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March 24, 2021: How do you attract major IT talent to paradise? AKA Florida? How does someone from a military background quickly scale the CIO world and also wear the hat of pseudo COO? William Walders, CIO and SVP of Operations Support at Health First gives us insights into his operations and IT roadmap including ITSM, Data Analytics, Security, IT Governance, IT Automation and App Rat. How do you measure productivity? Are your staff evolving? Do you think about succession planning? What is Digital Enablement? How do we get things into IT? How is that governed? How do we report out? Have you adjusted your hiring practices post COVID? How do you approach interoperability? And for people early on in their career, what would you tell them prepares them to be a CIO?

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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 get to catch up with William Walders. He's the CIO at Healthfirst, CIO on the Space coast of Florida, right across the state from me, and we have a fantastic conversation.

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You can also go to today in health And now onto today's show. Today we are joined by William Walders, the CIO for Health First, also SVP of Operation Support. Uh, a new title that's been added. William, welcome to the show. Thanks for having me, bill. I know we've been, uh, talking for a couple years now.

And finally, um, poll in both our calendars to allow the staff. Yeah, we have been talking for a while. I was . I, I tell you what first struck me as your social media post. I, I, I love how you've been talking about the, the ease. Uh, you're in the, the space area of, of the Florida coast, and when you talk about it, it just, it just cracks me up.

I, the, the, the last one was sh don't tell anyone unless you want to come here and change the world of healthcare. And it was a, it was an article about how wonderful the, the standard of living is in that, in that area where, where, where you're at. So tell us, tell us about Health First. Tell us about that area where you're, you're situated.

Yeah. Let's start with the easy one, right. So, I mean, the Space Coast of Florida is, is unique, I think. Most people don't know where it is. You tell 'em you live in Melbourne and they think you, you know, you live in Australia, southern part of Australia, , and then you start working your way up Cocoa Beach, and most people kind of know that one.

And then eventually you get to Orlando and then you're just concede. Yep. I live in Orlando, but in reality it's about an hour away. Right on the coast. You know, it's quickly turning into. What I think it once was in the fifties and sixties, right? The hub of the World Space program. And I keep saying, you know, we will be the space board of the world.

We had a launch last night. We've got another launch tomorrow, early tomorrow morning, late tonight. And you know, we're, we expect seven, eight launches a week between. You know Tesla, SpaceX, right? They're Elon Musk, SpaceX, and Blue Origin, which is, you know, Jeff Bezos and Amazon's project as well as ULA and, and oh by the way, NASA's still here and growing, right?

So it's a really unique part of the world, largely bolstered by defense industry and, and we're the health system for this community, uh, largely in a three counties region here, roughly 85% of the market, $2.1 billion integrated delivery network. So we have our own. Health plan about 180,000 covered lives.

We made it. You're following my social. It sounds like your are You saw the announcement we made in partnering with Oscar Health, uh, a couple weeks ago. In essence, uh, they're gonna do the administrative services of our health plan. Give us some really exceptional tools to speed to market on the, the consumerism portion of what health plans are are required to be doing these days.

Uh, four hospitals, which in aggregate's about a thousand beds. Our own medical service or MSO and Medical group, right? For our own providers. And then our community health services is everything else. I call it the Cats and Dogs of Health. First. They probably don't like that title, but it's home care, it's gyms, it's hospice, you name it.

Durable medical equipment. We have 30 something things in that portfolio. So it's interesting and it's one of these I call, I also call the Starbucks of Brevard. Because having lived in Boston and Seattle and a lot of places during my military tenure, you know, it's a Starbucks on every corner. Not here. I think we have three or four, but there certainly is a health first logo on every corner.

And one of those capacities, either medical office building, a hospital, you know, home care facility, or a long-term care facility or a home care office, or even a insurance broker who's selling our plan that puts our logo on, on their signage. So it's, it's a really fun place. And not to mention, I mean, bill.

You know, I know this will stand the test of time when people were reviewing this, and hopefully by that point, the storms that are occurring throughout the country and the power outages in Texas and the in the Midwest and others, and these freezing temperatures are gone. But here I'm looking outside, it's 80 degrees, sunny.

I'm staring at the ocean and you're on the nap. You know, you're in the other coast and it's no different, I'm sure. Right? So hurricane season, so yeah.

You know, hopefully no one's going to, you know, cancel the show because they're, they're upset that we're talking about how beautiful it's down here. But, you know, it's interesting. On Friday night, my wife and I drove up to Orlando when we had dinner with a friend who, who came over from there. He works for Boeing.

He was moved from Southern. It was interesting to talk to him. He's like, I, I couldn't be happier. I was worried about moving my high school age daughter across the country. His daughter had started in a college that's not too, from there, I think it's Emory, Emory Riddle or something to that effect. And, and he is just like, and I thought it was gonna be horrible.

He goes about, uh, two or three months, my girls were like, why didn't you move us here earlier? This is amazing. You know, the, the one girl was 16, was under 16 years old, but she's allowed to drive a golf cart and she's like, you know, I can go for pretty much everywhere she wants to go. She can go with a golf cart.

