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August 20, 2021: Today we are joined by Brent Lamm, Senior VP and Deputy CIO at UNC Health. With their tremendous wealth of expertise and research they really are moving the needle on health and wellness. What are the biggest challenges around rural health care today? What is UNC doing in regards to health disparities? What are their plans to get underserved communities vaccinated? There’s a multitude of structures around analytics data science. What does UNC’s structure look like and how does it interact with the organization?

Key Points:

  • Physician recruitment in rural areas is really tough [00:08:20
  • The IT is centralized, the data is centralized but the analytics is actually federated [00:22:00
  • How are we keeping a pulse on employee burnout and other psychosocial issues that come with not being in the office every day? [00:31:05
  • We’re seeing major increases in the number of candidates wanting to work from other states. And that presents real challenges for HR and legal. [00:33:45
  • There’s still some resistance with cloud adoption [00:38:15
  • UNC Health

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 Thanks for joining us on this week in Health It Influence. My name is Bill Russell, former Healthcare, CIO for 16 hospital system and creator of this week in health. It . A channel dedicated to keeping Health IT staff current and engaged. Today we are joined by Brent Lamb, the deputy CIO at UNC Health out of Chapel Hill, North Carolina.

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

I ran into someone and they were asking me about my show. They are a new masters in Health administration student, and we started having a conversation and I said, you know, we've recorded about 350 of these shows, and he was shocked. He asked me who I'd spoken with and I said, oh, you know, just CEOs of Providence and of Jefferson Health and CIOs from Cedar-Sinai Mayo.

Clinic, Cleveland Clinic and all these phenomenal organizations, all this phenomenal content, and he was just dumbfounded. He is like, I don't know how I'm gonna find time to listen to all these, all these episodes that I have so much to learn. And that was such an exciting moment for me to have that conversation with somebody to realize we have built up such a great amount of content that you can learn from and your team can learn from.

We did the Covid series, talked to so many brilliant people who are . Actively working in healthcare, in health, it addressing the biggest challenges that we have to face. We have all of those out on our website and we've put a search in there. Makes it very easy to find things. All the stuff is curated really well.

You can go out onto YouTube as well. You can actually pick out some episodes, share it with your team, have a conversation. We hope you'll take advantage of our website. Take advantage of our YouTube channel as well. Today we are joined by Brent Lamb, the deputy CIO at UNC Health out of Chapel Hill, North Carolina.

Good morning, Brent, and welcome to the show. A really privileged and honor to be here with you. I'm looking forward to the conversation. Yeah, I'm looking forward to it as well. People who are listening to this on the podcast, not watching it on YouTube, probably don't recognize that you have a hurricane.

Going by you right now, right behind you, which you're welcome. We just sent it up to you from South Florida. It was my first hurricane in south Florida. It dumped an awful lot of rain, but that's about it. And my neighbors are telling me, don't worry, this is not a normal hurricane. Eventually you'll get your big hurricane, which is I think, what we expect when we move to Florida.

So we'll have to see what that looks like. The benefit for us in North Carolina with this one, like so many, and it's unfortunate Floridians, but by the time they get to us, when they come up through the Gulf, I should say, or through Florida, usually by the time they get here, it's like this, it's a lot of rain and just gloomy days.

But I think the, the folks south of here down your way took the front of this one. I'll let you know how the next one goes. So this is the first time for me to be talking to somebody from UNC, and actually this is our first meeting as well. So I'm really looking forward to this conversation. I always like to expand my network and to talk to different people, to hear what's going on in the industry and UNC Health is very unique.

Tell us a little bit about UNC Health. Yeah, so we are an integrated academic, uh, delivery system, 13, 14. Now, I think hospitals in our system, little over, depending upon how you count 'em, a little over 850 physician practices. In our system, we've got about 5,500 physicians, I think in total across our, our network.

And we're spread really from one end of our state to the other. Our mission is to improve the health and wellness of all the North Carolinians that we serve. And that's something that we take, um, to heart. It's something that really drives our team on a day in and day out basis. And we're very proud of what services we've been able to deliver to the citizens of North Carolina.

And we think that we are moving the needle on health and wellness and certainly have a lot more to do, but. We're very proud of our state heritage. Well, it's interesting 'cause I've been to Chapel Hill. My son went to Elon University, which is right up the road, and anyone who's driven from Greensboro to Raleigh and anywhere around that North Carolina corridor recognizes pretty quickly that there's an awful lot of space between those cities in North Carolina.

