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June 3, 2022: Today Bill and B.J Moore, Executive VP & CIO at Providence discuss the EHR, ERP solutions, digital imaging, tech debt, the hybrid work model and more. The technology infrastructure in healthcare is still 15 to 20 years behind other sectors. B.J brings his previous Microsoft experience to the table. How can we avoid tech debt? What keeps us from moving forward? What kind of architecture and strategies can we aspot? What advances have been made with imaging? Does dual factor authentication ruin clinician satisfaction? And how do you pull off consolidating to a single instance of Epic, in an extremely complicated health system?

Key Points:

  • The 3 strategic pillars: simplify, modernize and innovate
  • A lot of the advancements around AI and machine learning are coming from imaging
  • There’s so many analytics capabilities you can get through Azure, that the traditional health system who hasn't adopted cloud isn't experiencing yet
  • Providence

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

Today on This Week Health.

Any company, whether you're Microsoft or Providence IT is a lifetime journey. I think what's unique about the transformation I did at Microsoft was the cloud itself as a brand new industry trend and nobody was on the cloud 15 years ago. So every company will have to go through that transition.

Thanks for joining us on This Week Health Keynote. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health πŸ“ leaders.

Today we are joined by BJ Moore CIO, EVP of real estate operations for Providence. BK welcome to the show.

Thanks bill. Fantastic to be here.

I'm not sure all those things were set in the right order, but I know that CIO real estate operations. I know you're an EVP, so I don't know what over they go in.

It sounded good to me though. So I know it's a long title. It's a kind of word salad.

Yeah. Well, we, we talked like in the first month of you joining Providence and you came from Microsoft. And you were one of that, that group and people go in two directions here. They either go, Hey, you know what, we're going to bring somebody in from the outside, bring new ideas in from the outside.

Or they say, we're going to take a physician and move them into the role because they understand that. Healthcare. I'm not saying which one's right or wrong. We have great people in both camps. We might come back to that later, but I have to start with the standard opening question, which is tell us about Providence.

One of the largest us health Catholic health systems in the United States. Mostly here on the west coast, we've got 52 hospitals thousand clinics. We're in Alaska, Montana, Washington, Oregon, California, New Mexico, and Texas. We were at the epicenter of the pandemic. We actually received the first patient into our Everett hospital, January of 2020. So the pandemic, unfortunately it was front and center for us. And overall I felt like we served our communities well, too, through the pandemic.

how many hospitals is it? Is it 60 or so? 52 hospitals, 52 hospitals. Have you visited all the hospitals? That's gotta be difficult.

I've probably visited 10 to 15. COVID kind of put a stop to a lot of that travel. That's an executive. Especially a CIO that shows up to a hospital during a pandemic, not the most popular person in that respect, respects those folks and keep out of the hospitals during that critical time. But yeah, I've gotten out to see a diverse set and I've seen a hospital. And every one of our states, all seven states.

The interesting thing when people think about Providence, they think big health system, but the reality is you cover rural and you cover urban. Obviously you're in Alaska. You're a lot of parts of Oregon you're in west Texas. You're. I mean, you're hearing a lot of a lot of different types of markets, I want to come back to when we first met, you were coming in from Microsoft, you had modernized that environment of Microsoft. Again, people would try, probably find that funny to hear that you had to modernize that environment at Microsoft, but even tech giants end up with a lot of tech debt and a lot of misallocated investments over time and it requires an architecture and a strategy to bring it forward. You were brought in one of the things you were brought in to do was to modernize healthcare, to modernize Providence. Talk to us a little bit about that that modernization.

Yeah. So any company, whether you're Microsoft or Providence it is a lifetime journey. I think what's unique about the transformation I did at Microsoft was the cloud itself as a brand new industry trend and nobody was on the cloud 15 years ago. So every company will have to go through that, that transition. So yeah, had completed that journey successfully at Microsoft joined Providence three years ago.

And that first interview I had that stark realization. I think it was where the first quote came out, that we were about 15 or 20 years behind that observation was that provenance. But as I've met with other CEOs it's really a healthcare issue. So three years ago we embarked on a journey to modernized.

