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 Welcome to this week in Health it where we discuss the news information and emerging thought with leaders from across the healthcare industry. This is episode number 48 Today we look at the changing care settings and health innovation. Um, this systems are, Work with a trusted partner that's been moving health systems to the cloud since 2010.

Visit Health Lyrics do to schedule your free consultation. My name Bill Russell Healthcare, c i, writer and advisor with. Today's guest, a new friend, industry veteran. Rich Pollock is an advisor with servers, advisors. Rich is more than 40 years. 40 years wow. Of healthcare management experience, 20 of which were focused on the m r success.

Rich serve the Vice president and c i O for V C U Health system in Richmond, Virginia. Uh, from five recently. Uh, interim. For Clarion Health Partners, a uh, 2 billion health system in Indianapolis, Indiana. Uh, good morning, rich. Welcome to the show. Good morning. Glad to be here, bill. Wow, 40 years of healthcare management experience.

I, I seem to be having these people on the show that have just a, a wealth of experience. I, what do you, uh, what do you attribute to your longevity in the space to. Well, uh, yeah, perseverance I guess. But, um, but I actually had, uh, uh, you know, two careers. I, uh, my first, uh, career in healthcare was in the field of radiology.

And, uh, uh, I thought I would stay in that forever. And I had about a 13 year, uh, career in that. And I transitioned, uh, in the late eighties into, uh, it. By happenstance, it just, I happened to hit it at the right time. It was beginning to take off, especially on the clinical side. And, uh, I worked for, uh, a couple of vendors and then for a large community hospital and then sort of gravitated for some, you know, due to some personality I ality.

I, I'm passionate about what I do. I love the industry. I can't believe the time that's gone by and, uh, doesn't feel like 40 years to me. Um, uh, except when I look in the mirror maybe. But, uh, , I see, I see the lines, but, uh, it's, uh, it's been just a, a great run and, uh, continues to be a great run. I, I just have witnessed so much positive change over that period.

Yeah. So now you're with, uh, my friends at, uh, Starbridge Advisors. Uh, give, give us an idea of what you're doing with Starbridge Advisors. Sure. Um, so I, I joined them shortly after I, uh, retired from B C U and, um, and I knew, uh, David, uh, months for many, many, many years. I knew Sue a little bit less, but still knew her.

Uh, didn't know Russ, uh, until I joined Then. Recently completed a six month, uh, senior executive. It.

Other than the, uh, traveling back and forth from the middle of January , which was a little challenging for, I mean, main was lovely. I've been there many times in the summer and the fall, but, uh, um, but it was great. It was very gratifying. They were big Cerner clients. They were rolling out Cerner in the ambulatory space.

They certainly needed some, um, help with, uh, new governance and, and road mapping and a whole bunch of other areas. A whole new executive team had come into place. Um, so I essentially was a coner to the, to the c i o who was very, very confident, uh, individual, but uh, needed some extra help. So, uh, that was a six.

After I finished that, I decided, uh, for some odd reason to go ahead and get my right knee replaced. So , I've been spending the summer recover partial right knee replacement, but it's doing extremely well. So, so I'll be back, I'll probably be back on the road in for the first of the year. Yeah, so it's, uh, interim, interim leadership.

I'll tell you the, the New England, my wife and I lived in New England for one year. We lived in New Hampshire. And, uh, you know, two, two stories from that. One is we got 136 inches of snow that winter. And that, that was enough to tell me that, uh, that I was not cut out. I was not strong enough character to live in New Hampshire for the long term.

That was, uh, that was something else. And then the second thing was the, uh, after a while I was driving around with a friend and I'm like, man, you know, it's just kind of lonely up here. And he said, he said, bill, look, look out. Look out.

Tore because they love trees more than they like people. He goes, if you people than you might go somewhere,

call it.

Well let, uh, Oh yeah. It, it is, it is so cold. And, and Maine is the same thing. It's just so cold up there. But, uh, but yeah, great, great friendships, great people up there. So, uh, lemme kick us to the show. We have, we have two good news stories and, uh, well actually before we get to our news stories, let me, lemme just hit on, you know, I was looking through the news and, and we had so many to choose from.

