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July 4, 2024: Michael Restuccia, SVP and CIO of Penn Medicine, explores the complexities and triumphs of leading a major academic medical center's IT department for over 17 years. How does one maintain momentum and innovation over such a long tenure? Michael delves into the importance of building a strong, mission-driven team and fostering a collaborative culture, especially in a hybrid work environment. They discuss the challenges of balancing budgets, the evolution of electronic health records, and the cautious yet optimistic approach to integrating AI in healthcare. What qualities make a successful team member in such a demanding field, and how do you retain top talent amidst fierce competition? Michael also shares insights into how technology can reduce administrative burdens for clinicians, improve patient care, and drive operational efficiency. This conversation provides a deep dive into the strategic thinking required to navigate the ever-evolving landscape of healthcare IT.

Key Points:

  • Leadership Challenges
  • Team Building
  • Budget Management
  • EHR Evolution
  • Technology Integration

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  Today on Keynote

 yeah, these were all good ideas, but what's really necessary? Have any of these really good ideas generated the benefits that you thought it would? I think we've fell victim to that a little bit, and trying to do the right thing for so many people ends up being the wrong thing for the frontline caregivers.   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 I'm joined by Michael Restuccia with Penn Medicine, CIO at Penn Medicine. Michael, welcome to the show.

thanks for having me.

Wow. It feels like we were just together because we were just together last week in Philadelphia sitting across from you.

And I guess this is a way of us capturing that conversation for others to listen in on. which is essentially the genesis for this podcast was, would people want to listen to a bunch of CIOs talking about stuff? And it turns out six years later that, they do want to listen to us talking about stuff.

So you've been in the chair for a long time. How long have you been a CIO?

At Penn Medicine for 17 plus years.

Man, what's the biggest challenge of, so Penn Medicine, Philadelphia. Penn has such a great name and Academic Medical Center but what's the biggest challenge of being a CIO for that long?

I would imagine, when you come into something, you're able to come in with a new vision and a new whatever, but 17 years, how do you keep things moving and progressing?

It's a great question because. I listen a lot to the counsel that people provide me. And in the early days here at Penn Medicine, and I joined here just as a consultant for a three to six month project during that time, there was some transition that took place.

I became the interim CIO and eventually the permanent and never did complete that three to six month project. So maybe that's why they're keeping me around.

They want that deliverable. Can you get that done?

But like most institutions, organization like Penn has a certain ambiance to it and reputation.

And the counsel I got was, listen, There's a lot of smart people here on the clinical side, on the research side, the administrative side. You're never going to be smarter than any of them, but your team can deliver the services that these people need to further advance medicine and advance and accelerate research.

And my biggest challenge has been to build the team that can enable and support. These great researchers and great clinicians and keep patients coming to Penn Medicine and try clinical trials coming to Penn Medicine. And that's why I spend a good portion of my day, week, month around two things.

One is human resources and focus on the team and on employee. Ensuring we're providing the right career paths and opportunities and ensuring we have the right technology to. Keep them turned on and ready to go and advancing their career and grow. And then I think the second area is just around budget.

It is at Penn Medicine. No different than I'm sure every other or many other provider organizations. Money is always difficult. Budgets are always tough. And trying to marry budget with human resources with the delivery of services. Is a juggling act, and it's always trying to do more with a little less.

And I think that to me sort of encapsulates what I and what my name and my peers go through each and every day. Balancing act.

I want to talk about the culture that you've built. Philadelphia is interesting because you have, Not only other health systems right around you, you have other academic medical centers right around you.

And the battle for talent is pretty fierce there So let's talk about culture and let's talk about teams. You spent a lot of time really focused in on that. What qualities do you look for in team members? Let's start there when you're making the team up when you're looking to hire what are you looking for?

I think what it boils down to what we look for and what we've trained our leaders and our managers to zero in on, and just for order of context, our entire team is about a thousand employees. And out of that, there's about 150 leaders, managers, directors, VPs, whatever. We focus a lot on our leaders in the recruiting to determine how individuals will be energized to come into a not for profit organization with a mission for the betterment of mankind, health, research and find those individuals that believe in that mission and who want to exceed expectations each and every day.

And that's what we promote during the recruiting cycle. We ask individuals to share with us whether in their professional or personal life, where have they exceeded expectations? What was the standard? What goes above and beyond? What would they bring to Penn Medicine in that respect? And it's curious when you hear some of the responses you might get, because that's not a question that most candidates are prepared for.

