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November 5, 2021: As you start talking about automation, you have to be open, transparent and purposeful with your employees. Some of them will think you’re bringing in a fleet of robots to take over their jobs. What is Intermountain doing with this incredible innovation that promises to offload the mundane and repetitive daily tasks? How does Intermountain develop solutions that stem from the voice of patients? How do they set up citizens for success when it comes to data and access to systems that will help them accomplish what they need? And how do you approach a new leadership role in the middle of a pandemic? Ryan Smith, CIO joins us for all of this and more.

Key Points:

00:00:00 - Intro

00:11:10 - When it comes to human centered design, don’t let IT people design consumer solutions. That's principle number one.

00:13:10 - Intermountain Digital Platform

00:15:50 - Intermountain has been really purposeful talking about robotic process automation and intelligent automation. How can we let people find more joy in their work and be able to focus their time and effort on the things that really matter and bring value?

Intermountain Healthcare

Transcript

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

 Today, on this week in health it Did you get into automation? If you're not purposeful about talking about it really openly and transparently across the organization, it's really interesting how some employees think about it. They literally picture that we're going to be bringing in some fleet of robots that are about two and a half feet tall on wheels that are going to be going all through our facilities and taking their jobs away from them.

And it's kind of a scary thing. So we've been really purposeful about talking about. Robotic process automation and and intelligent automation. More in terms of how can we really let people find more joy in their work and focusing their time and effort on the things that really do matter and bring value.

Thanks for joining us on this week in Health IT Influence. 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 our influence show sponsors Sirius Healthcare and Health lyrics for choosing to invest in our mission to develop the next generation of health IT leaders.

If you wanna be a part of our mission, you can become a show sponsor as well. The first step. It's to send an email to partner at this week in health it.com. Just a quick note before we get to our show. We launched a new podcast today in Health it. We look at one story every weekday morning and we break it down from an health IT perspective.

You can subscribe wherever you listen to podcasts at Apple, Google, Spotify, Stitcher, overcast, you name it, we're out there. Uh, you could also go to today in health it.com. And now onto today's show today, I am excited. We have Ryan Smith, the CIO for Intermountain Health joining us. Ryan, welcome. Welcome to the show.

Hey. Thanks, bill. Great to be here. Love the show. Love all that you're doing. Thanks for what you're doing. Well, I'm glad you're on the show. We've talked about this, I don't know, for two years. In fact, we talked about it before you were at Intermountain when you were, I think when you were, you were with Health Catalyst for a time prior to this, weren't you?

Yeah, for about two years. And then I was glad you, let me kind of get onboarded here at Intermountain a little bit before we. Took the time to talk because it's such a huge learning curve. So thanks Bill for giving me a little bit of time to come up to speed a little bit. Yeah. So this is not your, your first time at Intermountain.

You were there before, right? That's right. Yeah. Joined in the mid nineties right out of college. I was a software engineer by background and had an opportunity to do a little internship at three M Health Information Systems and many of us old timers, . Remember the old help one system was an acute EHR system and, and I was a developer on that system as an intern there at three M, and Intermountain was one of the biggest customers, and any rate had an opportunity to kind of jump over and be part of the development team on the help one system at Intermountain in the nineties.

And that kind of started it all off. So that's your background. Do you have a development background? I do, yep. Software engineer. Wow. So do you still find yourself wanting to code or are, are those days Yeah, absolutely not. There. I, I went through that, a trauma from going from a kind of a individual contributor, loving, slinging code and doing all of that to getting into management and.

Really missed it for a while, but you know, after five years or so, your, your skillsets , things change so fast. You, you know that they wouldn't want me touching code at this point. Let's just put it that way. Yeah. I like to tell people, if you need help on your OSS two system, I'm your guy. But if you want me to work on Windows 11 or whatever's next, I'm not your guy.

Hey, today we're gonna talk about a lot of cool topics. Digital, we're talk automation. We're gonna. Talk about putting the patient first, but my listeners are always reminding me to ask this question. I know a lot about Intermountain, but they like me to ask you the question so that you can level set us on the health system that you work for.

So tell us a little bit about Intermountain to get us started off. Sure. So Intermountain's a not-for-profit integrated delivery system, headquartered in Salt Lake City, Utah with expanding operations. Really throughout the whole Intermountain West, we have a pretty significant growth strategy, so, so that's having us move into some new regions, and along with our current 24 hospitals and 215 clinics, we also have a fully integrated health plan organization with about a million members.

We're really into value-based care. And it's really a special organization, bill. Yeah. And, and one of the things I like about Intermountain is you guys are aren't afraid to take chances. You do a lot of stuff around innovation. You have an innovation center right there on campus. So let's start there.

Let's start with digital. And talk about the innovation that you're doing. Talk about the consumer engagement with how the consumer engages with Intermountain through digital. Yeah, great question. We've really been focusing on consumer digital for a number of years now, and maybe what I didn't mention for your listeners or or viewers is that I, I joined Intermountain in the mid nineties in 1994.

