This Week Health

Newsday: Controlling Data & Navigating Vendor Contracts in an Era of Cloud Migration with Mark Dobbs

July 3, 2023: Mark Dobbs, Global Healthcare Alliances at Pure Storage joins Bill for the news.How has the adoption of cloud technology affected the healthcare industry? What are the potential risks and vulnerabilities associated with cloud-based healthcare systems? How can healthcare organizations balance the need for data access and security in a cloud environment? How can healthcare organizations ensure effective disaster recovery and business continuity in a cloud-based infrastructure? What are the cost implications of moving healthcare data to the cloud, and how can organizations manage these costs? How can healthcare organizations maintain control over their data when relying on a single cloud vendor? What challenges do healthcare organizations face when renegotiating or renewing digital health contracts?

Key Points:

  • Cloud adoption in healthcare
  • Balancing data access and security
  • Disaster recovery and business continuity
  • Cost implications of cloud adoption
  • Challenges of renegotiating digital health contracts

News articles:

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Transcript

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

Today on This Week Health.

what happens when your data's. Locked into your digitization method was part of that as going into the cloud. Again, talking about the pendulum swing of where information may come back.

How do you control your data if all your data rests within one vendor's hands?

Welcome to Newsday A this week Health Newsroom Show. My name is Bill Russell. I'm a former C I O for a 16 hospital system and creator of this week health, A set of channels dedicated to keeping health IT staff current and engaged. For five years we've been making podcasts that amplify great thinking to propel healthcare forward.

Special thanks to our Newsday show partners and we have a lot of 'em this year, which I am really excited about. Cedar Sinai Accelerator. Clear sense crowd strike. Digital scientists, optimum Healthcare it, pure Storage Shore Test, Tao Site, Lumion and VMware. We appreciate them investing in our mission to develop the next generation of health leaders.

Now onto the show.

 All right. It's Newsday and today we are joined by Mark Dobbs Global Alliances with Pure Storage, and I'm looking forward to this conversation. Mark. It's been a while since we've talked on the show. It has, it's been a little while.

Bill, good to see you as always.

Yeah. You're still doing that silhouette thing with the background. That's really cool as well. What room did you end up with in your home office? Are you like in an attic or a second bedroom?

I got tucked into the attic. Yeah. We moved into a new house and I found my office and it was downstairs with a beautiful view, and now here I am tucked away into the attic, the hottest room in the house too.

Right. So it's a beautiful

spot.

People ask me, what's the best thing about being an empty nester? And after I get through the first three, one of the things I always say is I now have my pick of which room I want to have as my office. Oh. Which is, this is gonna be a glorious day when

I can move my office back downstairs

to civilization.

Oh. But trust me there's downsides. You miss the kids. Yes. So it's it works out. We've got a lot of things to talk about. We've got some security stuff. We have some future leaning stuff. But my favorite is this what will EHRs look like in 25 years? I'm gonna close with that, cuz I'm gonna ask you what healthcare it will look like in 25 years.

I, I don't even know how to project that. I used to tell people I could only do three year plans in health. It cuz. 25 years is insane. 25 years from now I'm likely not gonna be here. So how could we possibly know? I think the other way to think about this is 25 years ago. What were we talking about in it?

Exactly? Yeah. That was what we were talking Y2K is what we were talking about. Yeah.

Y2K mods. Yeah. The good stuff, right? Tape is still a thing. Yeah,

exactly. Let's go into cybersecurity. So, F B I warns health systems and others of clap, M F T ransomware tactics they say of vulnerability and move it.

A managed file transfer product from progress software that provides automated high volume, HIPAA and GDPR compliant transfers could leave hospitals or healthcare organizations at risk. And You know it, it goes on. The company provides cloud and other services, which integrates with E H R records and other systems.

You could see the interconnectedness of this software, which is what I think scares a lot of people. Clap is using, oh, I'm gonna say this wrong, L E M U R, Lumerlut. A web shell written in C that is designed to target the Move It Transfer platform. CISA said in its summary and technical details released on June 7th the web Shell automation, incoming HTP service requests.

