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Today on This Week Health. 

what happens the day when your institution does get hit in the cloud? Does the cloud vendor say oh here, you can continue giving your users access to the environment with limited functionality? Where does a cloud provider shut down the access until you have mitigated the ransomware attack or the     (Intro) security breach?  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. Clearsense, CrowdStrike,. Digital scientists, Optimum Healthcare IT, Pure Storage, SureTest, Tausight,, Lumeon 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's Newsday, and we're going to do something a little different. We have two people joining us from Pure Storage. We have Mark Dobbs, who is the Enterprise Imaging Global Director. Eric Nystrom, Enterprise Imaging Principal. A lot of imaging going on over there. Gentlemen, welcome to the show.

Morning, Bill. You guys seem to like nature backgrounds. that a company standard or are you guys actually in the... It is, yeah.

No, Eric and I have made it a mission to travel, right? So we go to all the shows internationally. And so some of those backdrops are when we fly in early on a weekend and we get a chance to do a little hiking.

But,

Eric, where's yours from? Oh, it's just in somewhere in Scandinavia with those wonderful red houses and grass on the roofs. So

seriously, it looks like a scene from The Hobbit. I mean, you got the grass roofs and the, it's pretty amazing. Uh, As people know, the Hobbit was filmed in New Zealand, and the landscapes are just unbelievable in New Zealand.

The Kiwis, as they say, right? The Kiwis. Yeah, well, talk to me about enterprise imaging a little bit. We had an AI... webinar yesterday and Lee Milligan joined us and he is formerly CIO for SimonMed and he was talking about how prevalent AI is becoming in imaging. I mean it's been growing over the years he said but it's essentially everywhere he identified a couple, I think 100 companies that are working on imaging in very specific spaces because you have to get FDA approval on it.

by disease code and that kind of stuff. So it's very, you can't just say, Hey, we're doing all of chests. You have to do chess for pneumonia and then get approved and that kind of stuff. I mean, what are you seeing in the space? What are you seeing in the especially with regard to AI and the imaging space?

Yeah, I'll go

first, Eric if you want to layer in. It's interesting, the market blew up, right? So AI and imaging is probably one of the areas that took the most interest, I would say, out of the gate in healthcare. And I think it's because, obviously GPUs can be used. So NVIDIA was really...

Focusing on the AI market space. And so people really needed help. There's a lot of reasons why AI is seen now, thankfully, not as a threat, but an aid, so some people call AI additional information out there. It's a new coining of it, right? It sounds less scary than artificial intelligence. And radiology has really been hurting for trying to find well, tool sets to keep up with the surge, right?

People are living longer, so we now have longer histories to read through as a physician. And you're having larger data sets, just like our TVs went from 720p up to now 4K. So the resolution's increasing. And, you still have the same number of hours in the day to read. So I think AI is now actually coming in to be seen more as an aid.

And enterprise imaging is just one of those areas where there's a definite need for that, I think, in

healthcare. What do you think, Eric? I mean, the data sets are so large and with so much data being generated, I truly believe that AI the diagnosis aspect of it, but it will also utilize when taking the load off of the clinicians and the physicians.

Yeah, he noted that at his previous employer, There were times where the queue had tens of thousands of images waiting to be read. And he said, that's daunting, but if you can have that first read done by AI, you can just escalate the ones that require additional looks. We have one, two, three, four, five, five stories.

Let's see what we can get through. Again, we're hitting all the stories you can find on our thisweekealth. com slash news site regardless of who they're from. This, the first one's from the Guardian and the Blackstone CEO, Steve Schwartzman accuses remote workers of lesser productivity and is saying that they don't work as hard.

That's a direct quote, by the way. Remote workers do not work as hard. And I love the headline is Remote workers don't work as hard says head of the world's biggest commercial landlord. Yeah. It's like, come back into my buildings. I need more money. Yeah, exactly. A lot

of irony there.

I actually take that as an insult in a way.

I mean, I've been working from home for 20 years now, and the biggest complaint from my family is that I work too much. The problem is essentially stepping away from the desk or stepping away from just taking that quick call or doing that quick email that I have to get out because my workstation in my office is right there at home.

So... I would highly disagree with that. Now, I'm sure there are, we hear, the water cooler talk and it's better when you're in the office together. And for some lines of business, maybe that is so, but where I sit in this world of enterprise imaging, I've worked in support implementations.

architecture of systems. So, I find that interesting, but I agree. I mean, if he has a bunch of real estate, that would make sense, right? If

I had a bunch of real estate, I'd be doing these articles all over the place. let me give you the handful of use cases where, by the way, I think we're working through these things.

