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(Intro) innovation is really our lifeblood for growth and for digital transformation. And ultimately, isn't that kind of why we're here.

I'm Sarah Richardson, a former CIO and president of this week Health's 2 2 9 community development where we are dedicated to transforming healthcare at one connection at a time.

Our keynote show is designed to share conference level value with you every week. Now let's jump into the episode (Main)

Sarah Richardson: Welcome to this week Health Keynote, where we engage with top healthcare leaders to explore the intersection of healthcare and technology.

Today we have the honor of speaking with Ryan Smith, the Chief Digital and Information Officer at Intermountain Health. With over 30 years of experience in healthcare it, Ryan has been instrumental in driving digital transformation and innovation across multiple organizations. His leadership has significantly influenced patient-centric care models and operational efficiencies.

Ryan Smith: Thanks so much, Sarah. Pleased to be here today.

Sarah Richardson: You have had such a distinguished career in healthcare IT. I'd love for you to share what initially drew you to this field and what motivates you to continue driving innovation.

Ryan Smith: Yeah, great. So my major Sarah was computer science and I was initially hired by 3M Health information systems here in Salt Lake where I live as a software engineering intern. I think that was my title. Back on the original help one hospital, EMR system that Intermountain happened to use. Intermountain actually hired me full-time as a software engineer during my senior year to continue developing on that help one system.

And I've, been hooked ever since. around the motivation for driving innovation, look, our industry is in a really challenging place. No, no surprise to any of us. You know, That, that follow your podcasts. We have like. Just unreal cost pressures that we need to manage and physicians and nurses are leaving the industry faster than medical and nursing schools are really able to replace them.

Especially, with an aging population as we go forward. It's really going to be a challenge and those that are still working. So we know they're really burdened with administrative tasks that are like burning them out. And I love what our CEO, Rob Allen here at Intermountain Health says.

And I look at it and all of these challenges require continuous innovation. We're at such an interesting crossroads right now in our industry. We're this like nexus of cloud computing large data sets, generative ai, machine learning progress around data interoperability. They're all really poised.

To let us make these leapfrog advances toward rapid digital transformation in the industry. And I've gotta tell you, that really motivates me. I think with all the challenges that we have we just have so much to be excited about as well. I'm super excited for,

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Ryan Smith: Well, first and foremost I'm only like 90 days in back in role.

And even though I've served. I'm like one of those three time Boomerang employees, which um, you know, is pretty unusual quite frankly, but really working hard to, to align to intermountain's key objectives.

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two primary things we're like laser focused on. One is this idea of simplification.

It's really simplifying the experience for consumers and caregivers. That second one is moving upstream, like I just talked about with Proactive care services to really focus on the health and wellness and preventing disease and to keep disease states from progressing, et cetera. And under, newer kind of value-based care models.

We've gotta go live in September. Really excited about that. And we're just up to our eyeballs making that happen. It's a, it's basically a big bang go live. And so, the teams are really busy, really focused on what we're doing, and at the same time. I'm coming in and also working, starting to put together a three year strategic plan for our digital technology services team, or DTS that we're called.

And part of that, is advancing Intermountain's digital transformation. So those are our strategies around our data cloud APIs, interoperability, ai, cyber analytics, automation, you name it. That's all part of where we've got a lot of focus and. Finally, I'd just say also advancing our culture of innovation.

We're fortunate that we can both work on our long-term sustainability at the same time that we're really advancing innovation, because that's a big way that we've got to deal with those challenges that I mentioned at the first. So this culture of innovation that's really core to what I'm trying to bring forward with my team.

Sarah Richardson: Everything you talked about, that whole list that you just went through, it's what everybody is literally talking about. You're doing it with a big bang approach and by still having this whole innovation centric mentality as well as your patient centric mentality, and that's one of the things that Intermountain has always been known for and recognized for.

Ryan Smith: Yeah, great question.

So as we look at things, you like say our, our digital front door set of strategies. Well, they're really there to provide our patients with seamless access to Intermountain

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channels. One thing I learned when I was CIO at Banner Health was that patients and members of the community.

