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April 26, 2024: In this episode, Chuck Podesta, CIO of Renown Health, delves into the intricacies of healthcare IT leadership, particularly the challenges of budget management and the responsible implementation of emerging technologies like AI. Podesta shares his experiences and strategies for transitioning from a 7% to a 4% budget, emphasizing the importance of aligning IT investments with organizational goals. He also discusses the need for education, governance, and collaboration to ensure the successful integration of AI into healthcare systems. Thought-provoking questions arise: How can CIOs balance budget constraints while driving innovation? What role should education play in preparing healthcare leaders for the AI revolution? How can organizations navigate the pressure to adopt trendy technologies while prioritizing value and patient care?

Key Points:

  • Healthcare IT Budgeting
  • Responsible AI Implementation
  • Organizational Governance
  • Leadership
  • At Home Solutions

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


Today on Keynote

(Intro) β€Šyou go to these presentations and are all around this new technology stuff, and that's great from an education standpoint. Sell it to the Stanford's of the world. they got innovation centers, let them do the shiny white object stuff, and then tell us what works, so that we're not piling stuff on the bleeding edge,

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) It's a keynote episode. And today we're joined by Chuck Podesta, CIO for Renown Health out of Reno, Nevada.

and Chuck, welcome to the show.

Thank you, Bill. Happy to be here. Thanks for having me.

I'm trying to figure out, you have had such a great career in health IT, UCI, and then you were up in Connecticut for a while, But anyone who's watching this video is, and anyone who's seen you recently, knows you've really taken the part of the Western Reno, Nevada CIO to heart.

And you've got the hat on. You look like you're straight out of the casting call for, CIO for Reno, Nevada with complete with the guns at the hip, I don't know. Yeah.

Yeah. I've got those as well, Bill. Yeah. As part of the. We were talking earlier I think what happened to me was I never was in a place where the Western came out of me.

I still remember when I was a kid watching Westerns with my dad and what, John Wayne and Clint Eastwood and all those loved them. But, I grew up in Western Pennsylvania, coal mining town and, moved to New England and, I was never in a spot. Then I was in, Vermont and Southern California.

Just really never in a spot where. You could dress like this and have it be natural. And when I came out here, I started to dress like this and it just felt right. It just felt like this is me. This is who I really am. And yeah, so it's, and as we were talking before, it's never too late to reinvent yourself.

So that's a saying of mine now.

Absolutely. Coal mining town in Western Pennsylvania. What town?

I was in Monongahela, Pennsylvania. claim to fame is I went to grade school with Joe Montana. We were both born, if you look up Joe Montana, he was born in Monongahela. We're the same age.

And so those first grade pictures, we have the little squares, pictures, he's up here and I'm down here. And in our first grade, second grade pictures. And yeah, my father worked for U. S. Steel. Very much a blue collar family. My mother worked US Steel as well.

That's how they met. And then and once she started having kids and stuff, she became a homemaker and my father continued to work. And then he got transferred to New England to Worcester, Massachusetts to the US Steelworks there. And yeah. So luckily We kind of got out of there because all my cousins, they drove cement trucks and coal mining.

I had a cousin who passed away recently, young, but he looked much older because he was in the coal mines and he painted scaffolding. So you can imagine what that was like going down the coal mine every single day, painting scaffolding. And those are the kinds of jobs that were, in those areas.

So I was lucky to get out of there. I was actually the first Podesta to actually go get a degree in college. Our whole line. So that's kind of definitely blue collar.

It's yeah. And I grew up in Bethlehem, Pennsylvania, which is yeah big competer competition for U.

S. Steel was Bethlehem Steel and not my claim to fame, but who went to my high school was The Rock went to my high school. I don't have the little square picture of the rock there and that kind of stuff. And actually he graduated a couple of years behind me. But anyway similar experiences.

A lot of parents worked at Bethlehem Steel and around the time I was in high school, a bunch of my peers were wondering if they were going to be able to go to college because their fathers were all getting laid off at that


It was yeah, the

seventies. My yeah, my father ended up retiring when I was in high school.

Cause it was he had his years in luckily, but they were closing and people getting laid off. But luckily he had enough years in to retire.

So you've been doing this healthcare it thing for what, about 30 years now?

