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I have no doubt that one day we will look back to think about how primitive were we when we were prescribing drugs and therapies for people without really knowing what constituted their DNA makeup.

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) Hello, I'm Sue Shade, Principal at Starbridge Advisors and one of the hosts for the town hall show here on This Week Health. But today, instead of a town hall, I'm doing a keynote interview, and it's with Albert Oriol the VP for Information Management and CIO at Rady Children's Hospital and Health Center.

Thank you for having me, Sue. Excited to be meeting with you this morning.

Yeah, and we'll have plenty to get into here. Let's start by having you describe Rady Children's for our listeners.

Sure, so Rady Children's is both the provider of choice and the safety net provider of pediatric services in San Diego, Imperial, and Southern Riverside counties. We're the largest pediatric hospital in the West Coast, and with the upcoming merger, with, Children's Hospital of Orange County, we will soon be most likely the largest, pediatric hospital in the nation.

We're at. Top 10 pediatric hospital, in the best city in the U. S., if you ask me, I'm biased, I know. We've six time recipients of the EPICS Honor Roll and known nationally and internationally for innovation and excellence in care.

You said it's how cold there?

Yeah, it was chilly this morning. It was in the 50s, which we're not used to here in San Diego.

I get it. And here I am in Massachusetts and it's, like 20 something with a windchill that makes it feel a little cooler. It's all relative. What we get used to.

let's start maybe broadly talking about children's hospitals and the challenges that you all face today. What are some of those key challenges and how do you see technology playing a role in addressing them?

There's definitely no shortage of them. Probably the biggest challenge, I don't know that this is unique to pediatrics, but it's exacerbated in pediatrics.

It's around reimbursement. Of course, 50 percent of our patient base is covered through Medi Cal, which is California's Medicaid and the rates are just atrocious. So that reimbursement pressure is tremendous, and that means we gotta be innovative and creative on how we meet the needs of our patient population at a lower cost, right?

We're dealing with that. We're dealing with the aging of the workforce in particular on the clinical space and the shortages that creates across many disciplines. And we've seen that now combined with some pervasive. supply chain shortages that have added additional challenges for us and which both drive resource scarcity and escalating costs.

One of the questions I wanted to ask you about is precision medicine. You just referred to it, I think you said personalized medicine. It's obviously a promising area in pediatric care. How are you working with IT and the infrastructures to support the needs of personalized treatment?

I have no doubt that one day we will look back to think about how primitive were we when we were prescribing drugs and therapies for people without really knowing what constituted their DNA makeup. Now for many years, we've used augmented intelligence to help our genomic clinicians come to a diagnosis.

treatment. And our Genomics Institute folks have been pushing the envelope there in, combined with a tool that we call GTRX, which is an expertly curated database, which today has over 400 known treatable conditions but we're anticipating we will expand to over a thousand here in the next not too distant future.

We do personalized medicine when it comes down to surgery. We have a very advanced 3D imaging lab that basically has allowed us to

So that's also been amazing. And of course with all the new drugs that have appeared in the last few years, right? The million dollar drugs with CAR T treatments and, And gene therapies, etc. Those are very expensive, require great synchronicity between kind of the patient's data and the drug manufacturers.

And so that also involves a lot of data sharing and technology along the way. So there is no shortage. I could go on and on for hours on. Personalized medicine efforts here but needless to say in the 21st century it's all stuff that can't be done without the digital world.

Wow.

What role you and the IT team play with that?

It's a team effort and really, it's all led from the operations side our champions in the Genomics Institute lead that effort. We provide a supportive role, from an infrastructure standpoint, right?

We're organized. In a way, we're we provide corporate services for all the infrastructure, all the integration we we have all kinds of platform engineers and clinical informaticists and integration engineers and data analysts and data scientists bioinformaticists and you name it, working in collaboration from central IT well as the folks on the Genomics Institute to develop, build, support the technology.

And then we bring those two. sets of data together along with a number of third party available dictionaries out there to be able to deliver that, that end result. There are other folks that do things similar maybe not at our scale but great minds.

And if you miss them then the impacts and the sequelae are going to be impactful. And in some cases, really devastating to those kids and those families. And so we. I think that is unconscionable, and we have the information and the technology to make a difference. We, can't boil the ocean, but we can certainly make it much better than what it is today.

But again I think it's going to be the future and when we look back 10 years think about how come we haven't been doing this. sooner, right?

Okay. And are you unique as a children's hospital, in these initiatives? You talked about being the largest children's hospital on the West Coast and that when you merge with children's of Orange County, you may be the largest in the country.

Did I get that correct?

You did. Yes.

Okay. And is what you're doing in this space with the Genomics Institute. to you or other leading children's hospitals doing this as well?

Other folks are doing some of this, but I think what we're doing here is unique and I think what we're doing here is.

Okay.

The moment that a baby in our NICU is identified as a candidate for genome sequencing that triggers orders and consents in EPIC that then drive the lab process, to extract it.

So it's not just a research entity. It's part of our caregiving process. And I think that is extremely unique.

That is the level of integration we want between research and care. And it sounds like you're accomplishing it. that's great. That's great.

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So you've been CIO at Rady for over 18 years. Is that right?

That's right. Seems like yesterday.

So tell us about your own career journey and what brought you to Rady?

Yeah I think what brought me to Rady was Ultimately, if I bottom line it, it's having great mentors, I was lucky enough early on in my career to land in an interviews.

