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August 18, 2023: Drex DeFord and Wes Wright and Bill, members of the former healthcare CIO club, sit down for a wide ranging discussion. Delving into the challenging dynamics faced by IT leaders within the healthcare sector, they discuss navigating the constantly evolving landscape of technology and demonstrating a steadfast vision for the future, even in the face of resistance from various stakeholders. How can we enhance the Digital Front Door in a way that truly aids in patient experience? Do Patients truly know where their data is or if it is safe? What are the necessary traits for a successful CIO? How can CIOs ensure a synergistic relationship with their bosses, and why is this crucial for organizational success?

Key Points:

  • Digital Front Door
  • Patient Data Safety
  • CIO characteristics

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Transcript

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

Today on This Week Health.

That is the vampire that is sucking every health IT resource out there. I mean, if you could get that 35, 000 down to 3, 500, think how much more time your staff has for innovation. Your staff has for customer service 

Thanks for joining us on this keynote episode, a this week health conference show. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health, A set of channels dedicated to keeping health IT staff current and engaged. For five years, we've been making podcasts that amplify great thinking to propel healthcare forward. Special thanks to our keynote show. CDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders. Now onto our show.

All right. Hey, this is keynote. And as we usually do every Friday is we do individual interviews, but today we're going to do something a little different West, right. And Drexel Ford and I have been talking about getting together to have just a fun, casual conversation about healthcare and technology for several years.

And Wes finally, put some time on his schedule for us. So we're able to now finally have this discussion. Wes and Drex, welcome to the show. Oh, thank you so much. Wow. I'm like, you guys have known each other for quite some time, haven't you? Yeah.

95, I think

95 in 1995, I was in grad school. I had been a CIO at a small hospital and the school of healthcare sciences and went to speak at a conference.

Wes was at that conference. He was the CIO at a hospital in Japan at the time and very tiny, small hospital in Japan and we, and our paths cross there and yeah, we've been best. But he's in big toes ever since

yeah, Randy, I was doing a logistics internship in the Air Force is doing a logistics internship at the Air Force Academy and ran into met Randy Carpenter there, who is, the retired health South CIO and after that I met him there and got to be friends with him and Randy and Drex.

We're going to UAB together and I met at a symposium in 95 and the rest is history.

Wow. Yeah. And you guys are goofballs. They already missed part of the conversation, which was a conversation about couches and afternoon naps and those kinds of things.

But we'll skip through that. What I thought we would do, the three of us, would be sort of, a little different than what we normally do on these. There's an awful lot of respect that happens on these shows where we always agree with each other. We never disagree. We never cut each other off.

We never, say anything that would potentially create a discussion. And what the three of us have sort of agreed to is... If we disagree with one another, which I know can happen from time to time, we would actually say it is, are those okay? Ground rules. Are we good with

that now? We now we actually have a real reason why I was never invited on the show build because that's

well.

It's interesting. So many times I'm interviewing CIOs and little known facts. Sometimes I disagree with things they say or whatever. And I do not correct them. I do not say like, really, that's what you think. That's the direction we should be going at. I'm not sure that sounds plausible now, granted.

The CIO role depends on the size, a CIO for a small hospital in Japan is very different than being a CIO for a 16 hospital IDN. And so the roles look very different, but, so, what I did is I picked three topics that I thought we could we could go around on and spar a little bit on, and I thought I'd start with a place where you guys are very comfortable, which is the state of patient privacy, a patient's perspective.

So, this is an area where you guys have lived for a while. I found this survey. They surveyed 1, 200 patients about their attitudes towards health information sharing. It was done by Health Gorilla. Patients are concerned about their security of their health data.

Let's just stop right there. Do you think patients really are concerned about the security of their health data? Is there really, I mean, this this survey is going to say 95% of patients are concerned about it. Well, that has not been my experience. Is that your experience?

Yeah, if you ask them specifically, are you concerned about your health care privacy?

Are they going to say no? Of course they're going to say yes. So, the question itself skews the survey, but I'm with you, Bill. None of my relatives, friends, colleagues have ever once mentioned to me their concern for the privacy of their health data. And frankly, I'm not that concerned either.

I think there's a, there's probably different degrees for different people. So the general answer of yes is like, I think Wes said, yeah, of course I'm concerned about it. Am I really concerned about it? Is it a thing that keeps me up at night or is it something that would it drive a decision about where I went to be?

Maybe if that place had just had a giant breach, I would be a little more thoughtful about it. But oftentimes you don't have a lot of choice in that. Anyway, you're in a health plan. It says that these are the doctors you can go see, or this is the hospital you can go to. So here's

an indication of how concerned we are about our health data bill.