40. I my first job was 1981 and I was a computer operator at university of Massachusetts Medical Center.

Actually started there as a data entry operator and accounts payable. Then met the guy who ran the computer center in the cafeteria and he was looking for a nighttime shift operator. And so I jumped on that

to assume 81 is right around the PC era or before the PC era. So You were probably playing around with mainframes at that point, or what were you playing around with?

Yeah, it was mainframe, but it was also Data General started. It was those minis that started. Digital, remember Digital Equipment Corporation, DEC mainframe Harris Computers Yeah, it was, but mostly, Massachusetts, it was Data General and also Prime Computing. They were on a roll. So you had all of those and that was see, I think Dec, Ken Blanchard, he was the and then PC's just started to come out.

And now Ken Blanchard, who was the CEO of Dec, I remember at the time made the famous statement, why would anybody want a computer on their desk? And so Dec did not go into the PC business to their demise.

I see, I still see some of those phrases from time to time. I know The most recent, when the Apple Vision Pro came out, I saw all these phrases like, Why would someone wear a computer on their head?

And I'm sitting there going, I didn't know that. 20 years from now, we're going to have glasses that help us and assist us. And we're going to be like, yeah, remember that statement. Alright, so four decades the space. Grew up in western Pennsylvania, coal mining town. What drew you? Did you study computers in college or was it just No, I

actually, I actually graduated a bachelor of science in elementary education and I was going to be a

That's come in handy as a CIO from time to time.

It really has, I can tell you. And, oh, with the, with a focus on special needs. Which came even more handy yeah, in healthcare. But yeah, I graduated that and, I started applying for jobs and you can imagine, even today what they pay teachers is a crime. But back then, you can imagine in 1979, 1980, it was even, it was, I think the first job offer I got was.

15, 000 a year, something like that. and all my friends were kind of getting into, a couple of them worked for Data General and they're like, Chuck, you got to check this out. And back then it was, basic programming, COBOL, FORTRAN. And so I went back to night school to just try it and for programming.

And I really liked it. I liked it a lot. I like the analytical side of it and creating something from nothing, and didn't, go back for a degree or anything, but it was enough where I could get that data entry job at UMass Medical. And then again it's all about networking and connections and working hard and on the job training.

I never went back for my master's or anything like that. I just worked hard and worked my way up and pretty much. Had every job there was in IT, working my way up to a CIO, which I think was super helpful when I did get to the CIO position.

Yeah, that's, man, we have a lot of similarity. I didn't realize how many similarities.

So I also worked my way up, a programmer, carrying a bag, installing networks, doing that whole thing. I remember. When I got to be a CIO at health system one of the statements I made is I've probably done every job in here in some respect along the way. And people looked at me like I was crazy.

And then I started having conversations with them and they're like, man, you really understand what I do. I'm like, yeah. Cause you know, you do it for 25, 30 years. Especially from the ground up you get that perspective. That's very different.

I was a MUMPS and MISE programmer, and that MISE was Meditech, if you remember that, and MUMPS was IDX and EPIC.

So I actually, I understand the logic, the tree logic behind how those databases are created, which I don't know if that comes in handy, but I do know, actually down to that level of detail of some of these systems. And you're right. I was a manager of systems operation before they called it CTO.

And I can talk to CTOs. I certainly don't have the technical knowledge they do, but yeah, you still have networks and it's, there's a lot of similarities.

So let's stay high level still. We'll get down lower, but you know, throughout your career, you've witnessed significant changes in healthcare technology.

Think about, and maybe share a few pivotal moments or projects that have been particularly impactful for you and in your career and in your organizations that you've worked for.

of my biggest jumps was I did some consulting for a company and they placed me down in McGee Women's Hospital, which was part of the University of Pittsburgh system.

This is 86. And at that time I was a kind of a manager of IT running a data center. At the time and a couple of levels between me and the CIO and the director still remember this from a career standpoint. I was actually at SunQuest, if you remember them, a lab system.

I was in Tucson, Arizona at SunQuest. And I got a call from the CIO who I never get a call from. So it's it was on a sticky note, right? We didn't have a, I had to go to a phone, a real phone. And I'm like, Oh my God, I'm getting fired or something like that.

