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January 10, 2022: Drex DeFord from Crowdstrike joins Bill for the news today. Florida-based Broward Health announced that an intruder accessed its network affecting the personal information of more than 1.3 million patients and staff members. No matter how robust your security stack is, your organization can still be vulnerable to intrusions stemming from compromised credentials. Oracle acquires Cerner. What does this mean for the healthcare industry? 

And the 5 Tech Trends to look out for in 2022 are:

  • Digital Transformation Drives Chip and Software Production
  • Applications Get Dynamic 
  • Hyperscalers’ Continued Revenue March – Up and to the Right
  • A Changing Role for IT: Running the Business
  • The Talent War Goes from Lukewarm to Scalding

Key Points:

00:00:00 - Intro

00:04:30 - Today modern cybersecurity programs have to be built around speed

00:28:20 - In healthcare we have to figure out how to develop the muscle of coding again

00:31:00 - The world continues to grow and technology continues to change and things that we could only dream about doing literally 4 or 5 years ago seem pretty normal and routine now



Newsday - Oracle Acquires Cerner, Broward Health Breach, and Cybersecurity Possibilities

Episode 477: Transcript - January 10, 2022

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

Bill Russell: [00:00:00] Today on This Week in Health IT.

Drex DeFord: Today modern cybersecurity programs have to be built around speed and finding the bad guys fast and kicking them out fast and then sealing up the hole that they came in through. You can build taller castle walls and wider deeper moats. That's sort of an old version of cybersecurity, and it's certainly expected that you're still going to do that. But modern cybersecurity is about speed. And finding and killing off the bad guys quick.

Bill Russell: [00:00:30] It's Newsday. My name is bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week in Health IT. A channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH and Cedars-Sinai Accelerator, who are our Newsday show sponsors for investing in our mission to develop the next generation of health leaders.

A great way to keep up with all the things that's going on at This Week in health it is going out and following us on social [00:01:00] media If you want to know about absolutely everything we're putting out there Twitter is the place to be You can follow us at this week in hit thisweekinhit and you can follow me billrussellhit of course. And we're having great conversations happening over on LinkedIn as well. You can find us at This Week in Health IT. We are touching on the highlights of all the great stuff we're releasing. If you want to talk with me, we can connect on my personal LinkedIn as well at Bill J Russell. [00:01:30] I love having conversations with you and sharing perspectives and sometimes I even get to share your thoughts on the podcast. If you are more of a watcher than a listener, you can go over to YouTube. We post all of our shows there except Today in Health IT which is audio only of course.

Alright. It's Newsday. Monday. We do Newsday on this channel. And what we do with Newsday is we bring on various guests and we discuss the news. So if you're tired of hearing me just talk [00:02:00]about the news every day of the week, on Mondays you get to hear me bounce it back and forth with another person.

And today is one of my favorite guests. He's been doing this for a couple of years, Drex DeFord with CrowdStrike. Drex how's it going?

Drex DeFord: It is going great. Always glad to be here. It's always a ton of fun and I'm really, I'm excited to kind of see what's happening with you in 22. The expansion of the channels and I was watching yesterday. I saw you posted something with John Halamka and there's [00:02:30] nothing better than you and John Halanka talking about cannabis. It was really interesting. You weren't expecting that were you.

Bill Russell: Yes we do. We do a lot of cannabis talk on this show with us. That's our primary topic. No John is, John's great. He's going to kick off our keynote show. We're trying to elevate that show. Just 52 guests this year on the keynote show.

And we're trying to find people that you would go to a conference and expect on the stage for a [00:03:00] keynote. In fact, just before talking to you, I finished interviewing Aneesh Chopra and that was a phenomenal conversation. And I mean, we just have some great ones lined up. We have somebody from Amazon lined up for for the show, looking forward to that.

Well lets see when you come on we start by talking about cybersecurity in some way. So there was a breach. Let me find the story here. Talk about CrowdStrike for a second here, cause you guys are a [00:03:30] sponsor and I'm excited to have CrowdStrike as a sponsor because every time I talked to a CIO now, they're talking about the great work that CrowdStrike's doing.

Give us a little, little background on yourself and what's going on to CrowdStrike?

Drex DeFord: Sure. I feel, I've sort of talked about in the past being kind of luckiest person on the planet and I feel that way again having joined CrowdStrike in March as the Executive Healthcare Strategist. I was a consultant with CrowdStrike for four or five years prior to that, as they started to build out the healthcare vertical and the more [00:04:00] momentum that CrowdStrike got in healthcare and the more I saw how easy it was to deploy and how it actually just worked and saved a lot of time and money and energy, the more interested I became. And so when they came to me last year and said would you, I know you said you never would take a job again anywhere, but if you did, would it be CrowdStrike?

