March 6, 2023: Bob Klein, CEO at Digital Scientists, joins Bill for the news. Healthcare is struggling financially . With some having 20% budgets, CIOs need to have greater access at a much lower cost per touch. How can we reevaluate our architecture and decide what is actually generating ROI? Can we save rural healthcare systems from the financial crisis? How can we combat the rise in labor and supply chain costs? How can hospitals continue to excel when we are running on low-power mode?
Healthcare needs innovative ways to address staffing shortages from clinical to IT employees. Are you curious about how technology can help support your Healthcare staff? Join us on our March 9 webinar, “Leaders Series: The Changing Nature of Work,” to explore how Health IT can be used to supplement Healthcare professionals https://thisweekhealth.com/leaders-series-the-changing-nature-of-work-remote-hybrid-onsite-shortages/
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Today on This Week Health.
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.
(Main) 📍 All right, it is Newsday, and today we're joined by Bob Klein, c e o of Digital Scientists. Bob, welcome to the show.
Hey, bill, great to be here. Thanks for having me.
First time on the show, I'm looking forward to the discussion and the conversation. Give the audience a little idea of what digital scientists is about.
Well, digital scientists, we refer to ourselves as a product strategy and development firm. We're really all about improving the provider and patient experience. So that involves essentially either helping firms, health organizations create new capabilities or actually launch commercial products of their.
So, we're a team of roughly 30 people that are a mix of design development and product management. And we also leverage nearshore resources as needed. But we're kind of a group of Makers Bill, and we like bringing new products to life and there's nothing that gets us quite as excited as building things that create utility and help the delivery of care.
It's interesting. Last week I was in a room with a bunch of CIOs and we talked. . There was a time where healthcare CIOs got rid of their development staff. Like we used to have large development staffs. And there's this move back towards filling the gaps with building out experiences that are specific to our clinicians and specific to our communities.
And when I ask them how are they doing it? They're not building up their staffs again. They're coming to firms like yours and saying, Hey we need to find a partner. that could meet with our clinicians, help us through the entire life cycle, from ideation all the way through development, delivery and support.
I think that's one of the things people forget is once the software's out there, it's not over. It's just beginning.
Oh yeah. I think It's a big part of what we do. Sometimes it feels like, some people refer to it as build, operate, transfer, but it's, or co-development where there are a lot of smart people and have a lot of good ideas and there are a lot of lessons learned.
And the providers, they're kind of wired where they want to solve their own problems. And honestly, the IT architecture that exists can be a little fragile or rigid. It's hard to solve the problems. I talk to frustrated providers and pharmacy and elsewhere where they're not necessarily happy with their own visibility or their ability to innovate, inside the four walls of the hospital.
And those are the us, the folks that we're trying to help, but it's very important to leverage the expertise. It's inside of IT. To your point, I think they need to evolve to be, they're not necessarily just a maintenance organization or support organization. Applications like Epic, Cerner, point, click Carrier, and the like.
Right. But there is a willingness to start to build their own, solve their own problems. And it's very different than things were 10 years ago. Right? And not everything is so difficult to do anymore.
Right. We can spend a lot of time on this but we're gonna get to the news, so, okay.
I'm gonna stay with software. I feel like I'm playing Jeopardy software for a hundred. so there was a LinkedIn post and it's tied to an article and the article is behind a paywall Twitter cuts Salesforce bill by 75%, as more buyers scrutinize software spending.
And I'll give you a little from the article, but the post was interesting as well. So Heymont Ramani said firstly, I don't understand what Twitter was doing with 20 million worth of salesforce.com software. Secondly, speaking to customers in the last six weeks, I am clearly seeing a pattern of overbuying software now expensive software that there is a mandate from CFOs, CTOs, CEOs, as well as CxOs From SaaS apps to platform consolidation. Now it's the time to do this once and do it right. Look at the licensing and so forth in the article. I mean, 20 million worth of salesforce.com, and they cut it by 75% down to 5 million which was a pretty, pretty big cut. The healthcare struggling financially right now.
