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June 14, 2021: It’s Newsday with Eli Tarlow, Director of Healthcare for Sirius Healthcare Solutions. His experience before his current role was as a CIO for multiple health systems. With many leaders eager to get teams back in the office, will those opting to stay at home be perceived as less engaged? We need to over communicate in healthcare for the sake of the patient, but is there a way to cut down on time tied-up in meetings? Care is becoming more refined and the demand for acute hospital care is decreasing. What does this mean for future building projects? Remote care is increases the amount of off-site devices connecting back to the health system servers. Can we keep our organization safe from nefarious actors? How will wearable tech play a role in this shift? With a higher demand for team members and more remote opportunities, how can your organization focus on retention?

Key Points:

  • Will a return to the office alienate those who would rather work remote? [00:06:40]
  • Healthcare professionals spend a lot of time in meetings. Can we find a way to increase meaningful time on-the-ground? [00:10:40]
  • The shift to remote care and what this means for the fate of in-patient hospital facilities [00:18:20
  • Keeping health system secure while linked to out-patient and remote care tools [00:30:45
  • How Apple is integrating wearable technology into the care journey by partnering with EHRs [00:36:00]
  • The future of healthcare with patient-driven interoperability [00:39:00]



This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

  All right. Welcome to this Weekend Health it. It's Newsday. Today. Apple had a worldwide developer conference and we will talk about that, a forecast that says Care is moving out of the hospital over the next 10 years. And so we will discuss that as well with Eli Tarlow, who our guest today, Russell.

Special thanks to our sponsor today, sir Healthcare, and we really appreciate them. They've been investing in our mission to develop the next generation leaders. And we are so thankful they're a part of our mission. If you wanna be a part of our mission as well and become a show sponsor, send an email to partner at this week in help it com.

Alright, quick note before we get to Eli. And Eli is patiently waiting. Check out our latest article on the changing role of the cio. It's out on our website this week. It just went out last week. It's a great piece. Interviews. William Theresa, Springman, Craigsville among others. The role is changing and check out how right from those who are living it.

Alright, today we're joined by Eli Tarlow, a recovering CIO and a client advisor for Sirius Healthcare. Eli, welcome, welcome back to the show. Thanks, bill, and thanks for having me again. It's always a, a great pleasure when we get a chance to, to chat, so you are a recovering CI.

And so you were, how, how long were you ACIO? Yeah, I think it was like 12 steps. I think I had just finished. I had my, uh, . Yeah, so I was, before I joined Sirius, I was ACIO of a hospital in, in Brooklyn, Brookdale Hospital there for a couple years before that, CIO at Bellevue Hospital. And I'm sure people have heard famous Bellevue Hospital in Manhattan, metropolitan hospitals.

I've been, uh, CIO for hospitals for many years. Been in the, in the healthcare IT leadership. Part of the just a healthcare IT leader since 2001 before that in other sectors and other industries. So. Bellevue has a, has an interesting history. When it was founded, it was essentially free care to the, to the community.

Yeah. A couple of, uh, couple of, so I was there for a little over five years as CIO. A couple of quick notes since you brought it up. Number one is Bellevue's been around since before we were actually a country bellevue's been around for 290 years, I believe, give or take. So before we actually existed as United States, they're the longest running

Hospital. There was only a hundred days in all that time that they weren't in business, and that was right after Hurricane Sandy when I was actually employed there. And that was the only gap in their ability to provide care. A incredible organization, incredible hospital, part of the overall New York City health and hospital system.

Yeah, hurricane Sandy swamped. The parts of New York were just completely swamped. So that impacted Bellevue pretty significantly. Yeah, we are, we began with shelter in place. What I learned during that time was just a remarkable experience. What I learned was that you don't really have the option as a hospital organization to just make decisions on whether you're gonna empty out your hospital.

When it is a, when there's a situation that's arising, you have to actually, patients have to go other places and . Because of where we were on the water table, we were advised, um, to do shelter in place. The team did a remarkable job just making sure the patients stayed cared for and what most people don't know unless they really read up on, on the situation, there is, and Bill, you and I have talked about this, the only as strong as EU weakest link.

It wasn't the medical staff, it wasn't anything other than the fact that we didn't have . Potable water. So we had emergency generators running, we had patients taken care of, but people couldn't actually functionally use the facilities. And sometimes you really learn about how important housekeeping is and how important the engineering team is.

And essentially that's what led to the, to the discharge and the quick discharge of, I shouldn't say discharge, but transition of care to other hospitals in the area. So 500 plus patients. All evacuated from the hospital, no vertical transportation. 20 plus stories all down steps to a waiting parade of ambulances.

And every patient did not only survive, but they had a good outcome. At, at the last series, healthcare to Healthcare event, I was talking to some people that were ACIO and and CTO. At one of the other hospitals in New York and they tell harrowing stories of just the first couple of floors loaded with water and they got everybody.

Everybody had to leave their hospital. They had no ability to really provide care because critical at that point, this is how we used to think. We put that data center in a place that it was the least expensive real estate in the place, which was the basement. And who knew that, that the Hudson River could, uh, come up that high.

