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President and CEO of CHIME, Russ Branzell joins us to discuss what he is seeing in the world of innovation from around the world. Hope you enjoy.

Transcript

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 Welcome to this Week in Health It where we discuss news, information and emerging thought with leaders from across the healthcare industry. My name is Bill Russell, recovering Healthcare, c I o, and creator of this week in Health. It a set of podcasts and videos dedicated to developing the next generation of health IT leaders.

Today, innovation or evolution? What's the imperative for health it? This podcast is brought to you by health lyrics, looking for someone to be your personal coach in healthcare technology. Let's talk visit health lyrics.com to schedule your free consultation. Our guest today is World Traveler and, uh, president of Chime and c e o of Chime, Russ Brandel.

Good, good. Uh, good morning Russ and welcome to the show. Thank you very much, bill, for having me. This is, uh, it's a wonderful treat. Thanks. Wow. I, you know, I, I follow you on LinkedIn and I, I, I end up seeing all these pictures from around the world. Uh, give us an idea of some of the things you've been, uh, been doing with Chime over the last, I don't know, 12, 12 months or so.

So, obviously, you know, our, our first love and, and what we've always will do is continue to take care of Chime Proper, which is across the United States. So I've probably visited half the states in the United States in the last 12 months. Uh, probably more than that, but I think it's a fairer estimate to say at least half across the country.

Uh, and so obviously there's stuff going around everywhere, even just here domestically. But now when you look at this from a global platform, what we're really seeing is innovation and change is occurring at a global pace and a global perspective like never seen before. So I just got back from Israel, uh, where I gotta spend some time at the Big Data Tel Aviv conference and spoke at that.

And there's just monster amounts of things happening there, whether it's security or their typical startup nation or ai. But then you turn right around and you look at just over the last few months, places that we've visited or have activities going on, I. In Italy, in the uk, in Ireland, in Germany, over in the Asia-Pac countries.

And, and again, nobody's sitting still. And I think for the first time ever, what we're seeing is the global platform is starting to really emerge and the global network is actually starting to connect. That's interesting. Uh, are, are your services different? I, I mean, I know you do advocacy here. I, I. And, and that's probably different than maybe what you do, uh, internationally.

Is it more about bringing people together and the sharing of ideas and, and, and building that, that community? Well, what chimes always been about, one of our core premises is to create a network of, of people, of leaders to not only develop them, but also connect them in such a way that they can truly share best practice to share their worries and, and problems of the world, and do that, that is universally true across the globe.

What we've discovered is it doesn't matter form of payment system. It doesn't matter form of, uh, government, it doesn't matter. Any of that doesn't matter. I health it is health it, and the struggles that people have universally is across it. So all of our services from that perspective are almost always there.

And so we make sure that's there. We don't do advocacy internationally. The members in those countries might and get very involved with local politics. We obviously have a pretty big play here in the United States with our team in dc. We spend a lot of time making sure that we do that. I don't think we will do that long-term internationally.

That's probably the predominant thing. The other predominant thing is we don't have big events. We partner with others and for bigger events in those countries, uh, usually an incumbent in that country. So our goal is not to compete, but rather augment or, and or add to it along the way. So we've got some great partners all around the globe, uh, more and more occurring every day.

But it also allows us to stay lean and mean and not really add a bunch of team members or expenses. What we do is we partner with the incumbents in the country. Yeah, I know. Um, I was new to healthcare back in 2010, uh, came in as a C I O and uh, got involved with Chime and it was phenomenal to just build that network so rapidly and, uh, so many people.

Are willing to share, willing to help, and, and actually a little different than other industries that I've been a part of. So it was really refreshing to have, uh, that kind of network and, and people fall back on. Um, you know, I, I, my, my friend sends me, have you ever seen Flat Stanley, the thing you travel around with, take pictures?

Yeah. She always sends it to me when her, her kids get to a certain age and she's like, oh, you know, 'cause I know you'll go to a lot of places in, in, in about, You know, three week timeframe I took it to, uh, 10 different states. But I imagine where I should send flat Stanley Nexus to you. Probably , probably see a lot more.

