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This Week Health: Live - Engaging with Health IT: AI, Cybersecurity, and More

June 11, 2024: In the pilot episode of This Week Health: Live, hosts Bill Russell, Drex DeFord, and Sarah Richardson dive into the latest trends and challenges in health IT. They discuss the current state of AI, cybersecurity pressures on CISOs, and the impact of new technologies on healthcare. Join us for engaging discussions, insights, and a look at what’s next in health IT.

Key Points:

  • AI Revolution in Health IT
  • Cybersecurity Pressures
  • Health IT Infrastructure
  • Future Health IT Trends

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This is This Week Health Live. As we said, We're flying without a net. There's no editing or anything, so we have to be very careful. That's why we didn't invite certain people to be on the show the first time around. We have a bunch of CIOs looking over our shoulder because they want to see what it looks like to put a live show together.

Our next show isn't going to be for a month. And then we're going to start doing them every week, but we just wanted to put one out there and get some experience with it.

Sure. So, Drex DeFord, President of the Cyber and RISC Community. For the 229 project. Yeah. Hi. Former CIO for a bunch of health systems. Yep. And, Sarah Richardson, President of the Executive Development Community.


And, former CIO. Actually, you were a CIO down here. I was a CIO down here. was this your first healthcare standard?

Well, it wasn't, it was my third healthcare stint, my second CIO role.

Okay, yeah, because you were at HCA at one point.

I left HCA to come down here, and then from here I went. Back to California, which was that triple acquisition of healthcare partners to give you a medical group to opt in.

Yeah, I often joke because I lived in California because I was CIO there and now I live in Florida. It's like somebody has to do it, right?

Somebody has to live in these places with the palm trees and whatnot, so. Here's what we're gonna do on this show. We're gonna, we're gonna do a lot of different bits. We're gonna try some different things out. We're gonna start with news. We're gonna talk about different news stories and go back and forth.

we have a, we had a poll that we put out. We're gonna discuss that poll. Mm-Hmm. , we may do, are you smarter than chat? GPT with a question that will be posed to chat GPT. See if we actually, which is kind of crazy. Like, are you smarter than the internet? Are you smarter than ai, right? I'm not, I'm not sure.

Hey, we're excited that everybody's here and, we're just gonna jump into it. I'll throw out the first story, and if you haven't hit it yet, We have a whole bunch of people aggregating stories for our site, and then we publish a newsletter on a daily basis.

It's a really good rig, right? I mean, if you go to, you can sign up to be one of the curators. Basically we give you a text number, and as you are reading things on your phone, when you see something like, everybody needs to know about this, you should see this.

Basically, click that sort of forward arrow, and you send it to the text number, and then it goes into the machine, and it comes up for everybody else

A bunch of automation shows up in our Slack channel, we read it, we go, yeah, that's a good one. We hit the thumbs up, and it goes out onto our website, and ends up in our newsletter.

one of the things I was thinking of doing for this is just looking at the news stories for the week that have been read the most. And this one has been read the most. So we've posted this. I talked about it on the Today Show. The AI revolution is already losing steam. Wall Street Journal article.

They have a handful of points. One is once you've hoovered up all the information from the internet, there isn't another internet to go out and hoover up information. It's not going to all of a sudden get a lot smarter. That was one of their points. they talk about the fact that AI could become a commodity. In that the open source models are catching up to the really expensive big models that are out there. and then they talk about the fact that AI is really expensive to run. And if you care about sustainability at all, the amount of compute power it takes to run these things is pretty amazing.

And it doesn't get smarter. Like every time you run a query that says, Hey, you know, this about health IT. It essentially generates a new answer. It doesn't go back and read the old answer. It generates a new one. So it's almost the same amount of processing every time it does. Now that might be a layman's understanding of it.

price and the value of NVIDIA now. Because a lot of those Machines are being built on those chips, and that's the kind of power that you need.

Well, that's one of the points I make in the article, and I've seen this quote before. They talk about the sustainability of AI in general.

