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Newsday: Business Continuity, Upcoming PAC Systems, and All Things UGM with Lindsey Jarrell

This episode is brought to you by HealthLink Advisors. Value. Insights and Solutions. Expert consultants serving the healthcare industry. Check them out at thisweekhealth. com slash healthlinkadvisors.

Bill Russell: Today on Newsday.

Lindsey Jarrell: Those kinds of things cause light bulbs to go on. That kind of conversation fires up the business and clinical side to say, I want to own business continuity.

How do I get more involved And so then the momentum starts. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health. where we are dedicated to transforming healthcare, one connection at a time. Newstay discusses the breaking news in healthcare with industry experts

Bill Russell: Now, let's jump right in.

(Main) All right. It's Newsday and today we're joined by Lindsey Jarrell. You are back on the show. Lindsey, welcome back.

Look forward to this conversation. We're going to talk a little UGM. We're going to talk a little bit of business continuity and a little enterprise imaging based on what's going on this week. are things going? hearing in the industry as you're moving around these days?

Lindsey Jarrell: Yeah it's

great to

be back.

Thanks for having me back. We are at HealthLink Advisors, we are really busy, and it's been a little bit surprising for us this year. But that's a good thing, right? I think that's what we all want to hear. A lot of focus on how do we spend money wisely from the seat of the CIO.

We're spending more time with other operating executives than we other have before, as people get more keenly interested in it, like COOs and CAOs, and CFOs. It is just a really busy time for us and the, I know we'll talk about EPIC and UGM here in a minute, but that train does not seem to be slowing down.

Bill Russell: It's

Lindsey Jarrell: always driving a

Bill Russell: lot of business as well. It does not. Let's see, 44, 000 people attended UGM. 11, 400. We're actually in the Deep Space Auditorium. I was in that auditorium. It's impressive. I don't know why. It's just it's impressive to look around and then to realize, I'm looking around and I'm looking at the people that are in that room and I'm like, this is a really great group of people who are in this room.

I ran into BJ Moore, ran into oh my gosh, Brent Lamb. I ran into just a ton of CIOs. Jason Joseph and others. Just great CIOs. Talked to some of their staff. I talked to the UPMC team, which is in the throes of their build process. I talked to oh gosh Intermountain is there as well.

They're coming down the pike.

Lindsey Jarrell: Could you imagine if we could harness all the smarts in that room and put them on the problem of healthcare delivery, we wouldn't need generative AI then, we'd have it all answered.

Bill Russell: that is one of, Judy's points that she likes to really preach on, which is essentially, you've solved a lot of problems in this room, you just all haven't solved the same problems yet.

And so she tries to create that environment where it's, People helping people. That was one of the things I think that was interesting in the announcements. One is, there's an international flavor to it now. They're talking a lot about the work that's going on overseas. And they really highlighted the organizations that have stepped up to help other organizations go live.

Advocate helped the gosh, it wasn't NHS itself, but they helped essentially large entity in Europe go live. And it was the largest big bang go live in the history of Epic. But the advocate team went over and said, Hey, this is what we've done. And they came alongside of them. In that process.

And yeah, it's definitely a culture of sharing

Lindsey Jarrell: Helping each other with stuff above the competitive level, right? It's all about the care delivery for our patients, and we need to be doing more of that to help each other out.

Bill Russell: Epic showcased a lot of AI.

There's just a lot of AI coming down the road. Now, some of it, It looked like it was all Epic and it's not all Epic. Some of it's a bridge and some of it's Nuance and Nuance doesn't exist anymore. Microsoft. So they've now officially branded Microsoft. So some of it was that. Some of it I was looking at and I'm going, boy, that looks an awful lot like Lean TOS.

But I talked to somebody later and they said no, that's Epic building out those capabilities. So you have, some of the partners are in that weird space of wait a minute, we're partnering very closely with them, but they're also developing out those capabilities. So a lot of AI, we saw that a lot of emphasis on scheduling efficiency of scheduling, nurse scheduling OR scheduling, and those kinds of things.

