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The way in which healthcare has historically thought about its technology estate and the management of its digital assets has been rather stagnant. Super solid and extraordinary. Operates very, very well at scale. But not necessarily something that promotes the sort of fluidity that's required in an industry under change like this one.

Thanks for joining us on This Week Health Keynote. My name is Bill Russell. I'm a former CIO for a 16 hospital system and 📍 creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health 📍 leaders.

All right. Today, we are joined by Angela Yochum, EVP, Chief Transformation and Digital Officer at Novant Health. Angela, welcome to the show.

Thank you, Bill. It's great to be here.

I am really looking forward to this conversation. There are certain people that it took me a while to track down and you're one of those people that I've been trying to reach out to. And I understand why it's hard to track you down. Cause every time I turn around, you guys are doing amazing things at Novant. I mean, you're doing things in AI. You're doing things in the digital consumer space in the innovation space. You seem to be in the middle of all of them cause I keep reading quotes from you in those articles. So exciting things going on. And I look forward to talking about some of those things today,

Bill you're so kind. We have been having so much fun here doing good work and there's no end of that work to be done. Is there? But you know, this is, this is what we're here to talk about today because there's a part to be played, I think by so many members of the ecosystem, by so many members of the community, that's going to be listening to your show and it's just a pleasure to be part of it and have a chance to open that dialogue.

We're going to touch on a lot of topics. Digital healthcare. We will talk about clinical staffing shortages, some of the things we're doing there and whatever else we can get to the next 40 minutes. Before we get there though, how did you get to healthcare? I mean, you didn't start in healthcare. You seem to be around it for awhile, but you ended up in it. So give us, give us a little bit of that background.

Well, Bill, as you know my background, I started out in technology. So very deep technical roles across a variety of industries. I had an opportunity to take on larger and larger areas of responsibility, domain spaces, and ultimately ran large technology divisions for other companies in a variety of industries.

So a lot of learning, a lot of fun, a lot of growth. Opportunity. Typically I go into industries where the industry itself is experiencing a significant transformation. Either intentionally or it's having transformation, thrust upon them. And it's almost impossible to think about the sort of change that's happening in healthcare. The advances that are happening in medicine and science without also taking into consideration as you well know all of the advances that are happening in technology and the unprecedented access to data that we now have. So healthcare is the absolute perfect place for me to be from a, as I think about my geeky side, things I like to do. And of course the mission is unparalleled. So it's very gratifying.

It's almost like you've been there. Right? So in banking, you got to see the transformation go on in banking in retail, you've got to see the transformation going on and retail. And now you're sitting on the cusp of a significant amount, especially through the pandemic, a significant amount of digital transformation in healthcare as well.

Let me ask you this. So you were, I think one of the first that sort of this, this has happened to, so you have a Chief Transformation and Digital Officer role. The CIO reports into you. We've seen that now at Ascension. Eduardo has the technology team, as well as I think strategy and innovation reporting into him.

We just saw that at JP Morgan, I heard the CEO, John Starcher for Bon Secours Mercy. I think they just hired somebody from Cigna and they moved that whole technology stack underneath that role as well. Why does that make sense? And why was that the path at Novant?

So at Novant this role has been an evolution. It was recognized four years ago. A little over four years ago when I joined. It was recognized that the way in which healthcare has historically thought about its technology estate and the management of its digital assets has been rather stagnant. Super solid and extraordinary. Operates very, very well at scale.

But not necessarily something that promotes the sort of fluidity that's required in an industry under change like this one. So Novant, the board of directors, the CEO, a very visionary CEO as you well know, and our executive team recognize that it's probably more than just a technology job.

So my role began as Chief Digital and Technology Officer with the CIO directly reporting in and it gave me an opportunity to expand the capability set. So we crafted a Chief Data Officer role, for example, and that gave us an opportunity to be very prescriptive and very strategic in how we now think about managing and do manage our data estate, which enables us to see around corners which has been fabulous.

Then the role expanded pretty rapidly to include our digital health line of business. So our operations group for all things related to digital health, the clinicians that that see our on demand patients. The device company that we manage, the e-commerce platforms that we use for our gift shops and other other sorts of sales items. All of that expanded to be part of my, my responsibility.

Then we moved all clinical informatics under my group. So now we have a broad clinical informatics team as well. The chief health informatics officer and all of the CMIO's that are aligned to the different parts of our business. Then we have our new business growth team. So new business growth is the team that explores and defines all new revenue streams for the company. So things that there may be a technology component to it more often than not there is, but there doesn't have to be these are things that these are folks who are used to spinning off adjacent businesses to companies. So we are focused on that that work is part of my team as well.

