This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Al Smith: (Intro) I don't think as an industry we've done enough talk about business continuity.

I think many people have just said that's cyber, that's the CIO's job, and it's really not. It's a shared game.

Bill Russell: My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week.

Now, let's jump right into the episode.

(Main) Alright, it's keynote and today we're joined by Al Smith with Lifepoint Health. Al welcome to the show. Thanks. Thanks for having me. we've had several conversations in the past. And I don't think we've ever captured a show. Have we ever done a show before?

Al Smith: No. We've only

known each other. What, for six months, eight months,

Bill Russell: six months. First time on the show. Maybe a year, something like that. Alright. For some people might not be familiar with Lifepoint.

Al Smith: So Lifepoint Health is a for-profit health system based here, right? Just outside of Nashville, Tennessee. We have 58 acute care hospitals spread across the country. Think typical hospital for us is a hundred to 200 beds, so more of a rural health play.

And we have 45 rehab hospitals freestanding and we're number two in that market. And adding those about eight to 10 of those a year. And then year plus ago, we got into behavioral health, and now we have 23 freestanding behavioral health hospitals, about 2,500 employed physicians as well.

So a little over 10 billion as of last year.

Bill Russell: Wow. And you guys are going in a lot of different directions. Are they very different to manage or are they similar systems across the board

Al Smith: They're different systems. Well, a couple things about us. We're a private equity owned, we've been in acquisition mode for all 25 years plus that we've existed.

We run a lot of different EMRs. Most of that's in the acute care side. We're a lot more formulaic or standardized on the post-acute, but they are slightly different businesses. They build differently. The regulations are different. Some of 'em are up under like MUPI, other ones aren't.

So it is a challenge.

Bill Russell: That sounds like every day could be a different day for you depending on what's going on and what's coming down the pike. Before we go down this path I'd love to hear more about your journey of becoming A CIO at Lifepoint.

What prepared you for this and how did you end up in this role?

Al Smith: Yeah. You know, a little bit of an accidental IT person. Accidental. CIOI, I can't say that, you know, way back when. Well, to be honest, when I started more than 30 years ago, there weren't CIO roles. So I don't know, any of us sat down and said, I wanna be a CIO someday.

Those roles, as you know, they didn't exist. Right. So I was a finance undergrad group in Michigan. Went to Michigan State and ended up going to work for Anderson Consulting through a good friend of mine encouraged me to go the big five route, tell 'em they would teach me a lot in a very short time period.

I like to tell people I haven't moved, but I've worn three different logos in those 14 years. It's been kind of interesting to go up that way. So kind of fell into it. This wasn't really the plan of being a finance major, but I got into it and I just loved it. I get bored easily, so I just love the challenge.

You're always learning something new, whether it's a business process or technology sitting in the seat that I do.

Bill Russell: What's a pivotal moment or person that shaped your approach? To the role that you're in now the CIO or healthcare technology leadership?

Al Smith: Yeah. Throw out a couple, if I go way back to, how did I get into IT? There was a good friend of ours neighbor, who ended up being a Fortune 50 CFO, and. You know, I was a finance major. I thought I'd go into banking or something. At that time in the eighties, everybody wanted to go to Wall Street, you know, all that kind of stuff.

Go back and get your MBA and do something else. And so that was part of how I got into it, was just listening to him and taking his advice. And I've thanked him several times since that he changed my life in a lot of ways. The other one I'd throw out is when I first became a CIO, I worked for a really good C EO and he gave me a lot of latitude, had a lot of trust in me to kind of build a team really from scratch, do a lot of system conversions and kind of take in a different trajectory. And he really shaped a lot of just management style. I really liked working for him E loud. He gave us enough freedom to fail a little bit.

You don't bet the farm, but you know, try things. Don't be afraid to try things. It doesn't have to be perfect all the time. And he always taught me to always just keep moving forward. Sometimes it's not graceful, you're not always sprinting forward. Sometimes you stumble. But just keep moving forward, keep making things better day by day.