And what, what are the demographics in your area? Is it, is it young, young engineers or is it, is it retirees as well? I mean, what, what's, what's the demographic? Really I'm the aberration, you know, mid forties kind of guy. It's, it's a lot of older folks, naturally and a lot of younger folks, younger engineer, we're kind of bifurcated right down the middle there.

But that gives us some, you know, we pull our market data all the time responsible for the data team that does that. And as part of our huge pivot, we're making an $800 million bet on consumerism. And that's in that post. When I say change the world of healthcare, we genuinely think we will. And we can probably talk about that a lot later.

But you know, these. And pulling all that data we're really split, right? Young engineers, defense industry is huge here. Not to mention, you know, the, um, the space industry, but who is it? Northrop Grumman Harris, Boeing. But Northrop Grumman and Harris are headquartered here now. L three Harris. And so they're huge here.

And then Boeing's in the area, a lot of aerospace and just aeronautics, Piper, tons of places. Rivian truck, you name it. Right? The sun bum. You know, we have all these partnerships with a lot of these brands, if you will, that that are. Born here and growing. Right? So I say all that to say this is we're to manage that, right?

You know, the folks who, who genuinely wanna come into a healthcare setting and they wanna stay there all day, they wanna chat, they wanna interact. That sort of social setting. And then the, the younger folks who do this every something on this device for every interaction in their lives. And we've gotta cater to that as well.

So it's, it's fun to be candid. So yeah, roughly the demographics, there's, there's certainly some in the middle, but we're, we're the minority, you know, kind of middle aged in this community. Yeah. I moved into Naples and they referred to me as, as the young, we're the young couple who just moved in and I'm, I'm, I'm in my early fifties and and I was like, I haven't been called the young couple in, I dunno, 30 years.

It's crazy. Um, yeah. This reminds me, I don't, Austin's a really easy target if you'd visited, I mean, and I would equate this to Naples because I grew up in not too far north of Naples. We used to go down there all the time. It was just sand dunes and a handful of things right back in the early eighties.

But I equate this to when I was visiting Austin about the same time, uh, in Asheville, probably 10 years after that. So, you know, if I was a betting man and I'm, I, you know, moved my family here, investment in my own real estate, whatever, you know, personal things, it's gonna have a similar trajectory as, as those two cities, right?

Where Asheville and, and, and Austin is now blowing up with, you know, all the, the tech that's growing there outside of Dell. But, but yeah, it's, it's, well, let's talk a little bit. 'cause a lot your social media posts are. Attracting talent. Do you find it hard to attract? I mean, it's funny, attract paradise.

Yes. And. You know, I just told you my competitors is the same, the same folks, right. You know, Northrop government and we're in It is my, my passion, my love. I, I've shared with you, I'm now responsible for other aspects of operations at the idea and kind of a, a pseudo COO in a sense, responsible for all contracting and supply chain, which is another 500 staff.

The contracts that do, you know, environmental services, you know, get phone calls about instead of networks being down and vulnerabilities, I know, get 'em about transportation and linen as well. I, I'm sorry. So how, but before we go to talent, how did that happen? How did you end up with those added responsibilities?

That's an, that has to be an interesting story. You know, chance favors the bold, I guess, you know, came here right during Dorian, if anyone remembers that storm of, of 2019 on our coast h. As ACIO, six weeks in running a command center operations center jumped right in 22 years of military experience. It's not hard to lead people.

That talent was recognized. I guess, quickly it became, you know, besides them hiring me as the CIO became somebody to watch, I guess in a sense, in these words that were shared with me and gradually grew, came in it, did a full contract review, saved us $13 million right out of the gate. that certainly did not go unnoticed.

And then our COO happened to retire and they're looking for folks to cover down for, for his vacancy. You know, you get the call from the CEO who, you know, calls into the office and you're like, hair in the back of your neck stands up. You're like, this has never happened. Like , this is gonna be great or horrible.

When it was me, it was free, right? Mapped out an org chart, our COO is responsible for all those things I described, plus facilities. And security. Those, the gate facilities, our hospital division, CEO, and security, went to our hr, uh, EVP, and I got the rest. So that's how that went. They saw my, the way it was shared with me, not me, gloating, they saw how quickly I was able to scale.

The CIO world and, and won't say turn it around because it was well on its way to being turned around. But change the culture, change the perception, get the folks motivated, and then do a lot of the operations capabilities within it. Growing in hr, I. For professional development, really having a roadmap for the IT staff to evolve and develop.

That was something that our surveys had said they were missing from professional development perspective. And then again, that contracting piece, building out our own contracting team, a vendor management office, I'd call it if, if we were to formally give it a title, and then really saving those resources.

So now we're doing a similar thing in contract supply. I've got . You know, 400 staff there, a great senior vice president who's leading that. And, uh, we're doing a similar transformation there. So that's kind of the, how you could ask my CEO Steve Johnson if, if I'm, if I'm accurate or not. Maybe he'll comment if he sees this.