And yeah, we were fortunate and our data centers were elevated. Uh, and I think it was the fifth and sixth floors. The problem was that our, the, the pumps for the emergency generator in the basement, and so when water breached the walls, the pumps were dead. Whatever the fuel was left in the generator was all we had left.

It was its couple hours of life safety basically left. And we actually formed what they nicknamed the Bellevue Bucket Brigade, where we had people wrapped around the staircases to the generator handing buckets of fuel to fill it up. And I know we wanna talk about other news, but uh, just the last thing I'll say is they.

They say you learn about the, you learn about the loyalty of your staff in the, in, in those times of crisis. Either they either run towards you or they run away from you. And we wouldn't, we didn't leave for a week. And you can imagine that was without showers and I was just hoping that they would be less loyal and start running away from me, and not shower for five days.

But it's a great team, super proud. It's a time of my life I'll never forget. Yeah, I, I can talk about disaster recovery stories all day. They're, they're pretty amazing. They're pretty amazing how people do step up. The camaraderie that's developed during those times are pretty amazing, but just the stories, it's, you sit there and you make the best plan you possibly can, and then it's that little, whatever it is, that one little thing that you're like, oh gosh, that's a lot more important than we thought it was.

Best laid plans, all systems and.

Aspect because a disaster just it. It doesn't, it doesn't discern. It just does what it does. Yeah. There's an overused phrase. People, process, and technology, everything will fail at some point. I shouldn't say that. Things are likely to fail, and if you have good people, you will succeed. And if you don't, it doesn't matter how strong your technology or processes are.

It all comes down to the people. We're gonna talk people today because people keeps coming up. I I'll, this let's this, this out the, but go over LinkedIn on this so it's pretty fresh. Judy Kirby, who we all know. Uh, Kirby. Kirby and Associates. Kirby Partners. Yeah. Kirby Partners. Thank you. It says recruiting in the healthcare space.

She posted a, a, uh, poll on LinkedIn and she said, what's your take? People opting not to return to the office, be perceived as less engaged or not, and then she has four answers. Yes. Definitely depends on the person. No, not at all. It's too early to say, and I was reading that question. I answer that Give.

And then I have the answer that I think is gonna happen, and they're two different answers. Do I think that people who choose to remain fully remote will be perceived as less engaged? I think what's actually gonna happen is yes, they're gonna be perceived as less engaged. They're not gonna be there for the hall hallway conversations.

They're not gonna be there for things. But what do I.

Adapt to having people be included in some way if they choose to be remote, because there's very good reasons to be remote. So I I, I'm curious what your thoughts are on that. So, I, I thought a lot about this when I was ACIO was. The, it was all work from the office. I wore a suit and tie, including Fridays, right when there was, there was no dress down.

You never knew if you were gonna have an executive meeting there. And now working for Sirius, it's entirely remote. I haven't seen our headquarters yet. And really when I think about this, it's uh, the one word that comes to mind is balance. I. There's nothing in this world I believe that is good if taken to an extreme.

People talk about whether working from home is great or not great, I think it's applicable in different areas. I think there's certain things that you cannot do, um, as well when you're remote, and I think there's things that you'll do better when you're remote, right? Someone who needs to be in front of clients and selling, right?

There's no value in them sitting in an office. They're wasting their, their time, and they should be out in, in the field. Someone who needs to have bedside manner and really there's a, there's a, that personal touch, you can argue that being distant or being remote is at a disadvantage. I think it, I, I, I think overall we've been really heavy on being in person more than we needed to be being on site.

I think one, one of the things that Covid did forcing people to work remote is it it highlighter reality that we were too much. To an extreme about, there was almost like the default was you work on site and there's an exception basis if you wanted to work remote. I do think as far as being engaged, and this is talking to many of my, excuse me, many of my colleagues, I think really it highlights a person's engagement when they're remote.

I don't think it changes their engagement. I think there are people that have been engaged and they're even more so, or at least attempting to be engaged when they're remote because they, they don't want. To lose what they have if they like to work remote. And then frankly, there are people that may not have been as engaged at work and now they're outta sight outta mind and maybe they're less engaged being remote.

But I don't think it's a peanut butter spread or, or one answer fits all. Well, let me give you a different one. Again, it is social. I happened to be active on social media this morning for preparing for the show and preparing a of time i'll things. And who do you think has the advantage here? And it's from Derek.

A. Derek doesn't have his last name on here. He's an information security manager at a healthcare or hospital. And he said, we've mired our defenders down with administrative nonsense. Imagine a police department that put cops on the streets for just 23 minutes per shift in a city of two 20,000 or more.

And then he has this list and he has a picture. And he said, you know what? The attackers, uh, cybersecurity again, right? So what the attackers are doing right now. Their priorities are, number one, reach the network. Number two, monetize. He goes, what the defenders will do today. In other words, what him and his department will do today, he said, number one, four hours of meetings.