NVIDIA did 50 billion last year in revenue. So there's those chips to run AI, and AI as an industry did about 3 billion in profit. So if they're spending 50 billion on chips, and it's 3 billion in profit, they're betting on the future for this. And then finally they come down to the use cases are, they're not as vast as what people thought and there's been slow adoption of this.

So this is their case for saying the AI revolution. is already losing steam. What do you guys think?

So, part of that article, and I went down a rabbit hole like I usually do, if I find a line in an article that's interesting to me, I'll go further into that. And it's akin to what happened with the telecom industry with the bust, with all the fiber optics that went out there.

Here's the thing, while that initial fiber optic boom and the dot com bust happened in that same time frame, here we were preparing ourselves for the internet and that next round. So, all that dark fiber came in really handy, As soon as we really needed the internet power that was available to us. And so if we have overbuilt out AI or some of its capabilities, there will come an inflection point where it catches up and it's necessary, and then we'll be ready for it.

It's just like all the plumbing that we as CIOs did to be ready for telehealth and so many different aspects. I could not get telehealth off the ground pre COVID.

one of our physicians who was the most, quote unquote, against it to a degree at the time, was the first one who jumped in because they had pre existing conditions where they could not see patients or they would put themselves at greater risk.

they became the telehealth champion and all of a sudden it was in place in like a week.



Somebody has to build infrastructure too because at some point when people are ready to jump in, the organizations that have built the infrastructure and are ready to scale are the ones who are going to get the market share in the beginning.

So the people that get there first, the people that get that market share first may very well wind up being people who acquire everybody else.

I remember, having a conversation with Darren Dworkin, actually an interview with him, and we were talking about, telehealth, and he says, you know, it was one of my goals, the year of COVID, it was one of his goals.

And he said, prior to the, pandemic hitting, he's like, there was no way I was going to hit that goal. Because then I exceeded that goal by a thousand and fifty percent. And it does feel a little bit like that. maybe we've gotten impatient because every other technology, when you think about it, the mobile phone, first mobile phone we installed in our cars, they literally were a part of our car wired into the car.

Yeah. And it wasn't until what, 2008 that we got the iPhone. That really changed everything.


And we look at that, and now with ai, we're sort of looking at it and saying, Hey, that. Can we condense that into a couple of weeks?

problem of, I was reading something the other day, the author was sort of talking about how AI is the thing that you always aspire to, but you never actually reach.

By the time you do something that you would call AI, and you have it and you're using it, That's not, that, we don't think about that as AI anymore. We're looking to the next amazing thing that it can do. And so, maybe there's some of that

Alright, so our question, as a CIO, how are you preparing for AI?

I'm putting you back in the chair. I'm going to keep putting you back in the chair. Sarah, how do you prepare for AI?

You stay on top of what the key trends are that have the greatest value because you want to make sure that the information you're presenting to your board and to your peers and others, that it's not a decision made in isolation.

Keep everybody informed because the business ideas that come forward, that are actually going to have the value, are going to come from somebody who also then has to be your partner and your champion in that.

So understanding, and just like we do, you start slow, you start small, you start with something that is low risk You get the right voices in the room both externally, so what benchmarking sources are you using for information? Who are your partners or your vendors who really have some experience in these spaces?

Who in your organization is going to have a business case that is going to create the value and come into fruition the way that it should? You're the orchestrator of all of that. And so the CIOs that believe that AI is on them, and it's true, it happens in a lot of organizations, this is that opportunity to say, in this case, I'm not going to be the person that's doing all of these pieces independently.

I am the orchestrator and each of you have a piece in how this comes together

Yeah, interesting. so it makes me think back to the sort of the fundamentals of all of this. The data, the data that we're going to use. Do we have data governance? Do we know what all the sources of our data are?

Are we comfortable that that data is clean? I mean, maybe AI can help us with that cleanup too, but there's also just that. For me, the fundamental part of, you know, we have chat GPT on the internet, but you know, a lot of the internet is a lot of crap. And so, but that's in the model now. And so it uses that information sometimes as factual information.

The LLMs are really important. The data that they run on, I think turn out to be the real, the real oil of the machine.

have great data governance, data quality, data lineage,

to get what you're really trying to get out of the,



Yeah, my thought is, is just like this show, it's as many quick pilots as you possibly can do to learn what you don't know.

