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  Today on Keynote

(Intro)   we need those people who do know how to lead this work to take the charge in this job that we call Chief Digital Officer, Chief Information Officer. Albeit, it's a tough charge.

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 is keynote. And today we're joined by Buddy Hickman, Chief Digital and Information Officer at Roswell Park Comprehensive Cancer Center. Buddy, welcome back to the show. Hey Bill, thanks for having me.

It's great to spend some time with you again.

Man I'm looking forward to this. I find it hard to believe that anyone would not know who I am. Who you are, we have a lot of listeners and there could be some people that don't know who you are talk a little bit, let's start with your current role and then we'll go through some of the stuff you have done.

You've served with CHIME for many years. We'll talk a little about that, but let's start with let's start with Roswell and the work that you're doing there now.

Sure. So I came to Roswell Park Comprehensive Cancer Center mid January of this year. So I'm somewhere around 100 days in post at this point.

I'm serving as the Chief Digital and Information Officer. And I guess the distinction here for me is Roswell Park is a comprehensive cancer center. In an organization unlike others I've worked in. I've spent a lot of years in academic health science centers. Our mission here is specifically about caring for and finding the cure of cancer.

It's the oldest NCI accredited cancer care and research institute in our country. Named after a very innovative physician. In the late 1800s, Dr. Roswell Park who has a number of things that we can speak about as to his history but certainly early ventures into cancer care.

He was quite an innovative neurosurgeon. He was a person who advanced the idea of patient privacy well ahead of his time and a host of others. accolades. And the place has remarkable history. The I spend time here, the more I learn of stories that I could tell if we had time. Yeah.

So you have been around in terms of a lot of different types of health systems. Is a cancer center because of its specialty nature, a lot like an academic medical center its research function, or is it different?

I would compare it to say you're in a special cohort because the missions of the Academic Health Science Center are not only delivering care like other providers, but certainly the teaching research missions are prominent.

We talk about teaching hospitals, but then we talk about academic medical centers. Academic medical centers typically also have. A medical college is part of of its mission and its delivery. And that's, obviously a place I've spent time in a couple of rounds. The difference is with the focus being solely on cancer the care is generally, I'm going to say, probably more forward reaching in terms of the latest learnings.

the numbers of clinical trials that are occurring, and the things that are being thought of, not only in intervention, but prevention by different forms of screening that might not yet be common. And I'd add to that, then you add the research dimension of the organization, and it's got its own levels of complexities.

I was sitting and chatting with Dr. Chris Choi the other day who is one of our new scientists actually works for Renier Brentjens, our chief clinical science officer. And Chris was we were pulling apart his latest project because I was wanting to understand from my own view of what my role might be in helping him do what he's delivering.

He's responsible for the construction of our new. clean room manufacturing facility for synthetic cell and viruses. And so think about it like building a chip fab plant, but in this case, we're going to be building synthetic cell viruses. Today, typically would be acquiring those materials from a bioscience company but, with the regulatory world being the way it is and us believing that we can, work in that construct and work well in that construct, we're building a facility to do that.

An example then would be, a backdrop, CAR T cell therapy whereby we would be generating our own CAR T cells in this plant. And frankly, if there's, residual supply, there's monetization to other cancer centers that need synthetic cells and for those kinds of care regimens.

It also, if you think about it in the sense of some of the controversy that comes with how we harvest cells for cancer treatment uses and so on, it places that in a different, zone as well, in terms of how the folks that, carry an ethical concern around that would look at this. Imagine the costs bill of a second of downtime in a facility like that, whereby it could affect temperature, humidity, negative air flow, and the clean room construct on the whole.

little different animal. It is different than working in a classic academic health science center.

It's interesting you describe, part of what a day looks like for you. And part of what a day looks like for you is that, it's creative problem solving with the people who are doing the work sitting down.

Give us an idea of what a, I know there's no typical day in the life of a CIO, but what have your days look like in the first 100 or so days at Roswell?

When I took the job, Bill, I can recall one of the statements I made early on, and I think for so far, it's held together.