So talk to us a little bit about your patient population. What does it look like? We do have a, a substantial presence in what we call the triangle in North Carolina, which is the Raleigh Durham Chapel Hill area. And that is sort of the centerpiece, if you will, of our health system and, and our population.

But we really do have a, a statewide presence in mission. A lot of folks don't know. Depending upon just how you, you count it. North Carolina has the second highest rural population in the country behind Texas and rural health in providing, uh, better access to care, better healthcare services to the rural population.

North Carolina is, is one of our, our major focus areas. There's a lot of exciting work going on in this space. We're continuing to grow the UNC health system. We recently just added a Southeastern Health in Lumberton, North Carolina, blue Ridge and Morganton, North Carolina, and an affiliation with Carolina East and the eastern part of state at New Bern for those who know that area.

And I think those additions to the system continue to expand our abilities to do more outreach to rural North Carolina and, and further provide access and services to what we think are, you know, high quality healthcare services. The other aspect of that rural health story in many ways is the work that we're doing around health equity.

We've recently added an executive director, Dr. Crystal Sinay, who is leading our broader health equity initiatives, and it's something that we had started before the pandemic, and we have . Our academic side at UNC, we have a tremendous amount of, uh, wealth of expertise and fantastic research that goes on in the area of health disparities, and it's something that we're really trying to bring more to our patient care operations.

And under Dr. Sunna's leadership, we've done a lot during the pandemic, especially with the vaccination efforts like so many of our peer health systems across the country. By partnering with. Key community groups to help make sure that we can bring the vaccines to the areas that have historically and have been underserved.

So the health equity work is a huge part of that for us in our Rural Health Initiative, and I think we've got a lot of exciting things coming in terms of really sort of from a health IT and analytics perspective. For this podcast, we're really beginning to do a lot with our data science team. Working with the clinicians and really helping to drive operationally focused analytics to help identify where we may have opportunities to help close help disparity gaps.

So really exciting. Uh, topic for us right now. I could probably talk for an hour about it. I'm actually gonna park on that for just a second. 'cause rural healthcare is really interesting to me and the challenge is geography. Obviously there's a significant land mass that you have to get to the far reaches of North Carolina.

Um, but you talked about education and how different communities have different levels of understanding. There's access to food and various things that we know deliver actual health to the community. It really almost requires an academic medical center, somebody like UNC that can bring resources from a lot of different perspectives.

What's the biggest challenge around rural healthcare today? Uh, really also focusing on a, an IT perspective. Yeah. I think there's a couple of different things that come to mind. Bill. I think first and foremost is, and I suspect this would resonate with our peer organizations, physician recruitment in, in rural areas is really tough.

Making sure that we've got the right providers and care teams in place to provide the care that's needed in the rural parts of the state. So the natural thing is to say, well, why don't you just use telehealth? But that presents its own set of challenges. So that's a perfect segue. I've heard on your podcast, which I'm a, an avid, uh, listener, and you, you do a great service to our industry with what you're doing here and really appreciate all that you're doing, bill.

But I've heard recently people talking about, um, the, the digital divide, and that is something that is real for us in North Carolina. Our governor's office recently just announced some really exciting initiatives and. To help us try to do that. I think that is as much as anything probably gonna be in the next three to five years.

The biggest inhibitor to really taking advantage of telehealth or virtual care and our vernacular, taking advantage of it to support the rural parts of the state. People just don't have the, the bandwidth access. I, I've heard others on, on your podcast here talk about, I've heard you, I think recently talk about challenges right now.

In terms of network connectivity and a quality connection between the provider and the patient, and that's in more urban areas where there's higher grade bandwidth access. So when you really get to the rural parts of the state, that is even a bigger problem. And so I think, I think we, especially with what we're focused on in, in the effort in North Carolina, it's something I'm personally very interested in is what we can do to help close that digital divide and partner with government, nonprofit agencies to figure out how we can bring more.

Bandwidth to the rural parts of the state. I think that could be a game changer for rural health if we could really take full advantage of, uh, telemedicine and all of the advancements we've made in that space, as well as remote patient monitoring. Bring those capabilities to our rural patients, it really does take a village to do the whole thing.

