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Bill Russell: Today on Keynote

Dwight Raum: (Intro) Whether it's cyber security or data and analytics, or even the EMR, you have to have a really Super set kind of picture of what you intend to accomplish. If you don't have understanding of how to orchestrate that from a technology perspective, you're almost doomed to failure.

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) all right, it's a keynote and today we're joined by Dwight Raum, CDIO, Chief Digital Information Officer at Rochester Regional Medical Center.

Dwight, welcome to the show. Thank

Dwight Raum: you, Bill. Great to be here.

Bill Russell: So how long have you been at Rochester?

I've been here since December of 23. So about seven months right now. Seven months in. That's good. So that'll help to drive the questions. I love when people come into a new environment and how you acclimate and understand what's going on and then how you become a part of, of what's already going on there.

Dwight Raum: Yeah, so it's it's interesting, my, my undergraduate degree is in information systems and management science, very much operations oriented.

So some of the basics we needed to revisit and really re implement back here.

Bill Russell: The. Pandemic was probably the best thing to happen to governance and people will say that during that time we were very effective as both IT and as a health system.

Dwight Raum: very closely with Stephanie Real for the majority of my career at Hopkins and still work with her.

She and I actually just

Bill Russell: spoke this morning. Wow, that's fantastic. Stephanie is one of the people I heard from early on when I came into healthcare, because I came in from outside of healthcare and connected with her. And, Learned from her up at Harvard. There was a class up at Harvard and she spoke up there and it was exceptional.

The CTO to CIO, I will say that probably used to be a very common path is not as common of a path anymore. What's the benefit of taking that technical. to the CIO role?

Dwight Raum: Yeah, that's a really good question. I think, for me, at least having the depth and technical experience allowed me to see opportunities that others may not have, while I was at Hopkins, I had the opportunity to help launch an innovation center.

Bill Russell: One of the things I throw out the A word a lot on the show and meaning architecture, and it's interesting to me how many of the problems.

That we face in healthcare security related and other things could have been averted with good architecture. And when people say to me. Why would I hire a, somebody who really understands technology? It's more of a leadership role now. And I say, it's absolutely a leadership role, but you need strong technologists because architecture matters just like it does if you're building a skyscraper or something else.

And we're building those kinds of complex systems in IT these days. I completely agree.

Dwight Raum: And, you look at the complexity of the healthcare technology ecosystem, you can really paint yourself into some corners if you're not thoughtful about, where you intend to go and the steps it's going to take to get there.

Bill Russell: Yeah. So come in nine months ago with your background, your experience.

How do you step into the conversation? And actually, I guess you came in before that. You came in as a consultant. How do you step into the organization to figure out, what pace they're moving at and what things are important to them?

Dwight Raum: Yeah. I think there's a cookbook of things that you look at from an organizational readiness perspective, what's the velocity of change, how good are we at change management, how well connected are we to the operations you How good are we at governance?

There are a lot of sort of basic things that I look for in terms of building blocks and start to evaluate the organization against those building blocks and understand what our discipline is in terms of enforcing those and following those best practices. From that assessment, I was able to determine, there were Certainly some opportunities, but going back to that architecture question, what was the vision for our organization?

That really springboarded us, I think, forward into the conversation of how are we pivoting this organization long term, how are we achieving financial stability going forward?

Bill Russell: But was that strategic planning the IT level or was it across the entire organization? It ended up being

Dwight Raum: both.

Initially we spent a lot of the time focused on IT internally. Trying to, like I said, get things right. And then also thinking about what the future would be in supporting where the rest of the organization would be. And that flowed right into an overall enterprise strategic planning exercise.

Dwight Raum: I think, some of the challenges that we face here are probably not unique.

Certainly, they're not unique to Rochester Regional. They're industry wide challenges. I think understanding the real risk of cybersecurity and the need to make appropriate investments is an area that is not well understood by the layperson. I think it's, more acute now as we've seen change health care and we've seen what happened with Ascension Health it's become more real.

But that's a gap that's hard for folks to truly understand. The other area that I would say challenge and again probably one that again goes back to that architecture question earlier that we talked about is the importance of data and analytics and being very, prescriptive and deliberate about how you intend to curate your data and use it long term to drive decision making.

And how we take risk or how we don't take risk. We need to make sure that we're correlating that with a similar type of changes in the technology to support it. So that surfaced some gaps there, I think.