That's, you know, what's interesting about that is we've, Chad Ine, CIO at St. Luke's up in, uh, Pennsylvania, took on frontline revenue. So.

Uh, BJ Moore, who I'm gonna interview later this week, he is at Providence and he took over facilities and, and a whole bunch of operational capabilities as well. So we see CIOs going there. I've interviewed four CIOs in the past month who have all taken on chief digital officer roles. So we're seeing this.

Hey, are I, you, you got it running real well. We're gonna, we're gonna throw some more things your way and some are going in a digital direction, some are going in an operational direction. And to be honest with you, both make sense to me, right? Yeah. And I, I genuinely, we had ACDO I'm, if I was, I'm doing that job as well.

We just, I, I hate that title. I don't know what it is. Bill, maybe we can, you can be my therapist here, but, um, , I always thought that. It was funny, I even said that I feel like during my interview, like we have ACDO, this is what they do. And I'm like, that means your CIOs fail, right? Like you're in my mind, like the CIO is the CDO plus, the green light green Networks up operations guy.

If you extract the CDO element from it, you. I'll say this word neu or the CIO in a sense that they, they're no longer the fun, cool, glamorous like technology stuff. They're just operations, right? So if you, if you want just an IT operator, green light screen network is on, we're safe, we're not, you know, not vulnerable.

And security's good then. Sure. But it really great CIOs, I think do both. And I do both here. You know, if we wanted to keep that E-V-P-C-D-O title when I got here, it would probably be announced introducing myself as CDO. I just don't like the title, but I'm cur curious your thoughts there, bill? I mean, we probably don't, I don't know if we wanna get on that tangent and in particular, since you're interviewing, interviewed quite a four of 'em, or quite a few of them and four of 'em I think you referenced.

But yeah, I, you know, I, it's it interesting the don't have the title are still a lot of. But there have been, there have been some noticeable departures from that Ascension really put a lot of authority in their chief digital officer at Eduardo Conrado, and, and every time I've talked to him, he, he's extremely impressive, heavily involved in the operations, digitizing whole hospitals and, and the direction they're going.

Obviously leading the, the charge at Google and when you have some odd hospitals, I think you can understand how. No, and I gonna say scale. There's probably some sweet spot. Someone can draw a Venn diagram or some shows like what that crossover point is for requiring. I've seen it go a different way.

Actually, Thomas Jefferson Health, Steve Klasko is the CEO. They had that whole CD's dice and, uh, divested that entity and now outsourced their innovation. I mean, so maybe that's a direction that, that folks will be going next. I don't know, but I get, but yeah, you're probably right. That sweet spot of size, you know, John Alka at Mayo.

Great, great guy. We all know John and what he did in Boston. And, uh, great thing for something the size of Mayo as well. Health first we're good. We're good. Well, yeah, I mean, I, I think there is the sweet spot when, until you get to about, I'm gonna, I'm gonna put a number on the ground saying let's say about eight to 10 billion.

I, I think the CIO can do a lot of, a lot more than they're currently doing. And I think that's what we're seeing in, in those organizations. Plus, I agree with your neuter comment wholeheartedly. I think there's so many things that require the, and by the way, I'm supposed to be interviewing you, this is Anyway, but I think there's so many things that require the two to be so tightly integrated.

If the CIO can do both roles, if they have the skills to cross over to digital health and really understand the, the customer journey and bringing those things together that you should allow them to do that, first of all, it creates, uh, great career paths for the talent, the technical talent that you have inside the organization.

I don't think anyone understands the operations as well as the have. I mean there, you know, it, it, you're touching just as ACIO you're touching supply chain. You're touching the ehr, you're touching every practice. Uh, within there you're touching oncology as well as cardiologist. I mean, you, you just, you have to be really understand it.

I think outside of the CO, the CIO probably understands. Probably as good as, as anybody, uh, out there, to be honest. Yeah, certainly the, the operations and tactical, right, like the, the tactical and I call it tactile of touching, like real world operations, not, you know, sitting someplace and looking at reports and dashboards, but genuinely living through the operational problems.

The other folks who do it well that I think are, are natively. He apparent for COO type responsibilities or your facilities guys and gals, right, who similarly cross that horizontal plane. But you kind of, if you, I guess if you look at the pedigree of COOs, you don't see too many CIOs. You're seeing it now.

A lot of 'em are, healthcare administrators are kind of bounce around and run things and eventually land operations role. But I think you're gonna start seeing it from the, the line service components of it, right? Facilities, folks, it folks maybe, uh, contracting folks, supply chain, and then maybe even a handful of, um, you know, PO type.

Y Yeah, that was a significant tangent, but I appreciate you going down that road with me. Let's go back to attracting people. Does the social media thing work to, to attract people? Yeah, it absolutely does. I mean, you know, for whatever reason that, you know, LinkedIn is the one I've latched onto. I think I've like 500 Twitter followers or something.

And if you wanna see my, my kid or my pets, that's probably the place for. But LinkedIn is where I do, you know, the work stuff, right? So pretty great following there, either from my time at Walter Reed or VMware or now. And so it genuinely gets a lot of traction. You know, we're a non-for-profit health system.

