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

The paranoid guy in me, of course I think initially with chat GPT and generative AI I'm like everybody else. I'm like, wow, this is amazing. It's going to be able to do all kinds of cool stuff. And then in my sort of next breath, I'm. Saying Oh shoot, this might also go horribly wrong.

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. Newsday discusses the breaking news in healthcare with industry experts

Now, let's jump right in.

(Main) Hey, it's news day. And today I am joined by the incomparable Sarah Richardson and the festive and fun dressed Drex DeFord today. So this is our end of year episode. Look at you Drex. What, wow.

All is good.

He's

And the NFC West, so he can wear a Seahawks ish shirt and totally get away with it.

Seahawks and the 49ers are not the top news stories of the year, for sure.

No, not this year.

Unfortunately for y'all. Here's what we're going to do. We're going to cover the top events for the past year.

And then, I don't know, maybe give a little preview into what we think is going to happen next year. Let's throw out the two most obvious stories of the year and that's change healthcare and CrowdStrike, right? Those were far and away. incredibly impactful. Actually, what's interesting to me is change was much more impactful than CrowdStrike, but CrowdStrike was more pervasive, so it went

beyond healthcare, for sure.

And, I don't know, Delta couldn't get a plane off the ground for whatever reason.

That story is interesting from the perspective of it was another one of those things that happened to us over the course of the year that really put people in a position to think through their third party risk.

The amount of reliance that they have on third parties. Change was really the first one. I think for some organizations, the Ascension hack, because of the relationship their health system may have had with Ascension, was another one. And then there were others. There were some blood systems that were third parties that were attacked,

Third party risk and the impact that it has to our ability to deliver businesses.

So Sarah, you hosted a bunch of 229 events and city tours and whatnot.

What, I assume that ransomware, this third party risk, is a very top of mind issue.

Not only is a top of mind issue, because, Drex's point, you can have all of the best practices, some of the best policies and protocols in place, in the third party scenario, these things are happening to you, it changes the way you think about downtime, or it changes the way you think about interruption of service.

Because if you're down for 30 days, And that's what we continuously hear. You need to be prepared to be down for 30 days, which to me is a lifetime in patient care. And it's what some of our CIOs shared with us that, let's put perspective, when Change Healthcare happened, it took one organization six hours just to turn off the API that was feeding it because nobody had any documentation on how API had been set up.

Another thing nobody planned for, enough triplicate forms. So if you're going to be down for 30 days, you have to have enough registration numbers, and then you have to have enough registration forms. The things that nobody knows how to use anymore, per se, like no one has a triplicate copy of something and then planning for how long it takes to manually index all of the images that were taken and then stored locally and having to reintroduce those into your organization.

One is a clear example to me of architecture risk. And the other is a clear example of business risk.

So change is a business risk. And the CrowdStrike one is really an architecture risk. And when you think about it, it's it's fascinating to me. Like when this happened, people were like, Oh my gosh, I didn't realize something had access to our kernel that could take down, a Now, Drex, you worked for CrowdStrike, I'm very familiar with why it's built that way and why it functions that way.

That's how it protects us. It operates at that level. But we never really thought about, oh my gosh, something could happen at that level of a machine and take them all down. That's a myth. Hopefully it gets us to think different about architecture moving forward. The business risk of change, I think, just absolutely put people on their backs.

And I said, Hey, have you completely gotten through all that stuff? And he said no, he goes, we made it through. And we're functioning, but there's still residual stuff of claims that we're still processing and figuring it out. so the business risk there, let me talk a little bit more.

Cause I don't get to talk on the Today Show anymore. So I have some words.

You can join us anytime as a guest though.

, as we look at the architecture risk, it got people to start saying things like, Hey, maybe we should think about something other than a Windows PC as the core system.

The champion and the challenger. So you have an RFP, somebody wins and somebody's the challenger, and we're going to implement both of them because it's similar resources, same, similar things. And we're going to process our 80 percent of our claims through one and 20 percent through the other and have the ability to come up and down.

I like the fact that we are failing forward on this stuff. We're thinking, okay, how are we going to mitigate these things? Unfortunately, we don't really identify them until they happen.

