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 Welcome to this week in Health It where we discussed news, information and emerging thought with leaders from across the healthcare industry. This is the second part of episode 38. Well, we'll just call it episode 39, uh, special from the Becker's Conference in Chicago this past week. And, uh, the first episode, if you missed it, had a conversation with, uh, our first three guests, our first three CIOs from the conference who, uh, answered a set of five questions.

We had, uh, Jason Joseph from, from Spectrum Health on that show. Ed Marks from the Cleveland Clinic and Tom Barnett from the University of Rochester, uh, medical Center. On this episode, we feature Andrew Rosenberg from Michigan Medicine, uh, and David Chow with the, uh, with, uh, children's Mercy, as well as Jake Dorst.

I happen to have Jake and David at the same table. And, uh, so those two sort of run together. You'll see that at the end of this episode. Uh, we're gonna start this off with, uh, with Andrew Rosenberg. I hope you enjoy it. There we go. Alright, so, um, why, why don't you introduce yourself and give us, uh, the scale and scope of your organization and then we'll go into the questions.

Well, thank you. I'm Andrew Rosenberg. I'm the Chief Information Officer for Michigan Medicine, which is the University of Michigan Health System and the University of Michigan Medical School. Uh, the health system now is about a four, four and a half billion dollars in revenue health system. Our enterprise, it is about, uh,

900 staff. Uh, we are predominantly in southeast Michigan, but perhaps a distinguishing feature is because we are the state university, uh, tertiary, quaternary care center, we get patients from every county in the state, and we are even written into the constitution of the state of Michigan. And so we have a, uh, not only a public university culture and mentality, but really

Um, without it hopefully sounding like a platitude. Um, we, we affiliate, we affiliate with many other health systems in the univer, in the state of Michigan. And it's those affiliations that really, uh, add, uh, value, but also these interesting challenges. My personal background, I'm an internist, I'm an anesthesiologist and intensivist.

And I'm a, a faculty at the University of Michigan Medical School. Yeah, it's amazing. I mean, you just got done speaking here at the Becker's conference and you were talking about just those partnerships and those, uh, you know, partnering with Trinity, which is competitor in your backyard. Uh, and just about everybody in the, in that market will use your services in some way.

You're almost like a children's hospital in that it's sort of like Switzerland, everybody sort of partners. Right. And we, and of course we have the Mod Children's Hospital, but even, uh, for example, we just literally last week opened up a health . Uh, cybersecurity operation center, our h o and we're partnering with Beaumont Health.

Uh, we're partnering with Munson, we're partnering with other, uh, traditional, they're not necessarily competitors, but they're what you might initially think of as competitors. It's this, it's this affiliation that we're doing that's really part of our, our culture and cybersecurity such. I'm getting into an interview here and I don't, I don't wanna do it.

So first five questions. Let's, let's just go through 'em real quick. So, , um, how is your system thinking about digital and, uh, and addressing digital and healthcare right now? You know, I, I don't wanna sound like a contrarian on that, but I, I try to change that question just a little bit. Okay. What I'm really trying to say is, where are our varieties of strategies, either

Completely now being done through digital platforms, methods transformation or could be done better so that we don't have a digital strategy. We don't have a digital strategy officer, we don't have a cloud strategy. It's really recognizing how this move from analog or previous or legacy into a new way, particularly where digital, uh, will play into it, is aligned to the strategy and not a digital strategy.

And I'm trying to distinguish . Right. Because I think it aligns more with other leaders who don't typically think in terms of technology and IT, or digital, not feel like they're somehow being sold a, a bill of goods, right? And so when you think about, uh, removing the, um, the friction from transactions, when you think about, uh, improving, uh, quality outcomes through data and those kind of things, you don't have a digital strategy per se, but you'll bring digital tools to bear right on those things.

Lemme give you two. Examples that to me are superb and they're extremely recent in the last two years. The first was I wanted to promote much more advanced analytics, and I particularly wanted to promote varieties of machine learning. So we picked two vendors, one in structured, uh, excuse me, one in supervised machine learning and another in unsupervised machine learning.