And so we figured out how to make it work, but, but CrowdStrike is a great set of products that really do work well together. And we work really well with [00:04:30] lots of other products that you may use in your infrastructure today around cyber security. That's really kind of the power. It's easy to use.

It helps you stay ahead of the bad guys. Which today modern cybersecurity programs have to be built around speed and finding the bad guys fast and kicking them out fast and then sealing up the hole that they came in through. You can build taller castle walls and wider deeper moats. That's sort of an old version of cybersecurity, and it's [00:05:00] certainly expected that you're still going to do that.

But modern cybersecurity is about speed. And finding and killing off the bad guys quick. And that's really what CrowdStrike's all about. We've stopped breaches.

Bill Russell: Let me ask you this. What should my expectation be of speed? One of the things I talked about last week on the today show was that we need real time, right?

So people are going to get in, they're going to start doing their nefarious thing. And we should assume that they're going to get in now. [00:05:30] But we should be able to identify that fairly quickly based on the activity. That's an anomaly on the network and based on the anomalies that are going on on the computer, itself, in what timeframe do you think?

Drex DeFord: Yeah. In so many different ways now we have 16,000 customers, I think around the world, not all in healthcare, but 16,000 customers around the world. And literally millions of sensors, little tiny pieces of software that are deployed on millions of [00:06:00] endpoints all over the world and all of that information is pulled into the cloud. And so CrowdStrike in a lot of ways is really a big data analytics company that happens to be in the cybersecurity business. And we have of course artificial intelligence, but literal machine learning, running on top of that database, looking for lots and lots of anomalies that may be happening on any of those end points.

And so whenever we find something happening on an endpoint, anywhere in the family, anywhere in the [00:06:30] world that immediately becomes something we look for on every other endpoint. And so this community immunity concept is incredibly valuable. The more people that are in the family, the more we're able to see and find things and, and kick out the bad guys quickly.

So a lot of the work that we've done, especially on the incident response side customers who aren't customers of CrowdStrike endpoint detection and response, or identity protection, for example, that find themselves in the middle of ransomware [00:07:00] event and are taken down and call out for help talk to their insurance company who tells them to bring CrowdStrike in.

We see through those incident response deployments that we do, that very often the bad guys are in the first machine and move laterally within about two hours. And so once you move laterally, once the bad guy moves laterally, that creates a situation where you're way more likely to have a breach, meaning data's going to be exfiltrated, you're going to [00:07:30] get ransomware or something like that's going to happen.

And so you have about two hours. And so through one of our products called Falcon Complete. I feel like I'm totally doing a commercial here, but

Bill Russell: It's it's going to be relevant in a minute. By the way, for everybody who's tuning in to say, are they going to talk about the Cerner acquisition? Yes. We're going to talk about Cerner acquisition, but, but go ahead. We're going to start with a cybersecurity.

Drex DeFord: Just think about it's gotta be within two hours, you have to find and kill the bad guy in under two hours. Sometime around an hour and a half [00:08:00] really or the bad guys is going to move laterally. And once they move laterally, it becomes a much bigger situation.

So through a product that we have called Complete, where we actually deploy our products, but we actually run them for you too. We have something called 1 10 60. And what we can do with that product is that our SOC looking at all of those feeds can see something suspicious within about a minute. And that's usually the ML identifying there's something. Within about a minute.

And then within about [00:08:30] 10 minutes, we do an investigation. That's really something weird going on, or that's a false alarm of some kind we'll update the ML and that'll help keep us on track. So one minute we find it. 10 minutes we do with the investigation. If it's something bad that's happening within right now, our average is about 40 minutes, 39 minutes, I think. We clean up the problem and put the device back in service. And so within 39 minutes, it's like nothing ever happened. [00:09:00]That's not a breach. That's not it's, it's literally just an incident and in the modern world of cyber security, that's how cybersecurity has to work because you can build walls to keep bad guys out.

But realistically, what have we seen in the last two years? Ransomware's up, I don't know, 600% in healthcare. It's a ridiculous, some ridiculous number that may not be right. Don't quote me. But it's up ridiculously which means taller castle walls and wider moats aren't [00:09:30] working. You have to be able to find them and kill them quickly.

If you can. You're good. You can do this 24 7 365. You're good. But that's a real hard model for healthcare organizations to build and run on their own.

Bill Russell: Yeah I mean, two things. One is in 2016. Deloitte brought in somebody who used to work for the NSA and she looked across at me and said, you need to change your thinking.