They're prepared for, well, tell me about. with this tool in this job, not how you exceeded expectations.

So do you, it's interesting because we have this conversation all the time of, are you hiring for the skills or are you hiring for the qualities of the individual and you're describing more of the qualities.

I imagine there is a skills bar that they need to cross. But being a part of the culture, being a part of the mission and really resonating, it seems like it's elevated to really distinguish between the people with maybe the same sets of skills.

So you're exactly right. I think what I've learned.

over my career is that really good people like to work with other really good people. So surround me with other good, really good people so we can elevate and do more and exceed those expectations. I don't want to be here picking up the work of Mike who's a slacker and doesn't live up to expectations and is always late on his deliverable with poor quality.

That's not a turn on for a high performer. High performers want to be around other high performers. And think attracting the right type of person and then creating the environment for those individuals to succeed, be recognized, grow their career. work with their manager. It's why we spend so much time with our managers on performance evaluations and job opportunities, whether within corporate IS or in other places within Penn Medicine.

It creates a great culture for success. And at this point in time, and we didn't just meet and I shared with you, At least in the last 13 years, we've always had a 95 percent or higher retention rate. And this year will be 97 percent when we close out the end of June. And that to me is the thing.

And I had to speak to a group of new hires the other day. It is the thing creating that culture for retention and opportunity and supporting your family and supporting your personal and career goals. It is the thing that I am most proud of here.

Yeah, and that's no small feat. As we sort of mentioned earlier, you have Jefferson down the street, you have Temple, you have CHOP which is an academic research institution as well.

These are some large and some specialized institutions. What's, what what's your average

not sure I have the right answer to that, but generally the data we have indicates that out of the, on average, let's say 4 percent of the employees that turn over each year.

And that we're in an industry where the average is 14 to 15%, 4 percent is, world class. We lose very few people. in that first year, as you might expect. And we lose very few people after five years. Yeah. So it's that two to five year window where people have come in and either their life has changed, they're relocating, they have a different type of relationship, they're looking for a new opportunity, The experience they've got received here allows them to move somewhere else, perhaps down the street to a higher level position.

But it's that two to five year employee that we see the most turnover, albeit it's still a low amount. And we're working hard now to figure out how we address that range of employee.

Yeah just the fact that you know that is, is interesting. I would imagine. Not a lot of leaders know those specifics.

How do you foster a collaborative culture, a culture where the teams work really well together?

Yeah, it was far easier pre COVID and pre pandemic, right? When most individuals were on site five days a week. Post the pandemic, we have remained, for those that can, relatively a remote team. And thus, if you're have the ability to work remote, you do work remote.

And those that need to be on site, like clinical engineering and desktop and entity services, they're all on site each and every day. So I really have a very mixed hybrid environment and, how do you bridge collaboration there has been a bit more of a challenge as I think everyone's experienced.

But within the teams, we have daily huddles. We have at least weekly one on ones with the manager and their teams. And so we do a really good job of collaboration. That's the feedback I get from all is within my team, great collaboration. It's when I need to go across teams, when the integration team has to work with the application team, which has to work with a software developer.

Often it's the first time they're meeting and they're meeting through some type of MS Teams or Zoom call. And people are just trying to figure each other out. It's become a bit more of a challenge. We have some, what I think is fairly unique social interactions, where we have a tool that allows people to get on and join a particular discussion on a category, which is a non professional.

So it might be Philly sports teams, or it may be great hiking areas in the region, and they build some collaboration there. I will say that my legacy here, I am sure will not be that we have great retention or great teamwork or whatever, but I do throw. Some of the best parties ever recognized by Penn Medicine with literally hundreds and hundreds of people showing up to either a holiday event that includes the DJ and obviously food and beverage and giveaways and gift cards and a variety of other things, photo booths and then a summer solstice party.

That is sort of replicated just a little bit smaller scale. That's another great way for collaboration.

Do people attend those remotely or do they come in

Bill, it is remarkable that I can ask a person to come in on a day to support something, and I get the hee and the ah, and I have to drive into the city and whatever.

People show up, literally, I think there were 500 plus people at our last holiday party. Man, that's a big

person. That's fantastic. there's something about the Philly culture, I will say. I did get to go to a baseball game with my brother and we're walking around and he's seeing people he knows.