You get the idea, a lot of technical stuff, but essentially what they're worried about is this can Essentially get into your cloud platform, can get into, your ehr, can start stripping data and moving this in and out. You, you read this article, what are your thoughts as you're reading this?

Yeah, I think it's interesting

what came to mind, is obviously it seems like one of the things the article touched on was the fact that it's using hard coded passwords, which Bill brings us back probably 25 years ago as we were just chatting. We're used to store plain text, username and passwords in like, your text files, the way that applications used to speak to storage, for example.

And so it's harkening me back to those days where I'm like, wow, here we are leveraging like a high tech thing, which is cloud, where, all of us are cloud users today in some way or form. And yet we're still kind of dependent on trying to move data to these new technologies and we're doing it kind of in a legacy fashion.

I'm not saying that this is a legacy application per se, but when I read this bill, I'm just thinking like, what kind of impact does these type of exploits have or those that we don't even know about yet to healthcare as we shift and continue to shift to the cloud. So this basically showed us that hardcoded passwords can run commands, like basically as the data gets into Azure in this article.

You can emulate and spoof the user insert, delete modified data, basically. And who is it gonna look like? Well, the user. So how do you detect those anomalies if it looks just like a regular user? Not a necessarily an outside attack. So I found it interesting, bill, just that it's able to emulate a

user to some degree.

Yeah. Let me shift the conversation a little bit with you. It's, it feels to me like. We are full steam ahead in cloud adoption in healthcare. Most of the conversations I'm having, I'm hearing EHR start to move there. Several major health systems have moved to Epic and Azure. I'm now hearing of some moving to aws.

Their EHR platforms to aws, but it's not only that. I mean, you're seeing a lot of Workday implementations, you're seeing a lot of e r p implementations in the cloud and whatnot. So you're having these major platforms, service now you're even seeing some CRM type solutions that are cloud based as well.

So we're seeing a lot of adoption of platforms in the cloud. I assume you're seeing the same thing. You're seeing a lot of cloud adoption, right? Still at this point.

Yeah. My, my forte and kind of my background has been in imaging, so that's kind of where I've come up in the healthcare industry.

So talking about MRIs and radiology, cardiology, pathology, things like that. And it seems that the limelight has been, or the center stage has actually been on just that cloud, and that's a big area where there's a lot of data bill that you pretty much have to manage for legal reasons, seven to 10 years.

Most organizations. You were a cio, did you delete data? Most

of the time you don't, right? I never, I mean, our, my, our data retention policy when I got there was 25 years. Yeah,

there we go. Right? So, which we'll talk about in the future here, the next 25 years. So I think where I was going is, Cloud adoption is again a very helpful tool.

But I do know that because healthcare is very risk averse, we kind of sat and watched for the cloud to kind of mature, if you will, and we're now entering that full steam ahead. And I do know this, there are a lot of other industries that have found that hybrid is where the ultimate kind of goal is, right?

For best of breed. And for us, I think about hybrid this way. Bill, what's the best way to. Monopolize on physician satisfaction, which is better patient care, right? How do I keep your doctors happier? Which may mean that I want to keep some data locally faster, so hybrid on-prem to some degree, but keep the rest of the cost and shift the legacy information up to the cloud maybe for long-term retention.

Is that a best of breed? That gives my doctors access to everything they need, when they need it instantly, but also allows me to not have to manage mounds of data. I,

I'm worried that we get lazy on the architecture side. When I think of Disaster recovery. We tend to like to just pendulum like everything was on prem and we're never going to the cloud.

It's too much latency, too slow, not secure. And now we're penduling 'em in the other side. But before we pendulum, I would like to hear the architectural plans. Okay, so in the case of a disaster, and by definition, a disaster is. A disaster. Right. And so we were in Southern California and we had adopted a cloud.