Bill Russell: I've changed the format of the interview a little bit becuase

I wanna start getting how CIOs think out there. And one of the things I started doing, and Yoiu're only the second person I've done this with, but it's the CIO escape room.

So you're familiar with what, an escape room is, right? Yep, absolutely. I just wanna get your, like, how you approach certain things. So the first CIO escape room is the legacy system. Let's call it the legacy system Labyrinth. All right? So you're at a health system with mission critical systems, ton of legacy systems that are increasingly unstable.

Exit requires balancing the immediate stability with future innovation. How do you approach that? How do you make things stable that you have, but still figure out a way to innovate in the future?

Al Smith: Well That's a balance all the time. because we've got quite a bit of, if I look at my EMR stack, I've got all kinds of stuff.

So I'd start to risk stratify and then I'm very comfortable taking a look at partnerships. So , can you have somebody cloud host it? Can you give it to somebody? Maybe you don't have a good support team. Is there somebody, I mean, I've leveraged other health systems support one-off applications that I didn't know much about and I didn't have good skills.

So how do you use partnerships to see how you can shore up either your team or your technical skills or your data center or whatever you need to? So I'd start with risk stratification and then start going down through. What's gonna fail? Is this a technology issue? Is it an application sunset issue?

And then anything we do in terms of application rationalization, it's gotta have a good business case. Unless it's just imminent gonna fail in the business, you know, then you start talking business impact. And I think that's always super helpful is that you have to learn to translate these types of risks into what does it mean to the business.

There's never enough money to eliminate all risk. What risk are you gonna mitigate? What can you mitigate and then how do you go about it?

Bill Russell: Going back. So you've been in this role for quite a number of years. How has it evolved? I mean, you clearly have a very strong business background.

You're able to speak business but it's also important to be able to speak technical speak technology, if you will has that evolved over the last you know, 15, 16 years that you've been in the role. And Which of those do you speak more today?

Business or technology?

Al Smith: I, you know, I'd say it's about 50 50. It depends who you're working with, obviously when you're with your internal teams or then you're probably talking a little bit more tech. When you're talking to the business. You need to talk about use cases, you need to talk about innovation.

My role is chief translator. So when people go, I want AI, I start with first, what is it? And let's not talk tools. Let's talk what are we trying to do? because no tool is the answer to everything. So let's talk to use cases and then we back into technology that supports whatever we're trying to do. If it's takes cost out in the HR process, it may not be AI, it might be a RPA, it may be something else.

So, but I would say it's changed and we talk business more than pure tech that we might have done a few years ago.

Bill Russell: So, another escape room. This one hits a little close to home. We've had a couple of these over the last couple years, and it is partner failure, right? We've had Kronos in the cloud go down for an extended period of time.

We've had change healthcare go down for an extended period of time. So partner goes down, systems go down, that are partner type systems. How do you do that? Some of these are pretty well knitted into the fabric of what we do every day that it's hard to extricate them.

Al Smith: couple things. I think it's interesting because, we pride ourselves in running pretty efficient. We run pretty low cost, and one way to do that is to get to one thing, right? Run one contract, one vendor. Everything goes through change healthcare, and it's been interesting post that we've changed dialogue to, well, maybe we should have two.

Maybe we should spread the risk a little. So on one hand. I wanna get efficient and drive my cost down. On the other hand, I'm like, I may pay a little more, but now I've mitigated risk. So there's been some of those discussions, which has been interesting because until smokes happen, it was always get to one, drive the cost down, don't worry about it.

I think the second thing is done is and I've used this with our COO, we need more focus on business continuity. I own cyber and getting us back up. As the chief operator you need to own how do we continue to operate in a degradated environment because it's gonna happen to us.