And lo and behold, my boss was getting fired for something that he had done. And the CIO wanted to let me know that I was going to be the new director of IT. And that was a big leap for me getting that manager's because I was basically running a data center only systems and operations. Now I was over applications and, I'd already done the programming thing.

So that was a big, and that was probably 87, 88, that was big. And then after that, in the early 90s, I worked for Bay State Health Systems as a director, actually for the same CIO. He had moved on to Western Pennsylvania, Western Massachusetts. That was great. It got me back up to New England.

And we had a product called TDS Technicron Data Systems, if you remember them. Yep. Touched light pen, on the screen. And I think we were the second client of TDS behind El Camino. I think El Camino was first and we were second. And it was CPOE basically, if you remember, CPOE.

And we had rolled it out completely, and we had doctors using it. It wasn't electronic medical record yet, but it was still CPOE. And that was huge because we went from, clinical, from financial systems, AP and, patient accounting and all those types of systems into the real world now, clinical computing.

And now it's 24 seven, systems you're not on paper as much anymore. And that was a real eyeopening change because now on the system side, you had to keep those systems up, which was a very difficult thing to do. But we had visitors, we had site visits from all over the world.

Japan Europe Germany. We had Canada, we were doing three site visits a month. So we had these and they were from around the United States as well for TDS. And it worked out great for us because we were getting credits on maintenance and things like that. So it actually reduced our costs by doing these things, but we were getting real good at hosting and.

We do a whole presentation, then we do a demo, then we do a site visit tour, and and it was just amazing hearing from all these other countries, kind of, their healthcare systems and what they were doing and their challenges that they had, and and also the culture and the differences in the culture.

I still remember one meeting with the Germans. And I was presenting at the end of my presentation, they started banging on the table and I was like, Oh my God, what did I do? And somebody pulled me aside and said no, that's it. That means that's good. When they bang on a table, that's positive.

And I was like, Oh, great. But that was a big turning point for me because that was a switch from, that was probably 91. And that was a big switch from financials to clinicals, and really never looked back after that.

TDS, LightPen, CPOE around that timeframe, that was true digital transformation right there.

Yes. And I'm wondering, what's the equivalent today? What are we looking at today that, People are going to go, we've got to go visit them. That's pretty amazing. There's so many, there feels like there's so much going on, but is there something that's in that category of, man, if we're able to do something in this space, do something significant in this space, that's going to be transformative for healthcare.

Yeah, I think there's a couple of things. One is the and I don't think it's a company, I don't see another EPIC out there. But I think it's more of a product like AI, right? And ambient technology and everything that goes into that. Some of the pilots are going on and things like, the Nuance Stacks Express and there's variants of that, other companies doing that kind of stuff.

It's the game changers. We just came off a pilot, 25 docs. We're rolling it out now. Anecdotal stuff that we're getting is I'm getting home and we actually call it home for dinner program for the docs. I'm actually getting home for dinner. If you take this away, I'm going to quit.

Have you ever heard a doctor say that before?

about technology.

To me that's becoming. a game changer as to how we will use that and some of the things that are just going to come out over the next few years. Hopefully on mostly on the positive side, not the negative side.

But the other one is, I think when you think about hospital or home, now that had a kind of a fits and starts. Aspect to it with COVID, everybody thought, oh, that's the next big thing, we're going to take care of everybody at home. And, of course the reimbursement side it still hasn't caught up yet, but it's getting there.

But from a cost side, from a risk based model, it works quite well. But there's a lot of technology that's starting to come on the market where, Say you're in the, you're in the highest acuity area of a hospital, which is an ICU most likely, right? And you're hooked up to all this stuff and now you do a step down and then you're into med-surg, and then you step down from there.

Maybe you go to surgery and you step down from there. Post, post-op, now you're going home. There's technologies now that are gonna be attached to you from the ICU, and you're gonna take those home. All right? And because they're small enough and micro enough. and from a continuity of care standpoint, it's just going to manage that for you and keep that continuity of data coming back to providers.

And I think it's going to accelerate your recovery, and especially, being at home in the least costly setting, plus it's the place you want to be from a patient experience standpoint. I think that's another game changer. That's coming. And there are a few companies that are pretty far along.

I'm under an NDA on one of them. And I've seen some stuff that's, that will blow your mind. Pretty great.

