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Today on This Week Health.

(Intro)  I'll give them five years for other industries to look at healthcare and go, why didn't we adopt generative AI like healthcare? Look how healthcare evolved and changed and improved because of generative AI. Let's catch this wave.

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, here we are for keynote and we are joined by BJ Moore, CIO and EVP of Real Estate Strategy and Operations. Is it my imagination or are they adding things to

your title? They haven't added for a while, but yeah, unfortunately I've got the longest title in the industry.

I was looking at it on LinkedIn, it said operations at the end. I mean, every CIO is in charge of operations in some way.

Yeah, it's specifically operations though, of the real estate portfolio. So it's the maintenance, it's the EVS teams, cleaning the hospital rooms, it's all the basic core operations to run our clinics and hospitals, so.

When you see the operations in my title, it's that portion of operations.

The podcast is about the intersection of technology and healthcare, but I'm going to start with a real estate question, which is how much did the pandemic change the real estate positions for

Providence? On the shared services side, significantly We've sold our corporate headquarters last year, as an example.

We are getting out of downtown Seattle. We're getting out of most of those leases. We're cutting our administrative portfolio by over 50%. Either selling the properties or getting out of leases. And then on the clinical front, we're really evaluating, pieces of property, land that, we had high aspirations to develop, but we're not in economic climate to develop those.

So we're selling some of those properties off, and then we're consolidating clinical operations where we can to save money. So, COVID had a huge impact on the shared services, and we obviously need less space as we are hybrid. And then on the financial side, it's just caused us to be more Diligent on the clinical side of things and consolidate and generate cash where we can.

And last real estate question because nobody's tuning in to this to hear real estate, but I'm more curious than anything because everything we're reading is saying less is being done on the large. IDN, Campus, and a lot more starting to be done in these retail centers, even out into the home and that kind of stuff.

Is that playing a role in how you guys are thinking about real estate moving forward?

Well, like everything we had, too many of everything. So we had too many headquarters, we had too many locations. So I think we're doing a little bit of both. In a hybrid work environment, having, collaborative spaces where people can come together and be strategic is important.

And so we've got fewer of those, but we are investing in those and making those more collaborative, more modern spaces. And then, that's one of the reasons I own real estate and IT is how do we then, the work from home, work remote, how do we create these hybrid collaborative environments that are more effective.

So I think we're doing a little bit of both. Bill, you know firsthand, how many everything we have here at Providence and St. Joseph. So there was a lot of consolidation opportunities for us here.

Yeah it's interesting as you're talking about that, I'm thinking about application rationalization as well.

There's a lot of similarities in terms of rationalizing the portfolio to make sure that you optimize the operations. All right we started with question like five, seven, and nine. Yeah,

that's okay. I'm used to it. You never follow the script.

Back to the first one, which is essentially, tell us about Providence.

What's the reach? What are you guys doing these days?

So Providence is one of the largest catholic health care systems here in the United States. We're here primarily on the West Coast. So, Alaska, Washington, Oregon, Montana, California, New Mexico, and Texas. We've got about 52 hospitals and 1, 000 clinics.

And our claim to fame during COVID is we received the very first COVID patient in our Everett Washington Hospital January 2020. So, yeah, we're Kind of in the thick of things here on the West Coast.

Yeah, so gosh, we can go in so many different directions. Let me start with a basic question, which is What's changed since the last time we talked?

I think we talked probably about a year ago, maybe a little less than a year ago. So what's really progressed for you

guys? Yeah, for, we're looking back a year ago, we just completed our EPIC migration. So to a single instance of EPIC, that was a 10 year journey. Just completed that

And people might wonder why that took so long, but there was a lot of acquisitions during those

timeframes.

Yeah, that's right. We kept adding to the scope. So there was a core scope and then we brought on Swedish. We brought on St. Joseph so we kept expanding the health systems, and if they were on Epic, they're on a different version of Epic, or they're on Meditech and Allscripts, and so yeah, the goalposts kept getting moved on that, but it is a huge effort to go to a single instance of an EHR, in our case, Epic.

So a little bit of both.

Yeah, so our single instance, and I'm sorry, I cut you off. Yeah, I was going to

say, a year ago, July 4th of last year, we were kicking off our Oracle Cloud implementation. So consolidating all of our ERPs on Oracle Cloud. And I'm happy to say that we completed that this year as well.