And Philly is the biggest city with like small town feel to it. Like these people just they grew up, a lot of people don't leave there. So they grew up together. They knew each other from high school from college, whatever. And it was really interesting. The number of people that you just run into.

Do you tend to hire from Philadelphia or are you bringing some people in from outside of the area?

No, I think it's whether the folks are from Philadelphia or the suburbs or on the Jersey side. We're just a short way from New Jersey across the river.

So we have a pretty dispersed population of employees. But I do agree with your comment about, the small neighborhood feel. Philadelphia is known. By its neighborhoods. And it's often which high school did you go to or which neighborhood did you grow up in? Mount Airy, Chestnut Hill, West Philly Kensington, whatever it might be.

That's what people are associated with. And then of course, somebody knows ten other people that went to that high school or grew up in that region.

  📍 📍 📍 📍 📍 Hi everyone, I'm Sarah Richardson, president of the 229 Executive Development Community at This Week Health. I'm thrilled to share some exciting news with you. I'm launching a new show on our conference channel called Flourish. In Flourish, we dive into captivating career origin stories, offering insights and inspiration to help you thrive in your own career journey.

Whether you're a health system employee in IT or a partner looking to understand the healthcare landscape better, Flourish has something valuable for you. It's all about gaining perspectives and finding motivation to flourish in your career. .

You can tune in on ThisWeekHealth. com or wherever you listen to podcasts. Stay curious, stay inspired, and keep flourishing. I can't wait for you to join us on this journey.

 you've been there for a long time. do you have EHR implementation under your belt or was that, was the big switch over done prior to you getting there?

As I arrived at Penn Medicine in about the 2006 2007 timeframe I think we had 14 different electronic health records, whether supporting the inpatient or ambulatory settings. Most of the larger ambulatory departments had their own EMR or version of an EMR at that point in time. And part of the mission initially was twofold.

One was that at the time, 95 percent of all IS services were outsourced. Oh, wow. So one of the first steps was to begin to insource and build that team and that culture that we've spent so much time talking about. And As we were doing that, we began to set the stage for the deployment of a standard EHR platform, initially in the ambulatory setting.

And then eventually that grew into, over the years, moving that ambulatory solution, which is EPIC, into the inpatient setting and ultimately the home care setting. But we sort of do things in phases here. There's a lot of discussion that Penn Medicine. Or the University of Pennsylvania has been around for, 280 years.

And so one of the ways you can keep that momentum going is never do anything too fast or too risky. And so we do things in a lot of phases versus Big Bang. And the phased approach that I, when I speak to my colleagues is sort of like pulling the Band Aid off your arm with the air very slowly.

Comes off, but takes time versus, and it hurts, but it doesn't hurt that much. Versus ripping it off all at once and you scream and yell, but it's over quick. We do things the slow way. I applaud my colleagues that do it in the big bang approach. Cause man, they get over it, they get done and they move on.

that's interesting. So it requires you to take a much longer lens, a much longer viewpoint to things. And I'm wondering Penn's moving. I see you out in the county now. I see you you're moving in a lot of different areas. Do you set a strategy?

And then when they go, Hey, we're going to launch this new facility, you go, all right, we're going to bring that up on the standard so that you're prepared. How do you make those transitions? Slowly because a lot of people would say you're leaving a lot of inefficiencies in place as you're bringing that stuff up.

Yeah I think it's part of the plan, Bill, that, you're expanding into a region, you might be merging with another facility. There's some groundwork that has to be done in order to get people in place, get the facility in place, get marketing in place get all that in place. And while that's taking place, we begin our implementation.

Of a rollout of the EHR or whatever applications it might be. My point about the big bang versus the phased approach is big bang brings with it more risk. Cause if you get it wrong, you really don't have a chance to learn from it. You have to fix it on the fly. Whereas our approach tends to be more incremental rollouts so that if the first one has some challenges, it's contained to a smaller scale.

We adjust and the rest of the rollout goes pretty smoothly.

Wow. Talk to me a little bit. I was told by a CIO the other day that my viewpoint on budgeting has become outdated. They were saying that, we no longer do annual budgets and those kinds of things. And my thought was, I might be having a conversation with one organization and all the organizations do budgeting a little different.

Has budgeting changed over the time that you've been there? Has the cycles and The way of looking at budgeting, changing,

I think it's remained relatively the same. What I've seen has changed a little bit is the ability to look at a present investment and then understand the potential ongoing cost of that investment tied to the ongoing benefits of that investment.