We, we've got a great mission and great story and you know, for folks, I seem to find these great leaders and I feel like I've stolen quite a few senior leaders from like. Pennsylvania, Oregon . It's, it's like, not even fair. Yeah. It's like, just, just wait until this week. My, you know, my parents have two feet of snow in, in Bethlehem, Pennsylvania.

So just start calling, uh, St. Luke's in Bethlehem or Lehigh Valley and, you know, yeah, I, I got my CTO from Providence in Legacy. Got a similar thing, you know, his wife, by the entire, I mean, I lived in Pacific Northwest for three years. I don't know how you do it. But you know, they got tired of too many of those.

And I, I joke that I stole away the next legacy CIO and a gentleman by the name of Michael Carr, who's our CTO, you know, so, so it does work. I mean, January gets, gets things out there, gets eyes on it. You know, I'll be candid, it was very easy. We've got a, I just got the report. We're 99.8% over the last 12 months on retention, right?

So I don't hire a ton, but it's still on the IT side, somewhere between three to four month. And we want to grow a lot of that talent from external, but we'll, we'll naturally. Find it here. We partner with universities. You mentioned Emory Riddle, which is just north of us. FIT, Eastern Florida are here, you know, genuinely in our backyard, starting to do all the right things with them, with building an IT track.

We have nursing tracks, we have, you know, medical attending and RAD tech and that, and building an IT track there. So, so absolutely getting it out there. It does, it does work. Phil. Wow. The, you know, coming from the military, do you think a lot about success succession planning? I would. I. Yeah, and I, I think it really weirds people out like that.

I'm, I'm, you know, that I'm so open and forthcoming, like I want, I've got three direct reports on the IT side who literally are three way tie for who will be the heir apparent to the cio. Like, I will not hire a search firm. It's, I think it's an inevitability that I grow out of the CIO role at Health First.

I don't want to, I love it, but I think that's just directionally where my leadership is taking me. And you know, I. I've got the best and hardest decision to, you know, I don't have to go outside. I've got three, three folks and I'm training 'em to that end, or, you know, building my relief as we called it in the Navy.

And it was weird for one of that, you know, it was like no one's ever been so open, like, you know, I guess maybe it's natural to protect your territory, but No, I absolutely do. And thrust them into those situations often for Covid response, I, I happen to be in. St. Lucia for spring break almost exactly a year ago when, you know, the hospitals started ramping up command centers and requiring the CIO to be president and spinning up ICUs and building hospitals and, you know, basketball stadiums, et cetera.

I put two of those three in the command center while I was in my own command center in St. Lucia on the phone waiting for a flight to get back for three days. But, uh, no, they're great. So.

The, you know, are you gonna adjust your hiring practices going forward? I assume you guys are still outta the home. Uh, what do you, how are you thinking about that? Yeah, we're, I go in three days a week on Monday, Wednesday, Friday. I'm home Tuesday, Thursday. And I love that balance. You know, I say I, I did not adjust my hiring practices during Covid when I got here.

I don't wanna, it was different culture, right? People, it was competitive who got to work first. Whose car was in the parking lot. And then it was a bit of a, it was a game of chicken on who left last. Right. And I was very lucky. Twofold. It, I was probably the only active duty military officer who was remote working in support of the Cerner deployment.

That $12 billion thing that's happening in DODI was in Seattle ish, was in the, across the sound. But you know, and my staff were all over the world. Right. And that happened to be where the first wave went. But I worked outta home. Five out of five work days a week. So I learned that culture. Then I go to VMware for a year and you know, that's entirely remote.

So when I got here I'm like, we are remote, like we need to prove it. Uh, we're in, you know, with hurricanes, with everything else, I want anybody being on call. I don't want anyone have to drive 45 minutes into the building to reset a server. Like let's prove that we can do it. And we did. People loved it. It was a great, well, one retention tool, but secondarily recruitment tool and we literally flipped the switch.

So. So yeah, to change hiring practices in a sense, right? Where we're just telling them you'll likely work remote. That we're, we're poaching people from Tampa and Orlando, who in a prior leadership regime would've said, you have to be here or at least come three or four times a week and we'll give you that one day to stay home.

But now I'm like, stay home. , like, I don't need to see you. We were looking at growing, building a $6 million administrative building to house. You know, administrative services in, guess what? Those plans are scrapped. In fact, we divested ourselves of another 3 million in, in rental space, right? So, yeah, this is not changing.

We're we're in it for the long haul and the system supported, oh, by the way, we've been measuring productivity this whole time. The health plan is the easiest one to measure for me for claims processing, et cetera. But even the other stuff, on average, we're up 17% more productive. How do you measure productivity in it?

Yeah, so it depends on what you're doing, right? So it's easy on security side patch management compliance. We watch our, when I, when I got here, our patch goal was 80% and it just blew my mind.

So we, we drastically reduced that gap for our system administrators. We have checklists and things we have to do for patching compliance and the ability to take on more work as new systems are added. Help desk productivity is an easy one. We, you know, 6,000 ish open tickets now that hovers around 200.