Right. So talk about those partnerships. Obviously you have the government, I mean the broadband companies. I would assume that you have to partner with others as well. What are some of the partnerships that you have to put together to make this a reality? I think the biggest challenge is always the last mile, making sure that those carriers in the particular area are, have the infrastructure in place.

And so I think it's money and, and unfortunately a lot of this is money and, and making money available and making it, uh, a, a, a business case that closes for those carriers in the rural parts of the state to help. Make those investments in getting it there. We've got a tremendous amount of support for this in North Carolina with the big health systems and we're very fortunate to have fantastic health systems in our state.

So there's a lot of support with with there, and I think it's how we can continue to have a strong voice to try to help drive available funding for those investments that the carriers need. That to me, that really is the, the biggest hurdle. So I probably should have started here, but I'm gonna come back to it.

Your deputy CIO at UNC Health. Talk a little bit about the span of control of that role. I'm very fortunate. I've been in my role now for, I think about six years here at UNC. I spent my first 10 years in my career at IBM, and it was a wonderful experience, but I had been doing a lot of traveling and was looking to be more settled in, and so.

Back in 2009, initially with the School of Medicine, working with ours, and then moved over to the healthcare system side in 2012 and. A phenomenal experience and a major opportunity. So my role has evolved a lot during the time I've been in this deputy CIO role. But now at this point, currently I have under my direction the, the bulk of our IT and analytics organization for the integrated UNC health system.

So we have about, um, 900 IT analytics professionals. In our organization, which is an integrated. Department, like I mentioned, which includes all of our application teams, including our Epic and our EHR, our and our ERP system, which we're on Infor, as well as all of our technology teams, our data center team, networking, et cetera.

And we have a, a very robust project management office that runs all of our IT and analytics. With about 25 project managers running on any, you know, given day about 200, 220, 240 unique IT projects. And then we have a very robust analytics arm. We've got some senior leaders in our organization that really five, seven years ago.

Recognized that we needed to invest in analytics and we've got obviously epic reporting teams, which is very robust as well. But we've also, uh, invested in, in a pretty strong data science organization and that falls under me as well. And, and that. Has been one of the exciting additions to our team is having all those analytics unified within our group and the partnerships and collaborations between our application teams and our analytics teams.

There's a lot of secret sauce that happens there that we've seen over the last year or two. That's been amazing. I. I'm definitely gonna come back to analytics. That's a, a great topic. We'll talk about that a little bit later. Uh, I'm curious, you're at UNC, which is one of the premier universities in the country, and my curiosity is do you ever have somebody, a student walk in and say, Hey, what do I have to study to get into the role that you have?

Or what kind of path did you take to get into the role that you're in? That's a great question and, and I suspect there may be peers in our industry that would share this symptom. I, I'm, I'd be interested to know that, but you know, I'm very, I'm always sort of jealous, um, or envious, I should say, probably of I.

Those folks in our industry who've come from the clinical side. My boss, our CIO, who's been with UNC Health now for 39 years, she was a nurse and started her career as a nurse and moved into nursing informatics and, and then into it now as the CIO for UNC Health. And I think, I think those are, are always really exciting pathways and, and we've got others.

We have a. Pretty large number of clinicians that have made the jump into it or informatics that are a part of our team, and I think those are really exciting pathways and I see a lot of energy about that. For me, I went maybe more of the traditional route, which was electrical engineering degree at NC State, and then I did my MBA at UNCI.

I think that pathway still works, but I have enjoyed being a part of our. Academic arm that is what we call our Carolina Health Informatics Program. If you'll allow me just for a minute to go down a little bit of a tangent here, it is something that I think is directly related to your question. UNC and Duke had partnered about a decade ago to put together this health informatics program, and it's started out as a certificate, then a master's, and now a PhD program.

And I. I think folks that are coming either from sort of the business IT side or, or coming from the clinical side, I think that's a really, you know, nice way to, to get involved in health IT and what we're doing. We've hired a number of graduates from that program, from both UNC and Duke into our team.

And, and they do amazing things. They have a really unique perspective. That they bring to what we're doing and, and really in terms of that relationship between the provider, the care team, and the patient, and a lot of the exciting things, especially now around, um, digital health and consumer oriented health, that, that they have got really unique perspectives.

So, so I, I think any of those pathways are great. I, I probably, like I said, I'm envious of that clinical pathway to get here. Yeah, I am. I am as well. My first job in healthcare was as CIO for St. Joe's in Southern California, and I, I remember sitting in some of those meetings going, man, maybe I should just go back to medical school.