That's awesome. Let's talk vision and strategy is, CIO of Renown. What are some of the goals for this year, maybe this year and next year? And what are the plans to move those forward?

Yeah, very timely. Question Bill. 'cause we just came out of a, in 2022 we lost $128 million. Wow. Off, off a base of 1.6 billion. So you can do the percentage on that. That's huge. I've never seen that in my life. Never hoping to ever see it again. In 2023, we actually made 24 million.

So we had a $150 million turnaround in one year. Never seen that in my career as well. So two number ones there, that big a loss and that big a. Turnaround. So now we're actually we're working with Kauffman Hall and now that we've turned it around it's time for strategic planning, right?

And to really update, get a three to five year plan together. We're in that visionary stage and it's really interesting because technology is actually taking a lead in a lot of ways. Instead of being enabling, it's actually leading. Some of the initiatives that we're looking at, but right now we're in a phase of what's Renown Health going to be when we grow up and just as important what we're not going to be.

And so we're really focused on those things right now because you can't be everything to everybody. We're the largest, we're the only integrated delivery network in Northern Nevada. I think we're the only nonprofit. And so we have a special mission. We have to make sure keep that, but we're really focused on, like with primary care, for example, we have a lot of people coming in from other states like California, so we know we have to expand primary care.

That's a big one for us right now. And we have some others that we're looking at, but we're still in the early stages, we'll do about an eight month effort. We'll hit the fall, again, we'll hit the board get board approval and whatever we come up with for initiatives and then 2025 will be our launch year for whatever those initiatives, but, AI, ambient technology is going to be front and center.

And a lot of that's why we're starting to do some piloting. Not from a shiny bright object standpoint, certainly. And we've talked about that in the past, that actually does work and where you can use it. We're also shifting, we do have a hometown health, we have an insurance company.

So we're actually shifting a portion of our population to value based care, pop health, as they call it. And again, that changes the strategy around, what we do with IT but we're still in that kind of fee for service. Pop health mode. So you've really got to squeeze as much as you can out of the fee for service side.

So web cycle is going to be a big focus this year of squeezing as much reimbursement as we can, because that's going to allow us to fund the move to value based care over the next three years and hopefully get a good portion of our patient population there, which then lends to, the hospital home and different way of caring for people.

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Yeah, it's interesting to hear you say technology going from being an enabler to a leader. Yeah. I know that we've, for years, we were warning people against allowing technology to be a leader and a lot of CIOs took that position of, oh, we're just an enabler. That not only that is the technology enabler, but IT's an enabler and it's almost like a passive role And how the organization runs and you're just like, Hey, tell me what you want.

We'll make it work. And we're good. I'm seeing not only that transition of technology going from enabler to leader, but a lot of the roles, CISO roles, CIO roles, chief digital officer role. They're being asked to sit at the table and weigh in on how we're going to approach business and how we're going to approach moving things forward.

You've gone through this where we used to be an enabler and it was almost a different posture for the CIO. Do you see it being a different posture for the CIO moving forward?

absolutely. Bill, and I saw your podcast with my buddy Drex DeFord Ford, and you guys had a little disagreement as to the role of the CIO and he was coming at it from the old way, right?

And you were basically presenting what we're talking about now. And I agree with you that, we are at the table and I'll give you an example. with the strategic planning, we have our president's council, which is the people that report to the CEO are there at the table at Kaufman Hall, but there's also another individual there that doesn't report to the CEO and he's the chief Analytics officer.

Okay, and he is front and center, and his team is front and center, because we cannot, unless we can apply analytics, and that's what we're calling it, applied analytics, to a business problem, don't know what the problem is. We kind of know what the problem is. I'll give you an example of migration.

We know people are going other places, but where are they going and why? You need analytics to tell you that. And then you can put strategies in place using technology to solve that. So that's one example where, you know, part of, it may not be just the CIO, maybe other parts of your team in IT that need to be at that table.

So it's not only CIO, it's chief analytics officer, we're both there. doing that. And I'm front and center with, here's where the industry is going. Here's where AI is going. Here's the areas where AI can be brought to the forefront to drive strategy. That's my job now. And it's not to sit back and wait for the CNO or the CEO or somebody to say I have this problem and here's this technology that I need.