I've done this long enough. That not much surprises me. And I know you have that sort of feeling too, cause you were out there in this role for a long time. If you count it all up, I've said as a CIO across I think it's, this is now my sixth organization. If I include a couple of interims in there and I've said as a CIO for gosh, 24 years in that role. Now, you know this, but I'll reference it because you said maybe not everybody knows who I am. I was also a partner at EMY along the way in the health practice spent some time at PwC early on have, served on the HIMSS board, the CHIME board was a bootcamp faculty for the Seattle Bootcamp for nine years.

And frankly, I just say I've been blessed by having all kinds of talent around me that was in front of me first that I learned from and around me as a contemporary. And now even to the point that some folks who might have called me a mentor Along the way, I called them for advice because that's just the way it works.

Everybody develops the body of knowledge. That's one of those things that Sarah Richardson and I share, by the way, she attended a bootcamp with me years ago. And the next thing you know, a few years later, she's one of the, one of the prize faculty. And Today, I think is your announcement today, as they're joining your team.

Yeah. But she is one of those souls that really has thrown herself into the industry and has done remarkable things. You asked me about my first 100 days here. My pattern is one to jump in fast and go into listen and learn mode. With everyone that I can get attention from and that may be in the form of sitting in one on one meetings in the executive suite or with the chairs of our research departments.

It may be walking a lab, it may be literally walking all of the inpatient units or through the clinics to observe how the technologies used, and or to hear directly from folks on the floor of what's working well, what's not working well, and so on. We've opened up a COVID assessment so that we're looking at our maturity on a framework basis.

We're getting ready to launch an end use customer survey to ask how we're doing on a number of dimensions. We've got our heads around budget in a different kind of way, I think. and thinking about how we can be as the best we can be with regards to our fiscal accountability and responsibility.

I am active in the standing up of governance. I'm active in the look see how it is that we're providing research IT to the research organization alongside of a research shared services organization and how we might. Blur that a bit more for the sake of providing more, better, faster, and maybe doing more things as a service and less traditionally in their orientation.

And then finally I guess it's probably worth noting we're still a best of breed everything organization. The number of apps that we're managing is well into the hundreds. And again, think about that because we are boutique ian, that we're cancer care and not a big national IDN.

sorting out directionally what we need to be doing about that is another top line item as well. The work is different than it was a long time ago. I can remember, gosh, Bill, I took my first CIO job at the age of 29 years old. In fact, I think it was maybe two days after my 29th birthday, that was my start date.

Betsy Hersher, for some people who remember Betsy, was the recruiter involved. I remember her looking at me saying, you have no business applying for this job. and I looked, I laughed. I said, maybe you're right. But the organization knew me and certain leaders knew me, so they were pulling me into the organization from a consulting role that I had been in.

It was a turnaround job. Straighten up everything that had already been started by some other folks and clean up the aftermath. I remember walking into the CEO of the health systems office for my first conversation with him and he looked at me, I came with, with page notes prepared ready to ask all kinds of questions and all that kind of stuff that you think you're going to do as a new CIO kid walking in the room.

And he looks at me and he says, okay, I have just a couple of things to say to you, maybe three. And I said, okay, he goes first of all, I want you to fix everything that's broken. I want the problems out of the boardroom. We have money. You can spend money if you need money, prepare us to grow. We're going to be growing a lot.

That's all. I said, can I ask a couple of questions? Not today. Thank you.

And yeah so we did what he said to do, including building out it back, back then, removing everything from being processed by hosted providers like SMS and McKesson. HPLC in house, and everybody's standing up data centers and all that. Of course, this is the way the pendulum swings all the time, when you work in the tech world.

And we built a corporate data center. Eventually that corporate data center housed 15 hospitals. And I think we did a lot of things right in that early job. The difference is, frankly, the amount of tech out there now, has grown exponentially, as all of the leading technology capabilities, like they always were, are more hyped than ever.

They already were, but now they're more hyped than ever. So calibrating that and knowing what's right, what fits, what's appropriate, and so on, and being able to do that, it may be an exponential lift. is probably biggest difference, over the three decades I've been doing this kind of work.

Yeah, when I started out, there was an awful lot of siloed systems and that kind of stuff, and they were siloed because we didn't even understand the concept of interoperability back then. But today, man, everything needs to feed information to something else, to feed another process, to feed another workflow.

