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  Today on Keynote

(Intro)   📍 all the other CIOs and what they're thinking about in terms of their strategy, what keeps them up at night. This is really one of those gravitational pulls that we either can get sucked into and it can paralyze us moving forward or we can use it as an opportunity to drive where we need to be

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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.

Now, let's jump right into the episode.

  (Main) All right, it's Keynote and today we're joined by Tim Skeen Sentara and Pete Marks with WakeMed out of North Carolina. And excited to have the two of you join us and have this conversation. Welcome to the show.

Thank you. Thanks,

Bill. we had a 229 project event. It's been a while now. It was in the first week of June, and what we've started to do is coming out of those events, we have the chairs on the call to just high level talk about, what's top of mind, what are CIOs talking about, what's the discussion, and share some of that feedback with the rest of the community.

What stands out as you think back to those conversations, what stands out as top of mind that you felt was something that CIOs right now are grappling with and dealing with.

Now, granted, this was the first week of June. Right now we're, grappling with and dealing with security because of CrowdStrike, but try to take yourself back to that time frame. Pete what do you remember?

So I think we were just coming off, not even coming off, but we were still involved with change at the time.

So security it's always top of mind. And so that was a big part of the conversation. Both change and the one that we're currently working on, some of these things have switched from, what's my perimeter look like?

What's my defense in depth look like? To now, What's my vendor management strategy? Because it's not the healthcare system itself that is suffering. It is a vendor that you're highly reliant on and really grinds you to a halt. So again, for the one that we're currently in with CrowdStrike, they're a great company.

We are not. Customer of theirs, and so we didn't feel the full brunt of it, but still we had third party vendors. We struggled to get some pharmaceuticals that we needed that are just in time deliveries for those kind of things. But, I think that was pretty top of mind, and I think it will be top of mind because two months from now, There will be another, and I don't know what that is, but continue to do what we do.

Let's park here for a minute. Has our approach, and I don't want to go into security for you to talk about your posture, but our approach changed from, you characterized it as

really worrying about the perimeter, to being more about recovery, and about architecture, and about vendor management.

The change in the CrowdStrike things those were very different attacks than say the Ascension attack was. That was specifically at Ascension took them out, but we're finding that we have tentacles in a lot of different directions and we can get impacted in a lot of different ways.

Tim, what are your thoughts?

Yeah what I, what comes to my mind is I think about and hear all the other CIOs and what they're thinking about in terms of their strategy, what they need to worry about on a daily basis, what keeps them up at night. This is really one of those gravitational pulls that I think we either can get sucked into and it can paralyze us moving forward or we can use it as an opportunity to drive where we need to be to, right?

Because if you say, I'm just going to fortify and I'm going to try to think about every nook and cranny, every partner I have, then, you're going to be rotating and having all your investment and your energy into it when we really should say, okay let's think about the other investments and things.

as to what you said, allows to recover and be more resilient. Let's get into the cloud. Let's get into federated data. Let's get into segmentation around how you control blast zones. Let's get into app rationalization and simplification, right? The fewer things that you have to worry about in your CMDB, the fewer pieces that you may have to worry about in terms of that security perimeter and what you're worried about, and the recovery of that, and the data around it.

When I think about Security, how does the CIO make sure that they take care, take advantage of this opportunity, as bad as it is in terms of the impact to the industry, to sell their ELT and their board with a concept that says, listen, yeah, we should all be worried a ton about this. And the other thing that everybody wants to rotate on is Gen AI and how that's possibly going to be a negative impact to us in various ways.

Some of that's, Security attacks as well. All those things to say, Hey, listen, we need to have a platform and an architecture that's resilient. And we're not there. We need to be focusing a lot more on that as opposed to letting some of the security components be 80 percent of what takes our time.

And so it's tough, but I think as a CIO and a leader, we have the opportunity and the courage to stand up and say, Hey, listen, We're not ignoring this, but it's important that you don't forget about all these other pieces because it's really important to where the industry is going right now.

I agree.

I was actually interviewed and somebody said, what's top of mind for a healthcare CIO? And I said today it's CrowdStrike, but you need to understand even though it's a significant thing that happened today, It's not all that they can focus on because there are so many other things to focus on.