It, it was so amazing to me after a year of sitting in there. That I, I, I was at such a disadvantage until you can come up to speed on the terminology, the nuance of workflow, just understanding the clinician's experience and how they interact with technology. It takes a while to come up to speed on all those things.

It's not like becoming ACIO for a manufacturing facility. I'm sure there are nuances to that, but healthcare has so many different aspects to it. It's, it's really kind of amazing. I've heard you talk about this before, and, and I can relate. I, I vividly remember first making the jump, you know, from IBM when I was working across industries.

Specifically to healthcare, and like you said, I mean those conversations, you, you, you spend hours on Google trying to understand what you just heard in many cases. But I, I, I will say, and I think I've heard someone talk about this before on your, your show, but, uh, what I experienced at UNC when I first made the transition into healthcare.

Was nothing but warm welcomes and open arms from our providers and and care teams. I, I was a little bit surprised, quite frankly, to see how well I. They how much respect they have for the IT and informatics side and disciplines of what we do. And so for me it was just an amazing opportunity to get to know a lot of really influential providers and faculty members when I first started and relationships that I, I have to this day and, and maintain and

And leverage, and we've got a culture here and I, I hope it's not just here. I hope it's everywhere, but we, we really have a strong culture here of our, our clinicians and, and faculty really have a tremendous amount of respect for our IT teams and, and analytics teams and, and what they bring to the table.

Alright, let's talk about analytics a little bit. I think what I'd like to talk about is the structure and how you guys are set up. I've heard a lot of different ways and that that organizations set it up. I've heard it centralized, I've heard it Center of excellence, I've heard it distributed, uh, a lot of different roles, data scientists, data analysts and whatnot.

What does your structure look like and how do they interact with the organization? We actually started. Our analytics journey in reality about about 10 or 12 years ago, and you know, like probably many organizations, it was started initially in our IT arm and was some business intelligence reporting data warehouse.

We stood up a data warehouse in 2009, and so a lot of it was, you know, focused on that kind of. IT centric work, but we recognized relatively quickly in that journey that the IT organization or department within UNC Health was never gonna be able to serve the totality of all of the. Ongoing ad hoc data and analytics requests that would come from all parts of the business, from the, the clinical side, the administrative side, revenue cycle, you name it.

And so we adopted about five or six years ago, a very formal hybrid or federated model, depending upon how you wanna call it, where we, we call it our community

pockets. Analytical teams of analysts that are doing business intelligence reporting, some mild data science type work that are embedded within the various operational and clinical departments across UNC Health and our centralized analytics team. Actually facilitates that community. So we have biweekly meetings, webinars with that group, talking about new data that are available that our IT team is releasing to production, talking about new training opportunities, new methods, a lot of show and tell across the teams.

And so a whole lot of building off each other, but yet those individual groups are still able to be agile and nimble to address the ad hoc, uh, reporting and analytics needs. So are those IT staff or are those department staff? They're department staff, not in the centralized IT group. We have common job classes now that they have, that they're in across job descriptions, across the system.

And they work in a common set of tools that it provides to them, but they're organizationally in the departments and we think that's really the secret sauce. So the centralized group though, work on things like new data sets, API connectivity, pulling in social determinants data. They'll create those data assets, if you will.

And then in the end they'll identify the tools that are used and then potentially those departments could say, Hey, we want to use something different. And that, I assume, would go through the normal governance process. Is that accurate? That's right. So the, it is centralized where we say the, it is centralized.

The, the data are centralized and the analytics is actually federated. So they, like you just said, those analysts live in the departments, they're . In analyst business intelligence, enterprise analytics type jobs or positions, they do analytical work for their business unit or their entity, but they use the the centralized tools and data access and data assets that we provide.

Yeah, so I would assume that the key to that is clarity, right? So across the entire organization and also collaboration. So the, the roles are very clear. The collaboration has to be ongoing, the education has to be ongoing, and for the most part, you have to be listening to the organization because data needs are constantly evolving.

As you said earlier, it's a dynamic space within healthcare right now. I think you, you hit the nail on the head. Every point you made is exactly right and key things that we drive. And that's why we keep that really tight community together. And it's not the individual departments going off on their own doing, deploying new tools or going out into the market and procuring new IT software solutions or whatever.