You know, it's just normal measures. I guess, bill from a, from an IT perspective, but that's how you see. Where, and mind you, I've not done multivariate analysis to extract the changes that we've made. New tools, automation. You know, robots and other things, but I'm, I'm counting it so that, that, you know, I, I, I sort of joked, you know, we're leaving 20% open.

But that used to be the mindset. If you, when, when I first took over ACIO back in 2011, we weren't worried about global threats and those kind of things. And it was like, all right, well, you know, we're gonna try to get every system patched over a one month. That was acceptable back in 2011. It probably wasn't acceptable, but that was sort of the, the, the norm.

And, but we've really had to adjust that, especially recently. I mean, it's just the, the attacks are constant and getting more sophisticated by the day, so. You know, silver lining, silver lining of Rauch, and that's the, you know, the, the ransomware that came out. It's been around for, I guess a year now, but most notably hit, you know, all the press that the EVPs read, folks that sit around the horseshoe, I call it on my floor, you know, and they start knocking on your door and like, Hey, should I be concerned about Rauch?

You know, like, this hospital's hit. I'm like, no, because you know. You know, remember all the resources we commit to security here and how we've improved the posture over time. Like we should be okay. But, but it, it, it put a spotlight on an area where to kind of justify. 'cause you know, this security's one of those things.

I was in DOD for 22 years, right? You're not, if you're not a hundred percent, they will turn your network on. I mean, that's just the culture. Um, because the medical systems ride the same circuits as missile codes intelligence data. Right? And you're, you're bumping up with NSA stuff, right? And so no one, there's zero tolerance regardless of how special healthcare is

And so, you know, it, it's just a, a culture shift and, you know, it's, it's one that folks here are starting to learn and understand and. You know, doing it for them and not to them. 'cause it used to just be we're bringing you down and, and why, because we need a patch, right? Not because you're gaining functionality.

You don't, you don't have your business partner with you on the why. Once you fix that and then you build credibility that, oh by the way, the four hours you're down is only the four hours you're down. Not that it bleeds three days later and you're scrambling as to how to get it back up. Uh, and you start to build that faith and confidence back from the business, um, you'll get them as partners as well on the security front.

I, I, I used to hire military people and the reason is 'cause they're so well prepared and they're so well-trained. The, uh, the new CEO for Ohio Health is a former military guy and he was talking about Covid and he said, you know, he said the first thing we did, now you think, okay, COVID 19, the first thing we did, and he said the first thing we did was security.

He goes, because the number one thing you have to worry about is when you're looking the other way is when they're going to attack. He goes, so we got together our cybersecurity. I mean, and I'm sitting there going, okay, that's the first, I mean, there's a lot of C iOS who wouldn't think that way, let alone the CEO, but that's, that's what the military does for you.

It's like, okay, what's our flank? How are they, how are they positioning themselves? How are they gonna attack us? How are gonna, and, and that, I mean, again, that's just the training. That's the mindset. Have to get into. It's pretty, it was pretty fascinating to hear him talk. Yeah. Great. Lemme, so you have posted on like , like the information Technology Industry day on February 26th.

What is the, and I apologize since this will probably go live after your technology day, but for those who wanna be a part of it, what is it and what, what are doing? Yeah, so I do 'em twice a year, so no worries. We'll get, you know, if you listen to this, uh, enroll in August, we always, um, put, put to save the date out.

But here's, here's the genesis of this. We all relate to prior things record. In my military time when, when I was at Walter Reed, I was responsible for six state region as well as kind of a side duty, the regional CIO of 32 hospitals as well as CIO of Walter Reed. And you can imagine, you know, I spent over that tenure about $2 billion budget in four years.

So do the math. Half, half a billion dollars spend. You got a lot of people want to talk to. And, you know, we all have our own strategies on how you do vendor management and who your partners are, et cetera. And I had this idea from another element of the military who did it. It happened to be our, um, contracting team who does, you know, who wants to get small businesses and service disabled and minority owned businesses into, into the.

Level of understanding on how a government contract works, how you can apply, how you can run this business. And I attended one. I'm like, why don't I do this right? It saves me the, I need 15 minutes. I need 30 minutes. My admin pulling her hair out on scheduling an hour meeting with somebody, but secondarily opens the aperture to everyone.

Genuinely the world can attend this. So what I do now is I save that flyer that shows the save the date. And it's, anytime I get a, I'll call it unsolicited email from a vendor. 'cause they all figure out our naming conventions of email and get your email and then your services. We sell these, I just send it to 'em like, Hey, I'm, nope, I'm not gonna give you 30 minutes, but I'll give you four hours.

Right? And here's the day. And for four hours, I'm gonna tell you the following. What, just high level, what we've done, who we're about, what we've completed, and what the success has been, and who those partners were. I, I want to celebrate success, but moreover, what's coming, right? Here's the RFPs we have coming out.

Here's the entire roadmap of what we're doing. If you can do one of these things, engage our VMO, we'll get you registered. Enter our, uh, registration, so you'll get every RFP if you want it, even though you know you may get our linen one. You know, you're, you know, and you're an IT company, but, but people want 'em, right?