It was essentially a private cloud outside of Vegas. It was in a colo facility and those kind of things. And we had to do disaster plans. Our disaster plans had failover back to the hospitals themselves. Cuz when you think about in those disaster cases, we're gonna be cut off from the cloud and most likely, I mean, if you have that big earthquake in Southern California, we planned on being cut off from the cloud and we also planned on having a lot of casualties coming into our hospitals.

Those hospitals have to function. We have to be able to get to images, we have to be able to get to the EHR record. We have to. Who knows what it's gonna look like in the case of disaster, but I'm worried that we're not doing the rigor and the diligence to make sure that we're not just over, we're not pendulum all the way over to the other side and leaving ourselves exposed.

In those cases?

Well, yeah,

bill, actually on that note, here we are doing, conducting a virtual webinar together. We're meeting, right? And so I'm solely dependent on my bandwidth and my users downstairs are my eight and my five year old, my wife and they're power hungry users. And so for us, we're a cloud family, right?

Everything I do right now is, there's nothing on my PC that I actually care about cuz it's all protected somewhere in the cloud. So there's benefits to it. Healthcare isn't quite the same. Who's, who deserves faster data access Bill, a radiologist, a cardiologist, or a general physician or a nurse?

They're all equal citizens. Right?

It's interesting that you had asked that question, and I'll get a lot of heat for this, but cardiologist,

there you go. Okay. And why do

you say that?

They generate the most money for the health system.

Okay, so, so monetarily then that's another approach, right?

So, so where I was going with that is you only have so much bandwidth, right? And we can have dark fiber, we can have express routes, but we pay a lot of money for only so much, right? Power is only a certain amount of power we can buy for our hospital, for our data centers or the cloud vendors. Same with internet connectivity.

And like you said, in the event of a natural disaster, we gotta have something on premise as a safety, right? We're not gonna go back to reading at the modalities, which yes is possible. You could do that, but that's just not really feasible, especially in cardiology. Right? So, so if you look at cost, that's the other magic wand that people were waving for.

Why to move to cloud, getting outta the data center business, right? My operational cost from my labor, my IT staff is expensive. They're highly specialized people. How do I get rid of those costs and dialed down my opex? They did the opposite. They cranked up the opex, everybody raced into the cloud and quickly it can become a runaway cost.

So, Storing data in the petabyte scale in the cloud may sound good because it's a lot of data to manage in your data center. So your footprint gets expensive, power space cooling. But what happens though, bill, when you become so successful that everything's in the cloud, like you said, every bit and bite of data and your healthcare organization goes to the cloud, what happens when all of a sudden the AI user starts stealing bandwidth from the human users?

The aid that you develop and you implement, right? Your AI algorithms along the way of patient care. They're gonna become power hungry. There's only so much bandwidth that go around. How do you solve for that?

We'll get back to our show in just a minute as we celebrate our fifth anniversary At this week, health, we've partnered with Alex's Lemonade Stand of Foundation, combating Childhood Cancer. And I've just been floored by the generosity of our community. We set a goal to raise $50,000 this year, I wasn't sure how we were gonna hit it.

And we are already up over $34,000 for the year, and we want to thank you for being a part of that. This June, as you know, we've been doing drives all year, and we're gonna do something a little different in June. We have 2 29 groups where we bring together healthcare leaders, about 10 to 15 of 'em in a round table format.

And we discuss the biggest challenges facing healthcare and how technology can be applied to those challenges. We have an event in June and together with our chairs of that event, our participants and our sponsor partners, we're gonna be donating $5,000, to the cause. We really want to thank our chairs.

For that event, Jeff Sterman and Chad Brisendine. Jeff Sterman with Memorial Healthcare. Chad Brisendine with St. Luke's University Health Network, for being a part of that. We want to thank our sponsor partners order, Gordian Dynamics Clear Sense rubric. Sure test VMware and Nuance for also being a part of raising that $5,000.

And we wanna thank you again for your generosity. If you wanna join us this week, health.com, you can click on the Alex's lemonade stand banner on the homepage and you'll get taken to our lemonade stand. You can go ahead and give directly onto that page and see some of the other people who have given Now back to our show.