I I, I'll be in Germany next month, so if you want, if you want Flat Stanley in Germany, just let me know. That's awesome. Uh, all right, so today we're gonna talk about, uh, innovation. I know it's a topic that, uh, that you've, you've talked about, uh, a, a fair amount and, uh, You know, chime is doing a lot of different things, uh, in the area of innovation.

I know that we talked offline a little bit about, um, partnership in, in, uh, at Intermountain and, uh, just supporting so many of the initiatives 'cause there's so many health systems now that are, that are, have launched, uh, innovation groups and innovation institutes and uh, and uh, accelerators and all sorts of things.

Um, so as you've been traveling around, I mean, what are, what are some of the things that you've seen, uh, from the innovation side that are, that are working or, or that are interesting, uh, uh, to date? Yeah, so it's, it's, it's fun to watch and, and what I've found is, and this, I think this is just a universal truth, is there is best practice out there in every area, especially this area of innovation or ai or whatever you want to call it.

Across the globe if we can just figure out how to leverage what's already been done, nevermind what's being worked on, we could absolutely revolutionize he healthcare even to a few years ago, a good example, Jang Hospital in Singapore went from a materials management department of hundreds of people to advanced robotics, delivering almost everything in a department of a few people.

That just sounds like, well, we just replaced some people with robots. No, it's advanced AI based. Their materials cost are way down. Their shelf time is nearly perfect. Nurses and and caregivers are saying that those are things they don't even worry about anymore. So we augmented the care process and improved it by doing that.

When one of our members there, probably the, some of the most interesting things we've seen, obviously, Is what I would call proactive security and what we've discovered from a, from a innovation perspective, and obviously there are countries like Israel that do this really, really well. Uh, obviously they have to, they have a little bit different security requirement in their country than others.

But when you talk to the security leaders that are there where we talk about stuff of, well, we need to make sure we react to this, or we're monitoring really aggressively, their answer is, we need to catch 100%. Everything coming in 100% of the time, and if necessary, fight back 100% of the time. Whether that becomes social profiling, whether that becomes some of the other things that are out there where they're actually using social media and other things to figure out where attacks might be coming from to protect their patient base.

And if you look at internationally now with G D P R and so many other things, The requirements, at least the perception of requirement will be that organizations go from a pure defensive posture to now they're gonna have to figure out how to proactively manage security in such a way that they're moving out ahead of their natural defenses to actually get out there and try to make sure they're protecting the organizations again, you could go on, for example, after example, after example.

I. What I love is some of the things that we're seeing in places like the UK where they're figuring out how to use advanced analytics to help manage patients in what I would call one of the few places in the world that are truly doing it holistically. They've combined health and social care, what we would call mental health care in such a way that the entire patient, the entire record, everything is being managed from a universal perspective.

Not only that, they're proactively looking forward on how to use it from a preventive perspective. Again, they're using advanced analytics technology, community engagement strategies, consumer strategies. We just don't see that, at least here, domestically quite yet. Yeah. You know, we, we talked to Charles Boise who was doing work in the uk and he talked about how, uh, machine learning and AI is being used as a predictive model, uh, around mental health and, and how exciting that was.

Uh, but I mean, you touched on it, handful of things. One is, you know, in terms of the US and the, the debate will start heating up on healthcare. Um, and, you know, the, the idea that we could implement some of these innovative solutions and uh, and drive down costs is interesting in that. That's what we wanna do in healthcare.

We wanna drive down costs, but then you're also gonna have this debate about okay, machines taking over. What? I mean, you, you touched on two of the things that are gonna be, I think, hot topics over the next year. And, and, and I don't think it's, and I've heard others talk about this, I don't think it's replacing people.

I think it's changing the nature of work and changing the type of work that we do. Um, and that's what we're gonna see is we're gonna see, uh, some of the mundane tasks, some of the repetitive tasks, some of the. Pattern matching type tasks, uh, we're gonna see those sort of go away. We're not gonna be sitting in front of keyboards, uh, for hours, just looking for patterns.

That's something that, uh, that, uh, machine learning and AI can do very effectively. Um, much more effectively really than humans, and seven by 24 and come back with insights. Um, it it, it's gonna be interesting. I mean, do you think, what, what other things do you think are gonna come up over this next year and a half?