Some just. So, uh, one is Apple and talks to give veterans access to their electronic medical records. That's a huge story that's in the Wall Street Journal. Uh, I think, uh, this morning. So that's, that's interesting. Maybe we'll talk about that in the future. Uh, another one from Becker's, AI for Precision Medicine.

Top of mind years health execs, health system execs. In fact, they 10 and number one.

And then, uh, you know, the one I think we've talked about a little bit on the show before, but there's a story that says, uh, hackers are not the main cause for health data breaches. I think we've known this, but they did the research. They went back and looked at all the, uh, breaches and it turns out, uh, that most of the data breaches were due to mistakes or security lapses within the healthcare organization.

So those, those are three stories we're not this.

The first one, the seven most valuable he health tech startups that failed in 2018. So we're getting close to the end of the year. We'll do a lot of these retrospective kind of stories. We'll see 'em and towards the, uh, and also we'll start to look at, you know, predictions for next year for whatever they're worth.

Um, but here are the top, you know, I'll give you couple of top seven most.

Blood testing technology company, Silicon Valley, $9 billion Valuation, uh, you know, complete, uh, uh, completely gone. Uh, number eight, medical simulation. Number nine, revision optics. Number 12, canes Health. 13. Uh, pay Eon. Payon. Well probably start with a different name. Would've been better. Number 15 was Winx, a sleep therapy system.

And number 22 was Claritas, uh, genomics. Um, you know, I'm not, I'm not outside of maybe one or two of these. I'm not overly familiar with too many of them. Are you, are you familiar with some of these? Well, yeah, so with a few, uh, not, not all of them certainly. Um, the Serranos, uh, is kind of interesting. You know, I was, before I was at, uh, iu I was at MD Anderson in, in Houston.

So I was in Houston for about seven years, and I was there during the Enron. This con situation kind of reminds me of Enron, so a of cards and Phan. Fraudulent, insufficient, insufficient vetting and validation upfront. Uh, but lots of folks taken in with the promise of something that's literally too good to be true.

So, uh, that's, that's, it's an analogous to, to me, in my mind with Enron, uh, you know, just, uh, let's, let's create something when there isn't anything there. Um, well that's a, that's, I mean, that's a big statement there and. The, you know, the, the lore of, uh, of the company was they, you know, they, they were able to, um, in increase speed to get to the result, decrease cost, and maintain the same level of accuracy.

So that was their claim to fame. And if they, but if they had been able to do that, would've changer.

You know, clearly question about it. Yeah. Uh, you know, it was built based, uh, and built upon, uh, fallacious information. And so, uh, which, you know, took a while to come to the, to come out, you know, that speaks to our, um, I don't know, I guess our culture of, uh, if, if it sounds too good to be true, we wanna believe it.

So, uh, as opposed to questioning it. Well, let's, let's talk about that. So it did take a while for that to come out and, you know, a lot of health systems are talking about innovation. Innovation, and there's a lot of innovation models within healthcare. There's VC models, private equity. Some, some health systems are incubating companies.

Some are acting as a wet labs for, uh, startups and obviously others are partnerships. Um, let's, what are.

These technologies to make sure that we're not, we don't end up in a partnership with the, you know, the group that ends up on this list in 2019 or 2020. Uh, you know, how do we, how do we make sure that, yeah. Well, I, you know, I think you need, you need to have some sort of independent, uh, vetting and validation.

Um, you know, uh,

You know, see, you know, is there a peer reviewed research that's been validated? Um, you know, not j just 100% relying on the, what the company is telling you, but can you go, you know, are there ways for you to go to, uh, to validate that, whether it's from an outside source or, um, you know, even a competitor or from your own academic, uh, capabilities, if you're, you know, if you're a.

Research institution and have the, the wherewithal to do that. So, uh, you've got to, there's gotta be some sort of vetting and validation that is beyond just what the company does. Yeah, absolutely. I, you know, I was, uh, as a C I O I was asked to be a part of a team that was to look at, uh, Theranos for our.

Uh, the, the hardest thing for us was they were not overly forthcoming with information. Not only, you know, was potentially the information that they were putting out there, not valid, but they weren't overly forthcoming. Um, right. And, you know, luckily for us, we were a little bit of a late adopter. So at that point some of the things started to, uh, unravel a little, a little bit.