It's advanced analytics, it's machine learning, but it's two particular . Types trying to go after two or a multitude of use cases, right? The one that I thought was gonna work out was the unstructured form of machine learning, with the idea that it would generate hypotheses that were previously not appreciated.

The one that really worked out was structured. Because for a variety of different users, the ability to speed up algorithm development, which they were already working on, was significantly improved. So there was an example of trying to improve our clinical design, uh, initiative quality, some basic discovery in some clinical trials areas in our ecosystem.

It was structured machine learning and one particular vendor that really took off another one now is in robotic process automation. Again, it's not that we have a digital strategy. Strategy for RevCycle backend, it's, we have a series of efforts and needs that fit into strategy or tactics, right? But, but explicitly looking for not just digital, but specific elements that we know are likely to work.

And then the final point, I'm actually using the R P A work, the robotic process automation for invoice management and rev cycle to really try to promote real ai. So I actually, in my mind, have more of a digital strategy. As the C I O, but I'm using these more pragmatic areas and other areas of the, um, of the institution that will drive their value.

But in the end, I'm gonna pull it back up and say, see, this is how digital. And digital transformation works. Yeah, it's interesting. I'm, I'm wondering how much your, um, your culture is influenced by the university. Having the university right there keeps you, I mean, the, the pool's constantly moving. The, the pond's constantly moving.

So, um, you may not be battling a stagnant culture as much as other organizations are, and so they're saying, Hey, we have to bring in this, these digital players from outside the industry to sort of shake. Things up, right? But with a university, you might, might, um, keep things going. I think that's true. I think that's a really insightful idea.

And, and what I would say though is, you know, uh, and I use this example a lot when we had a couple very large vendors come and talk to us about, um, analytics, they typically went right to predictive and prescriptive analytics of a variety of types. And I would say both sincerely, but somewhat to be provocative, just real-time data would actually have more value right now than

Anything into predictive and prescriptive and people would do what you're doing right now, they would smile because I think they have been thinking about that and get it. It's not that we don't want and want to be planning, and that's why Rev cycle, when I went to some of our other meetings, I would ask other industries, where are you seeing more advanced analytics really having value?

And they would talk about a lot of the backend logistic, unsexy kind of stuff, but I. Think even for areas where the culture's a little bit more stagnant, people will get this idea. 'cause I'm not trying to pitch to the C F O something, you know, arbitrage and global international markets. I'm saying we just wanna speed up invoice management.

They get that. Yep. Absolutely. So, second question here is, um, how do you determine the, the signal from the noise? I mean, there's a lot. You come out, come off of speaking at a podium and 10 people will hand you a cart and you know, one of those is probably phenomenal and nine might not be appropriate. Uh, be it timing or whatever for your situation.

Um, You know, did, how did your organization sort of sift through that to determine, hey, that that's a problem we wanna solve? When I created this new system, level C I O job, and I was talking with the Combined Leadership Group, I said to them, the first order of business after just getting to know each other well, we'll be.

Portfolio management, and I'm gonna get to answering your question in one second. In portfolio management, the demand portfolio, the project portfolio, and the asset portfolios, one of the key things that I, that I said we have to be able to do is that this will help us prioritize those areas of a very complex organization, which by the way, I don't think in many ways is that much more complex than many others in order to then say, what are our really

True key priorities. And once we started to get better at that, then when I hear different inputs, pitches, talks, reading things, the things that tend to look like they may align to those things that I know are of priority start to stand out. They start to emerge like a, a color image in the background of a black and white.

So an example would be knowing that analytics is extremely important to all of us, but making a point that I . Wanna look at either real time or some extremely unsexy, but pragmatic, uh, types of analytics in some of our backend work. When people come to me and start talking about workflow redesign for robotic process automation, that will capture my attention, frankly, more than the big moonshots.

Of, of, um, neural network enabled prescriptive analytics. I don't want to not be involved in that, but for right now, I am going to be much more pragmatic, much more aligned with some of these, but it's part of a, of a portfolio that we've developed. Yeah. That helps. Yeah, that's uhhuh. It helps to reduce what I call the shiny ball.

