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Today on Newsday.

it's like all this legacy technical debt weighed down the role of the CIO and kept them focused backwards.

As opposed to forwards   My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health. where we are dedicated to transforming healthcare, one connection at a time. Newstay discusses the breaking news in healthcare with industry experts and we want to give a big thanks to our Newstay partners,

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Now, let's jump right in.

All right, here we are with Newsday today.

I'm with Lindsey Jarrell the CEO HealthLink Advisors. And, Lindsey, nothing's really going on in healthcare and healthcare IT today, so this will probably be a short episode, I think. Yeah, right, we

can just give the listeners a break and just shut it down, nothing going on.

start change healthcare only because, just from our news site, I can see that this is still top of mind for many individuals let's start from a financial standpoint. what has the impact of change been on the industry from a financial standpoint do you think?

we've certainly felt it as a consulting firm, I can tell you, and just talking to our clients the cash deficit or the cash hit is very real, and I think it also just raises the hairs on the back of their neck even more about where do these dependencies lie from a business continuity perspective, right?

So, I think it's been a huge hit, and I think we'll continue to see that hit even once it's all resolved. And the cash starts flowing again. I think we're going to see behaviors start to change. This is going to just be another layer on what do organizations really need to do to be prepared for the future.

unfortunately we, have an organization we work with that had a ransomware event and got that resolved about 60 days before the change healthcare event which hit them very hard as well. And that kind of strike too can just bring an organization to their knees and they're an important part of the healthcare provider network in the community they serve, so I think we're going to continue to see a lot of, impact here the rest of the year as organizations are thinking about business continuity.

Well, here are some of the headlines that we have on our news site. Lack of transparency. Handcuff FEDS, change, hack, response, lawmaker says. So the lawmakers are getting involved they're going to pull them in. Another one, change healthcare rival onboards hundreds of thousands of customers during hack crisis.

And one of their competitors stood up a free version that gave people the ability to ramp it up pretty rapidly and they benefited from that send it to grill UnitedHealthcare over Change Healthcare Crisis. This is probably the one from a financial standpoint. Change Healthcare to start processing 14 billion.

in claims backlog as it restores the clearinghouse platform. So clearly they restored the pharmacy a while ago and other aspects, but it's this claims backlog, 14 billion.

Yeah. Can you imagine? and the other thing that we saw, so I'm sure other organizations have as well, is when this hit.

It was the hesitancy to pull the trigger to go to plan B the first week and the second week. And the orgs that just decided to immediately pull the trigger and start working plan B in an alternative vendor by the third or fourth week had already made great progress, right? And we're in the know. And I think that's just a particularly hard situation for healthcare providers to be in.

How fast do you pull the trigger to start moving? from a business operations standpoint. It's just so hard for them to be in that. I saw another headline. it was on the news side about the quote unquote monopoly of change healthcare. I'm not declaring they have a monopoly.

It was just probably put out there for some clickbait from someone, but it certainly makes you think, right, when we get a lot of concentration in some areas, how does that relate to risk for organizations? And I'm not one for more government regulation in what we do, but it makes the market economy kind of a tough place to live when you've got a lot of customer

concentration.

Drex and I talked about this last week and It's interesting we're drawing this line and my thought process on this is that the CIO, and we'll talk about the role of the CIO because it's an interesting couple of articles here, but the CIO's role is to see things through an information lens, right?

Through a data technology and integration, workflow sort of lens across the entire landscape. Okay. And my thought process was you talked about a plan B. What struck me is that many of the plan B's were hatched the day after this happened, like we didn't anticipate it. We didn't see it ahead of time.

And I'm saying, I think that's a deficit from a CIO standpoint. I think that's. Part of our role is to see that risk before it happens and let the organization know. The organization may accept that risk and that's fine, but to see it and say, Hey, do you recognize that if this supply chain of data goes down, it's going to impact this in this way.

But maybe it's one of those things that you just can't anticipate.