We have the innovation center, which is called the Novant Health Innovation Lab, which is a physical location. That's part of my world as well. And we do a lot of interesting things. You mentioned AR VR before as part of a conversation we had prior to this call and a lot of that work is happening as part of that lab.

It's just an ever expanding group. We have that we have a culture team that engages across the, the people in culture organization and the rest of the group. It's just been a tremendous. Just a been a tremendous team to, to see them thrive.

When I was at St. Joe's, I remember we had a big strategy get together. I was in a hotel, you can picture this. We're in a hotel and there's stations around and it represented the seven, I think, seven pillars of our strategy. And they had a time where they said, okay, we want you to go up to the strategy pillar that impacts you and just somebody it's going to be there to facilitate a conversation. And I'm sitting there, I'm looking at the person like, I need to be at all seven. I don't know how do you? Because people kept saying, well, we need to have, we need to have the technology team over here.

There's too much technology component. You need to understand what the impact was and that really is what's happening and healthcare is becoming digital. It's becoming technology enabled from the OR to the, to the home. And it's just like you need to be everywhere. So that's, that's why that the roles and the team I think is expanding for you, I think.

Absolutely. And, and you just touched upon something, that's a bit of a hot button for me. So I'm so pleased that you brought it up, which is the technology teams, even if you just think about the classic technology. This is the only organizational construct in most companies. Okay. I'm talking, I'm talking about in any industry, in most companies, if the only team that touches every single piece of the business, and if you are deep and very, very good at what you do in the technology domain space, there's a good chance that you understand every business process of significance across the company in ways that, in ways that it's not reasonable to expect any other leader to see. Any other leader to understand. You're involved in those discussions that are optimization discussions for every single domain space. You're also involved in the discussions out the flip side of optimizations sometimes, which is innovation and expansion, because so much of that sort of work is enabled by technology.

So you are absolutely right. And going back to your question. Anyone who starts out as a technology leader, who has a seat at the table and participates as a senior executive of the, of the company is, is extraordinarily well-equipped to see opportunities for that company that may not be obvious to anyone. else And so, you know that better than anyone and.

Yeah. And you know what I find as I'm talking to digital leaders, technology leaders in healthcare is there are still organizations that have not identified an innovation leader or a digital leader, or those kinds of things. Now, those, those functions, those roles will roll up into some, somebody's doing them at the organization, but if they're not named they tend to lack focus. And so the fact that your organization has named digital and even consumer, a lot of the things I see coming out in Novant is really consumer focused. Talk, talk a little bit about that, about your, your consumer focus and how you think about the, the consumer with regard to healthcare.

Sure. Well, first let me give props to our Chief Consumer Officer Jesse Cureton, who is a former colleague of mine from banking years and years ago. He's responsible for marketing and communications relations to the consumer. He also has a number of other responsibilities related to community engagement and a bunch of other things. But among his consumer, foundational capability sets that he and his team wonderful, a marketing officer, Tammy Jones and a comms officer Katie Everett had put into place. It was a tremendous foundation, very attractive for me to come into Novant Health and the role that I had because there were so many things that were already sorted related to consumer engagement before I arrived part of my digital health space is we have patient engagement, a large patient engagement and digital engagement team as well. So we have about 8,000 people who belong to this community that we use as test subjects for any new idea, their community members, their patients, their interested parties who have signed up and they become our focus group.

And it's a go-to focus group. And every time we send out a survey to these 8,000 people, we can expect to get 4 to 500. Right off the bat. Now this is not a construct I needed to build. This is a construct that existed. So fabulous resources and attention to consumer sentiment that existed. And a lot of, a lot of detailed understanding of our consumer before I arrived, which was extraordinarily helpful in directing my efforts. 📍

📍 📍 We'll get to our show in just a minute. As you've probably heard, we've launched a new show TownHall on our Community channel. This Week Health community. And it airs on Tuesdays and Thursdays. I'll be taking a back seat to some of these people who are on the front lines. TownHall is hosted by an array of talented healthcare leaders who are facing today's challenges head-on. We're going to hear from professionals and their networks on hot button issues, technical deep dives, and the tactical challenges that healthcare faces. We have some great hosts on this. We have Charles Boicey and Angelique Russell, Data Scientist, Craig richard v ille, Lee Milligan, Reid, Stephan, who are all CIOs. We have Jake Lancaster and Brett Oliver who are CMIOs and Matt Sickles, a Cybersecurity first responder. I'd love to have you listen to these episodes. You can subscribe on our Community channel. This Week Health Community, wherever you find and listen to podcasts. Now let's get to the show. 📍 📍

I want to come back to the consumer later on in the conversation, but I want to hit a few other things before we get there. You came from outside the industry. I came from outside the industry as well. I'm curious because I got this question a lot. What excites you about the potential future of healthcare, as you come from outside and other industries, and you've seen the transformation. What can you imagine healthcare could look like that would really benefit the communities that you serve?

