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  Today on Keynote

(Intro)   90 percent of the conversations I have with people are not technology based. And when they start to flow into technology, they start to want to give me the tickets.

It's I don't want to take your order. I have people to do that. I want to understand what the issue is. What's the bigger vision? What are you trying to achieve?

  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 Artisite, Dr.

First, Gozo Health, Quantum Health, and Zscaler. Now, let's jump right into the episode.

(Main)  All right, here we are for another Keynote episode and we are joined by Donna Roach, the CIO at the University of Utah Health System. And Donna, welcome back to the show. Thank you. Thanks. we were talking and it dawned on me that you haven't been on the show for a while.

And you are now in year three of your tenure at University of

Utah. Yes, just over three years.

Wow. that's an exciting time when I have conversations with people I was coaching, when you go into that role, and I think you relate to this, right? When you go into the role.

Everything's new and everyone's oh, the new person's here. They have new ideas. Let's talk. This is fun. This is great. But year three, they know who you are. They know your ideas and whatnot. It's different. The year three is you either have to reinvent yourself or quite frankly, some people, a pandemic happened, in which case the whole world changed and, year three was not that was very different.

But did you start during the pandemic? I

started smack in the middle of the pandemic. Wow. Even though it was expected of all the executives to still come in the office. It's like we came in the office, my door is closed, I have to wear a mask, if I walk out to go to the bathroom, I have to put a mask on.

It was, we were still in lockdown, but there was an expectation. Especially of the executives that they were visible and in the office. Now, my whole team, I have 400 plus people, they all work remote and they still do I have a hybrid workforce where I give them the flexibility to say, okay, if you're going to be in the office you got to commit to somewhat of a schedule for me, but for the most part, I trust you're doing the work and.

You are being productive, and it shows we do surveys, and people are constantly like, don't take it away, and I'm like, I have no intention of

taking it away. I know, and it's, they're so passionate about this. I'm not sure we're ever going back. I'm not sure we should want to go back, but I'm not sure we're ever going back.

I

agree, and I think IT is just so well suited to work remote. I think you get more out of people, I think, some, and not that I want people to, I think they work more. Which I really don't want people to. I want them to have a balance to their life. But I think they're more productive and they're happier about what they're doing.

Now, I'll tell you, I do have some people who, they probably have a lot of kids at home or maybe little ones at home. And they're like, I want to go back to the office please. And I can relate to that. I had kids. It's growing, and you're like, holy cow, I can't get anything done because if it's not the kids, it's the dogs, it's the, it's something.

I'm sure it creates a whole new set of problems. I was recounting with someone today, one of my HR stories from way back when I was at St. Joe's. And I'm thinking of the workplace had its own set of challenges. I can't believe that person said that to that person in that context.

And then HR would get involved. You'd have all those things and whatever. I would assume maybe those kinds of encounters have. Diminished, but you probably have other kinds of things where people are like, Hey, I'm not gonna be able to make that meeting. I have to, go shopping or I have to, maybe not that blatant but you do have some of that Hey, where are you?

There's a meeting going on that you should be.

Yeah. Yeah. I think, most people fall into the trap of. The little bit of complacency, right? I do. I do it. I've, have, especially if you're on different time zones and you go into a different time zone, you're like, oh, my gosh, it's central time zone, not mountain time.

But, there, what I will say, and I am very appreciative of the group of people that report up to me here. They are extremely thoughtful. And. Most of the time when I don't see someone on a meeting that should be on a meeting. And I pinged them. Normally it's, they're dealing with a problem.

It's not like an issue of, oh, I totally, lost it there. They're usually like, there's something bigger going on. And I'm like, okay, we got it. Don't worry about it. You have to have that trust level with people. and if you do have, an issue where there's just bad behavior or problem with somebody, you address the bad behavior.

You don't, because other people notice it. And if you don't address it and you don't put it out there it can come back and bite you in the butt. So it's address it. I try not to ever address it. In front of other people. Although I've, I've made a few mistakes

my mentor used to say, problems do not get better with time. And it's not like wine. Like you let it sit for a while and you go in and you're like, man, this has really gotten better. It usually does not. It's like address it now. And. Things, tend to

go better. And, I've always said to, bad behavior is bad behavior, but when you see somebody else with bad behavior that maybe isn't in your organization and it continues, right?

