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Today on Keynote

(Intro) it's not just about the technology it's also about changing the care model and the way the bedside nurses work to feel like that virtual nurse is actually a part of the team.

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.

(Main) Welcome to Keynote, where I have the honor of spending time with MariJo Rugh today. She is the Vice President and CIO of UC Health Affiliates and UC Health. What's most impressive about MariJo is 25 years in healthcare IT and bringing a wealth of knowledge and experience in leading complex system implementations and advancing digital transformation in healthcare.

We hear about that a lot. We're going to hear firsthand from her today. especially since she's been so instrumental in shaping UCHealth's Affiliate Community Connect program, which is a critical initiative that fosters connectivity and collaboration across health systems. MariJo, welcome to the show.

Thanks for having me, Sarah. Good to see you today.

good to see you too. I saw you in August, which feels like it was months ago at our city tour dinner, which is actually the first time we'd had an opportunity to connect. And the way you share stories and the way that you informed, really, the group that was there was so powerful.

And I think about. You sharing your journey into healthcare, IT, what drew you to it as a field, and more importantly, what has propelled you to stay and make such an impactful difference in this industry?

Yeah I found myself working my first job, my first real job out of college. Was as a med tech or, laboratory scientists, as we call them today.

Sounds much better than med tech. But anyway, I, I was going into work every day and, worked in microbiology and I just realized that while I loved science and I loved, the aspects of, identifying organisms and reading, susceptibilities and really having an impact on patients.

And so I interviewed for a position. Moved over to Kansas City, there, doing a lot of traveling for Cerner, doing implementations, and I just absolutely loved it. So that's what got me into IT, was doing implementations. So I spent a few years there and then ended up working for a healthcare provider and that's all she wrote.

I've just been in healthcare IT ever since then and like I said, what really got me there is I just really enjoy working with people. So When we talk about working in IT, it's not the technology that gets me there. It's really more again, about the people and helping them be more effective at their job by using technology.

Yeah my first big implementation of, at the time, CPOE it was really about just transcribing orders off of paper and, addressing legibility, and that really didn't do anything providers.

It made them slower, but, the positive thing was the laboratory would get an order that was legible, and the pharmacy would get a medication order that also was legible. But it didn't do anything for the provider. And so what I've seen over time is We are finally getting to a point where we're asking physicians and clinicians and nurses to do things in the computer where it's not just something additional that they have to do.

So it's gone from that aspect to actually starting to create value for providers and nurses. So I think that's the really exciting thing is that We're now to a point where it's not just going to be, like I said, a documentation system, but it's truly going to make a difference for the clinician and the patient.

When I look at how I interact today with my providers and the abilities that I have on the patient portal, The things I can do without ever having to wait on hold, or get redirected, or listen to a voicemail, ask for somebody to call back. It's so effective for patients now as well, that again, we didn't have that 25 years ago, even 10 years ago when I started in this.

We're making great progress.

Yeah, I think one of our real game changers is our virtual health center. We have a whole team of incredibly qualified nurses and doctors. Providers that work in our virtual health center. And we're really changing the care model and making a difference. Literally, when some organizations say they're saving lives, we are saving lives now.

It hasn't been an easy journey. Many of our clinicians at the bedside have not necessarily been real accepting. It's yeah, there's somebody on the other end of that camera or a voice back there that they're not really part of my team. And I'm still at the bedside. I know my patient best, so I don't necessarily believe what they're telling me.

good idea of what's happening. It's not voodoo or guessing work. It's like they have real good data. So oftentimes they would call the bedside nurse and say, you know what, your patient's declining and we think you need to potentially call the rapid response team. The nurse would say, there's nothing wrong with my patient.

They're fine. After a couple of not good outcomes, we actually made a change such that the virtual health nurse could actually take action, not just make a suggestion, but take action and initiate the rapid response team. We actually saw a 20 percent increase in the use of the rapid response team in one of our hospitals.

So that was a pretty significant change, but that's the stuff that really gets me up every day and just thinking about how we can really extend those key care providers and those experts to patients, not only within UCHealth, but outside organizations that, want to keep their patients in the community, but they don't have the ICU staff that can actually provide the right level of care.

But they can be extended by using our virtual health center. So again, it's a game changer from my perspective. And just Not only is it technology and the innovation, but it's changing the way people think and the way they work as

Yeah, so it really does set the foundation, or I guess create the foundation for some of those additional services to be provided. We're not necessarily going into it and marketing those as the reason you should do Community Connect. It's a nice fringe benefit, so to speak, that now you have the ability.