'cause I'm, I'm as susceptible to as anyone else to, Ooh, that sounds really cool. Or, I know this person, so I want to get to . Talk to them or, or whomever. It helps. I get it. I was on a panel once and they asked me it like, which one of these technologies is most attractive to you? I'm like, all of them. . Yeah, sure.

I mean, that's, that's who, who I am. So, uh, but yes. Um, so third thing, you know, uh, so you're gonna be talking to, uh, a lot of CIOs with this question. So, and uh, and, and I have a really good cross section of CIOs, you know, children's hospitals, small, large, those kind of things. But one of the questions I get a.

Lot is what's the, what's the one opportunity that's sort of sitting there for it that they just need to grab and, and what I hear you saying is there's so many pragmatic opportunities right in front of 'em that they don't need to worry about, you know, the crazy blockchain or this or that. I mean, there's just, there's just.

Basic things right there. What I thought about before, and somehow it seems to be working out really well and it may have been part of my clinical background, particularly where I would be in the I C U faced with a number of complex inputs. Why is this patient in the I C U? Well, there are actually at least two or three reasons that are all pretty close.

You have to pick one, and this is something I developed over time and I taught fellows and residents that even in these extremely . Complex situations, you still have to ground these decisions and these conversations into at least one of them. So I just say that because you said it perfectly before there.

Of course the answer is that there isn't one. Right. And so what I start by saying is, okay, in your organization, if you can at least try to say, what are your two or three top priorities, which is in and of itself already very difficult. Well, uh, but when you say physician, uh, physician satisfaction with the E M R.

So personalizing the E H R personal, I mean, Taking that on, getting them from working 12 hours a day back down to 10 hours a day would be, would be wonderful. Um, or, uh, or the digital consumer, or, I mean, aren't there, aren't there like at least a couple things that sort of bubble up every year that are just, it's not there.

They're not a couple of things. There are literally dozens. Dozens and dozens. Yeah. So that's why, again, I go back to this idea of portfolio management. But, but you know, we're all, let me give you an example, um, . One of my colleagues, um, would talk about we need a cloud strategy. Sort of back to one of your earlier questions.

Yeah. And what I'd say is we certainly don't need a cloud strategy. We need to know how already cloud, which is already deeply embedded Yeah. Is going to be somewhat controlled as we go forward. So within that, just within that topic alone, the priority I picked was to work to get . Enterprise level contracts with the three big cloud providers that we have to work with at U of M that we want to work with, so that dozens, if not hundreds of people could benefit in their variety of innovations in the cloud.

So I didn't worry about a single cloud provider. I didn't worry actually even about a single use case. From my perspective, I thought the force multiplier, it's a term we used to use in the Navy and the military is . To find what is that commonality among a variety of other uses. Yeah. And that would be one.

So for me, if you said what was your what? What was the biggest thing you did in cloud? I'd say we use the size of U of M to get best contracting for the big three. For a variety of people to now use. Yeah. Cloud's interesting. 'cause it's the core of my business and we go in and say, you gotta set up a framework.

For me it was, I got a phone call the first, like within the first six months of being the C I O and they go, Hey, this is blah, blah, blah. Dropbox, congratulations. You're one of our biggest users. I'm like, well, wait a minute. We don't have a contract with you. I, you know, it's just right. And so they're going to use it.

So putting that framework in place, putting the contracts in place, um, putting the security architecture and how we're going to audit and secure the data. Gave people the, the ability to now say, okay, can we solve this problem with some cloud technologies that are out there and oh, we have a framework for engaging cloud providers and those kind of things.

Right. And I could use dozens of examples of that, but one that I love was we put together a market map. Uh, I dunno if you're familiar with these, but you'll see these with VC and private equity firms. They'll show a variety of the vendors in particular spaces and . I showed it to the president of the university and he said, wow.

Wow. And what I showed him were all of the cloud vendors currently being used at U of M, right? And he said, wow. And there were about 130 and this one eight by 11 diagram. And then I said, and that's only four of our 19 schools. And then he really said, wow. And I said, the point is cloud is deeply here. Now the question becomes, what are the problems?