And was here up in until about, what was it, October of 2013 or so. Then I had an opportunity to go be ACIO at, at Banner Health and was there for about five years in, in the Phoenix area. Then had this stint with Health Catalyst for a couple of years, which was awesome, and then came back to Intermountain June of, of last year.

So kind of during the middle of the pandemic. But what I wanted to mention was when I was at Intermountain Healthcare, kind of on my first tour, we actually deployed our first secure patient portal. Which was an in-house developed web application back in, uh, you know, like 2001, I mean really early for, for patient portals.

And that was back when we were still on that help one acute system that I mentioned, as well as the help two ambulatory system that, that we developed at Intermountain. Well, fast forward 20 years in consumer digital. It's still absolutely a core focus here at at Intermountain. It's something we take really seriously.

We view that as a pretty significant differentiator for the types of services that that we provide to consumers, and we've taken really a deliberate approach to building a. What we think is a very high touch digital front door set of services for consumers, kind of both through a mobile native app as well as a browser version that we call My Health Plus.

And as part of that bill, we've taken a fully integrated approach by bringing together capabilities ranging from being able to research symptoms through our chat bot, to scheduling visits, to integrated virtual visits, messaging, just like you would expect access to, to your medical records, to to bill payment.

All under basically a, a single login and, and a digital experience. And this has taken a lot of work and, and working with some partners as well. But our app out on the app store, you know, it's actually rated a 4.4. And so we're really proud of the experience that is providing to our consumers. But back in, uh, 2011, I came into healthcare.

And we developed our own patient portal down to St. Joe's, and one of the first ones I downloaded was the Intermountain Portal to take a look at it. And back then it was, it was essentially a container app, right? So you'd log in, so it gave you that single, single login, but then it had like a whole bunch of other apps sort of in the container.

And it gave us that, that that single login experience. It, it, it still felt a little disjointed. It sounds like you're developing it more around the experience. How do you gather the voice of the patient to, to really understand what they're looking for in, in that environment? Yeah, really good question, and there's a lot of angles.

To, to, to answering that, first of all, user testing, right? So we test directly with various consumers, our new design ideas, and, and these are typically prototypes before, you know, we invest the time to actually build out a capability or a solution, but, but also with existing features when we need to kind of dig in further to.

See if we should enhance the experience, et cetera. And historically, you know, this has all been done in person where we would actually bring consumers in-house and, and, and work and really test through concepts, et cetera. But with Covid, we, we primarily have been using a new service, uh, called usertest.com to, to really kind of facilitate these tests remotely.

And working with, with that company, it's really given us the ability to. Work with testers as well as bringing our own consumers, um, into tests. So, so that's just one example and I'd, I'd suggest that that's kind of the most in-depth way that, that we do that bill, because you, you can really get that kinda one-on-one feedback experience on, on what's working, what's not working, how are they

Thinking about things, is this button that out of place, is it hard to find? And so it really kind of lets you get into the mind of, of the individual consumer, which is really helpful. But beyond kind of just direct user testing, we have monthly surveys that we do as well as in-app surveys that we do. And we're really careful on those in-app surveys, you know, that we're not popping things up in your face, et cetera.

But try to solicit feedback for. Consumers that are willing to to provide that. And both those monthly surveys as well as the in-app surveys directly related to net promoter score. So we watch that pretty closely. App score feedback. Well that's another big one I checked a couple of weeks ago and I think we have like 4,400 reviews on our app.

And I'll tell you what, we read every single one of those. And in fact, we directly interact with any of those users that, that happen to provide a lower score because we really want to understand what's not working, um, for, for them. Because sort of like a, a, a mouse in the wall, if you find one, there's 10.

And so we take that same type of mindset that. If a particular, you know, consumer end user is struggling with a particular feature, there's probably a lot of others that are as well. So that direct, um, follow up and feedback is, is really good. Then of course we have persona research that we do to try to typify certain, uh.

Cohorts and build and think about full blown patient journey maps through those processes. All the way from researching a condition to paying your bill and follow up care and things like that afterward and, and everything in between. So it's a pretty strenuous and exhaustive way to really try to understand the.

Consumer voice of the patient. I, I think people are hearing why I'm impressed with Intermountain and, and, and, and it really started, it was even before you were there. You this, it's a culture that really takes innovation seriously and really does listen to the consumer. I, I think technologists who are listening to this are thinking, well, do I want that much feedback?

It takes a lot of development effort and whatnot, and I, here's the thing I learned the first time we did an nap. And you probably are, are familiar with this. You could do it with paper prototypes and get feedback with Adobe xd. At this point, you can almost develop something that looks like a full-blown app, putting it in front of somebody, and you haven't even, uh, brought one coder into the process.

It's just a design person who can build out those apps. And I, I, and we started using paper prototypes and things like Adobe XD back in the day, and that was before we even sat down to code a single. Piece of the overall application and we got a ton of great feedback and it really changed what we were gonna do without investing a lot of resources upfront.