We need every member of our community to be as healthy as they possibly can. So traditionally, when we think about what healthcare, the role that healthcare providers play in that, in that mission, it is expanded access to care and it's improved quality of care.

Okay. Those are still our top two focus areas. So expanded access to care. This is how we think about providing care through digital channels. Being able to provide on demand care either through physical digital, or some hybrid channel. And then of course, expand in increased quality of care is in as far as my teams are concerned, it has a lot to do with advanced analytics, our ability to apply AI based solutions to get to faster diagnosis, to get to more personalized treatment plans, to predict major health events before they happen. This is all, this is all sort of bread and butter in the modern healthcare provider space. And I think we do that very well and we tend to do it first.

So I'm really, really happy about the team's work there. However, this is not enough. Healthcare should not be, when we think about like take, for example, a virtual visit, even with advanced sensors that allow you to take vitals remotely and all the rest of it, that is still just a digitized version of a traditional healthcare engagement.

Right. That's still the patient making an appointment with a provider, through whatever channel and all well and good and that should continue. The future of healthcare is going to be about empowering each individual, each family, each member of the community to manage their own health and wellness in a way that is more of a continuum and less about individual visits.

So today we've already seen some appetite on the consumer level for management of health and wellness. I mean, I don't know how many health and wellness apps you have on your phone. I probably have 30. And I've got so many wearables on, I don't know what's being tracked. I lost track. We love our American society is obsessed with these sorts of tracker devices. We love them. We love reading into the results. We actually load these results into the patient's record. Automatic. We do things with those results. We, we, we look for patterns with those results. These are, this is the beginning. These are the baby steps of this continuum of care, where we engage the patient on a regular basis in his or her on their health and wellness journey.

And it's not just when they're sick. We want to be constantly improving their health on a daily basis. We want to be able to predict what risks may be heading their way and be able to reach out to them proactively about that. And we want to be a partner with them in their health and wellness journey.

Now, as things stand today, the payer appetites are evolving. I think a lot of interesting realizations have occurred with real data behind them. Since the pandemic began. And since a shift to a less traditional venues of care has begun, I think we can start to see, we have enough data that we can start to see as a community health care community.

We can start to see patterns and which patients tend to be healthier. Which patients have fewer need to have, need to be readmitted to the hospital with less frequency. These are the sorts of things that I think are are facts that are now just known to the community. With that I think now we can start to imagine a future in which reimbursement philosophies start to expand. To focus more on the overall health of the patient. Keeping the patient from having to have a lot of visits and rather keep a continuum of care ongoing in their life.

You're the first person from Novant to be on the show. Tell us a little bit about Novant. You're in the Carolinas. Give us a little bit more background.

So as things stand today, we're in four states. We have several large hospitals about 17, large hospitals in primarily in North Carolina. We just we had a few in Virginia, Northern Virginia, which are now owned by UVA. We have 800 locations total. So this includes a lot of clinics and physician centers and outpatient centers and surgical centers. We have a subsidiaries in Georgia that do lip imaging and other sorts of lab work. We have entities that do a number of things across the healthcare spectrum. We are a nonprofit. We have about 37,000 team members. And our, I want to say that our revenue at the end of last year is just shy of 8 billion. So we're not the largest healthcare system in the country, but we are not a mom and pop shop. So we have, we have an opportunity to do, to do some pretty exciting things with the economies of scale that we have across the region we serve.

Yeah. And I, I think from a marketing standpoint, I've got to give your props to your marketing team. When I see purple, I almost immediately think of Novant. I mean, you guys have commandeered a color almost to the extent that T-Mobile has their color. But the interesting thing about the trackers to me is I found that outside of chronic conditions. Okay.

So with that as the caveat, I found, there's really three things that matter. It's, it's what you eat. It's how you sleep. And it's do you get exercise? I remember when I was trying to diet and I was at a thing and I was talking to a doctor I'm like what's the secret to health and he goes, you want me to give you some magical formula? he goes I'm going to tell you what everyone has said since the dawn of time. Get enough sleep, exercise and eat the right food. And I'm like, yeah. At the end of the day though, that's, we're, we're collecting all that information, but we haven't integrated that into the into the process of clinical care yet.

I mean, the doctors were like, look, if you give me every data point that's coming off their tracker, does your, have you guys started to think about how you, you pass that through analytics and pass that through AI and deliver insights to the care team?