One of which would be, how do we try. To, to shepherd people to be using these in a more secure manner. How do we on the other hand, shepherd people to be using these in a cost effective manner? Because otherwise they would just chew through their money using cloud if they don't do it. Things like that.

Yeah. So you have distributed budgeting somewhat, I would assume. Yeah. That's interesting. Uh, fourth question. Uh, what's the biggest threat to traditional healthcare? Cybersecurity. Oh, okay. Immediately. Yeah, I will, I mean, I didn't even need you to finish. And, and the reason I say this is that as a clinician, one of the threats that I would've talked about would be things that were on the medical side, pandemic flu, um, um, Another one I would've picked probably would be the financial system itself.

And, you know, we could go off on that forever. Yeah. Financial. But here's my question for you on cybersecurity. 'cause I, I, uh, was on a cyber panel this morning and one of the points I made was, uh, there we haven't seen a correlation between, uh, breach and it affecting the business yet. Now clearly there's fines and those kind of things, but you don't see a mass exodus of patients.

Correct. Um, but that's not what I'm worried about. I'll tell you, I'm worried about something that's a little bit more existential. So not So you're not worried about the reputation and . No. Okay. So I'm not Okay. And, and because of exactly what you just said, whether it's Anthem, whether it's UCLA's breach, whether it was, you know, you just kind of keep going down.

Yeah, I'm still gonna go to University of Michigan 'cause it has the best care. You and I would say even at, I would say there are a few other social factors going on, but this is my best crystal balling. Number one, as the population migrates, more and more of our population will just be that much more comfortable with their data being public.

Number one, right? Our kids are . All living in a world of infinite, more public, uh, data than we ever did before. So I would say just trying to look even 10 years into the future, let alone beyond, I think people will be much more comfortable with their data. Interestingly, I think it'll be dichotomous.

They'll be both more comfortable and they'll be more attuned to when it's being misused. But even if I'm wrong in that one, look at the breaches that have occurred now, some of which have been because of really . Just almost, um, neglectful attention. Even that, whether it's a smaller physician office or a large, you don't see patients.

I think leaving en mass, I don't. Think, and I don't know this as well, do you see pay people leaving some of the large corporations when their data have been misused and there's been a breach of the, a violation of the ethics around their data? So that's at least one reason, but but more importantly to me is look at some of the attacks that have occurred, like WannaCry, non-pe, a destructive attack, not a ransomware, but a destructive attack.

We were down for . Over a week, uh, when one vendor, uh, was attacked, that was not us. We just assumed that of course they had good business continuity, uh, and resilience, and that that just took out our transcription services. You know, who would think trans? Well, because we couldn't then deliver notes effectively.

So the, I'm, I'm concerned when, and, and my point is it's not just within healthcare, it's with . All the things that are related around it. Power of course, and other social services that are required for supply chain. The ability and the examples that are real world, these are not just theoretical. Uh, to me, non-PE is still probably the single best example that we're not discussing.

Where multiple organizations, Maersk Shipping others, they were down for days. And then of course there were actual hospitals in the UK and others with Petya, with WannaCry, and even non-pe. That were taken out and the speed with which it happened are is much faster. I'm gonna try to kill this one mosquito so that we all don't get Zika.

Um, oh my God. This mosquito has is destined. It's to live. Alright, I got it. Um, sorry about that. You're gonna have to, you're gonna have to get that one outta the recording coming out. There's, I, I'm gonna, I'm not gonna let someone get, I'm gonna care and protect you, . I appreciate it. Uh, these are existential threats that the only other thing I could think of in healthcare tended to be the epidemic, but so far, even Ebola.

Think about Ebola in the United States. How many patients were actually affected by Ebola when we were all worried . About that one, two. Well, that's what I was gonna say. It was less than 10. Right. But, but it was multiple markets. I mean, we saw it in Texas. We saw it in uh, well actually just where people visited.