And having been on that side, and maybe you got an op, somebody's got a solution on automating linen. But, uh, anyway, and that's kinda what we do. But more importantly, having briefly been on, on the sales side of this, I tell you what's not real , you know, don't chase these things, you know, back when you know lunch and learns and.

You know, line level and service level people having, you know, meals and playing golf and doing other things with, with sales folks, I felt like they were compelled to. To overshare at times or to talk about things that may or may not have been real yet are genuinely not real in the near term. So on the sales side, you start spinning up resources.

Hey, Healthfirst is working on, uh, blockchain and let's not talk about that. It's just the, it's the thing I hate the most in it at the moment. But, you know, and then you get all these blockchain vendors coming and wasting everybody's time, or even a good partner who, you know, goes out and gets an overlay and starts positioning blockchain solutions.

And I'm like, what? What? You're wasting your time right. Thousands, tens of thousands and hundreds of thousands of dollars in many cases of, of these partners. So, so generally four hours, here's what we're working on, here's what we did, here's who won our, I mean, tease it. And actually it'll be old at this point, but here's the decision we made on CRM and why.

Here's the decision we made on cloud and why. Um, and if you wanna be a partner, here's the things we care about, right? And so that's why we do it. It saves a lot of time. It's open and transparent. We're a non-for-profit and we have a foundation, so I like to plug the foundation there, even though we get very little traction during it.

But, but anyway, so that's why lots of, lots of, lots of goodness from it. And then I position my staff to present and they're coming outta their shell a little bit, some director level folks and who, public speaking, they had 600 of the last ones. So it's great to see how they interact with an audience like this, how they think on their toes.

Um, so I also use it as a professional development tool as we communicate the message. But it, but it's great. I'm gonna do love to you, uh, discuss technologies and priorities. And I'm gonna use some of the things you had listed on here. So I'm just gonna rattle through them, just your quick response. You know, I, is this a priority?

Uh, you know, where are you guys thinking about going with it? So one of the first things on the list was itsm, IT service management. What, what are, where are you heading with that? Is that a priority? Yeah, we, we made a selection recently with our incumbent, modernize that tool for me. And I wish I was in my office 'cause I have a two by three chart.

Kind of hierarchy in my mind. When you have great IT service management, you truly become that audit proof transparent partner. You can even call it ITBM. A lot of people do the business management of it. So you start at the service management, the service desk level, we document what you do, you understand what that is.

Then you extrapolate to what it costs. Um, and then you show people. I literally handed my EVPs that two foot by three foot chart that showed every application in the portfolio when I got here. 1200, now 4 34. And it was an eye chart. It was ugly via email, but when they laid it out on their desk, the hospital CEO looks at it and he's like, oh, that's visually everything I have.

That starts to tell a story, right? So for me, I've, I've got four foundational bases of our strategy at Health First and one of those is it service management. Data analytics and management. I would imagine this just con continues to climb the, the ladder of importance. So what, what are you looking at for this year?

That's the, that's the second of the four foundational elements of it. Uh, we are a holding company and, and we're a holding company in the, in the wellness business. Right. You know, we are a pillar in the community. You, again, 85% of the market and. So, you know, everyone's affected by health first. So we represent that brand.

We, we wanna do right by them. So getting all that data in a single data layer, ingesting in a way that's actionable, being able to deliver that. So we're, we're all in on, on the data element to, you know, and I won't try to use buzzwords, but the, the strategy is single data layer. You ubiquitous presentation layer with both data enablement people show you how to use it, and then self-service bi, right?

Where you can come in and do it. We've got pop health folks, we've got finance folks, and right now everybody's got their own ETL process and that's them taking it from our data source and ET ing it into Excel and pivot tables, right? And then we all know what that means. So once foundationally we're there, I've got a great leader in that role.

Tim Boskin, who is. building out all that maturity. And, uh, we're at the, we've done the plumbing, we know where everything is. We've now put the governance on top. We are starting down the journey of truly that ubiquitous presentation layer and really enabling the business to, to do great things with data.

So. We, we chatted about it, security and generally if people are wondering, I don't ask detailed questions around it, security of CIOs. 'cause every good CIO has been already told by someone not to talk about their security publicly and reveal stuff, but I, you know, I'm sure it's a priority and I'm sure that you guys are keeping an eye on that.

So let's, let's jump over that and just go to IT. Governance. Why is that listed? I mean, is that a technology project or what is, what is that? Yeah, so similar around that. IT service management framework, right? We right now, there's seven ways into it. So how do you get a request in? How do you get a new initiative?

We've now narrowed that down to two, by the way, but when, at the time of that writing, so what we're doing is, one, asking mature partners from a consultancy perspective, even a tool, and they exist. On intake, right? How do we get things in? How is that governed? How do we report out? Uh, and we've adopted, and I don't call it it here, but we've adopted an agile methodology with a product team, structure with product owners and something we, it's a governance council, we call digital enablement committee, but it's truly IT governance.

