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 Welcome to this Week in Health It where we discuss the news, information and emerging thought with leaders from across the healthcare industry. This is episode number 38, and this week we have a special episode from the Beck's Conference in Chicago, where I interviewed six different CIOs and asked them a series of five questions.

Jason Joseph, the Spectrum Health, c i o, Jake Dorst. Tahoe Forest, David Chow, uh, c i o for, uh, children's Mercy, Andrew Rosenberg, Michigan Medicine, ed Marks Cleveland Clinic, and Tom Barnett, the University of Rochester. Uh, it's so much content that we split it across two episodes. I'm gonna release 'em both on Friday, so you have a lot to listen to this weekend.

And, uh, we're gonna start with Jason Joseph, and then move to Ed Marks and then Tom Barnett. And in our next episode we'll we'll listen to, uh, Andrew Rosenberg and Jake Dorst. So without further ado, here we go. Jason Joseph, c i o, newly minted, c i o for Spectrum Health. Give us an idea of Spectrum Health Scope, scale.

Sure. Uh, spectrum Health is a, uh, integrated health system located in western Michigan. Uh, we serve primarily about the 13 county area surrounding Grand Rapids. Uh, we are growing and, uh, proposing a, um, an integration down in the southeastern or the southwestern part of the state. Uh, With Lakeland. Uh, but we really cover, uh, a much broader, uh, scope of that from a patient population due to our children's hospital.

So we have a children's hospital that covers the majority of the state and actually, uh, uh, beyond the, the walls of the state on occasion. And then we have a health plan, uh, that has, uh, around 800,000 members and covers the state of Michigan, uh, completely. So we're a little bit unique in that our health plan and our delivery system are similar in size from a revenue perspective and do not have a full

Overlap. So we have patients who are members, members who are patients, but we also have members who are not patients, uh, under our care. And we have, uh, many patients who are not members of our health. So you're the c i o of the system? I am the s in the health plan, I am the system. Uh, c i o. Correct. So I have responsibility for information services across the board, which includes our hospitals, our medical group, our post-acute services, our health plan, and our other, uh, corporate entities as well.

Wow. Sounds like a lot. I, uh, alright, so . Five quick questions. I asked Ed Marsey same questions. I'm gonna ask a couple more people. So, great. They're gonna sound side by side, so people are gonna, you can compare and contrast to a relative, uh, compare. It's mostly just different approaches to the same, same question.

So, uh, we'll start off pretty easy with, uh, first question. How is your system thinking about digital or addressing digital in healthcare? So, uh, we've been in the digital business for quite a while. We've been a, a leader. I think our initial patient portal dates back to 2008, if I'm not mistaken. So we're 10.

Years into the patient facing digital tool set journey. Uh, and we've been in, uh, multiple iterations of that. Uh, our digital approach has been that of providing digital services and integrated digital services to our patients and members, uh, in the way that they need them, when they need them. We have a mobile first strategy along with that.

So everything that we do online, we make sure is available in our mobile solution as well as in the, the other type of environments from an engagement perspective. But if. I were to kind of zoom out and think about digital, I think of it in three categories. Digital, used for patient, uh, acquisition, um, digital marketing.

How do we, uh, understand and manage the consumer of healthcare? How do we do outreach? How do we communicate? Then there's a, a digital engagement, which is essentially, uh, in my world, you know, think, think back to the early days of Amazon, right? Amazon started selling books online, and it was the online services that got you there.

It was still a paper book, . But it was a new digital way of buying it. And I think our patient engagement, our member engagement services really highlight the ability to interact with our health system and get the type of thing done that you need that's becoming more and more mainstream and more common.

And then I think the really third area in the emerging areas around digital health, and that is actually, um, converting the healthcare that we provide from an analog type of equivalent to a digital equivalent. And that can take the form of virtual where you're removing the barrier . Of space between the patient provider that can, uh, take the form of artificial intelligence where we can take some of the low acuity things offline.

It can take the form of really looking at the waste and the delays in healthcare, and finding ways to automate or use advanced analytics and new technologies to get in the way of those things. And I think that's the area that you're gonna see the most innovation in the years to come. Yeah, digitizing healthcare is really interesting changes to the access method as well.

As the, the data backend. Uh, one of the things I've been sharing with people is I just read, uh, Steven Klasko, c e o of, uh, Jefferson shared a health system without a zip code is his 10 year vision. Mm-hmm. . And, you know, digital plays such a key role in that of access, um, you know, delivery and, and all sorts of things.