It's usually somebody above is allowing that bad behavior to occur. And it's so you have to be really sensitive to how do you address it, because normally I just would head on and go, boom, address it, but if that person above is going, hey, I appreciate it because they get to be the bad guy.

It's Ooh,

I've never told this story on the air and it could be why you're a sitting CIO and I'm not a sitting CIO and on this side of the microphone, but I had to do a presentation once to some docs. And so I drove down. It was in the evening. And there was dinner and the one doctor got up to introduce me and it was going to be one of those meetings where they were going to tell me how bad the EHR was and all the things that we had to fix and whatnot.

And I was open for that and that's actually, I was hoping for that discussion with this group docs and he does his introduction and he shows a video. He goes I'd like to start by, showing you a video of, what we doctors experience with. this and it's a cartoon and this doctor just getting increasingly frustrated with the computer until he's, smashing it with a sledgehammer and he, it destroys it.

And he goes and this is the guy who made all that happen, Bill. And I stood up, I looked at him and I looked over at the senior executive who was with me, who was there to support me and stuff. And I looked back and I said, That was the rudest introduction I've ever received. And I just started going.

I'm like, that's the rudest introduction I've ever received. I want you to know that my, I have a team of professionals that's working really hard. to make sure that the EHR works for you. And I'm here to listen, to understand what we can do to make it better. But this could be the reason why you're a sitting CIO and I'm not.

But the thing I appreciated was that the senior executive who was with me who was an executive VP essentially pulled that doctor aside later and said, that was really

inappropriate. Yeah, and it's don't do that again. Yeah. I one time and I always think sometimes humor, helps goes a long way.

I had one of those okay, you're coming to the meeting. It's all these doctors, they're really upset and they're going to take you to task. And I'm like, okay, here it comes. And I actually thought about trying to find like an old breastplate arm, but my son at the time, He was friends with one of the coaches of the Bears and he had a Bear's helmet, like a real Bear's helmet. Oh, that's so much better. So I actually had placed the helmet in the podium. And so I go up there and they introduce me and I said, okay wait a minute. I was told that you had some real good comments for me, but hold on for a minute.

I need to do something and put the helmet on. and for the first five, 10 minutes, I just talked through with the helmet on. And these doctors were like, Oh, my God. I'm like, okay, I think I could take the helmet off because I think all the bad stuff's done. So I'm going to take that off. And I said, What else do you have for me?

And I I took a little bit of the air out of their balloon, it was like, but I get it. I know that you're upset. And I know I'm just the messenger You know, coming onto the battlefield and I'm just the target, I'll try to listen as well as I

can.

Yeah, and that's what we do, we listen. So I'm curious, you come in during the pandemic, did you inherit like a Five year strategy and digital roadmap, or did you have to, bring people together to try to

develop one? Yeah, no, it's funny. The second day I was here, I ran into the chief operating officer, who's now the CEO, and he says, hey Donna he showed me the value roadmap from the hospital.

So the strategy From the hospital, and he says, okay here's this one thing on here. You and the CMIO, you need to develop the digital strategy. And I'm like, oh, okay. And I thought, through all the interviews This

little bullet point over here. Hey, can you develop for us a digital roadmap and strategy?

Could you have it to me on Monday,

please? It was almost that, but not the Monday part. I think you But I looked at it and went oh, okay. I said, Help me out here. Tell me what you think a digital strategy is and he, and rightfully I think a lot of people, a lot of executives fall into this.

This is not him. I think everybody's it's virtual care, right? It's telehealth. And I'm like, ah it's a little bit more than that. And you're okay if I make it more than that, right? Oh yeah, go for it. And I said, okay, and free reign, and he's, oh yep. And so it just blossomed from that.

It was like, oh, and to me, it was like, this is exciting that, okay, here go forth and conquer. The other beautiful thing that happened, and I say this, no tongue in cheek at all. Dr. Good, who is the Senior Vice President of Health Sciences, so my boss, the CEO, reports to him he had created a 2025 strategy refresh for health sciences.