And so we've... Fully migrated our operations, HR, finance, supply chain, all of the core ERP functions over to Oracle Cloud and we completed that journey. So it's been a busy year. And as we've talked in previous episodes, my strategic Directives are, Simplify, Modernize, and Innovate.

And you can see the Simplify side of things getting on a single instance of Epic. Again, Oracle Cloud, we've really lived that mantra of Simplify.

Yeah it's never ending, right? I mean, I'm gonna push here a little bit. How many call centers do you have?

Too many to count. That's a huge opportunity for us.

Huge opportunity for us. So, a similar strategy there. We'll consolidate to a standard tech stack. In this case Genesis. But the bigger piece is going to be the business operations and the change management there, right? Every ministry has kind of their own call center services or activities.

So, there's a big opportunity

there for sure. Yeah it's amazing to me. How many call centers? They just spring up and all of a sudden, as the CIO, you're like, I thought we had six. Now we have 10? Like where are they coming from?

Bill, if we had six or 10, I would be celebrating. I don't know who you're talking to, but we don't have six or 10.

Maybe, but much, much more. Maybe in the state of Washington, we have six or

The idea behind Simplify, it's interesting. I was talking to Director Ford and West Wright yesterday. We talked about the whole concept of simplification and how important it is. In healthcare specifically, because for decades, prior to you getting into healthcare, prior to me getting into healthcare, for decades, it was just, you see a widget you like, bring it in.

And that creates problems, especially, we talked about the call center. The call center is going to tap into all those different things. If there's a thousand of them, building that out is almost impossible. Talk about the simplification journey

a little bit. Yeah, so when I came on board four years ago, that was when I first questions and the answer was we had about 3, 000 applications and I almost fell out of my seat coming from Microsoft, which is much bigger.

We had about 1, 500 applications. So hearing we had 3, 000 was shocking. My team probably doesn't want me to share this dirty laundry, but as we moved to the cloud and really went data center by data center, server by server, we actually found out we had about 5, 000 applications. And I'm proud to say we've retired about 2, 500 of those.

So if you look at what I thought we first had 3, 000, now we're at 2, 500. It sounds like BJ barely made progress, but actually the goal post moved on that as well. It went from 3, 000 and we've been able to cut that application count in half 500, but you know, we really focus on the key ones like our ERP and EHR system.

So. Although we didn't get a lot of counts by consolidating those systems, being on a single EHR and a single ERP is, going to pay dividends for us in the future.

Yeah, your, EPIC implementation obviously would consolidate an awful lot of clinical applications. Is there still an within the clinical applications to simplify?

Yeah, absolutely. The focus was on EPIC and we did the consolidation where we could. But now, we're trying to act as a single health system instead of a collection of 52 hospitals. So we're going through and standardizing, the oncology subsystems, or the, the blood bank subsystems, or whatever those are, and consolidate on a single standard.

And as we do that from a business perspective, then we're going to retire the applications that. Or non standard that don't align to that standard anymore. It's a never ending journey, right? It's, people do continue to add applications. We are adding applications to our portfolio.

So the count does slightly get bigger, but, to get it to below a thousand, probably a, five or ten more year journey to get there.

So, simplify, modernize. How much is the modernization effort hindered by the simplify? Like, you have to do that before you go into modernization.

We used the two really interchangeably so I kind of alluded to it earlier when I talked about the 3, 000 applications.

We didn't just modernize those applications by moving them to the cloud, right? We went application by application, server by server to inspect those and retired them. And so the modernize was actually a vehicle to simplify. It was like, we're not going to move, all of this. crud from on premise to the cloud.

Let's clean it up. And so they're really done at the same time. As we were simplifying, we were modernizing the app at the same time, and when we were done retiring the apps that are left are in a modern environment. They're in Azure, they're being hosted there, and then as we build new apps, everything new that we build is native cloud, or as we buy services from third parties, we only try to buy software as a service.

Solutions that are already in

the cloud.

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So talk a little bit about the cloud. People talk about cloud. When I hear that term, I hear it in a lot of different ways in healthcare and some people are like, oh, we went to work today, we're in the cloud. And I'm like, okay, what's your strategy? I mean, is enabled by moving to the cloud for a system like Providence.