We're gonna have a political cycle that's gonna start. It's, it's starting way too soon. I mean, what, it's April. We've got, uh, over a year and a half of the political cycle. What, what do you one, I try to stay out of the, the political fray that is for sure. Despite our job in Washington, we try to play as well as we can on both sides to get what we need to get done that's there.

I I have spent quite a bit of time in Washington over the last six months and, and spending time with both congressional offices as well as senatorial offices and some of the agencies as well. I don't think there's a. Appreciation nor an understanding right now of this next revolution that's coming.

And I, and I intentionally use the word revolution. Uh, I don't think it's a transformational process. I don't think it's a small innovation process. We are leaving the information age and uh, and that's my perspective. I've done a lot of study on it and teaching on it, and I think we're entering the fourth industrial revolution, which is the AI age, which you have to have the third one.

Information is to be able to do the fourth one, no differently than prior. And I think for the most part, there isn't an appreciation for what this means, mainly because there is no one alive today. Maybe a few exceptions. There might be some centennials out there that have seen it, that really we're there and living it when they transitioned from the second revolution, mass production to information aid.

We've all lived, you've lived your entire career and life in the information age. So have I. We don't know what it's like to transition. So when I talk to these congressional folks, whether they're staff or the actual congress, uh, uh, women or men or senators, and we talk about advanced robotics and chatbots and ai and rise of the machines, for lack of a better term, it, it's foreign to them.

They, they don't, they think it's just another computer thing. And what we are saying is it's gonna massively change the way our economics work. It's gonna massively change the way our workforce has to be developed. It's gonna massively change the way leaders are gonna have to lead, lead in a digital revolution.

We've never had to experience that in our modern economy. It, uh, I, I saw Ed Mark's interview, uh, Toby Cosgrove, ed Marks, uh, C I o Cleveland Clinic, Toby Cosgrove former. C e o for the Cleveland Clinic. And, uh, Tony Cosgrove has been spending time sort of, uh, in Silicon Valley and other places, and Ed just asked him, you know, what, what do you think the most disruptive technology is going to be in healthcare?

And he said, ai, hands down, nothing's, nothing's gonna come close. AI is gonna completely change everything. And it's, it's interesting to hear somebody as pragmatic as Toby Cosgrove say, no, no, no. I'm, I'm, I'm seeing what they're talking about. I'm hearing what they're talking about. Uh, I'm starting to sort of grasp what it can do in healthcare, and it is going to, uh, really be one of those disruptive, uh, technologies.

Um, you know, what are, what are you seeing as the disruptive, is it mostly AI that's gonna be the disruptive technology or are there others you're looking at? So I think you can use AI as kind of an umbrella to all of it. And we actually have a list of 15, 20 things we kind of bucket underneath. Ai, there is an ai, meaning the concept of actually using machine learning and actually drilling down and actually proactively computing and those type of things, I think we're gonna see a pretty significant, and it's a little different than what you said earlier.

I think we will see a fairly significant workforce change for, as you put it, some of the mundane, redundant tasks that are out there. Chatbots is a perfect example. We make phone calls every single day. You make phone calls as you travel, and you don't even know now that you're talking to a computer, you think you're talking to a human being, but you might not be, and they're actively, proactively talking to you, working with you with a human style voice.

One of the airlines that we were benchmarking against in doing part of one of our presentations was they got rid of 95% of their call staff, an airline did. It's all being done by chatbots. Their service levels are higher. The satisfaction with the interaction is higher, and their costs are down almost to zero.

With chatbots, well take your average health system. One of the health systems in New York City alone has 850 people whose primary job is to answer a phone. What are we gonna do with them? We can either wait and eventually their jobs are replaced, or we proactively work on them with a potential human, uh, workforce shortage.

Anyway, let's be proactive. That's there. Well take it to a little higher level. You can do materials management and cleaning and so many other things. Well, that probably is more of a workforce replacement, retraining process. Some of it will be automation and automation and augmentation and skills development and enhancement.

I. We saw a bunch of examples just recently where software found things that consistently were missed in radiological reviews, not because it was bad people, it was because they were focused on the primary DI diagnosis, not all the secondary stuff in a major CT or M R I and what they were so focused on the diagnosis that was there.