So, Um, but you know, that is the risk. The risk is, you know, not being early enough to market and not taking the risk. Obviously on the hindsight you look smart 'cause you didn't jump into something like that. But, you know, one of these could be a disruptor. And so, you know, when I think about vetting these companies, I, I'm gonna throw out some different, some different things we looked at when we were vetting companies.

To thoughts on it. So the first one for us was always the leadership. You know how when we met with the leadership, what, you know, how did they operate the company, what was their vision? How were they thinking about the market? Uh, did they come across as somebody that was in it for the, you know, that glory?

Or did they come across as somebody that.

Um, that's a, that's a tough foundation, but if they're in it for, to, to really change healthcare and you pick that up and generally when a leader tells a story that, you know, that resonates, uh, and, and you start to interview some of the people in the company and their stories resonate. That's, you know, so the first thing we look at is leadership.

I mean, what do you look for in the leadership of a startup? Let's assume there's startup coming to c. Uh, you know, when, when you're talking to leadership, what, what kind of qualities are you looking for? Well, I think you're looking for, uh, uh, well, I would be looking for a couple things. One, I would be looking for that, like you indicate passion to change the game, change the industry, change, you know, uh, the delivery of healthcare in, in a very positive way.

So the passion's gotta be there, but there also has gotta be a tremendous intellectual prowess there. So they really are, you know, doing something unique. Then whether it's the, the person that's the founder or his co-partner or somebody in that organization that's got some significant intellectual prowess, that has really broken through, uh, in a, in a new way, uh, and can, and can articulate that and can explain it without giving away the company's trade secrets, but really be able to, you know, lay out on a whiteboard.

So different, and this is how, you know, how we came up with it. Um, so that may be, both of those things may be, uh, co contained within the same individual, or they may be, you know, as I see often, you know, two partners or, or, uh, you know, the c e O has a, you know, their, their chief science officer, what have you.

Um, and then, you know, we, we, in an academic institution, uh, equal intellectual, uh, capability, And try to punch holes in that and see, uh, in, in fact what's, uh, you know, what's real, what's not. And we certainly have, um, we certainly have done, uh, work with, uh, startups with new companies that, uh, or like I characterize the three guys in a garage, uh, type of thing.

So, um, and that has its own challenges. But if we see that there's some value there, we kind of, you know, Go along and maybe it along and, and hope to, uh, see it through to maturity. Yeah. Well, you know, so some of the other thing I, I'm, I'm sorry. I have my arms folded here. My, my family's, I, I actually travel for Thanksgiving.

I'm in a very cold climate and they kick me out onto the porch so I wouldn't be too loud. So I'm freezing , just, just.

I think one of the, one of the other, uh, uh, startups, you, uh, that on your list is medical simulation. And now that may be overhyped, uh, and maybe at the Gartner Peak, but nonetheless, we use it extensively at V C U we have a series of simulation labs in the. You know, been there since, I think 1838 or some crazy time there.

But, um, that's been very successful for V C U in, in training and developing multidisciplinary teams to work together. That, that is a, uh, has been very, very effective tool. So, while it may have been over, it may be over height, I wouldn't that, um, and where it's on the peak, the Gardner hype cycle, but nonetheless, Uh, if you put in the resources and the commitment to do it, we, we certainly have, um, we have vision optics.

I, I was, I have no idea what that, I'm familiar with that. Yeah. So when you, when you think about medical simulation, I agree with you. It's on the, the top of the head cycle, but it, it sort of goes into the next couple of things that I would vet. I mean, you know, one are,

Technologies could displace, you know, whatever's there now. So that's gonna be a space that's in Fluxx, I think, over the next couple of years, just because of the, the pace that AR and vr, um Right, right. Coming along. So, uh, yeah, I think, uh, that, that's a good point. Uh, bill, because, uh, we don't, we were not using vr, um, in our, in our simulation labs, we were using

Multi feedback, uh, dummies, if you wanna call 'em, um, uh, simulate patients and the sorted equipment around that, in those labs to, uh, for those teams to work together in, in clinical situa simulated clinical situ situation. But I do think the advent of, uh, uh, virtual reality headsets are gonna change the game up.