Can you vet it, make sure it's secure and then go implement it for us.

Yeah, it's, the analytics officer is interesting to me. one of the things that struck me when I came into the industry of healthcare was the amount of decisions we were making anecdotally. And I was like, I thought we were scientists.

What, how can we be making decisions in the financial realm, in the financial world? And every meeting we were in, they're like, hey, show me the numbers and anybody who was. Six Sigma, it was always, show the numbers, prove it out, that kind of stuff. And then, you go, okay, now, just like you were saying, now we understand the problem.

We understand the scope of the problem. We understand what's actually happening. Now, let's solve that specific problem. Anecdotes, gets you in so many different rabbit holes. It's kind of scary.

I'll give you a quick example. I saw a dashboard that he and his team created.

The other day, it's a value based group that we have out there, the people that are under, Medicare Advantage and things like that, a value based care group, and he was able to stratify the group that was, one, using the most ED visits, two spending the most money, 70, 000 and up on average per individual where the average is, 10, 000 a year.

And, out of that group, there was, 2, 500 people in that kind of role. And then another, 2, 000 people that were in the 20, 000 range. And then you looked at, what was going on with them. And now you work with the physician community to say, how can we care for these people in a different way?

And now you have the data to have those conversations. And 2, 000 people may not seem like a lot, but when you look at the total spend these people, out of our total spend of like 220 million a year in our insurance company, they were 67 percent of the total spend. When you start to get that data and you, it's eye opening, now you can start targeting areas, meeting with your physician groups, and really changing the way that you care for these groups.

And if If you could take that 70, 000 spend down to 50, 000 or It's a huge, it's a huge impact on the care. So that's just one example where the analytics is just absolutely, you can't live without it. You can't survive.

of the things I want to tap into here is you have extensive experience of going into organizations as a CIO and typically, When you go into an organization as a CIO it's, I don't know if turnaround is too strong a word, but there's things that need to be looked at.

And I'd love to understand do you assess the current state of an organization when you go in and how do you lead change in that organization as you're coming in as a new CIO?

I'm an evangelist on this bill because I'm tired of, my catchphrase now is I'm, I'm getting towards the end of my career, so I probably won't run into this too many more times, if any.

But, every job that I've changed, go into an area where there's a mess you've got to clean up. It's really fixing, it's not even turnaround, it's fixing in a lot of ways and I'm evangelist now around, I'd rather build off your successes, coming into an organization from the previous leadership than clean up your messes, right?

I'm an evangelist about that, and I've talked to other CIOs that I trust and, I've had the same experiences and they're tired of it too. And the problem with it is that, a lot of people say there's not enough money being invested in healthcare IT as opposed to, banking industry, insurance, other industries.

We got plenty of money. We got plenty of money. We're just spending it all in the wrong places. Chasing the shiny bright objects to build some CIO's resume instead of doing what's right for the organization that they're working in. And I'm not afraid to say that because I've seen it and I've experienced it.

And I probably did a little of that when I was younger, a younger executive, but we got to stop that. And where you start, I think, is in the interview process, Intelligent Renown, one of the data points I asked for was, the budget. And, right away for calculation, what percent the budget a total OPEX of the organization, right?

And it was 7%. And right away I know, okay, there's a problem. And I know it's not just one problem. There's so many problems that are going to go into that 7%, no governance, right? probably issues with the PMO, if they even exist. Culture issues probably relationship issues between IT and the business.

And of course all those things occurred. And so I put a program together actually called, and you've seen it stick to the knitting. had to go from that 7 percent to get down to the 4%. I remember my first conversation when I started there, knowing what I was going to get into, I knew that, right away the CFO was going to be my best friend.

In this journey. And I met with her my first one-on-one. And right away I said, we're spending too much money in it, . And after I picked her up off the floor, I she said, can, could you say that again? And I said, yeah. And then and I explained why. And she goes, oh my God.

Finally a CIO that understands finance. So this is where the CFO's head's at, with you CIO people out there and your IT leaders out there. I don't think you have any clue what finance is, and you're not going to be able to partner with the CFO, who you really need to be successful if you don't understand finance.

So we worked on a program, we started with AppRap, application rationalization. What I wanted to do was a program that went from least impactful of people, that save money to most impactful people, which is a layoff, right? And so you start with AppRad and we had 740 applications. Unbelievable. We found 50 applications that were running on the network that nobody was using.