We had three strategic pillars around simplify, modernize and innovate. We've really focused on those first two pillars simplify. We had 4,000 applications in our ecosystem. You just can't. The modern and agile and, and create great caregiver and patient experiences with 4,000 applications. So we've massively reduced those.

The modernized was about moving to the cloud and then innovate things like big data and machine learning and artificial intelligence. And we've dabbled there. Bet that you have to do this simplify modernize. What I'm really proud of is the progress we've made. So we went from four or five different versions of epic.

We were on Meditech and Allscripts. When I joined three years ago, happy to say, as of March, we've got our entire health system now on epic, a single instance of epic. So we consolidated the existing epic instances and then got everybody off Allscripts, Meditech. So single instance of epic moved everybody to office 365 and teams.

That proved to be invaluable. As we started working remote during the pandemic the infrastructure basic networking wireless in our ministries, hospitals clinics, weren't weren't up to date. So we've been on a modernization journey there. In July, we're going to move from 10 to 12 different HR and ERP systems.

We're going to move to Oracle cloud. So we'll not only be on a single system, but we'll be on a modern cloud solution. That would be the foundation for us. So I think if I were to summarize it, bill, and we went from being 15 to 20 years behind to December of this year basically a three and a half year journey, we will.

I think beyond par frankly ahead of most fortune 100 companies, most fortunate 100 companies, can't say they're on a modern cloud ERP. And the core systems that we find ourself sense, a really proud of the journey that we've been on. And then remember two of those three years were during a pandemic. So to do that level of modernization in the middle of a pandemic, it just couldn't be more proud of.

So simplify, modernize, innovate. I'll tell you this, the thing, what you said there, which is most impressive to me, not that you're looking for my award, but the getting onto a single instance of epic, knowing what I know of Providence and St Joe's and some of the other acquisitions prior to coming together with St.

Joe's that's not, not just the technical. That is a significant organizational transformation that has to occur to get on a single instance of epic. So, I mean, kudos to the team for getting that done.

I'm glad that you went there, bill. I mean, that allows us to go from really 52 individual hospitals that have their own processes and ways of running things to really allowing us to actually execute as a single health system.

Right. And you can only do that on a single. EHR single set of business processes, and that we'll be able to optimize that, right? You can't optimize 52 experiences for caregivers and patients. And now we've got a single platform to, to innovate and standardize from.

Yeah. and also to build off your data practices, you talked about innovate and starting to utilize those tools, the, AI machine learning and other things.

But the reality is if you have all those different instances of the EHR, the data qualities can be different. The interfaces to bring. Data across some of it's going to be discrete data. Some of it's going to be, it depends on the EHR, how it was when it was.

even our five instances of epic each implementation was so different. The data appear to be different. So even trying to do analytics on our epic instances was challenging. So yeah, there's been huge benefits getting the single incident.

can't even imagine to be honest with you, I mean, having done a, an EHR integration of 16 hospitals onto we ended up with three instances.

We couldn't even get onto one instance because each region was. Saying, Hey, we practice medicine different and, and yours is a good case because you have rural and you have urban and you have academic as well. So you have, you have a significant mix of types of organizations that I would imagine that project took a lot of lot, a lot of collaboration with the physicians, bringing them together. I'm not even sure how you did that during the pandemic, to be honest with you.

Yeah. I sometimes, yeah, something like that brings focus to the organization. And I, I don't want to say the pandemic was a good thing, but it, they create a sense of urgency and clarity that maybe we wouldn't have had otherwise. So yeah, that, that helped

what keeps healthcare from moving forward. This is more of a generic question. What keeps healthcare from moving forward? I mean, I saw a quote from you. Where you were talking about singles. No, a dual factor authentication. That's what it was. And you're saying, Hey we do this in every other industry, but the minute you bring it forward in healthcare, everyone looks at you like, oh, don't do that.

That's going to ruin clinician satisfaction, those kinds of things. And we've all heard it. What keeps us from moving forward. What keeps us from accepting the amount of tech debt that we all accept.

Off the top of my head. I can think of three things. One it's technical. As much as we've modernized, we still have 25, 30 year old technology that's in our, our ministries and hospitals and trying to modernize when you've got that level of technical debt is, is difficult.