Number two, status updates. Number three, add notes to tickets. Number four, time sheets. Number five, HR mandated training. Number six, close tickets for false positive. Number seven, update slide decks. Number eight, update policies. Number 9, 23 minutes in defense work. He says Who? Who win and comical, comical, have culture, have a and PowerPoint culture.

Is there, is there a way to get beyond this that we are actually spending more time making the lives of clinicians better and more time making the lives of, of patients better and more times defending? And I know that those are kind of Pollyanna kind of comments because those meetings and a lot of those meetings, we do that work.

But is there a way to get out of this meeting centric culture? Yeah. First of all, I think the biggest disservice, uh, I can't say a brand name, but let's just say it may be an an email calendaring program that almost all of us use. I think the biggest disservice they ever did was that if you notice out of the box, default meeting time is one hour.

You have to actually go in and change it to be 15 minutes or a half hour. What if default meeting time was a half hour? How many people do you think would actually go in and make that a full hour? I think we just say, okay, let's just make it an hour. And then what do we say? Oh, good news guys to give you 15 minutes free back, right in your day.

If we end it 45 minutes, we, we all get excited. We have 15 minutes left and, and that just prepares us for the next hour long meeting, or 45 minutes if we get lucky. So I think number one, to your point, bill, yeah. Where communication's important, and again, this comes back to balance. So we wanna make sure everybody knows everything.

In healthcare, we o we, we tend to over communicate because under communicating can actually, god forbid, lead to a bad outcome for a patient. So we wanna really make sure we do timeouts before surgical procedures. We, we have to over ate to make sure every single I is dotted. And so that healthcare as a whole, we have to, and we still have to remain focused on communication.

So we wanna make sure everybody's in the loop. Also, you mentioned about policies, rights. Again, you know, look at policies we're measured by if we have a policy and if we follow the policy. You know, when joint commission comes in, they don't, they less question whether your policy was correct. They do, obviously, but they more focused on does a policy exist?

Is it a a systematic failure or is it an individual failure? So right away we jumped to creating effective policies. And I think it just comes back to what I said earlier, it's about balance. We have to communicate. We don't, we shouldn't over communicate. We have to have policies. We shouldn't have policies that are losing the sight of the box.

We, you know, we're, we're thinking so far outta the box, we actually lost sight of purpose. To directly answer your question about we, how do we get out of excess meetings? I think as good leaders. We do certain things that make that leading succinct. If we come in and, and this is just, um, meeting 1 0 1, right?

If you come in and it's, there's no formal agenda, there's no follow ups, there's no accountability, and it's a discussion, it's a kumbaya, then it's a 45 minute waste. But if it's, if you're meetings are calculated as a business, then I think there's a lot of value to it. I think it'll be interesting is if people start to actually capture the cost of these meetings in projects by which many already do, you'll start to see maybe, okay, we got too far, so sorry, little, too little.

Let me get here. My, my approach to the meeting centric culture was my, we allowed our kids to drink at home, so all of our kids are older, they've all gone off to school, and at least two of them had this comment when they came back from school, went to college. And, and, and we like wine. We were part of a wine club and that kinda stuff, so we drank good wine and my kids on several occasions, said to me, said, I said, so you drink a lot at, at school?

They're like, no, the stuff's not that good. Your stuff's so much better. And, and so what they did is they learned to appreciate good stuff. So they went to that party. They were just like, I'm not gonna get drunk. Good wine and good and, and as they don't have that at college, that's not what the, the goal is.

And part of the reason I share that story is to say that's what we did with meetings. We said, all right, we're gonna show everyone what good meetings look like. So after a while they become discerning and they look at it and go, that wasn't a good meeting, or That person doesn't put on good meetings. We need to do something to make those meetings better.

Not that I was gonna dictate, hey, this is the format for all the meetings moving forward, but I wanted people to be in good meetings. Crisp. The point had the conversation that we needed to have around the discerning and.

Up developing the, the, a great framework and that it, it struck me when they came to me and said, we need to have more meetings. I was like, that's the opposite of what I want. They said, trust us, we know what we're doing. And then they laid it out for me and they said, look, we're gonna have meetings that look like this at this time and this time.

And what you're gonna see eventually happened is a whole bunch of these meetings are gonna drop off. And they were exactly right and they just went to those standup meetings that the lean standup meetings in the morning and at night. And I'm like, people aren't gonna morning in in the afternoon. And sure enough, they met less during the day because they were focused in the morning and they knew that they were gonna have a in the afternoon.

They didn't need to call another meeting. 'cause the people they. And they just created a very efficient flow of meetings and a structure for meetings. Yeah. Remind sometimes it works. Yeah, no, you remind me. One of when I would have meetings at the most recent hospital I was at and they were my meetings, I would start off by saying.

This is the goal of this meeting. The first thing I would say is this is the goal of this meeting. Sometimes it could just be a weekly update of all the projects and the goal would be right, awareness and follow ups, et cetera. And then at the end of the meeting, I always say, I would discuss like recap was the goal, met or not.

And it was interesting to see when my staff would, would wanna draw me into a meeting, and either to get me to participate, they would . Start off in the email by saying, Hey Eli, can you join this in this meeting? This is the goal of the meeting. Or if I would participate in one of their meetings, they would automatically start off by saying, this is the goal of the meeting.