I think many people have just said that's cyber, that's the CIO's job, and it's really not. It's a shared game. So I think that's changed to some degree and because of some of these big issues changed the conversation and people get it more than maybe they did in the past.

Bill Russell: Yeah, we had a 229 meeting and usually we have the technology folks.

I'll ask the question, who owns business continuity? And they'll say, well, you know, it's gotta be shared operational and strategy. I did one. Where it was all the RevCycle leaders, so it was just RevCycle leaders in the room. I said, who owns business continuity? And they all said IT. I was like, I'm like, yeah, that's the problem.

It is like we're trying to get that message out that, hey, this is an operational problem, probably more so than a technology problem, but it's been a tough message to get out there.

Al Smith: I think some of that comes back to being that chief translator a little bit. What does business continuity mean?

I'm not there. What are you gonna do? So I hate to say that, but sometimes the best test is a. Change healthcare in our event that kind of forces everybody to say what are we gonna do? So it's been interesting. So it's a matter of when, it's not a matter of if these days,

Bill Russell: Nothing teaches like, lived experience.

Let's go down this path. Let's start with data strategy unified system, unified data lake, or specialized data ecosystems. Which direction do you think makes the most sense for a modern CIO today?

Yeah, I'd say a little bit

Al Smith: of both, but we've got a strategic partnership with Microsoft and then with Palantir, one of the challenges for us is because you have all the different business units and I run a lot of different EMRs. I can't ride one vendor.

But then you've gotta have some data marks. Now maybe those are just part of Unified Data lake or you're pulling 'em off physically. I mean, there's some different ways to architect it, but our goal is to get everything in one data lake. I call it almost like back office integration where you're pulling all the data and if you can pull all that out and let people make decisions, what we're trying to do is mask the fact that we have so much disparity upfront,

Bill Russell: Classic build

Al Smith: versus buy.

We are a buy company for the most part. I have, I think two or three developers. Having said that, we do have an incubator that we do. We let them build stuff for us, and then we've got some partnership like with Palantir, where they're building for us. But we typically buy things. Wow.

Bill Russell: Let's go down this path.

So, a lot of people are saying things like cloud first and cloud, whatever. I don't know what to pit it against. How about cloud versus best fit? Do you know what I'm saying? Like cloud first versus, like the best fit for what you're trying to do?

Al Smith: Yeah. Well I'm definitely in the best fit.

Does it give us some advantage? Are we looking at technical data? Are we trying to get out of a data center? What is it? But we are not just cloud first. We take a look at anything we do when we come up for replatforming or technical debt erasure. For lack of a better term, we evaluate both and make the best decision.

Bill Russell: I'll give you one last one. So, clear strategy, plan, execute, or agile adaptation based on what's going on?

You've gotta be more agile than that. So, a little bit of both, but I would say agility is becoming more and more important.

Bill Russell: Let's talk about building out a team. So, you know, as you're looking out to build out your team, let's start with the unconventional qualities that you look for in technology leaders that might not show up on the resume.

Al Smith: Yeah. You know, I was just talking with my CISO and he's got a few other things just the other day about this, and one of the things, he and I landed on was inquisitiveness, and that definitely doesn't come out. You know, is it aptitude or is it. I think attitude often wins out. If I've got people that are just willing to figure it out and take the hard stuff and challenge why can't we do it a different way?

I think I get a heck of a lot further. Now, having said that, you gotta have some technical competence too. I mean, you can't just come in and I'm really inquisitive, but I know nothing that doesn't work at all. But I really enjoy people that in a respectful way say, well, why do we have to do it that way?

Why can't we do it a different way

How do you create an environment where people feel safe, challenging you as a leader are challenging your assumptions.

Al Smith: I think some of it just needs to be, and this is hard for many of us, and it's hard for me too. You have to be willing to say you're wrong sometimes. Like, I'm wrong.

You're right. I think that goes a huge way. Because if you just lock in and people are like, why do I bother to tell you? You're not gonna listen to me anyway. So I think that's huge and or I think the other pieces just sometimes come and go, Hey Bill, I don't know what to do here. Let's go figure it out.