And, you know, keeping an eye on what you're trying to accomplish with it. And right now it's, until you start to use it and get in there, you just don't know what you don't know. Right. And so what I'm finding as I'm doing interviews is. Some people have a firm grasp on what they already cannot do with it and where the challenges are.

And other people are still talking about, yeah, we should do pilots.

. You need a lot of crappy first drafts to get to the point where you're like, okay, this is actually working the way I wanted it

It's like, well, we have to run that through. I'm like, I'm not saying use it for care. I'm just saying do a chart summary.

try it.

Have a couple docs look at it and go, yeah, that's not gonna work. Or man, that's pretty close. Like, what do we have to do to get this?

Drax, this one's you. CISOs under pressure from boards to downplay cyber risk. So this is a study that was done and the CISOs say they felt pressure from their corporate boards to downplay the severity of cyber risk. 43 percent say they are seen as nagging or repetitive.

42 percent say they are being overly negative about cyber risk. Yeah. What are your thoughts? I,

so I think in that same article, it talks about. There's also increased alignment with their board and their executives from another study. So these things are somewhat in conflict. I don't know how scientific they really are.

You know, the kind of takeaway for me is if there's a situation where you're a CISO and you're making recommendations and they are just hardcore not being taken by your leadership, you're doing the right thing. You talked about spitting into the wind earlier. You should just keep spitting. It's a thing that you need to do.

These are the analogies that people use to tell cyber security stories to non technical, you know, board level, executive level folks. Those are the same kind of things you have to try. Who am I talking to? What's the message I'm trying to get across? And what channel do I need to communicate on? What does this person relate to that I can use as an analogy to help them understand the risk that we're facing or the issues that we're challenged with?

So, again, back into the CIO role, and I'll start with you. What are the stories you tell around cybersecurity to help people that sort of, Get a grasp on what it's going to take to secure healthcare.

Back in, I think it was 2005, I started out my first sort of corporate role with HCA was as an information security officer at the division level, but we were, sanctioned from corporate.

And I remember one of the best things that Paul Connolly ever told us was, Cyber is in your personal life and your professional life. It's one of the rare things that transcends all aspects of what we do in the technology realm. So when you're telling stories, you're telling stories about why it's important to change your bank password at home, or why it's important to make sure that you're looking at these different upgrades and different systems as an example.

And so when you tell cyber stories, there is applicable information At home as they are at work. And that's to me how I always got to people was explaining that this is good hygiene for you in all aspects of your life.

And so as we tell personal stories, cyber is one, something that goes across all of us and it will continue to be so. How many people have all kinds of devices connected inside of their homes?


And you can, change your lights and your temperature and all that from your phone.

If you choose to. We actually put our first ring camera in recently, and now it's like the highlight kind of a thing. We don't have, our stuff can connect to the internet. I'm like, why does it need to?

And so it doesn't, but actually it's the thing that loses time the fastest as well.

Yeah, I love that. I think it is trying to find those stories that everybody can connect to, especially when you're talking to a broader audience, you have to try to find that connection point that everybody can relate to.

One of the folks in the Unhack the Podcast, told a story about a boxer and they said, you know, look, if you think your strategy for cyber security is going into a boxing ring and your plan is to never get hit, that's not going to work.

You're eventually going to get punched and sometimes you may get punched and find yourself sitting on the mat. The resilience part of this, then, is figuring out how to avoid those punches. If you get punched and get knocked down, how to get back up, how to have the right mindset about getting back up quickly and getting back into the fight.

Those are the kinds of analogies and stories that most people can relate to. And if you're trying to make a particular point about a particular piece of the work that you're doing in cybersecurity, it can make a big difference. I do feel like sometimes there are, CISOs and CIOs who do feel a little bit like, they're being told like, okay, calm it down, calm it down.

It can't be that important. But I think you got to keep the pressure on. It's important, you have to think about how to do it, there's a lot of executive relationship building, and how do you communicate it at an executive level, that's a big part of this too, but, you can't really just let it go.

I think the cyber stories are fascinating.