Yeah it's interesting. We had one of our 2 29 CIO events and we're talking about we were talking about contracts and one of the cloud contracts, they were actually moving from one cloud provider to another cloud provider.

And they asked the group, it's like, what should I know? And the. Answer to that was you should know what your contract says. You should know what your cost of transferring all that. The data transfer and all of the storage costs and whatnot are going to be the problem is a lot of that stuff's done.

In hindsight, it's not done. Ahead of time. I want to talk to you about contracts. One of the, one of the stories in this list is digital health should brace for significant amount of churn as hospitals reconsider covid era tech contracts. So covid happened 2020 ish. We're getting into the middle of 2023.

A lot of these contracts are three year contracts. This is specifically talking about all those really cool things. We threw in some telehealth solutions. We threw in. Some chat bots we threw in with like, we meshed together these digital solutions. Meshed is too kind of a word. We threw that in.

We threw all these digital solutions, but all these contracts are coming up. And they did some surveys and it's looking like people are saying, Hey, you know what, we're stepping back now and we're looking holistically on how we're doing this. So that's one aspect of it. The other aspect is I was talking to some CIOs at the event about contracts and one of the things that's happening to them is every vendor is coming back to them when renewals hit with a 15% increase more money.

Yeah. And it's like, and their major platforms, they're not going away from them. They're major platforms, and now all of a sudden it's 15% increase on your E H r 15% increase on your E R P 15. Percent increase on your service desk, 15% increase on your phone. So, I mean, it's just across the board. How do you sustain that?

Yeah. And you, and that was the question, how do you sustain that? And

your revenues aren't going up 15, 20, 30%. Right? So how do you afford that? Well, what happens when your data's. Locked into your digitization method was part of that as going into the cloud. Again, talking about the pendulum swing of where information may come back.

How do you control your data if all your data rests within one vendor's hands? And you'd mentioned Ts and Cs, right? If the contract says that to leave me, you have to pay egress fees and mass, you might not even be able to pay to leave, let alone get the benefits of the other vendor you wanna move to. How do you, so how do you get away from that?

So it's, again, it's like you're punished for being successful, following the trend, but you didn't go into it with eyes wide open, you were shopping on price maybe versus shopping on patient workflow and satisfaction, which is what you're trying to solve for.

Right? And this is where it's interesting. This is where we have to begin with the end in mind.

Yes. It's what's the problem we're trying to solve? And it may grow over time, but keep that set of problems front and center as we try to solve these problems. And so you look at it and you go, all right, so we have these core platforms. This group of software isn't going to change, or we hope it's not gonna change, it's gonna keep evolving with us and it's gonna be central.

One of the things we talked about was you have to consolidate as much software as possible. Epic was the biggest application rationalization initiative in most health systems. They went in, they consolidated about a hundred systems. Well, they should be doing that same thing with.

They're digital platforms right around potentially the CRM or other solutions. They should do that around their workflow automation and that kinda stuff around something like a ServiceNow or whatnot. They have to take those platforms that they know they're gonna spend money on and say, let's expand the use and consolidate the use cases.

I, I, that was one of the things we heard. The one I come back to is is influence with those vendors, it's there. There has to be a conversation where you're saying, Hey, you know what would help me Is if you were able to take this workload, you were able to take these things, then the 15% makes perfect sense to me.

Cuz I can shut this off, I can do these things. It's like getting involved in their product development life cycle. Yeah.

It kind of brings me to the old phrase, and I don't know if I'll capture it exactly, bill, but you know, it's, there's nothing too good to be true other than like, if it's free, it's not really free.

You are the product, right? So if using an app for free, you are the product, which means they're harvesting that data. And in this case are these partners that are giving you these services that seem very Attractive to you and seem like they're gonna save you so much time and money and effort. What's the long-term play with those vendors?

Like, what's actually gonna happen in five years with your relationship with that vendor? Are you still the product for them? Are you an actual partner? And I think the test of time will prove that out for us.

All right. I'm gonna, I'm gonna combine an article cuz we have about three to five minutes left.