Healthcare complexity itself. Is this off the charts you think about something like a hospital bill? And I use the analogy. I just spoke at a, at a conference in Austin and I use the analogy of a hotel bill. Right? If hospitals were running hotels, when you checked into your hotel, it would be, well, can't tell you how much a room is going to cost us anywhere between 50 and $5,000.

Depends on how many beds you use, how many towels you use. We'll bill you at the end and you would get this 10 page bill. All right, bill, used three bath towels. He used two wash cloths used the shampoo, but you didn't use the conditioner and your bill is $580. That's what we do in healthcare.

So the level of complexity keeps us from modernizing and then doctors and nurses clinic clinics, hospitals all worked independently. And so there was independent variation does by design worked in the system. So now that you're trying to do things at scale, so you take the complexity and then you take kind of a localization that happened.

I would say it's those three things that really create the barrier. So Kind of modernizing and simplifying healthcare.

πŸ“ πŸ“ All right. We'll get back to our show in just a minute. I want to tell you about the podcasts that I am the most excited about right now that I am listening to, as often as I possibly can under that is the town hall show that we launched on the community channel this week health community, and an Arizona Tuesdays and Thursdays. What I've done is I have essentially recruited these great. Hosts who are coming in and they're tapping people in their networks and having conversations with them about the things that are frontline kind of stuff. So it's, it's technical, deep dives, it's hot button issues. It's tactical challenges. it's all the stuff that is happening right there. Where you live on a daily basis. We have some braid hosts on this show. We have Charles Boise. Who's a, data scientist, Craig Richard, bill Lee, Milligan Reed, Stephan, who are all CEOs. We have Jake Lancaster Brett Oliver, who are CMIOs. We have mark Weisman who is a former CMIO and host of the CML podcast. And now a CIO. At title health and we also have the incomparable sushi shade who is fantastic. And I'm really excited about the fact that she's tapping into her network and having some great conversations as well. I'd love for you to tune into these episodes. I am learning a ton myself. You can subscribe on our community channel this week health community. You can do that on iTunes, on Spotify. On Google on Stitcher, you name it, we're out there and you can subscribe there and start having a listen to yourself. All right, let's get back to our show. πŸ“ πŸ“

So we talked about the HR and here at P T talk to me about imaging. Did you make strides on the imaging?

Yeah, so where we are. So we have about 300 different discrete storage's of images in our health system.

All locked up in proprietary systems. We're in the process of standardizing that, moving to that cloud and then using a vendor agnostic reader integrated in epic. So basically we go from 300 independent pieces of storage to cloud storage, where we're able to manage that more effectively, more cost-effectively.

But even better now that our, all of our images in one place, it's more seamless for our clinicians to get access to it. And because it's through a vendor neutral reader, you're not having to learn different readers and look at images in different ways. And then I talked about the simplify and modernize.

Those are two examples of those pillars, but once we have all of our images on the cloud, then we could start unleashing artificial intelligence against that one. You need all your images in one place. You need them all standardized and all the PII or. The only place you can do artificial intelligence is in the cloud.

Right. That's the only place you've got that compute power. So, yeah. Thanks for asking the question. Really, really proud of what we're doing there, and they get seven or eight petabytes of, of images we're moving to the cloud and yeah, that's both cost efficient as well as better clinical care.

Interesting because we're seeing so many advancements in AI and machine learning, but a lot of them are coming around images because it's it's quality data. Right? it's an image, right? It is what it is, whatever the picture tech

and the delts has that you can do. Right. I mean, a computer can look at all right. Bill has got an image every year for seven years. Right. A machine can go through and look at the changes in those images down to Millimeters that a human eye could never do. And so it's a perfect example of something that a computer could do better than a human. I can do that as a replace clinicians. Absolutely not. But does it aid them with tools? Absolutely.

are there different strategies that you so with, with epic, you, you were like, Hey, we're getting on a one instance. I know it's imaging. I mean, you have, lab cardiology, you have radiology, you have all these different kinds of systems.

It's almost impossible to get on a single system across the board. Not that you can't use. It sounds to me, it sounds to me like, you're just saying, all right, in some cases we're going to leave those out there, but we are going to bring all the images in as that was that.