Talk about a security issue there as well. Say we're up to about 5 million a year in software maintenance savings alone. We didn't have to touch anybody there to do that. We're down to 600 applications. And we keep moving. That's just one example. Spanning control, reorganization, focused on culture, turning around customer service, while you're cutting.

Now we're at 4%, 4. 2, somewhere in that neighborhood. And we know we're probably going to grow because we're in strategic planning. We've got new initiatives coming in 2025, but we're going to grow in a smart way based on these initiatives, not just because somebody went to a conference, saw a software.

product and decided to buy it and turned it and, said, oh, okay, here you go, IT, implement it which was the past here. We have strong governance now. We use an SBAR approach. The R recommendation includes a five year ROI. Better be there. Our President's Council, which meets every Wednesday for three and a half hours in person, not a Teams meeting.

We do all the governance. That's my IT steering committee. The business presents those SBARs along with me. a dual presentation. For nursing, the CNO and myself present. And that's where the approvals take place. if there's more work to be done on the SBAR, it's sent back. And we really Lock that down, quite a bit.

and so I call it stick to the knitting. I have a whole program on it. If anybody's interested, I happen to walk you through it. I've got presentations on it that I've done. And it's resonating because what I tell CIOs is, especially up and coming CIOs is, the next job you go after, imagine going against me and you're telling your story about this shiny bright object you implemented.

And you were the first to move a data, move Epic to the cloud, or you were the first to do this, or you were the first to do that. And then I tell my 7 percent to 4 percent story bottom five and employee engagement to top five, bottom five and customer service to top five. Who's getting that job?

You're not. You're not. And I know I'm trying to help these younger CIOs coming up, but you know, who else is to blame? And I know I'm going on here and it's why I get in trouble too. But the hymns and the chimes of the world, I blame them as well. you go to these presentations and go to a few and I don't do much with hymns anymore, the value there, just not there for me.

Chime I go to, and I enjoy, I know Russ, great guy and Vive. But their presentations are all around this new technology stuff, and that's great from an education standpoint. But then don't get up there and try to sell a bunch of CIOs on it. Educate them on it, but you know, if you're gonna sell it to the Stanford's, my buddy, Dr.

Pfeffer. Sell it to the Stanford's of the world. The Mayo's of the world, and the Cleveland Clinic's they're ready, they got innovation centers, they're doing all this stuff. Let them do the shiny white object stuff, and then tell us what works, and what doesn't work, so that we're not piling stuff on the bleeding edge, because we went to CHIME, and we went to a presentation, and the vendor followed up with us.

on some startup thing that can sink an organization if you don't do it right. the other piece is the CHCIO. They need to break that apart and put that back together again. Because if to me, all those letters after your name don't mean anything to me. And especially when I'm hiring.

MD? Yes. RN? Yes. JD? Yes. Those mean a lot to me because you know what you had to go through to get those. And you also have to keep them up. If you're a doctor, you're a nurse, you're a JD, you've got to keep those credentials up to maintain those letters. So each CIO, it's a one and done. And I've said that in meetings there.

You come up with something where there's something that somebody who has a C8 CIO needs to do to maintain being a C8 CIO once a year. CEUs, CIO educational credit. Something that, keeps it going rather than this kind of one and done stuff. And you really got to look at the curriculum and who's teaching those programs as well.

And it can't be the celebrity CIOs all the time. Because a lot of them aren't, even CIOs anymore for that matter. And they do have a lot of knowledge, and I'm not, knocking them for that. I'll be a, hopefully a celebrity CIO, but in the Western world in the future.

We need real life stuff going on, and we need real life continuing education, especially for the 35 and 40 year old CIOs that are up and coming that get a CHCIO and say, that's great, got the letters, boom, I'm now a, professional CIO. And that's not the case. So anyway, I'll stop ranting.

Chuck, normally when I ask a question and somebody goes on for 7, 8 minutes, I cut them off. So many of the things you just said are so salient. and, it's the undercurrent. Like people are saying it, but it's not bubbling up to the top. So I appreciate you saying it.