And then you have the means to do that, like I've been fortunate enough to work in healthcare systems that were big enough to have diverse paths from a fiber perspective, in case there's a backhoe that inevitably that's access to your facility because of construction.

And then you still may have a ransomware attack, which could shut it down in a different way. So you're always changing. Facing the equation of What is good enough?

It's really about risk, right? What you're saying there is, are we willing to accept the inefficiencies of running two systems that do the same thing that's going to cost us more money and more people and maybe more time and lots of other stuff?

Or are we willing to accept the risk and understand the risk and make sure that we understand the risk of going to a single system and using that because it's more efficient? I think about health systems. Would you intentionally go out and run both Cerner and Epic in your environment so that you had a, it just.

You know what your backup plan would be should you have to make that shift.

All right, so the next story has to be generative AI. If nothing else in terms of the just loudness of the number of stories. So we tracked about 2, 200 stories this year and we put them out on our site. They get sent out in our newsletter and whatnot.

A full 20 percent of them are about AI and generative AI this year. But are we going to say this year was the year of generative AI or is next year going to be the year of generative AI, is the next five years should be the year of. What is it actually? let's start with, was this year the year of generative AI, or is it just we're recognizing it's.

Ascension this year.

So it's pretty, Pretty impressive just to see. And

they're actually not a functioning, person in society that has a job and is bringing in income. Is that what you're telling me?

So it's pretty amazing to see , the three of us have been doing this for a long time.

I don't think I've ever seen anything other than the internet took a long time to uptake, right? From the time we first started playing with the internet until people realized what it was capable of doing. I've seen, this is. Generative AI has just been, 10, 10 times, 100 times that.

It's gone so fast, so quickly. You can look back two months ago and think, wow, I can't believe where we are compared to where we were two months ago on some of these things. Pretty impressive.

Yeah Sarah's not as old as you, so she may not remember the advent.

Oh no, I'm like laughing because I'm like there was , when you started having people that regularly traded in their pagers for cell phones, and you had to manage the phone fleet, and then you had the percent per minute charge, my goodness, remember managing the minute pools?

And

And then something like Gen AI, where it's probably one of those technologies that to me is so fascinating because it's gone faster. Then the ability to really think about how you get in front of it as thoughtfully as you would want to, and it's because of the ease of digital technologies today.

You can try to shut it off, but you're not going to be able to shut it off. And

So many of our partners use it in workflows and the workflows are about the automation that creates capacity for other tasks that allows you to either shut open RECs or not so much reduce the headcount as to reallocate headcount to other needs in the systems because margin compression and payer mix and all those aspects are real and until we know what happens policies from the new administration.

We don't know if innovation continues at the pace that it has in health care, which is already slow to begin with, or if it goes back to just keeping the lights on because reimbursement continues to be stymied in certain spaces. And so it really may be the one thing that can continue at a rapid enough pace that we don't lose any ground we have gained, while also, Making people feel comfortable enough about it that the governance and the security and the resiliency that's required to do it responsibly is something we can all be proud of.

We will talk about the election because I don't think the election was really a this year story. I think it's a next year story. So we'll cover, what Doge means to healthcare.

Because I talked to some CIOs and they're really concerned about it. But we'll get to that. We'll get to next year in a minute. Sarah, you hit the nail on the head and Drex, you hit the nail on the head. I'm going to use that analogy that metaphor over and over again.

But, Sarah, when we were bringing people onto the internet, we had to switch them from IPX to IP addresses. You remember that? Like we had to actually change the protocol because they couldn't get on, or we had to set up a gateway so that they could get on. They had to fill out forms.

That's sort of the point. It's, all the stuff was there. They had access to it the minute, and it happened at Thanksgiving, right? So something happened, At Thanksgiving, everyone became aware of ChatGPT. Then everyone started playing with it through Christmas. And then they're like, I could use this at work.

Oh my gosh, this is amazing. I think when we get to the end of this year, though, we're sitting there going, Oh, I see this, there's some limitations here. Like this baby still has a diaper on, like there's, it can still make mistakes. And these mistakes, as you say, Sarah, don't be like throwing generative AI around in the ED at this point.