So you can, you can really get a lot of good feedback before you make significant investments. Yeah. Bill, you, you bring up some really good points. I mean, the tools are so good these days to be able to do really pre-development work with full-blown kind of human-centered user designs and things like that that are.

Really straightforward. They can, like you mentioned, can virtually mock up actual flows, button clicks the advanced neck screens, all of that without writing a single line of code, which is really cool. Now, a couple lessons learned just around this kind of human-centered design or these kinds of principles are that, first of all, don't let it people design consumer solutions.

That's principle number one that I hope all of us as healthcare organizations. Ha have, have learned that and hopefully learned that a long time ago. And you know, I'm not on the screen, but I, I am laughing because we all learned that at some point, . Yeah, yeah, totally. And, and I hesitate to say this, but we kind of reserve those sometimes those IT human interface designs for our internal.

Customers and they hate it. And, and obviously we need to do a lot better, but for our, our real consumers, that would be very problematic. And, and then the second thing that we kinda learned, and, and Bill hinted to this, that whatever that app was that, that you downloaded from Intermountain, that's been a while back.

Okay. Because that container app really, that was a container app that we developed that allowed other vendors apps or HTML. Web screens, et cetera, to kind of fit into, which is also not a great user experience as it turns out, even if you can provide a single login because it's clunky, moving from component to component and to get the, the real nature of the integration, et cetera.

And so we believe that so much. So you know that, that we have taken a holistic design approach where Intermountain's really. Dogmatic about owning that entire consumer experience flow and that we don't turn that over to our vendors to any extent that, that we can help it. Okay. And so, so I mean, that starts getting into architecture and, and other kinds of considerations that these days, if you want to come and play into what, what we call internally, the Intermountain Digital platform, that's our consumer facing platform, and you're a vendor.

You can't come in and try to sell us a top to bottom vertical. Integrated stack of technologies, it is absolutely as important as the capabilities we do need from you, that they have the ability to turn off the capabilities that we don't wander, that we have elsewhere with within the digital platform.

So these are just some principles that in terms of really owning that consumer experience top to bottom and some of the choices that you, that you just have to make. Oh, I'm, I'm gonna come back to that, the digital platform, but I, I, I want to loop back to it. I, I want to talk about automation. Automation is such a hot topic right now.

We're, we're seeing a lot of things happen, and you and I have talked previously about what Intermountain's doing. I'd, I'd love for you to share some of that with the, with the community. Yeah, I, I think we have a good automation story. We, we certainly weren't the first healthcare organization to, to take a deep dive into automation, but I'd like to think of us as a fast follower, meaning we got on the bandwagon several years ago.

We actually have lots of efforts underway and they're maturing our automation capabilities day by day. And this time of. Our caregivers and employees just feeling immense pressures and stress, many of which are a result of the pandemic. Obviously, we're trying to target a number of areas where we can automate the types of mundane routine, just not fun work that, that our employees find tedious to, to really kind of help the work on higher value opportunities and internally.

A lot of times we, we kind of refer to as letting our caregivers work top of license and having to shed a lot of those. Level, mundane tasks that that we asked them to historically do. So we started our robotic process automation efforts well over two years ago and really took what I refer to as a crawl, walk, run, evolutionary mindset.

Rather than trying to plan the whole strategy and everything in advance, really, we took the first 18 plus months or so and we spent that time working with some different business and clinical areas, assessing different tools, running pilots, and in a few key shared support service functions and, and just kind of getting a feel for how automation could apply more broadly across the organization.

And with this work, I'll tell you, we had really. Solid executive support. In fact, in the very formative stages of our automation, um, program, we had our head of hr, our head of finance, and others, very involved and willing to meet with us on a monthly basis to help kind of oversee things, uh, give feedback, et cetera.

Because as you get into automation. If you're not purposeful about talking about it really openly and transparently across the organization, it's really interesting how some employees think about it. Okay. They literally picture that we're going to be bringing in some fleet of robots that are about two and a half feet tall on wheels that are going to be going all through our facilities and taking their jobs away from them.

And it's kind of a scary thing. And so we've been really purposeful Bill about talking about. Robotic process automation and, and intelligent automation. More in terms of how can we really let people find more joy in their work and doing, and focusing their time and effort on the things that, that really do matter and bring value and, and let's let these digital workers or bots behind the scenes increasingly.

Do just the, the unfun, repetitive, mundane kinds of things. So that's been a lot of the focus. Now as we coming into 2021, we were organizationally ready to kind of move from that crawl stage where we had probably automated around a hundred workflows or so into this walk phase where we could. Begin to build a more scalable program involving even more parts of the organization and trying to tackle even higher yield automations that would have a lot more impact, a positive impact to our clinicians, our administrative worker, and especially our patients.

And one of those areas that, that I love to talk about. Okay. Is my, my favorite area by far is Consumer Forms automation initiative that, that we really took into pilot about a year ago, so fall of 2020 as part of our digital front door set of solutions. So we have, as part of that pilot that's moved more mainstream since time, but we have bots that scan our, our clinics and hospital schedules for patients that will be.