It's how often we log into the patient portal to check on that stuff.

That's our second topic for today, by the way. It's interesting. How many credit reports have you guys? So I uh, credit protection. So I've gotten three. I know I was caught up in the United healthcare one.

But that was massive and I was caught up in another one. I'm not sure that was healthcare. And then there was another one of the health systems that I was a part of. Not currently at, but previously that my

kind of been breached. We both got caught by that defense, the office of personnel management.

Yeah. That whole thing, right. Cause we both have security clearances. And so when the Chinese got ahold of those records, they got everything. And they

had some good info in there too, man. I mean, that's like 10 pages of paper you gotta fill out. They interview your neighbors and stuff. And so they got all the juiciest stuff on us.

So once they did that, I went, eh, heck was it.

What do you think would surprise patients to hear about healthcare security? Like what don't patients know that they'd be like that they might be more concerned?

I think a lot of consumers still think about cybercrime as being mischievous kids breaking into, computers and stealing a couple of things.

They hear about ransomware, I don't think they understand now how well organized it is and how, a lot of these adversaries are actually just They're like, Google. I mean, they're high tech companies with really high end people that work for them. I don't think a lot of them really understand the sophistication of the companies and the people that are involved in the attacks.

And frankly, I think overestimate the sophistication of our defenses. I think that's something that they would be startled to put it mildly. They'd be startled with the standard rate of competency from a security perspective within healthcare, I think they would be startled, would be a happy where aghast might also fall in that category,

the variability.

I think it's the thing that I think huge. Yeah. I mean, you go to one health system and it's like, cedar Sinai is paying a fortune for security. I mean, and they are fairly secure. I'm not inviting people to attack them, but they're being attacked every day. They're spending a fortune, but you know, you go down the street to, even in California, you go down the street to one of the smaller health systems and there are a bunch of little small health systems in LA.

They just they're spending a quarter of that on security

and can they hook up? Bill you, we have stumbled into a nice soapbox area. Drex and I have been talking about this for a long time. And I really think, just like we had Meaningful use dollars that got us all up on the same level for EHRs, electronic health records.

We need the same thing from a cyber perspective. And Drex tells a great story about how we got to where we're at. And really, if you sit back and look at it, we got to where we're at because we were forced to get there. And when we were forced to get there, we didn't get the money and the resources to actually defend what they made us do.

Now they got to get us some money and resources to where we're all up to at least a bare minimum level to where, yeah, Cedars Sinai can still be the best one out there, but, Memorial down the road, we know they're at least this high so that, it's I think it was a big miss on our meaningful use thing, but don't get me wrong.

I still think the meaningful use program really accelerated our digital healthcare

journey. Thank you. Yeah, for sure. I mean, from an adoption perspective, meaningfully use, put a chicken in every pot kind of model. But there were a lot of things left out, right? We didn't interoperability wasn't really part of the conversation.

And so now we're still struggling, try to figure out how to do better interoperability and obviously infrastructure and security wasn't necessarily. In the pot either. And so there's still folks that struggle with sort of like modernization of infrastructure. Once they did the initial implementation of the EHR and they had to put switches and everything in those facilities, they still struggle with the sort of like following up and cleaning up and making sure those are relatively modern.

And then the security wasn't there either. So, I mean, I think it's the other thing I would say, because we all have friends who work in security, the reason that security may have challenges in healthcare. Isn't because people aren't working hard. There are a lot of really smart people who are working really hard to make the place secure.

But in the grand scheme of things, when you have some giant and remember how much care is delivered in the outpatient setting, when you have a doctor's office with 40, 40 docs and they're seeing tons of patients every day, and you've got one it person who also does security that there just isn't enough.

Resource capacity to do it the way that you would love to see it done or to get to that base level. And to your point, I think that's where we need to we have to sort of rethink how are we resourcing security? It is a critical infrastructure component of the economy. We see situations where when hospitals go down the guys across town our friend Chris Longhurst West just published a study at UCSD with a bunch of folks at UCSD that sort of talked about that when health systems go down, the folks across the street or the folks down the road, those hospitals become overwhelmed and it also has a negative impact on their patients.

And so they felt it really complicated issue, right? Of how everything's connected to everything else in this mess.

Yeah. And I think that's why, I'm a small government guy, but I think this is where there are certain places where we need government intervention.

And I think this is absolutely one of those places.

This is where Bill's going to disagree with you. No, I mean, Wes, you can say that. Drex can't because. The probably one of the bigger recipients of funds. If the government pours money into cybersecurity will be crowd strike. And I'm buying the stock like that day when I know that the government's going to put that money in because it's meaningful use epic.