I think it's interesting that you brought in all of this, we keep coming back to this architecture conversation and that came up in two different ways. One is the complexity of the environments that we have to manage. And the other became the usefulness trying to get more value out of the environments.

We're trying to get more value out of the data. and the research that we're using it's more and more becoming, hey, are we building on a firm foundation? Tim we ended up having a really good conversation in the meeting about data. I'd love for you to share a little bit about, how we're approaching data in this AI and heavy analytics world.

it was one of the areas when I came in just over three and a half years ago that was an obvious Kind of something that wasn't being focused on, right? It was just about a team of DBAs managing operational data stores, maybe managing a large data lake for basic reporting and analytics, but it wasn't seen as strategic and valuable.

And so right away, driving towards creating a chief analytics officer role, chief data officer role, the concept of an enterprise data platform. platform roadmap, starting to develop and architect what that looks like and starting to move down that path of implementing it was really critically important.

What it helps to do is allow you to put these other kinds of components more quickly into your environment to take advantage of it, whether it's homegrown or it's third party analytics, you've got lots of different advanced analytics and things that are well known in the marketplace. We have both a health plan.

and a care delivery organization. So those are a little bit different in some of the things they use, but all of them need this enterprise data platform that has a proper ontology, that has proper cleanliness and quality to it. And it's also really key, because we weren't doing it back then, to be leveraging external data sets, whether that's SDOH data, whether that's other financial, social data.

All those things contribute to the personal interaction and the personalization we can do to our patients and to our members. But it also allows us to predict future care needs, other future needs transportation, housing, whatever, for those consumers that we're trying to support. Getting that data framework in place.

Putting those bronze, silver, and gold layers, which we're continuing to build out, that stack, allowing other data lakes to exist like our OMOP structure for our clinical trials and research data set, creating those components, creating other kinds of pivot environments, creating our own private, chatgbt 4.

0 instance that we can do training on and prompt engineering on. I think all of those things are really critically important to build, beef up that area of the data environment. And then what you'll see when you start building that out is that this concept of a data fabric or however you want to call it that links into an operational data stores that make sure that data is moving , interoperable across all of your platforms internally as well.

externals and allowing data to be ubiquitous in that environment, as well as obviously secure with right privacy and right consent. But I think it's foundational for you to do any of these other things to build on top of. And what we did along that way was not just make a technology architecture. I created an enterprise , architecture team that started creating OBAs, right?

Operational Business Architecture Artifacts. And that's something that at least when I got here in our area, I was sorely missing, right? There was a lot of different technical diagrams, but not really those OBAs that you would think back to our old TOGAF days of architecture and the structure, right?

They're important to understand how the business architecture operates.

Bob, you just gave us an awful lot to go off of. It was interesting to hear the challenges. And I remember some of the conversation that was going on around this. There was significant gaps in the data.

There's data quality. There's people asking about data governance. There's data is becoming so critical and yet it felt to me as we went around the table and I'm going to throw this one to you. To you, Pete, is it felt to me like everybody was at a different place in their data journey.

I'm curious your thoughts.

Yeah we're pretty fortunate here. About five years ago, we realized from the data perspective that we were struggling. One of the things when we really want to move the needle is we try and make a board of directors goal. That gives us the opportunity to talk to the most senior leaders and to have something that's measurable.

That says what's going to be our success over the next years. And so we did that about five years ago. We used the HMSA analytics model, right? It's pretty simple, communicates well. We actually don't even need it anymore because we've really transformed how we use data. I liked a lot of things Tim said.

First, it takes a tremendous amount of discipline. And you have to have a mindset that says we're going to bring all this data together. I love the fabrics analogy that we're going to protect this data, that we're not just going to bring the vendor community in if we don't address the data and how the data integrates up front before we ever sign the contract.

I don't know if Tim, you said that directly, but I certainly felt it , in your talk. We have been doing that here. Most of our success is on the clinical side. And the last thing I would say is that we do the technology side and we're major participants, right? But we turn over most of this work to our Kaizen promotion office because it's an outcomes related activity, right?

So data, descriptive data is nice and we need to see it. But if we're not moving the ball with what the outcomes are. then, you'd have to say how much value we're really getting from it. And so we can map all the outcomes, clinical outcomes and some operational outcomes, because we're moving into that area right now.