Into the, into our facilities in the next two days. Okay. And then the bot basically sends the patient an SMS text message and or an email kind of depending on the situation with a link to complete their registration and clinical intake forms from a mobile device. So that can be on their phone, an iPad, what, whatever the case would be.

And after the patient goes through a quick i'll, I'll call it authentication process, it's pretty cool because. Their electronic forms are then really prefilled with information we already know about them. They already have a, an existing relationship with Intermountain, and that lets the patient complete just the fields that either need updating or are blank because we didn't have that information.

And then another set of bots takes that data and directly populates it into the respective. Registration and intake forms inside of the EHR, which as you can imagine, really saves our caregivers as well as our patient service reps at the time of check-in a a lot of precious time. And we set what we thought at the time over a year ago, before the pilot started, we set what we thought were some pretty aggressive outcome measures or targets that kind of span things around patient experience and satisfaction to patient adoption of the tools to what would it mean for our MAs and our.

Patient service reps, et cetera. Well, we exceeded virtually all of those expectations. Just as a quick example, we had over a 300% increase in copay collections, 45 minutes daily time savings per MA at these participating pilot clinics, 96% patient satisfaction. Where else do you get a 96% patient satisfaction?

And, and mind you, this is in the lens of of a hypothesis that we're shifting a lot more of the work to the patient. Right. But I think we've learned in a lot of other industries that we as consumers are more than happy from a self-service perspective to take on some of the burden that. Previously, you either had to interact with someone in a contact center, whatever the case, we want to be empowered as consumers, and this certainly validated that.

And then finally, we saw in our top performing clinics up to like a 91% pre-visit, registration, completion by, by our patients, where our goal was that maybe a quarter or 25% of our patients would actually take that, go through the process digitally. And it turns out nine out of 10 have been more than happy to do that.

So. Bottom line. This initiative's really validated, I guess, the significance of these types of digital tools in healthcare, coupled with AI and automation that has really bottom line has resulted in a big win-win for both our caregivers. Our administrative workers and, and certainly the patient. So that feels like knocking it out of the park.

And we've been really excited about this one. You've given me a lot to bounce off, by the way. Great success story there. You know, combination of RPA bots and whatnot. The culture struggles with automation. I guess we, we see these stories on TV or, or just history of automation means less jobs. But this is the third recording I've done today.

And in the first two, what has come up in both cases was a shortage of workers, shortage of nurses, which is getting worse, pathologists, which is getting worse. It's just getting harder and harder. Frontline care workers, it just in general is getting harder and harder. And the promise of this, I mean, we're not on, uh, a lot of clinical processes with RPA yet.

The promise of this is that we will offload the mundane, as you said earlier, which is something that we want to do for the clinicians at some point, offload as much of that mundane as possible, the daily repetitive tasks so that really they could get back to the bedside, back to what they went into healthcare for is, is to care for people.

Yeah, totally agree. And again, you look at across the country right now. I'd be hard pressed to think there's a healthcare organization out there, um, that's not clamoring to, to fill a lot of open nursing positions. There's a lot of traveling nurses that, that people are contracting with. Physicians are filling a lot of burnout, et cetera.

It's challenging. So totally agree with you, bill. Anything we can do. To, to automate the routine, to automate the mundane, to automate those less fun tasks. I, I think we're helping to do, it's a big favor towards all these clinicians, caregivers and, and, and others, but it still has to be approached, I think, in a transparent way with what the real intent, outcome purposes for the organization are and how leaders are thinking about it.

Again, we get back to, we're not looking at this to, to reduce positions. Okay. We're doing this to help people really kind of work, quote unquote top of license and help them, uh, find more joy in their life. So one of the measures of, of our program around automation is trying to understand the direct or indirect impact it has on employee engagement scores as, as just one measure, because we think if we do this right, employee engagement scores increase.

Not decrease. Right? So we have to work to take that fear element out of it, I guess. So Ryan, one of the things I've appreciated about Intermountain is you, you have a history of inviting the developers from the community, from innovation companies to participate in the things that you're doing. Talk about how you're doing that today with your digital program and with your automation program.

Thanks. Yeah, so we're really taking that kind of same mindset around our citizen development approach for, for automation. There's just no way my team could be responsive enough in, in it to consult on every single automation to, um, build out all those automations, to support all of those automations, to try to flesh out all the good ideas for automation.

This has really gotta be a crowdsource function because nobody knows their workflows better than those frontline, uh, you know, caregivers and others that are in the middle of those workflows. They are the ones that understand what would be nice if it could be automated, et cetera. And so what we, what we basically have is, is an idea generation process, uh, whereby we can see ideas as people are posing automation, you know, concepts, et cetera.

And just this year is again, it's kind of moving from that crawl to that walk level. We're wanting to start to get the program to where it can really scale out, um, without having to add a lot of FTE resources to support us. So Bill, part of what we did earlier this year, through the help of, of outside consulting organizations, we basically have stood up in, in an intelligent automation, not just the program, but an actual center of enablement.