And, you know, gives you a little glimpse into my life. Every now and then I'm with some of the people in my neighborhood, and I'll tell them some of those cyber stories, and they're like, riveted. Because it's like Hey, did you know that Caesars and MGM were hacked in the same week?

They're like, you're kidding, no, I didn't, because they don't follow it like we do. I'm going, yeah, here's how they got in, here's what they did, here's how the ransom happened. One paid, one didn't. I tell that story to my board. the crazy one now is the deepfake video one, where, was it 50 million?

transferred a bunch of money. The person transferred a bunch of money after getting on a video call with The person and was convinced that actually was the CFO who was telling them to do it. So they kind of tried to do everything right, and they got, they got popped.

a threshold though of like if you call me and tell me to transfer 15 million dollars, even if I think it's you, I'm probably gonna call your wife first just to make sure it's okay.

No, for sure. I mean, and I think a lot of that's what happened after the the Vegas Casino Hacks is that a lot of organizations who used to have just sort of like one level Can you tell me your employee ID number and if it matched then they would change the password or let them re register an MFA device That's gotten much more complicated now for healthcare help desks for the most part.

They've created New protocols and new rules around that, around finance and transfer of money. But this gets to your

earlier point. It's like, okay, I'm now going to have a conversation with my family. Because, you know, our staff, our staff's 12 people, and I've already told everybody, look, I'm never going to call you or text you.

But what about in your family? Because that's still a possibility. I mean, I have a family password.

We have a password that we know that if somebody's asking you to do something really important.

So, what's the name of your cat?

It's not the name of my cat. Yeah. Oh, you have a cat? Oh, okay. No, I don't. No, he only has a dog. Just a

dog. Okay. Good boy, Jackpot.

last story.



Last story. How AI will kill the smartphone. And, this was Computer World. Really pretty interesting, because they, they, I have things that, you know, that AI features will likely divide the market into two types of phones. Like, today we have smart Actually, I used to know a bunch of people had flip phones.

I don't know that many people now who have flip phones.

Doesn't one of the Samsung phones purposely open double up? Yeah, but not like an actual old school like Motorola.

like, if you wanted to detect somebody, you'd have to go like, 8, 8, 8, 3, 3, 3.


Exactly. And what they're saying is we could see another bifurcation of the old smartphone, which is really about network connectivity and, a camera essentially, and one that's just enabled with all sorts of, smartphone capability or AI capabilities. that are, you know, that essentially what you'll see is people just interacting with this device like it's a person.

it'll be your personal assistant. You'll be able to talk to it. It'll give you the information that you need or bring up on the screen whatever it is you need. Instead of me manually going into maps and saying that I want to go somewhere.

do that now with voice.

I know, but I'm just, this is just an example.

and this article comes out on the, there's a bunch of rumors that. Essentially, Apple is going to sign a deal with ChatGPT to, I don't know if it's replace Siri, but definitely augment Siri, because Siri is seen as falling behind.

has been for a long time.

she gets confused when people say my name, sometimes people's phones kick off. saying something about Alexa over a live broadcast and then people's devices at home all go order something off of Amazon. For it to not get mistaken, often enough to be disruptive.

Yeah, it will be interesting, the, what they're essentially saying is the old method of going, you know, I have to click on this app, like you were saying, and that will sort of go away. And you'll just talk to the device and say, I need you to map to this, I need you to do this, and oh, by the way, can you, you know, tell Dan to stop answering the door because it's just, you know, whatever.

I mean, it literally will be Something that starts to understand you, know you, respond to you, and that kind of stuff.

and learn over time. Learn about you, and things that you like, and the way that you ask those kinds of questions.

Hyper personalization. And we talked about this earlier, because you were saying, hey, is that the article that at the end they talk about glasses?

Because one of the points they make is, is this the right form factor for that? maybe is a set of glasses that. It has some augmented reality, and also, I mean, if all I'm going to do is talk to it, it's going to respond. the classes are right here at my ear,

Any thoughts?

Yeah, I'm not a fan of having, I wear contacts,

they're going to do it in contact.

it also corrects my vision, then I'm going to have an issue with it. In that case, I would probably welcome it because trying to do, you know, monovision with contacts is always a fun experiment at this age.