Uh,

There, you know, there's no substitute for that, you know, human interaction because that's what really happens in team, uh, based, uh, healthcare delivery. Uh, so it'll, it'll be interesting to see how that, how that factors in, in what we do currently with simulation. Yeah. At the, uh, exponential Medicine Conference, I.

Where, you know, a, a physician, a surgeon with goggles on, actually it overlays a whole bunch of data right? On the patient itself and themselves and yeah, I, I can only imagine where that's, where that's gonna go. Um, obviously, you know, some of the other things we look for, financial models, technology fit. Uh, you know, I, I love that discussion.

I think, you know, we'll have to keep an eye on that, uh, the, the changing landscape. But let's, let's kick it to the next, uh, the next story. This is your story, so I'll let you set it up. Uh, sure. Yeah. Um, you know, I, I took a look at this one in the news that consumers seeking care in new settings for lower costs.

So, um, because this has gotten a lot of play. Um, in the, in the last, uh, couple years of retail clinics, uh, particularly, um, V C U, we've partnered with, uh, Kroger, uh, department stores and have, uh, retail clinics out there and other folks are doing the same. So I look at it as retail clinics versus traditional urgent care versus virtual care models.

So I see those three.

Um, virtual care has actually out there out California with Kaiser, a huge number, a huge percentage of their outpatient visits are now virtual visits. Um, is similarly at u in Pennsylvania. U P M C is. Has, uh, deployed a tremendous, uh, program for virtual visits across the state, and others are doing, you know, doing likewise.

But you have to keep in mind that right now most of these are focused on low complexity, convenient to consumer care. So by that I mean it's the sore throat, it's the rash, it's the,

you know, although, Yeah. Uh, and a need for that, no question. And, and it, there's an advantage in not, uh, cost advantage, I think, in not burdening our, you know, multimillion dollar facilities with, uh, with waiting lists of people coming in to see a, a primary care provider in a clinic setting for a sore throat that could be done either in a retail clinic or, or virtually.

So there is advantages to that, but there is a complexity curve here. And although the urgent care model, because they typically incorporate labs and x-ray capability that the retail models don't have, they can move up the complexity curve a little bit, a little bit further. However, what I, what strikes me that people are forgetting, uh, or, or not paying attention to you on this is remember that 5% of our patients consume almost 50%.

So the, you know the, if you're going to really affect the cost curve, you really have to deal with the chronic disease, complex care populations with multiple comorbidities. These are fragile diabetics, asthma kids, et cetera. And they typically require a multidisciplinary team, mental health, social work, pharmacists, physicians, nurses, et cetera, approach.

Virtual visits, you know, combined with home monitoring may play a key role in, in the in-clinic management of these patients with, uh, better outcomes and lower costs. But I just don't see the MinuteClinic or urgent care being physicians to deal with this. And that's where, uh, we kind of, when I, we were at V C U, we put a lot of effort into setting up a complex care clinic to deal with that small population.

Incurs a huge financial burden. Yeah. Yeah. I, yeah, I understand what you're saying, but I, I have a feeling the retail players are sitting back going, that's fine. You can have that business, the high risk, high complexity patients, you can have it vc, we'll let you have it. Here's what we want. We do want the low risk, uh, high volume business.

Uh, you know, video visits are nice, but I think, you know, the, the Walgreens, the Walmarts, the CVSs of the world would prefer the walk-in visits. 'cause the walk-in visits mean that they're gonna come in, they're gonna pick up their medicine, and they're, they're gonna make money on their core business and their core business.

Obviously being, uh, you know, the, the retail items that they. Um, I, I thought it was interesting that, you know, the two examples you gave U P M C and Kaiser are, are both payer providers, right? So U P M C with Highmark and Yeah. And Kaiser obviously is an internal kind of model. They, uh, and, and so, you know, the televisits, yes, they're going through the roof, but they're, they're the, uh, the incentives aligned for them.

So they're already getting paid on the insurance side, if they can do a lower cost model, which they, you know, they are obviously with the tele and, and the, uh, follow up visits, they're, they're actually gonna do better financially. And, and so when the financial incentives align, I think you, you find that the behavior of the health systems line now this year happens to be, I think it's gonna be a banner year for most, most health systems.