Yeah, I guess I think about it in a couple different buckets. One would be kind of a data center strategy. One of the early observations is, data centers is not strategic for us. We're not good at data centers. And so those applications, moving them to the cloud, moving to, The VMs, moving to this cloud infrastructure where we have the elasticity to spin things up, spin things down, manage those environments, back them up more effectively.

I think that's one thing and that's one benefit of the cloud. So I'm no longer running data centers and then I've got the cloud flexibility. Yeah, saying you're on workday and you're in the cloud isn't really a cloud strategy, but saying that you're on a software as a service. So I'll take Oracle Cloud as an example, the benefits of ERP being in the cloud is, it's in the cloud, it's more scalable, it's more extensible, but every quarter, we're getting new features from Oracle, right?

And there's a discipline of us maintaining our environment so we can accept those quarterly releases. Whereas if you're on prem, I'll speak from my experience at Microsoft and here, you tend to to bastardize your environments to the point where you can't take the upgrades, or you take an upgrade every two or three years, or the software vendor doesn't even provide an upgrade for two or three years.

So by saying you're in the cloud on a workday or Oracle cloud, there are a lot of benefits to be on that cloud. And then these modern software companies, sticking with innovation's happening, right? They're not going to do. Generative AI on their on prem products, because you just really can't do that capability on premise.

They're going to do on the cloud products. And so there's tangential benefits to being there. And then the third bucket is kind of these native cloud applications where you just take advantage of the extensibility and scale of the cloud. So all of our data is now in the cloud. It's big data. We no longer worry about performance.

We no longer worry about scale. We no longer worry about volume. Right, when you're on premise on a SQL server, it's all, oh crap, I can't put any more on there, I can't process it. When you're in the cloud, that totally disappears. And then similar to software as a service, now you can do all these great cloud capabilities that are only available in the cloud.

I'm afraid I'm going to say generative AI, like, a thousand times, Bill, I apologize. But right. Things like that, machine learning, artificial intelligence, those advanced compute capabilities only exist in the cloud. So if you're not in the cloud on the data front, on your application front, on your data center front, you're going to miss out on a whole wave of innovation.

Yeah, when when people ask me about the innovation at Providence. I talked about your cloud move when you first came in, there was a a deal with Microsoft. You looked at it and said, look, we're moving to the cloud. We need a cloud partner. And you chose a cloud partner. I think the work you're doing in India also is fascinating to me.

I see the posts every now and then, and you have a significant team over there. And I think how you run that operation. is also really innovative. Talk a little bit about what you're doing with that team in India.

Yeah, so we team up about three years ago. It is a team of now 1, 300 caregivers.

They're Providence employees. It's a Providence company that, that we set up. It's not outsourcing. As soon as people hear India, they think, Oh, BJ's outsourcing jobs from the U. S. to India. And that's absolutely not what we're doing. It was always about talent acquisition. It's always about agility.

It was always about Coverage, 24 by 7 coverage, right? Hospitals are 24 by 7. So, our network operation center's there, our security operation center's there, our core cyber is now there, our big data and analytics are there. The capabilities when I joined four years ago that we didn't have, like, core engineering, software engineering, we just built that muscle in India.

So we haven't looked at a function in the U. S. or we didn't lay off teams in the U. S. and move those to India. Instead, as we had attrition, or as we had investment needs in new technologies, we evaluated, could we do that in India? Or could we only do that in the U. S.? And if we could do it in India, that's where we invested there.

And it's Been a huge success. Couldn't be happier with what we've done there. It's been such a big success that other health systems are looking to partner with us to leverage what we've built there and allow them to do similar operations offshore. So, when I hear as a cost, yeah, are there cost savings of being in India?

Yes. But even if India was exactly the same price, I would be there because what you can't put a price on is that 24 by 7 coverage, right? If I have a network incidents. I can follow the sun and cover that both sides. And then the agility, one thing, is actually a shared services example.

Early on in our journey Leel had a bunch of legal questions that they submitted to some legal counsel in India and submitted them end of the day. And when they came in the morning, all those questions were answered. And the light bulb went off and Leel's head is like, Oh, now I know what you're saying about agility.