Yeah. So that's an ongoing discussion. I mean, we do not ,the physicians, if you give the physicians the piece of information that, you know, so-and-so. It had 15,000 steps that day. There's no science, there's no science that tells them what they should do with that. However, if I can tell you this person's blood oxygen level is, has, has been trending downward or this person's heart rate variability has had the following trend and maybe instead of so there are a couple of things that we're working on right now that I think is going to be a big deal in the coming year if we can get it done, which is just popping up some risk factors. We do this already today for a couple of areas, but it's not comprehensive yet. I suppose it will never be comprehensive because the amount of data available to us will continue to expand, but that popping up some risk areas, ask them this, ask them that. And this can be pulled, not just from data that's streaming in, from devices or wherever.

This can be from data that we collect from the last 10 years of notes. I mean, think about next time you go to see your physician, ask that or your advanced practitioner ask that person, how many notes they read before you walked in? You might be one of 30 patients they see. You might be one of 10 patients they saw that day. And, and how many people they see on a daily basis probably determines how far back they go in the notes. If three years ago you had some anomalous behavior in your heart, heaven forbid or whatever and you've been fine subsequent. If they're just reading the notes from the last year, they may not even have any idea that they need to ask you a couple of extra questions about your heart health.

And so we can pull things like that, just using natural language processing out of the notes and say, pop it up to the top of the attention and say, Hey this happened three years ago, ask them about this because then the physician applies or that the advanced practitioner applies his or her best judgment. ,It's not we're not changing the workflow. You know, we're not trying to interfere with any care delivery. It just gives them a hint as to where areas of inquiry might be interesting for them to explore.

I remember having a conversation with one of the physicians and she was saying, yeah, I ask this series of questions every time they come in. I'm like, isn't that already in the EHR? And she said it is, but I asked that series of questions every time somebody comes in, because I will not have time to read all those notes. I'm like, why, why can't you read all the notes? I mean, do you not essentially what I was saying is do not care about me.

And she just, she sort of laughed and she goes, all right, let's pull up the EHR. She pulls up the EHR. She shows me this thing. She goes see this and it was PDF files. She goes, there was, there was like a stack of PDF files. She goes, are you reading this many PDF files? I'm like, no, not a chance, but that's, that's where technology excels. Right? Technology, NLP, and other things can read those, identify patterns and call those up and bring those to the attention. I want to talk about innovation. Let's start with, talk to me about Novant's model for innovation. How do you think about innovation?

So philosophically, we don't believe that innovation is a team. We don't believe that it's a project. We don't even believe it's a methodology. We believe that it is a lifestyle. And so everything that we do in support innovation is in support of a lifestyle and a way of working that is highly innovative. And so the mechanisms that we put into place are accelerators of innovation.

So I'll tell you what they are. First, about a year into my tenure. I co-founded the Institute of innovation and artificial intelligence with our chief medical officer, Dr. Eric who has a strong interest in the power that AI brings to the clinical space. So with the foundation of this Institute, it created a set of constructs that allow us to pull certain projects into the institutes oversight. It allows us to gain easier access to subject matter experts across the system. You have 37,000 people. You you have expertise somewhere in something, and so you need to pull it in and allow it to be leveraged in these, these critical critical efforts. So that's one construct that we had in place the Institute, and we've, we've run several successful projects through that.

We also have an innovation lab, as I mentioned, that is a physical location next to a Makerspace. And that gives us an opportunity to do some, do some hands-on experimentation. And this is just a lab I should mention. It's just getting off the ground. We've had, we've had elements of this in place across the system.

We're actually consolidating into one place in Charlotte, North Carolina. So there's going to be a big announcement about that in the coming couple of weeks, couple of months. So in the lab, we'll have a variety of different almost like exhibits, but they're hands-on exhibits. So you'll have, for example, the AR VR pod. So as we think about, we use VR today across the system at a variety of ways that is in production. So for example we use VR to calm patients down before a procedure, or we use VR to train a patient. This is what it's going to look like when you go into an MRI. Those sorts of things. It's very helpful and pain management is another.

We're about to give you a shot and your child here, let me put this helmet on, you watch this it's very distracting. It's helpful. So these are the sorts of things that we do well today. We, we use 3D printing for patient education as well. So we will 3D print things in the innovation lab.

For example, if you're having a heart procedure, we will do a 3D print of your, and this isn't for every patient. There's just for some cardiologists are leveraging this with this right now, but they go 3D, print your heart and say, this is your heart. And this is the piece right here that I'm going to go in and take a look at it and they can actually hold a replica of your heart in their hands.

It's helpful when you think about going in to surgery. In advance of surgery, I, I personally feel better if my surgeon had had a replica of his heart in my, in his hands or her organs. So these are the things that that, that, that we can do in the innovation lab that it's just it's baby steps, but it, it it's things that can be seen and can be felt.