Yeah. I mean, there's multiple ways to standardize we could standardize on a single imaging vendor and standardize that way. It would be hundreds of millions of dollars to replace all those devices, if not a billion dollars to replace those devices. So yeah, we looked at it a different way and said, okay, can we standardize the images themselves and, and store them and in a vendor neutral way. And that was the approach.

So we'll, we'll end up with standardization, but without replacing the machines or devices that sit in the clinics and hospitals

talk about the analytics capabilities that. You get through Azure that maybe the traditional health system that hasn't adopted cloud isn't experiencing yet.

Yeah. So I'll date myself. I'm a SQL guy. My brain seems to work like a relational database. And so I've been working with data and relational databases for 30 plus years. But that data being on premise as powerful as relational databases like SQL are like you're limited on the scale and performance. So you end up spreading that data across multiple systems.

You have multiple sources of truth. The huge advantages we've had moving into the cloud is now we can have a single instance single truth scales, no longer an issue. When you're on premise on a SQL database a a hundred gigabyte databases big, well you can have exabytes of data and you don't have scale issues.

So you have a single source of truth. And as I mentioned earlier on images, the same thing with, with data, all the advanced machine learning and artificial intelligence, all those capabilities only exist in the cloud. And so if you're going to take your data if you're doing the reporting reporting is more powerful because you're not limited by the data sets or the performance of those data sets.

If you want to do machine learning and artificial intelligence. The only effective place to do that as in the clouds. So, yeah, we've moved away. We had hada, we had SQL databases, Oracle databases expel, Excel, spreadsheets, access databases. We moved all of that to a single data source in the cloud in this case, Azure data lake.

So we got rid of all the on-premise stuff, single source of truth. And now we have better performance. I mean, it's such a no brainer to move to the cloud. No, but it's a lifetime gift that me as a SQL when I used to write SQL databases, This is the gift I've been waiting for for decades.

I'm sorry. We're still tooling around and finding access databases.

Oh yeah.

Actually we crash access a lot, but access was so powerful in, in, in, in the respect that it put power in the hands almost of the user themselves so that they could create some really sophisticated stuff. Now, if we could do that, With the security models and the scalability of things, that'd be great.

The end user actually feeling like they could build applications for their department or whatever. Yep. Talk to me about, so w one last tech that, so what's the most stubborn tech debt to rid yourself of at Providence.

God, that's a long list. My team has coined a new term. It's called it archeology every day that come to me with some artifact fax machines is unfortunately an artifact because they're still business processes that are aligned to that.

Our PBX is in the hospitals 20, 30, 40 years old, the vendors have gone out of business are replacing the PBX infrastructure in hospitals is, is tough. Nurse call, oh my gosh, the poor caregivers at the bedside and the number of devices they need to carry. That's tough to kind of modernize that and move that forward.

So there's a long, long list there. I also own real estate as he called out in my. The word solid of a, of a title, right? We've got boilers that are 80 years old. There's the one day I should come up with a list below of kind of what's the, all this technology must difficult to get out. It's hard to, what

are you telling me? There's boilers that the original sisters actually installed in the hospitals that are still

absolutely. Absolutely. And those boilers are still working for us.

I still tell those stories. It's it's when people ask me about. I always go back to working in Catholic health care. And I say nobody does it better than Catholic health care. They tell the stories of the sisters coming to the Western lands. I mean, these are women traveling into rugged country,

Wagon trains.

And wagon. Very little money in their pockets saying, how can we serve you? And if they said build a school, they built a school. If they said, build a hospital, they built a hospital. And today people are like, oh, Catholic health care, look how big it is and mammoth and stuff. That's not how it started. And, and the other thing about it is they tell those stories so well that it, it, it permeates the culture.

If you don't, you don't have to be there long before. You're like, Hey, I'm proud of. Part of a, a women founded organization that has lasted this long, that has had this much success in this much impact on the community.

And it's big, but it's big because I mean, in our case, it's 170 years of investment, right? How many other industries have 170 years of capital investment to build up? What's kind of the foundation of, of their ministries, which is the case for Providence. And I assume other Catholic health systems.

But that's why we're talking about tech debt. It's 170 years old vicious and

the gift and yeah. And some kinds of punishment.