Is cybersecurity, CrowdStrike?

I mean, it's, I agree. I mean, it does appear and could appear a little self-serving. .

Self-serving, yeah. Yeah.

But I'm. I'm hoping that the time the 30 years I put in before I became a vendor, that kind of count for a little bit of saying, no, you're not just saying that to make the money.

You've got to actually believe

it. Don't well, Hey here's the other thing. I think that would surprise patients. It's it's how far their data moves. that they are not aware of. Right. So it goes to an outside third party for billing. It goes to gets anonymized, gets used for research, in fact, I think it would surprise some CIOs how far some of their data moves if they had a map of where that all that data was moving within the system and outside of the system and then back into the system.

And we see that third party risk is just becoming more and more of a concern in that third party risk is when that data that we think just resides at the hospital has moved outside of the four walls and is maybe not as secure as it is within even those four walls.

Yeah, I think the first thing that patients would be surprised about though is that, they have anywhere from a 5 to 10% chance that When their records pulled up, it could be somebody else's record.

That there's a chance when they pull up my record. It could be mine, but it could be one that they made in the ED, with 000s and the social security numbers, and they're documenting in that instead of my regular.

Patients don't have any idea that there's some kind of percentage chance that their wrong record could come up. They've got no idea that is a possibility.

Yeah, I think about how, you and I have worked together multiple times in the Air Force at Scripps at Seattle Children's, and I mean, this long running nonstop duplicate record, gun battle has been a thing that we have fought every place we've been, and, forever.

Ultimately it comes down to, like, yep, we do our best, I think, to do patient matching and make sure that people are documenting on the right record and we put in policy to make sure that they are not re registering patients and creating duplicate patient records, but we still don't have a universal patient ID and there's not a great way to sort of apparently pull this off yet.

So there's a lot of work that goes on there, but again, it's a, there, there can be a gap in the system.

Yeah, tracks, I'm going to disagree on the universal patient. I do think, yeah, because we've talked about it before. Just there are there in financial services. They want to match me to my credit report.

They asked me like three or four questions. And they matched me to my credit report. I mean, this is not rocket science. In fact, we had a whole bunch of data at St. Joe's and we were trying to match it. And we were doing the traditional, I think it was initiate by IBM. Is that? Yeah, I remember that. I think that's right.

We're trying to do the matching there. But we had a. Really advanced third party that was developing software for us on our second floor and I went down to them and I said, Hey, let's take a look at this matching thing and they applied advanced data science techniques and they were able to match better than initiate was a matching.

I mean, it's like we just haven't brought the. Architecture and the infrastructure and the thinking beyond what we were doing 30 years ago or 30 years ago.

There's no money in it, Bill. Yeah,

there is no money in it.

You're right. That's that's the whole that's the whole issue is there's just no there's no money in that.

And. Health care and guilty is the next person, health care is big and if it ain't broke, don't fix it. Well, if it ain't broke, I ain't even going to pay attention to it really. I mean, that's how bad the resources gotten.

Isn't that why we needed meaningful use? Because it wasn't broke.

Paper wasn't broke and we weren't going to fix it.

Yeah. That's exactly right. Yeah. Cuz no, because there was no money in it for anybody. Alright. So the government had to step up and say, Hey, here's some money. Do it. Anyhow,

let's go to digital front door. So, this is a, an article I'm gonna pull from Providence article has a bunch of good stuff in it.

Sarah Azi who we all know wrote. this with Doug Grabsky. It looks like first sentence as a typical for Gardner hype cycle. The 2019 hype was all about the digital front door for health systems positioned as the mechanism to transform the consumer experience. And they go down and they say that subpar.

experience compared to the other industries. Most health system services cannot be booked or managed online. Consumers still cannot shop for care, can't preview what services will cost. Outbound communications are not well coordinated. Clunky EMR patient portals are still largely A default entry point into the health system experiences aren't integrated with core ecosystem partner experiences and health system.

Digital experiences still aren't omni channel. So these are some of the things. And by the way, she goes on to talk about. You know how we should address some of these things and how we should move them forward. I'm curious the digital front door and we still hear that. I hear it an awful lot on the show people talking about their digital front door.

Is this a foundation for digital transformation? Or is the digital front door just a checkbox to say, Hey, we're digital at this point? Where are we at this? Do you guys think? Drex, I'm gonna start with you.

Yeah, there's, I think there's some degree of, a drive toward consumerization and the at least conceptual belief that It would be awesome to have a Amazon like experience for our customers when it comes to healthcare.