I would assume that all of these things are gonna get a complete and thorough looking at I'll start there and then we'll go into how we do that.
Well, yeah, the I think that's what's really hard about the healthcare CIO's job where these days with the cost
nursing and it is an expense item. They're facing some red ink and they're gonna get some cuts. And so, there's part of this theme of over time, over the next five to 10 years, you're gonna have to do much more greater access at a much lower cost and lower cost per touch. And so there's nowhere to run.
But that means every year you really need to rationalize the architecture that you have. So there might have been decisions. made 10 years ago, who knows how long where you've got this application. You've gotta make sure that it's gonna support your needs today and tomorrow so the C I O has to architect, the vision for tomorrow, but still support today.
I work with a client and I actually, we replaced Salesforce, turned it off, took us six months, and they haven't looked back. And honestly, it wasn't a fit for where they were going. I'm not sure it was implemented. Well, I don't, I don't know everything, it was happening, but there was rigidity.
They couldn't change their workflows, honestly. They hated it, but, Salesforce is a very nice product. , right, is a good fit when it's a good fit, but it's not a fit for everyone and it's not a fit forever. So for other applications like Epic and Cerner, I mean, those things aren't going anywhere, right?
Those are gonna be longtime, parts of the architecture. But I think for most CIOs, you've got a question. How long is something gonna be in the architecture and do you need it? And yes, all those third party applications that are set up to charge you for every license, for every seat forever.
And I don't know. I think you have to rationalize that every year. And it doesn't surprise me. The licenses and the like. People lose track of that. It's like, oh, we've got 500 licenses and we're just gonna renew. And it's more important to decide, is this generating ROI every year?
Is this worth it? Every year in a way you've already. Expensed or amortized the implementation cost from five years ago or 10 years ago, and I need an ROI every year or otherwise. Why? Why do I have it?
That's an interesting approach. Essentially, bring the team together and you get the nail on the head in that, in healthcare these numbers are getting more and more vague as I get older, but I know we had 900 applicationsand:nd it was like that old skit.:
And depending on. The appetite and the governance and all that other stuff, a lot of software gets in there. It would be interesting, though, to set up a group and say, okay, here's what we're gonna do this year. We're gonna go through all 900. Contracts that we have, and we're gonna do this analysis.
We're gonna determine what parts of this software we are not using. Yeah. It was amazing to me when I came in and I did an audit on one of our product groups, happened to be Microsoft. I'll go ahead and say it. Microsoft could get mad at me. . But I looked at it and I looked at what we had contracted for and what we were actually using.
I'm like, why have we paid for all this year? And the group came back and said, well, we plan to use it. We just never got to the implementation. . I'm like, all right, well you just spent a couple hundred thousand dollars on something we didn't use and we could just as easily have called Microsoft in the middle of the year and said, Hey, we would like to do this.
And I'm sure they would've turned it on for us.
Yeah, I mean, there's room to negotiate with these SaaS products. They're not there forever. You can turn 'em off. You can turn 'em on. Right. It depends on the level of customizing and honestly, for a lot of organizations, The customizing makes it rigid.
And to innovate, to create, let's say health at home workflows. These are completely new, so they have to extend, otherwise they're in the way. And if they're in the way of doing something new, you have to question like, well, why do we need it? Or maybe we don't need as many licenses after all.
I'm usually trying to decide the organization's maturity and readiness to build, solve some of their own problems, bill, and they understand the shortcomings of what they've got usually. Yeah. And. The point is that they can't get in the way, and for this client, it wasn't necessarily the license cost, it was more of the solution provider.
The product wasn't all, it was cut out to be, they weren't using all the features and functionality and they just said, we don't need it. But they didn't.
So talk to me was easy. What was hard? Talk to me about architecture. So it's interesting, the life of a small business owner, which is what I am.
I launched QuickBooks Online. . It's integrated with our benefits. We're now an open enrollment. Me, I kicked off the open enrollment just by clicking a couple buttons and hitting. Everybody got their emails, everybody's filling out their stuff. It's going back into that. I then sent out four or five contracts all from DocuSign.