Now, there are a ton of innovative things happening that don't have an aspect of them that can be seen in. So a lot of the tremendous work with AI is not necessarily something with a physical manifestation. And so that won't necessarily be showcased in the lab, but it could certainly be co-created in the lab using the space leveraging the collaboration mechanisms that exist there.

And so it's a space where when it makes sense to bring multiple parties into one spot to do co-creation work, we'll have that ready for them as well. So in many more, I mean, I glossed over a lot of the things that will be there, but.

Right. With innovation, it's interesting because it's having been in other industries, coming into healthcare, the challenge of scaling the innovations, it was one of the ones that was very unique to healthcare. In other industries, it's you get something, you scale it up. Now, if you're touching the consumer, there's some complexity to it and whatnot, but I mean, there's, there's regulatory. There's well, it's health, right? So we're talking about your error rate has to be essentially, and those kind of things talk to me about scaling those innovations and, and if you have an example of something that went from a concept to implementation that that would be phenomenal.

Okay. So let me, let me run through a couple of other things that we have in place, and then I'll give you an example. When we think about innovation, we tie it in oftentimes to our new business growth area. And so the new business growth area that's part of my world has the ability to measure as we think about a new capability set. Not only do we ensure that there's an appetite for it what's the relative desirability of this in the community for individual patients and a particular patient cohort what does that, what does that desirability factor look like? We also look at, is this something that's operationally feasible for our existing business and it's not operationally feasible, what would need to happen to make it feasible?

Something that we can actually run and do well and scale to your point. Lastly, as it relates to scalability, we pay a lot of attention to long-term financial viability, because as there is so much to be done for the patients that we serve and we give away as we well should so many services to the community.

In our case, it was over a billion dollars last year. We could spend all of our money in six months and have to shutter the doors. So we have to make sure that it's going to be financially viable over time. And this is that viability piece and those projections are a very delicate.

And that's another aspect of scalability. So we look at the operational impact. Is it feasible to run. To be looking at the viability over time? Can we pay for it to run over time and at scale? And then of course, does anyone care about it? Is anyone going to consume this service or product? So, so those that's just part of the, part of the analysis work we do just like, just like, you'd see in any number of other companies. The other piece I'll mention about innovation is that we have a fund. So our finance organization, I have a partner, John D. Cooper who runs for our CFO a hundred million dollar innovation fund. And so this is where they invest in startups from across either re of their, either startups of regional interest or startups of functional interest to us.

Because when we think about health in our communities and health and our regions that we serve, we know that health is not just about. Health care health financial health is a big deal. Access to employment is a big deal. Access to education, access to food fresh foods. These are the sorts of transportation, corridors all the things that, that make up a healthy community, having a safe place to walk that has streetlights funded.

I mean there's no end to how we can define health when we try to make our communities healthier. So this innovation fund helps us to invest in areas. That will benefit one or all of those segments of, of what supports health for our community. And that's been exciting to be a partner in that space.

The Institute of innovation and AI. That sounds that sounds like a place I want to tour it and see what's going on. And AI's application to healthcare is one of those things. That has sort of gotten a black eye, I mean, cause we had a certain large company that won jeopardy come in and then sort of, it did not deliver on all the promises.

They thought they were going to come in and be able to diagnose cancer treatments and all sorts of other things. And we know the complexity and the data and those kinds of things. Have we gotten smarter in this area? Have we started to identify the use cases that are gonna make more sense as we step into this.

Yeah, so we can dissect what went wrong with our big blue friends Endeavor all day long. I there's an architectural component to what went wrong. Yeah, there were, there are a number of issues.

Well documented issues.

Well documented, well understood issues. So what are the things that I love about this role is I have a chance to work with some extraordinarily smart data scientists. And our data scientists are very, very good at understanding what it takes to build meaningful models.

What level of what kind of data are required how much data is required. And the accessibility of that data is of course paramount for us. And you've probably heard me talk about this because it's it's, to me, it's just table stakes to you. It's table stakes, but in the healthcare space, as historically, it's been difficult to do, which is getting your hands on your own data.

The clinical data that you've owned, getting your hands on it so that you can operate on it freely, is historically sort of difficult to do? So we've been able to do that. And along with the data that we've acquired commercially, data that's behavioral in nature, data that streams in from a variety of devices as we discussed and all sorts of other interesting data elements operational data, things that, that tell us about how we engage with patients how are we measuring ourselves? All of those sorts of things. Having access to that data and having that at scale has opened up opportunities for us that have, that are unprecedented. So working with the data scientists to identify things that we could do that might not be obvious to anyone has been really exciting. So for example, we work on things like we can, we can predict major heart health events before they happen for patients who are being discharged from our department, our HPI or heart and vascular Institute.