We work very closely within the community. They feel empowered. We can control. The IT solutions from an overall spend perspective and efficiency. And we can help really, our IT team can focus on making more and more data available and easier to use data structures and data sets. So, so stay through that lens for, for just a moment as we move through the pandemic and it's starting to wind down a little bit, actually wind back up depending on when you listen to this episode, 'cause we record them earlier, what did the activities of the group look like?

Let's say during February and March of last year, through the first six months of experiencing the pandemic in the United States, uh, let me try to stay through that lens. So the community side, immediately, every one of those teams I talked about went to work. We have a pharmacy analytics team. You can imagine what they were doing, especially as early evidence about what therapies might have support and help for covid patients became available.

Our supply chain organization. Team, our supply analytics, swat chain analytics team, PPE, top front and center. We had war rooms like I'm sure everybody did, of our data scientists. We do have our data scientists in our central organization and they work with the various, um, analytical teams. If your house system is like our house system, PPE back in the day was tracked by the box, not by the individual mask.

And that was one of the, the challenges come coming into the pandemic. Did they have to create new reports and new ways of looking at the data? You got it. It's exactly right. And how do you forecast a box, right? That's got a hundred or a thousand uh, units of whatever you're talking about. So we absolutely, we've got some fantastic data scientists, like I mentioned, and while none of us would've wanted the pandemic to happen, it really was a silver lining for our team, was that data science became front and center and for our organization, for our system, and really made miraculous.

Solutions that helped our top executives and frontline managers make decisions on a daily basis. And so we had, like everybody else, we had realtime dashboards of PPE forecasting based on machine learning algorithms. We had weekly forecasts of what we expected our hospitalizations to look like. Our ICU.

A utilization to look like. I personally sort of spearheaded a lot of that work and met with our CEO and Dean and our senior executive team weekly to review those data. And they were used in weekly operational planning discussions. Like every I'm, I'm sure this is a story that health systems like us all have a similar version of, but it was an amazing journey and we would not be where we are today.

Uh, coming out. We're not out of the pandemic yet, but you know, hopefully towards the end of it, we would not be where we are today if it had not been for the amazing analytics that were done last spring and summer. You know, not to, not to put you on the spot or highlight one group over another, but what was the coolest reporter analytics that you were able to create and present to the executive team?

That is tough. We stood up about, I think, 27 different enterprise dashboards that have various aspects of this. I think for us, the really the coolest experience was we did, early on in March of last year, we partnered with Duke and, uh, RTI, which is a, a major contract research organization here in North Secretary Cohen who is our in Carolina.

To really try to figure out how to get our handle on what the projections would look like. And for us, it was exciting after the fact because the forecast models that our data science team here and our group put together ended up being highly predictive for the UNC health experience and, and really for the state of North Carolina experience overall.

And looking back on it. We've really been amazed at how predictive what the team put together so quickly has been, you talked about this a little bit earlier as we were getting into the vaccination. I, I assume that team is working on models and feeding information to those teams to identify programs to get the community vaccinated.

And probably if I could highlight one aspect of that. There's so much going on with the vaccination effort, but we've got a program, we stood up, our operational clinical leader stood up around, called Cover nc, and it was really a program to do outreach specifically to community organizations to help partner with them.

To really build stronger bridges and relationships in those communities that were, especially early on in midway through the thrust of the, the vaccination effort. They have really underperforming, um, results in terms of vaccination rates, and we use analytics and census track data combined with other patient data to really try to pinpoint where those outreach efforts might have.

The biggest impact in our clinical teams and our ambulatory clinics, our VA vaccination clinics. We're using those reports on a daily basis to, to make decisions and it was really exciting. Still are actually, yeah. Since we're still going through the pandemic, is your workforce still remote or are they on site now?

I was hoping you would ask about this. There's two, two aspects of this that I would love to talk about, if you don't mind. I mean, first is the, the whole. Looking beyond the pandemic and what is the new workforce look like? So our staff during the pandemic from an IT and analytics perspective have almost all, uh, been remote during this time.

Like so many articles we've all read, they have been extremely productive. They have not missed a beat. They have done amazing work. I worry about burnout. I really do. With the pandemic and all of the pent up demands before the pandemic that are now beginning to kinda be brought back to the, the front burner.