Well, I think you're spot on. And getting that risk framed up and explaining it in business terms so that the business leaders are all in that conversation, I think is key. It's just, it's an incredibly tough spot to be because in the years we're coming off of, not even producing an operating margin and having to prioritize business continuity items against whether or not I need a, a piece of clinical diagnostic equipment for, from a capital dollar standpoint.

It's put a lot of organizations behind.

there's an article called The Death of the CIO, and whenever we talk about this topic, I'm taking back to John Halamka so, John Halamka Probably one of the most prolific CIOs. Just very few CIOs could say they wrote in EHR, right? So just from that perspective alone, understood it at a different level than most.

He had his challenges as well. I mean, there was a period where their network went down and it was covered by the Boston Herald, I think it is. And he and I talked about that and how challenging that is. So no matter how prolific you are as a CIO, there's challenges.

But , in the last time I had him on the show, he goes, I think the CIO is a role that's not needed anymore. And I was like, I was shocked to hear him say that. I'm not even sure I want to go after that in that way, but I'd love for you to think about the best healthcare CIOs that you've run across and just some of the characteristics that make them best CIOs.

Are they more technical? Are they more clinical? Are they more broad than that? Are they more leaders? Provide leadership skills? Are they more business leaders? Are they more technical leaders? is it organization dependent on what they need? Yeah.

Wow. What a way to get my brain going here before lunchtime. Cause that's a great question. And the best ones that I've worked for or worked around or, strive to be at times we're collaborators. They were strong leaders within their department, setting direction, organizational function, teaching the importance of process and systemization, and back to the collaborator, they were just relationship people with the business, right?

They were constantly learning about the business to understand impacts and then translating that both back to their team and then translating the technology back to the business. And high energy and intellect, of course. that job will wear you out. That's for sure.

You've got to have kind of a special set of characteristics. I generally don't ever talk about technical capability there because I think it's a CIO's job to hire the right team. That death of the CIO article that was written got me thinking a little bit. I think the Chief Digital Officer, the CDO role, and other roles like that have confused the role of the CIO a bit to business leaders, and that's unfortunate.

I certainly don't see the CIO role going away but I do believe it has to constantly adapt to be closer to the business.

I remember having this conversation with Darren Dworkin when he was at Cedars, and he said, we'll never have a CDO, and I asked him about that, and he said, Look, bringing in the CDO only confuses things for the organization.

Maybe the title of chief information officer isn't correct, but it's the person who sees all those things that I said before, who sees the data flow, who sees the integration, who sees the workflow and sees the technology underpinnings of that. And then the reason we added a chief digital officer, It felt like at the time, and I think it still feels this way a little bit, is that the CIO sort of retreated back into the operation.

It's like, I operate these things and then it's the organization's job to think of how digital is going to get applied to the future of the patient experience. and the clinician experience and those kinds of things. And they sort of abdicated that to the world and it wasn't moving very fast. And so they thought, all right, well, there's a leadership void here.

It seems like other industries bring in this chief digital officer and they're the ones that really get engaged with how digital is going to be applied to the business, to engage the consumers more, engage the patients more, engage the clinicians more, and create. a better experience and a more efficient and better process and workflow around those things.

But Darren's thought was no, no, no, that it's the same person. It's the same role. It was his thought and I think I agreed with him. Yeah,

it's just, I think it's just a matter of evolving that role. And just to add a little bit to what you were talking about, because I love your point is, it's like all this legacy technical debt weighed down the role of the CIO and kept them focused backwards.

As opposed to forwards, right? And then the good ones knew how to balance that. But that allowed to think kind of some of the other business leaders to adopt the mindset of what you just described, like we need something new. It's got to be digital. The other thing I think that contributed to it is how marketing changed and became more dependent on digital and the overlap with marketing and patient access, right?

So digital marketing, our digital connection with. our customers, patients, families, the public begin to confuse where does technology play in that effectively. And that, that CDO role got labeled pretty easily for, oh, we'll just, those people help, fix that. And it just became a layering issue in my mind, but I know a lot of organizations are, sticking to it.