And that is really the driver. But you have to have the discipline with the data, with the vendors, with how you are pulling all that stuff together in a data lake, making sure it's available, even when some of the circumstances may be poor. But yeah It's been exciting and we're excited about our journey.=

non technical things that I think we're really moving forward that we think are going to make a difference. One of those things is a comprehensive enterprise data literacy program. So we recognize that data literacy is part of the problem, right?

Part of the problem is not having that across the enterprise and technologists. Assuming that people understand what you're talking about, right? That's a big piece of it. The second piece of it is we've created a core program where we're bringing in, we've made up the names, you can pick whatever name you want to, we're having to be calling from a HR hiring standpoint business data architects, but there's going to be BDAs that exist in all the core domains.

And some of the first three that we're really focused on, as you can imagine, is around, Risk and actuarial, obviously we're a health plan, one piece of that. There's going to be pieces going to be focused on population health, care management, utilization management, how we're doing that. And then there's a third one that's focused on ambulatory.

And when you think about ambulatory, think about new ambulatory care models and how that blows up into a virtual care paradigm for delivering of care in an ambulatory environment. These BDAs, along with the state of literacy, we hope is going to level and bring up quite a bit the conversation that we're trying to have as peers between the technologists and data science folks and the business.

It was interesting, and we'll talk about this. We're going to get into imaging in a minute, but just to tie this one up, we ended up with an interesting use case. And that is, Medicare, Medicaid, And the CIO specifically was talking about engaging that community. And that community is very difficult to engage.

It's very difficult to get the data around them. And you were talking about population health and you're talking about managing risk and whatnot. And we ended up with a, an interesting dynamic, which was identifying, like, how do you reach that Medicaid population? How do you reach that population?

Now, some of them are easy to reach. Some of them are not so easy to reach. in order to engage them in their health, especially with risk bearing contracts. Tim I don't know if you remember that conversation, but it was interesting to identify the gaps in data that we do have and the fact that CIOs are being asked, okay, solve this problem for me.

there are a number of niche players out there that are trying to grab that data. You think Bertha, as an example, grabbing a lot of the data around that Medicaid population. There are various Difference is Medicaid is at the state level. That's why there's so much inconsistency.

That's why Medicare is a little bit easier target to shoot after, but Medicaid, you've got that it's a state by state controlled program, right? That's has basic regulation from the CMS level, but the states can do whatever they want to within those minimum benefit guidelines. And so you've got various all payer claims databases.

You've got public, private, HIEs, HINs in different states. There's a lot of place to peck for this stuff. And. Part of the beauty of Medicaid, though, is that data, since it's CMS funded, a lot of that data is accessible and, not everybody necessarily curates or grabs it, it's not necessarily the cleanest but some of the things I'm seeing, beyond just getting that data curated is what we think we need to do at the grassroots community level.

There's a lot of community organizations, charities, programs, it fits well within our non profit community asset mindset at Sentara where that is where you capture some of that, right? Working with ministers and pastors in the community, finding these populations any way you can.

And figuring out that this is more than just clinicians taking care of folks, this is a whole social worker ecosystem of environments that need to take care of this. There was an article recently came out of Becker's that was promoting, I won't say which group was promoting this concept that was saying that SDOH was, overstated and we're asking clinicians to be social workers and do all these other things.

No, we're recognizing that this is a village trying to take care of this population, and it's more than just clinicians that necessarily help them. Sometimes it's putting a air conditioner in a window unit for somebody. It's lots of other things. The more data you can gleam about where they're You know, in terms of food scarcity, where they're living, transportation potential issues, all those things allows you to support that population much more effectively, but that data is massive and hard to wrangle, and we've got to do that partnership with lots of other vendors that are out there driving and focused on it, because I don't know about Pete, but I don't have it.

Kind of the large engineering organization and the amount of funding to go after this thing on our own. We're going to have to do this in partnership.

Yeah. It's an all of the above strategy, Bill, where you have to go out to the communities, you have to have resources available, you have to. And this is obvious, everybody talks about this, it's not just the traditional clinical encounter, it's an encounter on food and transportation and housing.