And I think that's a little different view than perhaps when I first came into the role. Where it was, how much does it cost, how much do you need, and let's move on. So that projection out, and the potential benefits that might be derived, and how that might offset other costs, whether resources or other systems does take a bit more explanation.

I think it's much more business like. I also think it's, probably how other industries operate more frequently. So I think it's gotten a bit more sophisticated. I think it's gotten better. But I don't think the whole concept of budgeting has changed all that much, right? That you still have so much that comes in, only so much can go out.

What comes in varies based upon your payer mix, based upon your Population so it still has to be tied to, at the end of the day, you don't want to be operating with more expense than revenue.

From that lens, from the budgeting lens how will you and Penn Medicine approach all these AI tools?

It feels like at every turn there's a new AI tool, there's something to be brought in and integrated into your EHR, there's stuff to be integrated into your revenue cycle, or there's AI everywhere. How are you approaching that from a budgeting standpoint?

So first I would say the term I would use is cautiously.

So there are quite a bit of unknowns about how much utilization of AI will be embedded in our systems and in our applications, what that cost will be short term, long term. So to address that, we're trying to centralize a lot of our AI activity to the best that we can. So we have a communication plan that's gone out and said, We're part of the University of Pennsylvania, and we recognize advancement.

We recognize discovery, but again, there's risk associated with that. So if you're participating in some type of AI, or if you're contacted by a vendor, and every vendor has AI right now, right? sales rep walks in, first thing he says, we do AI. Really? Tell me a little bit more about your AI and how it differs from others.

But we try to centralize that and then working from a compute and storage perspective. We've allocated a certain amount of funding for this fiscal year that will serve to enable our discovery through AI. And, I say cautious, we're very cautious on the clinical side of the introduction of any AI because I think it's still yet to be proven there.

But on the administrative side, I think we've already seen some opportunities for AI, and we're a bit more aggressive in those areas.

Yeah it's interesting, the amount of AI we're seeing right now, and I'm curious your thoughts on this. It's interesting. hear CIOs saying, I'm bullish on this and push on that a little bit.

I'm saying, what do you mean by bullish? What does it look like to be bullish? And they're like, I believe in the potential of it. I don't believe that it's going to transform things tomorrow or maybe even in the next 12 to 18 months. But I believe that over time so when I push them on bullish, you think bullish means like, yeah, we're all in, we're whatever.

They're still moving cautiously, but they're saying now we've got to move. Cause this really feels like it's going to transform healthcare. How are you viewing AI at this point?

think we'd view it similarly. We have a variety of AI pilots running at this point in time, whether it's on the clinical side, particularly around clinician Satisfaction, when we look at documentation, ambient listening the ambient listening tool to try to simplify the documentation process.

And then other areas more in the administrative space, whether revenue cycle, follow up, whether there's activity in the, from an access perspective, leveraging telephony and trying to drive more calls to some type of automated resolution versus needing back end people to support. Some of those have borne some fruit, but interestingly like most things, the theory is great and it's embraced by some, and others look at it and say, yeah, this is okay, but the way I do it, it's just fine.

And so the adoption of this is yet a second phase. We have to get through the technology step first. make it available, and then we have to look to see who's going to adopt it. And I think from an AI perspective there'll be a little bit more flexibility in user adoption because it has to meet their workflow, has to meet the way they process, whereas I compare that to the electronic health record, you don't have a choice.

If you're an employee of Penn Medicine, you use the electronic health record, even though you might enjoy some other tool like paper or. Excel or whatever it might be. So I think the adoption will vary for a period of time.

So what kind of things are the clinicians asking for from the CIO today? What kind of things are they looking for from you?

What kind of problems are they looking for you to potentially help solve?

think the banner for that would be administrative burden. So can you help reduce, as I mentioned my documentation of notes, and that would be through ambient listening. Can you help me with better preparation of my patient visits?

And that would be through chart summarization tools. Like most large academics, patients come to us with a variety of different documents and backgrounds, and basically show up with a folder or deliver an electronic folder and say, here's my history. I was at hospital X for this, I was at hospital Y for that.

I have a complex case here. It takes an enormous amount of time for that clinician to prepare for that 20 minute or 30 minute introductory visit. So anything you can help from a preparation perspective and anything that can help with overall efficiency associated with the visit, meaning is there a better way to track our patients while they're in some of our larger facilities?