It's and I think we're both you and I, and probably a lot of people watching this are just, we're just informed by our experience. Right. So. It may work some places.

I'm going to shift gears and We're going to talk AI a little bit. It's everybody's favorite topic.

Yeah. I can't go without mentioning that. So in Nvidia had their conference and I was able to sit down and watch the the keynote. Did you get a chance to see that? I did not, no. I'll put it on my list. Yeah. Well, it, it is worth watching. First of all the auditorium is massive. I mean, it's just, and it gives you an idea of first of all, the influence that NVIDIA has right now on this industry.

They are, they're producing the chips. that make all the things that we're talking about possible. I mean, the anything around generative AI, pretty much they're the platform and they're the platform for AWS, for Google, for Microsoft, I mean, that's who they keep coming to as much as those organizations would like to develop their own chips, NVIDIA is so far out in front.

And so they demonstrated some things that I keep saying this, the pace at which this is moving, I don't recall. anything else in my tenure. So I'm, I, let's see, I remember installing IP addresses, going from IPX to IP addresses on workstations so that they could get on the internet. All right.

So I go back to that. And I remember the first cell phone I had was actually installed in my car. It was a part of the car and that kind of stuff. So I've gone through some, and my first PC was a Commodore 64. So I went through the PC area as well, but all of those seem to have like these step progressions that sort of, we sort of like we leaned into them.

And over time you sort of got used to it. You learn the new. nomenclature and whatnot. This AI is, and I realize it's been with us for 40 or 50 years, but it feels like these things are being democratized so quickly because the chips are moving fast. the number of competitors are moving really fast.

I saw OpenAI Sora text to video. Like, I can say, hey, I'd like a video of this, and it's creating video. I'm like, oh my gosh, like, this is moving incredibly fast. Now, we're going to get to healthcare in a minute, but I'm curious how you're experiencing this.

Yeah, one of our technical leaders in our advisory practice, showed me some data last week about how much AI consumes from a processing standpoint for just simple requests.

And then when you give it complex things like text to video, it's an exponential increase. in terms of the computing power it requires. And I can't wrap my head around it in terms of all the requests that are being thrown at AI to do things and what it consumes. I heard it was in part of a conversation, I think last week, and someone was speculating, I don't know if they have any data around this, that understanding NVIDIA is in the seat.

But we'd see a big pick up on Intel's side as well, because eventually, depending on the type of AI and processing done, we're going to have tiered processing just like we have tiered storage. And depending on the speed of what you need done, it'll be different chips and you can scale the cost down and also, how dense the computing power is required.

And so I thought that's pretty interesting, right? Because right now we're always looking at the leading edge. But this will become an ecosystem and architecture of its own, where we'll end up really having tiering all throughout. And so I think, just thinking about my, my friends in healthcare, how do we think about that over the next three or five years, right?

It's just moving so fast.

That's fascinating.

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  📍 Tiered AI is interesting to me, and when you explain it in the concept of tiered storage, it makes perfect sense to me.

Like, you have Different compute requirements, different speed requirements, latency issues, and those kind of things. the other thing I've heard people talk about is we're probably not going to have a single AI that does all these medical things.

You're going to have these very specific models and roles. And it's one of the things that NVIDIA talked A couple of things which jumped out at me at the keynote. If people have a chance, there's actually a 15 minute condensed version. But he showed a normal rack in a data center and he was talking about Exabytes of processing in that one rack and it's it's mind blowing in terms of, he goes, this used to be the purview of the supercomputers, and now we're talking about a single rack in your data center.

And That's pretty amazing to me in and of itself. The other thing is they're developing an architecture for this tiered you can have NVIDIA chips locally, you can have NVIDIA chips up in any one of the cloud providers and they essentially, because of their framework, you can create are we still calling them applications?