So there's no reason to shed any tiers for them. But I think what what, um, what we are gonna see though, is more, more and more pressure. You're gonna see, uh, regulatory pressure. Changing the game, uh, you're going to see, uh, retail players come in and they're not, they're not going after the, again, the high risk, high complexity.

They're going after the, uh, low risk, high margin business, and they're going to keep nibbling around the edges, uh, as, as well, uh, you know, outpatient surgery centers, which have for years and, um, you know, outpatient imaging, which has taken revenue.

You're, uh, more and more of that business, uh, go that way. How do you think? Yeah, I, I, I agree. I think I, I think that, uh, yeah. I'm sorry. Go ahead. Well, you know, I, as I was looking at this story, uh, you know, here's a couple of things from it. So it says, consumers views on health can change rapidly attitudes towards such things as openness to seeking care.

Into sharing health data with pharmaceutical companies have changed in just last five years. The analysis of the H R I Consumer Survey, many consumers are ready for healthcare to mirror other parts of their lives in terms of convenience, choice, and presence of affordable options with predictable pricing report added.

Companies that invest in data understanding. We'll be able develop tailored products and services. So there's a lot of things, you know, there's a lot of things competing for our mind share. When you're sitting in the c I O chair, when you're sitting in the executive chair, uh, how are we going to prioritize?

You know, we're not prioritizing good and bad. We're prioritizing good and good, and so how are we gonna elevate sort of the consumer mindset of how do we, how do we create more options, more cost effective options? For the patient consumers that we have out there, as opposed to maybe working on e h R optimization or RPA and other efficiency programs.

Again, all good programs, but how do we, how do we elevate the, the consumer work that that's going on? Yeah, I think, yeah, I think there absolutely has to be a focus, uh, today more than ever on. Consumer wants the consumer convenience, um, because they are voting with their feet and they are going to the retail clinic, they are going to urgent care.

And, uh, and even in our, uh, small marketplace, virtual visits are, uh, taking off with a lot of our competitors. So, um, you know, we, we, um, have, as I think a lot of other organizations. Uh, kind of no room at the, at the end, hundred clinics and 800 providers or so. Were com You know, it wasn't like they were waiting for patients, they waiting lists even for, uh, primary care was in the matter of weeks and for the specialists for the matter of months.

So, uh, so if we can. Uh, partner with a, you know, virtual care, uh, partner. If we can partner with a retail clinics, uh, as we've done with program, uh, then we have a, a cha, we open up new channels to have these, these patients, so we tame them. Into Integr. You know what, they're gonna come to us hopefully when they want their knee replaced or something more significant.

But, um, we're able to retain that loyalty, um, retain the data in terms of a single electronic record and, um, and still provide the kind of at, at home convenience that people want. I mean, you know, here's Black Friday and it's going to be probably more people shopping online than actually gonna stores. So that's just the reality of people wanna do things and we do so much online at home.

And being able to do virtual care, I think is going to potentially overtake some of the, some of those retail clinics, the retail clinics. Convenient. You're there shopping, you've got an issue, you, you roll right in. But you know, it's typically, uh, I've got a problem and it manifests itself and.

I think virtual care has a significant role that yet to unravel and, and deploy at this point. And, um, that's where I think, uh, health systems need to put a lot of focus on. Um, and it is a, it's a disruptive. In terms of our clinician community, they, they have to think differently about how they organize their work and their day, day and their workflow to be available for that virtual.

If you're going to use your own, uh, clinical staff for your virtual visits, uh, as, as we've done. So, it takes, it takes a little bit of work to, uh, work through that. I'll let you have the, the last word on that and you know, we'll transition into the soundbite section. So during the soundbite section. You know, I typically toss out questions in your direction, one to three minute, uh, answers, not looking for elaborate answers.

Sometimes people ask me like, why didn't you let them talk more about it? Well, you know, this, this section's really to, to, to give the, you know, the quick hit answer to some of these things. Uh, you know, if you go longer than that, I'm not gonna, not gonna cut you off. And, uh, if you wanna throw questions back at me, feel free.