But we can quickly, very tangible things that they can do, like Telestroke. we were already doing Telestroke, and we're doing it. With or for organizations that aren't on our instance of EPIC, but as soon as you put EPIC in there, it's like that's the next level of care and really provides the additional capabilities and knowledge that telestroke doc can really leverage and improve the care.

They're in a, mountain town that has a lot of tourism, a lot of, A lot of folks that are there in the summer but don't live there. And, a couple of situations where because they were on EPIC, they were, they had quick access to their health record, even though they lived in Texas or Oklahoma.

It just so happens they were on EPIC. Not only does it enhance the information exchange between UCHealth and our Community Connect partner, Estes Park, in this situation, but just that EPIC to EPIC. Interaction as well is huge. So again, it just brings things that you don't necessarily think about until you really experience it, but it really does.

It really is good for the patient and it's good for the providers. We always say we really do it because of the clinical collaboration, but it's not just that. Like I said, there's huge benefits to the patient as well.

And so as health systems become the aggregator the big one in town, as an example, what are some Key lessons learned from putting Community Connect together and how has it shaped the evolution of the program to date and where you want to see it go?

One of the things that we've discovered is, we're a big organization.

And she's they want to actually use the information that's gathered and during the pre admission testing process, and actually have that flow into the anesthesiology providers. And she's we've never done anything like that. We don't feel it's appropriate. So I said let's sit down and let's talk to them about it because that's what we always try to do is let's understand why it is they feel this is important.

So we really sat down and talked about, what they were trying to accomplish the next morning with the provider, as well as the OR team and the pre admission testing team and they explained why it's important. That there's a lot of information that nurse gathers in pre admission that's important to the provider and that he should know about it as he's prepping that patient for the procedure.

in your programs, then the intent and the importance is there. But how do you bring your clinicians especially into that mix? Are you using governance models, review boards, like where's the environment that being able to have a misstep and have continuous learning applied to what's happening inside your org or even with your Community Connect partners?

Where are those conversations happening?

And, a few years ago we realized that the only way we can really create a patient experience, that means it's the same regardless of which door they enter. We started to create that shared governance, which means we have expertise or representation from every hospital, every pharmacy, To a certain extent, but again we've stood up that shared governance prior to doing Community Connect.

And now as we are doing Community Connect, we just invite them to the table. So it is a little bit difficult because sometimes they don't understand the importance of the certain, and or the significance, but we literally have it written in the contract that you will participate in our governance.

It's made us, I think, a better organization because we do have to step back sometimes and consider not only how is it going to work within our organization across the multiple regions, but also how is it going to work in those community connect smaller hospitals. And oh, by the way, we have small hospitals in our organization as well.

So sometimes they get left behind, or they did, so it allows our smaller hospitals in our own system to also be heard. So it's definitely a shared governance. It's not easy, but it's definitely something that we've grown into ourselves, and then have added our Community Connect partners into as well.

I want to stay on the topic of the shared governance, mostly because I've been doing this for 30 plus years, you've been doing it for essentially 25 plus, which means we probably collectively have like over 60 years of experience in this, and yet governance is always part of the conversation.

Yeah it's tough.

I think one of the things that we do, in fact, I just got off of a meeting where we're talking about somebody was bringing something new in and it's what data? It's going to be shared and, or how do they access it? And so one of the things that we've started doing with every piece of software or even every subscription, not exactly subscription, but every, third party that we interact with or share data with, or every vendor that hosts data on the cloud, we do a really thorough system and security review, we want to make sure that, they've got protocols in place and things that assure that our data.

So again, I think we have really put some structure, some discipline into the process to make sure that we've got. Any third party that we interact with as well as I think the other component of that is, our employees are probably our biggest risk as well. Just trying to educate our employees on, what do phishing attacks look like and just making sure you don't click on links and, you just can't load an app on your phone and then use it.

So it's a complex issue, Sarah. I think it's I think it's just really scary. I would have never thought even 10 years ago that we would have these kinds of problems around cybersecurity. It's just, we talk about some of the other trends that are growing quickly. I think cybersecurity and what those bad guys are doing, , I am not an expert in it, but how they're really excelling and morphing and changing is what's really frightening.

How do we keep up with that? And I don't have great answers, but It's definitely progressing way faster than I ever would have imagined. So I think, creating communities to help educate one another and, we're not in this alone. So how do we use our, community partners or organizations like yours to help us stay abreast of some of these cyber security threats and just know what's coming and be prepared.

And the community beyond your, even the local market, to your point, when we think about, and Drex shares this on the Two Minute Drill on Hack the News and his podcast and beyond, is assume the bad guys are already there and they got there by getting there through a human.