They didn't see all the tertiary stuff that was out there. Yeah, and this stuff and the computer went back through and did augmentation. Said There's something here that we're not sure about. Why don't you take another look here? And almost always there was a major finding, and again, it wasn't because the radiologist was bad.

Matter of fact, radiologist was probably great. And now computers are augmenting their skills and advancing 'em to work. And this is where I do believe we will see people working at their highest level of licensure potential and in their jobs. Along the way, some jobs may have to change, just like there are jobs today that didn't exist before.

And so I think there's that kind of stuff that we're gonna see pretty significantly. Well, let's, let's talk about, let's talk about digital health funding a little bit here. So there was an article recently, uh, April 18th that said, uh, digital Health VC funding down 19% year over year. And essentially what they're saying is, uh, you know, it's up from Q four to Q one, but it's down year over year by, uh, couple hundred million.

Ish. And, uh, you know, when somebody reads an article like that, they, they might sort of think, hey, you know, the VCs and, and, uh, and private equity is, is pulling out. Um, but that's not really your take. I'd love, I'd love, I'd love for you to share your take on, on digital health VC funding and specifically this article that, you know, funding's down right now.

Uh, I'm not gonna question whether funding's down or not. Uh, I'm just gonna tell you what my experience has been in, in my . Um, observations have been, and I've spent quite a bit of time with some of the venture firms and capital funds in New York and a couple other places. Talked to some of the firms and funds that are being run within health systems as well as internationally.

And what I am hearing is there's a different appetite and there's not as much attractiveness. It's not a lack of money, it's of people are looking for maybe something that's a little bit more stage two or three in the development cycle. And the problem is, is there's only a very small window when somebody's trying to get funding, whether they need to take the next big leap up or if they have their own funding stream.

Now, I don't need outside money. And so what we're seeing is, or at least, uh, again, not scientific by any means, is there's plenty of money. Uh, but they're being maybe a little bit more picky on what they're looking for right now and, and where they are in the maturity cycle of their products as well. And so, uh, if you have a great idea there, there is zero doubt in my mind that there is money out there for you.

Uh, and, and actually one of them was actually very fresher. One of the firms in New York was very frustrated 'cause they have so much money sitting on the sidelines right now that they can't find the right thing to put it in. Yeah, there's almost a maturing of the process. Uh, there was a time where everything was getting funded and, uh, let's say about three years ago, everything was getting funded.

People were starting things up. Um, and, and, and it, it was almost kind of, it's kind of silly, but it's maturing now and they're, they're looking at it going, um, it's, it's not necessarily, uh, just the great idea. The great idea is not enough. What these startups have to do is they have to prove that they know how to sell into healthcare organizations and how to, uh, implement projects in a healthcare organization and sell into pharma and sell into life sciences and other things.

Um, before people are just gonna throw money at an idea. I think that, I think that's what we're seeing. That's, that's my take on it from conversations. Yeah, I think that's very fair. Um, so let's, let's talk about health IT leaders. You know, a lot of times . We had, uh, uh, Hal Lumpia came on here and said, you know, the, the role of the C I O has changed Totally.

And uh, and when we talk about, uh, when we talk about innovation, this is one of the things, and I think everyone agrees now. The c i o role is changing. It's changing underneath us. Um, and I was sitting with some, uh, healthcare CIOs a couple weeks ago and, and, um, You know, they were, they were throwing out the buzzwords that they hate and disruption was one of 'em.

And, uh, you know, uh, innovation and, and some other things. Not that they dislike innovation, but just that they hear it so often. You know, the phone call rings and they, they take the call and it's, you know, we have this innovative startup that's gonna do this, this, this. And, you know, you only get that phone call about a hundred times before you're like, you know, okay, let's, and, um, And so I, I think there's a reason that this is disruption is sort of grading on, on CIOs.

One is, you know, if you just look at their, their job and their budget, 90% of their job is to keep running this legacy environment. And they have to do that well, they have to keep security intact. They have to keep everything functioning pretty well. Um, the other thing is, we've been hearing about disruption now for.

I don't know. I mean, at at least 3, 4, 5 years, the word disruption's been thrown around healthcare and we haven't seen it really be, uh, disrupted per se. If anything, you know, margins have gone up. Fee for service hasn't really changed, uh, dramatically, uh, yet over those five years. And, uh, And so we haven't seen it be disrupted.