Your thinking should be there already in your network. Okay. Now, how do you defend? I'm like, and that changed everything in my [00:10:00] mind for how we do security. And that's what you're describing. The second thing is

Drex DeFord: This whole idea too around this is where ideas like zero trust or born from that you can't trust anything. You have to be looking all the time. Yeah, because bad things only take a few minutes to unleash themselves. And when they do, if it's Saturday or bad guys love to attack us on the weekends and holidays when you've got somebody on call, but they may not get the email for four hours and they may not do [00:10:30] something until two or three hours later to try to resolve a problem. And by then, it's game over. You already lost that war. You already lost that battle.

Bill Russell: I love the fact that we get to talk about this, but with that being said, our first story, Broward health announced that an intruder had accessed its network through the office of the third party medical provider. They breached 1.3 million records. The normal things for fraud were taken. Name, date of birth, address, phone number, financial [00:11:00] bank information, social, medical record number, driver's license number, you name it. That was what was taken. The thing I found interesting about this story is they access the system on October 15th through the 19th. Four days. And generally in healthcare, we would say that's pretty good, right? I mean, they've

Drex DeFord: Found the first one in four days and not eight months.

Bill Russell: Exactly. We've heard stories where it's like, oh, they were in there for [00:11:30] six months and we're like, well, what did they had to take everything? I mean, if you're in there, that'd be like somebody robbing your house for six months.

I would assume they can get whatever they want, but four days, granted they got 1.3 million records, but that's what they can do. In three days, or three or four days, they can get 1.3 million records. And so that's why I asked you that specific question, when are we going to start reading about the breaches where the breach happened for five minutes and they lost 50 records and we're going to go, yeah, that's, [00:12:00] that's going to become the norm instead of four days and 1.3 million records.

Drex DeFord: Yeah. Or I think the the reality is that if you do this well, you wind up with a situation where you have an incident, but not a breach. You have an incident and because you caught it so quickly, nothing was actually exfiltrated because you had good cybersecurity protocols in place to say, when this weird thing stops happening, first of all, just stop it right there. And then let's investigate really quickly. [00:12:30] And then we'll kill the bad guy off it if it turns out there's something going on there.

Bill Russell: Are we layering technologies here? I mean, so, so you're just looking at the end point and finding that thing that's happening, but don't we have technologies on the network that's looking for the exfiltration and the odd movement of data.

Drex DeFord: Sure. I mean there's definitely a lot of products that are available right now that do lots of different things, whether it's filtering emails as well as I do. In any organization, [00:13:00]probably 1% of the emails that are sent to that organization actually get through to an Inbox because 99% of them are filtered out because they're spam or there's some other kind of phishing email or something that we know that's happening. And that happens because you have a cybersecurity company that's working with you on email filtering. And on and on and on. So yeah, there's definitely, defense. And like I said, taller castle walls and wider moats. That's fine.

You have to continue to do that. Absolutely. I [00:13:30] mean, I think the reasonable person expects that that's going to be the case, but you're really not going to be secure unless you're focusing your cybersecurity program now on speed. And response time.

Bill Russell: All right. Let's talk about Cerner and Oracle. This is one of the more interesting things. So David Feinberg was on, let's see another podcast. What was it? Oh, Fixing Healthcare podcast. This was back in August. So he came on from Google formerly with Geisinger. And here's the quote. My competition is in Epic. [00:14:00] My competition is heart disease and suicide and opiate misused and preventable illness. And that is the way he thinks, right.

That is generally but competition is Epic. I mean, if, if Epic wins the DOD contract and the other government contract. Anyway, if they, yeah. If they win those contracts Cerner's like a footnote in healthcare at that point. I mean, those things really between the Intermountain [00:14:30] and the two government contracts.

That kept the, stopped the bleeding, if you will, from Cerner. I mean, they're just, every time I turned around, it was this organizations moving from Cerner to Epic. So that, that was happening on an ongoing basis. As the sisters used to say no money, no mission. And if Cerner kept losing business, then yes.

And that the primary organization taking it. Even, even today, we're seeing M & A activity. And when they have Cerner and Epic, it's not a very [00:15:00] long conversation before that decision's made of we're going to Epic and

Drex DeFord: If we're going to rip and replace that's the direction that they go usually.

Bill Russell: Even if the primary, the acquiring company is Cerner. That's a much longer conversation if they're acquiring an Epic shop. It's really, it's really kind of a fascinating thing. And all right, so now we fast forward and in one of the shortest tenures of CEO in the history of anything we see the acquisition about 30, [00:15:30] I think it was 34 million for Cerner to be acquired by Oracle. Oracle moves into healthcare in a big way. They're already in healthcare. We know they're in healthcare. They have PeopleSoft acquisition and ERP solutions and some other things.