I want to go back to, and I could go in any direction here, but I want to go back to the 7%, 4%. We've sat in 229 project meetings at the roundtables, and I've heard CIOs talking about how difficult it is now. And because they didn't initiate the 7 percent to 4%, they now have to get to 4 percent anyway.

And I hear things like, I don't think IT can be run at 4%. I don't think it's going to be possible. I don't think those kinds of things. What do you say to the CIOs who are looking at it going, Hey, you're almost cutting my budget in half. We could barely get stuff done before.

we have to get as much done, if not more, with half the money.

My first reaction is you should quit because you're not competent. And again, I, I know I'm probably when people see this, I'm going to get all these hate emails, but what you'll find if you don't try, you will never get there, first of all.

And my goal was 7 percent to 4%. If I got to 5%, I'm still in better shape and I, I would still have an opportunity to go back to the CFO and even CEO and say, look, we did our best. Here's all the things that we put in place. We did app rat, I did span control and got rid of layers of management.

Even I did position freeze, which I hate to do. Eliminated open positions, maybe even had to lay off a couple of people. now I'm to the point where if I do anything more, it's going to affect, and I've turned around the employee engagement so the culture is better. If I do anything more, it's going to start affecting those things, right?

Morale and stuff like that. But then you have that argument. At that point, you have that argument. can't have the argument at 7 percent or 6%. Because you haven't done the work. You haven't done the analytics on what you can actually do and what you can't do. And you're basically throwing your hands up in the air and given that, and that's what I'm saying, you might as well just quit because you're going to be told what to do, then you're going to do it And as a leader, worst thing you can do as a leader in an organization is go to your team and say, we, I got to go from 7 percent to 4%. Because my boss told me we have to, or this CFO told me we have to. believe me, there's a lot of leaders out there instead of standing up and saying, you know what, we need to go to 7 percent to 4 percent because.

That's what's right for the organization. And as your leader, that's what I'm going to do with all of you. And that's the problem in some ways. You've got leaders who just won't take that on.

So let's go back and forth a little bit. I think it's interesting. There's times when a leader has to stand up to their own organization.

And I remember when I went into St. Joe's, the IT organization hated me. Because I was pushing on them all over the place. On the flip side, there's times you have to stand up to the organization. You have to go out to the organization and represent IT and say, Hey, look we don't have enough money for cyber security.

You can't keep this too low of a priority. We've got to up that. So there's times where you're standing up in both directions. It's interesting to me, there's CIOs that I run into that I'm like, I don't think you're standing up in either direction. just keeping things going.

one of the case studies I give all the time, as I said, we were 16 hospital system, seven and a half billion dollars, and we ran it on Meditech. And people were like, what, were you stupid? And I'm like, look, it ran the hospitals really well. Effectively it may not have been the Cadillac at that point, but our percentage of revenue was always, every time we got those Scottsdale Institute or Gartner or whatever, we were always so low because it costs like, I don't know, like half of what it costs to run Epic is what it costs to run Meditech.

And so I always started from a base that was so much lower than everybody else's. Because we weren't running Epic and they're like, yeah, but you're spending the money here and spending the money there. I'm like, yeah, but you're at seven and a half, 8%. I'm at 4 percent and most of that is just the EHR itself.

And, but the problem is nobody's willing to stand up to that train of all those doctors and all the administrators and all in the entire industry and say, Hey, look, this is running the health system really well. Like, why would we spend for us it was like, 750. Million plus an increase in operating expenses and whatever.

Why would we spend close to a billion dollars With an increase in three to 4 percent of our operating income on this system. Help me understand the ROI here. Like what additional things are we going to get, but that argument, you think yours is going to get emails. That argument right there gets me emails all the time.

If people are like, you're an idiot. I'm like, why am I naming it, I it's critical thinking against the common industry norm, I guess.

It is. It's like everybody's doing it, with Epic, we're Epic. Everybody's doing Epic. I think a lot of those decisions actually come from the board.

If you look at what happened in Southern California, they were all, gosh, it was Allscripts territory and Cerner. Now if you look at what's going on in Southern California, it's all Epic. And what occurred down there was, I don't want to use the phrase of a virus, but you know, you got one organization that caught it and then, everybody else sees what they're doing and then the boards get involved to say, hey, UC San Diego, our big competitor is doing Epic.