I come in and I'm immediately productive. Like all those questions I had in the middle of the night were answered and I come in and I'm productive versus if I would have handed it off to a U. S. law firm, it would have been until the end of that, that next day before I got answers. So agility, access to talent, a 24 by seven coverage.

I can't say enough about it.

Yeah, I mean, the third leg that I always talk about Providence is data and the things you're doing with accessing the advanced technologies in the cloud, but I want to stick with one thing you said there with, which is that software engineering muscle, and it appears like that has become a critical piece of the set of services that healthcare IT needs to deliver to the organization.

There's just a bunch of key areas where they fill in the gaps. Talk a little bit about that software engineering and how you've utilized it.

I was at Microsoft for 27 years vice president of engineering, so software engineering was, It's kind of in my DNA.

It was kind of the currency when you're at Microsoft. When I joined Providence four years ago, that was one of my first questions. I had an IT team of 3, 000 people. How many of those folks are software engineers? And the answer came back zero. And I'm like, Well, we must just have a taxonomy issue.

Maybe you call them something else. So I described what a software engineer was, and like, no, we don't have any, we don't have any of those. And what my observation was is, we're really good at implementing third party tools, which I think is their best practice, right? There's no reason to reinvent the wheel if you can, purchase a product like Epic and implement it.

That's fantastic, but I found, at least at Providence, that was the only muscle we had. As I mentioned earlier, we still have 2, 500 applications. Well, those applications are islands. They need to communicate and talk and interact. And that's where software engineering can be that glue to connect it together.

Instead of a human being the individual that goes in EPIC and goes in a system A and goes in system B and goes in system C and does these things. Software engineering, you can streamline those things, you can stitch those things together, you can build APIs, you can move data, back and forth seamlessly.

And so... When I looked to build that software engineering muscle, I looked, we're here in the Puget sound. So we're competing with Microsoft and Google and Amazon. I can't afford software engineers here. And so that was okay. It's a brand new muscle we need to build. I can't afford it here.

I can't compete for the talent here in the U S. I could compete for that talent in India. And we actually do have on my staff, Microsoft engineers, Google, Amazon, Facebook engineers in India. By India standards, I pay a premium, but I can afford them. And now I can build that software engineering muscle that can connect all these experiences together that I couldn't before.

So Bill, maybe you, I'll ask you a question. I mean, is that a problem other health systems have? Or they don't have that software engineering muscle and they just have the system implementers? Or was that kind of a unique?

No, that is a problem that people are starting to fill in the gaps and they're trying to fill in the gaps, I think, with a lot of tools, right?

No code tools and those kind of things, but still that's kind of limiting in terms of what they're doing. And then I think the other skill set that we're starting to need and didn't. really anticipate is hardware is now becoming software, right? So it's now a DevOps kind of situation.

We're automating things through essentially programming languages. We're automating our routes and security software.

Find networks and, yeah.

Yeah. It's so that skill. is needed in areas that we used to have hardware techs. We now need software from one end to the other. And the skill is software engineering.

Yep. Yep. Very good observation. And the trend's only going to accelerate there.

Yeah.

So I want to give you permission to say the word generative AI for the remainder. And by the way we have a fundraiser with Alex's Lemonade Stand for childhood cancer. And every time the word. Generative AI is set on our show, we put 1 towards it.

All right, so they're up to about 1, 000, 000.

No, but we are up over 40, 000 this year, so it's been a, it's been a good year. So, but I want to talk about data and the things you guys are doing in data. Obviously you have a partnership with, well, actually I'm not sure that's through the IT organization.

You guys actually formed another company to do some analytics and some things. on a research scale. True Veta. Yeah, True Veta, but that's actually separate from some of the things that I think you're going to talk about

as well. Yeah. Back to my strategic pillars, Simplify, Modernize, Innovate.

That was one of the first things we did on the data front. All of our data was locked up on prem and spread across SQL servers, Oracle databases. We had SAP HANA. We if there was a data solution, I had it. So we moved all of that to native cloud and Azure Data Lake. And then we partnered with Snowflake for a lot of our relational cloud operations.