I, I may have answers, I may not. We. So let's start number one. So you've been the c i o for several organizations and have been, uh, interim c i o as well. What are you looking to do in the first 90 days of your tenure? Uh, and, and I realize those two are different. So let's say the first 90 days of your tenure as a, as new c i when you're first starting as a, as a C I O versus an interim, whatcha looking to do in those first 90 days?

Sure. Yeah. Well, good question. Good question. First, listen and learn. Make rounds with staff and caregivers, um, begin to establish trust relationships with your new boss, with your peers, with your staff. Uh, I try to create an atmosphere of openness and being approachable. Uh, I think it's very important to do that right from the beginning.

Um, and finally, I would identify the most immediate and critical needs and address those via collaborative action plans with staff and stakeholders. You know, something you don't wanna be. You know, step into a big pothole, uh, on your first 90 days. So you really do need to identify, are there some really, uh, critical issues out in front of you that require immediate attention?

Um, often there are, um, now you set yourself up for the next 90 days by gaining an understanding of the organization's direction and goals and where it is aligned or not aligned. So I think those are the, that's kind of what my thinking in those first 90 days is about. So it's about establishing trust, relationships.

It's about doing a lot of listening and learning, um, and, and making rounds and being very open and approachable. So you're gonna, you're just gonna be a sponge. You're gonna try to absorb a lot of information, a lot of history, a lot of culture's been there for who knows how many decades. Yeah.

When I took over as c i o for health system, I, within the first 30 days we had a reportable breach. And you know, you just, you, you, you think, well, I have some time to sort of get it up to speed, but you have to identify those, those emergency items. Yeah. Um, so all right, so the second question would be, we, we talked about full-time c i o.

How does your approach to an interim c I role, how is that distinct? What, what do you look to do there as opposed to a full-time ccio role? Yeah, it's much the same. However, I've found that those roles, uh, provide me with a sense of objectivity and that present when my concern, uh, include long-term success.

So, um, it's easier to confront and challenge established norms, uh, and culture as a independent source. Um, you're not, you know, it, uh, you know, I could tell you that, um, it, it just, it gives you a different feeling. Um, and especially if you're in a very challenging, and I've been in some of those very challenging environments where, um, just the ability to, you know, at the end of the week say, you know, what, if they continue to just.

Pissed me off that much. I'm not coming back on Monday. , it gives you a kind of a freedom, uh, in terms of, uh, being able to speak your mind and offer, you know, um, very candid and, uh, perhaps not really, uh, looked for, uh, advice, but that needed to be heard. So there's an independence of thought that, you know, maybe, you know, should be there.

Frequently we're, you know, we couch that we, we, me mellow it out a little bit because we're concerned about, you know, the long term, uh, ability to work and stay with this organization and, uh, and, and be nice, you know, with, with the folks over that long term. When you're in an interim, it's really much, much cut, more cut and dry and you know, this, this is what you gotta do.

And, you know, tough up, you know. Yeah. Do, do you find, so a c e O might look at you and say, uh, I guess there's 2, 2, 2 schools of thought. One would be, Hey, just keep the seat warm. We're doing a search process, we're bringing somebody in. I, I, I don't find that to be the case so much anymore as the other, which is, Hey, we're doing a search.

We're bringing somebody in, but we'd like for you really analyze this environment. Give us that, you know, and you know, if there's changes we need to make now, and the person starting. You know, we're willing to make those changes. I, I find the C CEOs to be more in that camp than me. You know, just keep the seed warm.

Absolutely. Yeah. My experience, that's been my experience as well, so it's been more of, you know, yeah, we want you to keep the seed warm, but we also wanna really, really take advantage of your experience and your capabilities to. A fresh look at everything we're doing here and you know, does it make sense or not?

Um, so yeah, I would, I would wholeheartedly agree with that. Absolutely. So, alright, so third question, e h r. Usability, one of, one of our favorite topics. In fact, I think next week we're gonna be talking to people at class, um, about their, uh, research on the, on the subject. So us.