And every year we do directed steps out of that. And somebody showed me the document and the directed steps. And I'm like, oh my gosh, this is like an IT person's dream come true. Because here, just throughout the whole strategy, were IT components that would have to be addressed. And so I had a meeting with Dr. Good and I said, I saw this. I said, this is great. He goes, really? And I'm like, yeah, This will be the basis of our roadmap. And there was a meeting coming up to do the directed steps. And he's we'll get you invited. And I, got invited to the Baker meeting.

And so we do this on a regular basis. And I've told Dr. Good and my DEC members and everything. That document to me was a gift. That's a gift that kind of in your lap because now you really do know what the organization wants from IT. Now, is it a lot of stuff? Absolutely. Does it all come together in this beautiful little picture of stuff?

No, but that's my job. That's part of the roadmap. That's part of what the deck, governance needs to help in prioritizing, but it At least it teases out and tells you what they're looking for and what they want. And you know how hard that is to get. Oh, I know. And it's here, take

it.

So well the wisdom you showed with the COO at the time and just asking the clarifying questions. it's so important. 'cause expectations are the mother of all disappointments. Let me just clarify real quick here. You're asking for this. What do you think this is? Oh, it's this.

Oh, okay. I mean that there's so much wisdom in getting that clarification. And then the other part of the wisdom is, if there's already something moving. that has momentum. It's so hard to get something going from nothing. Yes. Something's already moving and it's close to where it needs to take you.

my gosh, take advantage of the momentum.

It's like Kotter, change management. Think about it. The drive has already been there. Now all of these guiding forces and groups are already formed. it got jump started. It's ooh, I'm just jumping right into this.

And it's taken us, we're like onto Our fourth digital roadmap. So now we're developing our 2024 one. but if I showed you a picture of where we were to where we're at now, just the visual itself shows you the complexity and how it's been added on to when, and the.

The changes that have occurred, which really it's makes you feel really good that. You tapped into something that helps guide and direct you. And had a meeting today and with our home care people, and I was trying to tell the new CEO of our home care group about this, and he's wow that's really good. That's unusual. is home care on in the directed steps? And we're, I'm like yep, because we do a Heal at Home program and looking at hospital at home, like everybody else. I said, yeah, and there's other things too, when we think about remote care, and how we can, yeah.

tap into and really help support the remote nature of how we deliver care. Because if you think about it, Utah is in a huge state, but it has a lot of rural pockets to it that are really underserved. And there's, Indian reservations and communities that are underserved. And so being able to reach out.

And kind of raise the water level of the quality of care. for me, that's what drives me, but that's also one of the missions of University of Utah

Health. you do a lot of education of the next generation. I know you do the Seattle boot camps and any opportunity you have to pour into the next generation, you do.

This question is along those lines. For the next generation, I'm How would you describe a day in the life of a CIO?

So there's a double edged sword to that, right? Because I can describe how I look at it right now. And I think about it from a strategic level of how am I like in Hamilton, how am I invited into the room?

And how do I get to be at the table? To me, that's key in terms of what I do. Now, it's dangerous because I grew up in the IT space and so I could, I'm dangerous enough to know the application side and the network side and, program management and stuff. And so I can ask some really detailed, pointed questions, which make, it makes people very

nervous

did some consulting work for you at a previous company. Yeah, you do ask pointed questions.

they'll look at you and you're like you're micromanaging. And I'm like, no, I'm zooming in. And then I zoom out. And if I'm comfortable in the zooming in with you, I will keep zooming out.

So I have a better picture and a trust level with how you're doing. So that's how I operate, right? The thing is that people coming up. They're, and I have several of them on my staff. They are so energized and they don't see the limits. They don't get bogged down by some of the stuff.

barriers sometimes that I see because I came up this route. And so I'm cautious. This is where the double edged sword is I don't want them to lose their enthusiasm. I don't want them to lose their way they look at the world a little bit differently. And then, it's I don't want to squash it.