But what's most interesting in that sector, I really think about is, If everyone's just talking to their phone instead of typing, do we just have a whole bunch of people sitting around mumbling to themselves all of the time because being embedded in your smartphone is not a social connector.

Sounds like a great time on an airplane.

think you literally on a plane. Everybody does this. Everyone just kind of doing their thing because I was on Delta, free Wi Fi. So everyone has it now. Of course, they make you sign up for the account, but great, you got free Wi Fi.

Everyone was mumbling to themselves. On planes or in public.

It creates an interesting dynamic when you think about the social aspect of what that really means.

one of our coworkers, Jarris and I, were talking and he said he saw this picture and it was from a party in the eighties and there was a band playing and there was kids in the front and there all this other stuff.

And it said, what do you notice about this picture? Well, the first thing you notice is, nobody's holding up their camera recording the band on the stage. That's the first thing. And then the second thing is, people are actually looking at each other, having conversations. They're not, like, looking down like this.

And, you know, we're, we're an older demographic, you and I. Oh, what are you talking about? Just, just you and I. She's gonna look right past her. Okay. but, but we tend to, as we get older, look at it and go, oh, can you believe, can you believe, can you believe? Yeah. you know, these people looking at their phone and, you know, they're getting these neck injuries now because they're always looking down and that kind of stuff.

But I don't know. I mean, I sort of want a personal digital assistant. I think doctors want a personal digital assistant. And that's, the challenge with new technology, wanting to pull you in a direction.

You think part of it too is, I mean, I don't, it feels like there won't be just one way you can communicate with virtual, personal digital assistants.

So you should. Theoretically, that device would be your personal digital assistant, but you'd be able to type messages to it if that was the appropriate surroundings to do it. You could talk to it if you wanted to talk to it.

I thought it was interesting on the Apple device, the Apple Vision Pro, that they, they actually follow your eyes.

So how you move a mouse, you just move your eyes around and you focus in on something and that's what it clicks. So I thought that was ingenious, because now you don't have to go, like, do all this stuff. But then the other thing I thought was ingenious, because it has like six cameras on it, one of the cameras is pointing down, and so if you wanted to click on things, you didn't have to do this or whatever, you could just literally have your hand on your lap and just do that.

And so you look at it and click like this.

that you're actually wearing that gown. I love the idea of a personal digital assistant, but I believe as one of our, our team members who posted that I don't want these things to do a lot of my tasks so that I can go do more laundry.

I actually want the swap of the things. I want to be the one who can go out and have some of the extra free time available to myself. So a multi mode availability to do something will be important. And then the things that you really need it to be able to do versus the things that get thrust upon you and an expectation to be able to do.

Like when texting became the primary form of communication. I was a fan, but I remember having to go upgrade my phone to keep up at that point. And so in certain populations, is that even sustainable? Do we create an environment or it creates more chasms? Because one of the things it talked about is how expensive these phones get.

1500, $2,000 is already like 1500 bucks for a new iPhone. Right?

or have nots.

Yeah. We didn't really touch

on that, that they said the death of the smartphone. And one of the reasons they say that is because. It won't depend on a 1, 000 block of hardware because it's software.

And as Mark Andreessen said a long time ago, software is eating hardware for lunch. And if it becomes software update, software update All you

need is a dumb terminal.


Green screen.

Green screen terminal. Everything is actually out on the mainframe.

Well, let's hit the poll of the week. will cybersecurity meaningful use programs for healthcare providers make a significant difference in our industry's cyber readiness? First of all, what are we talking about with cybersecurity meaningful use program? Rex, what are we talking about?

so, you know, there's, I think that's probably a terrible name for it.

I think it's, it's the, it's the concept that's the idea. Of, you know, when we went through the EHR meaningful use program, there were 10% of health systems or hospitals that had electronic health records deployed. EHR came along and within five years, 90%, 95% of hospitals and health systems had EHRs deployed.