Bill Russell: talk about data and analytics it almost reminds me of the Covey principles, begin with the end in mind.

Talk to me a little bit about how you communicate to the organization to help take these concepts like around cybersecurity and what that really means or the effective use of data as an asset. How do you make those real to people in the room? are there stories you tell?

Is it just taking articles and saying, Hey, here's change in Ascension. That could be us.

One of the analogies that I've probably over leaned into is over the years I've used this analogy that information technology is a lot like football. You actually have three different teams within a football team, right? You've got an offense, you've got a defense, and you've got special teams.

Infrastructure and operations, cybersecurity is all about defense, right? Your success there is not having failure. Your application teams, where you're actually delivering the business using technology, that's your offense, right? And success there is moving the ball down the field, scoring points.

Bill Russell: appropriate way.

love that analogy. So the special teams, does that manifest itself as project teams or does it manifest itself as innovation groups or how does it manifest itself?

Dwight Raum: Yeah, I actually think it manifests itself as both, right? In its purest form, special teams is really innovation, but innovation can be thought of in a couple of ways.

It could be a cross functional teams that are going after a very acute problem that you're trying to tackle with, alacrity, but it could also mean, targeting a problem that is. much more ambitious in terms of, are we going to invent something new here? Are we going to employ new technologies in a new way?

I think it covers both aspects of that. So it can be innovation that's externally focused and it can be task oriented innovation that's internally

Bill Russell: focused. So I'm hearing a lot of people look at, the problem to drive the innovation, but I'm also hearing a lot right now around don't want to say product based innovation, but I want to say essentially around AI.

Dwight Raum: AI is so frothy in terms of the hype cycle right now.

There's not a day, literally, that I'm going to get multiple emails from some random AI company that, has a solution for me. But in that froth, there is reality. There is new capability that we can bring to bear. I think the challenge is to maintain, enough wherewithal, and this is where I've tapped a lot of my technical experience, understanding of how these tools actually work helps you also understand what their limitations are and where they may apply.

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It's just popping up in some places. There's definitely

Dwight Raum: organic adoption of artificial intelligence tools. Obviously, LLMs are the big one right now that everybody's looking at. And I think there's a real risk in that, quite honestly. There are reasons why we do risk assessments against these types of tools.

A lot of what our responsibility is, I think, as technology leaders is to educate our community on, how these tools work, but then also what are the rules of the road for adoption of these tools?

Bill Russell: So you're nine months in. You have a strategic planning process. What projects does it lead to?

What initiatives does it lead to? Does it lead to Some blocking and tackling, but also some innovation as well.

Dwight Raum: Yeah. So a lot of my effort right now is blocking and tackling, right? Trying to get the basics and the fundamentals of the game executed and playing right, but we can't do that in isolation.

We've had several examples over the years where we've done really pretty amazing things with RIT. As I've come on, as you said, eight, nine months into this into this tenure here, I'm looking for those opportunities. How can we build not a series of one offs, but a programmatic approach to innovation in conjunction with RIT?

Bill Russell: the foundation from, I guess you could take data or however you want to approach this, but what's the foundation for innovation? Is it, the technology, is it the culture? What aspects do you have to build up for that for innovation to, to truly

Dwight Raum: happen?

So the key thing I believe is Empowering people with the confidence to try things and to do so in a way that is safe, but challenges the way they approach problems. think a large part of activating a large organization through innovation is, Giving them the permission to do these types of things and challenging them to do so as well.

And you do that a lot of different ways, but one of the ways I've found to be very successful is you find case studies within the organization and you celebrate those. And those become guiding lights for others to say, Hey, I can do that too. And a lot of innovation is. is throwing stuff at the wall and seeing what sticks.

And a lot of it is about failure. So being prepared to, to accept and understand that failure is actually just a step towards success. It's not an

But when I find someone like you and others, I say, have you ever had to ask for a seat at the table? And invariably people look at me and go, no, I never had to ask for a seat at the table. They wanted me at the table. what differentiates, what, how do you get a seat at the table? What aspects make somebody say, yeah, we need Dwight at this table.

Dwight Raum: In my experience, the ability to have vision that's greater than just your immediate portfolio is critical. So if you can articulate a vision that touches a lot of different pieces and demonstrates understanding of how those other pieces work, but then also match it up with your portfolio, your technology portfolio probably.