I, I, I worry about the state of where they are. We've recently done an engagement survey to try to understand where folks may be struggling or having some issues, and we're looking forward to seeing those results and trying to see if there are interventions and, you know, changes we can make to try to help improve that.

But for the most part, we've fully embraced. The remote work like every everyone else for them across the country. I think we are at a place right now where we're doing a lot of planning. We are gonna offer to our team members the ability to continue working remote for those that don't have to physically, you know, be in the office to touch things or work directly at the elbow with our care teams.

We're gonna offer obviously the, the opportunity for folks to come back on site full time. But we are, uh, gonna offer a hybrid model to our workforce. And I suspect, bill, that's what most of our team will fall. The bulk of our team will fall into that hybrid model where, you know, a couple days a week at home, a couple days a week in the office, and, and hopefully try to do that in a flexible way, but in a way that also allows some team cohesion.

Where we can have scheduled face-to-face team meetings or, or gatherings on a quarterly, monthly, whatever basis. I think that would be important. I, I do worry about the social aspect of what this has done to folks, and I do think that as we're thinking about and planning for this. We've really gotta figure out how we are keeping a pulse on potential burnout and, and some of those sort of psychosocial issues that come with maybe not being in the office every day with your coworkers and having those hallway conversations at the the coffee pod or water fountain.

Yeah. And how much of that is done as a system when you're sitting with HR and everybody and having the conversation? And how much of that is done with you and the CIO and the IT leadership making decisions based on your specific work requirements or needs? We are absolutely doing this in a strong partnership between IT and HR and facilities.

And so we're meeting weekly right now as leadership teams across those areas to try to think through this. And one of the guiding principles that we we have is we're relatively large health system now. We've got about 40,000 total employees and providers and we've got 5,000 plus what we back office workers.

And that's a pretty substantial, you know, number of folks to try to coordinate and think through. And we want to be consistent. We, we don't wanna have individual departments creating new and unique and different ways that could create some internal. A grass greener type of thinking in terms of, oh, well look what that group is doing and why don't we have that, you know, opportunity.

Capability. We've, we'd like to be consistent, so we're working very closely together to try to drive this as a system. This is a difficult and really nuanced issue. There's a lot of different ways that people can react to this. There's a lot of different scenarios and situations that can just arise out of, out of the flexibility that people have.

That have had, I've heard, talked to some CIOs where their people have moved to other states. They created payroll tax issues, created situations where they didn't know whether they were going to make the employee come back on their own dime, or if the company was gonna have to pay for them to come back for projects that were actually gonna happen on site.

I'm glad you went into as much detail as you did, but I'm sure those conversations have been very long conversations because there's really a lot of aspects to consider with this. You mentioned, just to touch on one point you made there, the remote work from different states. I mean, we are a North Carolina based organization with our entire history, and we've been able to have the vast majority, you know, of our, our employees and, and team members living in North Carolina, but.

As remote work is becoming more available, like I'm assuming most organizations, we are seeing, uh, a major increase in the number of new candidates we're interviewing who are wanting to work from other states. And that presents real challenges for HR and legal to, to make sure we're ready to provide them with solid and robust employment, you know, on par with what we do with our current employees.

And those are big parts of the conversations we're having. How to work through. Yeah, I, I can only imagine. I appreciate that. We'll probably come back and have a conversation with you later about how it's going, the ongoing monitoring, and I, I think that's just going to be a key. It's interesting because we need to get the environment right, caring for their kids, caring for their parents, those kinds of things.

They might need that environment for an extended period of time, or maybe even indefinitely, but some people don't operate well in that environment. It's hard. I mean, I've done it for a long time. It's really hard to separate this office from that living. Yeah, absolutely. And if I could jump to one other tangential piece of this bill very quickly.

I think everybody in the country is dealing with a major challenge with finding fantastic talent in health it and keeping, and, you know, re retaining the the folks they have. And that's something I worry about too, as we are coming out of the pandemic and we're seeing. The opportunities that folks have now available, which is wonderful.

But you know, we're facing some extreme competition. You know, here, here in the triangle of North Carolina. Recently we've had Google, apple, and several other major tech. Microsoft just put 'em, literally the building I'm in right across the courtyard. Microsoft is putting in a facility. They're hiring I think 300 to 400, uh, employees there.

So I mean, we're in a real talent battle. Here at UNC Health with our IT and LX staff, we've been very fortunate to have extremely low turnover over the years, and we've got a wonderful mission that really means a lot to our team members and we see a lot of buy-in about our mission and it's just a wonderful thing I.