And as part of that, we've hired a manager and a, a couple of analyst resources that have come into that. We, we now have defined standards for our automation tools, most of which are, are code free type tools that as automation ideas come forward from various shared support service areas, like from within my own organization or within the supply chain, HR finance, dot, dot.

Ancillary functions, clinical, operational areas, et cetera. Those teams can come forward and can be basically consulted by the center of enablement to help them kind of get started down their automation journey where we can help get them trained on the tools, help them think about how to automate work so that they're thinking about it.

For example, we're, we're really quick to suggest if you've got a really inefficient process. All automation does is, is speeds up a bad process, which maybe you could suggest that's a little bit better of an outcome, but a lot of times it's, Hey, let's go in and let's rethink the work in the first place.

Now where we have areas that we can come in and, and help from an automation perspective, but we're really working and, and some of this is still a science experiment, is how well can non-engineer, technician people. But understand their workflows really well use these tools to actually automate work and kind of own it.

And we have a process whereby with the investments that were made into the center of enablement. And the tools, there's an expectation by our finance partners to turn around a, a return on that investment and, and basically they're targeting about a three x return minimally. So part of that is, as part of this broader program, we're really trying to do what, what I'll call value capture.

So as we're doing intake for automation ideas. We're trying upfront to, to capture on kind of a scale of low, medium to high, what type of value is this going to return, even if it's not direct financial return. A lot of times, again, it's patient satisfaction like I was talking about around our digital front door automation stuff.

To automating pharmacy workflows, to, to other business workflows that we see across a lot of different areas. So that, that's basically been our citizen development type of approach, if, if that makes sense. But, but it, it really is a bit of a hypothesis on how well this is ultimately gonna work out. I, I do have some concerns that as these automations get built, how much time and effort does it take to maintain those?

Now I can tell you. A lot of just front office type automations. I'm completely convinced that the workers across the organization can use some simple tools like Power Automate from Microsoft. That's one of our standards to really automate email workflows and a lot of other things like that. I. But for these higher end, big back office integration workflows, that's where my teams typically, or or partners, are going to have to get in and really help to kind of think through how to engineer those, how to support those for the long term.

Because as backend source systems have version upgrades, things like that. We've gotta be cognizant of that kind of, that what I'll call that whole it supply chain so that we don't, um, break things that, that were automated. Let's loop back then to the Intermountain Digital Foundation. So that's, that's an interesting concept to me, and I think that is forward.

Think, uh, in terms of just. Uh, thinking through the, the core elements that need to be in place for, to support not only citizen developers, but others and keeping that core foundation sort of intact and accessible, interoperable, and all those things. Talk a little bit about that. Yeah. Yeah. So again, internally, we're calling it the Intermountain Digital Platform.

It's not a single vendor play, but, but the mindset kind of starts with this notion that like every other healthcare organization we have. Many source systems behind the scenes. You think of the, you think claims processing systems, systems. That I think Gartner, at one point you maybe titled those systems of record.

Right? And those systems by and large were never really engineered or, or thought of back in the early days to to be a consumer engagement kind of a system. Right? And, and so the conundrum I think we all have is that you've got all of. These systems behind the scenes that are your workhorses or are very high transaction internally facing system that automate or at least help from an electronic processing perspective.

A lot of the workflows behind the scenes, but now all of a sudden we've got these consumers that are coming in that that we need to have. More or less directly interact with these systems that were never developed to, to interact that way. So the Intermountain Digital platforms, really this abstraction layer.

Again, multiple technologies, much of which are cloud-based, that range from front end user experience capabilities to business process type of a layer to basically API kind of gateway type layer. Down to a data abstraction type layer. And, and so each of those layers kind of play their own component with a lot of vertical integration.

So when we talk about MyHealth plus our, our digital front door tool set, we're using those top end tools coming down through an abstraction layer. I. So that, um, we don't necessarily have to have that tool being wired directly to our EMR platform, to our revenue cycle platform, our bill pay pieces, et cetera.

A lot of that can be abstracted so our developers can move much more agilely. We can have that elastic, um, capability of, of having that in our case, be out, out in Microsoft Azure, um, cloud services. And it just gives us so much more flexibility to move forward now. When we do that really well, like I suggested we've been doing with MyHealth Plus directed to consumers, well now we've got all of these same type of capabilities.

So as an example, this year we have kicked off a, a provider digital engagement type, mobile native mobile application concept that that really is sort of a. Pre-onboarding of providers all the way through all the different kinds of services that need from a non-direct specific individual patient perspective.

So it is sort of the everything else providers need that today. We throw all different communications at them, force them to go through all different kinds of logins for re-credentialing, for CME type tracking, for getting. Medical staff, bylaws and, and just everything else now can just come through again, just like we're doing for the digital consumer treating providers as we go forward, like a digital consumer as well, of all these internal services and capabilities.