Can we do about 20 minutes here? We have the Forbes article, how technology is transforming the future of healthcare. Has a couple of ideas here. The metaverse in healthcare, digital twins medical training, specialized therapy in the metaverse have web three is gonna democratize healthcare.

You get the idea. There's some of those things and then I want to come back to. Epic Cerner 2048. What will EHRs look like in 25 years? It's interesting that they have Epic, Cerner 20 48. Yeah. And they ignore like a hundred other e I know. It's hard to believe there's still a hundred other EHRs out there and they I think what they're essentially saying is they're all outta business, which I don't believe, quite frankly, cuz I believe Meditech will be around.

For a long time, and actually I believe the ehr, I hope the EHR will look fundamentally different in 25 years.

Yes, it should. It should. Maybe it'll be more patient-centric by then, but Coming back to it. Bill. I think something funny in the Forbes article that came to mind is, it talks about the medical training and specialized therapy in the Metaverse, but then also kind of, it tiptoes into talking about like how patient care could be used for the metaverse.

And I don't know about you, bill, but the last thing I want to do is put on my headset to go visit my doctor, but to be put into a virtual waiting room, right? Like, I don't wanna go into a virtual reality to then go to a waiting room. I wanna go like, I want convenience as a patient and the articles talking about like, wouldn't it be beneficial to be in a virtual waiting room as you, sit in the comfort of your home?

I'm like, no, we should be making you where almost healthcare is like instantaneous. If we're gonna take that leap of going to virtual But I found that funny. I don't know what your thoughts are around kinda the web three unlocking kind of the patient control of data.

Well, that's a hot topic for me.

I believe that the that one of the key drivers for advancement in health not necessarily healthcare but in health, will be essentially patient-centric interoperability. Think of it this way my entire medical record, my entire medical history on this phone. Then anywhere I go, no matter where I go and wherever I present, I can take my medical record with me and it's there.

I hear about interoperability all the time and I'm like I don't understand. What the problem is, give me my medical record, give me all my records and let me take it from place to place and just gimme a QR code, they can scan it and then have my medical record. I also think that's a way we get rid of this problem of intake forms.

The intake form problem just cracks me up cuz it's like, well, every time I go somewhere they hand me another clipboard and you can go from. One place in a health system to another place and they hand you another clipboard. Another clipboard. Yeah. And I'm like, look, at the end of the day we've solved this problem.

It's called the Common App. And someday, I don't know how old your kids are, they're gonna apply to colleges. And my first two kids applied to colleges and every college they went to, they had to fill out another application. By the time my, my last child went to college, she filled out the common app, which covered like five of the universities she was applying to Quick apply.

Yeah. And it was like, all right, well, why don't we have the same thing and just manage by exception. There's like the common, check-in form we have this, it's just we can create the user experience to keep that updated as we go. And then manage by exception when you are gonna go see a cardiologist, maybe there's an additional.

Section that they want you to fill out or keep updated every time you go in. I think there's a whole host of things that if we could organize instead of around the health system, we could organize around the patient. We would be far. Healthcare would be far better off.

Bill, you talked about interoperability, the buzzword of the past, what, 20 years?

Right? Still doesn't exist. And you talk about legacy, we still, we're still selling fax lines, right? We're still using, I know, faxes of reports in radiology. But on that note though, and to kind of tie it back into the future of 25 years from now, what is, what's the EMR gonna look like? EHR gonna look like.

I think you're right. I think the patients will be able to basically control the data. It'll be a patient-centric workflow that the EMR is designed, probably will be called something other than EHR, emr, right? It'll be a new name, a new acronym. But where I'm going with that is, yeah, you'll walk into the hospital.

There'll be the ability for you to kind of share out what you need based on what the hospital's requesting, right? Just like you have. So you control your own data domain. But I see the catch 22 on that bill. Some of us may not want to share some of the data that is being asked of us by the healthcare.