They rarely are getting in by hacking your systems or hacking the humans. So that level of awareness. is monumental. You mentioned the APIs, and I had a conversation with the health system that when there was a third party event this year, and they had to go shut down their APIs to avoid transmitting additional data to a partner who had been compromised, they didn't have the right documentation in their organization to be able to effectively shut down that API for over six hours, because the team had done a great job building it, but The last thing that any programmer ever wants to do is documentation.

I hear you loud and clear for all the large language models that we use and the ability to transform healthcare, the bad guys have those same tools and they get to focus on only that. Now, if you told me the only thing you did all day was focus on how to keep your organization safer, more resilient, and more capable of keeping the bad guys out.

then who would be doing all of the other things that you have behind every single day? Yep, totally agree. So when you think about these new technologies, and AI gets overused, except that it really is everywhere, and we've been using it for years, it just happens to be the forefront of the way we talk about many things.

Yeah we're trying to be very strategic in, how we use AI in how we're thinking about it. We definitely want to use it from a, efficiency perspective. How can we make a doc more efficient? We're not going to, we don't want to replace the doc. We don't want to replace the nurse.

But how can we make them more effective? That's what's driving, at least on the clinical side. Now, I've also recently had some conversation with our CHRO. And, she's really looking at it as to how can we retain talent? How can we recruit talent even? How can we reduce our turnover rates?

And then, like I said, be very thoughtful. The other aspect of it is, many states are looking at And just legislation and making sure that AI isn't used in a way that creates biases or particularly on the human space. And again the HR avenues. So again, we are evaluating that right now, pulling our legal team in so we can be, have an awareness of what we need to be thinking about as we put it into place.

So we've got a lot of ideas out there right now. We are actually applying it in some ways over on the clinical side. Haven't gotten there so much on the people side yet. But again, eventually it'll just become a part of every application. It's not, we don't see it as a separate, we don't need an AI committee it needs to be an organic part of all of our applications and how we apply it no differently than other tools that we've, implemented throughout the years.

But again, you have to be thoughtful how you use it, how you implement it and make sure that you're thinking through what the, I always like to say, if are there any unintended consequences that aren't good ones and need to think through those.

And even one of my mentors, truly, she is a lawyer for a firm that specializes in healthcare law, but also recently in AI, because her whole perspective is if you have a strong governance model, like you were talking about, what is the audit trail?

How are you making sure that AI is producing the results that you can stand up for in her case in court? And from a perspective of the technologist or the CIO coming in, it's The layers that need to come in with these solutions may include general counselor, third party risk, audit. They've always been a part of the conversation.

totally agree. It'll be interesting to see, they say it's moving so quickly. So that's probably the scariest part is that it's moving so quickly. So do we have time to get some of those things in place and address those?

Concerns and risks. And so I think that's what organizations have to be careful of, is that they don't rush it, regardless of how quickly it's moving. Just be thoughtful, and do a 360 review of it and make sure that you're moving forward with the right things.

When you think back on either implementations, initiatives, projects, however you want to go about thinking what are some that you look back on that are hallmarks in your mind of everything went right with that project, or I'm not going to do that again because this happened in this project?

As you think about some of the things you've done successfully in your career or lessons learned from a benchmark in your mind perspective, what are things that you think back to that allow you to make some really good decisions today?

And oh, by the way, this was after a failure. We had done one previously and basically decided both parties decided it wasn't going to work. This in a way was our second attempt. But we were much more thoughtful this time in selecting our partner. We were much more forthright in, There's things that we haven't encountered.

We know how EPIC works. We know how it's used in our organization, but we're not exactly sure how it's going to translate to your organization. You manage your providers and you might manage them differently than what we do. So there's a lot of risk around that, but these are the expectations. We tried to really say positions not entering orders.

And I say partner, I'm moving away from the term affiliate community connect and really calling them a partner because they really are, and if they don't think of themselves as being a partner with us, as we go through this journey and implementation of our instance of Epic, it's probably not going to work out.

And I think using that first success as the example is to just to make sure they realize as we move forward that they're partners. Fast forward, we did another implementation. Small critical access hospital in Nebraska. It's where I grew up, so I love doing work out there. Farmer ranchers are the guys that you see in the waiting room or, in radiology getting a chest x ray.

Yeah, who would have ever thought that we could go live with, more of a completely virtual analyst team behind the scenes and now that's become our norm, so things that we thought we had to do during COVID. We realized are actually really great things to do. Like I said, we used to bring the whole team on site, but because of COVID and trying to reduce the risk to our teams, we decided to do most of our command center and analysts remote.