And that might be true for some subset of customers, right? Some subset of patients, depending on how you refer to them. But I feel like there's a couple of categories or maybe more than two categories of patients. There are patients who have chronic diseases, who are frequent flyers, who are back all the time.

It probably would be great for them to not have such clunky experience around everything from. Looking at the record in lab results to getting this is not a bill bills, in the email or regular snail mail where you wind up with sort of the stack of stuff that I'm not really exactly sure if I should be paying it.

Should I be asking somebody about this? I don't know What are you

talking about? It says right on the top. This

is not this is not a bill. I know But it's still worrisome for a lot of folks That in my family that have gotten those, right? So they call me, Hey, I know it says it's not a bill, but does this, am I really going to have to pay

this?

I know it says it's not a bill, but it sure looks like one. Yeah,

sure. And it says crazy

things. Yeah, is it warning me? Why is that? Why are they sending me? Are they just preparing me or what? What's going on? Right, right.

So there's that, there's that whole sort of part of it. I think the digital front door, if we could get it right, would be great for a subset of patients.

But for people who are generally healthy, knock on wood, I've been, in a pretty good spot. Yeah, Wes, I'm with you, as we were talking earlier, I don't remember the last time I logged into my patient portal and looked at something. It's been a long time, and it's probably been after some significant health event, orthopedic surgery or something like that, where I've gone back to look at notes, but it's not something I do every day.

Yeah. What's

gosh, I'm trying to figure out what the question is here. What do we want the digital front door to do? I

like the first thing that she said in the article. You can't do enough with our current digital front doors to make it worth your while. You go in there, you I'm like, for like six months, I've been trying to get a colonoscopy scheduled at

that age. And it's that, well, in

fact, if you're going to be at the next conference, I'm sure we could do that for you. Can we do that for him, Drex? We know a guy. We know a guy. Yes. Yes, we do. Yes, we

do. Lots of guys. But the. Thank you. That's where a digital front door should come in. I should be able to just click.

It's all scheduled. But no, they tried a digital front door on top of the cow paths that were there. And so it just it doesn't make sense.

Plug into

the portal to get the phone number for the place that you need to call to get the Has a call tree with nine options on it.

Yeah. Yeah. Yeah, I

think I mean one we need better content too But frankly the content and how it feels sucks. I mean it feels like it's old technology It doesn't feel like a digital front door to most people

So here's my premise on that. My premise on that is that we as healthcare leaders and the CIO just being one of them, we haven't done the operational work to streamline the operation behind it.

Right? And so the digital front door can only surface what is behind it. And sometimes what it surfaces that's behind it. Is really convoluted mess. And so you say, yeah just make the phone call. It's just so much easier than trying to figure

it out. Yeah. We're going through some stuff and I'm trying to do stuff online.

My wife just. No, I'm just going to call him. I'm just going to pick up the phone and call him. So she doesn't even care about this digital front door or anything. Nope. Just going to call him and 80% of the time she gets stuff done faster than I can get it done in my digital front door.

We talk about this all the time as sort of a people process technology, but this is a Like perfect example of that, right?

Wes and I are both Toyota lean production guys. Bill, it seems like every time I talk to you, this winds up coming up, but a lot of it is about process improvement and making sure things run well and work well and processes are good. And then you should. Try to automate it. So in less than certainly say this a bunch of times too, but sometimes digital front door, if it was already a train wreck and you put automation on top of it, you've just created a fast and efficient train wreck.

And that makes it uncomfortable for the people who are using the technology, whether it's. Consumers or patients or whether it's the people inside the organization who to use a phrase that I've heard Wes say a hundred times, always feel like we're doing something to them and not something for them.

And so a lot of this isn't just the technology. It's not digital anything. It's about. Reinventing the whole process to accommodate some great use of technology, to make it better for the people who are using the tech.

I am right now logging into my United healthcare portal.

You're not going to show us a screenshot.

Are you

a share screen? No, but they have updated their terms of service, which I'm going to go ahead and click. I understand. And I know I do not understand 800

pages of scrolling. Yeah,

 We'll get back to our show in just a moment. I'm gonna read this just as it is. My team is doing more and more to help me be more efficient and effective. And they wrote this ad for me, and I'm just gonna go ahead and read it the way it is. If you're keen on the intersection of healthcare and technology, you won't want to miss our upcoming webinar, our AI journey in healthcare.

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but I will tell you it's really interesting. And I don't know if it's just the pairs have better access or whatnot.

I have the ability to schedule a a telehealth visit. today. And so that's one of the things we talked about the digital front door. Can you schedule a visit? Well, first of all, we have to determine. Are you already a patient in our E. H. R. If you're not a patient in our H. R. Then we have to figure out.