Yeah. And that just, the complexity of that, especially when you're talking a couple hundred applications is daunting.

Yeah, very fair observation. We live in an ecosystem of data at this point and having systems capable of those exchanges is obviously critical, understanding all of those libraries of exchanges that might be available is also remarkably important, a data governance construct around that.

critical, and honestly I don't see an end to that. I just think that continued development, that path is going to continue to open up more and more possibilities. And our ecosystem will feel like the global economy is just going to feel like it's continually

shrinking. Hey, if you're doing the end user survey, and I love sending surveys out to doctors, but the first one I did, I, Included a lot of blank spaces that they could write whatever they wanted and I laughed so hard reading doctors are very funny. Very creative even though they were taking shots at IT. It it was fun to read. I still remember one of them. The comment from the doctor was, Hey, 1984 just called, they want their technology back.

And I'm like, yeah I understand what you're saying. But it's a lot of fun. So you have chief digital and information officer titles. Is that fairly new for you to have both, or is that just a realization of that interconnected world that we're talking about.

I think it's a realization.

when I interviewed for the job, my predecessor, Tom Ferlani was operating under the CIO title. We find many of our colleagues preferred the Chief Digital Officer title these days. I think there's still some real history, regard, and understandings that come classically as being a CIO.

And so my preference was to say, okay, let's talk about both. one of our friends, Bill, would say, the role of the Chief Digital Officer is to be the digital evangelist for the organization. My view is I absolutely believe that and I believe I have a responsibility in that.

I also believe I have a responsibility in doing everything soundly by the appropriate principle and the blurring of lots and lots of different competencies and having a lot of engagement with people from a lot of different disciplines. And so to me, the use of both titles to me meant, yeah, I do want to be the person that's pointing forward.

And yet I also want to be the person that's trying to find the balanced responsibility bring both of those ideas at the same time.

Yeah, you point forward, but you don't keep the systems, the trains running on time and the systems running. You tend to not be around long enough to keep pointing forward.

absolutely fair. And, it's interesting because sometimes in big organizations, some folks are starting to use the CIO title as though it's the train's running person. The digital officer is the person over here. The reality is for our size and scale, it really should be a person.

That generates both energies.

let me ask you about digital transformation. Digital transformation early in your career meant what, and what does it mean today,

so digital transformation early in my career would be the standing up of a lot of package suites.

Capabilities, and usually having, in my case, smaller development teams where the development teams were being moved more and more toward package capabilities as they stood. You already referenced the fact that our world of integrations was very different a long time ago. HL7 was new. as an associational feature, and those libraries were new and early.

We were still dealing with the world of point interfaces, and oftentimes what I called manual interfaces. The person looking at one screen and typing it into another system over here. So the idea of transformations, my view is what we were doing 30 years ago, were our first forays into automations that did find, in most cases, efficiencies and maybe better effectiveness, but did not have the reach that we talk about today.

Today, when we talk about digital the capabilities are in a very different place. We could be looking at. Let's say I'm going to call it the data exhaust that comes from, the bringing together of many data marts to source marts and then operating across all of those data and being able to do things computationally that perhaps we couldn't have conceived computationally either.

It's even like the idea of, I'll give you an example. Back last fall as part of a CHIME related meeting, I was at Cleveland Clinic and oh, the CISO there Vugar, took a group of us, about 10 or 12 of us, over into the research building to talk to us a little bit about the IBM Watson Health supercomputer project that they had going jointly.

And as I understood it, they were basically running about 30 projects at the time, that was the portfolio. And if I keep it simple in my own way, the way I heard it is, it's not so much the exercise of the lines of code. That they're running. You're talking about, things written mostly in R or Python because you're doing something statistical and or something predictive.

But the data arrays are so massive that you have to have that kind of high end computer processing to exercise that small line of code across that much data and therefore by the math be able to, I'm going to say, see the things you could never see in the data before. to point you directions as to your hypothesis.