We got to do Epic. We got to do Epic. We got to do Epic. Now Sharp's doing Epic, and they all, just like tidal wave that don't think from a CIO perspective, you could actually stop it anymore because it's not coming from the CIO going to the CEO and saying, Hey, we need to do an RFP and we're going to pick, we're going to look at Meditech and Epic.

And that's not the case anymore. It's you're on something. And then the board is we're moving to Epic. And you're like, okay.

Yeah. I still blame Scott Jocelyn for Southern. Yeah, it's true. they were the first year. You're right about that. Yeah. Pretty amazing.

let me give you a closing question here. the pace of change is moving pretty rapidly at this point. I guess, We've talked about the basic blocking and tackling.

We've talked about being responsible. What does it look like to be responsible with AI, like the investments in AI? I'm sure you're getting pushed. I'm sure the conversations are happening of, oh my gosh, look it's responding. It's doing notes now and it's responding and you're doing ambient clinical listening and those kinds of things.

how do you make a responsible move, a responsible fiscal move? Not necessarily from a clinical side. We'll, I'll cover that with. do you make a responsible move from a CFO, CIO, partnership standpoint into some of these emerging technologies?

Yeah, so again, it goes back to that shiny bright object piece, right?

You can rapidly go down the rabbit hole on this stuff because of what's happening now and what will happen over the next couple of years.

And, what you have to do is set the foundation of your organization first. So you've got to do a lot of education. I'll give you an example. We did a lunch and learn with the president's council, my colleagues with Microsoft on just what is AI and what isn't AI, what's ambient technology versus what AI is, just getting your organization educated on what it is and what it isn't.

And then some of the applications that are being used today. In healthcare. Some of them are bleeding edge. Some of them are piloting. Some of them are generally released now. So you've got to get an idea. And then what some of the use cases that are out there that people are actually working on.

Get your senior leaders educated on that stuff. Certainly follow what's going on with the government, because the government's getting involved in this. There's some new stuff coming out from the Biden administration just recently on it. I think it was today or yesterday. All right. So you've got to follow that stuff.

Then you've got to put some policies in place in your organization. You've got to get, as much as you don't want to do committees and things like that, but you need some sort of governance structure around that. Again, my, our chief analytics officer is basically in charge of AI if you're going to have a person, but he has a broad group across our research, clinical research that are also involved in there really looking at where it works, where it doesn't work.

The efficacy of it. Where you don't want to use it. And so getting ready, that's where you need to do it today. And then start looking at what, Mayo and, for example, Stanford piloted DAX Express, which is now DAX Copilot, they, a week ago announced that they're rolling it out to all their physicians.

We're following along with them. We piloted it kind of side by side. Great. We stay in touch with them. We see what they're doing and what their data is as to why they're rolling it out. Matches our data, we're rolling it out. So it's really that type of approach I think you need to take rather than going all in with a company or, cause there is no epic of AI.

No, at this point, anyway, Chuck, this was a fantastic conversation. I'd look forward to you seeing you're on a magazine cover now.

Yeah, I got it right here. I'll show it if you can see it. I don't know. Right here. Oh my god. That's a model magazine. I'm doing photo shoots

That picture is you could have been in Yellowstone.

Yeah, I'm hoping, I'm getting, like I said, I'm on a casting site starting to get kind of side jobs on Westernware modeling did a photo shoot a couple weeks ago out here. They say I have the look, which is great whatever that is.

And we talked a little bit about early, one of my big sayings now as I get older before I ride off into the CIO sunset Is it, you're never too old to reinvent yourself, but life begins at the edge of your comfort zone. Yeah. So all of you out there, when you get to the edge of your comfort zone, take that next step and just try it and see what happens.

I could have easily, when I was approached to do this, said, no, that's not for me, I can't do it. I'm going to be terrible at it. And maybe I would have been, but I'm having fun. It's enjoyable. And who knows what it will do in the future. And you're right, Yellowstone and now Beyonce's coming out with a Western album.

You're going to see all these women out there with cowboy boots now following Beyonce. And so I'm going to ride that whole wave, I guess.

That's fantastic. Chuck, Thanks again for sharing Appreciate it.

All right, Bill. Thank you for having me. I appreciate it.

Take care, everyone. β€Š πŸ“

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