We're not, I don't use the G word much 'cause we're governed by our board, but everyone hates governance. And then we don't call it boards. Boards for the same reason. So it. So we had a great partner help us set that up. We're starting to look for tools and process and maybe even some service provider to help manage that with us.

Yeah. You have digital enablement as the next one. What, what exactly is that? Yeah. Is that, is that enabling the underlying infrastructure to accept digital tools and that kind of stuff? Or what is that? So, I shared earlier, we health system, we, we sold off. 20 ish percent of our company to Advent Health. So our partners to, and a big partnership.

It's been great. We've done a lot of things with them, but we did it for one reason. It gave us $800 million in what we call pivot capital to really enable consumerism to our CEO calls it the digital pivot. I call it digital enablement. So that's what that is. So we've. The announcement with Oscar is, is a proof and parcel of what that looks like on how we're gonna, you know, gain speed to market on digital tools.

Uh, a year and a half ago we made a partnership with a company called Privia Health who does a similar thing for the ambulatory space. We're looking at the moment for things to stitch that together and moreover. And the HR vendors won't like the following words, but how do we do that in the ambulatory, in the acute space, rather on, you know, stop being beholden to the Cerner's epic, Allscripts, you know, of the world because it's our biggest spend.

Right. I, I'd be hard pressed to, to know any CIO who doesn't spend, you know, eight plus figures. On, on their EHR provider and, and for what, you know, in my opinion, a marginal value. But not to disparage those folks, some of which may be a sponsor of your show bill, but, but that's what it's, right. And so for us it's enabling that digital component, putting healthcare tools in the hand of folks in the way they consume it.

And frankly, you know, once we know you, we always know you is something our CEO. So how do I take that across platform? And you may be getting to it, but we're doing a thing. On that list because I don't have a list committed to memory, but we're doing something very unique here called Our Health Villages, right?

And, and folks are doing 'em around. Here's our version and I think it's the best version naturally, but so imagine if you will, everybody drives by a, a shuttered up mall these days, right? These concrete wastelands. We're taking a couple of those, turning them back into park-like settings. Ours are, happen to be connected, one to the beach and a boardwalk, another to a bird rookery, another to kind of a, a natural reservoir near the St.

John's and turning those into health villages. So imagine if you will. A central location. I've lived in Europe a while. I call it the city center. It looks more like a park than anything. And your medical office building is there naturally fit into the environment, A whole foods or type brochure. Is there a tropical smoothie, a spin cycle, or an orange theory?

Integrating that into truly a wellness business. We envisioned by our studies, 90% of the people who visit there have nothing to do. Right to somewhere in a social setting. Pivot is where I need digital enablement. I am now going to be charged with somehow integrating a health system into a hotel chain who's also a short stay hospital, a whole foods right?

And imagine the power of that. Right? You know, I just sit down with my dietician. And I joke, a robot will then walk me out down the aisles of Whole Foods and tell me what to buy. But moreover, maybe an app, right? Or maybe the dietician herself, him or herself, walks out with you. But those integrations, right, and we all do it for other things.

You've heard this in in other settings where, hey, if you're delayed, I. We know you're coming because you have our app and we see driving, we tell you where to park, and oh, by the way, the doctor's delayed, so go to Tropical Smoothie and get a smoothie on us. Like that's, those are table stakes at this point.

Right? I think folks are starting to figure out that consumerism element I want, we wanna take it to that next step, and that's why the data component is so important as well. Yeah. Gosh, we're coming. We're coming up on the end and I can talk to you for another two hours, but it automation, RPA is, is that something that's on your radar?

Yeah, we're all in. And this is a, a coin or term I coined in in the DOD, which sounds harsh, but we'll paint the picture once I say it. We're capturing every bit of low value work we can right. So, you know, we're spinning up robots left and right to do the simple stuff right now with claims and other things.

We're taking in a finance patient reg, a lot of places where there's genuinely low value work and there's a whole nuance on how you get folks to adopt that. And we figured it out here. Um, one, it's not calling it low value work, but , but, uh, but folks get it, you know? And. They're always afraid. Many of them are afraid, like if you remember the dictation folks or the transcription folks of the past, right?

With those technologies is, Hey, you're ignoring stuff every day. We need you to do the high value work. And, and we're doing a lot of it and we love it. I've got a couple providers, there are great partners, but the the ones you know, look in the, look in the upper right hand corner, Gartner, so the Magic quadrant, and you'll know who, who we're working with there.

So, so App Rat has been, uh, pretty key since you've gotten there. Has that been a focus? And you just gonna keep your foot on that gas pedal? I mean, no one hires a new CIO and says. Here's all the money you need to transform and here's all the time to do it. So I think how I've been so successful is I started with a financial background and contracting flavor.

I can look through contracts, I can cut fat, I can do , and that gives, and all I say when I get here is just let me keep my savings right. You know, all the performance improvements we have, that is my innovation budget. That is my transformation budget. So in essence, let me run AP and l and not have to give back every time we save something to the greater number.