And that's integrated with Zapier, which is integrated with our Google Docs and Google Sheets. It updates, where we're at with every client. Have they paid their bills and have they, all that stuff. And so the team has access to everyth. . And I think about it, I'm like, to a certain extent small businesses have more automation, integration connectivity than some of these large organizations who quite frankly are spending gobs more.
It's the interoperability challenge, right? So for health, it, sometimes I tell a story about building a 20 room house, one room at a time, and they can't connect all the dot. The integrations are terrible or they don't exist. So I've chatted with folks in pharmacy, they're like, well, we can't even see our own data inside the hospital.
And they're not in line to get anything new I talk to a lot of providers and. there's a lot of shopping that's going on, where get pitched a lot of products and things like that, and they're ready to both build and buy and to rationalize within what's in their architecture, but to come up with the solutions and think about what's differentiating for themselves.
And there is this fundamental shift from it being a cost center to it being a profit. And that's a major paradigm shift where they have to be involved in the delivery of care and not just the recording of the delivery of care. Right. And this is a challenge to all the applications.
They have, the mindsets around it and they're just a very different approach to it. Where for some of the smaller hospitals or folks that, buying these SaaS products is really the best. To get started, but to talk about small business. Yeah. We have to be nimble. You know what it's like.
Yes. And it's not inside a regulated environment and you're not as worried about some of the things around privacy and security. But I mean, you are. But there you're trusting some of these integrations to work. Right. And they're not flawless necessarily, but I think just as a side note, I went to HIMSS last year for the first time, and I was taken back when I heard somebody say what they liked about Covid, and this was somebody like an IT administrator who. We were allowed to fail or we weren't required to be perfect. Like everybody was under pressure and they were allowed to fail when they were coming up with things that were new and Covid was what was driving that.
And they liked the comradery and the idea that if you do something that takes two weeks or four weeks to do, you're not assuming this level of polish and perfection on everything. And it's a stressful environment to work in.
Yep. No I agree. The the number one thing I heard from IT professionals that the silver lining of covid was focus.
Right. So everything else fell away and they said do this, and they did that, do this, and they did that. Now we don't have that luxury in our lives anymore, but yeah.
if you have yet to hear, we are doing webinars differently. We got your feedback. You wanted us to focus on community generated topics, topics that were relevant to you in your role. We have gone out and gotten the best contributors that we possibly can. They are not product focused. They are only available live.
And we try to have them at a consistent time, the first Thursday of every month with some exceptions. And the next March happens to be that exception. March 2nd, I'm on vacation. So March 9th is going to be our next webinar, March 9th at one o'clock Eastern Time, and we're gonna do a leadership series on the changing nature of work.
We're gonna talk about a couple things. One is the remote distribution of health IT staff and what we have to do from a management standpoint in that regard. We're also gonna talk. The lack of staff specifically in the clinical areas and technicians and whatnot, and what the role healthcare and technology in particular is gonna play.
With regard to that. Love to have you sign up. Our first two webinars for done this year have been fantastic. Over 200 people signing up for each one of them, and we expect just spending for this one. This is a great conversation. Great panelists. We have Tricia Julian Baptist Health System out of Kentucky.
Will Weeder Peace Health and Andy Crowder with Atrium Health are going to join us for this discussion? And I've talked to each of them about this topic and I love their insights and look forward to sharing 'em with you. If you wanna sign up, hit our website, top right hand corner. We always have the next webinar listed.
Just go ahead and sign up, put your question in there and we'll incorporate it into the discussion. Look forward to seeing you then. 📍
📍 Alright. So. Let's go to this one. Dartmouth Health, c e o, rural healthcare at a breaking point. And this is Joanne Conroy, Dr.
Joanne Conroy, c e o, president of Dartmouth Health, and they are in Lebanon, New Hampshire. And I've been there. It's not a very big place. American Healthcare was in crisis before the pandemic. However, based on what we need, we are now seeing, especially in rural hospitals and health systems, the worst may be yet to come.