So I'm really careful about when I'm trying to mentor or guide someone, I want to know, what are you thinking? tell me, how are you developing this idea? And if I see holes, I'll be like drill into this, look at this, and then come back and let's talk about it. Now, they don't always like that, but it's that's the guidance I would give them.

It's be really comfortable in being challenged. Yeah. Because if you aren't comfortable in that, you won't survive at the executive level.

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it's a day in the life is an interesting question to me. 'cause I would say there's seasons that happen throughout the year, and so there's a budget season.

Yes. And during that budget season, you almost feel like a CFO. You're the CFO so a lot of the, time you are, corralling, Hey, what are the objectives? How does it match with the strategy? What's the financing? How much do we need? Do we have to do all that this year? Can we spread it out over to you?

It's a lot of financial conversations. So the day in the life, if you catch me in that season, you're going to be like, wow, you do a lot of numbers, but then that season ends. It ends less and less. Now we talk about money a lot, but once that season ends, you get to like immediately following budget season becomes implementation season.

Okay. Here's your budget money. Go do these projects. Now all of a sudden they're like. Man, you look like a high level project manager. It's yeah we're kicking off a lot of projects. I'm mentoring people. I'm getting them started. I'm making sure that we put the right governance in place. So it looks very different at that point.

almost hard to say a day. two days look the same to you?

no, not really. But the one thing I'll caution you, and I think what you just said would have fit 10 years ago. Yeah. I don't, it's not that way anymore. It's constantly a budget cycle. It's constantly an implementation cycle.

We're trying to do things more in an agile way. I really want to get away from waterfall. Lori was on your show and I'm like, Oh my God, she's just wonderful. From university of Vermont and that whole concept of. Okay, being agile, let's turn these things around faster. And what that does, it's an implication to your budget and how you manage your budget, whether it be dollars or resources.

And it's also your relationships with your operational leaders, getting them involved. yes, there's still the whole budget cycle. So you still have the operating budget and you have the capital. But even

then I've heard CFOs talking about like these agile budget cycles essentially is the terminology I'll use it for this.

Yeah, and we've moved, even on our capital process, we moved to a three times a year, I think it's a review of capital. And so it's changed because the whole nature if you wait for a budget cycle, you've waited too long. You have to be like constantly, what is the right thing to be doing in a shorter amount of time?

And it may be. condensed in terms of your outcomes, but your iterations are much faster.

Let me ask you a question about that then. So are we more aware of projects that aren't going well and do we shut those down with these shorter cycles?

I think so. what we try to do, especially in my shop, and what I'm trying to get my team to think more about are the earlier stage gate reviews.

When I first got here, executives didn't know how their name was being invoked to a project. I pulled it all back and said, okay. You're gonna understand when that new project proposal gets submitted, that you have to sign off on it because I'm not doing any work on it.

I'm not having my team do any work until you say, yes, this is a good project. So we have different stage gate reviews before we really jump into even an RFP implementation, getting contracts or anything in place. And we try to circulate that pretty fast. We also have, standard, okay, primary, secondary, tertiary kind of prioritization, and I'm sad to say I've had to educate organization on, you know what, if something's tertiary, it's probably not going to on the list.

You're really just, we're focused on the primary and secondary. And if that tertiary stays on for longer than 18 months, it's getting kicked off the list. And they're like, no, you can't. And I'm like, it's old. It doesn't even apply anymore. And if it's really, truly initiative. It needs to come back and you need to re initiate it and your executive needs to make it either primary or secondary.

last three years? What's a project that your team has done at University of Utah Health? that you're proud of that, you would tout to your peers.

I'm going to talk about this later this week.

It's, so we've worked really closely with Microsoft and Nuance and the whole Co Pilot, and we wanted to get away from the older version of the ambient listening and move more to Co Pilot, but we wanted. to do it with EPICS's Haiku in mainly ambulatory practice, right? It took us a long time to get that contractually and just in a good setting in order to move forward.

To the point where I had physicians like, we have to do this now. Let's do it now. And I'm like, we have to have the right contract. So finally we got it going. And just in the last two weeks we started out with eight physicians and it, again, it's the ambient listening. You initiate the office visit through Haiku, and it captures the information and the notes into record.