And it changed the way we follow up. We were working with MIT on an image analysis algorithm, which allows us to look at a mammogram until with some crazy high degree of accuracy the likelihood that that patient will contract breast cancer in the the next four to five years. Again, changes the way that patient follows up on her health, his or her health. And it follows up with the way we, it changes the way we follow up with patient.

These are very real health outcomes. We're talking about it. I mean, a computer vision, by the way, it just amazes me to know end. And how it's being applied and whatnot, but just the fact that we can look at historically, all the people we've discharged. People who have had heart events after they've been discharged that can inform these models and we can identify them before they walk out the door. The potential to save lives there is really staggering to me to just think about.

It's staggering to think about. And that's, that's what we do. That's what we do with, with data and data science these days. And that's what everyone should be doing. There are things there are off the shelf solutions that do this very well, by the way. It's really accessible to anybody. Things like vis AI for stroke. Saving lives every single day. And it's, it's really extraordinary.

The Institute of innovation and AI, does this sit on its own outside of your analytics team in your, your data science team? I mean, because you could apply data science across the entire continuum of care, is this one very focused and then there's a data science team over here that's doing other things.

We have one data science team and it's, it's part of the chief data officer's organization and part of my senior staff. Yeah. The Institute, let's talk a little bit about it. You said you want to tour it. There is no physical location of the Institute. It's a set of constructs. So there are no full-time staff members of the Institute. The Institute is is a governance model and an engagement mechanism that's been defined. It's a, essentially a mechanism that allows us to activate a cross-functional team and activate funding for that team activate engagement for that team and spin up very important projects for the system.

Now that's separate from the work we do that is more exploratory or experimental because that work tends to happen in a smaller. So, for example, if I'm doing something experimental, I'm not going to pull in all the radiology leaders and all the neurosurgery leaders, you know what I'm going to, I'm going to probably get one or two, co-conspirators to work with me on on, on some experiments, as opposed to as opposed to pulling in the world and everybody. But the Institute allows us to do that when the time is right. And that's how we move very, very quickly to do some great things across the system.

I love that. I like when I do these interviews and I'm taking notes. That's a wonderful concept. You came from outside of healthcare, is there anywhere where you look at it and you see analogs still and you're in, it's sort of like, I can't believe there's we still have this analog going on within healthcare.

Sure. Of course. Of course. We think about how much we know about retail customers. Think about what god, bless him. Think about what Amazon knows about me and what they know about you. I mean, they know. I mean, I have their devices in my home for goodness sakes. I've been reading almost everything on a Kindle for 20 years give or take. They know what, how late I stay up watching Amazon prime and how frequently I reorder my salty, crunchy snacks. They, they, they have, they have a lot of my dirty secrets at hand, but they also know a little bit about my positive habits. Think about how powerful that data could be if applied to healthcare. They know a heck of a lot more than my, my, even at Novant health and I feel like we arm our physicians with a lot of data. They know a lot more than my physician knows about me.

I mean, you bring that up and it was interesting cause I, I interviewed John Brownstein out of children's in Boston and he's a data scientist as well. And he was just talking about how they were mining Google searches to determine where the pandemic was going to peak. Because we go to Dr. Google first and we asked the question and as all of a sudden it spikes in our area, people ask asking the question what are the symptoms they go likely we're going to have an outbreak in this area. That, that data is is so valuable with regard to just it's almost a great form of predictive medicine. The questions people ask to Dr. Google could indicate what they're feeling and what they're having. Let's just talk about Google for a second. And I don't know if you have a partnership with them or whatnot, and this is this is way off script, but I just hosted some CIO's and I was talking to them, talk to them about engaging the consumer and patient acquisition. And I shared a story of working with the health system, where we were rethinking their patient acquisition. And I brought up SEO. I'm like, this is like fundamental in every other industry.

If you want to engage consumers, you have to think about SEO and it kicked off a project around SEO, but it wasn't part of the initial, how do we engage consumers. When you think about Google and its impact on health care, how do you think about Dr. Google in the markets that you serve?

First, let me say independent of a particular organization like Google, I'm in favor of having our patients and our community members have as much access to data as possible. If Dr. Google so to speak is providing information about you that, that, that allows them to make a decision to initiate a virtual visit for their child at 10:30 at night, instead of waiting until the morning to take their child into the pediatrician. And it saves that child's life. Yay. Thank you so much, doctor Google. Thank you so much for making them aware through whatever site was found using the search mechanism. Giving them valuable data, obviously there's garbage in garbage out problem as well. When when an engine indexes the entire internet and makes it available and searchable that.

But this is why I was so encouraged to see Dr. Feinberg there and Karen DeSalvo there and really thinking through, okay, what information do we want to present to people around the pandemic? What information do we want to present to people? I love that clinical perspective being applied to that massive dataset.