Like I said, that was a success that now is a practice that we've taken forward and it's, it ended up being a win for everybody. And I love hearing that story.

hey, you don't always have to be right there to make things happen. And so there's been this trend for people coming back to the office.

There's also been this expectation that if you work maybe remotely, you're always available and how much faster technology is going. How do you balance that expectation with your team?

I've learned to do things like schedule emails during regular business hours. Don't send them out at 5 a. m. when I'm up. You know what I mean? It's don't try to make them think that you have those same expectations and that you don't have to be online, 12 hours a day. So I do try to make sure that my habits reflect at least what I communicate with them and when that it reflects.

What I would expect of them. Like I said, I try to model what I'm doing, even though it's not exactly what I'm doing, but they can perceive it that way by doing different things. try to help with those expectations. But I also think, setting boundaries and just saying, look, I've got time on my calendar or, do not disturb.

I try to always tell people or make sure the subject line is appropriate. If it's an email thread, like where there's five emails, pull to the top what's important to them, especially if you need an action from So I think there's things that we can coach our people on, also, help introduce some of those best practices, being virtual, and just really lead by example and help them know it's okay to set boundaries.

Yeah, we work hard when we've got to go live, you're expected to be available, whatever your shift is, because we work 12 hour shifts. But that's not the norm. So I think balancing that, but. Then also, recognizing, because I think one of the things we do at UC Health is we just move so quickly and we just go from project to project, but really also taking time to acknowledge, look guys, this was a huge accomplishment that we did as a team.

With you setting the example that way, about time of day, about celebrating the wins when they are happening, are you finding that type of supportive and collaborative culture creates the right motivation for the team in this always on environment? We've always been always on. And the projects are coming faster and faster, and to your point, the complexity of what it takes to launch something is so much greater than it was before.

What are some of those key elements though, if I asked your team Hey, what makes you excited about work every day? What about your team keeps you going? What would they say?

And so I think, doing fun things together, which I need other people to help me make those things happen with the team. And do, in person meetings to try to, like I said, create that sense of family, even though we're all located in different regions, different areas of Colorado, some are in different states.

That's normal for many companies, but I think Like I said, just working together, helping them understand what their roles and responsibilities are that, we're a team. I always like to say, if we are a basketball team, not everybody can be the center, right? We all have different positions.

And if somebody's having, an issue with a family member and they need to, be late for a call or they can't facilitate a meeting that there's always someone there to fill in for them. And so I think I've been able to create that culture, not just me myself, but I think, with the group that I've got and just trying to

to with

Really message the importance of family that, it's like, guys, I had kids, one of my PMs one morning said, I'm really sorry, MariJo, but I got to go pick my son up from daycare and I'm like, been there, done that, go, so it's like, You really have to also acknowledge that we all have things outside of work, right?

We have families. And so while your job is important and you're important to UC Health, your family is also important as well. So like I said, I guess if I were to give one message there, it's really creating family and making people want to be a part of the family.

It's nice when you know that somebody has your back and can cover for you when you need it.

And someone's I got you. Don't worry about it. I can handle it. And it's nice to know that we have that flexibility in so many of our environments. I want to take a look ahead with you as you think about some of the long term goals that you have for UC Health and what you want to

Yeah I think most of my career has been so very focused on clinical applications and EMRs and clinicians and docs and, technologists.

I think what we've realized through COVID is just The importance of our employees. And so I think with, the turnover rates that we're experiencing while we're making a small dent in it, we really have to stay focused on our employees because guess what, if we take care of our employees, then we're going to take good care of our patients.

Why should an employee have to, go into SharePoint and enter an issue in a SharePoint app for when they have a facilities issue. And then they have to go over here to actually enter an incident into, our incident management system that we use in IT. So just like we need an integrated medical record where it doesn't matter if the patient was seen in clinic or if the patient was seen in the ED and admitted, it's all an integrated record.

Said that a couple of times, but also just so that they're effective. have transparency into what's happening with my ticket. I don't even know. It's like it went into a black hole. How many times do you hear that? And give them the visibility to actually know the status of the issue or the situation so that they can feel like they know what's going on and don't have to worry about it so much.

So like I said, that's a focus for me. That's probably not all healthcare IT leaders, but I really have made that a priority. And like I said, as I look at the next few years, that's going to continue to be in my forefront.

Which is so important because to your point, is it easy to be a patient? Is it easy to be an employee?

And that lens of saying it should be easy to do business here from any aspect is really key when people are having those great experiences and they're going to find ways for others to do it too, and research has shown us over the years, An employee knows within the first two weeks of joining a new company, if they've made the right decision.