Our rural health systems and healthcare systems continue to lose money. Many think the pandemic is over, but it's not. We have a lot of things R S V and other things still coming through. In addition to the increased demand caused by the Triple De, we have ongoing workforce challenges and we'll do another story on that.rural hospitals closed. From:
And it's not necessarily the hospitals themselves, although they are impacted. It's the post-acute care facilities. And these hospitals have nowhere to discharge the patients. . And that's becoming a problem. So, they just talk about we have a crisis in our rural hospitals.
If our urban hospitals are barely breaking even right now the rural hospitals are really taking a beating. She has some things in here in terms of we need to update our training models. We haven't done that in over a hundred years for physicians. She's looking to congress to extend some benefits in that and to keep an eye on the rural healthcare and the gap that's starting to be created or in, in rural healthcare.
Do you think we're seeing right now a fundamental shift in. how we deliver healthcare. Is this like the seismic shift that we've expected for some time? That when we come outta this, five years from now, how we deliver healthcare, how we receive healthcare will look fundamentally different?
I think so. I mean, I think you've got acute care, ambulatory and at home, and this is the challenge of extending it, beyond to people's homes. I can't I'm not ready to do whatever. An appendectomy in your bedroom. But this idea that the hospitals the health organizations have to ex extend their services into people's homes, right?
And they've gotta be able to support that as and to provide access. It's just not the way that they're set up today. And telehealth has been tremendous. I mean, it's been a great way to improve access. It's not perfect by any means, but I see all this fill in of telehealth. To provide that access.
And we actually do a good bit of work with post-acute care for, whether it's long-term care or skilled nursing facilities, things like that, where you've got people think of telehealth as, just doctor patient. But I could have staff member. Provider onsite, I could have specialists offsite.
This whole need to bring the right people to resolve a patient problem wherever the patient is. In a way, it's this hybrid challenge. I've got some folks on site and some folks who are not. But I've gotta bring them all together in a very efficient way at any time of the day to solve a problem with a patient.
And I'm not gonna have 'em all in the same place. It's just not gonna happen, so, it's not perfect. I have questions about what's gonna happen with like, regional hospitals, is it mass General Brigham, or, if I think about some of the brands that matter, Whether it's Cleveland Clinic or Johns Hopkins or Mayo or whatever, the big regional hospitals that are, that have brands that, healthcare is not just the four walls of the hospital.
It's a trusted brand of folks that you think they're gonna take care of you and have everything from acute to ambulatory to at home services. Yeah. So, I don't know how to. For Lebanon, New Hampshire, we have the same problems here in Georgia, where in South Georgia most of the hospitals have been closed and there's no easy answer.
To for access, but we've gotta do everything we can. And a lot of it leverages technology. Technology is the leverage. I don't know what else there is to help improve the access, but yeah.
Yeah. I Isn't Georgia's plan just to extend Atlanta until the whole state is Atlanta? Yes.
Yes. Don't tell South Carolina or Alabama.
Right. So, and I think we got issues with, water coming to Florida too, but that's a whole nother story. .
Yeah. I think we're gonna start looking at this as a healthcare supply. The brands are gonna win. Yeah. The, the Mayos, the the New York Presbyterians, the just the brands the ones, the Cedar Sinai and the others that are out there, Cleveland Clinic they're gonna win and they're gonna be.
On the acute care side, they're gonna be that brand that you're gonna want to go to. And you're gonna see payers and things start to be navigated towards, Hey, if you have cancer, you're gonna go to MB Anderson. You're gonna go to Moffitt, you're gonna go to City of Hope. . But if you have, some other diagnosis, you might go to Rochester cuz you know what the cost of a flight.
400 bucks round trip and you get the right care plan and whatnot. And then you just have this supply chain that leads up to it. And we'll have telehealth providers, we will have at home providers as well. I think most of the major IDNs have to make a strong push. To home health. I mean, I know they're looking at it, but they have to get serious about it.
They have to build out the experience, the software. They have to build out the delivery capabilities, cuz it's different than what they've done. And then I think they have to start rationalizing the campus infrastructure. It's too expensive. They have to rationalize their service lines, obviously, across multiple locations.