So you saw it up in Ohio? Correct. It was very, I mean literally a handful at most. Yeah. Only one of these big cyber attacks have affected millions of people. And for what reason? I'm not quite sure. We tend to still not be as worried about it, so that's why I jumped on that right away. Yeah, that's interesting.

It is one of those areas that . I think, um, there's, there's so much commonality we could, we can partner and we did in our market, we did, we, we would sit around a table and in, uh, in our market and talk about what are you doing in cybersecurity? 'cause it's not a, it's not an area of differentiation.

Correct. And, and we can talk, in fact, in fact not only that, but it's a great example where I think everyone I've talked to immediately gets that only through cooperation are we, it's one of the better examples where actually working together, we will be better off. Yep. We literally only started our health soc this week.

So with all these discussions, we at the University of Michigan have only started it a week ago. We only have had our CISO for two years. These are still, you know, extraordinarily at the beginning of something. And as we get more and more digitized, as well as the rest of our infrastructure is digitized, I'm really spending a lot more time with that lever than the previous one, which was financial.

I mean, as a C I O, you recognize . Probably the lever you had to deal with more than efficiencies and interoperability and reliability. Maybe. I'm finding security is a much stronger lever now than even some of the financial. That's interesting. So last question, if you could rewind the clock and we'll play one of these games, if you could rewind the clock three years, what do you wish you had spent more time on three years ago to prepare your IT organization for today?

You know, it's fun about this. You've already, you've already, you've already talked about this. I've talked about a few of these, but I'll talk about one other one that . We've not mentioned. And, and, and I'll just preface this by saying you something you've already mentioned. What's very interesting about this work, and I can tell you compared to even the clinical side of healthcare, the number of choices, opportunities, and things that we talk about that are new are demonstrably more than any individual person you would talk to in a, in a clinical field.

They just are. So I say that because one other one that we've not talked about, if I could do it a little bit better, even through . Years ago it would be procurement, it would be it contracting, procurement, and all the workflow and underlying systems around how do we procure, have more efficient contracting.

Uh, and also another one would be inventories. So, so what I mean by that would be we just finished an enormous device inventory. It took us about two and a half years. We spent millions . Inventorying all devices that connect to our network and now we have with network access control, the ability to also, uh, better control it.

We have no inventory of our applications other than knowing that we probably have about 15 to 1800 applications live in our environment. So inventory, application, and other type of lifecycle management, and then the procurement attachment to it will help us . Free up resources for the new things because now increasingly we are just trying to find enough money to manage, run.

We really don't have these opportunities for grow and transform as much as we would want because we're spending that much more supporting our run rate. If we were better in our contracting procurement lifecycle management, I think we could be more precise to start to carve out more money for grow and transform.

It's interesting, I, I've heard so many interesting answers on that. Uh, but agility seems to be, uh, hyper efficiency and agility seems to be the commonality of people saying, I wish I could do more today than I'm able to do. Because there's so many things coming at us, so many things to do, right? And if I had, um, if I had a more agile system, I'd be able to provision servers in a couple hours instead of a couple weeks.

Weeks I'd be able to, uh, scale up and scale down. I'd be able to move all that work. That's your pocket protector kind of stuff. And my dad grew up with a pocket protector, but just, um, move that all to, uh, to, you know, just run rate kind of stuff that's handled by far fewer people. Right. And your people are spending a lot more time with the clinicians rounding and, and really solving a higher level problems.

Right. And when I think about that point you just made, we could talk, I could have said, oh, we're gonna invest in DevOps. Uh, we're gonna invest in fabric data centers, whatever. I'm trying to find, again, like I talked about with portfolio management, these commonalities, and that's why I chose this idea of contracting and procurement because I.

I think that's still where there is enough inefficiencies. We can find that much more money, resources. Um, I, I, I think it also might help to also do what we all talk about doing, but I haven't met anyone, including me who's done it well, which would be, how do you get, um, how do you deprecate legacy? That's not really that helpful anymore.

Right. We all talk about it, but it's a lot harder to clean your . Garage. It's a lot harder to get rid of some of these small applications that just keep running, and it's that process that I'm working on next. It's interesting, I was, I was talking to an AI company, so AI machine learning, and that's where they started.