They give healthcare organizations a lot of latitude from a physical facilities perspective. They understand that some facilities are a hundred plus years old and other ones are maybe a year old. And so they, they know that as health organizations, we're going to have a lot of disparity in the physical facilities themselves.

We refer to these like digital touchpoints with our patients as moments that matter. That's what we call them, and they're kind of divided into seven major touchpoint along a patient's journey or path with us. As it relates, you know, to coming needing to uh, have, an episode of care with us.

And so that's things like helping them understand and help with their learning needs. What options are there in front of them, et cetera. It's scheduling and preparing for their visit. It's a arrival to their visit. It's the visit itself, it's the follow up to that visit, and then, you have billing and financial needs and then.

Kind of between visits, how do we help them with their ongoing health needs until that next visit occurs, and then it's sort of a rinse and repeat, and they're back on that path. And so we have this kind of cool internal graphic, you know, of, of this, journey through, through a patient's life.

And we've got a long ways to go with that. I don't wanna make it sound like we have arrived. This is a current kind of three year strategy for us to really. Up our game there and to continue to improve despite already having I think, a really pretty good experience. But, through merger and acquisition it's brought a lot of new technologies and maybe some disparate by region experiences.

So, we're continuing to work to really homogenize that for our patients and the impact,

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I'd say it's been pretty significant and just continues to improve, with improved patient engagement. Improved access to care, enhanced patient satisfaction, et cetera. So those are some of the things that we're doing to

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Continue to focus a lot

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And so when you think about automation in healthcare and how it can streamline operations and also improve patient outcomes, what are some of the initiatives you're considering or looking at what the highest level of either success or favorability in achieving all the objectives you have on your plate right now?

And when I was here previously, during the first part of the pandemic we really got laser focused on automation initiatives. And at that point. RPA is, was what we were all talking about, and I think things have only advanced from there. But you know, at this point we, we have over 4,000 RPA based bots.

AI and automation type capabilities within their systems. And the nervousness that I personally have is that just kind of like analytic packages that were bold on, you know, 10 plus years ago that we all had to start paying our vendors that much more, to get those which then proliferated all of these different analytic packages.

They can make decisions and they can move work forward automatically and, one agent can be the output to another agent's input, et cetera. The challenge we're going to have is that it's not like we're building all of that, so we've gotta have a lot of dependency on these vendors, but I need to be able to stitch those, horizontally, so to speak, across multiple vendors.

I think virtually touch every aspect of the business within Intermountain Health, and I'd be very surprised if that isn't ultimately the answer for all of us as healthcare organizations and as payer organizations because we need to get that level of.

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support enablement automation happening within our organizations, to take cost out to help remove a lot of the mundane tasks, that our caregivers today have to do.

And it's burning them out and they need relief. And as we talked about earlier, we just don't have enough. you know, Nurses and, and physicians and for the trends of where we're going, again, we've gotta figure this out. This is really key. And that's why I think it's just a super exciting time, for us

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'cause I see massive amounts of data that we're having to parse out and still protect while we're sharing it through APIs and other functionalities. What's your approach or some of your thoughts on how you protect the organization from a cyber perspective?

Ryan Smith: Well, yeah, I mean, we see in the news every day, right?

Um, this is one of our key challenges as an industry. Healthcare has been woefully slow to adopt, to embrace, to invest in a lot of the,

[Mic bleed] you know, cyber protections and measures that, we absolutely need. And it's just wreaked absolute havoc on our industry.

As part of doing that, we're also protecting patient data. But you know, our top goal is to ensure, the reliability, the stability, the availability of a lot of these health lifesaving kind of IT systems. So part of how we're doing that, if I boil that down just a little bit, is one.

We're fortunate to just have an awesome cybersecurity team here. The company from very early on has really invested in our cyber capabilities and that affords, a portion of that team to, to really think like bad actors and. That's what we kind of have to do these days. So we look at some of our top cyber threats, how the bad guys are getting into other organizations, and it's really kind of threefold.

You've got, tier zero at the top. That's your domain and your enterprise admins, and also your directory databases, your domain controllers, et cetera. You've got tier one, that's All of your servers and your server admin, so your EHR, your ERP, your business, clinical apps, your EDW, all of those systems.