And at the end they would come back and say, was the goal met? And it, it's a change of of thought around that, but it you, when they saw me doing it, they started doing it as well. Then they have accountability at the both ends of it. The craziest meeting I ever called was a cadence meeting. We called it the project cadence meeting, and we had every project present.

Within the IT department. So the project manager came in and any owner would come in and present four slides. Present four slides, you know, hard. That is for, we had at the time, something to 1520 project. And you say, Hey, use these four slides. You would think we'd ask people to solve world hunger because they're like, oh, I can't tell you about my projects in four slides.

I'm like, I, you can't tell me about it in 20 slides, so you might as well just make it succinct to four slides that the first time we did that meeting, we set aside four hours and my team was like, ah, don't do this. This is crazy. And uh, and I said down, look, the goal for this is I'm tired of being the intermediary.

I know what's going on in all hundred 10 projects. 'cause people come to the CIO but you guys dunno what's going on in each other's projects. And I can't tell you the number of times. There's so many dependencies that you guys just don't know about. And so we did that first cadence meeting. We set aside four hours, ended up taking six hours, and when we were done, I'm like, okay, was that worth it?

And they were like, oh, absolutely. I, it's amazing how many things that came up. And then that meeting got much more crisp, much shorter people understood what it meant to do a four slide presentation on a project. What we were looking for, what we were after. What are the dependencies? What does leadership need to know?

What's gonna cause this project to fail? These were the important things, but sometimes you need to have the six hour meeting in order to get everybody on the same page to eliminate some of those things. I'm sorry, I'm pontificating. Let's get to, you wanna talk about the news? Sure. I was just gonna say one last thing.

I dunno if it's a half joke or half truth, but they say. If you're about to send a colleague an email, pick up the phone. If you're about to call your colleague, meet the meet, meet the guy in person. And if you're about to meet the guy in person, let's do the work. . Yeah, . Let's get, alright, that gets us off.

Hey, all we've done is the back and forth intro for you and I. Let's get to the news. All right, so this is, let's see, where's this come from? This is Modern Healthcare. Which means it's behind a paywall. I happen to pay for that paywall because I appreciate a lot of the, the stuff they do, but since it's behind a paywall, I'll do a little more reading than usual.

And this is, they have a forecast. Care is moving out of the hospitals over the next decade. All right, so let give you some of the context. Health systems might wanna hold off on expanding inpatient services during the next decade and move more investments to ambulatory surgical centers. Outpatient settings setting, and as you and I both know, there's I I, I'm talking to hospitals.

You're talking to hospitals, they're still building towers. So, uh, that work is still underway. That's according to a new natural report out that predicts that where care will be delivered over the next decade. Inpatient discharge volumes overall will decline by 1% by 2029, while outpatient volumes will increase by 19%.

And ambulatory surgical.

Data will be delivered and be delivered outside the hospital. Couple more things. So that's the context that's study's going on from inpatient care is being driven by a few factors. There are more innovations in medical technology that allows for less invasive procedures and therefore less of a need for all the bells and whistles of hospital that a health hospital provides.

There's also been considerable growth in ambulatory surgery centers, partly due to financial backing from private equity firms. The shift will accelerate as CMS eventually allows all previously inpatient only procedures to be done in other settings. Upon the things ASCs can do by the end of 2023. And then it goes on to talk about the growth in physician offices and what's gonna go on there.

And, and they talk about the, the gaps in the continuum of care. And the other findings include that emergency department volume will increase by 5%, urgent visits will decline by 15% in the ed. Behavioral health visits will increase. And in addition, skilled nursing facility volumes will decrease by 5% by 2029, and home care will increase by 15%.

So I, I'm trying to figure out if I wanna give you an open-ended question or a more specific question. The, the specific question would be. What does this mean for our building project? The general question would mean, would probably be that, do you agree with this? Are we seeing this? Are we gonna see this move to the home?

Let's start with the general question. Absolutely. Number one is, the answer is absolutely yes. My, my most recent CO job at Brookdale Hospital, we actually were merged with two other hospitals as public knowledge with Kingsbrook and interfaith. And the idea was, this was actually announced a few weeks ago, formally, was to actually

Move all inpatient services out of one of those hospitals. So I, I was there, I lived through the whole strategy component of that. Before that I was with the hospital system, 11 hospitals that came together. Hospitals are either merging and inpatient and they're collecting or combining inpatient services, and many hospitals are actually closing down or filing for bankruptcy because they can't, they, their whole model was based on things that are no longer necessary.

And don't call, don't call me the exact numbers, but . I believe in just 2021 to date, being that it's in June, seven. Hospitals already closed this year, 21 last year. I think it was almost 50 the year before. And, you know, going back to 2018 was. 20 plus or something like that. So we're seeing hospital closures happening across the board.

It's not because people are getting healthier necessarily. I would love to believe that, and maybe that's a big part of it, but it's because they're, they were previously designed for in inpatient services, and as you mentioned, there's a steadily steady decrease inpatient services, which means excess inpatient capacity.