They're smart. We need to, we need to operate in the world. First we need to be aware. We have contextual awareness of the world in which we're actually living. So the world that we're actually living is one in which information flows to our patients through a highly fragmented ecosystem. And that information is fueled by whether you're getting it from your neighbor's mouth, where you're getting it from your your favorite internet site, your favorite portal, your favorite social media platform or at church or soccer practice for your kids. Wherever you're gathering this information from the radio, all of this information needs to be distilled and put into context. It's not reasonable to expect that every single member of our patient community is willing or able to do that contextualization so in as much as we hold ourselves responsible and we certainly do for the health, the general health of our communities, we have to use every avenue in our disposal to make sure that our patients have access to good information that's relevant to them. And how do we certainly know what's good.

How do we know what's relevant to them? Well, that's when we have to borrow from tried and true methods used by so many other industries who have engaged. Are patients who happened to be consumers of many other types of products and services so well. So that's, that's why we think so strongly about consumer engagement.

Yeah. Little tangent. Thank you for answering the question. I appreciate it. One of the greatest challenges facing healthcare right now is clinical staffing shortages. How's your team approaching this specific challenge? I assume that's come across your plate a couple of times in the last, last a year or so.

It's really extraordinary what our clinical staff members have, have done for our communities across in every healthcare system, across the country, around the world. I mean, it's, it's really, unless you've been in it yourself, it's nearly impossible to imagine the stress and the load that these individuals have been carrying. And we like every health care system have have pulled out the stops to try to support these individuals who are at the bedside, who are in the operations teams who are enabling the care delivery that we're able to provide to our communities. And so in many ways we're doing a lot of things that are exactly like what others are doing.

So we're making sure we're paying everyone a competitive rate where you know, making sure we're giving them, we just announced a big, it was, it was all over the news. We gave everybody an extra week. Take an extra week off. And by the way, if you don't need a week off and you'd rather take a week of pay extra on top of anything else you already make, you can have that instead.

So these are the sorts of things that we're doing to try to give people a little bit of a lift. We're trying to get creative in how we think about staffing and schedules to give people a little more flexibility. Obviously the digital capability set that we roll out that tries, we try to make it as easy as possible for everyone who has those really hard, super hard jobs to do their jobs as well and as easily as possible.

And we're getting creative in a lot of ways. Like we're about to start an experiment with some robots that help carry supplies from point A to point B in our hospital facilities. Some that help us patrol parking lots and get people help who may maybe help who may need help.

And we just can't see them because they're on the outer reaches the parking lot. And if there's not a public safety officer there at the time, maybe they can't. So we're, we're enhancing human, human activities with digital digital assistance as much as we possibly can. If we can support them, if we can keep people safe, physically safe. Financially secure. If we can provide them with social constructs that keep them sane and make them happy and have them fulfilled, and then reward them for their amazing work that they've done and all the different sorts of reward systems. And I wish I could take credit for those four important things. I actually just stole that from my friends at North Highland. But they did a great job outlining that. Those are the things that I think we, we all need to be focused on to, to help with the staffing issue.

The robots are interesting to me. I mean, cause we're, we're taking away the mundane work so that the the clinicians can do higher level work and as well as, as even beyond the clinicians and other areas as well I'm going to close with two questions here. One, I'd like to talk to you about platforms a little bit.

I mean, we hear the word platforms used all over the place these days. How do you think about platforms and why, why are they important for the work that we're trying to do in healthcare?

So as we think about and I assume you're talking about platform in terms of like technology platforms. Solution sets that are built as platforms that we can incorporate into our states and leverage. So, so as with anything as we design the estate we think about a couple of different things. Number one, we ask ourselves, what are the capabilities that we need to have in place to support the outcomes we're trying to achieve for this. And those capabilities might have technical components. They might be process-based. They might be people-based. But once we're able to define and organize those capabilities. Then we can start identifying how we meet those, how we fulfill that capability need. Oftentimes you'll see platforms that correspond to some of those, those capability sets. For example classic platform across multiple industries, our CRM, our customer relationship management platform.

We happen to be a Salesforce shop. So Salesforce classic platform. It was a SAS based solution, started out as a SAS based solution that did one thing. And then they rearchitected their solution to be an entire platform, which was useful because then all of a sudden it wasn't just up to Salesforce and its product roadmap to deliver capabilities to the platform, but they opened it up so that other users of the platform could put capabilities on top of the platform. It ties the customer to the platform and provides easy integration to the other components that are using it. Tremendous business model for Salesforce, for the platform company.