It's just staggering to think what that might look like. Second question. Yep. How do you determine the noise from the value, uh, in the digital space? So you just finished, finished speaking . Becker's conference and about, you know, 10 vendors surrounded you with their cards and whatnot. But, you know, one of those might be awesome and nine of 'em might just be noise.

How do, how does your organization do that? You know, I think healthcare is in such an interesting time right now. And, and in order to separate the noise or the signal from the noise, you need to separate the strategy from the things that are opportunistic, right? And as I think about it and look back, our core, um, our system just went through a big epic implementation.

As many have. And to leverage that investment, you have to understand the roadmap and the development that's going into some of your core platform vendors. And for my money, if it's anywhere near that core, that's our answer. Um, and that's really the, the strategy that we're gonna employ is do not invent what you don't need to invent.

So, so you're encouraging people if, if my E M R provider does this go somewhere else, if my E M R provider does this, I would, I would tell people in the startup space this as well. If you're trying to compete and go after Epic. Clients with functionality or tools that Epic has or will be providing as part of their core in the future, you will not outrun that bear and they will supersede your functionality at some point in the future.

And the fact that it's all integrated is always gonna trump whatever incremental functionality at. So not to be disparaging and say, you know, don't innovate, but innovate in the right space. Innovate in those spaces that don't have a core adjacency to the stuff that we've all spent millions of dollars putting in.

And implementing, and we're now trying to optimize and get our value out of, help us in those areas where you can add on top of the value and start to think of it differently. If you'd want to compete with Apple, you're Samsung, and that's probably one or two or three vendors in that space that are gonna be successful.

However, if you want to be an app developer on the app store, there is a huge marketplace for you. Just recognize when you're on the platform and when you're actually selling an app. Yeah, it's uh, that's, no, that's really fascinating. I work with a lot . Of, uh, startups and they say, I don't understand why this health system doesn't buy my stuff.

They need it. It's absolutely necessary. And I say, well, do you realize it will take them probably 18 months to implement it? Just, just from a contracting standpoint, it's gonna be six months contracting, implementation, change management, understanding the workflow integration points, and then you, you look at whether that problem is actually the biggest problem, the health system.

Right? Maybe a problem, but it doesn't mean it's the biggest problem. And we all have finite resources in terms of . Money and time to spend on this stuff, and we've gotta be judicious about how we do it. Absolutely. So what's the biggest opportunities for health it right now? You're talking to a whole bunch of CIOs, potentially.

What's the biggest opportunity that you see out there? Yeah, I think you could answer that question in two, two fronts. Um, one, I think that we, uh, have a huge opportunity to leverage some of our core in, uh, infrastructure and simplify it so that we are more digital ready. Um, I mean, I, I'm a big believer in having a few core systems that you really

Invest heavily in, but the pace of change is such in our business that you're still going to need to adapt and you're gonna need to flex into those strategic opportunities. And it's incredibly hard to do that if you've got, um, complexity under the hood. And so I would say do not underestimate how much that can complexity will hurt you in the long run if you're not ruthless and rooting it out not only for the cost, but also for the agility that it's gonna provide you.

And so that's kind of philosophically I would . Say, our opportunity is to get more simple so that we can be more agile, so that we can innovate. And I think the innovation's gonna come in two main areas. You've already touched on 'em, digital and how we transform our healthcare systems digitally. Some of which will be, you know, very common types of capabilities that we're all gonna have in our, in our toolbox.

And then there's going to be those things that are true, truly differentiating. And the second is how well we use the data that we actually have in our systems to come up with new answers and new outcomes. And that's where our business and our clinical community, Competitive advantage is gonna come in with advanced analytics and some of these tools.

If we can apply those well, we will actually see significant changes in the core of business of healthcare. There's other things that we do every day that just helps us kind of make the core a little better. The things that I look for, the things that actually change the core, the things that say you no longer need that diagnostic process.

Um, you know, I'm looking forward to a point in time, and this may be way out there where you could actually go in and have some . Medical imaging done, and when you walk out, you're going to get a report because it's so protocolized and the AI engine has become so strong that you're gonna get a 99.6% accurate report out.