If you staff a hospital, you don't change your staffing models, you don't change, you know the services you provide. You're running hospitals at a deficit. It's no different than Air Airlines. You know, if, if people were starting to whatever reason, travel in business class, first class, and most of your plane remains coach class, you're gonna be flying with empty seats and it's just cost prohibitive.

So the number one is absolutely, there's a decline in, I wouldn't say the need necessarily for inpatient services. But there's a de definitely a decline in inpatient services, in a hospital setting, in a, in a acute care setting. That's my larger answer. Yeah. And, and we've seen this, I, I played golf with a guy this week who had his hip replaced three weeks ago.

I scratch my head. I'm like, I remember my mom going through this. And it took a long time. First of all, the, the, he had a little incision, barely even noticeable. And they went in there and did all the work and that kind of stuff. And he showed me the, the X-ray, and he did his bionic man, whichever one likes to talk about.

And then he, he talked about, he was on a, for a week, he was walking after the first week, he was with a seven. Now he's out playing 18 holes of golf at, you know, at the three week mark. I'm like, yeah, that's the kind of stuff that's happening. And that's, that's just one procedure. We know that's happening across the board.

We're getting better, we're getting better at getting people out of the hospital and in healthier state than we used to after long, uh, periods of stays and those kind of things. So the, the acuity level in the hospital is going to go up and we need those things. But there's gonna be less stays in the hospital and less need for, for those services.

So what does this mean for, uh, building projects? How should we be thinking about building projects? We still need towers, right? We just had covid, if any case could be made for, we need beds and, and for certain periods of time in, in our history, the case has just been made that beds are important in communities we.

It's, it's still in the hospital setting. That was a very, it's a high acuity situation. Clearly with the hundreds of millions of deaths that we've seen, or hundreds of thousands of deaths in the US that we saw. You have the need for high acuity care and the need for those beds. But what does this mean? Uh, how do we approach this?

Let's, first of all, from a healthcare standpoint, and then I wanna take you in the technology route around this. Yeah. I wanna come at it from two angles. Number one is. Hospital will continue to exist. So what should that look like? If, if we're gonna build new towers and we're gonna build hospitals, what, how do we prepare for that?

What are, you know, what are we building for five years? And then the second thing is why and what is now happening outside of the hospital and to your, well, first of all, why would someone not wanna go to hospital for many reasons. Number one is you can get sicker in a hospital, right? You can go in for hip replacement, catch something in a hospital.

Someone has a different type of a health issue that's, it's a airborne pathogen or whatever that might look like. You went in for a procedure. Why would you ex go into a place where you're exposed to greater risk than you need to? So we always wanna have the lowest, you know, risk where we're, we're being cared for.

The argument wouldn't be like, why not be cared for in a hospital? The argument should be, why do you need to be cared for a hospital? And one of the things we saw with Covid was we turned those hospital rooms into things that they weren't. People were, it was we. We were challenged. We didn't have enough.

Rooms. We had rooms designed for other things, and we quickly flipped them around and made them as best as we could to treat COVID patients. So what we, you know, one of the big lessons from Covid is we have to be a little bit more flexible in our design around what the future hospital room looks. We can't have a hospital room that's only for airborne dis diseases.

We have to have them a little bit more modular or flexible, whatever that right word is. Obviously there's a higher cost for care in a hospital, right? So we try to look for lower costs. Payers are, are very well aware of that, right? They're not gonna pay for a procedure at a, at an emergency department rate or an acute care rate if they know that other hospitals are doing that at lower cost setting.

Everybody's woken up to this. This is not really today's news. There's no the, it's almost by exception as opposed to by the rule that you're being cared for in the hospital. So there will still be a need, there's still an investment of. Talent and technology that only makes sense in a hospital. They can't be that unique specialist in every ambulatory care, even if it's possible to provide the service.

And so I believe that for a very forever, there'll still be some kind of a hospital existing, but they're being complimented by so many other. Care settings that are more appropriate. I'm thinking about, I, I want to go down the technology route, but I'm also thinking of all the service line work that we did.

We probably will see more hospitals close and more, uh, systems acquire other hospitals. But because one of the things we did in the, the, in our largest market. Which was a, you know, $3 million or 3 million person market. It was a pretty large market in, uh, Southern California. It's, we did a lot of service line work and we stopped doing certain procedures in certain hospitals, and yes, people had to drive a little further, but the level of care we were able to provide at the remaining hospital, we typ typically looked at it and said, Hey, we need to have a certain level of oncology in every market.

But we had specialty oncology. For the entire market, the entire region at one hospital or we had orthopedics at one hospital or we had those kind of things. And, and, and that gave us the benefits of scale, which don't exist in a lot of things. And so that's the res, it don't exist in a lot of markets because you have.

Orthopedics across the street from another orthopedics across the street from another orthopedics, as is is the case in New York City. So people have a lot of choices and so if you're not at scale, you continue to to struggle financially because those are very capital intensive types of operations.