And some people have some health systems have. I just want to be real clear. A way to create sort of a ghost record until you become a patient and then attach you to that record and have that ability. And I know that I was talking to Saad Chaudhry about this and I think they've gotten it down to three clicks from a Google search to three clicks and you have the appointment and you're scheduled for the

he's doing some really great work.

And I mean, this is what happens when you have also have a guy who I think he also has marketing under his belt.

Yeah, it's, and it's interesting when you think about United Health Care, do you think their systems are any more non legacy than health care? No, they have to be just as a legacy, don't you think?

Yeah,

I think here's the thing about, so, Payers are for-profit. So they're always trying to find a way to use the data to gain an advantage. So when you compare payers and how many probably data scientists they have working in their organization to leverage and take advantage of that data and tissue in their two, show it and field it to make it work

in their $250 billion a year organization, you mean?

Compared to small hospital down the street or even large hospital down the street, how many data scientists are there and doing, great data visualizations to help improve workflow and, change the way people do things. It's a tough comparison between two very different kinds of companies in the same business.

Well, I

think I, but you said the thing, Drex, it's their for profit and they think, and the for profit people think of IT as a strategic, a potential strategic advantage and not for profit healthcare. I don't know of a single CEO out there or COO that is thinking of healthcare or health IT as a possible strategic advantage.

And it really could be. It's just for some reason that mindset is not in the leadership of health care right now. And it's a shame. I think maybe in at Saad's place, they are but in most places, they still think of IT as just a cost center. Get your, get the cost down as low as you can. And then that'll make me happy.

Ironically, potentially for the same cost, they could just do so much better, but it's not thought of as a place where you can gain strategic advantage and a lot of times in not for profit organizations, they don't

really look at some of the smaller players, though, they have to rely on their partners, right?

I mean, they make the point that, hey, A bunch of health care providers stop at offering the portal that comes from the EHR provider, but at the end of the day, I'm not gonna be able to, if I'm at a one or community hospital, a federally qualified health clinic, that's what I'm going to put out there.

I'm not gonna go hire a staff and create a whole new digital experience and that kinda stuff. I'm really gonna rely on those partners and whatever other partners I decide to bring in. That's why it's so interesting to me how important it is for the EHR players to remain open, because as a small player, I need to bring in other partners that are going to access that data.

surface that data either for clinicians or for patients so that they can, live healthier lives or have a much more efficient process. I think that's the group. I I really do empathize with the person who has 15 people on their it staff, which includes cybersecurity interoperability and everything else.

Yeah. And I mean, I think healthcare is traditionally very much relied on partners. Most health systems don't have like software development staffs who are actually building things. We're buying a commercial off the shelf product, and maybe we're doing some modifications to it to make it suit what we want to do.

But yeah, I mean, this is all Everything's connected to everything else, the ecosystem of health care, you've got to have some great partners who are able to produce the things that can make you more efficient. Those partners are often hindered by the lack of process and other work that's gone on inside the health system though, so they can only give you what really have and what you can really offer, so it's a challenge there too.

I think the big bugaboo and healthcare it soapbox. Issue number two is the number of applications that we have, bill, I mean, it's, I don't think there's another industry that has the num one of my locations I had I think they're called Sky High. There were a casb I had them come into one of my organizations.

I had 17,000. Web based applications. No, sorry. 18, 000 web based applications. 17, 000 on prem applications. How the hell are you supposed to secure that?

I

know you can't. I remember coming into health care and they said, Hey, this is how many applications you had. And I looked at him. I'm like, What are these people doing? Like, what happened

here? Most people think, I mean, Mark Hurd Rip he made a big uproar in HP of consolidating their applications, how they do their finance and their operations, consolidated it down from 20 to 1.

We have 20, 20, 20. I have 20 applications that can tell you about diabetes running at my, at the hospital. If I could get that kind of ratio, that's the problem. That is the vampire that is sucking every health IT resource out there. I mean, it is just, if you could get those, that 35, 000 down to 3, 500, think how much more time.

Your staff has for innovation. Your staff has for customer service right now. We're, we are just spending every bit of our time plus some contractor time trying to keep the old crap running that we shouldn't be.

There's a great video and I don't know if it's a tick tock or if it's just out there on the internet and CEO talking about his car.

Versus the tesla and the competitive advantage that tesla has and he said, look, he goes, I have 130 different pieces of software in my car and each one controls like this control unit, this thing he goes. When I go to do an update on those things, he goes, we didn't even write it. It's not Ford code.