But in moving into Cerner, they move into it in big way. What do you think Oracle's play is here? What are they looking to do with this?

Drex DeFord: Man. I mean, I think it's such an interesting, I'm like you. I mean, there's a part of me that just [00:16:00] wants to sit back and and watch it unfold. But I also worry a lot about, I think Oracle continues to move toward the cloud and try to find ways to add revenue that can, they can drive to the cloud.

Is this at least in part there's gotta be a strategy around remote hosted Cerner moving to Oracle, running on Oracle cloud. I don't know. I'm wondering if it's a multi-pronged strategy and we only see part of it unfolding right now. [00:16:30] What do you think? What do you think the challenges that they face and where they're going?

Bill Russell: Oh my gosh. The challenges are, are amazing. So the biggest challenge being they're a publicly traded company. So this whole thing is going to transpire right in front of us on a quarterly basis. We're going to, we're going to see.

Drex DeFord: Those will be interesting earning calls, right?

Bill Russell: You're right. You can't hide it. So the other thing is being a publicly traded company creates, I don't know what it's called. Just a false sense of timing. You can't look at things over multiple years. It's [00:17:00] hard to look. I can't say you can't. It's hard to look at things over multiple years.

Your, your investors get get antsy and it gets difficult for CEOs who don't deliver numbers on a quarterly basis. And so one of the advantages that Epic has over everybody else. Epic's able to take a 50 year view as a private. And And I think it's one of the things that they've really benefited from.

So Cerner has struggled with that. They were public before that. And now you have [00:17:30] Oracle, so they're gonna, they're going to need to show a return. So at some point they got in front of their board, they had this PowerPoint and it said, look, here's why 34, 3, 4 million. Is that what I said? That's wrong.

Drex DeFord: I don't think it's 34 million. Sounds low.

Bill Russell: 34 billion. Sorry. Did I say, I did say million, I'm sorry. 34 billion. They had a slide deck and it had, Hey, here's their ROI on this thing. We're going to get this much more cloud revenue. We're taking this away from AWS because that's where Cerner was heading.[00:18:00]

And we're going to move this onto our books. This is healthcare revenue. Therefore we intend to retain this number of clients. We're going to grow the government business because they have these government contracts. I think one of the risks is out clauses. I'm sure the government contracts have out clauses.

They have to shore up those things. And clearly, that's also being rolled out in the public eye and it gets dinged every rollout.

Drex DeFord: Oracle's had amazing deep hooks into the federal government for years and [00:18:30]years and years. So, I mean, this maybe another way to just continue to sink those in.

Bill Russell: And maybe Oracle is looking at it, going look, Cerner had no idea what they're doing with the government.

They got this first contract. But we do. We know how to run these things. We know how to run them in the public eye. We know how to do it effectively. We have better vendors that we can bring to bear on this stuff. I don't know maybe, maybe there's a little bit of arrogance going into this. And maybe there's just a little bit of inside knowledge of how the government works and they [00:19:00] know they can retain the contract.

They don't have to worry about an out clause. So yeah, they increase their government contract space. They increase their cloud space. One of Oracle's tactics, which is not not good, and I think other players do this, so I'm not pointing them out specifically, but they tend to get very creative on their licensing.

And you're like, you look left, you look right, and all of a sudden your licensing costs have increased by 10% and you're like, you know what happened? Oh, well you're now paying by the [00:19:30]millisecond that you're on the system or something. I don't know. They get created.

Drex DeFord: There's a club freedom coalition that's burgeoning now too. That's looking at cloud providers but mostly organizations who sell products and run them in their own cloud. And then when the client decides they want to take that product and run it in on a different cloud service that cloud provider says, yeah, cool. You can do that. But the price of the product is just the licensing of the product is just gone up by 200% or something.[00:20:00]

And so there's that I don't know. It just doesn't feel good as a client to get wrapped up into that kind of a situation. And I think a lot of folks kind of didn't even know what they were getting into. And we're starting to figure a lot of that out now and I wonder how that's going to play in the Cerner Oracle relationship too.

Bill Russell: Alright so let me tell you how I think I win. If I'm the CEO of Oracle on this. This is a little harder because all right, so you come into health, you got to change. You have to change the [00:20:30] game on Epic. It's almost like this, this game is played out. So the first thing is there has to be value in the data. And you have to figure out a way to unlock the data.