It is your team back in the office yet, or have you adopted a new work model?

Yeah, so we opened up a couple of weeks ago we opened up a couple of times, but we believe we've opened back up permanently a couple of weeks ago. Yeah, we fully embraced the hybrid work model.

it's been good for us, right? I would say before the pandemic Providence was a hundred percent come to work. Absolutely. Zero remote work. Didn't have that muscle belt whatsoever. Two years of the pandemic. We probably overbuilt the muscle of working remote and working over teams and other collaborative platforms.

And now that things are opened back up. Yeah. We're getting back to that collaborative hybrid work environment. We'll never go back to the way it was before. But we also won't be a hundred percent virtual, I think the sweet spot somewhere in between.

So office teams and whatnot, is that your primary platform for making that all work? Do you have different project management platforms and that kind of stuff that all went digital?

We really went for a standardization. And so for us standardization on the productivity tools is Microsoft. We didn't go at best Sabrina approach. We're not going to differentiate ourselves from other health systems based upon the best of breed of a project management software.

And so we've decided just to standardize on, on Microsoft and, and get the performance and scale of a single vendor strategy versus five or six different vendors.

Back when I was doing work for GE capital back when they existed. But back when I was doing work for them, I remember talking to. Somebody who's saying, Hey, why don't you have a project management tool? Because they were doing everything on Excel spreadsheets. And back then we sort of looked at that and said, I can't believe you're doing everything on Excel spreadsheets. He said Hey bill, if I gave you an Excel spreadsheet with the project management, the tasks and all that stuff on it, would you be able to change the cell?

Would I have to train you on how to change a song? I'm like, no, but I have to train you on it. And he just went through all this. I'm like, no, you won't have to train me on any of that stuff. There's your answer. That's why we use a tool that everyone knows how to use. It can get the job done. It may not be as fancy as all these new things, but it works pretty effectively.

Yeah. And if that was our core competency, right? Our core competency should be delivering care and taking care of our communities and patients. That's where we're going to differentiate ourselves. We're not going to differentiate ourselves with project management software and so good. It's good enough. And obviously Microsoft's fantastic platform.

You now oversee a multi-country set of it. People from time to time, I see your, your team, which is pretty proud that team in India is pretty proud of the work that they're doing and stuff about. See some posts how much of your it staff now resides in.

So we've got 550 people in India. They're Providence employees. As you rightly stated that's now an international company. So we set that up. That was Providence first international company. It wasn't an outsource strategy. It's really been building a muscle that we didn't already have. When I arrived at Providence. And so we've hired engineers there network engineering security engineers. So it's there's been some attrition in the us, but it's mostly been growth in India has, like I said, it hasn't been an outsource strategy.

the interesting thing about that is we always struggled with. It's 7 24, 365. Exactly. Right. And, and, and you're saying, okay, do that all with people that reside in Renton, Washington. Well, you can't, you really can't

one of the most expensive labor markets in the world where tech talent is really scarce and yeah. Now you want somebody to work the swing shift. Yeah. No, it's it. Wasn't a convenient strategy.

How was it managing that staff? I mean, you had, you had a pandemic going on. I'm trying to, the timelines are a little vague to me of when it was hitting India and when it was hitting the us I, it feels to me like we were, it was hitting the U S first and then it really got exacerbated in India. were you able to sort of balance the workload with. With staff being impacted in both of those markets at different times?

Well, the good news is that your, your timelines are basically right at the U S first India. Laughs. And it wasn't really until the second wave. I think it was Delta that really hit India hard, but the good news is both the U S workforce as well as the Indian workforce were just as effective remote as they were in office.

And so there really wasn't a from a COVID perspective, there wasn't a hit of productivity and either reading. But I am proud that when, when COVID hit, I think we had five employees in India and the fact we're able to add 545 additional employees during a pandemic. I'm super proud of what the team was able to do that.

Switched to the business here a little bit. So there's some headwinds while there's headwinds in the economy. There's headwinds in healthcare as well. The we have staffing challenges, specifically clinical staffing challenges that are going on right now. And it, it appears those are going to be sustained for some time because we can't just print new nurses. how canIT best support the clinicians or potentially the lack of clinicians in that.