What do you think? Tell me. I've often also told people too, I'm only gonna get mad at, I'm only gonna get mad at you if you know I'm gonna get run over by a train. You don't tell me it's coming. That's the worst thing you can do. If you think it's really wrong, then you need to come and say, Hey, I don't think it's the right thing.

That I don't wanna hear for the next 10 years. Well, I still don't disagree with it. That doesn't help anything. So. I think if you do those things. I think the other thing is skip levels. sometimes my VPs get mad. They're like, did you have to call so and so? Well, I'm like, you were busy and I need an answer.

So I called Bob. Yeah. I also think that helps empowers the next level and the next layer down to say, oh, he cares. I know who he is. Oh, I can drop by and if my boss isn't there and say, Hey, I got a problem. Can I get help on that? I think that goes a long way too.

Bill Russell: When I went in the morning, I used to just walk around the office, whoever happened to be in I'd slide into their office and have, or slide into their cubicle, have a conversation.

Oh, we're having challenges with our PAC system, blah, blah, blah. You know, and i'll tell you, it created, at first, it was a really uneasy kind of environment. It's like, Hey, they're gonna stop coming to me and go and going directly to you. I'm like, they're not gonna do that. First of all, they have to find me.

I'm too busy to do that. And second of all, you're gonna change your leadership to make sure that. You're listening to them and you're bringing that stuff to me. So they don't have to wait to find me to tell me those things. And it did change the culture. It, but it does take time. Yep.

It's the old kher management by

Al Smith: walking around heck of a lot harder now that we're all virtual. Much harder. I, that's part of what I'm all in on virtual and most of our people do that. And we've been doing it for a long time, given who we are. But I do miss that, just the man just being walking down the hall and somebody to say, Al, you got two seconds.

That's really hard In a

Bill Russell: virtual world,

how many states are is Lifepoint in Probably a lot.

So I'm sure we added some states this last year

Bill Russell: too. your team equally as spread out or is it mostly within near Nashville?

Al Smith: Yeah, no, we're the amalgamation of a couple companies. So we've got a big concentration in Nashville, a big concentration in Louisville. But last time I looked at this, we were in about 18 different states.

because there's a lot of virtual people. Just from an IT team perspective,

Bill Russell: how do you keep your direct reports, how do you keep the leadership team in sync on the vision and the direction and the things that are going on?

Al Smith: Most of the people on the, that directly report into me with a couple exceptions live here.

One lives near you and one lives out in Oklahoma. So, and actually one lives in Pennsylvania now that I think of it. So most of 'em are here. That makes it a lot easier. But weekly meetings where we get together, we call it our HLT, and it's, I have my list of things I want to go through, and any big decisions that are coming up from any of the domains, we bring 'em up so everybody's aware of it.

I usually chair it, but everybody talks through and we go through all the big stuff. So it's definitely harder in a virtual world, but those are some things that we try to do.

Bill Russell: What questions haven't I asked that you had prepared for? You thought, man he, I'm sure he is gonna ask me this.

Al Smith: Well, you and I talked about when we were down at one of the 2 29, a little bit about just I guess cost containment, efficiencies and something kind of near and dear to, maybe for-profit healthcare a little bit more than some of the other domains.

Bill Russell: Well, you know, the good news for us is that healthcare has moved beyond that. There's no need for any financial challenge. No, actually, to be honest, I mean, we just had a 2 29 up in Boston. It's still top of mind.

And. Good organizations will say no to things and they're, a lot of times they're very good things. You'll say, well, should we do a new cancer center or should we do a new you know, pediatrics ward? And you go, well, we only have resources for one, so we're gonna do the pediatrics ward. And people go, well, don't you care about cancer?