You have to make Cerner clients so much better with their data than Epic clients. And by the way, I think this is doable. I don't think anybody's won that the data analytics and machine learning and AI side of this. And I think that's an area where Oracle can really help Cerner.

Cerner [00:21:00] had some challenges. I mean, I dealt with Cerner on the data side. It was, I scratched my head a couple of times when I walked out of meetings. Like these are some of the smartest people in the industry, but it didn't feel that way. I also think Oracle has some experience outside of healthcare that they can bring to healthcare.

That's another aspect. They're touting their voice and experience. Technology. I think that's only a revenue play. I don't think their voice and any of that is any better than Nuances or even gets close to [00:21:30] Nuances because healthcare is such a specific vocabulary set that you have to introduce, that I think Nuance is going to be pretty far ahead of them. So I think it's going to be a couple of years. But I think there is a play there in the experience side, if they can somehow break apart the pieces of music. And put them back together in a way that is 10, 15, 20% more effective for clinicians to interact with the EHR.

And perhaps that [00:22:00] uses voice in some way, shape or form. That's going to address a major problem that healthcare faces right now, which is a staffing shortage. All right. So they plug themselves in as a, you know, we can help you with the staffing shortage. We can help you to really when the race on this analytics without bringing in too many third-parties and oh, by the way, we can start to integrate your ERP eith PeopleSoft and other things that others can't and we can give you this complete system. And obviously grow the cloud revenue. I think those are [00:22:30] the, the winning strategies in healthcare.

Drex DeFord: I like that. The point being things like staff shortages and the what are real problems in healthcare that that's where they focus their energy.

Now that may be through analytics that they get to answering that problem. And it may very well be that they bring a bunch more smart data scientists and database kinds of people to the show, which can help Cerner go faster. I like that strategy. I mean, I like what you're [00:23:00] saying there. That makes sense.

Bill Russell: So you'd let me take over Oracle as their CEO? I wouldn't be

Drex DeFord: No I'm not sure I'd go there.

Bill Russell: I wouldn't go there either. There are jobs I've taken in my career where I didn't really have the credentials, but I knew I could grow into it. I don't think I could grow into that one. That's a little little beyond my pay grade.

Drex DeFord: I was talking to somebody today and they were saying they were asking about my career and I said my, my career was built a lot around people [00:23:30] asking me if I could do things and me saying, yeah, I can do that. And then I just sort of figured it out later. So but some things are just, you're definitely kicking your coverage.

Bill Russell: Yeah, I know what I can do now. I know what I can't do. I can be an advisor to Oracle around healthcare, but that's really probably as far as I can.

Drex DeFord: If they're listening, you're looking, you're looking for that gig too.

Bill Russell: Yeah. Next story. And then we'll close with something I think that's interesting. A little fun, a little exercise. All right. Five tech trends for 2022. [00:24:00] Digital transformation, cloud and talent wars reshaped by a myriad of technologies and digital transformation.

Our economy is shifting towards a software centric model with far reaching consequences. I think this is really true. In fact, when you described CrowdStrike you didn't describe your latest chip set or it's a software data analytics company, that's getting information real time and analyzing that stuff with advanced technologies and providing that [00:24:30] information out.

And the more data you get, the smarter it gets. I think everyone's starting to realize that the battle here in healthcare is for turning the data that we have into solutions that we need better outcomes, better equity better security and those kinds of things, because we are a wash with data and not really sure we know what to do with it all the time.

Drex DeFord: I think there's a little bit of like everyone [00:25:00] trying to reinvent or everybody trying to invent the wheel themselves. And we continue to sort of see this motion into. Everything is a subscription, because if you put all the smart people together in one place and let them work on it for you, they may be able to give you a better result as a monthly subscription or annual subscription, than you can get yourself trying to do all of those same things.

I think we'll continue to kind of see that [00:25:30] model, especially around technology where you licensed software today, you may, that will convert to subscription models over time.

Bill Russell: Yeah, I think that's true. All right, let's go into these five things. So digital transformation drives chip and software production. I heard two stories around this. I thought were interesting. The first being the impact of the chip shortage on automobile manufacturing and how it did not impact Tesla. And one [00:26:00] of the reasons it didn't impact Tesla is they have their own software staff who was intricately involved with their design.

And so they were able to program around the different chip sets that were available as opposed to, hey, we have a supply chain issue and we couldn't get to them. And so, because they had that software capability in house, they were able to code very quickly around the limitations that maybe a GM wasn't because [00:26:30] GM relies on their third-party suppliers to build out that whole ecosystem. That,

Drex DeFord: I wonder how that looks long term, right? When it comes to then software maintenance and service and support. Because now you've put 20 different chips in your product and you have a different software package for each one of those chips. That seems like a much more onerous ... work.