I think IT's probably the best asset to help that. So let's just keep the model simple. Let's say we're either growing or shrinking that workforce. Let's say we're just very able to keep it static. But the community needs of delivering more healthcare growing. So where tech really plays into that as what do we do to make our caregivers, our nurses, our doctors, more, more productive. Unfortunately, our estimates are about 40 to 60% of what our doctors and nurses do is administrative work. And I can't imagine they went to nursing or med school, but to do 60% of their the paperwork. And so we can automate that away. Right? It can be things like the partnership with nuance and the ambient listening devices. So they don't have to type into the HR and just listen and annotate the notes for them. It's just reducing administrative burden, simplifying their work processes.

There's a lot we can do, and frankly, it can only be done with technology. And I think it can be a win-win so you can take somebody that's maybe. Let's say a nurse that's 50% delivering care and 50% doing paperwork. If we can reduce that paperwork burden, then that immediately goes towards helping with product patient care.

So if you go from 50% to 40%, you just increase, improve their productivity by 20%. Could you go out and hire 20% more nurses? No, but could you make a nurse 20% more productive? Absolutely. By reducing the administrative burden, but what's great for this caregiver. I guess that nobody comes to work excited to do paperwork.

So you're actually allowing them to focus on what they enjoy that actually has impact to our patients, communities. You need to take away things that contribute to burnout, which is administrative paperwork and burden. So yeah, I think playing the biggest role

that, that simplification, I would think would allow you to, to go from pilot to to scale pretty quick. The it's interesting. You signed the sign, the deal with Microsoft early on. The nuance thing came later, did that just fold in nicely or do you have a nuance agreement and a Microsoft agreement?

Well, because yeah, we signed the nuance agreement before they were acquired by Microsoft.

It's separate, but I'm happy to say nuance was a great partner before they continued to be a great partner under the, under the Microsoft umbrella. One thing I want to bring up bill, if you don't mind, cause you brought it up a couple of times, when I say simplify, modernize and innovate. Really should think of that as almost like Maslow's hierarchy of needs. Right? The simplify is the eating, breathing, sleeping, the modernizes, like sending the kids to school and the innovative self-actualization right. You can't do that innovate. You can't self-actualize as a person, if you don't have housing or food or, or safety. And so. It's kind of come up. I want to make it explicit.

And you just brought it up again. If you don't simplify your environment, you can't be agile. If you can't be agile, you can't be modern. If you can't be modern, you can't do these innovative things. So it's really a a process you have to go through to really achieve the best results for your health.

And I don't, I don't generally talk about security because you're not allowed to talk about security anyway. It's what they coach CIO is when we get into the role, it's like, don't, don't, don't throw down the gauntlet because they will

come after you wherever we become superstitious. Right. As soon as we say, we've improved security than the hackers tickets,

but the, the simplify is also a big part of that, right? I mean, 4,000 applications, your attack surfaces is so good. Very challenging.

And those 4,000 aren't modern. Right? You have 4,000 because some of those are 20, 30 years old. So there was a cybersecurity with a lot of these apps for bell. Yeah. You hit it spot on.

Well, I was talking to somebody the other day who reminded me that Ady is 22 years. Active directory is 22 years old, which is to the developers that put that together. That's an amazing technology that last for 22 years on the flip side, it's 22 years old. I mean, it's kind of

well, as you said it though, I'm thinking, well, I've got apps that are older than 22. What did they do for identity? How do I secure those? Like 80 may have issues, but mention pre.

One security question I think I will ask is about cyber cyber liability insurance. Yeah. You may or may not like this, but you've become sort of a statesman for health it CIO, because you you run one of the largest ones out there.

A lot of, a lot of CEOs are struggling with this. I mean, the, the costs have gone up pretty significantly to the point where they're looking at it going. I, I'm not sure we. There's no sustainable way to keep paying for that cyber liability. Are you, are you sort of looking at the same thing that the liability insurance is getting harder to? I'm not going to say harder to justify that's the wrong words, but just harder to, to swallow each time you get.

Definitely harder to swallow. And hopefully no insurance companies watch your podcast here at bill, but I'll, I'll say it actually creates healthy tension. Right? It's it's one more reminder on my obviously, never want to get attacked.