And understand, are they in radiology? Are they heading down for lunch or whatever it might be outside of their room? Those types of things make that a little bit more satisfied. I think the last thing, and this is more on the national scale also, is we are so proud of our patient portal, and we've branded our patient portal MyPennMedicine.

We have over a million five patients registered, and virtually all of them using it at least once each year. That, to me, and to us here, has just made our organization much more efficient. But at the same time, it's opened up some communication channels. with the caregivers that have shifted the telephone calls to the front desk and the telephone calls to others to an email to the clinician.

And there is great email burnout in trying to make sure you're getting back to patients in the required time frame. And so again, putting some type of front end tool in front of that to sort of deflect or divert those messages to the proper centralized location. Is an ongoing effort that we're going through.

But if you look at those three or four things, we can take that administrative burden off the clinician, give them more time in the clinic with their patients. I think that would be a win for everybody.

Have you guys done a significant documentation review looking at, is everything we're collecting in the EHR, is it required?

And is it still, it's funny because regulations change so often. heard conversations between clinicians, they sit there and go, the regulation doesn't require you to collect that. And the other person's oh, no, it absolutely does. And nobody really knows, but we just keep filling it out every time Because it's there.

It's in the EHR. Have you guys dug into some of those things?

Yeah, we have. And to your point, I think what we've discovered is every rationale, reason we've used to introduce something into the EHR is a really good idea on its own. And so whether it's a regulation that you have to abide by, whether it's something that might bring a little bit more efficiency.

to a portion of the organization, perhaps RevCycle or HIM or others all independently good ideas. There might be something for compliance or something for patient safety and quality. All of those get put into the EHR. And then one day you wake up and you've choked the EHR. And it's time to go back to your point and start to peel out, yeah, these were all good ideas, but what's really necessary?

And have any of these really good ideas generated the benefits that you thought it would? And I think we've fell victim to that a little bit, and trying to do the right thing for so many people ends up being the wrong thing for the frontline caregivers.

so I assume you've mentored people over the years and you've you have a leadership team and whatnot.

How do you prepare the next generation of leaders? How do you train them? How do you pass on your wisdom and your experience to them?

Is that specifically within my team?

Yeah. For the most part.

So I think where I'm pretty fortunate is back to my point about retention. The folks that.

I work most closely with.

They've been with you

for a long time. And so it's an evolution University of Penn's pretty good place to be, Wharton school, so there's opportunity for education in that respect we also sponsor a fair amount of online training that I think has been really beneficial for folks.

We certainly have a mentorship program, whether it's me mentoring or One of my peers mentoring others either within the IS department or external is another way. And Penn has a really strong tuition reimbursement program. So that was one of the first things that most institutions cut is your tuition reimbursement program.

And they really minimize it. We continue out fairly strong so that, outside support, whether it's through conferences or additional degree programs, masters, PhDs people are constantly learning. And, I think that's combined with the personalized attention and being part of a collective team.

I know the next set of leaders here, they understand what's worked. And I think they also understand with some tweaking because the world or change. How the world will work at some point in the future.

So as you reflect on your career what advice would you give an aspiring CIO or somebody who's new in the role?

Don't do it.

I hear that actually, there's a certain amount of truth to that statement.

jokingly say that cause I've had the good fortune of having three great children that have all grown up and as they went through their college career. They were able to do some type of internship at places here within Penn Medicine.

And, when they were coming out of college, the question I asked them is, so what is it you want to do? And they said, we're not totally sure what we want to do, but we know we don't want to do what you do. And so that, that's their perspective on things. But I think if I was to as I mentor other CIOs and talk to them, I go back to my earlier point.

It's really not about you. It doesn't really matter how smart or how bright or whatever you are. It's what type of team you can build and what type of culture you can create. And then foster within that culture. success. And that's where you spend the majority of your time. Find really good direct reports who understand infrastructure and technology and software development and applications.

That's the stuff those folks should be focused on. You need to be focused on tying it all together, building a culture, and making sure people want to spend their careers at your place.

When, and if you ever retire, love for you to be a part of the process of hiring future CIOs. I've been through a couple of interviews.

When I left St. Joe's, I went through a couple of interviews. was striking to me, the questions that were being asked, and I'm like, irrelevant. didn't say that, but I thought, that's an irrelevant question. That's not what you want to know. And a lot of times it was like things about the EHR.