Let's talk technology. They talk about ambulatory surgery centers, they talk about outpatient services. They talk about growth in in office visits. I assume I didn't see it here, but I assume a growth in telehealth visits and whatnot. If I make you the CIO for a health system today, what are we looking at in terms of a strategy to ensure that we're ready for this dispersion of patients from a central campus model to really being seen all over, including in their home?

first of all, the CIO, um, responsibility. Five, 10 years ago, even, maybe even more recent, was really just focusing on care in the brick and mortar building. If a clinic, a clinic was, it was a pretty simple setup. They needed access to our EHR or they needed access to our technology systems, but we really didn't think about what is the technology footprint look like in the clinic?

What does technology footprint look like in a patient's home? What does technology look footprint look like in a post-acute care as much, we always needed that to an extent, but not as much as we do recently. It was always focused on our ORs, our ed, our patient inpatient rooms, and our waiting rooms, our administrative offices, all about that.

Today's CIO can't think anymore. Only about. The technology in the hospital and they have to really quickly learn about technology in those other settings. What's the appropriate mix for today? This will continuously change. I know, bill, about our patient room. Next concept, and I do wanna talk about that for a moment.

We don't call it patient room of the future 'cause that'll continuously change. It's more about just being able to see around the corner and being a little bit ahead. So CIOs today have to take into consideration number one is. Like, like we talked about, what is the technology investment in the hospital that doesn't change?

And it's a little bit different because A, it's not what it was, but B is also, it's not what it is. It's what it will be. So you have to think about those new towers. What am I building for? That'll still be, still make sense financially in five years from now, but they also have to include in their strategy.

All the other technology components and whether or not we're talking about technology and on a patient's wrist, at a minimum, they have to create the backbone and the, the, uh, infrastructure for that. Right? When they're planning for their core EHR, their core systems, they still have to, they have to plan for, we, you know, we're gonna be taking in data from patient's wrists that's presented by them, not by ca not captured by us.

So the, the responsibility of technology and what that includes in the whole portfolio. Has just blown up. It's not anymore what's in the physical building. It's intering. When I think of moving to the home, ambulatory surgery centers and those kind of things, one of the first thing that strikes me is we used to have an old adage, it was long time ago around security, which was physical access is access.

You've given me access to any server physical access to any server. I can hack it and I'm not even that good. But physical access is access. There's enough tools out there that you get there. So now I'm thinking, okay, great. We moved everything to the data center. That physical access to the servers is, is done.

Physical access to the devices in the hospital, we secured that. So we have a security department. They make sure that the equipment is not tampered with and people aren't coming in and out and doing things like that. Now we're starting to move into these remote locations and we don't have the same level of physical security.

We might have cameras and those kind of things. And that's good and that's helpful. And then we move into the home and I think, how do I ensure that I have a secure connection between. Home and my location and I worry, I used to worry about people sitting in our lobby on our free wifi, getting on our network and trying to hack our, our routers and hubs and switches, and maybe that was just a CIO's paranoia, but now they could just sit in their home or somebody, some, somebody could sit outside their house, hack their router.

They know that there's devices in there that are communicating straight back to our hospital and our devices. How are we gonna ensure that stuff? That's the kinda stuff that I get. I hope smarter people than I are really working on to identify the traffic. That's an anomaly. Shutting down that traffic, identifying it quicker, identify it within seconds, closing it down within minutes so that we can keep hackers out.

That's, that continues to be as we continue to make this progress. I think we need to make this progress in terms of delivering care in a lot of different settings. I, I worry, I, I continue to worry about the cybersecurity threat. So the first thing we do is we have one hour meetings, one hour status reports, one hour of time sheets,

And at the end of the day, we figured this out. Um, all serious. All kidding aside though, I think we need to learn from other industries. I. That have a leap on this. We trusted our banking, we've trusted our money to, to open access, not just money in the bank. We went to ATMs. We do bank from homes on our phones and on our laptops and what are all that, right?

Nobody's figured out. I. I don't, and I think the challenge will forever exist is, forget the saying, but it's security and comp, uh, security and convenience. You'll never meet. We get frustrated with a triple factor authentication and sliding puzzle pieces to make it match and all that kind of stuff to get in.

So I think number one is we've forever trusted things that were important to us and we need to, and in, in healthcare, we need to really . Align ourselves with that. It maybe even be better than that. The, those ways of securing what's important to us at a distance exists in other industries and we, we need to really learn from that.

Number one, and there was a number two, but I think that's, oh, the number two was as artificial intelligence continues to mature, that's something that's, that we're, that we're gonna continue to take to our advantage. And you talked about. Behavioral trends and I get a phone call from my bank if they know I've never, ever shopped on a Saturday morning 'cause I sleep in late and all of a sudden there's a charge of my credit card.

I get identified. These are things that we need to, to start to do in healthcare and use, use behavior, use all the things that other industries are doing. Have you, have you ever done that? Like you applied for a loan or something or whatever, and you get that text like within seconds now it's unbelievable.

Yep. Emails, texts. You, you, you log into your bank for the first time in three months and automatically they suspect it's not you or a different IP address, or they match up the fact that you're logging in from Detroit, but your last credit card swipe was in Ohio. Like these are things that will help us with healthcare as well.