It's like, of course we care about cancer, but we can only do one and we will come back and evaluate that later. But. It seems to me that there's an inability to make those difficult decisions anymore, and therefore we just let everything come out. But I would imagine that doesn't happen as much at Lifepoint, is my guess.

I don't have 72 committees. I have to run things by. We can usually get. I'll say five, sometimes, maybe a little more, five to 10 people in a max to make a decision, even big decisions. And then we move forward pretty quickly. So, I think some of that comes from being not only for-profit, but also being in the m and a world where you've gotta make decisions and you've gotta integrate people quickly, et cetera, that you have to make hard decisions.

I think we are, there's others, but we're kind of uniquely positioned that we are willing to make hard decisions and live with those. So that's a really good thing.

Bill Russell: How much transparency do you provide them with regard to the workload within it? I mean, do they understand it's like, Hey, we're at 80% capacity, we're at 90, we're at 110.

I mean, is that

So I don't think it's as transparent as it probably needs to be and that people don't totally understand how many projects that we do get hit with. I think we've got 250 plus going right now of various sizes. So there's a bunch of them. So there's some work we gotta do on that.

Bill Russell: You being the chair for the number of years you've been in.

To a certain extent when you go in and cry uncle, they go, okay. Yeah. I mean, we've thrown too much. One of the things I coach people in these meetings and I just say, look I think you have to do that work. Otherwise, they just assume like, man, it, we give you guys so much money.

Of course you can do anything. I mean, you got, you have so many resources. It's like, no we have a lot of systems. We have a lot of tech debt, we have a lot of legacy. We've, there's a lot of work that, it's hard to educate the organization on. Yeah, it looks like a lot of money, but. It's a lot of stuff too.

It's a lot of things. Yeah.

3 75 to 400 people in it. And we literally went team by team and they sat in with me for two hours and we went, this is what this team does. We've got Meditech, we've got six people support that, and how many facilities and some key metrics. We went through that. I think it was really enlightening for them to hear a lot of that.

because a lot of times they're like, yeah, 400 people. I'm like, well, yeah, but we have a lot of small teams and when you have. Every EMR known to mankind. You have a lot of little small teams and when you add that up, suddenly you have a big team. So that, that was really good. I think the other thing was interesting on across for the last few years, we've gotten kind of bogies, go find X, right?

You need to cut X from wherever inside IT. So I tell people, on one hand we pulled all the TCOs together. That's great. That's how you control it. That's how you understand it, and you can do some about it. You also put a massive bullseye right on your forehead. because now some people are like, holy cow, it costs a lot.

Let's talk. Otherwise we're gonna renew. And so that's been good. The other thing we did was we created a list of, we didn't do this with core things like EMRs. We did it with things that I would call optional. Do you really need UpToDate? Do you really need some of these things that you could probably debate whether you really need 'em or not?

Not core things, foundational to the business and through the CFO in this process, we went back and said, okay, legal, you own this. Why do you need a contract management system? Here's the spend you defend it. Because the IT spend is ultimately the results of lots of people's decisions. It's not IT making those decisions.

Bill Russell: Is there a single change that you made that unearthed a probably more money than you anticipated it was gonna save.

Al Smith: Oh wow. That's a good question. As part of moving to one consolidated ERP, we've finally pulled all spend. Because I had multiple GL systems, it was really hard to get to spend across vendors and just the visibility to know all the different pockets and understand how many contracts et cetera has taken us time.

That's been huge. Because if you don't know what that is and where it is and what the real spend is and how many contracts, I don't even know how you approach somebody. You can't approach and say, bill, I've got four contracts for my spends a million. You're missing half the thing. So that's number one.

Why can't you go to the standard vendor that we have? So making that more of a team sport and ingraining it into just sort of the DNA of how it works has been huge. because not one person can do this. You gotta have a whole bunch of people finding it and then negotiating and thinking about it.