And, back to those core principles, obviously the simplify, having your data spread across 20, 30, 40 data sources isn't effective. Having all in one place is obviously much better. Having the cloud is much more effective, but, to the magic word of generative AI. Those tools only work on cloud, right?

So those were, when I talk about simplify, modernize, and innovate, I also talk about it through the lens of kind of Maslow's hierarchy of needs, right? Simplify is like the eating, breathing, sleeping, the kind of basics of the pyramid. Modernize is more like sending the kids to college. Innovation is that self actualization.

It's the same thing with technology. You can't jump to straight to generative AI if you haven't made the investment to get your data all in one place. Get it in a modern cloud solution, in our case, Azure. You just can't light up those scenarios. So it not only helps on the analytics front, but now it's going to unlock all this innovation on these, new waves of technology.

Well, I'm sort of curious. I mean, the interesting thing about this interview is I used to be CIO at St. Joe's, which is a subset, a small subset of what you're overseeing. And in my, my last two years there, we started to kick off data governance. And it was a huge lift at St. Joe's. You now have a much larger organization.

Moving it all to one location is one thing, but how do you clean up the data and then how do you... drive sort of data stewardship across the entire organization.

Yeah it's, it made it harder and it made it easier, right. It made it harder because we had to do the work, right. When it was peanut buttered across 50 systems, you could do governance, but if you didn't fully do governance, it still worked because each system was kind of autonomous.

So my moving it all in the same place, we had to make those tough decisions, but frankly, we needed to make all this tough decisions. So data governance is like, application simplification, it's a lifetime journey. I'm not going to look you in the eyes, Bill, and say we've got data governance figured out.

Yeah, I'll never say that. Anybody that says that doesn't understand data governance. But having it all in one place, right, it forced a lot of the tough decisions. So is it done? No. But being in one place, being in the cloud, having, a single source of truth has enabled some things that as far as data governance that we couldn't have done before, but yeah, it's a lifetime journey.

I've got a whole team that does that. God bless those individuals. Like that, that is a thankless, tough job. It's so, so necessary.

It is a very difficult job. I want to talk about your approach to AI and your approach to generative AI. We've had UNC on, we've had Stanford on and others.

And there, They talk about the need to educate the organization, set up the governance around it, and those kind of things. And then they talk about the different use cases and whatnot. How did you guys step into it? I mean, AI is not new for Providence, I wouldn't imagine. I mean, it's been around for a while.

It's not, and I'm glad you said that we did a board presentation about a month ago on this topic and remind, because that's, that's some of the first questions from people. Oh my gosh, this new wave of technology, how are we going to manage it? How are we going to effectively integrate it?

How are we going to do these things? The very first thing to do is remind folks, we've been doing this for years and years, right? It was machine learning, it was the more rudimentary building blocks of AI, but we've been doing forms of machine learning for a long time, right? Algorithms that estimate no shows for surgeries, or, sepsis, risk, or, in the case of COVID, COVID surges and PPE needs.

Inventory management, we've been using these tools for a while. Generative AI is definitely a huge leap forward, but I would remind your listeners that pretty much everybody's been using some form of AI or machine learning for years. It's just, now we've got a new tool in our toolbox.

Yeah. generative AI. I mean, there's misconceptions about generative AI, like we're, Hey, we're just going to be able to. Put all of our data into the generative AI model and all of a sudden we're just going to be able to query it and say, How can we make Providence more efficient? And it's just going to spit out the answer and away we go.

I mean, what does it take to train these models? One of the things you said before we started recording, I thought was interesting is, We have our partnership with Microsoft and we're doing things there. And we're doing things ourselves and training models internally. Talk a little bit about that.

Yeah, so there's kind of two big buckets.

One I call the easy button where we are going to do generative AI through partners, Microsoft, Nuance, Epic, Oracle Cloud, right? By using their products, we're going to naturally get the benefits of generative AI because they've done the integration, they've done the testing, they've done the work. And then on the other hand is kind of more our custom solutions where we'll use the large language models, in this case developed by Microsoft and Azure, but we'll use it to train on our specific data, on our clinical data, or our knowledge bases, or our internal data and so we were experimenting with some solutions there kind of across the board, we've got three solutions.