They already are, but they'll just continue to get better. I think that's how we extend the security wall or the security D mark. To patient's homes. It's no different. Alright, let's hit on a couple topics real quick. Apple Worldwide Developer Conference, as he has stated, a long time ago, Tim Cook said If you zoom out into the future and look back and you ask the question, what was Apple's greatest contribution to mankind, he said, it will be about health.

And they continue to make investments in this area. It's really interesting to, uh, to watch. So they now have this. They have a couple things it, the iPhone captures the way users walk. Now users can access their risk of falling with walking steadiness, and so the metric uses the built-in motion sensor to measure how fast and evenly you walk and those kind of things.

So another way to use your phone as a device to help you live a healthier life. They're also. Adding to the context of their lab results, which is important. So now it will tell you that LDL cholesterol is bad, or Yeah, is bad cholesterol, and whether your cholesterol is within the expected range. So they give you also some historical charting in there as well.

But I think that the biggest announcement that came out of here is Apple is now partnering with electronic health record companies. Including Cerner and Meditech to give users the ability to share their Apple Health data directly with healthcare providers. Apple stress that the data is shared privately and that not even Apple will have access to the information shared.

Apple is also letting users share their health data with other individuals. A user may choose, for instance, to share their health data with their adult child. In this scenario, a user could see their parents' health data and receive notifications such as high heart rate alerts and change in mobility.

The data is encrypted. At in transit and at rest, and users have granular control over which types of data to share and with whom. So data sharing, they have a updated way to look at labs and results, and they have the walking features. The data sharing one is interesting to me as Apple Health Records.

Has a huge list of organizations that have signed up for it, that are sharing a portion of the health record through the, through the iPhone. And this is the next move. So now not only do I get access to it, but I can share it with, I can share it with another doctor, I can share it with another health system, I can share it with, uh, my family and create a care circle.

What are, what are your thoughts on the progress that they're making around Apple Health records? So, first of all, I, I, we don't leave home without this, right? It's nearby, essentially, when I, by the way, 40, 49% market share. Apple. Yep. Apple. Apple. iPhone has 49% market share right now. Yeah. Number one is essentially what this did for us is two things.

It allowed us to walk around with an entire computer where we are. So all the things we're doing with this, we theoretically could do on a computer. And it also added IoT, right? Sensors and cameras, all that kind of stuff. Years ago when people talking about Walla and computers on wheels. I said, if you can't fit it into a doctor's pocket, it's, there's a, there's a time, it's just not gonna be relevant at some point.

Nobody wants to be tethered. So there's a lot of advantages. It brought, it brought, like you said, the ability to do things from a medical perspective for patients and contribute proxy, right. So that now you can do things in flight. A doctor, you can be, family members can have access to information specifically to, to data sharing.

To Apple or any others? Androids having, I'm a big fan of data being available for the betterment of my health. I love you. Had another podcast talking about who owns the medical record. The hospital does. I want it, I wanna have a access to it because I wanna, I wanna be in control or be part of the decision making around my own health.

There are certain things, obviously you don't, there's certain bad I shouldn't, there's certain information that you don't wanna get into other people's hands, and we have to be able to control that. But to the extent that I as a consumer of or, or someone who cares most about my own health, I need to have data available to me.

And if this is my way of getting data the quickest and and the most easiest way to get my data, then it has to be available to me. So I'm a big proponent of. Whoever can be the fastest in this race, whether it's Apple or somebody else, of making it so that it's across multiple EHRs, across multiple care settings.

One record that follows me and. Just like we have, it was an NYSE, right? I have one bank, but I can travel the world and get my money. I wanna have one way of getting access to my entire health, uh, record. Yeah. So in that podcast, I, this is one of my hot topics. I believe. This is, I. One of the most important topics in healthcare.

Patient directed interoperability, I think will change healthcare over the next 10 years more than anything else that we're even talking about or, or thinking about. I think data has the opportunity to, to change so many things, uh, in terms of transparency, in terms of equality, in terms of engagement. So those are the things I'm looking at.

And I'm a proponent of joint custody of the medical record. Okay. I, I acknowledge that the health system owns it. They created it, they own it, and that's a common misconception, but they do own it, and that's fine. I just want to have access to it because it has so much value to me as a, as an individual.

And I, I love this. I think this, I. Takes us in in the right direction. I am a little disappointed and I preserve the right. Hopefully Epic comes out next week and says, no, we support this. We're behind it a hundred percent. But they were not mentioned from the stage, and they're not included in the press release.

It talks about Cerner and Meditech. I would love to see Epic be a leader here, and I was a little harsh on them in my podcast because, uh, I, I, I treat leaders differently. Epic is the leader. Epic is the leader over Cerner and Meditech. They've done so many great things for healthcare. They've taken our our failed EHR implementations and really addressed that significantly.

They are an organization that listens very well to their user community. They do so many good things. Quite frankly, Judy is so connected to more so than any CEO in the industry to their clients. And, uh, they're advocates, uh, for her and they should be because she has done it is a, a, a joint relationship.