And I think it's almost, if, if you keep hearing it and don't see it, you, you think it's not coming. Even though we know that this stuff happens, suddenly, it happens slowly and then suddenly. And then finally, I think the other thing I, I hear from CIOs is they're pretty overwhelmed. And so you've talked about this concept of, uh, sort of a, an upgrade to CIO's mindset, uh, for this, uh, for this digital age that's sort of upon us.

Um, how should CIOs be thinking about addressing innovation, uh, upgrading their skills, leading their organizations in this digital age? So, I don't, I don't disagree that, that the job has changed. My argument would be it's never stopped changing. Yeah. And part of that is, you know, we created a maturity model for CIOs.

This is when I was a C I O Wow. 15 years ago now. Working with Gartner and a bunch of others that were out there, we created the 2.0 model, which was helping CIOs go from nutritional technologist to kind of a business driven leader in the organization. And I would argue there are still many that haven't made that transition yet either.

They still kind of are traditional technology based leaders. That may be what their organization needs or they haven't matured enough, whether that be through education or uh, just overall leadership development. That is there. We would argue now though, that the 3.0 leadership dilemma or uh, paradigm has actually come upon us pretty fast.

And the transition from a 2.0 to 3.0, we use the term, it's, it becomes the transformational leader. And it's less about disruption. It's less about all those other things. It's the person that can help now an organization to truly change to something new. I'm sure there was a good person in there, but it was definitely not a transformational leader at Blockbuster when they were just figuring out how to get your, uh, stuff back into the store faster.

And they were doing some of the best stuff they've ever done and all of a sudden they realized the market changed. And I think that's true for everyone. The fact that we're doing this interview and spending this time and totally different places with video running between the two of us and we're doing it in different time zones, it's just a testament to the technology that's there.

Our leadership, our our members. Uh, some will retire off and not necessarily have to embrace this. Some though a vast majority and and it really is not age driven, are now realizing they're having to move in ways and learn things they never have. Part of this is actually to retool themselves technically.

You need to understand what AI is. You need to understand the potential of five g, six G, seven G things that in the past you kinda went, well, it's just the technology. I need to be a leader at the top level. All of a sudden there's new technology that you need to retool yourself with and so I used to make that statement all the time is a really good c i o doesn't spend much time in technology.

I would actually argue that today they actually need to get retrenched back in a little bit of the technology. 'cause what's coming. It's gonna be so part and parcel to changing the organization moving forward. Good ones have position themselves at the top. They have the respect, they have the, the ability to influence the organization, help drive them.

Now they're gonna have to use all this new stuff that's coming. Use the umbrella term AI as an example to truly place the organization in a different place moving forward. I don't disagree. We're not seeing change in the US as fast as we probably could. But what we are seeing on a global pace is almost the rest of the world, even it is not as much developed.

Countries are using these opportunities now to retool not only their organizations, but their entire country health system. Yeah. It's, it's, it's interesting. I think the largest, I, I saw a c I O panel, um, three fairly large, sophisticated health systems and the CIOs presented and when they were done, we were having a little conversation and the.

You wouldn't recognize. I mean, if you, if you put it back three years, you wouldn't recognize them as CIOs. I mean, the things they were talking about, uh, how they were approaching the job, uh, to them have essentially said they've given away large swaths of their budget and they've, they've gotten out of the whole budget game and they're more supporting the organization, which I thought was interesting.

Um, couple of 'em talked about the amount of time they're now spending with . Innovative companies and partnerships, and you're, you're hearing that a lot. So that's, that's the large systems and maybe the systems with, you know, a hundred million, 200, $300 million budgets or more. Um, but what, what about the rural c i o or, um, you know, the, the c I o, maybe four hospitals at this point, are, are they making that kind of transition or are they maybe approaching it a little different?

So one of the things that we've actually suggested is one, they need to up tool just like everybody else. They need to have just as much knowledge and awareness and understand the stuff. They're not gonna be able to afford to do a lot of these things, and they couldn't afford to do some of the other things that were there.

What they can do is position themselves and their organizations to be fast adopters at the right time, and partner with the right places. The nearby big health system or any of those type of things. Now, I, I've made my play at really big health systems and I've been at really small places. Even at a small place, sometimes you can be doing stuff in partnership that costs you almost nothing because someone wants to start small and do some, some unique projects that are out there, but, Just as small as a critical access hospital to the biggest academic system.