We did this in Southern California. We had things that were, I don't know, 10, 15 miles from each other. , and we had these really expensive service lines in three or four hospitals and it was really hard to rationalize him. But we had to like it didn't make sense that, hey, look, drive 15 miles and you could be over here and you get the same level of care, if not better level of care.
. We don't have to have all the services in every community, and I think we're just gonna see this supply chain, we're gonna start tapping into the academic medical centers in rural locations through telehealth and through some other aspect. I always say these things too quick.
It won't be five years, but 10 years from now, I'm not sure we will recognize healthcare as we recognize it today. Two,
two things. One seems to be, ambulatory care. So how do I do more in these outpatient centers? That are in, can be stood up in South Georgia. So no, no acute care or no hospital.
So not there. The other thing is probably going to be as well we need to empower pharmacists, right? So the pharmacists that are frontline workers that are working at the C V S Walmart, wherever and are trusted, and they don't have the tools that they. To do more because for a lot of people, the uninsured, underinsured, the pharmacist at your publics or the cvs is almost like part of your family because they dispense great, good advice.
They're very close to, anything that you're working with. But from what I've seen, they don't necessarily have the tools that they need to play that role. And again, I think that's a lesson learned from.
Yeah we have two stories to end. I'm gonna let you pick it. So we have an interview with Northwell, c e o which is Michael Dowling, who's always interesting.
And we have this this article from jama. About the existential threat of greed in the US healthcare. So those are your last two articles, and we're not gonna get to talk about 'em much, but which one of those would you choose?
I guess maybe the one from the Northwell ceo. The other one. I think we, we should do it.
Happy hour Bill . I know it,
it's, it is a alright I'll give it the two seconds and then people will understand this is not a quick conversation. But essentially they talk about greed and all aspects of healthcare. And then they come back with their recommendations. Healthcare professionals, and all disciplines need to become noisier about the conflict between unchecked greed and the duty to heal.
Silence is a scent. Second healthcare professionals should. That their guilds and traded organizations demote the pursuit of higher payment. Third, healthcare leaders and professionals should lobby Congress to pass legislation reign and greed. And fourth, healthcare professionals should insist that their organizations invest actively in improving true social influences of health.
And so you just get the tone and tenor. Of this JAMA article, which is essentially, Hey, there's a very real problem here that we need to take on. I'm throwing that out there just so people understand. It's an interesting article worth a read. And if you see either Bob or myself at five or hymns we'd love to talk to you about it.
I think it's, I think it's important to always put the patient needs first. And I think that some of the fundamental conflict for providers is they wanna put the patient first, and that's the do what's right for the patient. And then you always have to look for how do I justify the investment?
How do I make sure there's a return? How do I ensure the kind of, Financial stability of the organization that I'm in. And for everyone I've spoken . To that's on the provider side of the fence, I think they do that, but it is a conflict that they live with. Yep.
It's, and they talk about pharmaceuticals and other aspects of it.
So Michael Dowling, well respected, c e o Northwell 83,000 employees New York City and suburb. Of that was interviewed by Beckers. And he talks about the margin dip and what they can attribute that to. And it's essentially labor costs is the primary one.
And secondary is just supply chain costs and increased. And he talks about labor costs biggest opportunities to reduce expenses and increase revenue to offset labor costs. This is an interesting answer. Curious your thoughts on this Combination of a lot of things. We have a detailed capital plan.
We may slow down. We hire about 300 people a week, so maybe we'll target that hiring into specific areas and not be as broad based as we thought we could be. We'll examine if we can have specific programs or initiatives we can curtail without doing any damage to our mission. It will end up being a portfolio of items.
It won't be just one big thing. On the revenue side, we're working very hard to increase our neurosurgery, cardiac cancer, and orthopedic business. Over the next couple of months, all of these things will be taken into consideration. The bottom line is we are going to come out of this winning. Yeah. It's one of the things we don't talk about all that much, but he rattles off the places that.