And orchestrate a path forward, that's incredibly powerful. Folks really want to have partners at the table that can help them not only articulate the vision, but also

Me ask you another question , as you look back over your tenure, you've worked at academic medical centers, And I've spent some time in academic medical centers. Most of my time was at a large integrated delivery network.

Bill Russell: And I thought that a large integrated delivery network was very political and it was very political and there was a lot of different objectives and things going on. And then I spent some time in an academic medical center. I realized I was in the JV. There's a lot of different initiatives going on in an academic medical center.

There's research, there's money that comes from different sources and that kind of stuff. How do you guide things that are happening? But knowing full well that you can't control all the things that are happening.

Dwight Raum: That's a tough question to answer.

Without getting in

Bill Russell: trouble?

Dwight Raum: Without getting in trouble, yeah.

In others, they actually have some control, but it's the discernment of knowing when you have what and being able to lean into those things. Yeah, and I think, there's

Dwight Raum: obviously a political awareness that one has to have. all jest aside, the way I approached it was There were core things that I had deliver on, and I considered those kind of my sandbox, whether it was infrastructure and operations or applications and governance.

I had a lot of control within those lanes. I had a lot of political and relationship management I had to do along the way to keep those lanes, pointed in the right direction, so to speak. Then there were activities that were extracurricular where I could leverage my reputation, my gravitas, whatever, to help forward another initiative.

So across all three of those categories, you had to have management strategies and leadership strategies for each of those. It also helped to have a team that was really long tenured and had enough wherewithal and understanding around what was going on in each one of those. to help manage them as well.

Bill Russell: We're going to end the conversation talking about emerging trends, but before we get there, I want to talk to you about organizational change management, and it's one of those areas that CIOs need to be so adept at. So you come into this organization, we, you've identified some areas to move. How do you do that?

How do you do that effectively? On the clinical side, how do you do that on the administrative side? You can't cover the topic in complete. But what are two things that you look at from an org change management

Dwight Raum: So two things jump out at me.

So the internal core team has to function really well. You have to be able to trust your team, but then it's also about building relationships with your operational leadership. And that means getting out there and, beating the bricks, so to speak, going and meeting folks where they are, both literally and figuratively, understanding what their challenges are, bridging that into your strategy, sharing a little bit of your vision and being really open to feedback.

Bill Russell: You're a man after my own heart, cause I came up through the CTO ranks as well. And so I want to spend some time here at the end, just talking about trends and technologies that you're keeping an eye on. that you think could have a serious impact on some aspect of what's going on in healthcare.

Take the LLMs out of the picture for a moment. So many laser beam solutions, those, They really need to be brought together into full suites, right? And in the future, I I see healthcare and personalized medicine really getting a lift from those AI types of tools where, perhaps we have an equivalent of a digital twin running each patient.

That's not inconceivable in the not too distant future. Putting the parking, the AI discussion aside, I'm actually super excited about prospect of like drones, to be honest with you, when think about what we've done over the last 30 years in health care and digitization of health care and moving things into really managed systems into the EMR, what we've effectively done is just built a really good collection system for signal.

But what we're missing still is a little bit of that effector arm, right? So how do we actually take that signal, assimilate it, turn it into a model, and then build it? Do something with it now, I think all of us as technologists tend to fall back to we'll just, we'll send another email or we'll text message or we'll target a, an ad or whatever.

But I actually think we're getting into the, the realm of we can actually do things with robots. Drones are an example of a robot, but, we have a robot running around our hospitals doing deliveries from from med cabinets to the units. I think there's a tremendous amount of opportunity for actually doing real things.

So moving beyond just signal collection into actually using robot technologies do physical things in the real world.

Dwight Raum: I think so. Yeah. And the robots are, they're just the actuator arm of all this intelligence that drawing from the data that we're collecting and the models that we're running. But the more of those that we have, and, let's talk about aging in place for a moment, going back to my prior experience with Quill effector arm in the patient's home.

And that could be a lot of different things. It could be a pill reminder with a machine that's actually doing distribution of the pills. It could be a refrigerator door closer,

Bill Russell: things like that. We're going to have pill dispensers in a remote patient's home that only dispenses the pills that they need at the proper time.

It's possible now, yeah. Yeah, that's an interesting future. I think of all the challenges that we have to deal with. I was talking to somebody about the Chevron rolling this morning. And I think, it doesn't seem like a big deal, but it is a big deal because it changes so many things and you're like, Yeah, there's all these things we really want to accomplish, but we have to keep an eye on all this blocking and tackling just to keep things going.

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