For us, some of the things that have helped us, besides going out in the community, which we do really well but we could always do better, is, our resident program. We have the residents staff a clinic, that's an open clinic, just for those patients. To make sure that when they come in, and they tend to have a lot of comorbidities, and so you really need to be, you can't have that traditional 15 minute appointment.

And you're going to spend a lot of time with case managers, helping them get through a lot of the issues that we're not really used to. I think the other thing, and this really even surprised me, is there are small payments that they have to make, and we were finding that they weren't coming because of what we would consider small payments, five or ten dollars, right?

So we just cover those, and when we cover them, then they come in and we can get more into the risk stratification model because they're in. And we cover those small amounts, but the bigger impact is we're keeping people in the community healthy. And then we're trying to meet the rules that are both stated and unstated from the federal government.

And actually another thing to add to that bill that I think we did talk about that you triggered. And the question was. Using that data to figure out where to target within the community. So Virginia is where we have the largest Medicaid population. We're the largest Medicaid MCO on the health plan side.

And it also is the largest piece of our business from a care delivery standpoint. So we were going to, as part of that program, as far as community care, to also help Medicaid, but also uninsured, we were going to open up 14 clinics to do that, right? And originally that was 12 clinics. With two of them being mobile.

The two mobile ones we opened up and we, one, we opened up one brick and mortar. And the two were so successful that we're pivoting to having only three brick and mortar and nine mobile clinics. And what that allows us to do is look at the data, look how things are trending across the state in various rural areas, and even populace, urban areas, and move those mobile clinics accordingly to get the best impact on that community.

takes a lot of data also understand that you're directing them in the right places. And it takes a while to get enough of the feedback data to prove that you think you're actually have a good model that's directing those resources, properly.

What's a mobile clinic look like?

Yeah, it's like a big rock star bus, right?

So it's

like the old bookmobile. That came around.

Yeah, there you go. And many people, maybe you as well, Pete, we started way back when with some of those mobile mammograms. So we did, mobile mammography with some of these things. We've made them bigger and we have them more comprehensive in terms of the care they deliver, not just focused on imaging.

Yeah, these are the stories that really melt your heart, right? 20 years ago CIO was running the network, but now, and Bill, you brought us into this good conversation about data. Once you start talking about data, you really have to understand What the organization is trying to achieve, and we do that the mobile mammography and the stories that you get out of there of people who we've been able to detect cancer early.

There is a huge barrier why women who maybe don't have a lot of money won't go get that. And we've been able to help a lot of patients. warms your heart.

 

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So the CIO role has changed pretty dramatically. And more and more when we come to these 229 meetings it's, Interesting how much of the conversation centers on the business problems that have been put in front of you.

Hey, that we're no longer operating the four walls. We're no longer talking about switches, routers, and these kinds of things. We still have to know those things clearly, but a lot more of the conversation isn't about that. It's that's Basic blocking and tackling. You have a team that you rely on to keep that stuff running and more and more.

It's like, all right, Hey we're getting outside these four walls. We need to support. rural health care clinics, mobile clinics. We need to support virtual online visits. And it's interesting , it's like the technology has taken us way beyond these old parameters of being a CIO.

I'm curious. I'd love to get your two just insights into how is the CIO role changing and continuing to change for you? Pete, we'll start with you.

There was a group that was trying to put together some leadership training for CIOs. And they said, what's the most important thing? And my message was, yeah, my message was you have to love healthcare and you have to love people.

and trying to keep them healthy. And there's a ton of opportunity in using data to keep them healthy. In the end, it's going to be a relationship with a provider, be that a nurse or a case manager, right? That's the tip of the spear in terms of what that patient wants. But that data behind it and helping get the right data, the right place at the right time, And not just the clinical data, Tim mentioned it the transportation and the housing, getting those questions in up front when we're first seeing those patients and then, we've made some mistakes.

We used to collect that data, but then the physicians felt powerless because they couldn't refer. based upon the data that they were getting. And so we had to fix that problem. And I think if I go back to the beginning and say, you have to love healthcare because it's not a fire and forget, you don't just go in there and say, okay here's your questions.