So we started with eight, and we probably within I think a 48 hour period of time, we had notes collected and other physicians started to find out. So now I think we're at about 25 docs. Now realize were not even a month into this. So we have about 25 docs who are testing this out for us. We have over 600 nodes.

that have been created using this ambient listening. And it is really exciting. And the thing is it's exciting because it's going directly through Haiku into the record. And they still have to review it and for accuracy and stuff. But the funniest thing was, and here's something to think about.

The physicians were coming back to us and they're like, Hey, my MA usually collects all this information now and I don't need that MA to do that because it's right there in my initial exam and stuff and we're like, that's right. So They're like how can I include it? And it's why don't you shift? that MA into work that is probably more productive than that initial 15 minute coming in and collecting all the information and then the doc reviewing. Because right now it's all collected when the doc walks into that room and collects that information.

So it's a real like light bulb moment that's gone on that, we've leveraged a lot of MA utilization. and those people aren't going away, they're not losing their jobs. Those people can really now be shifted into work that we really need as we look through the whole clinical, workflow that is, really in need of that skill set.

So what's the gate that says, okay, we're going to roll this out to. As much of our ambulatory docs as makes sense.

It'll be a budgetary review that we'll do with our medical group because there is a cost per physician that we will have to look at. So that's the most critical gate to look at.

But if I can show efficiency, which I'm already demonstrating. efficiency from the physician. We're getting great feedback. And there was a few little bumps along the way, but we corrected them. So we can show that efficiency. We can show maybe even our repurposing of the MA. We can get feedback because we use Qualtrics in our patient experience.

We can get feedback that, hey, you know what, that doc isn't, on a keyboard, it's actually capturing the. Communication, and now I'm really having a face to face communication with you. Now the thing you have to prepare people for is that I'm going to be asking questions.

And it, in terms of it flowing into the workflow, the patients are very adaptive. They're like, oh, this is great. And especially if I can now have a face to face, eye to eye communication with you, that, me, that says a lot about improving the patient experience.

Yeah we have come so far.

With this the most organizations slowed down on this because of the cost? Yeah, because prior to the copilot model or the generative AI model the cost was really prohibitive because it was essentially scribes. in another place but it's still not a slam dunk.

Even with this model, even though we've taken a lot of the human scribe aspect out of it, it's still not a slam dunk. There's still a per doctor per month costs associated with it. So you still have to create That financial model that shows people, hey, look, it is this much per doctor per month, but it's creating this kind of

efficiency.

And the beauty of it is It's really the physicians creating the story and creating the benefit analysis back from a a cost support mechanism. So it's not IT going in saying, Oh, this is, it really is. It's driven by physicians in the ambulatory care space.

So

I assume you want most of your projects to emanate from the physician community and whatnot. Are there any projects that emanate from the patient community?

So we listened to a lot of great feedback from our patient experience data and. Really try to tweak and understand the portal, the interaction with, MyChart and the portal.

For example, like online scheduling, that, that's a huge one for us. And the fact that, they're ask of us is. Give us more. If I want to go online and I'm going online, you can't just push me out to a July 2024 date. What's available? And that online scheduling is one that is key to I think patient feedback and the whole patient experience.

Also, just the continuing improvement of virtual care. We look at that feedback that we get from our patients and that those encounters, it's like, how do you improve that experience so that it's not disjointed from a regular ambulatory visit. And then it's also, patients want that encounter.

That. follow up is a huge benefit to them so that they're not having to drive all the way into, what we call up on the hill and especially in bad weather when, we get, this is our big snow time, the snow was season. So that's a key one in our roadmap.

One of the swim lanes is all around personalization. And so how do we look at that patient experience data and we say, okay, how do we improve upon the patient, patient experience data? One of the, we're actually going, yeah, we're going live with this today. one of the features of Epic is called Hello World.

So it's that CRM component. So now if I'm, I'm at the navigation center, I can actually now collect information from the patient not appropriate for the medical record, but it acts as a way of personalizing those data points. from the patient's perspective, and can carry forward, or I can give that CRM note maybe to the office that it's directed towards, or to a nurse in that ambulatory practice.