It's our partner's code. He goes, so I have to get permission to actually update that code. And by the way, that code could impact some other stuff, but at the end of the day. It's not a fully integrated system. He goes, Tesla is a fully integrated system. They've written all the code in their car so they can do software updates like that.

And it happens on on,

on change control, right? It's why we do change control and healthcare is because one tiny change in one application can affect. Dozens of other or hundreds of other applications. And so you have to be very slow and thoughtful about the whole thing. Yeah, I'm with you, Wes. I mean, I think this vampire piece of work of the other thing.

I mean, of course, I now I think about a lot of things as a cyber security issue, too. But just simple is easier to secure to simple is easier to operate and make sure that it's up and running and that it's available to everyone. clinical business and research partners, but simpler is just easier to secure too.

So, consolidation across all of those areas. And I mean, it has to be a project that isn't like, okay, we've consolidated, we're done. You have to have the structure in that says, no, you can't have a little. Black operation over there, where you secretly sneak in, four more cloud based applications because you can buy access to them on a credit card.

And we see that kind of stuff all the time going on now. So

I actually tried to get one of my organizations. I tried to get that as one of the corporate goals for everybody that our application, this percentage this year. And reduction in the number of applicators. I was not successful,

which totally makes sense, right?

Because the consolidation is only going to happen if you can get the clinical business or research owners to also be on board with like, okay, we're going to kill off four other applications.

Yeah, exactly. Where I tried to get it as part of their compensation, but I got close. I got the final countdown, but no, it didn't make it

I'm going to interview BJ Moore tomorrow.

For a fall show, talk about talk

about some consolidation. Holy

cow, right? Well, I mean, he has a three point plan. I forget what the three points are, but the first one is simplify. And I'm like, so has that changed since you got there? He's like, no, I mean, he's now been there for. Five or six years ago.

Simplify is always the number one thing you got to simplify the environment to make it go. All right, let's talk about CIOs. I want to read a couple things here. This is what makes a CIO truly great. It's CIO dot com article. I'm only gonna read two sentences. Really? The blend of leadership skills, tech know how and business savvy required to succeed as a CIO make top notch it leaders a rare breed.

Here's what separates the excellent from the good. And then they Did this survey where they ask a bunch of people, what makes good CIOs and here's the adjectives. You gotta love this list. The responses included in alphabetical order, accountable, adaptable, curious, decisive, eloquent empathetic, financially savvy, focused, hardworking, intelligent, improvisational, interdisciplinary, mindful, motivational, patient, practical, principled.

strategic, thick skinned, trusted, and visionary. So, it sounds just like

you, Wes. All those... Yeah,

well, I have visions every now and then. Oh,

that's something else. Let's just say we started a hospital. We've been very successful, and we have a 20 hospital system. That we're now running. We want to hire a CIO.

Let's build the job description. What's Wes, you get to put the first one on the list. What do you want in your, in the CIO for this organization?

Yeah, I want some technical expertise. To me, that's why you're seeing a lot of non healthcare, not a lot, but CIO.

CIO is coming in because our leadership depends on us to be the technical resource. And if they don't, if there's no technical resource there, then, I'm a business guy. I can do all the other stuff. I need you to know what the business is, but more than that, I need you to know how to run the stuff.

I'm putting you in charge of running. So for me, technical competence above everything else,

but less is a 20 hospital system. I'm going to hire you to be my CTO. Do I really need that kind of technical know how?

Yeah, you need some. I mean, Drex and I played this our whole career and, Drex was a comm squadron guy, so he actually, at one point in time, probably had more technical expertise than I did, but, he has enough technical expertise to where when he's with The other C level, they ask him the question, and he can either tap dance it or actually knows the answer, but he has the resource to where he can come back.

So they depend on you to be that even if you have to pretend they depend on you to be that sounding board and you're supposed to know the technology out there that can apply to the business process. And that's what I need my CIO to do is know the technology that's out there on the horizon and be able to apply that technology as well as those for profit companies apply that technology to our business processes.

I don't need somebody that's just going to come in and maintain. The same old stuff that we've been doing all the time. So technical competence for me is a high priority.

Wow. He dissed you a little bit there, Drex. I think he said he's far outpaced you and his technical know how.

Just through though.

It's true though. I mean, you know what we did, what we did together, the places, we worked was. We had a very, as a matter of fact, I remember us sort of setting down and drawing out Venn diagrams between the two of us. And it was like, these are things you have to be really good at.

And these are things I have to be really good at. And there's a little overlap on the Venn diagram, but it's not. In the beginning, like in a turnaround, there was a lot of significant overlap in those circles, but over time, we aggressively pulled them apart because I had different responsibilities.