And, those are things we may have talked about, 20 and 30 years ago that are very real now. And they're real as a matter of scale, probably more available most of us than we realize. You could actually go out and lease time on IBM Watson Health. And pay for it by the CPU second or whatever it is.

Okay. The way we're doing things now is just so vastly different and understanding, the resources available and how to bring them to the available organization is also key in the role of the digital officer. We've got several things we're doing in AI. I can go there if you'd like me to spend a minute.

Yeah. I'd love to hear that. Yeah so I would say that we, like many, are still at the beginning of this discussion as an organization. We have some folks that certainly are using ChatGPT as a matter of finding efficiency their productivity personally. And, in fact, we have a Microsoft co pilot.

pilot running right now with a number of people working on some use cases to validate what the benefits of co pilot might be. When we deployed with co pilot, we also said, it'd be a good idea. A couple of my folks gathered everybody. This was right as I was coming in and we had our first AI town hall.

And part of that agenda was to talk with people about responsible use. especially even with the productivity tools. And along with responsible use, talk about maybe some standards of behavior, and then even have a way of reaching out in the notion if you see something, say something. Meaning if you feel as though there's a use that's occurring, that's a use of concern, there's a way to make reach to have that examined and validated.

More recently, we held a town hall. In fact, this was just last Tuesday evening. My friend, Vicky Peltieri at NIST, who is the person managing the NIST Cyber Security Framework, introduced me to her colleague, Martin Stanley. Martin's responsible for the NIST AI risk management framework. And think of it as a sort of trustworthy framework, the filter by which you should pass your thought about deployment of an AI or whether or not the AI is ready.

So we hear a lot of articles written about this, got a lot of consulting firms coming up with their own proprietary way of thinking about it and so on. But the NIST framework talks about, accuracy and reliability patient. Privacy and patient safety ethical use recognizing limitations continuous learning and improvement, and so on.

The idea being that in the end you want to be responsible. By assuring that the framework is trustworthy, or excuse me, the AI is trustworthy, meets a standard that is predictable, reliant, and so on type standard. The dialogue was good because we already have activity going on in the space of AI, in fact, beyond those individual kind of things.

Our EHR vendor. Is bringing forward some AI capabilities. We have a lung cancer screening tool that's in regular use right now that has certain AI features to it. Of course, the clinician overreads that, right? We use LeanTask like some other folks do. It's IQ product for scheduling purposes, and I know a lot of friends out there that do that as well.

It has AI algorithms that it deploys. We're doing some work in AI in the radiologic imaging area. We're using DAX, like others are using DAX and so on. So what I'm saying to you is we know that there are certain things that are commercially available that we now are starting walk into with given care.

It does raise a question though, because I have at least three other production site type systems that will be coming at us through, The selection processes that will bring on other AI. And on one hand, we're going to be standing up policy and digital health governance in a way to examine and know that's going to work.

Those solutions are going to work, and they're going to work reliably and in a trustworthy way. On the other hand, I've realized that we really need to be going upstream with that. And the way you go upstream with that is understand from the vendor, what the vendor has done with its own framework. And are they transparent with their own framework to assure risk management with AI?

And if they're not, how can we help them start thinking that way? Because otherwise we're going to have to bring it through our framework anyways, right? We have some research AI stuff that we're involved in right now. We have one of the solutions that we built that does a lot of stuff with data.

For IRB research purposes. Has some large language model AI now associated with it. To help work through all of the data. That nomenclature, which might be in various forms and span years. we're building out an imaging capability and imaging capability, not say an enterprise PACS that does a pre read and you do the over read, but imaging in the sense of combining several different technologies, something that would, for instance do an ONOMIC Segmentation and a visualization then of that onomic segmentation with an additional added capabilities give you a predictive read at that level, a totally different level of thinking about doing reads because most of the use cases that we're seeing commercially right now are, of course, around something much more conventional.

A total pathological read, a digital image read, a study, or whatever. So it's cool that, that we have folks doing development in this space as well. All of that, if it flows through a digital health and AI governance structure, it's a turn it on, turn it off group.

Meaning, we've got a use case, we want to look at the use case, here's the standards by which we'd look at the use case. the business case to understand what we think about it and its movement forward and even eventually its productive use, but how you assemble that team may have certain folks in it that understand the tech.