I guess, yeah, you were still creating applications that go across, and determine, what's the best way to get this done and to apply this. So, it's really fascinating. Healthcare. Clearly the most talked about topic at Vive and HIMSS was change. Second, second was AI.

But if change hadn't happened, it would have been an AI overload. Lots of panel discussions, pragmatic AI. AI in the clinical setting. There was AI in, administrative setting. Security vendors were talking about AI and how they're applying AI and those kinds of things.

If you were in the CIO's chair right now where would you be looking at AI and how would you be approaching it with the organization?

Yeah two thoughts on that, I think. One I would be seeking to teach the organization and the business leaders on how we ought to think about pilot and fast fail AI.

Because I know they're getting inundated with AI is the answer to everything. And it's just the latest thing they're hearing from all these vendors. So I think we have to recognize that we can't push it off, but create some kind of rifle shot governance around it, so we can figure out how to fast fail in partnership with our business leaders.

And that will help, I think, mitigate all of this. One off contracting for subscription based AI services that are just eating the CIO's lunch right now. And the other thing in terms of what I could influence Just assuming my budget's kind of limited, right, as they always are in healthcare.

Is looking to my big vendors to say, what's your roadmap for AI and trying to adopt quickly with them. Because I think that mitigates risk and to some degree, it can mitigate some costs there. Where maybe we've got more flexibility to pilot with our big vendors. So our, maybe our big ERPs or a big revenue cycle or a big clinical.

I think that would be my focus right now and while I watch what kind of comes out of the woodwork. The number of folks that we talk to, and I'm sure it's even worse for a CIO, of the next best AI thing, these, there's a lot of folks who just won't be here in 12 or 18 months, and we've got to let some of that settle out.

Yeah I agree with you. I think it's, there's a significant education curve and I think the CIOs that abdicate this that's the second time I've used that word. I don't use that word that often, but but CIOs who abdicate this role of guiding the new technology into the organization are going to be in big trouble like two years from now.

because no one's looking at the higher level architecture and how things are going to work together and whatnot, typically that's the purview of the CIO. You're going to want to help people to see it. And I think you, hit on, one of the things is existing vendors and platforms that you want to take advantage of.

I think I'd have a framework together for people so that they can understand the different, you technologies and the different ways of acquiring those technologies. Definitely find some champions who are willing to pilot some things identify the different areas. And this is the kind of document that's updated like today.

It feels like daily, but at least monthly you're updating the thing to say, Hey, here are the new things that Epic's bringing to the table. Here are the new things that Oracle or Meditech, you have your EHR platforms and then you have your ServiceNow's and your others. You have your security providers and then you have the other specific ones, but I'd create sort of this framework.

That I want to be the source of who people are looking to for that, expertise of how are we going to bring this to our organization effectively, how are we going to bring it in responsibly and trying to not lead every conversation, but to inform as many conversations as you can, because there's going to be a lot of conversations in the Next couple of years, actually, if not next couple of weeks. Yeah,

I'll throw a bone over to BayCare Health System. My old shop where I used to be the CIO, although that's been a while ago now. I sat in a presentation that the CMIO there did probably about six weeks ago, and I just thought they were doing such a great job around this.

Let's study AI, let's figure out if this works. And, understanding what they were doing there, they're really bringing in, on the clinical side, the physician leadership and having them design the study model to determine success or not. And you get some physicians who love research, right? All physicians know how to do it.

But those who love it and really know how to design a study, you've got magnificent, objective based study criteria. that can help you determine whether or not this is working. And then governance uses those criteria to say, yep, we're gonna stop that pilot, we're gonna move forward with this.

And I thought that was a really great way to, design something, and they're moving through a lot of different options every two, three, four months, just trying to find what works the

best. Yeah. Lindsay, well, hey, look, it's great that we found something to talk about in such a slow news cycle.

Yeah, had to make it all up, but we did it. Hey, thanks for your time. I appreciate you being on the show and sharing your wisdom.

Yeah, great to be here. Thanks, Bill.

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