A lot of talk about the payer platform. A lot of health systems have implemented the payer platform a lot of work on obviously prior authorizations and all those kinds of things. And then I think the last thing hit on, and then I'd love to go back and forth with you, was Cosmos. So Cosmos is being used for lookalikes, where essentially you can identify that needle in a haystack around the country of, hey, that patient's just like mine.

That's the term lookalikes and then best care choices is pretty interesting as well because it's, again, one of those things that we believe AI is going to be used in that massive data sets going to be used to really give us care guidelines and care pathways that are tested and proven.

Essentially, hesitate to go as far as to say because it's not peer reviewed and not sure if it is peer reviewed and whatnot, but that's the thought process. Maybe a little different way to get to there. What did you hear from Epic and what are those things, really jumps out at you?

Lindsey Jarrell: Our team and we might talk a little bit about this later too the team I had there spent a lot of time talking and learning about security and what EPIC's doing about that and what, more importantly, what other organizations are doing from a security standpoint. So I heard a lot from my team about that.

And also to your point on the scheduling side and the access side, right? I think that's a real game changer. Back to that point of what Judy made, we've solved a lot of problems individually, but now it's time to come together. And I think access and scheduling and allowing patients to move through a community and a network is going to really improve care delivery especially in some of our bigger MSAs.

And, EPIC just continues to expand in these markets and capture these other hospitals that don't have EPIC yet. So I think that's a good thing for care delivery. then the other thing we talked about and debriefed as a team and what I heard about was just more on some of the areas they're expanding.

Clearinghouse activity and integration with materials management and things like that the other systems. These are Game changers we've been chasing for 20 years, like effective integration on the materials management side. Some of that's really exciting to see. I love this is the first year I haven't attended UGM in five years and but I love the interaction and the inspiration that comes from going there.

To me, when I think about running a company and what they've been able to accomplish what I see, Is really good execution over a long period of time without a concern about a quarter. or a year end or a investor's conference, right? It's just steady execution over time with a lot of quality and thought put into it.

And I think that's a secret sauce for running a great company. So I'm always paying attention to the broader themes there as well.

Bill Russell: Yeah. I, one of the things Judy actually in her session talked about business continuity, and I thought that was interesting. And I know HealthLink Advisors does a lot of work in business continuity.

think that just has escalated. We had the, the CrowdStrike incident, we had changed healthcare this year and a couple other things, and she talked about a three tier model for business continuity. And I was like, Oh my gosh, a lot of organizations don't even have a two tier for, this is just from an architecture standpoint, don't even have two tier, let alone three tier.

It's interesting when we talk about business continuity, especially on the clinical side. I guess my question to you is who owns it? Yeah who literally, because some people look at this continuity, I think that's, that is an IT thing, and I think the architecture for it is, falls in IT a fair amount, but man, we just weren't ready for some of these outages and how they came down.

Yeah,

Lindsey Jarrell: that's exactly right. And these ransomwares and these outages that have come down I hope are causing us to reconsider the answer to that question. What you just said, because I think for a lot of years we've been saying business owns business continuity, hence the name, but in my experience sitting in the seat, and I wonder about your experience and others, it's nearly impossible to get a business and clinical leadership to own business continuity.

That's really not their fault. They're so busy doing what they're doing, then it fits in the seat of it. It becomes a line item on a plan, and we have to talk about business continuity. So some orgs that have the resources do it well. Many orgs who don't have the resources, don't do it well, and it becomes the defacto owner.

We think business and clinical leadership, own business continuity. And when we sit down and really talk with. The directors of nursing, or the chief nursing officer, or the pharmacy leader, or lab leader, or materials management director, and I could go on. And we walk them through a scenario of what ransomware looks like, and what's actually available, and then you're three days into it.

and you're five days into IT is working horrendous hours, working with a lot of colleagues and vendors, an emergency response to get systems restored. But from a business perspective, what are you doing? What do you need? How do you approach medication delivery? How do you approach payroll?