I said, well, how's the business going? They goes, good. We're not doing what we started to do. I said, well, what are you doing? They're going, legacy said we, well, we have this massive backend infrastructure, and people were like, Hey, can you just take our old applications, move that in, create a nice front end that we can get the data back out.

I said, well, yeah, we can do that. That's our core business. Like, yeah, but . That's what we need. And I'm like, well, how much? They're like 90% of their business now. Is that? Yeah. And I'm like, well that's a need. I mean, it is. You found that need. So yeah. Hey, thank you very much. Sure. I appreciate that.

Absolutely. Appreciate the time. My pleasure, bill. We'll have absolutely. Next up we have David Chow and Jake Dorst, who were sitting nicely at a table when I, uh, inserted myself into the conversation and asked them if they would be willing to be on the show. And they were both, uh, very, uh, up for it and I really appreciate them doing that.

Here is that segment of the show. All right, so why don't we start with you, if you could introduce yourself and system what you do, sir. My name is Jake Dorst. I am the Chief Innovation and Information Officer at Tahoe Forest Hospital District in Truckee, California. We're a critical access hospital and uh, we basically have a hospital in Truckee and we have another one in Incline Village in Nevada, which is a, a smaller entity.

Cool. Hi, David Chow. I'm the Chief Information Digital Officer for Children's Mercy Hospital in Kansas City. We're a $3 billion organization with two hospitals, 45 plus locations throughout the state of Missouri and Kansas. Well, that's good. We have an order of magnitude difference between us . Yeah. So, um, you know, we'll, we'll start with you.

This is an easy question for you, and we talk about this all the time, but how is, uh, how's your system thinking about digital and how are you addressing digital within healthcare? Uh, well, we're, we're definitely moving more towards, uh, patient-centered applications, technology, things that, that our patients can actually connect back with the hospital.

Hospital. I think we're gonna get into this conversation on one of these other questions, but the consumerism in healthcare, how are we mining that data and making a meaningful, smooth experience for our patients? In our area, we, we do. There are choices, uh, there's other options for our patients to use, luckily in our area.

We have a, a good capture of our market, but we want to hang onto that market. You sound like we're at a dance club, . Yeah. So, uh, how, how are you, how are you guys thinking about digital? So we're starting to drive this digital sort of by building, it's all about building new business models, building new business models using technology, and that's how we're starting to think about how we can take advantage of these investments that we have made the last

Two and a half years, I'm starting to get out of the weeds of core technology and really being that aggregated of all the various business model throughout the organization that's using these technology to prove experiences. So I'm, I'm leading that initiative. Um, but I had to do that by getting out of core technology or.

Yeah. So it's, it's no longer a good, uh, use of your time to sit down with this vendor and that vendor, or this vendor and have those in depth conversations. Right. But you know, you gotta have the foundation. Oh, absolutely. So my first two years, I've been there for two and a half years, the first two years of really building this foundation.

That's not great. But solid and good enough, just good enough to move on. And we're at that stage now to where we're looking at the next level. We're looking at ways to do things differently because that, that's what it's about. It's about how do you operate differently versus how you operate five years ago.

Yep. Uh, so second question, we'll go, we'll go to you this time. Uh, how do you determine the signal from the noise? You're, you're at some conferences, you talk to people. Um, there's, so there's stuff coming at you, right? And then there's stuff that you're looking out in the market going, Hey, we need to be doing that.

So how do you determine it? So for me, I keep my, I keep the pulse on what's coming out. I keep the pulse on the trend, be aware of the trend, but just know some of the trends you can't take advantage of today, whether it is organization readiness, skillset readiness with the, your team set. So that's how I filter out noise by keeping track of the trends, understanding where the organization's ready, but at the same time stay true to the core.

Right? If you have some, I mean, if your technology competency is core, let's just say your network, you gotta fix the, you gotta fix the network. You can't. Bypass that piece and build and go on to AI and some of these other pieces. You gotta have some of these style, the foundation. So really understand Where's your core, what needs to be the foundation's critical CIOs lose their job if their network doesn't work.