Same thing with low acuity, uh, primary cares. These, um, the, the engines, the intelligence and the machine learning is going to quickly make it so that these are, these are realities in the near future, and we have to be ready to capitalize on it. So this is me cheating, but in your, sure. In your, uh, session, you talked about the

Build versus buy, sort of, you know, we're gonna invent new analytics versus we're gonna buy new analytics. And, uh, you know, it's, it's interesting. In this space, how much if, if you sort of to, uh, put a percentage on it, you know, is it 80 20, 90 10? I mean, how much are you actually gonna build because you have to, 'cause you're, you need to differentiate.

Yeah. Uh, you know, I think right now it's gonna be closer to 90 10. We're gonna buy, uh, And I think as you get better at it, you're gonna build more because you're gonna have the tools in your right, once the platforms are in place, that you're not really building the platform, not not building the platforms, you're just customizing on top.

Yeah. And so where I would say our, our build is gonna come in is our understanding of tweaking the algorithms that we have, understanding and tweaking how the data fills into theirs. But from a platform perspective, uh, you know, you can't have a analytical platform that you build yourself and then have a strategy to leverage your core.

You know, common vendors, it's, it's incongruent, right? And so our strategy is going to be to leverage the core to the fullest extent by what's available in terms of reports, dashboards, algorithm, and focus on getting those to actually materially improve our business, whether that's clinical outcomes, financial outcomes, whatever it may be.

And then as we get good at doing that, understanding what it will take for us to actually innovate in that space. Yeah, leveraging the same platforms, but innovating in that . Space and actually creating, uh, something unique that we may have, uh, the ability to do. Alright, I'll get back on script. Sure. So, uh, what's the biggest threat to traditional healthcare system today?

Internal or external? Yeah. Which, uh, I think it's a boiling frog complacency. Um, all health systems are going through some form of, Hey, our volume's not going down, but we're still not seeing the same level of reimbursements at this, at the same thing. And, uh, we're all trying to figure out how value type engagements

Play into our business plans and our business models. And in the meantime you've got disruptors coming in saying, Hey, we're gonna buy a population and we're gonna do healthcare differently. And you know, when you look at the, the pool of money available in healthcare, this is the thing that fascinates me the most is we look at it and we say, we spend way too much money on healthcare, yet we think there's so much money to be made in healthcare.

It doesn't seem like there is, um, the way you make money is to actually reduce the cost. So the only money making opportunities are going to be things that are truly revolution. Revolutionary revolutionizing the care process and moving it out. I think the systems that aren't seeing that and that are just trying to optimize the business that exists today are at risk of having something blow in that they can, they can't keep pace with.

Um, I am personally not as worried about the things, uh, that, that are kind of flash in the pan. You know, Hey, this is cool and you're going to get, get it, um, you know, a, a new video visit or that kind of stuff. I think we're well positioned to still compete there and there's still time. To do it. I, I do worry a little bit about shifting the eyeballs of the consumer owning that relationship and then taking away, um, the things that do pay the bills for the health system in favor of the things that don't, and not addressing that disparity.

It's going to leave us all in a really rotten position if we don't. Yeah, that's the, that's the, the challenge is you have one, one foot in each boat and you're saying, okay, we're gonna disrupt our current business, but when we can disrupt our current business, our revenues come down. Therefore, our

Moderating comes down, therefore our cost of deck goes up. You know, it's like you, you're, you're reinventing as you are maintaining. There's a very narrow path to walk to get from here to there. And there's, you know, history is riddled with examples of businesses that did not do this well. Um, you know, everybody has the codec moment in their mind about how do you actually go there?

Um, and that's, I think the challenge for healthcare is making sure that you're both cognizant of the financial realities we live in today. , but starting to shift to take advantage of the financial realities of tomorrow. And if you're doing that well, you'll be successful. If you get off track one way or the other, it's gonna hurt.

That's crazy. Last question, if you, uh, new c you're the second new C i O. So I, I talked to Ed Marks last night and he's only a year into it. So this question's kind of interesting, but if you could rewind the clock three years, what do you wish you had done, uh, three years ago to really prepare your IT organization for today?

You know, um, I think we have a. Tremendous, uh, talented organization, especially in West Michigan. I mean, we've got great access to schools. We have a strong internship program. We really have very, very strong, uh, very, very strong teams. If I had to rewind the clock, I would say that we could have done even more to develop leadership talent, um, tech talent, leadership, talent, and moving people along very prescriptively to make sure that we always have, uh, a next layer of leaders ready to go across our organization.