Health systems make money, neurosurgery, cardiac cancer, orthopedic business. And so you grow that and you curtail some of the spending, and that's how you get through this. What are your thoughts on this? How are health systems gonna get through this challenging financial time?
The internal staff needs leverage.
Any better tools, better insights, more transparency into what's actually going on. There are cool things out. I follow. One is like this sense of a, like a hospital command center, a digital hospital in a sense where it's kind of like an industrial engineer's take on hospital focused on throughput and efficiency.
What are the blockers like? How long do people actually, take in terms of when they show up versus when they're gonna leave a little more rigor of creating efficiency inside the four walls of the hospital. Then there's also challenges with the handoffs. It's funny, I worked with Novant Health, really nice group of folks in Charlotte. And they're just the challenges, let's say between pharmacy and nursing, we're, we have a real problem. It's gotta be a better job. So the tools have to do more to support the people that are working inside the hospital.
And I think that's where the current form-based tools from Epic and others fail. Like, they're not enough inside tools. There's a heavy cognitive load. They're burning out. And so yeah. This almost sounds like something you'd tell Wall Street, this CIO and maybe things look that good.
I talked to some folks that they're saying it's taking a 20% cut this year, budget cut 20%. And I'm like, that's gonna hurt. That's gonna hurt in terms of care, delivery of innovation, problem solving for tomorrow. Because that becomes just, hold on. Right. Put your head down, but that's how a line item gets treated.
So the CFO tells the cio, you're gonna take a cut and you're gotta deliver more. And so I think the key is how do I get to automation? How do I get leverage for the staff who's here without burning them out? Where a lot of the, today's, the processes and the. Aren't helping them enough.
They help some, and I think that's the demand. I think the cio that's what they're gonna get. Yeah, because they're the architects of tomorrow. Workflows and processes and tools, people look to the cio.
Great. Architects of tomorrow sets me up really well for this.
I talked to one CIO who's getting one of those 20% cuts. I said what's your plan? So we're gonna go into low power mode. Essentially when your phone batteries down to 10%, you just Exactly. Just keep it running. Is the approach. The problem with that is the architect for tomorrow would be looking at this saying, look, We have to fundamentally improve the efficiency of every aspect of our chain, right?
The intake of patients, the movement of patients, the optimization of our ORs, the areas where we do make money. We have to diminish the areas where we are doing non-value added things. And so you are looking at things like I like your command center. That's a. Higher efficiency.
We're looking at computer vision and AI to replace nurse sitters to replace falls, hand washing, you name it. People don't like this, but you have to increase the numbers, right? So it's, more patients per nurse. Well, how do you do that safely and how do you do that effectively?
And it's with technology is how you end up doing that. And if you go into low power mode, It's fine for now, but five years from now you will pay for this. At some point you have to catch up because now whoever else is not going into low power mode, they've optimized those things.
They've gotten ahead of it. Now some people will say, look, it's just reality. You have to get there. And I would say, yeah, but you have 2 billion in investments. What do you have it for? If it's not for this time?
There's a lot of inefficiencies and some things are politically fraught on the internal, on the inside, so I've heard of.
Pharmacy and the nurses. And the nurses wait, hate the pixus machines, and they're, they've got errors there and duplicate entry. I joke and say like, there is no real integration internally. It's the nurses are the integration point.
The nurses are, and the patients are interoperability.
Yeah. So there's, the things that what everyone's learned to live with and it's not okay. When, it's gotta be a great job. We need everyone to stay and to make it better. So there's that process point and kind of reconnecting people where software or technology has to be the leverage for them
they don't feel like they're kind of slaves to it. I talk to a lot of people and they seem very frustrated with what they work with day in and day out. Yeah. And so there's enough there to build on top of and make things better. And I think that's kind of the charge.
Well Bob, I wanna thank you for coming on the show. Great conversation. I look forward to. Future conversations. I'll be thinking about specific articles I want to talk through with you. And I really appreciate your time.
Sounds great, bill. I really appreciate it. And if I'm in your area we'll take up that last article.
Sounds good. Thanks
Bob. Take care all. Bye-Bye.
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