But as the competition continues to increase, especially here in the crucible of the triangle, I, I do worry, you know, about retention and being able to continue to attract top talent. And it's something that's, I'm spending a lot of my time on. I, I smile and laugh. 'cause that's the problem we had in Southern California.

I think they called it Silicon Beach. And that's where a whole bunch of companies came and put their headquarters right along the beach there in Southern California, which was pretty interesting. We had Google down there. We had a lot of competition for talent and my answer to people was always the same on how to really address this.

And that was to partner with the colleges. And universities, and actually it worked pretty well. When you get into those situations with people as interns, they tend to be, there's a, there's a natural flow into your organization. I. Now you really do have to work at keeping them. It. It's a great first job to come into healthcare, especially on the analytics side, even on the cloud and infrastructure side as well.

And we just had a, a lot of really great opportunities for them. But you guys, I mean, you guys have UNC, you have NC State, you have Elon, you have a lot of colleges and universities right there in the area. I thought it was interesting earlier that you said you. You have partnered with Duke. Talk a little bit about that.

Yeah, we have a great relationship with them. I mean, certainly we compete in the marketplace for, for healthcare services, but we've got great collaborations with their team and we'll pick up the phone and, and call each other all the time. Hey, what do you think about this? Here's what we're thinking. So it's a very positive relationship.

As long as we're not talking about the basketball court, it's good. , . Yeah. A a lot of change going on on the basketball court, and we'll get into that later in. In a previous role, you were a cloud architect and healthcare was, if you just go back a decade, was fairly resistant to the cloud. How are we doing on that journey today?

What, what are your thoughts on that? I gotta tell you, bill, I, I don't know that it's one that I'm necessarily the best answer, but I'll, I'll do, I'll, I'll do my, my fair shot here. My good friend Craig, Richard v you know, who I, I have the privilege of, of talking with all the time. I mean, he really has done a lot when he was at Atrium before and, and now in Colorado and to really push the industry and many others have as well.

But there's been some real pioneers to have pushed the industry forward in cloud adoption. But I think you're right. I think there still is some resistance. We've taken a very pragmatic approach to it. We, we have a number of cloud or vendor hosted solutions. Our ERP system is fully cloud hosted. Uh, and we've had good luck with really good luck with that.

And many other, you know, specific application solutions are in the same boat, but we take it case by case. We, we don't really have like a cloud first mantra, or we don't have a specific goal or target around the X percentage of our workloads moving to a cloud. We we're, we're still looking at it in terms of our, we've got a very formal enterprise architecture review process that we leverage whenever we're bringing new technology in the door, when we're looking at.

Uh, major upgrades of existing technologies and a vendor cloud vendor hosted cloud type model versus on premises one of the main, uh, components of that architecture review process. And we look at it on a case by case basis and, um, if it makes sense to use a cloud solution and for that particular technology, we do it.

If it doesn't, we don't. So we have, you know, hybrid is a word that's being used in many contexts these days, but we have a very hybrid environment. We've got our data centers on site, and we use a lot of, uh, uh, cloud and vendor hosted solutions as well. And we think that for right now, that feels like still the right pathway forward for us.

Well, I'm gonna, I'm gonna give you the opportunity to really select the topic that we're going to cover through the end here. So we could go in the innovation direction, we could go operations, we could go security, or any other topics that you wanna discuss. Yeah. I wrote down a few interesting things that I, I know you always ask at the end.

I think we've covered everything I had said. I think the one thing we've not talked a lot about, I. So far this morning is, uh, virtual care. I think digital health. I think that from that perspective, and you, maybe you wanna come up with a question, but I'll just give you my 2 cents real quick. I'm really excited about what I see in the industry.

We certainly are doing a lot in that space as well. Like everyone I think, who. For the academic health systems like UNC Health, I think where we're gonna win in the end is if we can figure out the right balance between that ease of use that Amazon like experience or for access and, and ease of use balanced with continuing to offer a strong relationship with the provider for our patients and as consumers are moving more and more to North Carolina.

How we attract those new patients through Amazon-like experiences, but help them build long-term relationships with their care teams. I, I, I think that's gonna be the secret sauce for organizations like us. It's interesting, I jab at the industry every now and then 'cause I want things to have less friction, easier for the consumer to use and.