Is is . Is gonna challenge all of us. I mean, the demographics are changing. You're seeing leaders retire and move on, uh, at, at a more rapid pace. And, uh, you know, it's gonna be incumbent on all of us to make sure that we're not only stepping into that void, but we're preparing the next layer of leaders. And so I think that you can't spend enough time really thinking through how do we develop a high talent, um, impactful organization And with, within it, you've gotta have the technical chops, you've gotta have your IT talent.

But there's so much more that is gonna be needed for that in the future in terms of business acumen, communication skills, strategic thinking, uh, we gotta start now and I wish I would've started even sooner placing more emphasis on that than we have. Well, um, yeah, thanks. I, I will have to have you on a, a full show 'cause there's like, we could talk for another half hour on some things, so Yeah, absolutely.

Thanks for your time. So next up, ed Marks c i o for the Cleveland Clinic. Give us an idea of the size geography real quick and focus. I, I, I think we assume everybody knows Cleveland Clinic, but Yeah. Well, it's about a $9 billion organization, but what we measure is lives touch, not the dollar amount, not the bed size, but lives touch.

So we touch 1.8 million lives and our hope is to really triple that essentially in the next five years. So we have our, our main hospital, the original hospital is Cleveland, Ohio. Been there almost a hundred years, and since that time we've branched out Canada. We've branched out to Florida, we've branched out to Abu Dhabi.

We're going live with our first hospital in London in 2020. So we continue and we have a lot of partnerships, uh, around the world in China and other areas. Uh, so we continue to expand globally. But our heart and soul, it remains Cleveland and Florida. And again, we have some other states too, like, uh, Nevada, but Heart and Soul will always be Cleveland and Florida.

Yeah. I got to visit you up in Cleveland and, and, uh, your c e o gave a presentation. The, one of the things that struck me is obviously the, the reach is amazing. And the, uh, the research and, and the, the workflow and the things you guys do is, is really amazing, but the architecture of your Nevada facility, but I saw it.

I was like, that's unique. Yeah. I love it. The, the benefactor there is quite, uh, has an interest in design. And I think it's appropriate for what we do there specifically. Absolutely. So here are the five questions. Start with the first one. How is your system thinking about, uh, digital or addressing digital in healthcare?

So the most awesome thing, not the most awesome thing, but one of the most awesome things I. At the Cleveland Clinic is, if you were to hear my boss, the c e o, uh, Dr. Tom Hovi speak, you would think you're hearing a c i o. So he loves, he believes in digital, he believes that's the future. So we have a lot of emphasis on it.

So, uh, we believe the future is all about digital. So everyone is really focused on taking advantage of that. Yeah. That's awesome. The, uh, yeah, so second question. How do you determine the noise, uh, signal? From the noise? Really in the digital space, there's so much going on. I mean, ai, machine learning, you have all these mergers, you have consumer yet Silicon Valley, apple.

I mean, how do you determine that that's that's real for us, that's what we're going after versus that's just, just noise. Yeah. It's tough. There's a lot of good ideas out there, and you don't wanna miss any, so you need to have good processes. But for us, we're, we're in the midst of developing a strategy for the entire enterprise.

And as we're going through that process, we have nine different work streams that look at, look at everything from patient engagement, caregiver engagement. Technology, growth, risk, those sort of things. And all of them touch on digital. And so we're coming together now with a single vision, a single plan.

So if something doesn't align with the plan, we see that as noise. We only have finite resources, so we really have to focus now . In order that we don't miss anything. We also have a separate innovations arm, so it's quite large. So we have a separate innovations arm. We have a separate ventures arm. So we have a, a group of, uh, individuals who, who invest in, in startups and other companies.

So that's our ventures arm. And then the other arm we have is our investment arm. And so we look to them to help make sure that we don't miss anything out there on the periphery. Makes sense. The thing I like about this interview is I'm gonna be talking to smaller health systems. I mean, you're 9 billion, so you're gonna have a venture arm and.

Those kind of things. And, uh, it, it's exciting to see what you guys are doing in Providence and Dignity and others that have, have a fair amount of resources. But those smaller players, every time you say an arm, it has to be partners. They, they just have to go out and find people that they trust and, and, uh, partner up with them.

If it's another health system or an innovation arm or. Yeah, and we believe the same. We do the same. So we have partnership relationships with, uh, a couple of companies or, or that are emerging that we're going through the process right now. 'cause we believe one is too small a number for greatness, so we can't do it all.