And then on that runway we're taking, we're going to take the same concept for. Non-provider, internal caregivers, and other members of our workforce as well, to try to automate, like for leaders, instead of having to log in 15 different applications on a daily basis to approve this or, or to approve that, or to submit this, or whatever.

To try to bring to, to try to basically. Abstract all those backend systems for at least their, their most highly used transactions and capabilities and bring those into just a, you know, quick, easy mobile kind of an experience where device of their choosing anytime, day or night, wherever they happen to be, and be able to interact with things very quickly.

So that digital platform is, is really being . Focused around not only consumer needs, but provider needs as well as our internal workforce needs so that we can leverage a lot of those consistent services across the board. That's basically the approach with a data aggregation layer that can bring a lot of that data up, kind of get it more normalized, et cetera.

So that might be a little bit too much in the weeds, but no, that, that's sort of the parameters around how we think about the digital platform. It's not, not at all too much in the weeds. The crazy thing is I. But in, in 25 minutes here, we just covered topics that easily could have been three hours because you could tear apart that architecture.

Start talking about so many aspects of how you created the abstraction, how you're handling data, consistency, quality, those kind of things. We could probably, we'd spend the next three hours just talking about the architecture around that. But in the time we have left, I, I want to focus a little bit on your road, uh, to the CIO and, and, and your time at Intermountain because you.

Uh, as you said earlier, you came into this at a time when the, uh, pandemic was just starting to, just starting to peak. So talk a little bit about your journey. What did the road to the CIO look like for you? Good question. Well, it, it certainly, I. I guess a couple things. I talked about kind of the start of my healthcare IT journey being right outta college at Intermountain, but I distinctly Bill remember it.

I don't know if it's 1994, the year I started, or maybe 1995. It was in the first year or so of, of when I started at Intermountain that we had an all hands it meeting where Larry Grande, the CIO at the time, and you, you, you probably remember Larry, I'm assuming. Before my time Mark is as far back as I go.

Okay. Well yeah, so two CIOs before Mark Props actually, and, and Larry was the first CIO Well I remember being in this, this all hands IT meeting and back then we probably had 150 total IT employees. I mean, we literally fit on one floor of a, of corporate office space in, in downtown Salt Lake. And he laid out his strategic plan in that meeting and

And I recall thinking at the time how awesome it would be to get to be a leader like that who, who defines the whole technology strategy for the organization. And I'll just tell you, that was kind of my first glimpse thinking about the CIO role in healthcare. Not that I ever thought I'd be honored to, to be at that level.

Okay. Clearly, I'm just saying it turned a light bulb on like, well, how cool is that, that you've got this guy that's over all the technology and here he is sharing this vision and well in hindsight. I guess, um, I didn't realize at the time that there's actually a lot of people across an IT organization with outside consultants, et cetera, that make a lot of contributions to what ultimately becomes the IT strategy.

In other words, it's a team sport and, and you quickly learn as a leader that. No one has the, the fortitude and experience and brainpower to create all of that. Right. He, he was just the talking head, uh, like got to convey the, the message basically. So, so that's a lesson that I've certainly learned, but I've had a lot of diverse management and leadership opportunities, mostly in it in the subsequent 15 years after that, spanning at just at Intermountain, overseeing clinical applications for a time.

I moved from that over to infrastructure and operations. Being the chief software architect at, for about a year and a half to helping build out the cyber program, actually left it for about a two and a half, three year period to run what we call e-business back in the time that that really had all of the consumer facing the web assets, the public facing website, that the patient portal, the internal employee intranet, physician portal.

And it was sort of, it was really a fun couple of years because it had. Everything from strategy to execution and, and we partnered with it to build a lot of those solutions, but it was really, really fun doing that for the few years. Then I came back into the IT organization and you know what I guess I want to share with your listeners is, I still distinctly remember, I think it was 2011, having a succession planning conversation with our CIO who was market at the time, and that was really the

First time that we had a real conversation about being ACIO at Intermountain. Okay? So that was 10 years ago. And the first thing he told me, and at that point I was in essence, um, the chief operating officer of the IT organization and, and he strongly recommended that I pursue getting an MBA. And second, he thought it might actually be helpful as well.

To maybe go be ACIO at another healthcare organization to get that experience to be a better candidate, to be ACIO at, at Intermountain versus just coming up through the ranks. And, and so I did both in that next year and a half, I earned my MBA and it was a busy time of life, to be honest with you. Work was really busy with all the responsibilities I was training for and running marathons.

During that same time. I had some ecclesiastical church leadership responsibilities as well, but . Got it done, got the MBA thing done and, um, had an opportunity to, to go to Banner Health as, as CIO and, and to kind of cultivate that skillset over the five years. And, and then Mark finally, uh, he retired last year and, and he's been a good friend and a great mentor and kind of came back full circle to, to be in the role I'm in now.