Bill Russell: But that's the beauty of Tesla, right? So I receive updates on my car, which is the crazy [00:27:00] thing is my car is 2013. So it's now nine years old. And I went out last week and I have a new dashboard again. I mean, that's the level of sophistication that they have.

It's like they've rolled out computer end points that happen to have wheels on them. And they reprogram the dashboard and change different features and and those kinds of things. So I think they understand the layers of abstraction that are necessary and the layers that need to be [00:27:30]customized in order to interact with those chip sets.

I do agree with you, obviously we want to reduce the complexity as much as possible, but the companies that are able to deal with the complexity, I mean, you're talking about a multi million, if not billion dollar opportunity for Tesla. Because they can just get cars out there when no one else can.

Drex DeFord: Yeah. And I mean when you talk about digital innovation, sometimes that's what innovation is all about. It can't be about trying to [00:28:00] figure out how do you simplify what is necessarily a really complicated process. And so maybe, maybe that's the innovation, some of the innovation at Tesla.

Bill Russell: It's interesting. One of the things I I've been looking at closely is I think in healthcare more and more, we're going to have to figure out how to develop this muscle of coding again. And yeah, we've done it. We've had middleware, we've had some people that were doing things that maybe SQL, I don't know if coding is the right word, but they were doing some sophisticated things with SQL and [00:28:30] whatnot, but I think

Drex DeFord: Modifications. Modification, modifying cots products and those kinds of things. Yeah.

Bill Russell: But I think now we're getting to the point of there's there's going to be an advantage in being able to take your digital front door and constantly massaging it to be a better experience for your end users and those kinds of things.

But that means understanding the software development, life cycle, understanding abstraction, layers, understanding coding. And when you talk [00:29:00] about how are you going to maintain that code? I've worked with companies and they're like, yeah, our release date is this.

I'm like, all right. What's your plan after that release date? And they just look at me like, Well, it's just, it's going to work.

Drex DeFord: Yeah, sure. We've all been, we've all been held up on that one. I mean it's interesting to look at that idea and think again, is it something that we're going to do in house or is it something that we're going to subscribe to a service for somebody else who's figured out all the pieces and parts and can work with us on the [00:29:30] inventory of the products that we have that we want on the digital front door. And then they can plug all that in and give us what we want. I don't know. It feels to me like that's a business for somebody.

Bill Russell: Yeah, no, I, I agree. I don't think, I don't think healthcare CEO's are all of a sudden going to go out and hire 20 developers and have them sit in the back room.

They might have two or three who are managing third-party vendors and they're reviewing the code and making sure whatever model really makes sense for that specific healthcare organization. [00:30:00] I assume these no code low code.

Those represent some opportunity for health systems. Maybe we don't have to have full blown coders anymore. Maybe it's more high-end configurators who are building applications on these low-code no-code environments.

Drex DeFord: Yeah. You look at the API world, which we can have another program at another time about cybersecurity and APIs, but you know, this idea that you can take data from lots of different applications that [00:30:30] now individuals in the health system clinicians want that particular application and they can have it now because you can plug that application into the power strip. That is the electronic health record maybe or whatever the core database is going to be. And the data, the data can flow. And it's a lot easier and works a lot more effectively than it did back in the days when we had interface engines and we had to have the equivalent of network spaghetti in a closet. The equivalent of that trying to transfer data between [00:31:00] applications. So yeah, the world continues to grow and the technology continues to change and things that we could only dream about doing literally four or five years ago or things that seem pretty normal and routine now. Or at least the capability to do them as normal and routine. We may not be doing them yet, but they're being done in other industries.

Bill Russell: Well, let me give you the last two, and I'm going to ask you to comment on the last one. One is the changing role for IT. Getting closer to the business and developing [00:31:30] products is one of their things. But the final one is the talent war goes from lukewarm to scalding hot. Talk to me about talent. How, I mean, I've been talking to a lot of CIO's, and I've, also already been on record as saying, this is the number one issue facing healthcare IT going into next year. But I'm curious, are you hearing the same thing that the, talent war is very challenging, right now?

Drex DeFord: Same. Yeah, exactly the same. And the pandemic is almost, not almost, pandemic has been an [00:32:00] accelerator for that, because now if you live in Indiana and you want to work for a company in LA you can. And it's pretty okay. Like nobody nobody worries about having to move you to LA.