We've had people... Turn up working for multiple organizations like they literally were full time employees This happened with Epic Analysts. They were like, hey, I could probably handle working for XYZ Health System and this health system and get paid twice the amount of money that guy caught Predominantly because Epic can see it Right.

So Epic has visibility into what's going on. but regardless, I think some of the areas where it sort of falters is onboarding. Onboarding takes a lot longer. We're currently onboarding a new staff member to our organization. And if she was sitting outside my office. We'd have conversations, likely go a lot better.

I will say that there's personalities, and I've talked to some of these people that are like, I'm like, why are you going into the office? They're like, I have to go into the office. There's too much chaos in my home. I have to, I just can't do it. And then there's other personalities, quite frankly, that needs somebody to look after them.

Like if you just leave them in their home they're going to struggle. Now we're disciplined. We've been doing this for many years, but you have to admit there's people that, If you gave them sort of the run of the place, they would they'll go shopping in the middle of the day.

That's

right. Binge watching Netflix, just on the couch, waiting for a call, right, to do action, to do work.

figuring out what this looks like. Yeah, exactly. I think that's

Man, we got to get our employees back in office. It's funny. You see, like when Apple says something, right? Then Google says it and they all follow suit.

Isn't that amazing? So Silicon Valley the banks JP Morgan and others are saying, Hey let's get back in the office. Amazon recently. I mean, their distribution and stuff has said, Hey, three days a week, no excuses, get back in the office.

And I think maybe

that'll be another rebound. Maybe in a year from now when we're talking with you, there'll be a new article that says we're forcing people to take two days at home. Like, who knows where it's gonna land. But you're right, there are people, like, think about when you're working out, right?

Some people have to be in the gym with people. Motivating themselves, challenging themselves against other people, right? So that's that in person spirit that you can't get. But there's others. That are fully self motivated, right? Or self disciplined, is probably really the, like, with that work ethic you talked about.

But anyhow, it's just, we keep seeing these articles and it's just quite comical how it's like a hundred percent or zero percent, it's like there's little in between and as they're slowly marching to more days back, really it's to get back to a hundred percent. And I don't know if the body of employees in mass would agree with that.

I also believe there's a lot of new companies that have been started since COVID or after COVID. I have a friend of mine that's the CEO for a company where they have no office space whatsoever. They're all remote employees and they use remote chair office spaces when they get together and meet.

And I think that it comes back to what Mark said, if you structure it properly, from the beginning and set the expectations, two days, three days, or one day that we meet together as a team, then I think it's okay. But of course, there are horror stories also, right?

Yep. Hey, perfect word, by the way, expectations.

That's the key, right? So if you're hiring somebody to set the right expectations, hey, we're three days a week. I don't think anybody's going to complain. They're going to say three days a week. Fine. As long as I have to get those two days, it's what we're doing to existing employees, I think that's creating this backlash.

It's like, Hey, you're in the office every day. Pandemic hits, Hey, you're home all the time. Hey, now we want you to come back. Hey, we're now defining a new policy that looks like, and they're like, well, just pause. Yeah, exactly. Can we breathe, and I think there's going to lead to some turnover, but let's take a look at the next story, because I think this one's interesting, too.

Oh, there's our turnover. Exactly. CEOs are leaving their job in record numbers in what the Executive Suite version of the Great Resignation. I've seen this talked about in a lot of different ways. One was, they helped to get through the pandemic, and a lot of them stayed on a little longer than they were going to help their companies get through the pandemic.

And now they're just experiencing burnout and other things. It's, uh, it's a hard job. Well, we always knew it was a hard job, but evidently it's leading to people leaving at this point. Does this surprise you? Are you seeing this?

Little tongue in cheek, right? The two contradictions of those articles, it's like everybody get back to work But they're like we're burning out.

We're out of here. Like we're done with this place, you know So not necessarily in that manner. I don't mean that you know with levity, but yeah, And it's saying that the tech industry and particularly I think it mentioned that the government side of things was those types of roles so CEOs and Governments and the tech space were of the higher turnover here.

There wasn't it said there wasn't reasons given for some of the other industries, but yeah, burnout was mentioned. Right. And so, unfortunately burnout can come from many ways, many different things. what my just two cents is, as you said, Bill, like expectations and then figuring out how to work now, say post pandemic.

I think it's going to be the balancing effect. Companies probably helping find ways to figure out what those, like, what you as an individual employee value for balance of work life. And can you be remote or do you need to be an employee that identified as someone that's better suited in person?

And same thing, maybe the CEOs are just not able to control that or see that or don't want to make that commitment to ride this out, right, to see that through, because it is turbulent.