With the e r better. Yeah, absolutely. I'm glad, I'm glad you asked that. Um, we, we've had great success at V C U over the years, um, recently, uh, scored a Davies, uh, award. Uh, as you may know, um, and to a great extent that is a result of us creating a very unique office of.

His ability to deliver high qu uh, high quality care, the triple aim, you know, high quality care. This was a brainchild of our first C M I O, uh, Al Kin, um, and published in, in Jamia, uh, back in October of 2011 if anybody wants to look it up. Uh, it was a considerable investment. Well over a million dollars a year, uh, and informatics docs, informatics nurses at the elbow trainers.

Cetera. Um, it was a, a hard, it took us about a year to make the case, uh, myself and the C M I O together, and in the end, um, uh, it was actually the dean of the medical school that coughed off the $3 million seed money for the first three years to get this off the ground. But it was usually successful after that.

And, uh, and the organization began to, the board recognized it.

And really was the secret source, uh, as our current, uh, C M I O, uh, states, uh, real world examples of that success were real-time dashboards that address the early warning in the I C U patient safety blood usage, uh, and just a higher level of satisfaction among the medical staff. Not that everyone is in love with the emr.

I think EMR between the, you know, ideal, uh, user interface usability systems that are out there in the world. Our EMRs, there's a big gap, uh, in the way they're designed, so there's no question about that. Um, and they need, still need to, a lot of work needs to be done, but nonetheless, with that kind of focus on the clinician that that clinical transformation office provided us and, uh, some significant skillset, uh, within the E M R itself.

So we are very adept, uh, Cerner. Uh, developers and users within our team that could really, uh, make the system and lot of things with M pages and dashboard development and, uh, improve physician documentation. So there are absolutely, uh, incremental improvements that could be made all across the board. If you've got, you've got a mechanism to link in your clinician community and, uh, as a collaborative force, uh, to do that.

Interesting. So Office of Clinical Transformation, if people are interested, they can, they can reach out to you on that. That sounds like, uh, an interesting conversation. Um, absolutely. Fourth, uh, fourth question. So, r o i is such an important part of it. When I sit down with operations people and finance people, they're always saying, you know, how do you measure R o I.

Measuring R O I within it. And any tips on, on measuring it, reporting back on it? Well, actually, uh, not many. Uh, if you're talking about financial ROIs, um, much more so in terms of improved outcomes, patient safety, reduced sentinal events, reduced near misses that we've been able to document. So that's a return on value.

Uh, Financial return on investment, um, you know, and e and even those, you could not lay that 100% at the feet of the E E M R because the EMR is part of an ecosystem of changes that affected that. So, uh, other work processes that were put in place, uh, individuals training, uh, variety of things that, uh, those changes, but the m r and our ability to build guard.

Absolutely affected those improvements in outcome. The, uh, one easy financial r o i I was ever able to nail down was our patient keeper project, uh, which is a, uh, mobile, was a mobile, uh, system still in use. Uh, we've had it for many, many years. Uh, that, uh, collects, uh, it presents clinical data to the, to the, uh, provider, but it also allows them to document their, um, Their encounter with the patient and with the appropriate coding for billing purposes.

And they replaced, uh, many years ago, the little three by five index cards that they had in their pocket where they would write down on the level three visit or what have you. And, uh, because that pro previous paper process was so fraught with loss. On, you know, people unable to interpret physicians, uh, what they were documented, et cetera.

Uh, we literally documented millions of dollars in r o I return. Uh, so people initially didn't believe it until we ran a pilot with it, and then their amounts were gave. They didn't realize how much money was being left on the table. In, uh, provider Uhers, remember as an academic medical center, So it's not like it necessarily in their self-interest to be diligent about this stuff.

So, um, so that was the one positive financial r o i that I could put down in a book somewhere and say, yeah, absolutely take this to the bank. But, uh, that I, I can't remember too many other than those. We'll, we'll keep moving on. Uh, the, uh, last question I have for you is, uh, let's, let's talk about contractors and consultants.

I get this question, um, every now and then from, uh, CIOs and, and some others. Uh, where have you found the best place to utilize consultants within health it and where would you avoid using them with as a C I O?