It's absolutely huge. If we can solve these handful of things, The amount of automation we're going to get out of it, the amount of work that we're going to be able to lift off of people's cognitive load and let them practice medicine There's a lot of optimism as to what it can do, and I guess that's where all the.

all the stories come from.

The paranoid guy in me, of course and you've both heard me say this before. I think initially with chat GPT and generative AI I'm like everybody else. I'm like, wow, this is amazing. It's going to be able to do all kinds of cool stuff. And then in my sort of next breath, I'm.

On Thursday, a new button shows up on your application. That's a software as a service application, and you will have a new capability. And you didn't even know about it. You didn't ask for it. You didn't know it was going to show up. It just showed up on the application. This is all terribly difficult to manage and govern and hopefully we'll find our way through this and everyone will do the right thing.

threw out the obvious stories of the year. Sarah, we'll start with you because you're always the most prepared for these things. I know Drex is just winging it over there in his blue Seahawks thing. But another story that jumps out at you from this past year?

What I really appreciated about this year were two aspects.

For Those that are providing hospice and elder care may have a harder time than someone providing care in a med surg unit, as an example. And yet equally, there is a balance across the continuum. The other things we talked often about that I appreciate are both access and equity of services. Most of the CIOs that come on our show.

are concerned about access. So let's just say we're using generative AI to do a whole bunch of blasted messages for preventative care and wellness checks or end of year things that need to be taken care of. , if all that goes exactly as intended, now you have, let's just make up a number, 500 people who need an appointment.

And at the end of the day, We want people to have access to care, have quality outcomes, and have a trusted relationship with the health system that is serving their needs. That sounds simple, and it was one of the hardest things to solve for, and it will continue to be one of the hardest things to solve for, especially as we hit this massive amount of boomers that are coming into senior care, and so many ways to make sure technology is thoughtfully adapting to how they receive and expect care to be delivered as much as the providers and caregivers doing that. All of those equations came together in really thoughtful and structured conversations that I believe if we take with the same level of intentionality, we'll have good outcomes because we're willing to talk about what it takes for that to be a true statement.

Yeah, those are awesome stories for this year. Drex, do you have another one to add?

We saw health systems who were in the process of acquiring hospitals from other organizations. And when the big organization was breached the acquiring organizations struggled to figure out how do we accelerate our whatever, EPIC deployment or whatever, to the new hospital so that we can get them out of that old situation.

in the cybersecurity world, there were just a ton of acquisitions that happened. From early stage companies to bigger companies. So everything's connected to everything else. That is definitely part of the challenge of the world right now. That not just the internet and computers and all that kind of stuff connection, but we're also dependent on each other's processes that.

When we see a break in the supply chain, so to speak, the decision chain, so to speak, we wind up really creating a lot of chaos.

So it happened really fast. It really happened fast from the beginning of the year to now, how the pricing has improved and how the technology has improved. It's gone really fast.

Yeah. And so those vendors are going to struggle next year. They have to differentiate themselves.

It's the act of actually listening to a conversation and creating a note. is complete commodity. And, maybe somebody's 2 percent better, 1 percent better than somebody else, and we can argue that is huge in healthcare, but it's 1 percent and 2% you are going to have to look at differentiation.

It's done now. And so things like Citrix are being moved out. talk to more and more people who are just like, I might be able to get rid of my Citrix contract by the end of this year. I don't know about you guys, but for me, first of all, it was one of the most complex environments we had to manage.

It was one of the most costly environments we had to manage and it was, Really not the most stable environment. It was a pretty fragile environment. Like we had to keep it at a minimum. We had to keep rebooting individual sessions, but sometimes we had to reboot like whole servers and stuff.

It was never like rock solid, like a lot of the other stuff. I think those three things from a, just a pure tech side, those are three big movements this year.

Yeah. We're good. The Citrix thing, it definitely requires a lot of care and feeding to keep stable and there are so many other interesting options technology wise that again, a year ago, probably we're just beginning to.

All right, we'll delve into this. You guys don't want to delve into this. Neither do I, actually. But we'll delve into this.