We don't have, we don't, you know, we don't have a lock on all the innovation that's out there, so we definitely look to partner with other organizations. So it, it, uh, third question. If you were talking to every C i o, every ccio sitting here right now, it's a chime event. Uh, what's the biggest opportunity in health it right now?

It's not blockchain.

I think the, the greatest opportunity is for us to become better partners with the business. So I still see a disconnect generally between . It technology and all the capabilities we have and the rest of the business. So rather than telling you some sort of technology and give you a technology answer, I really think it's shoring up that relationship and for us CIOs to step up as a business partner.

I'm even still learning that. I learned it. We went through this process recently, uh, to seek funding for a major project, and I learned it again, and, and I learned more about myself. I learned more about process. I learned more about how important it is that we are. Seen as equivalent peers to the, to the other senior executives and that we are a partner.

Yeah, I, I love that answer. 'cause I think the biggest, one of the biggest opportunities we have is our roles going from hero to a teammate player. Yeah. Yeah. And, and that's a, that's a huge shift. And, and for us, That's a burden off of us, but it's also an opportunity to, to speak into strategy. Totally. That, that's so much fun.

Like I said, we're developing strategy now as a executive team and all of these work streams. The common thread, is it technology enablement, digital, and so now's the time to step up and lead. It's not like . So, you know, the other thing that gets me sometimes is, uh, it people say it should never be leading a project.

Should we always have a business sponsor? And I, I don't believe that at all. I think in the old days that was true, but if we are, if we consider ourselves equals at the senior table, then we better step up just like any other person at the table and lead. And so, so I took ownership actually today of the huge initiative, but probably the biggest one that's going on in the health system.

And you know, first in my back of my mind, I was like, well, no, it should be this other person or this other person. But then I thought, no, no, I, why could, why shouldn't it be the c I o? Absolutely. Uh, fourth question, what is the biggest threat to traditional healthcare, to the traditional healthcare system today?

Well, I think there's a lot of things, a lot of challenges that we deal with, and I think it's a little bit dependent on the organization and where it sits and, and you know, in terms of penetration of value-based care and those sort of things in the payer mix, I think we, I. Are threatened by extinction.

So because we are so traditional and haven't really embraced this whole concept of the digital, we're gonna go away, brick and mortar healthcare large is gonna go away. There'll always be specialty need, but by and large, we need to be thinking what's coming down the horizon. And I, I think it's only three to five years away.

So, for instance, one of the things that we're working on now is hospital at home. So our, our tertiary care center is a hundred percent occupied and that's not necessarily a good thing. So how can we keep patients from being admitted? They don't wanna be admitted. So what can we do to help them convalescent heal at home?

So we're looking at dig in the digital space to help us with that. And so I think the biggest threat is that of extinction. If we don't start thinking that way and, and picking up clues from other industries, whether it's Amazon or, you know, my, my, uh, financial insurance company, U Ss a a. Very, very progressive.

And if we don't start learning from them and making changes, then, then we will be extinct. Yeah, absolutely. Uh, Dr. Klasko, uh, just gave an interview and he talked about their health system, talks about, uh, uh, a health system without an address. Yes. No. Yeah, no distinct physical location. He said, I, he believes that's the future.

I've heard him say that. I've heard Rod Hoffman say it now. I'm here. Yeah. Cleveland Clinic. So the, the leaders are really recognizing that the model is changing and that's that disruptive. Yeah. I, I, I call it the fourth dimension, and I always try, as we're going through the strategy process, I'm always reminding myself,

And my peers that we need to think about this other dimension. 'cause it's so easy to focus on the brick and mortar and the way that we know practice today, but we have to be thinking in the future and it is this sort of virtual help and that we'll have a relationship with you even after you move away from Cleveland.

So let's say you're, you're, you're a young person, you graduate and you move out. We still want to be your care provider. And we can do that through virtual care. Oh, absolutely. Here's my last question and I, I sort of had fun with this one, but, uh, it may not be appropriate for you 'cause you haven't been there for three years, but if you could rewind the clock three years, what do you wish you had focused on three years ago that would prepare you for what's going on today?

I mean, you weren't there three years ago. It's kind of a unfair question, but if, if you were there three years ago, what do you wish I, I mean, obviously the blocking and tackling is, is easy stuff, but. Is there a, an emerging technology that you're like, man, I wish we were a little, I wish we'd gotten ahead of that.