Correct. That's for sure. Uh, so how about you single from noise? Well, I'll echo some of what David said, but what, what we try to do going at a, the beginning of our budget cycle, we sit down and say, what are our top three things that we want to do this year? And that kind of gives me a focus. So then I've automatically narrowed down if I'm, if I, if someone comes up and, hey, uh, I've got an awesome AI solution for you.

That's not on my roadmap for this year, but gimme your information so the right thing at the wrong time right is still the wrong time. Right. And that makes it easier for me also to say, 'cause I'm a nice person, I like to give everybody time. So it makes it easier for me to say, you know what, that's not on our roadmap yet, but I'm building this foundation that David talked about is really like, we want to get there, but I've got certain things this year that, that I have to do.

Then I can find those vendors and we can go in depth. Um, and we try to seek out some of kind of that early startup type of, Um, um, companies that are in the area that we want to move to, like, like, uh, Nutanix or hyper conversion infrastructure and those types of things. Yeah. Uh, so you're talking to CIOs right now.

What, what would you tell 'em is the biggest opportunity within health? It. Uh, for me, I think it's, it's really improving the patient experience. I always try to put the patient first. I'll, I'll echo Ed. Marks on that is, is, uh, is keynote here last year really synthesized a lot of thoughts that I had had going in here fucking doing this for 20 years.

Um, really. Putting the patient first, making that experience for the patient. Kind of like that Disney experience. I just got off the Disney cruise from my family, saw . It's fresh in my mind, but you know where they, where, where you feel like you're a special person or a special case with each one of those.

And that's how we get there digitally is all gonna be those digital tools and building that foundation to get there and going to the digital platforms. Eventually getting into AI and giving the, those tools to the people that interact with our patients, I think is, is, is where I would like to spend my money.

Yeah. It's interesting. We check in at this hotel and it's just a barcode and everything's, uh, you know, the. Access keys, everything's digitized. And Disney is a great example. I, I went to Disney World and they gave me that bracelet. Yeah. Unbelievable experience from, from end to end. I'd have to think about much.

Right. Until you get the bill at the end, until you then think, yeah. Like yeah, I do remember those 25 latte. But it was easy though, right? Yeah, it was easy. He made it easy. So healthcare it easy, you don't wanna go anywhere else. And that's my point of, of being a, a consumer driven platform that healthcare is becoming, which it hasn't been traditionally.

Is to move to that, and that's how you're gonna get there is with digital tools. So what are you telling CIOs when they call you up and say, Hey, this, if they're, if I could boiled down to one thing, this is the thing you should be focused on. If you say blockchain, I'm gonna hit you . No, no, no. It's about understanding the business model, understanding how you can drive the p and l and understand how you provide a better clinical outcome.

It's not about technology. You gotta understand the business model. Yeah. And most CIOs, they're, they fall short of that. They don't understand how the business model work. And that's, that's a detriment actually. Yeah, I see that. So, so you have to understand what the economic drivers are for your business, and then you can, uh, then you can talk about the technology.

This technology can be brought to bear in this way to thrive. Right. Everything relates to. Some sort of outcome and tie that into the outcome. Even as simple as network upgrade. Don't just talk about, here's a network upgrade. Talk about how you're gonna improve efficiency. A few seconds shade from a clinician logging in because of your upgrade.

There's a financial factor, so you gotta take it to that next level because everything ties into some sort of outcome or how that ties into maybe it's new features where your B Y O D for your patients and, and you have new wireless. That makes it much more seamless and smooth to deliver content to your, to your patients, which kind of has become an expectation.

So what's the biggest threat to traditional healthcare today, do you think? Staying traditional. not changing. I think that's the biggest threat. Right? Lose traditional, right. Or. You have to change. So you have to change about what is the new future, future business model that you want to move towards. And here's the challenge.

You have to make a strategic investment and you have to move towards that. But it's a hard, it's a hard thing to do. Most or most executives, they can't make that gut call or they can't make that tough call, and that's a problem. Because we all know what we have to move to. Right. That's the, the classic Kodak example of digital cameras versus film, you know, making that move.