But that's why I'm so disappointed because they are a leader. They have an outside, outside outside's voice on this topic and they've chosen to really drag their heels on this. And I really wish they'd get out in front and say, we are open to this. We're not going to believe that we're the only ones that can build this walled garden.

We're gonna go ahead and partner with Apple and get this out there. And I, I recognize that a huge number of people on that list are, uh, on the list of providers that are working with it are Epic clients today. But to be able to start to share that information and whatnot, they're, they're just not on this list and I'm, I'm curious why they're not there.

I'm just a little disappointed on that. I'm not looking for a comment from you. 'cause I don't wanna get anybody in trouble on this show. I just wanna keep myself in trouble, not get anyone else in trouble. Let's talk about one last thing. Let's talk about employees, and we've been touching on this a fair amount, so I don't wanna spend too much time on it.

A couple of stories. Texas Children's Hospital is giving a 2% raise and, uh, an extra week's vacation to all their frontline workers. And it's so important to take care of our staff. And that goes along with another story that I, I had pulled up and we're not gonna get a chance to cover, but it's hybrid work, how to prepare for a turnover tsunami.

And in that story, oddly enough, it says that 54% I. What's the numbers? 52% of North American workers plan to look for a new position in 2021 and 26% of workers plan to leave their employers after the pandemic. And I'm not sure that healthcare is, uh, protected from that. I think that those numbers and those surveys that were done probably are indicative of healthcare is.

Clearly what Texas Children's is, is, is doing is acknowledging a couple things. One is that exists, but also acknowledging the great work that people did during the pandemic. What are some other things that you've heard or that, uh, we can do to make sure that we retain, uh, our, our staff coming out of the pandemic?

Yeah, thanks Bill. And I had a, a boss who one time used to tell us when a recruiter calls one of your employees, if your employee picks up the phone and says, what are you, let me hear, you've already lost that employee. You wanna have your, you want your staff. If a recruiter calls your staff, you want them to send that call to voicemail.

There's always, there's always gonna be a better job for everybody, but . An employee who's appreciated and an employee's, I should say, rather celebrated, is an employee who's gonna really think 25 times before they change to work at another organization. And, and as leaders, sadly, many times, um, leaders will, will try to motivate employees based on what motivates them.

If an employee, if a leader is motivated by financially, they'll just talk about raises that are coming. If a leader is motivated by work life balance, . They'll talk to their staff about how great work life balance is. I think as a leader, the first thing you have to know as ACIO or any other kind of leader is what motivates each individual employee.

Some employees might love the fact that they can punch the clock at five o'clock and be home for dinner with their kids, or maybe they have care issues for parent or for a child and they need to work that into their commute, or maybe they're growth oriented. So I think the first thing is really take a step back and say, if employees are leaving, have I done a good enough job

Historically as a leader to know what, why my mo, why my employees have been here. If my, if, if employees leaving post pandemic, they probably wanted to leave a year ago, they just now have a new opportunity that didn't exist a year ago. And in it, we're seeing that you needed, historically you needed to be, if you wanted to work at a hospital, you need to be in that city.

You, you need to be in that state, whether it was for tax reasons, for liability issues. With covid, it all changed, right? People are, we were desperate. We said, okay, you work across the country, I need two more people. Boom, you're in. And that's just not just for it, but that's for everybody else. So now all of a sudden it's like the world's become a little flatter.

Even in our little industry here, I know personally many employees that many IT health IT people that are now taking jobs that are across state lines, working out of their own home. You know, if I could work from home in my house, from my own hospital, three blocks away. I can work in my at home, in my own house for a hospital that's three cities over that's given me a 10% pay increase, or that's allowing me work from home where my own hospital says, no, you have to come back to work.

Now the pandemic is over. So I think it's really important to know all the time pandemic, not pandemic. As technology gets smarter, what are the motivators for your employees so they don't pick up the phone or recruiter calls? That's number one. I think number two. Is that we have the ability, though, to do more for our staff than we didn't have in the past.

It comes back to what you're saying bef way back in the beginning about the day. I love how the events you outlined from one of the comments commenters about let's think about how we're modeling our day, how we're taking accountability for our own, for a team, and for our performance, and let's use the tools that have all of a sudden become available to us to help our teams become more motivated and, and more, more loyal, I should say.

Wow, Eli. I love the love the advice. When we look at employees, it has to be an N of one. Everybody's an individual. Everybody has different drivers, and we have to take the time to get to know them. I've kept you up to the maximum amount of time that I have been allowed based on the unnamed calendaring program that we all use

So, hey Eli, it's always great. It's great to catch up with you. Thanks. Thanks for coming on the show. My pleasure as always, bill. Uh, if you know of someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week,, or wherever you listen to podcasts, apple, Google Overcast, Spotify, Stitcher, and whatever else comes out next week, you get the picture.

We wanna thank our channel sponsors who are investing in our mission to develop the next generation of health leaders, VMware Hillrom, Starbridge Advisors, McAfee and Aruba Networks. Thanks for listening. That's all for now.


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