All of these things. And so those are eye opening particularly when you talk to the CFO and say you might have to cancel elective procedures for four or five days once you get hit by ransomware. Those kinds of things cause light bulbs to go on. That kind of conversation fires up the business and clinical side to say, I want to own business continuity.

How do I get more involved and own this? And so then the momentum starts. And it's a beautiful thing when you see the business leaders engaging in that at a detailed level in partnership with IT, of course, but We're doing some exciting work there, and it's exciting to me. I started out in health administration and found my way into IT, and so I see a lot of light bulbs going on when people really start to understand the intricacies of these systems and interfaces what they're dependent on for care delivery.

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Bill Russell: Some people might be wondering, three tiers. What was Judy talking about? The second tier was just a full blown like, Hey, first year is down. Second tier kicks in at scale and and she was talking about this tier. That's like emergency only, like you're not going to scale it up and everybody's going to log into it.

You're going to give access to one person in the department here. It's almost like a minimal viable product kind of thing. It's the minimal. EHR system that is segmented off, like the data comes to it every maybe batched over, but if the thing's going to be down for a long period of time, they're still able to get to the data at least in some fashion.

So that's what she was describing. It was critical

Lindsey Jarrell: that then that kind of thinking will help a lot because we're outside of the Epic universe, we're having that kind of conversation across all the departments, I love that you said MVP. Because that's exactly the approach. It's what do I need right now to keep working for the next 25 days until this bigger issue gets resolved, because I have to schedule surgeries, deliver care and get revenue so this place can stay open.

Bill Russell: I don't have a story, so I'm going to cheat here a little bit. I want to talk enterprise imaging with you because it's a conversation that keeps coming up in our 229 project meetings imaging environments over the years, I've never seen anything like it. Somebody put up a diagram and it was an academic medical center and it had, I think no less than 30 different imaging systems, not all of them were repositories and PAC systems, but it was mind blowing when I thought, man , and it wasn't a large academic medical I'd like.

I had 16 hospitals. If I had allowed what happened at that AMC to happen at my system, we would have had a hundred. But, individual decisions were made and, oh, this specialty and, this thing. curious, how are we solving this problem? Because you guys do work in this area as well.

How are we solving this problem of just the proliferation of stuff and now the need to say, you know what there's a lot of commonalities in these systems and we also need access to these higher level tools obviously AI on top of an X ray has very high success rates right now and can be very effective.

Lindsey Jarrell: Yeah. I have this vision. Maybe this image in my head, Bill of, an adult making this beautiful five layer cake with the layers all perfectly done and the icing done beautifully, and it's just a masterpiece, right? And then if you ask a four year old to do the exact same thing, what that may look like.

When we arrive at these big organizations, sometimes it looks like the four year old's layered cake. It's just layers of imaging systems, right? It's not put together very well. But again, it's to your point, it's because we really wanted to recruit this specialist and they needed this certain equipment and we built a new outpatient center and we decided to try the imaging system here.

And so there's a lot of good reasons, but now it's resulted in occasionally bad performance at the reading station. Lack of access for patients to get images and to be able to move images around. Bloated costs from too many applications and maintenance agreements. And so when we are working in this space, one of the very first things we're doing, as you would suspect, is inventoring what do you have from an imaging standpoint and how do you define an imaging system.

That alone is an eye opener for a lot of these organizations. Sometimes we're in there because of performance. Many times we're in there just to help from a roadmap and strategy standpoint. But it's about inventorying. It's about putting the right governance around rationalizing it. Many times it's about building that governance.

When we think about what clinical leadership do you have in the imaging space to govern decisions a lot of times that needs to be built. And so we stand that up and help them understand how to build and communicate with those folks. And once they realize they have the power, the governance group, they're ready to make decisions.

And then, building the roadmap and going forward. On occasion, it's about a new PACS system, but that can be very expensive, although there are some very attractive new PACS vendors out there. It doesn't have to be about a new PACS system. It just needs to be about how do we rationalize our imaging technology going forward.