And then we look at and think about, tier two as our workstations, our, device admins, et cetera. Well, what typically happens is, the bad actors they come in at tier two they compromise either through a social, engineering compromise or a third party compromise.

Because otherwise you have to assume the bad guys are still in there. And so we're putting a lot of. Emphasis in how do we ensure that you can't have that traversal up those tiers or being able to, cascade and or have an exposure going down. And so a lot of separation and abstraction between this tier two, tier one tier zero in essence just to prevent privilege, escalation, and a lot of effort going into that effort.

Is it foolproof? No.. But this is an area, that the team just works tirelessly on day in and day out, to really try to,

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Sarah Richardson: And just the aspect of educating organizations about how to stay safe from a cyber perspective. Is a ton of energy because that social engineering piece is all of the time.

Plus some of these big bang approaches for operational efficiencies. What are some of the tricks that have worked for you and approaches for the organizational change management aspect of what's going on, because at every single city tour dinner or summit we have, we hear mostly two things now besides reimbursement and other concerns, it's the OCM aspect of getting things done, and it's a governance to make sure we're doing the right things.

How are those things appearing, I guess, for lack of a better term, inside of Intermountain? How has it changed since you've come back and where do you see some opportunity there for your organization too?

Ryan Smith: It's such a great question, Sarah. One area that I've seen that just speak volumes to is with our Epic migration.

It's like, okay, we've gotta get 55,000 caregivers. Registered for training so that they know how, how, how to use the system. And every one of these big spikes, whether it's getting people , registered for training or going through the training or doing our operational kind of technical dress rehearsals or whatever the case.

I've been so impressed here returning back to Intermountain Health to see the level of senior leader engagement through governance to really help protect. The time that, that we need our DTS caregivers and other operational leaders to really focus on these critical path kinds of activities.

Let us help you, you know, with, [Mic bleed]

it's prioritization issues whatever it is. And I've just seen this great kind of top down support for a program like this. We're working on really trying to get that level of governance in across you know, everything that our DTS team is involved in.

This is our project, you know, talking about all of us in here and it's going to take all of us to be successful here. And I love that kind of just operational stakeholder, executive engagement because that's what helps these kinds of projects be as successful as possible. So I think it's a great question.

We're focused a lot on operational change management because at the end of the day, it's a big part about how we think about innovation within the organization. We have a ventures team that you mentioned and. They're always scanning, startups and looking at opportunities.

And that's not how we look at innovation here. We're really increasingly looking at innovation of learn early fail fast. If that's the outcome. That's okay. And for things that are working. How can we get that to scale and to get it to full implementation production across the entirety of the organization.

And that takes a ton of operational change management, but that's just so hand in glove with how we're thinking about innovation, that it's a really important subject.

Sarah Richardson: To your point, pilots that go on into perpetuity that never really end or go away. And then even if it's not a solution that the organization loves, somebody loves it, it just sort of sticks around, right?

How do you avoid pilot fatigue though, by having an innovation center and keeping the lights on with all the different projects you have on your plate? How do you actually help prevent innovation fatigue?

Ryan Smith: It's challenging. I've gotta admit, we have the large percentage of my team they're a lot more focused on day-to-day, project work and keeping the lights on, right?

And so some of these pilots, from their perspective, they kind of come in from the side. They need a lot of attention. They need a pretty fast, it's competing with the work they've got on their plates. And um, and so again, that kind of comes back to the governance piece of it. And so.

But if the pilot. Goes well enough and we need to scale that and kind of get, start getting that actually out of the lab and into you know, a broader pilot, so to speak. It can be really challenging and I hear about that, at least a few times a month, where my team is kind of crying, foul a little bit over like, hey.

How do we do both? But I remind them we have to do both because innovation is really our lifeblood for growth and for digital transformation. And ultimately, isn't that kind of why we're here. It's not just keeping the lights on. It's not just for, getting our 200 annual projects done.

It's, we have to at the pace of business, we have to be bringing in. New ways of doing things, and it's our job to help enable the rest of the organization to be more nimble, right? To be more agile, to test things and, and, and to really help the organization move forward. We've got a big part of that as our responsibility.