And then you'll know if they have a transportation insecurity or a housing problem, right? When they come back and they go, Hey, with, if we can't refer to that, Not that we shouldn't ask, but we're not getting any value out of asking. And then you've got to come back and do it again, and then you're going to learn something else.

So you have to love healthcare. You have to enjoy being with those frontline folks. If that's your focus, I think you have a great chance of being successful.

What I would add to is a couple things, right? Because say part of that key thing is understanding the business, Then if you see some of the what you have from an operational responsibility that reflects that must be the case, right?

So in my previous CI role at a payer, right? had an operational role over claims reso and claims call centers in addition to the tech, not all the technology areas, right? In my current role in Sentara, I just started last year, took over the clinical access center. So I'm consolidating across all of our 400 plus facilities, a 500 plus person clinical access center.

So we have an entire call center that's also doing nurse triaging, other things that's under me as well. Maybe it's a, chief dishwasher, but you think about the CIO, that's a tough thing. Is it a job that's too difficult to do across all that spectrum, right?

I think for me, at least with my experience, and if you have a lot of experience, like Pete as well, in that healthcare environment, taking on one of those other pieces, I think you can manage that. But, you're seeing a lot of segregation where the CISO organization, security organization is going under another leader inside of the organization, the Chief Digital Officer, the Chief Data Officer Analytics Officer, right?

You can see, Chief AI Officer, right? The first one that you just saw announced today with Cleveland Clinic, right? Rohit is You know, he's CDIO, is CDIO the right distinction between having a CIO and a CTO? Because you see some of the CTOs out, right? So do you have them doing kind of foundational, and then you focus on the strategy and knowing the business?

Or is it also interconnected that separating it just makes it too difficult and ineffective if you can't have a leader that can do that? And I think there's so much more value if you can have that connectedness because Why do I care about having a clinical access center and why do the CEO tag me with that?

Because we know we're focused on one center and trying to improve consumer experience. And that's another touch point. While I'm trying to figure out all these omni channels and digital interactions with the, our consumers, How can I not also see the interdependency of that with a clinical access center and what that experience is going to be and whether they can get scheduled or not scheduled, whether it's in person or with somebody on the phone or self service, right?

So they're so interdependent that you almost have to have all that because something's going to fall on the floor break if you haven't been able to have that wide enough purview. You can do that in a really good matrix organization, but we all know that a strong matrix organization is just really tough.

It's just a really tough to be effective in. And I wish we were all talented enough to do that well. But in this case, I think having that broadest purview and aperture is really a benefit to that lead.

Just after meeting, Chero Goswami from University of Wisconsin Health chaired one of the meetings and keep making fun of him because he ended up with.

like three new groups and one of them is transportation. I'm like the head of transportation, Ciro Groswami, so explain that to me. He goes it's an operations challenge major contracts associated with that. It's a people, challenge and those kinds of things.

He goes, it's all things we've been doing at CIOs. It's and they just said, Hey, you don't go in there, manage that group, give them key performance indicators and, get them, moving in a direction, take care of the contracts. And it's interesting as he was describing it, I'm like, yeah, you essentially just said the CIO is.

Fairly close to being a chief operating officer who really understands technology at a deep level. And and he said, yeah that's probably pretty accurate. We were involved in so much of the organization. That makes sense. I want to throw out the imaging. We had two companies in the room that were dedicated imaging centers.

And it leads to an interesting conversation. One, I did not realize so many health systems were struggling with imaging. I thought that was hey we have that sort of baked and running. And then I was also surprised that health systems are actually outsourcing their imaging to some of these companies.

Which is usually the case. If you struggle with it long enough, then eventually you outsource it. not going to ask you specifically, but what was interesting about that imaging conversation to you? Tim I'll start with you.

A couple of things, right? So one of them was interesting because we talked about One of the CIOs that was having success in terms of running their PACs and their VNA up out in the cloud and, about three years ago, three and a half years ago, because our cloud transformation started five years, that was one of the places we hit and pulled that back into our cloud adjacent colo because of the performance of being in cloud.

So maybe That kind of triggers me, maybe it's time to rethink about what that means. Depending on access and with large data structures like that, they just keep getting bigger with advanced imaging. The cost of cloud for that kind of persistent storage is one of the things to consider as well as the performance.