Those are all things that are driven from our patient's feedback.

Final two questions and these are more outward focused kind of questions. forward a decade, You look at healthcare what technology or what things that we are looking at today do you think will be indispensable to healthcare?

Something that we really can't believe we've lived without to this point.

my vision or what I've always thought we should be able to have is utilizing the backbone of Our cable systems, our internet systems, is that there's more real time outreach to people in the home when they want it.

That I can call up a station and be connected directly into and being personalized to my healthcare provider or to just some kind of ancillary service that I'm interested in purchasing. And It gives me, especially like I have older parents where, I think being able to have that more virtual care and being able to offer it without having to pack them up and get them to the doctor's office, that it be a more seamless service.

I don't. truly have all of the pieces and parts of how to improve upon it, but it's all there. The backbone, the technology is all there. Now it's just the people process. Things that need to be incorporated into what we're doing. So that, I think that would be exciting.

Yeah, do as well. I'm going to, because we're running up on time here, and I want to respect your time.

the career path for a CIO, they're all the same, right? Everybody just follows the same path and they end up becoming a CIO. I joke about that because people always ask me, it's like, what's the career path to become a CIO? Now, when I met you and Ciro, neither one of you were CIOs. You were both in, a very reputable healthcare institution doing various pieces of the organization.

what do you attribute The success that the two of you have had to get to the level of being a CIO for the type of institutions that you're for, is there a certain type of learning? Is there a certain type of demeanor? Is there a certain approach that you feel helped you to be ready for this opportunity when it presented itself?

Yeah, so I understand the healthcare industry. I understand all the various elements in the delivery mechanism of healthcare, more so than I am an IT professional. And knowing that workflow, and knowing all of the components of it, because my background is in health administration, and I understand where healthcare came from, how it's gotten to where it's at.

And I can. almost project. my husband says, I have this weird way of knowing what's going to happen five years from now in healthcare, because you start to see the trends and you start to see how it's going to be impacted. So understanding the almost healthcare economics for me, is really key because then I can have conversations.

With people in my institution and outside of the institution that aren't about IT, it's about health care and health care workflows and where's health care going and how should we position ourselves. So that to me is key. I also think you have to be really careful in this job to be a relationship person and want to build relationships.

and understanding of what are different people's needs. Knowing that 90 percent of the conversations I have with people are not technology based. And when they start to flow into technology, they start to want to give me the tickets. Oh, be an order taker.

It's no. let's talk about the big picture. What do you want? Where are you going? What do you want to do with all of this? And that sometimes makes them very uncomfortable because they're looking at me like why aren't you just taking my order?

It's I don't want to take your order. I have people to do that. I want to understand what the issue is. What's the bigger vision? What are you trying to achieve? And then, for the most part, it clicks in, but you have to be really careful not to fall into that trap. And I know Tiro really well, and he does the same thing I do when people get into the nitty gritty of stuff.

He's no, let's talk about the bigger picture, and let, where do you want to go with it? And You laugh because it's like, people want to drop it in your lap and you're like no let's address it together. Let's work on it together.

You are a higher order problem solver.

And by facilitating those conversation, engages people as co creators in their own future. it's phenomenal advice for those who are looking to get into the CIO job because people will ask me, what's, what is the CIO job? I'm like, I'll talk to a hundred this year and they're all very different in terms of their background, their education, their whatever, but the commonality is they're really adept problem solvers.

the ones who get to be at the elite institutions are really good with people and really good at helping people.

And I think too you can't let your ego, like somebody is always going to be smarter than you and you just have to acknowledge it. You're like, yeah. And give them their due, right?

Like I learned so much from my peers and I am very blessed. to have a group of peers that want to share, but also are so intelligent. I'm like, sometimes I look around and go, how did I get into this group? I just don't know.

Ah, you belong in that room. I appreciate this conversation. it was enlightening as always.

And we will have to do this again. And we should not wait this long before we do this again.

I would like that. Thank you, Bill.  

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