No, I, I think we're, you know, I, so I'll answer it from a year perspective. I, I think we've brought the appropriate amount of attention to emergency technologies and we're starting to push the envelope a little bit. So we're doing some pilots like hospital at home that I mentioned. Uh, we're starting to push the envelope a little bit.

I think the area . That I would've doubled down on. It's just the team stuff. This is all basic and everyone listening probably knows this already, but I know it too, but I still suffer from it. Uh, you know, building the right team from the get go and making hard decisions right away. So I knew certain decisions in terms of developing the team, and I waited and I waited and I waited, and then I may have had some false starts.

So if I could go back, I'd be really focused first on that team. Fantastic. Well, thank you for your time. My pleasure. . And now our last guest is Tom Barnett with the University of Rochester Medical Center. Uh, introduce yourself and, uh, the health system and the scope of the health system. Sure. Uh, Tom Barnett, uh, c i o for University of Rochester Medical Center.

Um, we are a six hospital with our affiliate, um, organization, about 1400 beds, uh, total, um, about a 900 member, um, medical faculty group. Okay. Uh, and, uh, we also have our. Medical school, nursing school, and dental school also under the umbrella. So, uh, it makes it kind of interesting. Yeah, I would imagine. So is Rochester, uh, I might get this wrong, is Rochester where Kodak is?

Absolutely. It is. Okay. Yes. So you, you, when you guys talk about the Kodak moment, you're really, it's probably not something you guys talk about all that much given, um, the similarity is I grew up in Bethlehem, Pennsylvania. Bethlehem Steel was the largest employer, uh, up until I got to high school, and then they ceased to exist.

Absolutely. There's a lot of, uh, there's . A lot of history and a lot of deep roots. Uh, with, with Kodak and Rochester area, although, you know, I was, I was driving in, um, I was driving up towards in the Midwest and I drove by a Kodak facility. So they're still around. They're still doing, absolutely. They're still around.

Oh, they're not quite the size they used to. To be right. Uh, but they, they definitely have focused on a few really specific niches right now and seem to be, uh, seem to be surviving. Yeah. That's amazing. Alright, so I have five questions. I've, I, I'm talking to five different CIOs while I'm here, so we'll, we'll splice these together.

Um, yeah, I don't know, maybe we'll play Family Feud with somebody at some point. Okay. You know, top five answers from CIOs are on the board. Um, alright, so first question. How's your system thinking about digital or addressing digital with ? In healthcare, uh, the digital from a patient engagement kind of perspective, could be patient engagement, could be, uh, physician experience, could be, um, you know, the, the, i the first question is almost purposely vague.

Okay. But to be honest with you, everybody went straight to . Consumer. So if you wanna touch on the, the, you know, what, how digital's transforming the clinical experience that would, it's almost like those, those two-way mirrors, if you think about it, I always think of the e EMR as it's a panel that, that sits between two people.

Yeah. And one side of it, of that mirror is what the patient sees. So that's how we're asking them to interact with their healthcare through both, you know, a, a patient portal or, or any other method that they're using to get data back to their physician. But on the other side of that panel is where the provider's at or the physician.

And we've got to balance that equation because if you focus, make everything, you know, work well on the patient side, you could end up with dissatisfied or, or overburdened, uh, providers as well. Yeah. And we've, we've done that. Yeah. To a large extent. To a certain extent and to a certain extent. And I. Think the E M R takes a little bit of a knock.

Um, in some of those instances, it's almost a case of shooting the messenger. And, and not every case, but in some cases, 'cause it's, as you know, a lot of that is regulations, uh, that are coming out either from Washington or from Medicare, Medicaid and so forth. So part of that is it's a frustration point, uh, for everybody.

The, SO classes, um, I think class put together the Arch Collaborative published their results, and it was interesting how many of these . Uh, you can actually look at it now and say, alright, this much of it was self-inflicted. Like we, we didn't train right. We didn't do it right. Those kind of things. Or we made wrong assumptions.

Mm-hmm. . But then there's the, the other side, which is the, the technology just needs to come along. I mean, we we're on the cusp of a lot of things like voice and, uh, you know, voice interaction with the EMRs. Right. There and, uh, mobile digital experience and those kind of things, but we're, we're just, we're on the cusp.