I'm like, don't know about you, but I didn't have credentials to log into the EHR. asking me very specific questions. I could talk about workflow, and I could talk about various things, but they want to get into the nitty gritty. I'm like, again, just didn't think it's like from a relevant standpoint, you're asking me to run a thousand person organization to deliver not only your clinical side, but also your food service and your revenue cycle and your, real estate and your accounting and your ERP and your supply chain.

You're asking me to do all those things. And you're drilling in on this. I understand how important it is, but you're drilling in on this one thing. And it really is

how the system handles recurring orders.

it's that old adage. they asked I don't know if the story is true, but they asked Patton, how would you dig a trench from here to here or whatever?

And he said, I'd ask my corporal to do it, or I'd ask my whatever to do it. I hearken back. I was in so many meetings as a CIO that a lot of times, You had to give it to the corporal to do it because you can't do all this stuff.

Your summary of it is great because I often explain that as a CIO, and this is counsel I provide people, is your breadth of awareness and knowledge has to be really wide.

You can see my arms go out really wide. But your depth of knowledge across all that is veneer thin until you need to get really deep. And, today I know way more about cyber security than I ever dreamt I would know. But I have to know it. And that's an area where I have to know it. And when there's that much risk upon the organization, and I know we're no different than every other healthcare and any other organization in any industry.

Cyber security continues to be one of the top three risks. for every organization. And so that's an area where I think you have to get really deep until someone solves the problem and you no longer have cybersecurity challenges.

I'm looking forward to that day for sure. It's almost funny cause what you're describing is skill set you want to identify in college that would be good for this is cramming for an exam.

and actually I felt that way as a CIO, because The first meeting of the day you'd start and you're talking to somebody about, I don't know, oncology and then you go to the next thing and you're talking, we're building a new tower, so you're talking physical plant and that kind of stuff.

Then the next meeting you're talking about supply chain and it's every meeting I'd have to sort of reset my brain and go, okay, we're going into this meeting, what are the key in preparation? There's what are the key things I need to know about those? And you described it as To a certain extent you're this deep until you have to be, and then you're a little deeper.

And I probably know more about building buildings now than I ever wanted to, but, and I will never use again, but it was necessary at the time.

And summary of it is part of the teamwork that's required. So I talk a lot about internal teamwork within the IS team. But then being a good teammate.

With that person from real estate and construction and a good teammate with that person from revenue cycle and a good teammate, with that person from patient safety and quality. That's the glue because IIS is involved in virtually every activity that goes on within every institution. And we're relied upon to be enablers and to help be part of the solution, not part of the problem.

And that's being a good teammate. Okay. And I do think that's something that people recognize our team is really good at. We're consultative in nature, we're supportive in nature, and we're enablers in nature.

Mike, want to thank you for your time. My exit question for you is going to be probably a futures question.

So as you look out, three to five years. It's about as far as we can look out anymore. And, the foundation for technology that is in place, how will healthcare change as a result of technology over the next three to five years? If you were going to describe it from the patient and the clinician perspective, how does it change over the next three to five years?

So I've described our efforts over the last 15 years as one of being able to put technology platforms in place. So from the EHR, we have a single platform. From telephony, we have a single platform. From a mobility perspective, showing my phone, we have a single platform. The platforms take time to build, they're that foundation.

And now, we as a community. Patients, clinicians, caregivers need to drive value and efficiency out of those platforms. And I think that's where the next change comes from. So I've often shared that my background was particularly focused on building teams, structure, governance, all those things.

And, I think we have a lot of good things in place, but the next leaders need to be able to work with the patients and the clinicians to drive more value and efficiencies out of those platforms. There'll be, as indicated, much more technology around clinician efficiency and perhaps, from an AI perspective, more predictive or cognitive type of, disease identification and recognition.

More engagement from the patients. I indicated how proud we are of our patient portal, all the things we can do on that portal. But there's still more that needs to be done, right? There's more education that can be performed. There's more televisits that can be performed. And so leveraging those platforms to drive more value and more efficiency and add tied to that a higher level of care.

And perhaps even research acceleration, think is where the next three to five years are. And that's why I often say, I think the CIOs of the future many of them will have more operational experience than perhaps IT background going forward.

Yeah, fantastic. Michael, I want to thank you for your time and I want to thank you for sharing your experience with the community.

It's greatly appreciated.

Always a pleasure, Bill, and look forward to speaking further. Thanks again.

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