I've also sat in the role, the CIO role, so I know that we have contract negotiations with physicians. We have all those things that we had unionized nurses as well, and we have to provide systems because we could lose our providers. I mean, I'm not speaking for you, but in the, in our case, in California, we could lose our providers.

They could go contract with another organization. The nurses could strike, and the nurses and . Did actually go on a couple of strikes while I was there. And in a couple cases they noted some of the technology items that they were not happy with. So there's an aspect of we, we walk this really interesting line and you've gotta make the technology easy for the consumer to use, but it really does have to serve the clinician and that community and serve it well.

So how do you balance those two things when you are looking at a digital solution that you're going to take into the community? How do you create that balance? You hit the nail on the head. We are spending a lot of time right now across various aspects of our leadership team to think about these things.

It, it's tough, bill. I don't, I've not yet seen any easy answer. Silver bullet. I think I. For us, we, we always keep the patient first, so the patient value, making sure that we're providing the best quality and access to services for the patient is foremost of importance. And, and then in the situation, what does that mean for the provider or care team?

What provides them with the best experience balance with that patient experience? We've got a lot of clinical leaders, a lot of administrative leaders that are meeting in our, our virtual care steering committee and oversight groups that I. Are, uh, thinking about this question, I think there has been a lot of progress made in through the pandemic in terms of the pandemic has catalyzed so many different aspects of what we do in help it, but I think it's also catalyzed a lot of both on the technology side, the ethics, the Cerners, the others moved much more quickly, Amwell to offer better ease of use for the providers and the patients.

But also I think on the provider side, I think the experience of having to jump into the pool feet first and work with these technologies in ways they haven't before. I think they've come to the table, at least here at UNC Health in a great way, and, and their understanding of some of the, the limitations or challenges and their.

Thinking about things maybe differently than they would have before the pandemic in terms of, yeah, this seems acceptable to me and we can make this work and, and this is a better experience for the patient. Yeah. We really have experienced a cultural shift. Are you planning to go to himss? I will be at HIMSS this year, yeah.

What's your plan for hims? What will you be looking at? What will you be trying to uncover while you're there? Bill, I gotta tell you that. I, I haven't put a whole lot of thought into it. I, I certainly wanna understand where the industry is going post pandemic with AI and machine learning. That's something that we're thinking about heavily.

The Google ACA deal is really interesting. I think that has an opportunity to have a lot of ripple effects. Uh, I'm really interested to see what vendors are thinking about that. And we are still doing a lot post pandemic here at UNC. We, we've invested heavily in our value care initiatives and, you know, alternative payment models and population health.

And I still have yet to see anyone crack the nut of how do we work in a, a true vendor, multitude of vendor, EHR vendor, clinically integrated network, and how do we really bring. Meaningful EHR data together in interoperability or other ways and help continue to move the industry forward in, in terms of value care, payment models, and I, I, so those are two of my personal interests that I, I'm hoping to see some movement in the industry going forward, coming outta the pandemic on both of those areas.

So you guys live in a multi EHR world there? We have an extensive clinical integrated network that's got hundreds of independent providers and that have, if, if there's an ER vendor or version out there, I, I suspect we have it in our clinical integrated network with our independent providers. All of our UNC health providers are on our epic instance, but with our independent providers that are part of our network, we, we have to work in that heterogeneous environment.

When people ask me, what was the hardest thing you faced in healthcare, the answer's always the same. And it was really bringing the data together for the clinically integrated network to create the, the provider scorecards the success metrics across that entire network. That was far and away the hardest thing we had to do.

Well, and if I go one step further, I mean, and with all the great work that's going on right now with consumer facing digital health capabilities. Now try to do those in a, you know, clinically integrated network environment with, with all these different EHR vendors. That's what I spend a lot of my time thinking.

How in the world are we gonna accomplish a lot of that work? Yeah. Will, will you be going to the user group meeting? Funny enough, this will be my first Epic UGM. I've been to Epic many times for various meetings and events, but I've never been to UGM, so this will be my first one. Brent, thanks for the conversation.

That was wonderful. I really appreciate getting to know you and, and learning a ton about UNC, so thanks again for your time and your service to the industry.

And thank you, bill. I appreciate the opportunity, but like I said earlier, really what you do is amazing and what you and your team are putting out week in, week out is a true, uh, value to. 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.

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