And so there's a lot of dollars to be saved there, particularly if you don't have to go down the new PACS realm.

Bill Russell: There's Two things that I'm hearing in our meetings that are interesting. One is, couple have actually started to outsource this stuff. And I'm like, this is a major revenue stream for the health systems.

I was really surprised to hear this, but they were saying, look cost of capital on the big MRI systems and whatnot, and some other things they're saying it's like guaranteed revenue. Like somebody else who really knows how to manage that. That's a lot of times it's PE backed companies that are coming to the space and partnering, but they're like, it's guaranteed revenue.

I don't have to worry about these big expenditures and that kind of stuff. That was interesting to me. And then the other was the advent of the term I'm hearing more and more in healthcare, which is enterprise architecture. I'm like, wow. And one major health system said we. We actually have an enterprise architect and they oversee a group that oversees the architecture.

It's an architecture committee for the entire system and they have wide ranging control over new systems coming in. So even if it bubbles up from a department, hey, we want this, they look at it from an architecture standpoint and say, You know what, that leads to blind alley in five years and here's why.

Here's your alternatives. And they're trying to solve this problem of we get into These, I keep saying alleys, but these dark alleys, and we have to call you and say, Yeah, man, reads are slow. We can't integrate anything. I don't

Lindsey Jarrell: know. Good for them. I think that the role of enterprise architecture is becoming more and more critical with these new systems just coming over the walls every week.

That's a beautiful thing. Good for them for standing that up and establishing those standards to practice against, because that'll create a more secure environment. But also an environment that performs better for the end users, and I think we probably need more of that in healthcare.

Bill Russell: Can we get to a single PAC system for, think of all the different ologies that we're reading into these things. Are we to that point where we can have a single PAC system and a single VNA for all of these? We're very

Lindsey Jarrell: close. And in the last few selections we've run though one of the things that's come back up, I can't help but smile a little bit, where it's clear the system can do the job, but the subspecialists still say, It doesn't do it as good as I want it to.

I want this other system. So there's people change, I think is the biggest issue. It's not, we're going to be really the technology here shortly. It's but there are some very impressive vendors out there in the PAC space right now.

Bill Russell: What's the benefit of getting to us? Obviously, sharing of images, sharing images with the patients, moving those images to remote reads.

There's a lot of benefits to getting to a single system. Yeah,

Lindsey Jarrell: expense management, security, performance and flexibility, I think, too. Another challenge we hear about all the time in our work here. is the shortage of and I'll use the term radiologist. There's a lot of specialties in that.

So I don't want to take anything away from those folks, but when we think about radiology, there is a big shortage of radiology doctors and clinicians. And that is really affecting how these organizations are having to contract to get their services covered. And so if you have well architected system.

that's more or less all centralized on one system. That allows you to have good flexibility around temporary labor reading offshore if that's applicable to you, night reads, just different ways to cover the labor shortage you may be experiencing. So we hear a lot about that too and it's very cumbersome in order to get access for some of these reads.

Bill Russell: Last segment here, but the CIO for PE backed radiology imaging company, and they're outsourcing these health system. I asked the person, what's the hardest thing? And the response was. Every health system we go into is a major project of integration, training we have to integrate into their EHR.

We have to integrate into their workflows and all this other stuff. I'm like, what's the biggest challenge there. And the response was just getting answers. It was just interesting. It's like they're outsourcing it, but they still can't get IT to move fast enough to do all those integrations and all that stuff.

And this was somebody who used to be a CIO at a health system. And I just just made me chuckle. And I'm like, So you understand how that, and they're like, yeah, I understand completely how it happens. It's just really frustrating.

Lindsey Jarrell: Yeah. Yeah. Back architecture standards, having too many projects to work on, not having the governance to do demand management appropriately. Gosh, it's a tough place to be right now. Healthcare IT and a lot of awards. Yeah,

Bill Russell: absolutely. Lindsey, always great to catch up and look forward to our next conversation. Thank you very much. See you soon.

Bye.

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