We're going to start talking about next year. So each of us are going to get an opportunity to talk about what we think the trend is going to be for next year. But I want to talk a little bit about the election because I know this is top of mind. I've talked to a number of CIOs this week and each one of them mentioned We don't know what's going to get cut.

One of the big themes of this administration is we are going to drive efficiency. And no one really, look, we're doing this in November. No one really knows what this is going to look like yet. You have VEC and Elon saying, we can be more efficient, but there's not a lot of specifics of what efficiency looks like.

It's not irresponsible to think about it now, because to me, this is no different than when you're sitting in a board meeting or a C suite meeting and each team in your hospital is told to find X amount of dollars.

Don't really care how, don't care if it's headcount reduction, don't care if it's app rationalization, don't care if it's new applications that can help increase margin, at the end of the day you have to go hit this number. And I've heard a number of two trillion thrown out there for the federal government as an example.

So depending on how they divvy it up, they're going to be like, each of you has to go find this amount of money. Where I'm hopeful there is synergy is that Because there is such a sprawl of government programs that if you're turning off one service over here in the lab, as an example, it doesn't affect something in supply chain adversely because you're both trying to achieve the same goal.

Yeah, I think that's what worries me, too, is the bull in a china shop approach that is our greatest fear and hopefully is not realized.

On the cybersecurity side of the house, I can tell you that, sitting down with CISOs a couple of weeks ago, a lot of concerns around, What's going to happen to CISA? What's going to happen to a lot of the work that we've done the last few years? You would hope that cyber security would be a bipartisan issue and that keeping the country and healthcare safe would not be something that we would really argue about.

But in this environment, it's hard to say. I hope we can keep that squared away and keep moving forward on a lot of the work that's happened over the past 10 years.

I'll close out this part of the conversation with warning and then what I'd be focusing on if I was a CIO.

That's his approach. It's if you don't have to back office on this stuff, you haven't gone far enough. I don't want him doing that in healthcare. I don't want him going, oh, bummer that, that was too far. So I'm afraid of that. Here's what I'd be thinking about if I was a CIO. And actually some of this came from directly from a conversation I had with a CIO.

And it is They're going to be looking for cuts. Cuts are going to impact the health system. And as you said, Sarah, it's, percentage here. Here's the things we do know. We know that there's going to be a physician's shortage, no matter what they do.

There's going to be a nursing shortage, no matter what they do. There's going to be burnout, no matter what they do. We're going to be caused to pick up the slack in some areas, no matter what they do. Therefore. Knowing what I know about the health system and being the CIO, I'd be driving as much automation and efficiency as I possibly could.

I'm going to steal some of Drex's thunder, because let's be honest, everything we talk about now is through a lens of cyber, which I am so grateful for, because I remember 20, Yes, 20 years ago, going and doing the audits, like so many other things, and making sure that access and identity management was appropriately administered, that people were getting their access removed within 24 hours.

So cyber is going to stay at the root of the conversation except that now it's not just the people in the basement or the guys over here in the corner talking about it. So I would say that cyber security as a core strategic priority is going to be a conversation we will have often. And, like Drex does so thoughtfully, putting it in plain English and talking about what that means for people, both at work and at home.

If security is literally embedded into every layer of technology operations, from your all the way to your IoT enabled medical devices, then that continuum is a conversation that everybody can have. Much like how AI is being trained in some organizations across the continuum, because we're going to see AI driven operational and clinical enhancements.

There's a huge level of enterprise level deployments and adoption in 25. We have to be able to create the margin we're talking about. And the last piece, and this is something we do topically as well, is focus on resilient and scalable cloud operations. So if cloud adoption continues to expand, then CIOs can prioritize.

She took all three. Those are all really good. They're really good. You're going to

have others. You two always have others. So that's what I love is now we have five predictions or ten. Or just pick

your

favorite.

You know what, Sarah, those are exceptional. I'll change mine.

Drex, what do you got?

I, at a very high level, I'll go along with you on AI. I think we're going to look back a year from now, and we're just going to be like, wow, there's some crazy things that have happened with AI. There's somebody this year that's going to try to do surgery without a surgeon.

When we went through COVID and we decided to go to a lot of software service and outsource a lot of these capabilities. We built this web of relationships and connections that we don't really have well documented or understand. And there's a booby trap in there somewhere and somebody somehow will wind up stepping on it.