One that's consumer facing with grace or chat bot that we put up during COVID. She now has generative AI in there that makes her more intelligent. Internally for physicians, we've done inbox management that goes through their inboxes and basically categorizes their emails. We're not triaging it yet, but we're at least serving it up so a doctor can look at their inbox quickly and say, okay, this email is about, Side effects.

This is about scheduling. This is about, whatever it may be, so they can quickly look and say, oh, I can look at the scheduling things later. I can delegate this, but you know, this one that's about side effects, I better open and read. And so we've got that in production. And then we've got one around Physician training and physician referrals.

That's called PERL, that's using some large language models. So we're trying to invest on both sides. Kind of the easy button things, and put easy button in quotes, even, like Epic has got a good partnership with Microsoft and the generative AIs, but you're not just going to flip on the Epic capabilities and do it, right?

It's experimenting, it's doing the change management, it's doing the rollout, it's, figuring out a face approach. So even the easy button does not. It's easier. It's not easy.

I'm trying to think, Art, would you classify yourself as bullish on the potential for AI and generative AI?

And what, what gives you pause or what caution would you give to people?

I'm extremely bullish extremely bullish on it. I mean, there's so much we can do. And, generative AI is, one of those words that's, means a lot of things, obviously it means creating content, but it's a summarization of content.

It's a reviewing of content. So I think the power is going to be there. I'm sure you've had the same experience. It's kind of an experience curve with generative AI. You first play with it, it feels like magic, and you play with it more, and you see some of the hallucinations and some of the fallacies of it, and then you get really scared, and then you figure out, okay.

It's just not going to work perfectly out of the box. I need to do this or that. And as you make those small tweaks and adjustments, you see the power. So I think it's going to be transformative. And I'll give you an example where it's going to be transformative and I'll immediately turn it around to an area where it scares me to death.

An example is, kind of self healing environments, self monitoring environments. The thing about cybersecurity, you've got these models that are out, looking at your environments, looking for vulnerabilities, patching things as identify issues, immediately quarantining, self healing.

I think it'll give us a new tool in our toolbox to help protect our What scares me to death is the bad guys are going to use that exact same technology. So it's not like only the good guys are going to use this, the bad guys are going to use it. And so their toolbox has just got more and more powerful.

And just like I can have a AI bot looking through my environment, finding and fixing things. They could put AI bots in my environment that are finding things, exploiting vulnerabilities and breaking things. And so that, that scares me to death. And then, we're going to make mistakes.

One of the examples we talked about is like a helpdesk experience, you call into the helpdesk, you say you have a printer issue, well a bot may be able to, a generative bot may be able to help you with that. Okay, Bill, it looks like you have a printer driver issue. We're going to go ahead and, the bot could have immediately just patched that driver for you and now your printer just works, you never had to interact with anybody, that'd be great.

Being smart, we're going to then have the bot look for all the other computers that also have the old driver and update that driver. And so, there's 10 other people that would have had printer problems that aren't going to have problems because of this technology. That's great. There's also going to be examples where that same bot thinks it's doing really altruistic things, and it's going to upgrade some drivers on a bunch of machines and break those machines.

It's going to make mistakes like that, and be like, oh my gosh, why are these hundred, PCs no longer working, and we're going to do the diagnostics, and we're going to say that bot thought it was doing a helpful thing, well it fixed the printer issue, but it broke, the mouse, driver over here, and making the scenario up, but just as it can do good at scale, it can do bad at scale.

It's, we were talking about autonomous driving, and Charles Boise said to me that, humans can have fatal accidents every day, but the first time a robot has one, people are going to be up in arms because it's like, no, it shouldn't be able to do that. And the reality is the things you describe happen in data centers and happen in IT teams all the time.

They upgrade the wrong thing. They just don't do it in.

They don't do it at the speed of light, right?

Yeah. So how long have you been in healthcare now? Is it over five

years? Over four years. So it was January of 2019. So my anniversary is January of this year. So I guess that's four, four and a half years.

So,

you come from Microsoft, you come into healthcare you talked about some of the things you saw, like, just couldn't believe the number of applications and those kind of things. I put a poll out there this week on LinkedIn, and it was what's the quality that's most important in a CIO?