Yeah. And yeah, so the thing about Kodak is it was the executives who said, bury that. Yeah. So we see the digital camera, we don't like it. Bury it. And so does the c i o lead this or is it really the entire executive team has. C has to be a part of moving the culture and moving and changing it. In my opinion, it's gotta be the whole team.

Um, if you've got some folks that are sitting in a meeting saying, yes, this is great, but going back to their directors and saying, just wait this one out. Uh, we'll go back to things will calm down and we'll be back to normal in a year. Like, It's never gonna work. So you really, you have to have that supportive team, that family, almost environment where everybody's got each other's backs and working towards a common goal.

So if you're a c i O in a role where you feel like you're the, you're pulling the whole thing or pushing the whole thing uphill and you're not getting any support, you're. Probably in a place that's not gonna be around in five. I would back off of that, come up with something different. . Well, C I mean, my opinion, c e o has to drive it.

Yeah, right. Without the c e o making the push, it's really hard. The ccio should influence that. You have to figure out how to influence that decision versus taking a back seat. I think we're in a good spot because the good ones, we see all the various business models and we see from this journey of a patient from start to finish.

We know we, but we need to understand that that model. And we need to influence that change that needs to happen, I think. I think it's the CIO's job to bring the idea to the table, sell that idea, if that's the right idea, get everybody on board, but also be the risk assessor because the C I O should be in a unique position to understand.

Will this work in this? And if it doesn't, what are the risks if it doesn't financially? Alright, so we'll start with you. If you could rewind the clock three years, what do you wish that your health system or that you had focused on three years ago that would prepare you for what's going on today? Uh, I think we've done a really good job.

We had, we had a, we had some fundamentals, like David was talking about building that foundation, um, that we had to do three years ago. Um, specifically some of the things that I, that I would've liked to focus a little bit more on is just data help desk, help desk data, service level agreements, getting those type of, um, I T I L systems in place where I can really have a, a better insight into how we're.

Uh, how efficient we are as an IT department. Um, we're working on getting those now, but three years ago I would've would've liked to be a little further ahead of game where I'm at now, currently. What about you, skillset training you think about? We allow organizations, including where I have been, I have not focused a lot on skillset training.

So now you want to, you want to move towards the all cloud, you wanna move to all mobile, but you have a talent shortage, your skillset in your organization, they just don't have it. So, yeah. A lot. We did not focus a lot, a lot on that to prepare them for that future. So that's something, looking back I should have emphasized a lot more because now that's my, that's very year though.

That's my requirement. . Now I, the challenge, I, I expect them to have it. Yeah. Most people would not make that personal investment. So you're, you're in rub. Yeah. Do you, do you force 'em to make that personal amendment or do you try to make that as part of your mandate? Right. So is there something you're looking at three years from now that you're.

This is what I'm focused on now because I know three years from now, the skills are gonna need to be different. So I would say we're still focusing on the cloud. Right. You know, getting an understanding of how do you get to the cloud. It's not just about lift and shifts, about how do you secure an environment, secure a container.

Right. Most organizations, we don't have that. We, they, they think they could just put it up there and mask it. Good. No. And then thinking about mobile development, because that's your platform of choice. Are you developing mobile first solutions versus traditional? Because if not, you have to adjust your development platform.

Mobile first is where it's at. Definitely. Thank you, gentlemen. Appreciate you coming on. Thank you. Thank you to all the guests who came on. Jason Joseph from Spectrum Health, Jake dors, Tahoe Forest Hospital District, David Chow, children's Mercy, Andrew Rosenberg, Michigan. . Medicine, ed Marks Cleveland Clinic and Tom Barnett, university of Rochester Medical Center.

Uh, it it, it really was my pleasure to, uh, interview these guys and I learned a ton. I hope you did as well. Uh, so please come back every uh, Friday from our news information and emerging thought with leaders from across the healthcare industry. Check us out at www.thisweekinhealthit.com. That's all for now.

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