You never wanna be ransom. The one other incentive is how do you manage your, your premiums, right? And so you look at your investments and say, Hey, if we get attacked, if we have to file an insurance claim or insurance is going to go up. So now we're even more inside. It's not like we needed more incentive, but we more incentive is good.

So it incentivizes us to do the right thing and make sure our health system is secure. So to me, raising premiums are a reflection of cyberspace. Cyber attacks are becoming more common, but it's also a reflection of the risk of your organization. So if your premiums are going out of control, maybe as a CIO, you need to look in the mirror and go, boy, have I been doing enough to mitigate or manage this risk?

I'm perceived as a high risk. Not only because the industry I'm in, but I'm perceived as a high risk it's maybe we haven't invested in cyber, like we should. So we, we use it as, as a balance point to make sure cyber is always at the forefront.

I remember when I first went in, as CIO went to the board and, and I think we, we went from three to 8 million the first year and in our investment in security, and they're just like, They're like, what is that all you need? I'm like, oh no, that's the start. I don't know all I need yet.

That's just as fast as I can go. Any more money? I can spend a responsibility.

Yeah, this is the down payment and it's just pretty interesting. So you talk about these three pillars to these three pillars. Are you, are you changing your strategy at all? Are you adding pillars? Are you taking will there be modification to this or will this be sort of the foundation for, for awhile yet?

I not only find it enduring. So we came up with those strategic pillars. About two and a half, three years ago. Not only they remain static, but the other businesses at Providence have adopted them.

Right. You can take that and apply it to our insurance business. You can apply it to running a hospital. Like these are really enduring strategic pillars. So if you're a chief executive running a hospital, What are you doing to simplify our processes or simplify your operations? What are you doing to modernize, right.

And that really sets you up for innovate. So it's not only enduring for IIS. I'm finding my peers. Using it as well. And I've been at some industry events. I don't think these individuals know I'm the one who created that, but I've been at industry events where I've heard other speakers start using these three pillars because they've adopted them for themselves.

And I'm like, well, that's pretty flattering. It's becoming pretty ubiquitous in that.

real estate operations, I'm going to go, I'm going to go here and it's not surprising. I mean, CEOs negotiate so many contracts and in very complex contracts, they're used to working with legal. They're used to working 10, 15, 20, 30 year projects.

So it's not, it's not unheard of. And so getting that role makes sense, but I want to talk about real estate specifically. So we hear a lot about hospital at home. We hear a lot about digital health It's how we look at real estate changing at all in health.

Yeah. And that's why we moved it over. Not because it is credit management contracts, I'd say it is not going to managing contracts.

That's pretty hard. So I think we manage a lot of contracts.

We do, but maybe that's a problem. Maybe, maybe we shouldn't be managing many contracts. But yeah. My CEO, rod Hochman moved that responsibility over to me for, for three reasons. One, we kind of talked about it modern.

Workplaces are now going to be hybrid, right? It's not, you've got your office. And people are going to come to work every day. It's now this hybrid work environment, it's a mix of technology and real estate. So wouldn't it be smart to put that under one leader, one leader that could think about both physical and virtual spaces.

And so that's one reason we moved it over to during the pandemic we learned that hospital beds are no longer just physical assets, right? At the beginning of the pandemic, we were worried that our hospitals will be overrun. Well, the reason our hospitals didn't get overrun. And one of the big reasons that we flex with virtual care, right.

Telehealth and care at home, and we quickly realized the hospital bed instead of being a contract. Thing. It was actually an abstract thing. A hospital bag could be a better at home. It could be a bed in the hospital. And again, that's wearing two hats is wearing the physical real estate hat and it's wearing an it hat.

And so that's why it's the center me. And then the third is we have a big, bold goal of being carbon negative by 2030. And unfortunately the two biggest carbon offenders in any company are it and real estate. And I radically the two can help each other. Right. Technology can be applied in a real estate environment to capture carbon costs.

And if we more effectively use get out of data centers and move to the cloud, we can use our real estate more effectively. And so. Again, another good reason to combine those two functions under one leader. And so it was really those three reasons we moved to undermine.