Well, I mean, also to that point, I mean, it could, you could say, out with the old and in with the new, and maybe the newer CEOs coming in are more open to, remote work versus the older ones.

Because if you look at the articles, the comments of, we need to get back into the office, or we need to take, bring them back to the water cooler, is primarily coming from the older CEOs out there in the field.

Yeah I, by the way, I think this is going to continue because we are, first of all the pandemic was the start and maybe a little before it of an economic slowdown.

And so being a CEO in an economic slowdown is challenging to begin with. And then I was talking to a startup CEO recently, and he was sort of pining for the days when he can be a snow bum and just go skiing because he's like, every day, it seems like I'm just raising money. It's like.

Just keep raising money. That's the job now. And it's not, in fairness to them, it's not what they signed up for, but it's world that they've inherited. And then the other thing is we have a transformation that's going on with AI right now. I think that is going to wipe out a series of CEOs that just aren't, they don't grasp it and they don't understand how much it's going to transform their business.

And as it's transforming their business, I think there's a bunch of them are just going to throw up their hands and go, Oh my gosh, this is. This is insane. Yeah, it's a good point. Actually, Eric mentioned

something that stuck with me, early when I got into the medical imaging world, I remember that a lot of the people that I was training at the time were basically almost afraid, Bill, to touch the computer and mess things up, right?

Because when they started getting used to technology, and I think this is playing a factor mentally, right? Just so if you guys follow me through. So I would have to train people and they go, listen, we're afraid, being a little bit older, we were doing the computers and putting in the system, putting in the paper and the punch cards and things like that to basically get an output.

But if we did it wrong, it would break. Like we physically would break the device. He's like, so we're afraid of breaking software now. We don't know, we don't almost trust it. It's like this, it's a one way portal, right? I give it input, it comes back. And I think that mentality of like technology is something that still is hard to put your hands around and you go from a mentality of learning how to use a computer for the first time to now like trying to figure out how to wrap around AI and chat GPT as it invades even your employees being, leveraging those tool sets.

It's probably hard, right? How do you trust it? That, you're getting the output that you're paying your employees for at the end of the day, right? The performance and the expectations kind of line back up. So yeah, I think Eric's got some point to that. But age doesn't necessarily mean, we're not saying that, like, older people generally can't adopt, right?

That's not the case. It's just that maybe the mentality, the general consensus is how you came up with it.

I'm getting older and there's some things struggling to adapt to, but Eric, I want to come to you on this next story, cloud security and health IT challenges, opportunities, considerations.

And I may not go into the story as much as recent conversations CIOs. They are concerned about the rising costs of Contracts and so every vendor out there has gone to a subscription model for software and other things and whatnot and cloud is no different there's a everything you do in the cloud is essentially per user per month per whatever per month and I'm wondering obviously, we're seeing workloads move out to the cloud. I'm wondering if we're going to see workloads come back because of that licensing model, or if the licensing model is following suit in the physical data center as well. I

mean, even when it comes to security, I have, problem with it. And I...

I strongly believe what you are saying. We are seeing a migration back on prem for those reasons. For rising costs, costs that you can't really control. Also, environments where you can't really manage the environment as your own, right? So, when you go up in these clouds, just because you're going into the cloud, that doesn't necessarily mean that you have the same cybersecurity protection that you had with your on prem environment.

And the question that we... Talked a lot about, actually, Mark and I is, and we haven't seen it yet, but what happens the day when your institution does get hit in the cloud? Does the cloud vendor say oh here, you can continue giving your users access to the environment with limited functionality? Where does a cloud provider shut down the access until you have mitigated the ransomware attack or the security breach?

So, I honestly believe that we're going to see for certain workloads and costs, specifically imaging, right? Because the imaging sizes are just growing and growing. And Mark and I, we just came back from a digital pathology. trade show. And, we're looking at data sets there and they're running into the multi gigabytes, right?

And now we're talking massive egress fees and ingress fees. So,

I remember going from megabytes, uh, to gigabytes. And I thought, Oh my gosh that's massive amounts. And then You know, then gigabytes to terabytes, I'm like, oh, terabytes. What are we talking about here? Now? We're terabytes to petabytes.

What's after petabytes? Is it exabytes? Exabytes are, we're not seeing that yet, are we? Yeah. Yeah.

Well, yeah. Outside of healthcare probably there's probably not an individual healthcare institution or IDN perhaps that has. There may be for all we know, but I don't think we're quite there yet.

And if we can, is the cost worth it? If you go, you got to really think again about IT and where are you going to put your data? Probably more so than you thought you would, right? I think people are looking for cloud as the savior to remove all those obstacles. But I think that you've got to put a little bit more scrutiny and calculus on just how you're going to use that data to determine

where you're going to place it.