In addition to working with Jim, I worked with Mark Lazarus, who was the VP of managed care and halfway through my fellowship, they both offered me a job, and that time I was young and naive, and I thought I was going back to Barcelona shortly thereafter. So I told them, you don't have to pay me for two jobs, but if you'll allow me, I'd like to do both jobs, because I wanted to just learn as much as I could before I went back.

And that got me to, at some point, Jim left to go to Denver Children's. He reached out to me to see if I'd be interested in a role there. I went to check it out. I worked with him five years in Denver. And when I was ready to move to that next level we had the kind of relationship where I could tell him, it's listen, at which point do I need to start looking for a CIO job?

to be honest, because I didn't think I had the chance. What I didn't know is that they were coming out of a very bad financial crisis first, followed by some safety crisis at the time. And I was probably the only candidate that they could afford. And so I got the job and I've been very lucky to work here.

It's a wonderful organization and 18 years and three CEOs later, I'm just happy to have been able to lead very talented team that has allowed me to live up to my motto of better care through HIT. It's just an amazing place with amazing people.

Obviously, if you've been there 18 years, you've proven yourself. That is a long tenure for a CIO. So that's awesome. Congratulations. So in terms of leadership style and approach, I'm assuming that have to work with a strong partnership between your IT team, your IT leaders and the operational teams.

Can you give us some examples where that collaboration has It's been critical to solving major issues.

My associate CIO Josh Grummel took the bull by the horns working in parallel with, in partnership with our associate chief nursing officer to get to the bottom of line. We've had tremendous partnership from our vendor who basically, On the one side we worked on a kind of short term solution for how do we fix that.

So we reached out to Zoom, who we were using for video conferencing on the business side, and said, Hey, have you considered. Being on the clinical side, and they really hadn't, so we reached out to EPIC and did the first Zoom EPIC integration. And for many years, we were really happy.

Maybe we were a little bit ahead of our times when we started it. But that forethought got us to be ready when it was really needed.

I'm curious, what's it dropped back to now?

We're about 10 percent of our volume. So I want to say it's in the a hundred to a hundred and fifty a day.

Okay. That's still pretty

good. Yeah, that's good.

there are so many opportunities. We had, during the pandemic, our CEO got a call from the mayor asking if we would set up a health center at the San Diego Convention Center because we were going to be housing 3, 000 minors. Who were separated from their parents at the border during the border crisis.

I remember hearing about this from you and maybe talking about it. Yes. Yeah. And

And that proved key because the city wanted us to test those patients. for COVID every three days. Imagine trying to do that on paper. Yeah. So yeah, there so many things where, you know, and obviously that was not IT led, again, that was operations led, but strong collaboration with IT.

That's great. I want to switch gears again, talk about remote work. And while I have not read all the articles, I'm seeing a lot of headlines on some of the big companies, big tech companies, mandating everybody back in the office every, I think it's back in the office full time. You want to comment on that?

Let me comment on the general trend first. Okay,

sure.

The cynic in me thinks kind of those band aids are an easy way to force labor reductions without having to deal with severances, etc. So that is a trend that, we're seeing in companies that are trying to bolster their financial, particularly public companies traded in.

They leave it, they breathe it they understand the why behind the why. They're connected to the mission. They're part of the culture, but it gets harder. As more and more of the workforce are new and remote and have never set foot in the organization, and they maybe don't have that connection.

And so that makes it harder. I can't take credit as much as I love to take credit for remote work. Remote work in my team existed before I got here. Really? More than

18 years ago?

Yes, our coders and health information management were remote prior to me getting here.

Let's keep them on site. And we saw, again, we didn't see drops in productivity. On the contrary, we saw improvements people gained quality of life not having to sit for an hour or sometimes two each way to get to work, right? And traffic and whatnot. All in all, we thought it was good.

We've seen a couple of instances where it hasn't worked out. And, when. Those things happen, you identify you deal with it but for the most part, it's worked really well. What we are realizing is that there are some functions that obviously need to be on site, right?

They're remote, but they're local. If they need to come in, they can come in, et cetera. But in many cases, we have people in over 30 states right now, about 30. Wow. 30 states. Yeah. About 30 percent of my team is remote. Remote out of area, meaning not in the San Diego metro area. So it's either Northern Cal or or out of state.

And a couple of instances, we realized that in a small teams where everybody was, was not local and made those things hard. So now we're thinking about, we need to find the right mix of, you can still work remotely in many cases, but we want some local presence so that if somebody needs to come in, they can.

So what do you do to take care of yourself and to encourage your team to take care of themselves?

I think Early in my tenure here in San Diego, I our CEO at the time, my boss, came in and told me, Albert, I want you out of the office before five o'clock, at least twice a week.

And so I took that to heart and I got back into rugby, which is the sport that I used to play growing up and I took up coaching, et cetera, so I love sports and, whether it's old man's rugby or getting out of my paddleboard or rowing or used to be running, but now it's more walking the dog or, if anything else fails, I go to the gym, but that's good for me.

Are you telling me you don't play that well? So you can't play? I'm not that good.

I'm not that good. Okay. I read, I write, I love to travel. I love to watch my son play rugby.

I take the time and I take care of me and I expect them to do the same.

That's great. That's great. I think that's a great way to end. And that you walk the talk so important. Thank you so much for your time today.

Thank you. It's been my pleasure. You always make me think.

Great. Thank you so much. Thank you, Sue.

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