I mean, different things that I was good at and things that we needed as a team. For the leadership in that part of the organization to be responsible for. So Wes was driving, basically all the technology in the organization. I was spending most of my time thinking about, change agent, business client, clinical research, leadership relationships, looking at understanding what it is that those folks were doing.

So that I could turn to Wes and say, I think over the curvature of the earth. These guys are going to want something like this and Wes would go help figure that out. So, I mean, it was a great team, but I mean, I think for me, change agent is probably one of the most important skills you have to help people change is so difficult.

Especially in health care, and you have to really help people figure out they need to change. They need to build programs that are agile and that can change. That's the only way that they're going to continue to be able to stay ahead and deliver, great care for patients and families.

Actually, Bill, I want to change my first.

Please, go ahead.

comes from what Drex was talking about. And I think the first thing I'm looking for in a CIO is to be a great communicator. Because I look at what made us successful, Drex and I, throughout our careers, at least we think we're successful, we don't know.

And I'm still learning this from Drex, is that, yeah, he would go to those C level board meetings and listen to what's going on and that kind of thing, and then he would come back and not just say, hey, go check it, check like this. He would give me the full background. I mean, he, this, Drex is a great storyteller.

He would tell me the stories of why he got to the decision he, he got to. And that would then arm me with the information to where he thought maybe we should go this way, but he told me the whole story. So that clicked to me, maybe we go this way. So I'm changing my number one from you got to have technology to you've got to be a great communicator slash storyteller.

And I'm still trying to get there the way that Drex did, because that's, I mean, when you know the why of what you're doing, everything is so much more fun.

Yeah, and I, it's interesting if I'm going to throw one of the problem with this role is there's so many adjectives you want to throw on here.

There's a catch all that people have, which is called leadership. And that catch all of leadership to me is too broad. And the reason it's too broad is because it includes communication. It includes a lot of different terms that the change agent is part of leadership and those leadership qualities.

But the the one thing I want from my CIO, I want. I can't do it. It's two things. I want visionary leadership and I want courage. I want the combination of those two things.

That was my third is courage. Cause it, it takes a lot of courage in healthcare to change anything. Cause again, most of the time.

Most of the time, it's not super broke. I mean, we're peddling hard to keep it unbroken. And so it's not broke. So it takes a lot of courage to try something new and potentially break something. And that's my communications, technical leadership and courage. Those were my top three bill. And you hit that last one.

I was

just going to say there's a Navy Admiral named Hyman Rickover. And I always at one point in my Air Force career, I had a quote of him at my desk. This is when I was regional CIO West education and training command. And the quote is good ideas are not adopted automatically.

They are driven into practice through courageous impatience. And that was a time period where Wes remember we were trying to completely change how we do structure and end point modernization in the air force. And we built these programs ultimately that were adapted by the air force and then adapted by the department of defense, but they weren't good ideas in the beginning.

They were only good ideas to like a few people. But over time they were proven to be really good money saving efficiency simplification. But yeah, the courage to stick with it when you might be fired because of your position, you're right. Or you're pretty sure you're right. You got to hang with it.

The cool thing was though, I mean, we weren't in those regional CIO positions. We weren't tasked with day to day operations. So that gave us time to raise our heads up and look at things and see what's happening over the horizon. And to me, that's the problem right now in health I. T. with the C. I. O.

position is it's very unusual where the C. I. O. is not just pulled back and pulled deep into the day to day operations, I think, huh. I think Drex said, operations elite strategies for lunch every single time. And that's what's happening out there for it. When we're in the Air Force, we could sit back and actually, in my last gig, that was something I never had the time to do was sit back and look at the technology and try and see where things are going.

And boy if the CIOs of today could just find the time. To try and do that.

Is that what you think? You see some of these like the chief digital officer now is separated from CIO. Yes, absolutely. Somebody's got to have time to think strategically and not be pulled back every day into the fire.

Yeah, I,

I see that. And frankly, I'd rather have seen. Things break the way they break when you and I are working together, and that's that the, that Venn diagram that gets pulled apart as operations become better and better, and you get to concentrate, you, the CIO, get to raise your head up, and then the CTO is the one that becomes responsible for the operations kind of thing, and that way you can lift your head up.

I would have liked to seen things transpire that way, but I think maybe the other Cs, the EOs and the OOs were maybe getting a little impatient. With the CIO. Hey, you're just your head's buried in this day to day stuff. I need somebody who's going to look over the horizon and be able to apply this data where we need it.

And I think that's why that CDO goal has evolved because the CIO just didn't. There are some exceptions out there but most of the time they just they can't get out of the operational bog to, to get that change agent innovation app.