We're gonna have to make sure we bring everybody along through this entire process at some point. Some of these things will just be second nature to the systems that they already support, analytics, AI based learning. It just comes with what they're buying. But that'll take a little bit longer in the curve.

So, Probably the biggest part right now is education and networking and staying connected. You talked about it earlier. Yep. You've gotta stay connected. So before we end the show, talking about your golf game, 'cause I, I'm curious how you, you're keeping your golf game steady with all this travel. Um, the, the last topic I really, so how does a, how does a c i o keep their staff current?

I mean, how, how is Chime sort of looking at that? How are you sort of coaching them to, to, you know, upskill them and get them ready for this next round of, of changes? So it's it. It really was part and parcel to our strategy a few years ago when we looked around and we realized no different than we realized there was a void in developing CIOs 15 years ago, 10 years ago.

We created the bootcamps and the other programs that were out there. We actually looked around and said the concept of the C-suite of the c I O is actually here and now, and we're not supporting it very well. So we started new organizations for technology officers, security officers, uh, analytics and application officers.

But really our goal now is to support all the leaders and help develop them. We just finished one of our, um, bootcamp programs that just happened recently. A very high successful program, a hundred percent top box. But our goal is now to make sure that all the leaders and potential leaders are being developed in such a way that they can move up the

The organization support the organization because I didn't, I didn't, never even had a c I o I, I didn't even know what a C I O was when I was a C I O Securities was just what we did as an organization. Um, and now all of a sudden, a C I O is one of the most critical roles in a medium to large health system that's there.

C i o kinda steps out of the way, moves up to their next level. C i o comes in behind. But does the C I O have all the skills from a leadership organizational influence, soft skills, all those kinds of things to be able to work in a very complex organization? Often the answer is no. And so we have to spend a lot of time developing, developing leadership skills while we're also making sure that there are technical skills out there or organizational skills being developed at the same time as well.

I led a panel of Chief Digital Officers, uh, recently at a conference, uh, discussion with them. And that's probably another group of people that could use sort of a, a way of coming together and sharing their stories. 'cause it's interesting they're coming in from out. I I, I really related to them 'cause they're coming in from outside the industry and to a person they're saying, man, it's really hard to get stuff done within healthcare

And I was, I was sort of looking at 'em like, yeah, it's great that you've come from these other fan, fantastic consumer oriented. Companies, and you're bringing that thought and that mindset, but there's also learning, uh, the industry and learning how, uh, things get done. Not to slow them down. We obviously want them to move as fast as they can, but, um, but to sort of help them to make that transition into how to be more effective.

So, so tell me about your golf game. You, you are, uh, you're a big golfer. You like to golf. I, I mean, are you getting to golf or are you golfing in other countries? No, I very rarely golf in other countries unless it's a, a deliberate trip and, uh, Sadly, I will say that my golf game is not what it used to be.

Um, it's still decent, I can say that, but, uh, no, I get, I only get in about four or five, six rounds a year now, where I used to probably get four or five, six rounds in a week. Um, and, and days of old. So, no, it's, uh, a lot of travel, a lot of time. And then when, when, when not doing that stuff, you invest back in your family and those type of things.

And my wife now have, and I have, uh, Have found saltwater fishing is kind of our passion now down in South Florida. And so instead of six hours on a golf course, I'd rather spend about eight hours on the water if I can. Oh, that's, that's fantastic. Well, um, is there, is there any way that people can follow you, uh, LinkedIn, other ways?

Yeah, so on on Twitter, it's uh, at Chime ceo and then just look for my name, Russ Brazel on LinkedIn. I try to send a little encouraging message out every day. Uh, it's a tough industry right now. It's a difficult job for everybody in there, no matter what role they play. Uh, and I think we need to remember in the end we're all doing good and trying to take care of patients and so we try to send something a little bit positive out every single day.

Absolutely. Well, thank you for coming on the show. Uh, this show is a production of this week in Health It. For more great content, you can check out the website at this week in health it.com. The YouTube channel at this week in health it.com/video. Thanks for listening. That's all for now.

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