Yeah. And I'm going to come back to the question, but how much more efficient are the Microsoft data centers or the, the colo data centers that you're using versus the data centers that you inherited?

I can't put a number on the otherness say Efficiently run a data center is not good. Right? We put our data centers in hospitals. It's probably the most. In the United States, it's the last place you'd want to put a data center and then Microsoft and other tech companies also have these carbon neutral or carbon negative goals as well.

And so Microsoft not only can run their data centers more efficiently, but they're removed moving to full renewables. So I'm able to get out of my data centers, I'm able to free up space in my hospitals that can be used for clinical care. And then I moved. My servers to a data center that now is running a hundred percent renewables.

It's a win-win right. So it's more efficient. It's more cost-effective. And then I free up my precious space in the hospital, but the analogy I use is when you go into an apple store, you don't see that. Trying to process payroll in the back of an apple store, right? Apple stores are a hundred percent retail because it's a really expensive footprint where we take a hospital that's billions of dollars to build super expensive.

And then we immediately put a data center in it. Like it's just silly. And so yeah, it's a, win-win on so many fronts.

So yeah. Getting back to the original question on real estate, the. strategic, everything I'm reading strategically says more care delivered at home or in, in, in places that aren't the the multi-billion dollar campuses and whatnot, is that a strategic direction that Providence is moving. And how is that? Yeah.

Yeah, absolutely. So let me give you some numbers before COVID we were doing 10 until have helped visits a day during COVID. We were doing 10,000 before COVID we weren't treating patients at home during COVID. We treated 30,000 patients at home. So it's absolutely part of our, our. Strategy I'm not going to make a bold proclamation here, but just think of a world where we have 52 hospitals and 20 years from now, we still have 52 hospitals. We don't build any new hospitals. And the only way you can do that to serve a growing community is to make. The hospital space more efficient.

So that's my data center example get non clinical things out of a hospital, free that up for clinical care, add beds. And then the other place to flex is is that remote care? So yeah, remote care is absolutely front and center for us. As far as the strategy and it's what's best for patients and communities, right?

If you had COVID, it could be taken care of effectively at home. That was a much better place to be than in a hospital setting.

Well, let me talk about communication and story. I'll probably close on this, but the a couple of times now you said let me, let me give you an analogy. So Maslow's hierarchy.

Let me give you this. This is the role of CIO. Really is one of communicating in some cases, complex concepts, making them something that people could put their arms around. How much time do you spend on the, on the story and on the on the communication, even this simplify modernize innovate is.

Yeah, it's something that heck I, I mean, you've said it to me three times and I can now probably say it for the rest of my life, because it's because it's just such a simple framework for people to get their arms around. How much time do you spend as a leader thinking, all right, how am I going to communicate this? How do I get this to stick?

I'm guessing, I'd say 15% of my time, but you really hit it on the head. Right? You've got these complex concepts. How do you deliver that to the board, executive management, your caregivers your employees stories are a great way to deliver that. These pithy steak sayings simplify, modernize, and innovate it's key, right?

My role as a CIO, unfortunately I'd left to actually do programming and real world. I don't get to do that stuff anymore. So my, my value as a CIO is to be strategic, right? Create a strategic direction, create a strategic framework, communicate these ideas, get stakeholder buy-in. And that really only can be done with this level of complexity with, with storytelling

So so that the team won't stand up a single server for you to play with, or

no. No, but I used to love those days. My gosh, I loved having a SQL server underneath my desk. I'm playing with that, but yeah, those days are behind me, unfortunately.

Oh, fantastic. BJ, always fantastic to catch up with you. And I really appreciate you sharing your experience and wisdom with the community. Thanks again for doing that.

Thank you. Appreciate it.

What a great discussion. If you know someone that might benefit from a channel like this, from these kinds of discussions, go ahead and forward them a note. I know if I were a CIO today, I would have every one of my team members listening to a show like this one. It's conference level value every week. They can subscribe on our website or wherever you listen to podcasts. Apple, Google, Overcast, everywhere. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our Keynote sponsors who are investing in our mission to develop the next generation of health leaders. Those are Sirius Healthcare. VMware, Transcarent, Press Ganey, Semperis and Veritas. Thanks for listening. That's all for now.


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