Ryan Smith: Next few years? Well, we're going to continue to see. A lot of margin pressure in our industry, no question about it. So how do we advance innovation at the pace that we need to advance innovation while we are being. Good financial stewards, which oftentimes means, how can we sign up for a two to 3% year over year, say cost reduction while we're keeping the lights on, while we're advancing projects, and we're doing these really innovative things.

And so trying to keep up with that. And understand what impacts that has on us. That's going to continue, I think, to be a challenge for the foreseeable future. And as part of that, we're trying to lean in as much as we possibly can, to

help advocate for certain positions. Again at the. State legislative levels as, as well as at the national levels. And trying to have a voice and trying to partner with other organizations to have a broader, more collective voice. But, you know, it, it feels like it's changing every day and it's just something we're just going to have to continue to really keep an eye on.

Our moment to be able to shine digitally to do whatever we can, to help these caregivers be able to show up, bring some of that joy of providing care to our patients and members of our communities. And it's such an important mission and I think about Intermountain's mission of helping people live the healthiest lives possible and to do that effectively.

Our roles as digital leaders is just so vital to helping that for the future. So those are probably the three things that I kind of personally look at as most challenging cyber. That's just interwoven in all of that. Okay. So I'd be remiss not to mention that, not going to be a continued challenge as well because it absolutely

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Yeah. And I am very hopeful at this point in my career to be able to see more and more time given back to a physician or a care provider to spend. Physical, face-to-face time with their patients.

Ryan Smith: Absolutely. And I'm like super excited about all that we've got going on in that realm as, as well because we are both helping to save time with a lot of those mundane administrative tasks, that clinicians just hate.

We're just at the forefront of this, and it's just going to get much, much

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Sarah Richardson: We know that you're gonna be leading the way, so we'll talk about it every probably year just to make sure we get to hear all the amazing things you're doing with you and your team in Intermountain Health. Okay.

Speed round questions. These are the really hard questions for today, Ryan. What is the one piece of technology you cannot live without?

Ryan Smith: I would say probably my smartphone. Okay. I am an iPhone user but probably my smartphone. But if I think about it, I. It's probably like my copilot and my chat GPT apps on that smartphone.

I can't imagine getting by without being able just to, bounce ideas off of these LLMs and getting pretty decent answers coming back. Not perfect by any stretching the imagination, but yeah, somewhere between large language models and GPTs and my smartphone. That's it.

Sarah Richardson: I would agree. By the way, if you weren't in it, what career path might you have chosen?

First, 80, 86 computers, Macintosh's, et cetera, came out and I just found myself completely immersed in those and trying to figure out basic, as a programming language and then Pascal and what have you. And I was just such a sucker for, I. Those personal computers when they very first came out and continue just to be a huge fan and it would definitely be something technology related.

I'll

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Sarah Richardson: I laugh as you say that because I grew up in the era where we had like command prompt video games. Your venture games were Oh yeah. Prompts for a period of time. And so we would just have paper all over the walls mapping out like the environments. And here now kids have everything on their iPads right in front of 'em.

Ryan Smith: Alright great one. So I'm currently. Listening to an audio book. It's called The Digital Mindset.

I'm really enjoying it. I think Paul Leonardi is the author of that one, if I'm remembering right. But the digital mindset, and it's just a really great way, it's not healthcare specific incidentally, but it's a great way to just how to be thinking. About digital transformation within any industry and some of the key skill sets that we need to have if we're going to be relevant.

And especially I think as leaders that are driving digital transformation I'm learning quite a bit from it. A lot of it's like, yeah, yeah, yeah. But there's a lot of stuff also it's like, oh, you know, that's really, great advice. Probably another one that I read recently that I really enjoyed it, it was the one by Reed Hastings, the founder, CEO of Netflix.

And how that really, fosters such an awesome culture and a culture of like reinvention. So I've enjoyed both of

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Sarah Richardson: We'll put 'em in our show notes for sure. And thank you for sharing those with us. Brian, thank you for sharing your insights and experiences with us today. Your leadership continues to shape the future of healthcare it, and we look forward to seeing how Intermountain Health evolves under your leadership.

Thank you for listening to keynote. That's all for now.

That's all for now.