Because if you show up on day one and your computer's not ready and you can't log in and your desk isn't ready, or if you're virtually can't get into the systems, what does that say about the rest of how your company is organized? And so for you to be leading with that as one of the things that's really important.

I want to be a CIO. What do you share with them?

Yeah, I think it's just, for me, it's just the fundamentals. It's, be honest, be transparent. Transcribed Be flexible make sure you listen, it's I actually was interviewing someone today and I'm like, oh my gosh, I realize he's in an interview and he wants to make sure that we understand, but I'm like, I don't know if this guy could listen, based upon what I'm hearing.

I think it's just really important. to walk into every situation, even though I've got 25 years of experience, you've got 30. How many times do you learn something new every day, right? So as you walk into a situation, don't assume that you know where they're coming from. Don't assume that you know what their issue is or what their problem is.

So be okay admitting, that was a mistake or that was the wrong direction to take. And quite frankly, if you find yourself in a situation, of which I have, where I couldn't be those things, I couldn't be honest, I couldn't be transparent, I couldn't admit I made a mistake, I had to leave the organization.

So If you find you're in that situation, it's probably not the right organization for you. Again, be able to be you, but from my perspective, you need to be those things I mentioned, which is honest, transparent, and there's always a level of flexibility and compromising that you're always going to have to make.

So again do what the organization needs you to do and not necessarily what you want to do from a career perspective. Because in the end, with the situation of our healthcare organizations today, 70 percent of hospitals in Colorado right now, today, have margins that are unsustainable. So as a healthcare CIO, you need to be helping them make the right decisions for their organization to keep their doors open.

And so I think you need to go into. The position with that understanding.

Being honest with yourself as much with your organization. Pretty darn key. Thank you for that perspective. And to your point, you got to understand the finance and operations, because it's so much more than the technology today. All right.

Are you ready for speed round? Yeah. Okay. What is one tech gadget or tool you cannot I would say my AirPods.

Very basic, but it allows me to multitask, like I can pop my airpods in, I can call my kids, they're all out of the house, or I can call one of my friends I haven't talked to, I can either cook or I can clean up after my husband's cooked, and I couldn't live without them. Hey, I'm riding my bike.

Say taking Gus for a walk. He's my dog. I can't run at the end of the day. I always have to do that earlier in the day.

But again. It's just a kind of a 30 minutes or not even 30 minutes. It might be 20. It's just a time to get outside. I love the outdoors. Get outside, just like decompress a little bit, think about the day and prepare a little bit for the next day. Visit with neighbors if they're out. Also take my mind off of work.

So yeah, I would say just taking Gus for a walk, or a smell, because he does lots of smelling, so it's a smell with some walking along the way.

And you may get to stop and smell the roses literally along the way too, and maybe even your earbuds in to help out. That's funny, we had a dog as he got older, that was all it was a take him out to sniff.

Yeah, that's a tough one for me. I haven't done a ton of traveling, at least outside the United States, so I don't think I could choose a place. I think I would want to go work maybe like in the Swiss Alps for three months, maybe in Iceland for a few months, because those are areas that I haven't necessarily experienced.

Iceland is obviously very different than Switzerland, but I think I would want to go to multiple places and just bounce around. I don't think I could choose one.

I do appreciate that. I can tell you're from Colorado because you're like both those places are potentially very cold and have mountains in your body.

Whereas I'm thinking like, Oh no, I need palm trees. I need sunshine. I need the ocean. That's great. And my last question for you in speed round, if you could instantly solve one healthcare challenge, snap of your fingers, what would it be?

So I think if I could fix something, it would be could we implement regulations. in a way that doesn't create inefficiencies or add expense. I get the need for it, but for example, I scheduled a patient via my mobile app last night, then this morning I pick up my phone and it says, your estimate is available.

That's a regulatory thing that we've had to put in place, but it's added expense to healthcare, and it's added some other problems as we tried to implement that. I'm probably, again, this truly is a magic wand moment because there's no way to fix this, but I do feel like there's a lot of things that we have to do in healthcare around regulation that just creates expense and inefficiencies and challenges that nobody really wants to deal with.

Like I said, I don't know how to fix it other than if I had a magic wand. So yeah,

I look forward to being able to do this with you again next year. And we get to talk about a whole new set of challenges, opportunities, and things that you have continued to solve through your philosophies, through your leadership and through your expertise. Thank you again for being on the show today.

Again, thanks for having me, Sarah. Good conversation. I appreciate your feedback and just your perspective as well. Always good.

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