Bill Russell: So, let's close with this. And, , there's a cliche question that I've heard asked, but it's always telling, and this is sort of a way to give advice to the next generation. It's, if you could give a keynote to the class that's graduating here in May.

And these people are, you know, looking at potentially coming into a health IT or a healthcare technology type role. What would your message be to that graduating class?

Al Smith: I'd say a couple things. One is

Do this type of job because you wanna make a difference. Don't do it because it's part of a career path, or you just think you should make more. It's a tough job. Do it because you wanna make a difference and you love to impact Patients. Caregivers, et cetera. I think you have to have a passion for that.

You, you haven't been able to prove anything in three or four years, then you're not working hard enough. You're not thinking we've gotta do better. And as an industry, we've gotta do better. And I think it is a huge piece of that. And then the third thing I'd say is just love to learn.

That's why I like my job, to be honest more than anything, is I get to learn all the time. I don't think there's too many days that I don't learn something from one of my team members, a clinician, a new workflow, something I didn't know. And if you just. Try to be a sponge and learn everything you can and then work really hard to do a good job.

then I think you'll be in good shape. Keynote: Partner Failures, Risk Stratification, and Strategic Translation With Al Smith

Key Points:

04:57 CIO Escape Room

14:14 The Importance of Inquisitiveness

17:31 Strategies in Virtual Leadership

26:12 Advice for Future Healthcare IT Leaders

X: This Week Health

LinkedIn: This Week Health

Donate: Alex’s Lemonade Stand: Foundation for Childhood Cancer

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

LinkedIn: Who Owns Business Continuity When Healthcare Systems Are Attacked?

Who owns business continuity when healthcare systems are attacked? Al Smith, CIO and SVP of Lifepoint Health, reveals why business continuity ownership remains confused across healthcare organizations. CIO escape rooms and reaching the board in this #keynote: LINK #TWH #HealthIT

Twitter: Escaping the Legacy System Labyrinth In Healthcare

How can healthcare escape the “legacy system labyrinth?” Al Smith, CIO and SVP of Lifepoint Health, discusses the essentials of risk stratification. CIO escape rooms and reaching the board in this #keynote: LINK #TWH #HealthIT

In many cases.

You're like, wow, this is a really dynamic environment. Yeah. There,

Al Smith: There aren't too many people that get to, you know, go work with HR and payroll and then you're talking coding and CDI and the next meeting you're in you're talking to a physician about workflow.

Remember, many people get to do that inside of the organization. We're one of the few.

Bill Russell: It's pretty amazing. Al, I wanna thank you for your time and I look forward to the next time we get to sit in one of the 2 29 meetings. I think it'll be fun. Awesome. Thanks for having me.

Thanks for listening to this week's Keynote: Partner Failures, Risk Stratification, and Strategic Translation With Al Smith

Key Points:

04:57 CIO Escape Room

14:14 The Importance of Inquisitiveness

17:31 Strategies in Virtual Leadership

26:12 Advice for Future Healthcare IT Leaders

X: This Week Health

LinkedIn: This Week Health

Donate: Alex’s Lemonade Stand: Foundation for Childhood Cancer

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

LinkedIn: Who Owns Business Continuity When Healthcare Systems Are Attacked?

Who owns business continuity when healthcare systems are attacked? Al Smith, CIO and SVP of Lifepoint Health, reveals why business continuity ownership remains confused across healthcare organizations. CIO escape rooms and reaching the board in this #keynote: LINK #TWH #HealthIT

Twitter: Escaping the Legacy System Labyrinth In Healthcare

How can healthcare escape the “legacy system labyrinth?” Al Smith, CIO and SVP of Lifepoint Health, discusses the essentials of risk stratification. CIO escape rooms and reaching the board in this #keynote: LINK #TWH #HealthIT

keynote. If you found value, share it with a peer. It's a great chance to discuss and in some cases start a mentoring relationship. One way you can support the show is to subscribe and leave us a rating. it if you could do that. Thanks for listening. That's all for now..