Or vice versa. If if you're in a small place and you've got a lot of money, if you're in a rural place and you've got a lot of money, you can hire some pretty great talent now if you're able to pay for it. So the whole, like, I don't want to live in wherever Oklahoma. So I'm never going to go to work [00:32:30]for that company.

But I think those times are largely gone. You may have to go to Oklahoma once a month for a couple of days. Maybe not even during the pandemic, you may not even have to do that. So definitely the market is with the individuals, with the talent now. The companies are going to have to pay whatever they can pay. Especially like in our world, cybersecurity, there's just a massive shortage of people.

And there's going to be a massive shortage for people of people for years based on everything that that has projected. [00:33:00] So yeah, it's hard to get good people across the board.

Bill Russell: All right. Let me ask you this. Conferences. We're not that far off from conference season are we, I mean, JP Morgan just went virtual attending that on Monday, Tuesday, right here from this chair.

That will be a tough two days. I did it virtual last year. It's a lot easier in person cause each after each meeting, you stand up, you talk to three or four people around you and whatever. When I stand up, I can talk to a dog. I can, [00:33:30] whatever. It's a lot tougher doing it, virtual I'll just say, but I will sit in on every aspect of that meeting because it's such a valuable meeting to me.

Drex DeFord: Consumer electronics show, a bunch of people pulled out, but it's still went on.

Bill Russell: Yeah. So, what are your thoughts? I think we have Vive in early March and we have HIMSS almost immediately after that. So they're both in state of Florida where I live.

Drex DeFord: March seems like it's a long time away for Vive and for HIMSS, but I mean, dude, it's[00:34:00] only like a few weeks away.

Bill Russell: It's less than eight weeks away.

Drex DeFord: Yeah. I mean, I think we're right. We're pretty close to eight weeks away. And I think a month ago we intended, two months ago, I think we were like, oh yeah, of course we're going.

And now eight weeks out, I think we're watching every day what's happening. And it seems to not be getting better. It's getting worse. And so we'll see. And I think a lot of companies will be in the same boat. Like, will they go won't they go? You may still wind up [00:34:30] having a conference, just like he did last year with HIMSS. It was just lower attendance.

Bill Russell: What's interesting is the doctor. I mean, there are still deaths because there's Omicron and they're saying that the prevalence is Omicron right now but Delta is still out there and it's still deadly. Omicron is less deadly.

Again, I'm just talking to physicians who are telling me what they know. And I'm not a doctor. So take this for what it is. The other thing they're telling me is that it spiked very quickly in South Africa. And came back down [00:35:00] very quickly. So they expect it's starting peak back down to be a lot quicker than it was before.

They're also expecting different variants this year. So they're like this could be just a January thing potentially or depending on where you live. Like if you started spiking in January 1st, you could see at the end of January that your spike is coming down.

It's almost that, that quick. And part of the reason is like we had a bunch of friends who had Omicron. They didn't go to the hospital. They didn't [00:35:30] even consider going to the hospital. They got a Binax test. They tested. They tested positive. A bunch of them texted me and said, what's the CDC guidelines.

I'm like, that's a great question. And I went out and found out what they were. I said this, and I was actually kind of surprised at what they were Drex. It's five days. quarantine. Don't have to test to come out. But you can come out of quarantine after five days if you wear your mask for five days. I haven't talked to a doctor about that yet, but that was kind of a surprising.

Drex DeFord: I think there's a lot of [00:36:00] controversy about the recommendations now and what's what, and what's best for folks and it's part of the challenge. I think, of the world we live in right now.

Bill Russell: It's all new. And people are like, well, this is different than the last one. I'm like, it's a different variant. It's a different disease. There are years where the flu is wildly contagious and deadly and there's years where the flu is nothing. And I think we're seeing that.

Drex DeFord: It continues to be really clear that if you're vaccinated, even if you get it and you have a breakthrough case, chances are really good that you're [00:36:30] not going to have as bad of a result as you would otherwise so.

Bill Russell: On this show, we rarely talk about this stuff but this is the topic that a lot of people are talking about. And there, in the context of conferences, if you were holding a conference in early March, would you be putting plans together right now for going virtual?

Or would you essentially say now we're doing it either way? Cause it's in Miami, whoever shows shows.

Drex DeFord: Yeah. I think I'd be looking at virtual options. Even if it [00:37:00] was virtual options in conjunction with the live in-person conference. Just because I think, look the spectrum is wide on the amount of comfort that you know, especially like Vive or HIMSS that the conferences attendees and the companies who are sponsoring those conferences, their comfort is in a wide variation.