That's an interesting piece, but that's a very technical component of thinking about it, right? But when you think about the ability to consolidate and to optimize, that's been the challenge I've been having, still trying to standardize on a consolidate solution across my enterprise this was my first time in at least the provider side of healthcare three and a half years ago.

So I didn't have this previous experience, but I didn't understand. The radiologist and how the radiologist thinks and how powerful they are in terms of wanting to drive the way, working the way they want to work. And so as we consolidate this, most of that resistance is not around a technology capability to do this.

It's about a resistance to change within that particular clinical specialty area. Which I was not I was not prepared for, but I know that imaging that is a profitable area. So it does beg the question about the outsourcing. How does that help? Cause it also leads for so many other pieces.

know.

No, that was an interesting part of it because it is, it comes back to the data conversation almost. Cause they're saying, look here's the challenge. One is running out of technicians. So the technicians just to run those things is very difficult.

Second is they represent very expensive pieces of equipment. So you want to keep the utilization on those equipments really high. And sometimes the utilization gets out of whack. You don't have enough technicians to run them. Then your reads are happening all over the place, literally remote and all sorts of other things, which creates a business model where, Hey, you can have the reads done by somebody else and brought back in.

And we talked a lot about integration into the EHR and whatnot. It's an interesting little jigsaw puzzle and some people have just thrown up their hands and said, I can't get all that data, I can't figure this out. Like, how do we keep that thing running? How do we keep people there?

How do we from a utilization standpoint, they were talking about getting An additional one or two reads an hour leads to a lot of money. these are dollars. Pete, were your thoughts on that conversation?

we have a partner radiology partner. Some of the things is one, they're your business partner, but they're also business partners with other folks as well.

And so how are you going to integrate that care model in a way that makes sense and still being respectful that they're serving other customers as well. So you have to have a lot of conversations like Tim was saying about how you're going to integrate data. And then they may really do a segment so they may do what we consider traditional radiology, but then you have all the cardiology imaging right now is massive, and they may not be doing those reads, or they may be doing those reads, or how do we increase, The interventional radiology.

A lot of that stuff, some happens at their clinic locations. Some of that stuff happens here as well. And so I would just say that I think first, it's a great model, right? But you really need to understand the technology how it integrates with your other be it cardiology or interventional, whatever those things are.

From a patient perspective we're not bouncing the patient around all the time. And those are important conversations to have up front. You won't get it all right up front then the most important thing is having a strong relationship. We have a very strong relationship with the CEO of kind of our imaging partner.

He calls me on the cell phone. I call him on his cell phone. We try and coach him. You mentioned that it's hard for them to keep a staff in IT. So we try and coach them, maybe around security. Some things. They look at us as a consultant in that area. Because they don't work for you, you have a lot of other bases to cover.

But if you do it with that relationship first, I think you can do a good job.

P, what would you say, because partners, the imaging partners, we asked them, what's your biggest challenge? And they said, working with the health systems, they're like, we've got to integrate the data, and getting your attention, like getting you to work with us is hard just, it's a heavy lift.

What would you say to them for that?

So it's always going to be imperfect. But I really think the relationship is the most important thing. And also, what we've been talking about is, if you're the CIO, you have to have the sensibilities of the COO and realize this is your, You can't survive without them, right?

They really need you as well. And not to look at them as somebody who just we have a contract with and everything needs to be spelled out in the contract. This is a different business partner for you. If I had to boil it down to that, to one important thing, it would be that, right?

You have to realize that relationship, what it means to your patients and what it means to your system. But if my colleague Satish who runs ours sees this, he may say, yeah, once in a while, we have a hard time with the healthcare system, but he can call me. He calls my cell phone. It's not a big deal.

One thing that triggered for me in addition to that thinking is not just where we're at now, but where we're going to be five years from now, sustainability of that kind of. talent or to run do the reads, operate the machine. It's interesting right now because trying to get that population base trained up and being able to populate those roles and say, this is a role that's expanding while at the same time, you could argue, that the reads and the radiologists themselves may be going the other direction, right?

We've been talking about, David, we've been talking about Gen AI a little bit, but if Gen AI is going to have any success in optimizing either assisted reads or automatic reads, where it's had some of the best success over the past five years with AI, now with Gen AI, is in doing that radiology read. So now if you all of a sudden can make that that cook with that technology, you still got the point of the person that's having to physically beyond the machines and get the person through the process of being imaged.