Yeah. I'm going to come back to visionary leadership and courage, the visionary leadership.

You have to see something in order for it to become a reality. You have to see it. When I came in at St. Joe's, I said, we're moving to the cloud in 2012. And people looked at me like I was insane, especially the IT organization. They looked at me like I was insane. It's like, nobody's doing it. Especially at that point, because

cloud was

like, I don't even know what you're talking about.

Yeah. But I saw it clearly in terms of I could articulate. I'm like, and it wasn't because I was. Omniscient. It's because I came from other industries that we had already moved to the cloud. So I could just describe to them. I'm like, this is why it's better. This is what it's going to look like.

This is what it's going to feel like for us to have I T operations in the cloud. It's going to be programmable. We're going to be able to automate a whole bunch of things that we haven't been able to automate. We're going to be able to stay current on our infrastructure instead of having 80% of it end of life.

I could say, Hey, here are the problems we have today. These problems go away. Now there's a new set of problems we have to deal with. But we will deal with those problems. And here's what they look like. So seeing around the curvature of the earth, the great thing about health care is you could be seen like, you're Nostradamus just because you're looking at fintech and going back 10 years and going, Hey, I think this is what's gonna be possible.

The problem is it's the courage to continue to do that on the constant onslaught. My I. T. Organization wanted me run out of the town on a rail at another V. P. Come to me and say, Look, hey, there's a lot of I. T. Jobs. A lot of I. T. Of your I. T. Staff have their resumes on the street. And I said, okay, and he was just like, what, you're not concerned.

I'm like, concerned is yes. Concerned is the right word. I'm concerned. But at the end of the day I've given them the vision of where we're going. They're choosing to go somewhere else. That's fine. There's going to be plenty of people that when we put the vision in front of them, they're going to go, yes, I want to be a part of that.

Part of that, yeah. So, and then the courage to, the constant onslaught, and you guys have been in these meetings where the cardiologist is sitting there going, we need a new PAC system. And you're trying to hold the line and say, look, we do need a new PAC system at your facility. I'm in total agreement with you.

This one is not serving us well. We have four others within the health system. These are our options. Well, that's not the one I want. Yes, I understand. But we're gonna drive towards one. And, going up against cardiologists that is putting your job on the line. That takes courage. And you don't do that alone.

You do that with backing from the Ceo of saying, Hey, we're trying to simplify. We're trying to whatever. But at the end of the day, You could lose your job. And quite frankly, if you lose your job trying to hold that line, you should go to the next organization.

It's, you said something really important there.

So at Seattle children's, the best boss I probably ever had was a guy named Tom Hanson, Dr. Tom Hanson. And so, for example. When I went up and did the initial interview with Tom, he said something about we need to bring together the hospital and the Research Institute and he said, and there's a bunch of people that are going to try to kill you if you do that, and he goes, I will never fire you for helping us reach that goal and that was a thing that was like, because I knew, I mean, we had forbidden We have been to other places where we had this sort of situation and to have your boss, just say, I have your back.

I will stand up for you. You're doing what I want you to do. No one's going to talk me out of it. And so that backing is also a huge. I don't know if you put that in the CIO job description, but it's a thing CIO should be thinking about when they go to a position to make sure they really do have affinity

with their boss.

They should be connected. There should be a natural affinity that happens in that first meeting where you go. Yeah, this is somebody I can work with. This is somebody I like. Yeah,

Yeah, for sure.

Well, gentlemen, we've come to the end of our time. This is fantastic. I hope we can continue to to do this.

And I just want to thank you guys for coming together and having this discussion. Thanks very much. It's been a pleasure. I was sitting here

thinking, between the three of us, there's about a hundred years worth of information

and technology. Yeah, and you're the only one that looks at directions.

I'm not sure. Well...

Man, he's always like this too. Henri is a smart cat.

Softball, you gotta hit it.

It's just too, it's just too easy. Thanks, gentlemen. We'll we will definitely have to play to do this again.

All right, Bill.

I love the chance to have these conversations. I think If I were a CIO today, I would have every team member listen to a show like this one. I believe it's conference level value every week. If you wanna support this week health, tell someone about our channels that would really benefit us. We have a mission of getting our content into as many hands as possible, and if you're listening to it, hopefully you find value and if you could tell somebody else about it, it helps us to achieve our mission. We have two channels. We have the conference channel, which you're listening. And this week, health Newsroom. Check them out today. You can find them wherever you listen to podcasts. Apple, Google, overcast. You get the picture. We are everywhere. We wanna thank our keynote partners, CDW, Rubrik, Sectra and Trellix, who invest in 📍 our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.

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