And that's how we innovate. So that's how I've done it everywhere I've been. You, I won't say cut the fat, but you, you eliminate d. Duplicative, and then you guess what? You saved 20 million bucks. Who wouldn't want that? Right? To, to innovate, to update, to adjust. So, so that's why it's always been a priority for me and how I, how I've always, I think, been successful in, in some of these emerging, that's an exceptional approach.

By the way. Just, just let me keep my savings and. And we'll be able to, we'll be able to create a digital budget and a transformation budget and those kind things. That's, that's, that's really interesting. And any regulatory priorities that you're tracking right now? Yeah, all of 'em. Right. Uh, this for us Florida House Bill, and I forget the number that's now CMS requirement.

In order for you to do a virtual visit at the bedside and to the acute and ambulatory and build that gap there, we've got a couple technologies. We're bridging that. All the information blocking, information sharing things, you know, we've, we've all vacillated on the, on the regional sharing. We do that well with some partners and poorly with others.

So, so absolutely all of them. We've got a compliance team who tracks us through those. The biggest one for me on, on the interoperability side and selfishly I know Blue Button's coming and having lived in the blue button world, you know, and the D-O-D-V-A information sharing, that's the one I focus on.

'cause I know we can do it pretty, I won't say easily, but DOD and BA can figure it out. We can figure it out Health first, so. Yep. Uh, price transparency, anything going on there? Or are you guys Yeah, we have, we have it. Um, we're banking it better. So again, we have many different service lines. Um, we've captured most of those things.

We meet the need with partners on the urgent care and ambulatory side. I wanna take that to this higher level. Kinda like billing is starting to do right now. We get 20 bills right now. You get 20 ways to get price transparency. If you want to go to the surgery center, you get it there. If you wanna know your urgent care, you have to go there, right?

So taking it one level higher, integrating all our price transparency tools. So, you know what's interesting? Gosh, it was, it was the Wall Street Journal article said, you know, they're doing it for you, right? So I, and I went out and looked at this Turk. Turquoise Health has gone and scoured everybody's website because you're required to put 300 shoppable services out there.

They pulled all this stuff in, so I just went in and did tonsil removal in my zip code. The prices range from $259 to 49,006 for tons removal. I, you gotta be kidding. And by the way, the 49,000 is an outlier for sure, but there's, there is 19,000. 20,000. Yeah, it's, or someone's founding, you know, worst case you, you have to get in the hospital 'cause you did it at an ambulatory surgery center and you get an ambulance rather, and they rush you somewhere and you have some er visit.

But yeah, that is high. Obviously an outlier, but Right. That's, that's the problem, bill is this, uh, rationalization of these, of these stories. Right. Dartmouth Atlas tried to figure this out a. You know, and that was my go-to for a while, and I always loved the story. If you were in your part of the word Bill, it was, you know, three grand a year for a capitated patient.

If you're in Rochester, Minnesota getting care at the place based in Rochester, Minnesota, it was a third of it. Right. And it's just, it's crazy. But healthcare is from a pricing and transparency perspective. But, all right. Well, I, I'm gonna close this out with more of a, a philosophical question.

What do you think the lasting impact on health it is gonna be as a result of. Oh, it's gonna be, I mean largely that how much of a partner they are not an inhibitance. I, I love saying this expression that it has done for you, not to you from that, but genuinely that it is a partner and they are there to help.

You know, what it was able to do in scaling ICUs and building applications. I mean most recently with a vaccine and being able to quickly turn that in registration. So genuinely as it is a partner, I think a lot of people shook their fist at it and said, oh, you know, it's horrible. Or it's a black hole and they never get what I need.

Uh, for those. Good CIOs overcome that. And you know, your goal is to shake that well before pandemic. But for those who maybe still had that perception, I think they quickly saw, uh, what a great partner it is and, and to involve them in, in some of those things we were talking about earlier. There's more strategic decisions.

These are bright folks with operations mindset or certainly can think outside of the walls of it. So. Well, William, we still have like an another hour of our show, but, but we only have like 30 seconds, so I, I just wanna thank you for your time. This was incredibly insightful. We'll have, do this again in the, in the fall.

Do we have, fall in. Yeah, I think, you know, the leaves fall a little differently and you know, like sometimes you run your heat like one or two days in the fall, but otherwise I don't, I dunno, growing up here and the, the only thing that took me away from Florida was the Navy and there's a reason I came back and so, no, I don't know that we do.

But yeah, part two in the fall. Happy to chat. Yeah, absolutely. Hey, thanks again for your time. Appreciate it. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions. Please forward them a note, perhaps your team, your staff. I know if I were ACIO today, I would have every one of my team members listening to this show.

It's it's conference level value every week. They can subscribe on our website this week,, or they can go wherever you listen to podcasts. Apple, Google, overcast, which is what I use, uh, Spotify, Stitcher, you name it. We're out there. They can find us. Go ahead, subscribe today, send a note to someone and have them subscribe as well.

We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders. Those are VMware, Hillrom, Starbridge advisors, Aruba and McAfee. Thanks for listening. That's all for now.


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