There was an incentive program if you were able to do these things with your EHR, you got this much money in year one and the same thing in year two. So I think there's sort of a dream in cybersecurity that there's something. That's going to come along for cyber security and we see the stage kind of being set with cyber security performance goals and other stuff that's starting to come out of the government now.

Tons of conversations in the house and the senate and the president's office. around cyber security and so The challenge is, maybe, can we get anyone in the government to come to an agreement on what this program, whatever we call it, might be? Can we get it funded, and what does it look like?

Because as with all this stuff, the devil's in the details.

Yeah, the program should just be called Securing Healthcare,

And there's always unintended consequences, right? That's the other thing with the EHR Meaningful Use Program, was that I think we also wound up finding out later, like, a lot of physician burnout, A lot of typing, a lot of pajama time, a lot of things that we didn't think were going to happen, but then they happened.

And so the agility of the program too, to be able to like move and change and do things better. Drex, should we

really have to pay people money to implement two factor authentication in healthcare?

Yeah, it's you know, look, I think there's a lot of healthcare organizations that are in tough financial situations today.

But two

factor authentication is like, click a button and train your people. Yeah. This isn't an investment. And if they still haven't done that, I'm sort of sitting back and going, okay, why are we putting millions and billions of dollars out there if we can't get them to authentication? Now, I understand.

it's hard. Vigilance is required. It's really hard. They're still not clicking the button and training their doctors how to do this.

Yeah, yeah, for sure. I mean, it feels like that is super low hanging fruit. It actually cuts a lot of bad guys off of the pass with 2FA up and running.

There are applications depending on, the stuff that you're running, which gets to another whole conversation about how old is all the stuff that you're running and will that stuff actually even hold. a 2FA capability or do you have to build a portal to be able to run the 2FA through before they can get to the thing behind

It, it can be complicated and if you don't have the resources, the money, the experience, the talent, or whatever to be able to do some of these things, it's still a challenge.

So that's the point. Where did you come down on this poll? So 79 percent said yes, it will have a significant difference in our industry's cyber readiness.

21 percent said no. Where did you come down?

I came down with yes, only because of the importance of making sure you're doing the right things. Back to where we started with the conversation. It continues to elevate, as long as you are requiring certain aspects to make it happen.

So, I'm a fan of saying, yes, you need to do these things, and if you do them, do you get the money? Well, do you also get the money to maintain the environment that's been built?


that's where a lot of these health systems are now, and these, you know, Super thin margins. All of this technology was put in place to hit MU as an example.

The cost of doing that, and what are we hearing today resoundingly? Oh my gosh, I have old applications. I can't secure all the things that I have. Like, you create a different problem.

pay my annual maintenance bills and all those things.

and then the companies get sold and then they get consolidated and then they, your CPI goes way through the roof because now there's no contract pricing safety nets.

If everything else in your organization is at a baseline that you believe that you can sustain this. Then you're in great shape. Otherwise, everything needs to rise with it at the same time.

Thank you.

It's not an event in isolation, in any way, shape, or form.

yeah. So, it feels to me like we're going to make the same mistake we made with EHR, Meaningful Use, which is essentially, hey, we're only at 8 percent people who have digitized the medical record, we want to get to 100, and they threw money at it, and it was successful.

By all measures of that metric, it was successful. I mean, 90 some odd percent of all medical records, it has to be close to 100 now, we have all sorts of other problems. Interoperability, data, you know, standards, you name it. We had a public health emergency, we

couldn't pull the, I mean We couldn't get the data to the state public health agencies, because, you know, Interoperability wasn't necessarily built into the Meaningful Use program.

So let me walk you through this one. This is why I come down on no, it's not going to have any impact. And the reason is, because throwing money at a problem doesn't solve the problem. And so, we're going to give them money to treat symptoms. They turn on two factor authentication.

All the good things.

Just normal cyber hygiene and those kinds of things. but at the end of the day, they have not tackled governance or architecture. And so, yeah, they've put all these bandaids on, but they've increased their TA attack surface by a hundred percent because they added 75 applications.

'cause they can't say no to any department that comes to them and asks for a new application until they can do that.

We had a good conversation in Philly with a bunch of CISOs and privacy officers And the thing that really came out of that meeting was we have a really hard time saying no to anything.