You know, Ryan, I'm, I'm finding that these CIOs don't know how to retire. Every time I turn around, I see Mark's name. He's presenting, he's talking, he is on a webinar . I'm like, so I, maybe he is retired. Maybe this, this is what retirement looks like. Are, are you gonna be able to retire when it comes time? I, but I sure hope so, bill.

I, I, I think I'm gonna struggle with that a lot less than, than some CIO . I don't consider myself a workaholic. I relish weekends and time spent with family and, and unplugging from work when, when it allows. But, you know, the CIO role is, it's a busy role, um, as, as you well know. And, and I don't think I'm gonna struggle with that.

Yeah, I'm, I'm poking fun of Mark. I don't think he's a workaholic. I, I think he does a couple things, maintains a, a public persona, which is. We see 'em. You, you point out, one of the things that I, I tell people all the time when I get asked a question, I'll invariably, I'll be speaking to younger people and they'll say, you know, what's the path to a healthcare CIO?

And I'm like, yeah. The only thing I can tell you is there isn't one. I mean, some people went to med school, some people didn't. Some people have a technology background, some people don't. Some people, it's just the, the stories vary. So greatly that I, you really can't pinpoint it other than to say at some point that lesson that you talked about at some point people learn that it's a leadership role and not a technology role, and it's a leadership role, not a healthcare role.

And what leadership is about is empowering teams, helping teams to be more successful, getting the team really to work together and getting more outta that team. And that's the commonality that I hear if they come in as a physician, if they come in as a technologist. They've developed that skill of serving others and helping others to be more as a group than they could be individually.

And I, I think that's the commonality. Well said, bill. I think if you're a technologist, like I was coming up through the ranks, one thing that I've learned firsthand, um, seeing. Why other technology leaders have struggled getting to that CIO role is, is really two things. Sometimes they were so siloed in, in, you know, whatever organization's IT department they were in, that they only like new infrastructure and operations or they only dealt with the clinical applications or they're only in cyber, et cetera.

And, and not that some of those individuals hadn't made that jump to to be ACIO, but . I think the more diversity you can get across the various technology disciplines is really helpful If you're a technologist, but bottom line and, and you hit the nail on the head, it's, it's really a lot about building teams.

It's a lot about relationship building. It's a lot about executive presence. Those are the skill sets that if, if you really force yourself to get more experience in each of those areas, you, you're gonna have a spotlight shown on you and you're gonna be. Brought along because we have such a, a dearth a lot of times, I, I think in the IT realm of leaders that, that really have some level of the necessary polish around executive presence, team building, being able to work really closely at their customers and, and being able to kind of take a back seat to their customers and not having to be in the direct spotlight and say, Hey.

This is it that did this. I, I find it's far more easier to get budget, et cetera. If you have a physician leader, if you have a nurse leader, if you have head of supply chain partnered with you standing on stage saying, this is what we need to do and here's the investments we need to do to do it, and, and let.

Let us play a little bit more of a supporting, enabling role instead of trying to be in the limelight where you're directly single-handedly trying to justify the budgets, et cetera. These are all parts of, I think, the, you know, skill sets for, for making of a next generation CIO or you know, digital leader.

Talk to me a little bit about leadership style. Coming through the pandemic. Pandemic hits, we send workers home. First of all, where, where are you at in that journey in terms of your workers at home or returning to the office, and how has that impacted or changed maybe some of the ways you led or thought about leadership as you were moving through the pandemic?

Yeah. Perfect. So let's, I, I guess, you know, let's start with actually starting during a pandemic. Okay. And then, then I'll kind of get to moving back into the office and, and things like that with our teams. It, it, it certainly disrupted the historical meet and greet in person method that, that new executives I, I think, have always depended on, we just talked about how important relationships are at, at this level.

Well, I'd share that WebEx and Teams became the overnight defacto standard for not only one-on-ones, but conducting all of our town hall type meetings, et cetera. And that's largely persistent and, and so I felt like I had to adapt quickly to a new way of building and fostering relationships just like everybody else has as well.

It's just that when you're . A, a new entrant to an organization, you don't have the advantage of already knowing everybody before the pandemic started. Now, in my particular case, thank heavens there's still a lot of former colleagues that are still here from when, during that, um, eight year lapse that I was gone from Intermountain.

So, so that's one thing. And then I'd also say that. I quickly learned that after being out of the CIO role for about two years. Remember, I was at Health Catalyst as an executive advisor for a couple of years, which by the way, was just a ton of fun. Boy, I, I'd tell you, I'd recommend it any CIO that could do something like that for a two year stint and then come back into be ACIO, it really opens up a lot of your perspective.

Move over to the, the vendor side. Did you go through the going public phase for Health Catalyst? I did, yeah. Wow, that would've been a lot of fun. It, it was so much fun. It was a lot of work, and, and, but I'll tell you that two years, I, I learned so many lessons about healthcare being out on a plane every week and, and getting to visit healthcare organizations all across the country.