And so everyone's like, Hey, I could do this in my shopping experience. Why can't I do this in my clinical experience? It's like, well, and it's very, it's very, it's a more complicated model, obviously, within healthcare. Oh, absolutely. If Amazon ships the wrong box, no one's, yeah. I had a discussion. . About a year back with an executive who left Amazon, and he's now with a large outfit on the, on the West coast.

And he, and in his mind he said, I'm gonna bring the Amazon model and everything I learned to healthcare. And he said, and the first thing I realized in the first two years into that job is that it's a very, there's healthcare is people, and it, it, it's a very different model from the way Amazon works.

Absolutely. Uh, second question. How do you determine the noise from the signal, the noise to value? In the digital space. So clearly you just got done speaking with Becker's. You walk off stage, you get 10 cards. Now one of those is gonna be, you know, you should absolutely be doing it, but you got 10 cards.

So how, I mean, how do you determine, you know, which, which of these make sense? How does your organization sort of, um, you know, is it supply side, demand side? Are you looking at the market and saying that's something we should be doing? Or are you just saying, Hey, . These are the things we need to be successful and we're, we're gonna evaluate based on that.

I think there's a lot, as you know, that comes at you from 360 degrees. Yeah. Um, one of the things that we found at the last health system that I was with, uh, that I'm absolutely applying now at at University of Rochester Medical Center is you always start with what problem are you trying to solve? So you are inundated with new technologies, with new widgets, with new everything.

But if it's not playing directly into one of the use cases that we're focusing on, , that's kind of, not that it's noise. It absolutely may be valuable, but it's not what is a priority for us at that point in time. Yeah, and I'm, I'm always talking to startups where they're like, they absolutely need what I have.

I'm like, the timing might be wrong. It might not be the most pressing problem they have. Mm-hmm. . Yeah. That's, and that's, it's hard for people to really understand that there's a lot of problems to solve. It's not when you're digitizing and you have . To re-look at everything from the people, process, tools, perspective, end to end in healthcare, it's best to get one thing across the finish line and make sure it works well as opposed to have 22 different unfinished jobs.

Exactly. Uh, so third thing, uh, what are the biggest opportunities for health it right now? If you were talking to CIOs across the board? Um, you know, what's the one, the one thing you'd say, this is the biggest opportunity for our health system from a tech, the technology stand, from a technology perspective.

Uh, I, I still believe analytics, uh, is the big one. So getting enough access to data scientists and, and folks not necessarily for within healthcare, uh, who bring experience and other points of view from outside of that industry, uh, is one, uh, key area that we can definitely see that, that kind of growth on.

Yeah. I'm gonna want to have you on the show, 'cause we, I every . Everybody who comes on. Now, I talk about analytics, and the reason I do is 'cause every health system has sort of a different model for how they're, they're implementing it. It's, it's really fascinating. Uh, and that that's the, I think the big area, but another area onto that, that maybe might not be as sexy, but can have just as big of an impact now that the EMRs are rolled out to a large extent, uh, optimization is something that a lot of health systems are, they need to do, but not everybody knows how to do.

Yeah, that's, that's interesting. So fourth, uh, . First question is, what are the biggest threats to the traditional healthcare system today? Uh, that can be kind. Yeah. You, you were just on a panel. Amazon, apple, and I, I think, I think what Scott Becker was trying to get out of you guys was, is this a threat to you?

And none of you would take that bait. You're just like, well, . There's so many different changing models. Is this one really the, the threat? Um, yeah, there really is. And this is the one that I was thinking about. So, um, before, while I was still in college, I began a job with, with U P s and you kind of learned as you're working there how the United Parcel Service, I.

Kind of their, their model worked at that point in time. Um, u p s was breaking even from a cost perspective on each house delivery that they did. So the key at that point is you want more than one delivery per house, because that's where the margin is made. Uh, so case in point, gateway, remember, gateway Computer is the cow colored three boxes to a house.

Those were good deals they have back then. But then there was this company called Roadway Package Service, r p s, that spun up on the side and said, we're not gonna do. Home deliveries. Were only doing business deliveries. Businesses mostly get more than one package per day, so they targeted right in on the most valuable aspect of UPS's business.

Fast forward to now within the healthcare space, um, particularly in an integrated development or integrated delivery network, ambulatory and inpatient, it's a very capital intensive, very costly. Uh, company or, or business to be in from that perspective, when you see the Walmarts or the Amazons or, or the groups that are spinning up and trying to take, you know, telehealth or, um, you know, primary care visits, urgent care visits, they're starting to peel away at things that are part of the overall health system business model.