And so if you're smart, you're probably creating a situation where you can get as many people to attend [00:37:30] in whatever format. They prefer to be able to get the information and be able to continue to have the collaboration. And quite frankly, as a business keep the business running and keep the business alive and the attention on a conference that accommodated everyone.

So I wouldn't be betting. I wouldn't be putting all my chips on, come to Miami or don't come to Miami. If you don't come to Miami you're not going to be at the conference feels a little shortsighted.

Bill Russell: Yeah. I [00:38:00] went to the HLTH conference in Boston. They did a good job. They had testing onsite and created what I felt was a pretty safe environment.

Drex DeFord: Protocols for HIMSS, have they published?

Bill Russell: I would imagine. Yeah, it costs some money for them to stand that up. They brought in a company, a traveling nurses who do testing cost them some money, but I don't think it's exorbitant the amount of money it costs.

I think they'll do the same thing. And so I think HLTH will [00:38:30] drive that. They are a professional conference company. CHIME does conferences, but HLTH is a professional conference company. That's what they were designed to do. And I think they will drive that. And I think that if they do what they did in Boston I would feel pretty safe going to that conference, except for the travel of course.

Drex DeFord: Still got to get there.

Bill Russell: Orlando HIMSS. HIMSS might be a little different story. Cause they're looking at the first year was pretty devastating. Cause it peaked right at the time they were getting ready to do their conference and they lost, lost big [00:39:00] time that first year. Second year was not that great from what I've heard from people.

I mean, it was probably a great content wise and those kinds of things but there wasn't that many people there. And you're talking about a conference that went from 40,000 to maybe 8,000 onsite. That's a big blow financially. That's the second year. If you have a third year of similar performance. I would think you're more prone to say, look whatever we have to do to get people here, let's give them free tickets to Disneyworld. I don't know.

Drex DeFord: Yeah. [00:39:30] Well, I need to go look. I'm kind of speaking out of turn, but hopefully there's a good protocol and makes people who want to attend in person feel safe. The challenge with all of that is that there are conferences and people show up and they're vaccinated and they wear their mask at the conference and then they leave the conference floor.

And as you made reference to Canadians earlier, they leave the conference floor and they go out for dinner and they take off their masks and they're amongst everyone else and they do whatever. And then they come back the next [00:40:00] day and they put on their mask and hopefully that all works out. We'll see. It'd be great if there was some post-testing and all this too just to kind of see how it works, but.

Bill Russell: Yeah. And we're just two, pundants talking about stuff. Cause we know we know as much as anybody else. I mean, it's scary out there. I know people who were like, I don't understand. I didn't go out. I wore my mask, I did a double vaccinated and I got this thing. I'm like this thing has a transmissibility factor that is [00:40:30] just unlike anything we've seen.

Drex DeFord: Omicron specifically, right. You're talking. It seems to just be amazingly transmissable.

Bill Russell: Yeah. So we're guessing just like everybody else is. I think being able to look at this in hindsight will give us a lot more information, but looking at it forward is almost a fool's errand. Trying to figure out what Miami and Orlando are going to be like.

And you can create the safest environment. You're just at the mercy of whatever's going on. Drex, are you going to be attending either of those [00:41:00] conferences?

Drex DeFord: I'm tentatively attending. Oh, we'll see. As things unfold, we'll see how it goes but. My intention to be able to

Bill Russell: That's two full weeks, you're going to be.

Drex DeFord: Yeah, well, I don't know that I'll attend two full weeks. Right? I think this is another thing I have to sort of figure out it's a lot of time to be gone. I think it's a lot of time for healthcare execs to be out of the office too. There's clearly some competition between those conferences to get executives to come to one or the other. And probably not both, because again, it's a lot of time out of the office, [00:41:30] so we'll see how that works for me. If I attend both, it's probably some version of a few days at each conference and not the full conferences.

Bill Russell: Yeah. I will probably attend both. First of all, it's a drive. And by the way, if you don't want to fly all the way back to Seattle and then come back there, feel free to give me a call. Come over here. We'll hang out.

Drex DeFord: I was definitely thinking about that, right? Because of the other thing is it is a five-hour flight for me. And so I was thinking maybe I'll fly down. I'll [00:42:00] do the end of one conference and the beginning of the next conference and then fly home. So maybe I, maybe I will.

Bill Russell: Drex, thank you as always for coming on the show. And I look forward to potentially seeing you at some of these conferences.

Drex DeFord: Yeah, my pleasure. I'm always happy to be on. It's always a good time. We always seem to have fun doing this. And I look forward to hopefully seeing you sometime soon.

Bill Russell: Sometime in 2022, that would be great.

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