Organization, but the physician has good intent. They're asking for my clinical history, for my drug records, my, my information immunization records, right? But I'm thinking this is a cardiologist. Why does he need to know my drug records? Or why does he need to know my prior injuries? Right? And so patients may unfortunately, inadvertently, like pull themselves away from better care.

If they go, no, I'm gonna deny that access. And then what do you do as a physician? Do you debate with the patient why you need to request access? How does, well, I'll take, does that work?

I'll take you one step further, which is in 25 years, are we gonna organize around the health system? Are we gonna build AI around the health system, or are we gonna build AI around the patient?

And I believe every person in this world will have an AI assistant. A hundred percent. We'll have an AI assistant, but we'll also have an ai. Doctor, an AI primary care doctor, we've always wanted everyone to see a primary care doctor. This is how you do it. Ai, primary care doctor 25 years from now, fully versed on all the clinical trials, all the things that are going on, all the options.

And they will have all your medical data, including your genomics data and all those kinds of things. Now, the word interoperability is first of all, it's gone. It's gone. Bill, you're right. Second of all it, it has not only my medical data, it has my social determinants data. It knows what my college degree is, my education, it has my idea of what's going on in social media and that kinda stuff.

Now, do we trust the AI model? I think the AI models will evolve in such a way that it is Bill Russell's personal. A physician and it will adhere to the same HIPAA guidelines and all those kinds of things that are required. But it's gonna be able to say and obviously we'll have sensors and those kind of things, it's gonna be able to say, Hey, bill, based on your medical history and those kind of things, I suggest you go see, physically go see a doctor.

Right? Given your family history, given the readings I'm currently seeing and that kinda stuff, we will be much more predictive in 25 years. The question is, will it be organized around me or will it be organized around the health system? And I believe it'll be. Be the patient. It be I agree. It'll be the

patient.

Especially cuz we're not talking about our generation, we're talking about the next generation of users, right? Those that are very comfortable sharing all their secrets, like you said on their personal device. And they're also gonna probably be more proactive for an assistant AI to say, Hey, it's been a little while since we've checked your eye scoring.

Right? Like take, here's this app. Hold your phone away at arm's length. How's your vision, right? You're more proactive there. And I think that's gonna accelerate patients helping themselves without them really being I guess, forced to go see a physical doctor, right? And that may increase a better overall patient, public kind of

healthcare.

Yeah, I we'll close on this. Did you see Apple's announcement on their Vision Pro? Vision Pro? Yeah. I think it's what it's called. Yeah. Their new virtual reality, augmented reality. Virtual reality. Yep. Augment. Yep. I, it's interesting cuz I think their direction is more augmented reality than virtual reality.

And I think their direction is the set of glasses I currently have on is going to provide me all sorts of new data and input. As I'm walking through the world I think that's another aspect. I think it will shrink to be, right here I'll be able to see my physician. When the physician's ready to see me, a light will pop on.

Oh gosh. I hope it's not a light, but whatever. Yeah. Ready to see you. And then I'll say, okay, click in and I'll see them immediately. I think if we haven't figured out how to manage throughput in the healthcare system in 25 years, we will have done something very wrong. Oh yeah. We're. Longer.

We've got a massive explosion of data, so how are we gonna figure this out?

It's gotta be the pat. The patients have to take responsibility. We need to provide tools for them to be able to feel comfortable taking that

responsibility. Fantastic. Hey Mark, I wanna thank you for your time. This was a fun conversation. Likewise.

Thank you Bill. Always great to chat with you.

And that is the news. If I were a CIO today, I think what I would do is I'd have every team member listening to a show just like this one, and trying to have conversations with them after the show about what they've learned.

and what we can apply to our health system. If you wanna support this week Health, one of the ways you can do that is you can recommend our channels to a peer or to one of your staff members. We have two channels this week, health Newsroom, and this week Health Conference. You can check them out anywhere you listen to podcasts, which is a lot of places apple, Google, , overcast, Spotify, you name it, you could find it there. You could also find us on. And of course you could go to our website this week, health.com, and we want to thank our new state partners again, a lot of 'em, and we appreciate their participation in this show.

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