So the threat that I see is some of those . Enough of those start to peel away and you're left with in effect the hard stuff. The, the, as we referred to previously, the tertiary, the quaternary care things. And once you lose that portal to the patient, the people who own the portal are gonna be able to steer where the traffic goes.

I was, and I think that's our, our biggest threat. I was, um, at a, uh, an event and we were sitting around having drinks and there was a couple CEOs at the table. I remember somebody posed the question of, what's the number one thing, . You're afraid of. And this, this one, c e o just looked at us and said that somebody's gonna figure out a way to empty my or.

'cause if they empty my or I can't run the rest of it. I was like, wow, that's interesting. Now granted, that's a long way off, but I, I could, I could see not outside the realm of possibility though. Yeah. Really scary. Um, how long have you been in this role? Uh, this role Two years. Two years. There hasn't been a c I O yet that has been in their role for three years, which will make sense in a minute when I ask this question, but if you could rewind the clock three years, what would, what do you wish you had done three years ago to prepare your IT organization for today?

So two years, well, three years ago to prepare the current, yeah, so you're the third C I O I've talked to so far, none of you have been in your role for three years. I don't know what that tells me, but. It's, uh, well, it's the old, uh, the old, um, adage, right? Uh, c i o stands for careers over over. Careers over.

Yeah. Um, I, I think the, the focus on, from an IT shop, they've been so battered, I guess is the word from so many different directions. There's so much to keep up with changing technologies, increasing demand, um, that ability to focus on, uh, lean workflow and throughput for an IT shop. I think that ability to focus on what the

Are doing and how to do it in the most efficient way so that you can do smaller, uh, work efforts and deliver work quicker. Um, is probably one of the biggest areas that I see the opportunities for in the internal IT shop. So driving, uh, it's almost the conversation they were just having about ai, it's driving the, uh, efficiency higher

Um, in some areas, let's say it's provisioning servers and those kind of things so that the team can focus on. Absolutely. I think, um, value the industry has changed so much the it industry, not just in healthcare in older days, not too long ago actually, um, you could kind of operate in a plan, build and operate model and, and that's the way everything could work.

Things are evolving rapidly, and now it's kind of, I think the acronym that I heard is it's more in the, uh, it's the broker, the orchestrate, and the integrate. Yeah. Uh, and it's, it's this constant cycle of staying abreast of what's out there, being able to integrate it and making sure that you're putting the right combination of technologies together to be, have the biggest bang for the buck for the health system.

I, I was mentoring one of the people at my staff and, um, he said, what do I have to do to be a C I O? I said, why do you wanna be a C I O? He goes, well, 'cause you get to make all the decisions. And I'm like, and I got to step back and say, What do you think the role is? And as he sort of described it, I said, you're describing the chief technology officer, you're, you're not describing the chief information officer.

But I think what was interesting is you, that was, you know, three or four years ago I was having that conversation. I think even the chief Technology officer is a people job now. It's a people . Narrative. You know, how do we, how do we orchestrate people? How do we bring people along? How do we, you know, how do we, how do we change culture?

I mean, so there's very few pure technology jobs where I got into this. 'cause I love a computer, I love making them do things. There's, there's not as many of those roles in it anymore. It really is a, uh, a, a colleague that I used to work with who's, uh, who's now a C I O as well. He said 5% of this job is the technology.

Yeah. 85% is . The politics and the people. It's a people job. Yep. Well, thanks Tom. I appreciate, appreciate the time and uh, yeah, I look forward to look forward to having you on the show in the future. Oh, absolutely. I would love to. Well, I hope you enjoyed that. It was a blast making it. I really appreciate these, uh, gentlemen coming on and, uh, discussing, uh, some of these topics with us, given their busy schedules of most of these people on the show.

Uh, spoke at some point at the Becker conference. So, uh, I really do appreciate them taking the time. Uh, that's all for this, uh, episode. Please check out the second episode where we talked to Andrew Rosenberg with Michigan Medicine. Uh, Jake Dorst and David Chow, uh, are also on that episode as well. And, uh, you won't wanna miss that.

Uh, please follow us at, uh, our website this week in health it.com. You can follow me at the patient cio, follow the show at this week in h i t. And, uh, please come back every Friday for more news information and emerging thought from leaders from across the healthcare industry. That's all for now.

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