And, I'm curious as you look at that, because I was kind of shocked that industry experience was the lowest ranked number. And I can't tell you the number of times I'm like, just physically talking to people and they're like, no, look, it has to be a doctor. They have to know the industry. But the reality is there's so much, there's so much specialization in the technology field.

There's so much expertise that's required. I'm not sure it's easier to go from being a doctor to being a technology expert than it is to go from being a technology expert. You're not going to be a doctor, but Knowing enough to talk about that journey a little bit.

Well, that's what's interesting is you even caught yourself there, right?

Saying that I could become a doctor, you immediately pause and like, well, that's not a reasonable expectation. Like we wouldn't ever want BJ to be a doctor, like he wouldn't be qualified, but we don't hesitate to say, a doctor could come in and be a great tech leader, right? I mean, it's, I've got 30 years of tech experience.

You can't, a doctor has a high IQ, but you can't make up for 30 years of experience with IQ alone.

a lot of companies, what they ended up doing was sort of a dyad model. I assume you have a fair number of physicians and clinicians around

you.

But yeah, that's the way I look at it. We've got 120, 000 caregivers here, right? I've got 3, 000 people on my IT team. We've got a ton of clinical expertise. So when I got hired on, I used me as an example. Rod specifically hired me because I didn't have healthcare expertise. So, we have 120, 000 healthcare experts, adding 120, 001 healthcare experts isn't going to move the needle much, right?

Whereas bringing in a tech expert can move that needle. So yeah, I think and obviously I have a bias because I don't have a healthcare background, but I think having that bias towards best in class experience, And then supplementing that person with clinical experience to make sure that the right decisions are being made, I think is much more effective and scalable than taking somebody that's a deep healthcare expert and trying to teach them to be a technologist.

Because then nobody's day job is being a technologist. Everybody's second job is being a technologist. So, yeah. Obviously, I'm, like I said, biased because I don't have a healthcare experience, but I think having deep industry expertise, and it's other things, right? It's supply chain it's payroll it's these other things.

My observation after four years is that 80% of what we do in healthcare is really Industry agnostic, and we should really be trying to do that best in class and seek the industry experts, not the healthcare experts for those. 20% are very healthcare centric, and, having nurses and docs and the clinical expertise and focus there is hugely valuable, but pairing that off with the technical expert.

To me, it's kind of the best practice.

So I'll close with a dangerous question, which is, you've been in healthcare for a while now. You're right in the thick of it with a very large organization. So you've seen a lot of different aspects of it. We read these articles where, healthcare in America isn't keeping up with other countries.

We read stories where technology in every other industry has led to higher efficiency and those kind of things in healthcare. It doesn't appear to have done that. What's holding us back from an outside perspective? What's holding us back and what could maybe open the floodgates for just significant movement in terms of productivity or quality gains or health gains in our communities?

I'll be controversial. I think what you said before is what's holding us back. I think we're taking, people with clinical expertise and putting them in these highly technical areas and ask them to make technical decisions. And I think that's held us back. And so we've got 20, 30 years of technical debt.

Kind of back to my simplify, modernize, innovate. You can't jump to innovate if you've got a 30 year old set of systems and same thing in, in, in healthcare because we haven't kept up because we haven't invested because we haven't had the industry experts, not healthcare industry experts on whatever the function is within the health system we've fallen behind.

And, one, one thing I've advocated in other forums and I'll advocate here is I think we are behind other industries for the last 20 or 30 years. I don't think we're going to be able to catch up on all of those trends and catch this new wave of generative AI. My recommendation here at Providence and to other CIOs is catch this wave of innovation, be on the forefront of this wave of innovation.

I'll give them five years for other industries to look at healthcare and go, why didn't we adopt generative AI like healthcare? Look how healthcare evolved and changed and improved because of generative AI. Let's catch this wave. Trying to catch the consumerization wave, and the efficiency wave, and all the other waves that we've missed over the last couple decades.

Like, we're just not going to catch up on this. So let's focus on this wave of technology, be at the forefront of that. And Yeah, I'd love in five years, Bill, for people to be talking to you and I, I'm in XYZ industry, how do we do what healthcare did and be this early adopter of generative AI and really see these great outcomes and improvements.

That'd be fantastic. BJ, always a pleasure to talk to you. I appreciate all the stuff that you guys are doing at Providence.  

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