I certainly understand why many companies want to be platforms, tremendous business model, because it's very, very sticky. Once you have all these components that are essential to, to one's business that live on top of a platform, it's nearly impossible to extract yourself from it. So it's a wonderful business model.

And then if you're the, if you're the company who needs the capabilities leveraging a platform gives you just ease. Ease of integration. One stop shop for solution sets. You can use Hey, I, I have the vendor itself, the platform vendor itself that provides one part of the solution set that I need.

And then I can get it from a variety of their parties that operate on that platform. Perfect. Now, when, and by the way, it's easy to find typically for some of these platforms, it's pretty easy to find talent. So if you need someone in-house to do the work or the extensions or the support, pretty easy to find.

So a lot of great reasons to use platfroms. Now the reason I think you would move away from platforms are if you want to be a little more precise in how you deliver those capabilities. If you want to beat, if you want to be ahead of your competition so that you, you have the capability before anyone else does, if you wait until something is commercially available, everyone can buy.

You know. It's not so much about in healthcare. It's less about competition and in healthcare, it's more about saving lives. So if we can get to something now, before the platform. Then we will do it now independently, whether that's co-created with a third party, who's going to cook, who's going to help us do something. Or if it is something that we built in house more often than not, we could create, but not commercially available to anyone else. We get it out there, fast, our patients benefit or providers benefit. And then once it's available commercially, we might roll it into a platform and then be done and let them handle the maintenance of it.

Build versus buy. How do you think about build versus buy? Is it a matter of speed to innovate? Is it a appropriate fit to the problems? I mean, how do you think about it?

I think that build and buy are just two options of a mini option playing field. So we buy, if something is commercially available, for the most part, we'll buy it. The only reason we wouldn't buy it is if it's extraordinarily proprietary and locks us into something that we can never get out of. So that, that would be one reason we wouldn't buy. But for the most part, if it's commercially available, we'll buy it.

We won't, we won't try to take any other route. Build is an absolute last resort. Build on our own because we do a lot of things really well. And we actually have people who have built some of the largest transactional systems in the world on staff. However that's not our jobs today.

You're not going to rewrite the EHR anytime soon.

That's not on our roadmap. However, the thing that I think is most interesting is this notion of co-creation. So you mentioned earlier, I read about these partnerships with Google and what they sound like to me is that these entities are customers of Google. Not, not partners of Google.

When I talk about co-creation and partnership, I'm talking about working with companies who have software development shops who have active commercial products that we go together and co-create another commercial product and they go to market with that. Or at the very least, if we don't, we don't get a part of the action we're customers zero, and then they go to market with it.

When I talk about co-creation, I'm talking about real co-creation with with an entity that sees our expertise and our willingness to innovate our access to data, our ability to move quickly in a healthcare space, which is so difficult to break into and they're willing to do something creative with us.

Then all of a sudden, we are able to bring someone else's development, shop expertise and someone else's product to station capability. We're able to bring forward something to our patients that otherwise they would have. That's tremendously exciting. That's a partnership and there are some companies large and small that we are that we're actively partnering with and that we have in the past and very successful doing exactly that.

Angela. I have one out question for you. But I do want to thank you before, before I get there for coming on the show and sharing your experience, your wisdom with the community. When you imagine medicine and healthcare in, in your community, how do you envision it maybe five years from now? Maybe 10 years from now, that might be different than how it is today.

So I believe the care continuum will be redefined without distinct boundaries, between visits. As I mentioned earlier, it's I think the lines between physical care, physically deliver care and virtually delivered care are going to blur. You can see a lot more hybrid engagement. There'll be more of a continual engagement instead of, instead of getting so good at looking at the current state as a snapshot of a patient's current state of health. We'll get really, really good at looking at their future state of health and be able to predict many possible future states of health for that patient, and be able to work with that patient intelligently about next steps and follow-ups and ongoing management of one's own health and wellness.

And that is to me when we're able to incorporate that sort of forward-thinking and consideration of many possible futures into all aspects of care delivery. I think that's when we're going to change healthcare. That's the that's, that's the holy grail. That's when costs come way down. People get way healthier. And the ecosystem is, is transformed.

And that's, I think that's what I'm looking for. I'm looking for a partner in my health that is with me every day. And as I'm making decisions in the grocery aisle, as I'm making decisions for I mean just every everyday decisions that we know impact health. Should I buy an apartment here or should I rent an apartment here?

Or should I, should I live in this community? I mean, all these things that you sit there and to go there, there are health ramifications to so many decisions. I'd love to have a partner. And one of the most trusted partners in this ecosystem is the health care delivery organization. So I love that vision. Angela, I want to thank you for your time, and I want to thank you again for the work that you're doing at Novant.

Thank you for having me, Bill. It's been a pleasure and privilege to be part of this conversation with you 📍 today.

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