of that data together in the central sort of repositories To, solve problems, to gain insights, to make things easier for our physicians and our caregivers across the organization.

And so, yeah, I think it's always going to come down to striking a balance to your point of, what can we spend time on? And what gets resourced and what doesn't. And I think some of that is a bit science and some of that is a bit art. And sometimes we're willing to experiment with things and be adventurous and I think it's that adventure that sort of pushes us forward to new spaces of innovation that haven't already been.

So, Craig, you've been in the chair for three years. I guess this is my last question. Anything surprise you about actually being in the chair of the CIO? Like, now that you're actually in it, you're like this is a little different than I thought. Or this is, or some aspect of it that, that surprised

you?

That's a good question. I think I think I expected most of it. I think where I spend more time than I probably would have anticipated, just because I wasn't exposed to it as much, is really more in kind of some of the health policy pieces. That I think of interoperability, and I often am pinged about sort of legislative things that are coming forth either nationally or in California, and like, well, what do we think about this?

And helping advise like, the hospital associations on various topics of interest. That's not something that I guess I predicted or expected, but it's something that Takes up a fair portion of time. It's fun. And reading through I need a co pilot to summarize legislative proceedings in some cases, but I think that's been something that I guess I probably wouldn't have

anticipated.

Well, yeah you not only stepped into a leadership role at Cedars, you actually stepped into a leadership role in healthcare due to the nature of who Cedars is in, in their place in healthcare. So, yeah it's really interesting to you will be sought out by a lot of people.

It's interesting. Craig, I want to thank you. I want to thank you for your time. I want to thank you for Sharing your wisdom with the community. Always appreciate

it. Thanks, Bill. It's always a pleasure. Appreciate the opportunity.  

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