Drex, you win the metaphor challenge this week. The elephant

is

actually in the room. It's standing on my chest. Eat it one bite at a time. That's not going to cut it. Start with

the foot. I don't know.

I think AI is moving let's use dog years as an example, dog seven years to every one year. It feels to me like this thing is moving at a pace of, I don't know, like at least seven years for every one year.

Yeah. It's like inverse dog years. Yeah.

Yeah. And it's the amount of money that's going after it.

And the same with the rest of the players that are out there. We're going to see it show up and do some really incredible things. And we're going to get better at the stuff we have now. Like We used to talk about prompt engineers. I don't think we're going to be talking about prompt engineers next year.

I think it's going to be prompting itself, or it's going to be giving us the prompts to prompt it. And we're already seeing this agentic AI, where you have one agent that has these 50 things underneath it, a little bit like how the brain works. And it's hey, that's a math problem.

I'm going to give it to Drex. Hey, that's a sociology problem. I'm going to give it to Sarah. She has more EQ than Drex. And that's a nerd problem. I'm going to give it to Bill. It's like literally, the agents are going to go, I'm going to use that model, and it's going to bring it all in.

And when I get done, I go, oh my gosh, I was just introduced to this in June, and now they're like talking about full blown architecture systems out there. They're talking about use cases and case studies and stuff. I'm like as a CIO I'm so next year we will absolutely be talking.

About ai, I on the cyber side, I think we're gonna see I don't know if Drex, you and I had this conversation all those number of years ago when Trump was president the last time. I think they're gonna modernize the military. And in doing that, I think they're just gonna dump a ton of money into the military on cyber.

I think they're going to train a ton of people, which they already are, training a ton of people on cyber. But I think we're going to see a different approach to cyber. really isn't acceptable that, every health system you go to, you can look at their logs, and they've been attacked by nation states around the world every day.

I think we'll see a different approach to how we think about protecting American companies from these attacks. Who knows? But yeah, that's my bold prediction. Next year will be the year of AI. What do you think?

I think, it's interesting. So I did a story on the 2 Minute Drill and it was about the GPT thing, right?

Where on the cybersecurity side of the house, somebody had spun up a set of GPTs and said, go figure out how to take this zero day vulnerability and turn it into something we could actually use to penetrate an organization. make some money. And one of the GPTs acted as the project manager and the other GPTs worked on individual channels of the problem, right?

We know it's being done just as an experiment. There's got to be tons of people that are getting ready to do it in the business and clinical and research world,

I don't know about you guys, my investments now, I go on online with my investments and there's all sorts of AI that analyzes information I never would have been able to analyze before.

You wouldn't even have known to ask the question, right? that's the other cool thing that's happening is that, you didn't know you could answer. So you never even asked it. And then somebody's showing, Hey, you want to see this information? Yeah, I do, but I didn't know you could show it to me.

I didn't know I could even ask that question.

What's the future of this week health look like for next year? Any predictions, any forward leaning statements, Sarah we'll start with you. You're wondering what you can and cannot say, aren't you?

No, I'm actually thinking about.

One of our awesome, chair CIOs was like, hey, I want to help you promote this one program. All she did was feed what we had online into a program, and it creepily sounded like us talking about it. Yeah,

the Google's Notebook LIM. Yeah, I was like,

whoa, that sounds like me and Drex.

And then, if you take that, and we use a couple things you showed us, and you said, hey, this is really cool, it creates an avatar of yourself. So now you have your voice on file, and you have your picture on file, and you feed it a script that you've written, and all of a sudden, there you are. Except that you I used chat GPT to go and make sure perplexed at your cloud or whomever to make sure like what happens to my data and we talk about data escrow and data protection a lot in our cyber and just risk programs.

Now your DNA and your likeness are out there, and so You know, Twilight Zone episode, Do You Exist? That's a great Because someone else just created you. Maybe you created yourself. You gave you a way.

That's a great connection. The 23andMe, you got something back for it. You felt good and, you were able to do some things with it and whatever.