I mean, especially with imaging, I mean, it's basic math, right? Bandwidth, latency, packet size, right? And that will never go away. And the connection to the cloud is not necessarily the same connection that you have to your local data center.

Not yet. Yeah, hopefully. I mean, I can't even imagine. But do you guys see the story where the...

CISO for SolarWinds has been named in the SEC investigation, essentially as culpable, because he was hiding facts about their security posture. Oh. Didn't see this. Yeah, that's that's an interesting one as well. And a cautionary tale, if you will, to, if you're a CISO and you see things, my gosh, put it on a slide deck, put it in emails, get it out.

Somewhere, right? Document it. You don't want to be standing out on an island when something finally goes south. We have the story of a bridge raised 30 million. There's a belief that it is very difficult to raise money right now, but I'm seeing companies raise money so that there is money to be invested.

And they are looking for companies that have a strong value proposition a path to profitability that is near term not far term. They're not looking at growth at all costs. They're looking at well run, well managed organizations with a pipeline of sales that are actually closing sales today.

I'm curious, you guys read this story. I mean, what are your takeaways from this fundraise? ,

I find it. Interesting, right? And I found that article very interesting in the sense that they created the product for the patients first, right? It was created as an app where patients could walk into a doctor's visit and it would record the whole conversation and then translate the words that the patient didn't really understand, which were more doctor lingo, right?

And now they've taken this application and they've given it to the physicians to record their doctor notes and speed up their time that they're spending with the patient and creating the notes. I think that companies like this, we will see, continue receiving funding because like you said, they have a specific outcome and they have a product and they have a solution for a problem.

For products where, you know, like we saw early on, even early on in the dot com, PizzaBoy. com was funded millions and millions of dollars, and of course it just went away because it was not something that was a need for, right? But here we have a need. So I strongly believe that the AIs and the technology where we see an outcome and where we solve a problem, funding will continue.

This one's interesting to me because this space is getting commoditized. There are open source models out there today that you could do dictation at a pretty high rate of accuracy, and there are also obviously ChatGPT and others. There's also models out there that can take that dictation and summarize it really well.

Summarize it to the point where it can become a perfect soap note. And I've seen these startups, because I get called in to take a look at him and I bring clinicians and they go, Yeah, that's great soap note. And but the reality is I was talking to CIOs. They're like, man, these companies are popping up all over the place.

And they're excited about it because this used to be a technology that was cost prohibitive. They used to have to select just a handful of doctors or this percentage of doctors. And their hope is that because this technology is proliferating and being commoditized that they're going to be able to give it to all the doctors because it's, in their estimation, huge satisfier.

People are very excited about the technology and what it can do. Not only on the clinician side. But also on the patient side, because, we've used chat GPT and you just say, Hey, put this in a level that a patient would understand. Someone who didn't graduate. From medical school would understand and it can write the summary for the patient in that language.

Yeah,

in a more layman's speak. And that's what I liked about this one too because the net result of this, like you said, Bill, this technology leads to the physicians being able to engage and face the patient. Like the three of us are looking at each other on the Zoom screen. This type of technology brings the doctor back to observing the patient.

And so I think that there's, that art was lost when we went EMR, Meaningful Use Days. I'm sure you were there, Bill, for Meaningful Use. Probably the best time of your life there, right? Wow, that

hurts. Stop bringing that up.

I like this. And I think that as this evolves, maybe this is a weird way of saying this, right?

AI brings more of a human Effect back into the treatment of health care. And then it normalizes it, like Eric was saying, and you were saying, so the patients will understand the output. Maybe that encourages this reciprocity effect, right? For patients to continue to find medical treatment.

Well, to that point, the other article that you had from Nature, which talked about researchers using ChatGPT for translation, for emails and communication, and I can actually relate to this.

I'm naturally born in Sweden. But I didn't continue my education in Sweden. So for me to write business type letters in Swedish on an English keyboard is interesting. So is actually fantastic for, translating from English to French or English to Swedish or English to other languages.

And just like that article. spoke about in the Nature article. Here we see this is happening with clinicians and doctors in Japan speaking to clinicians and doctors in the United States, for example, where they can speak in their native tongue and then have it translated.

Yep, absolutely. Gentlemen this was fun.

Man, having more people talk about the news is a lot of fun. So I I really appreciate you coming in. I appreciate the work that you're doing. Over at Pure and yeah, I look forward to catching up with you guys again.

Likewise. Thanks, Bill.

Absolutely. Thank 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.

Cedar Sinai Accelerator Clearsense, CrowdStrike, digital Scientists, optimum, Pure Storage, Suretest, tausight, Lumeon, and VMware who have invested in our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.