AI, risk compliance and legal, and your subject matter experts probably have to vary, because based on the science that the work is being done in, the subject matter expert may be validating that the correct research science. Is also being thought of. So again, I think the level of complexity that we're dealing with this year is a notch above what some others might have to deal with if you weren't this kind of an organization.

And I expect a number of my colleagues out there the same experience as they work in academic health science centers and cancer centers.

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is going to be interesting to see how this progresses how governance gets stood up, how the research has done around this, the effectiveness of AI and the effectiveness of the various AI models.

I think there's areas where the AI is being brought into our systems That is generally accepted at this point. Like you talked about DAX and DAX copilot and whatnot. That's generally accepted because it has that oversight of the clinician. It's an assistive kind of technology.

And then there's more and more, we're going to see all this data coming together and people wanting to apply AI to it, and it's going to really be incumbent on the various organizations and the industry as a whole to do the vetting and the rigorous vetting that we normally do, because this is, it's healthcare.

It's clinical settings in a lot of cases. Obviously, there's a lot of use cases outside of clinical, but anytime it touches clinical, it has to go through that vigorous testing process. I want to take you, said six systems you've been at. You had six systems where you went in. And essentially had to establish and get started.

I want to talk about some of the challenges that you've seen as an industry. And I want to start with governance because you talked a fair amount about governance. Those of us who've been doing this a long time know that without proper governance, What's the best way to say this?

Without proper governance, IT just gets buried. Just absolutely, it just, it comes to a standstill. You end up with situations where you have, 600 applications and 250 active projects and all that kind of stuff. But it's still amazing to me how many people I talk to that don't feel like they've set up good governance yet.

have you found that in your travels, that governance is one of those things that we just, you Struggle to stand up?

No, the answer is yes. getting buried is a quite proper way to say it, Bill. Because that is what happens. It is the classic problem of supply and demand. And the analog I like to use for those people who like systems reading is the is the tragedy of the commons.

Because you basically are consuming the resource until the resource is just not there and that's what happens. We recently went through an exercise here hadn't done this before whereby we looked at how the team collectively across the number of folks that work in technology roles are expending their time and effort.

And, let's say number around 12 percent is administrative time, a big chunk on strategic projects, where strategic projects might be anything that is a board ordained effort because it is big or something that goes through, the additional, capital and operating budget approval because it's programmatic a large amount of time.

goes into keeping the trains running. As I say to people, often you buy the beast, you got to feed the beast, and you're going to be feeding the beast as long as you have the beast. And sometimes that gets more and more complicated, depending on how many beasts you have, that truly accumulates a lot.

And then what you have left over is really the time available to sign to all the tactical stuff that people are coming and asking of you every day.

We would all recognize that it's important. Why is this hard for people to stand up?

Yeah I think the answer is maybe some haven't thought about it this way, depending on how or where they were schooled or not schooled.

One of the biggest challenges might also be at times the the culture of the organization and the mindset about it. If it's done right and We would be talking about shared leadership governance, meaning a group of people that collaborate, make decisions together at the senior leadership level based on principles that they agree to that embody how the decisions will be made together based on our ability to fund and support technology and its best uses.

Do you answer the question of why doesn't everybody do it? I don't know. It's just interesting to me the number of places I've walked into at this point, either as the new CIO showing up or as a person coming out of either, even consulting backgrounds where I saw a lot of places.

And, um, it's cool when you see a place that has a collective act going on about it, because things just click differently. And there's, oh, let me use a Stephen M. R. Covey phrase this time. This is the son of Stephen Covey. He wrote a book called The Speed of Trust. When you get The place you have a culture of trust in that shared leadership kind of framework, the way that you can move is so much more fluid and obviously faster because everybody does have that trust with one another.

When you don't have the trust with one another, it's the converse. And so as long as everybody understands that the principles are about aligning to everybody's benefit and everybody wants to see that happen as a value system, I think shared leadership governance works really well. So that's the key to

I wonder have you been in cancer care long enough? The question I want to ask is, what are the expectations? of a cancer patient and their families from the technology at at Roswell Park?