We don't run our business like we should run our business. And it means that we wind up with more and more stuff over time. Nothing gets turned off. And from a security perspective, we're just asked to Make sure we secure this massively complex environment and it's really difficult to do.

You're not allowed to simplify it. You can't simplify it. What if we threw the

question out there that in, assuming you have any kind of a governance process, you're gonna add something you say yes, here's how much the cyber component of it is going to cost. How would that change the conversation?

I think it's hard, it's difficult to do the math because everything is connected to everything else and sometimes you don't understand when something's coming in what all they're really going to want to do with it.

This is what happens with, I mean, even if you don't add anything, right, there's no new applications, but the citizen data scientist in the surgery center decides that they're going to pull data from lots of different places and put it into an Excel spreadsheet on the shared drive and shake vigorously so that they can use that data to make better decisions about surgical operations.

The problem is, the keys to the kingdom that we all think of as being in the electronic health record might actually be in Bill's shared drive on the common drive. And Bill's worked in seven different clinics, and he's never had any of those permissions taken away from him, and he's only had permissions added.

And so if I can get Bill's password, I can get to a ton, millions of records. Can

I talk out

of the other side of my mouth now? Yeah, sure.

I totally agree with the government funding cyber security. Especially for, safety net hospitals, rural health care, because they may have the right solutions, they just don't have the money.

I want to make sure that that doesn't happen. and so there's a part of me that's like, yes, fund it, yes, put money out there, I don't care if it's in the billions, because that's maybe what it's going to take. And the more we create these, Interconnected hubs. It's almost like the TSA, right? You have to secure the most smallest airport, because if you don't secure the smallest airport, it's the route into the bigger haul

that is the devil's in the details, right? Do we means test a program like this? Because big health systems are already there and they're already doing these things and we don't really need to give them more money. If you're a big health system, you're not going to be happy with that, because if we did already spend the money to do this stuff, you should reimburse us for it.

Do we tie it to Medicare and Medicaid payments? Is there an incentive program and then there's a stick on the back side of it?


it's complicated.

It is complicated. Man, we're going to get better at this. This is why we're doing the crappy first draft, right? So the next session was, ask me anything. We did the poll the week.

Ask me anything. Let's see.

Do we have any questions from the audience?

Sunny, Safra, when we were talking about the phone, mentioned there's a movement of the younger generation giving up smartphones because of social media and going back to flip phones. I think there is a certain amount of, and we heard this today, especially in the conversation around ambient listening and some of the solutions there, I'm not going to say a specific vendor, although that was the majority of the conversation.

there are doctors that are looking at it going, yes, give it to me, this is amazing, and there's more and more of that happening. There's still a subsection of the doctors that are saying, look, My templates are fine. I figured this out. I'm pretty efficient now. No.

I don't want to add another thing.

like, I'm fine with my flip phone.

I can make phone calls and I don't want to get all fancy and stuff. This is fine. Are we going to have that kind of bifurcation within healthcare where some people are like, Yeah, you know, you guys keep your technology. My practice is doing just fine.

Is there a reason to believe you can't?

We manage those environments today. We've got the doctors who want that environment, the ones who want the traditional. You might have the one who's the, loves all the technology and the gadgets, and whether they choose to see twice as many patients or not is on them.

But if your RVUs or whatever you're measured by is set, however you get there, that's on you.

That's how you get there.

I like that. that is ultimately using health information technology to create a personalized set of capabilities. for physicians and nurses and business operators and others to be able to get their work done, right?

Meet their productivity goals and do it in a way that gives them a personal life and they can actually go home at night and not have to work online and all that kind of stuff. I love that approach.

At the end of the day, we might have to do something, but if I have three ways to do it, and one of them is, More preferred over another, then why wouldn't I do that?

That's three ways I have to run and maintain and support and upgrade and patch and secure. So you have to think about all that.

my favorite, yes.


or it depends.

here's my out question for this episode, which is I'm gonna make you CIO for a children's hospital.

So you have that experience. There was some children's in our facilities, but it wasn't a children's hospital in Seattle specifically. Billion and a half dollars, you're asked to save money. Where are you finding that money to save in IT specifically?