I. You see firsthand what's really going on out there and what CIOs are really struggling with. And you also learned that not every organization out there is Intermountain Healthcare or Banner Health. There's, there's a, a lot of, to say needs, um, out there. And so I, I found that really eye-opening bill, but with, after that two years jumping, jumping back in, during the height of the pandemic into the CIO role.

One thing that I noticed is, is that the, the pace, the absolute pace of healthcare and, and subsequently it had changed dramatically. So much work had to literally now be delegated to really highly matrixed solution teams spanning it, supply chain analytics, clinical operations. I mean, you. You, you've heard the drill a million times on your shows that it really has helped me kind of refine my leadership approach around thinking and in just a much more interdisciplinary way than how I used to probably think about things pre pandemic.

And finally, it's been kind of getting into the workforce of the future stuff. It's been really cool to. Help kind of navigate through the pre pandemic requirement of say, 95 plus percent of our employees, that, that in almost every healthcare organization we're expected to be on site every day for work.

Melding that now into this kind of true hybrid work environment where at least speaking for my team, and we have about 1100 F FTEs in, in it at Intermountain Healthcare, about 70%. We'll be remote for the foreseeable future, and that's them opting in to that type of work arrangement. And all these changes, again, have really, I'm just gonna say, have helped kind of shape my leadership approach on what's really possible and, and thinking about things like that work-life balance and, and employee engagement in, in just new ways that, that maybe we didn't always have to before.

Can you define remote? Because I, I think some people are gonna listen to this and say 70, 70% of their people aren't coming to the office anymore. But that's not what you're saying. Yeah, yeah, yeah. Not exactly like that. So, so if we think about office space itself, okay. Historically, we all have a defined office space, whether that was a, you know, four wall, the door office or a cubicle, whatever the case it.

Your name was hanging on the shingle out outside of that, and basically, as we went through all kinds of surveys over the last year, and we have a program actually being head up, headed up by HR that we're calling Workforce of the Future. We have really surveyed our leaders, we've surveyed our employees, et cetera.

To, to find out what has worked really well for them during the pandemic when virtually everybody was remote that wasn't, that didn't have to be in a facility, and what didn't work so well and, and then how did they see things as, as we go forward and when, so when we talk about 70%, what that means for us is that 70% of of our IT employees will be working remotely three or more days per week.

Okay, so, and if it's three or more days per week that you're working remotely, then we're not going to hang your name on a shingle outside of your cubicle or, or or office. You can come in on, on that one day, two days, and in some cases zero days per week. But when you do need to come in, you, you can just touch down in a hotel type cubicle.

We'll still have two monitors, phone all, all that kind of stuff there for you. But. You just come in and you can be by your other team members and, and we're not holding specific space for you, so that's the 70%, but it'll be working remotely three or more days per week. Ryan, we're gonna have to have you back on the show next year.

We only have a couple minutes left. Yeah, and, and part of me wants to just get to know you a little bit more. Are you binge watching any shows these days? Well, yeah. Just watch the new James Bond movie. That was awesome. It's been so great getting back. In person into theaters. I've gotta just say that. Oh, I really, oh, you actually went to a theater.

What was that like? A awesome . Alright. Is it, is it social distancing or is it like every other seat? Yeah. Yeah. So you can sit right next to family members, but then they keep, you know, a couple seats break between other, other people and, but yeah, we, our theaters have been open for a while, so gotta watch that one.

That was awesome. My wife and I, we happened on to, I don't even know when the series came out. Burn notice. That's the story about an ex CI apy . I've, I've watched the whole thing. It's really good. Yeah. And it's all, I think it was all basically filmed down in your neck of the Woods Bill. But, but at any rate, that one was fun.

We kind of binge watched that one and, and we've been done with that one for a little while. But yeah, that, that's kind of what have, have you seen, have you seen White collar? I haven't. No. If you like burn notice, you'll love white collar. It's, it's really well done. Telling me that she, she really got into it, but yeah, we haven't, we haven't watched that one yet.

The, the, the other one, and it depends, it depends what you have these days. It's incredible. 'cause you say something to somebody, they're like, what's it on? Oh, I don't have that one. But, uh, murders in the same building is, has been phenomenal. It's, it's Steve Martin, uh, Martin Short. And, oh gosh, what's her name?

Oh, my, my daughter's gonna kill me for, for forgetting her name, Selena Gomez. Oh, yeah. And it's, it's a great premise. Stinging is in it and, uh, there's just a bunch of people that are in it, and it's, I think it's on Hulu and it's, it's been, it's been a lot of fun. Well, well, I see you at Chime. I'll be down there at least for a couple of days, so looking forward to it.

Let's, let's for sure. Catch up there. Absolutely. Ryan, thank you for your time. Really appreciate it. Hey, my pleasure and again, thanks for the opportunity to bill to be on on the show. As I was talking with you earlier, this has sort of been a bucket list item that I can say officially checked, so, so thanks for the opportunity.

Thanks, bill. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions. Please forward them a note. Perhaps your team, your staff. I know if I were ACIO today, I would have every one of my team members listening to this show. It's it's conference level value every week.

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