Yeah, that one might be too early for me to answer. I say that, Bill, because I've not had, to be fair, I've not had that many patient facing encounters as to that discussion.

I residually from my colleagues. There certainly is the thought that I'm going to get the best cancer care I can possibly get when I come to a comprehensive cancer That would include, in the mindset of most people the best physician providers, nurse providers, and that they would have the best approaches to treatment, whether that intervention included a surgery or not radiation or Beyond that aspect of tech, I don't know what necessarily the patient's thinking. Are they thinking about, do you use the best AI, enhanced

approach to, I

don't think

so. But it's probably just the basics again, right? They want good communication between the clinician The specialists, the doctors, and the family, they want less friction in terms of the scheduling and the appointments, they want it's communication, it's operations, it's showing up and they don't have to repeat all the stuff it's probably very similar. I would imagine

All that you say, they want their bill to be right. They want their wait time to be low. And I think there's a different level of wanting empathy. Which is not a technology discussion at all. But you see it in the eyes of people when you walk down the hallway. And there's a lot of energy spent with our workforce.

Where we all connect enough to think about that. All the time and make that part of our value system and our fiber, given what's going on with the folks that we're giving care to.

we're coming up on the end of our time, and I appreciate you giving me so much of your time this early in your tenure at Roswell Park.

I'd like to try to ask 2 closing questions. This 1st one is really about future of. Healthcare technology, so as you look ahead what technology or innovation do you believe will have the most significant impact on healthcare in the next decade? And you may have already touched on this.

I'm just curious.

I've somewhat touched on it. You can say categorically. Capabilities that come with generative AI and the ability to leverage big data. Those are clearly critical technology to what we do with research. And then research, leads to intervention and then intervention is the closed loop back to research because of the data exhaust.

Yeah this was the promise of meaningful use, right? We're going to collect all this data and then we were going to unlock insights into what causes different things talked to somebody else about cancer care. Oh, at Alex's Lemonade Stand, I talked to them. They fund a lot of cancer research around the for pediatric cancer and whatnot, and they said they have seen an awful lot of advancements.

It's almost accelerating the number of advancements. And I don't know, maybe it's the access to data. Maybe things are progressing because of that.

You think about, something that you and I can reference is Moore's Law. And, the notion of, the cost of storage being cut in half year on year, whatever the number is, and being an exponential change.

The same thing is going on. Not only storage, it's going on with high performance computing and the ability to use technological tools that can cross nomenclature now. Whereas it used to be that everything needed to be structured data. The ability to ingest images, or like I said before, even, segmentation of images, something onomic.

it's just a different kind of playground. And it's going to require that those folks that want to work, in the front end of health care, meaning where the provider all the way back to the research aspect of provision, is you really got to be on top of all of that in a continuous learning mode.

And also build solutions that agile and new vile enough to change because year on year, you're going to need to be able to make adjustments.

Yeah, and I guess that's my closing question. Young professionals, leaders, taught in the Chime Bootcamp for many years, what are you telling the young minds who are aspiring to be the health IT leaders in the future?

I'll try to be straightforward with this. My feeling is one if you want to be in this space, you gotta be up for continuous learning.

You're an example of that, Bill. I think I'm an example of that. To stay relevant, you have to keep on game. The way you keep on game, if you're wired for this, it comes to you. Because you want to stay on game and you want to stay current and relevant and understand the space because you feel drawn to it.

If you feel drawn to it, you probably, some of us might say you're called to it. And if you figure out that you're really good at it I think you probably really are called to it because you're validated by all the circumstances around you and In addition to that inner pull that you have, so you ought to listen to all of that and understand that if you're called to it, then you need to do it and not walk away from it, because on the other hand, there are a lot of people who aren't.

And don't know how to do this work. And we need those people who do know how to lead this work to take the charge in this job that we call Chief Digital Officer, Chief Information Officer. Albeit, it's a tough charge.

It is a tough charge. And I appreciate you sitting in that chair. Keep going back to it.

You got out for a year and just went right back to it. It's clearly a calling for you and we appreciate the work that you're doing, buddy. Thank you again for your time today.

Thanks for spending some time with

me.  

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