And then 23andMe goes bankrupt. And now they're , potentially selling those assets, which is your DNA signature and that kind of stuff. Think about some of these things where you're going, all right, I'm going to create an avatar based on me. Oh, that company went bankrupt. My avatar just got sold to fill in the blank, and now they're using my avatar for their marketing campaign.

And these are all things you can just do now.

You can just do. Future of This Week Healthy, think the three of us are going to go on long vacations and just use the HN avatar and do Newsday and that kind of stuff.

I don't know about the long vacation part. We have a pretty packed schedule next year.

I know. gonna have fun getting, cause everyone's Oh, you get to travel for work all the time and see all these great cities. I'm like, When you go from Boston to Philadelphia to Buffalo, you probably see the Marriott and you see the airport. Now, what I do love about us, that will always be true, is we make it fun.

We're all genuinely friends, and so therefore, no matter what we're facing, whether it's some kind of an AI hack or it's a plane delay, we take it in stride because people expect us to, and when you have people you can count on, then you get to do that in stride. And so I'm grateful for what we've created for other people based on the foundation we have within ourselves.

Can I give a couple of the forward leaning stuff? Yeah, do it. The first thing I would say is we're going to double our commitment to Alex's lemonade stand.

So we raised 120, 000 this year, and we're going to shoot for we're going to shoot for 200 next year. So we went from 50 the first year to a hundred the second year, we're going to try to do 200 and towards that end, we will be hosting a golf tournament at HIMS. If you happen to be at HIMS, we would love to have you be a part of it.

But we're also doing AI. Like we're doing topical around AI. We're doing. cloud and infrastructure is another one we're doing. I think we're doing four CISO events. Is that true?

Yeah, four CISO summits.

Which is great. And we're doing up, we're over 30 city tour dinners.

So we're going to be coming to a city near you and essentially gathering 15 IT executives in a room, and we're going to conduct our conversations, maybe a little bit like this conversation, what's top of mind, what's going on, give you a little feel for what the 229 project looks like and feels like.

We'll see.

thought you would give us a little bit more on that. I thought you might just dive in just another couple of drops.

Drex since twisting my arm, we've identified two things. One, that we really believe. The one thing we believe, is that we have seen over the years that there's been a weird adversarial type relationship that's built up between vendors, partners, and CIOs.

And it's because, essentially, we've just created it over the years. We built it. We bombard CIOs with emails in some cases we have unscrupulous, sales reps who are promising things that can't be delivered and whatnot. And we've taken it upon ourselves to create some development and certifications around that.

Hey, what has worked? We have some sales executives who have just countless decades of experience to share with you in the certification. And we have some CIOs who are just going to say to you, This is what I'm looking for. I'm looking for somebody I can trust, somebody who brings this to the table and that so we're going to be doing that.

And I'm excited about that. The other one we're going to do is, I was talking to some CIOs at one of our 229 projects meetings. And I said, train you, not train you. You guys know what you're doing. You're fairly professional and you don't really need me to tell you how to do your job.

And so we've put together again, about six hours of training, certified healthcare technology manager training. And it's on leadership, culture, and teams. So it's how to effectively run a to identify leaders and build your team of leaders and grow as a leader, and then how to build a culture that will help people to thrive in that environment.

So I went from barely saying anything to saying just about everything, right? Good job.

I

love it. Yeah. now the cat's out of the bag. That's what we're doing. Keep an eye out. we'll put stuff out in our email. If you haven't signed up, hit our website and sign up to get our emails and we'll make sure that you're aware of that stuff when we launch it.

We've reached more people. We've had more discussions. This is exactly the picture we had when the, you guys have been advisors for as long as anybody. When we were talking about this before, I would say these things and you're like, how are you going to do this by yourself? And now you know, I'm going to do it by myself.

I'm going to have you guys do it with me.

I'm not going to do it by myself. Yeah,

Happy New Year.

Happy New Year. And cheers.

Cheers.

Thanks for listening to Newsday. There's a lot happening in our industry and while Newsday covers interesting stuff, another way to stay informed is by subscribing to our daily insights email, which delivers Expertly curated health IT news straight to your inbox. Sign up at thisweekealth. com slash news.

Thanks for listening. That's all for now