Um, I, I found a couple of areas where, uh, like what I, where I have used consultants, one was to mentor and develop certain directors or managers that needed an intense focus more than I could provide because they're moving into new roles. So in, in the case of our, uh, when we, we tapped a. Individual to be our director of, uh, of analytics in a newly developing analytics operation department.

Uh, brought in a well-known, um, uh, analytics, uh, expert in, in healthcare to spend some time one-on-one with him. And it was usually successful, uh, likewise for a new, um, associate c I. So I think in those.

Taking on new projects that exceed our internal bench. This is more contractors than consultants. Uh, if you wanna the subtlety of the terms. Um, so in other words, we, our C F O for many years, Uh, at V C U was all about minimizing headcount. She didn't have any issue with spending a lot of money on con contractors and bringing them into to address our projects, but she simply didn't wanna add head headcount.

When she retired, a new C F O came in with a 180 degree different, uh, philosophy, we began to shed those contractors and build off the bench strength and the, the headcount within it. So I think that that was one area. It depends against what the philosophy is, but, uh, with all the projects typically coming in front of a C I O, it's a rare department that actually has the bench strength.

To, to man all of those projects from the subject matter experts, through project managers, through, you know, report writers, what have you. Yeah. Um, the other area is very specific skillsets that might be missing. So when we were in the throes of meaningful use, um, Especially, uh, uh, stages. We, uh, we brought on project managers that had exceptional skills in understanding the regulatory climate and all of the rules and regulations associated with mu uh, that time.

So, uh, that's one. Or we would bring on a remote HL seven program or experience with a specific interface engine because we needed, uh, more, uh, capability and they just were hard to find in. So, uh, those are, those are examples where contractors or consultants have been useful, you know, in the past to me.

Yeah, absolutely. Well, that's all the questions I have for you. Do you have any for me or, or are we're good to go

see you Bill, about digitalization in healthcare's getting a lot of play. Uh, and it's, you know, it's all over the map. It's everything from, um, Precision medicine through consumer, uh, devices at the home, what have you, do you think it's being overhyped at this point? No, . I mean, and it is being hyped. It is really being hyped and it's not being hyped enough.

The, uh, you know, we talked. How as soon as the financial models change, everything's gonna change. You know, people want convenience, they want online bill pay, they, they online scheduling, they want, uh, you know, telehealth visits for, you know, my son's inside right now. He thinks he has tonsillitis. Well, it'd be nice to just get online with his provider and have a conversation, have.

You know, I, I think that's gonna change it. Ar vr, uh, ai, um, machine learning. I mean, these things are, you know, right around the edges and, and have the ability to really transform a market. So, uh, I I don't think that's being overhyped. It has the potential. Um, but what I think the thing that people underestimate is how long it's gonna take because of the fact that our incentives aren't aligned.

Are, uh, the organizational change management that's required to move these multi-billion dollar organizations, even some small hospitals. People are surprised when I say, you realize that's a $2 billion company? And they go, you're kidding? It's like, no. I mean, even small hospitals are multi-billion dollar 28,000 employee organizations and uh, and there's a lot of different entities out there that are.

A voice in, in the, in the community. So if that does slow it down, but it doesn't change the environment. This, this, the use of data, the use of, uh, just the emerging technologies is going to impact healthcare. Uh, it just, I've found every one of my predictions to be half as quick as it actually takes. So if I say I think it's gonna transform healthcare in three years, it's usually six.

So, um, right, right. So, hey, rich. Thanks. Thanks. You know, on Black Friday, thanks for coming on the show. I appreciate it. Um, what's the best way for people to follow you? Um, sure I have, uh, they can, uh, go to the Starbridge Advisors, uh, website. I'll see some logs I have there. They'll see my, in my contact information, uh, there as well.

And, um, And can, um, email me through that, uh, for any, any further follow off, uh, or information. Happy to, happy to stay engaged. Uh, just came back recently from Chime and so, so, uh, lots and lots of old friends. Uh,

Yeah, that's, that's great. So you can, you can follow, uh, you can follow me on Twitter at the patient cio. You can follow the show at this week, init. Our website is this week in health it.com. And the, uh, shortcut to the YouTube channel is this week in health it com slash video. Uh, that's all for now. So please come back every Friday for more news information and commentary from industry influencer.

Thank.

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