And that's a whole different thing we should start thinking about now and start preparing in the pipeline about how we're going to do it because otherwise we're going to get here a couple of years from now and you're just going to be

At a complete standstill. I continue to, and this will be the exit I'm not sure it's a question, just a comment and love to hear your guys thoughts.

It feels to me that We're making a lot of progress in one area, and that is workflow efficiency. Now there's always opportunities, but it feels to me like, meaningful use was very difficult, and we've gotten the EHRs in there, we've gotten the other systems, and we're connecting them, and we're sharing the data.

But it feels like we are now making progress in certain areas where the flow of the patient, the experience for the patient, the flow of information. it feels like we're making progress. Do you agree with that? is there just so much still to do that? It doesn't feel that way yet.

To be fair, I came from the for profit payer world, where it was a tremendous focus and discipline for a long time. So it feels like, That has been optimized to a pretty significant level. And even before that, when I was doing management consulting, all I did was business process for engineering, which is re engineering workflows and optimizing those, especially in a digital way, even 30 years ago, believe it or not.

And I'm pretty old but I got to the provider, you're right, there was a, behind the scenes, both in standard operational, think about, R RPA type stuff, in terms of automation, but then workflows, automation, or re engineering.

in more efficiencies across the EMR and across the operational clinical workflows in general. And so I see that, it's been going for a number of years. I think that being optimized and just taking to the next level and thing that makes that most effective always is having somebody that understands the business working with a good Clinical operational partner with a not with an all of knowing what technology is out there to say, Hey, let me not just re engineer and optimize this workflow.

Let me optimize that workflow with the knowledge of what tech and other tech emergence is coming out that can take that another level because I can take advantage of it while I'm just doing a simple, business process re engineering, six sigma lean kind of one on one thing. It's got to be different than that.

And I see that just. Blowing up. And right now, as I told you with one of our big One Centera initiatives is around care delivery redesign. And you think about care delivery redesign, that's a simple term, but it's so broad in what it can mean. And whether you're going towards, team care, all the different models you want to do, leveraging virtual care, leveraging partner extenders, right?

You got to know all that stuff in the tool bag, when you start thinking about how am I going to fully re engineer that care delivery redesign. And so it's a big step, but I think people are really focusing heavy on it. And I think it will lead to opening up more availability for our staff and clinicians to be effective, to work at the top of their license.

And I believe it will have a significant feeling of an improved consumer experience that they haven't had a great experience on for many years. And so very hopeful that there's a lot to get out of the system. Just by doing that workflow and reengineering process. So it's, encouraging.

Pete, we're going to give you the last word on workflow optimization and where things are going.

Yeah. The quote that we have for every complex problem, there's always a simple answer and it's always wrong. completely agree with my colleague,. So you have to really work hard to understand, let's take something that people would think is simple, right? Opening up appointments so people can do self appointing.

There are so many different kinds of appointments. There are so many different kinds of schedules. So to standardize scheduling you have to have trust. with your provider community. You have to understand what they're doing at the front desk when they're doing their appointments. And you have to get in deep in order to build something together, not the CIO, but to build something together that's in the best interest of patients and patient care years and years ago, I would look at this from an external perspective and I'd say this is easy, right? Just, open up the schedule of the providers to me and I'll just book my own appointments. The answer is yes, but you want to do that there's insurance issues out there.

Can you book the right appointment? So we're deep into this path, but back to Tim's point, you have to really get into the workflow and spend a time with your business partners and earn the trust of your business partners and explain or not explain, but Get in a team environment so they know why this is important as well.

In the end, you'll get more efficiencies, your patients will be happier, and hopefully we'll be taking better care of everybody in our community.

Gentlemen, I want to thank you for being a part of this and chairing an event. I think we raised, my gosh, we raised close to 14, 000 at that event for Alex's lemonade stand.

Throughout the month of June, we raised close to 40, 000. It really is a testament to this community. That's really a giving community. And I appreciate your involvement and being a part of it. Thank you very much for chairing the event. Thanks. Yeah.

Thanks for having us,

Bill.

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