I mean, for me, it's always been one of the first things I've done when I go in and do a turnaround is, we talked about the finance person today, right?

Bring somebody in who can help you round up all the contracts and understand what you're spending and what money is going out. And then for those big contracts, you sit down and just have a daily drill of going through and talking to those partners and saving money. That's the

same approach you would give to a.

I mean, for a children's hospital, honestly, I don't think there's anything that I would specifically come up with for a children's hospital that would be maybe different from a cost savings perspective. I want to hear, you must have something in mind.

No, I don't. It was interesting. So we had the first session for 229 project here. And a lot of it focused on application rationalization, money, and you know, how do you, I mean, and we talked about a lot of different things, but that was a pretty interesting conversation to hear. And people tend to be all over the spectrum on this.

When you say, hey, do you have copies of all your contracts? I would say half the room was like, yeah, we figured it out, we got all our contracts, we put them in a place. Now do we think we have all of them? No, but we think we have a majority of them.

Some of this depends on

where you are in your level of maturity, right? a big part of this then is just looking at continued efficiencies, like how do we Not buy one more new application and leverage applications that we have to do those things.

a huge fan of automation, and the key to automation is knowing where do you actually insert the human.

Right. Well, and do we have enough automation at this point where we can drive enough savings? If I said, hey, I need you to find a million dollars in savings, is there that in automation?

There could be, depends on the size of your org and how things operate. But between your testing and all your different environments, between a lot of the Just RPA spaces between your call center. I mean there's there's plenty of spaces where you can automate and automate is not Just, you know, scripting is an example.

And, it's been everywhere I've ever been. Like, hey, you know what? Where can we put in efficiencies or tools that help us with productivity? And in some cases, it is a headcount reduction. In others, it's a reallocation. In others, it's just not filling open roles. but those are sometimes never fun conversations.

And that's where You get some of the resistance from here. People think it's going to take away their jobs. If people see it as an efficiency booster, they're more inclined to do it either way. If you do not have really good operational or organizational change management in place, then it's going to be hard no matter what you take on.

This is why the role of the Chief Digital Officer, Chief Digital Information Officer, becomes more and more important over time. Because it's not just about the IT, it's about the people in process part of these things that you're doing. And a lot of that is change management. Understanding how to affect change and make it work and make it stick In my job, it was always one of the hardest things I ever did.



was always based off relationships. If people trusted you, and they liked you to a degree, then you could get them to at least be curious about wanting to do something new and different. They

didn't have to like you. You don't have to put them on him.

Like, I

trust you. Did I like you? But either way, you tend to do things for people that you like and you trust, and that's how you build it out. You can't walk in an organization and just expect people to do something and then, close your door and hope that all goes well.

Yeah, agree, agree. And people like when we disagree, by the way.

So, eventually we'll have to find those places. the thing I would add is, I would talk to the CFO about what constitutes savings. Right? Do I have to get it in IT? Could I help get it somewhere else? Because one of the biggest areas we've seen is in terms of claims processing and revenue cycle management.

when we apply automation and even AI cases to those things, we can reduce the number of rejected claims, we can improve processing and all those other stuff. Now you're talking.

We can gather more money, not do cost cutting. Right. Is that an option?

That's a big bucket. I mean, I've heard numbers in the millions because we're processing a lot of claims and a lot of money.

Well, here's the thing, too. If you're a CIO who's in a spot where you can help to increase revenue, which we all should be, and your budget is based on a percent of revenue, guess what?

Keep making the hospital more money because your budget's going to go up.

Absolutely. Alright, thanks everybody for joining us on this pilot. I hope you enjoyed the show. we will be releasing this, actually, on our podcast channel. On the Newsroom channel. Following the live episode, so you can see it up there.

Our next episode that we've decided to do is the 12th, right? I think so, yeah. All right, so we're going to be together a bunch, but we're not going to have to sit out in the sweltering heat with our, with our swag on and do that kind of thing. If you want to stay connected with us, you can do that on LinkedIn and check that out for updates.

And that's all. Bye for now. 📍

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