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January 2: Today on TownHall Sue Schade, Principal at StarBridge Advisors speaks with Jeff Gautney, Senior Vice President and CIO at Rush University System for Health as a follow up to their last conversation in September. They delve into Jeff's diverse career, his approach to integrating artificial intelligence within a healthcare setting, and the challenges of an integrated academic medical center. How can we ensure that AI-driven patient care and future integration is conducted in a safe, efficient, and holistic manner? How does the integration of university functions with healthcare systems add layers of complexity to identity management and more?

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Transcript

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.

it's not an unusual thing for somebody to be a nurse in one of our hospitals, taking classes, so they're also a student, teaching classes in the graduate school, so they're also a faculty member, and they're an employee.

The university adds at least a third or maybe half of those personas, it complicates those things, which makes it fascinating to work on, to be honest with you, but definitely more challenging

Welcome to Town Hall, a show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels and events dedicated to keeping health IT staff current and engaged.

We've been making podcasts that amplify great thinking to propel healthcare forward for over five years, and we want to thank our show sponsors. who help to make this happen. Armis First Health Advisors, Meditech, Transcarent, and UPerform. We thank them for investing in our mission to develop the next generation of health leaders.

Now, on to our show.

Hello. I'm Sue Shade, Principal at Starbridge Advisors and one of the hosts for the Town Hall Show at This Week Health. Today, my guest again is Jeff Gottney, Chief Information Officer at Rush University System for Health. We first met when we were both working at Ernst Young over 20 years ago. With Jeff's extensive consulting background and now serving as CIO at a leading health system the past two years, he has great insights to share with us.

We covered a lot in our first interview back in September and agreed we had more to discuss. So here's our part two interview. So welcome back, Jeff.

Thanks, Sue. It's great to be back and really happy to continue the conversation.

Excellent. I know you have a lot to offer, but let's start by having you briefly introduce yourself and tell us about Rush for those who may have missed our September

interview.

Sure. Yeah. So nice to see all of you. My name's Jeff Ney as Sue mentioned, and I have, I'm the Rush University system, so Rush is. The third largest health system in the state of Illinois. We are, at our heart, a pretty sophisticated academic medical center with two community hospitals and then a full service services university, so four colleges including a medical school, a graduate nursing program, and the such.

We're a fully integrated organization, so I'm the CIO of both the university, the research organization, as well as the patient care Business that, that we have. as Sue mentioned, I kind of came to CIO through a somewhat convoluted path. I rose to partner at Ernst Young, was a managing director at Deloitte.

In between that time, I worked at Northwell Health and led the IT operations there. In New York City. And then just two years ago, accepted the position here at Rush and moved my family to Chicago.

Great. And I'm going to tell people, check out the interview that we did in September because it was a lot about the health system.

Today we're going to talk more about the university side. But before we do that, I want to get into AI. In our last interview, you outlined the approach that you're taking to AI governance, including what you call the Office for Responsible AI. So, a short recap on all of that would be great, and then I'd love to hear your thoughts on President Biden's recent executive order regarding AI.

Yeah, so, since we last spoke the Office for Responsible AI is really up and fully functioning. So that's our governance model. If you listen, if you hear the other podcast, it really has four parts. There's a group that focuses on identifying opportunities, assigning value to them for AI.

There's this Office of Responsible AI, which is meant to make sure that we can do things safely. Write good contracts, understand regulatory issues and ethical issues associated with those systems. A group that focuses on tool sets, so that we don't have a million different tool sets and everybody bringing their own set of, environments and sandboxes and so forth.

And a group that focuses on data. And that group, in a lot of ways, that's the group that makes or breaks you because all of this is based, all of EIA protocols and the success you have is based on using good data to train them and making sure that data stays positive so that the, the results you get are predictable and what you intend for them to be.

So the Office for Responsible AI is underway. We're in the, we're making policy within that group and starting to. Disseminate that. We have a backlog of about 45 different AI platform or product requests. And I'm sure any of my colleagues that are listening 45 tool requests? Yes. Oh, not tools.

Applications. Okay. Okay. So, could be something like, for instance even today, we're going to examine Bear Calantic, which is an AI platform for diagnostic radiology imaging. So we're, we're looking at AI beyond just Gen AI.

, so that backlog exists, right?

And so for each one of those, it's a process of going through If you If you've ever looked at a contract for an AI platform, the contract puts all of the responsibility on the health system. And the problem with that is most of these vendors aren't very transparent in terms of what model, what data was the model trained against and what are the tools that you have to monitor the model and make sure it's not drifting or hallucinating or any of the terrible things that can happen when AI gets a little bit out of control.

It also Raises a lot of questions in terms of the cost because AI, well, when chat was. Delivered last November. It looked to be free, right? Everyone could download it. You could do it on your phone. Your kids were writing their term papers with it. Didn't cost a penny. But that's not the reality of it.

Running against those large language models requires a lot of GPUs and a lot of power and that cost comes back down to you on a message by message basis as you implement these solutions. So, it's complex and the contracts need to anticipate those things. anD we need to make sure that our legal department, as well as our privacy and cyber and all of those other groups, aren't just smart about how to write the contract, but they're also smart about how to administer and monitor the progress on that.

And that's really what that Office of Responsible AI is focused on. They're also focused on , regulation. And and that's where I think, you mentioned President Biden's discussions this week. I think the smart play is to not wait for government to come up with regulation, right?

It's to try to make sure that you understand yourself what policies are and how this, how things like HIPAA and the consenting process. And in, in our case in Illinois, we have something called BIPA, which deals with biometric information, which plays right The AI, world, that we understand how the existing regulations impact what we can do.

I'm encouraged by President Biden's messages, and I'm encouraged by the tech leaders getting together to to talk about self regulation. Because these tools have immense potential, and with that immense potential also comes immense potential, to do unintended bad things. I won't even say that, they'll absolutely increase the attack vector all of us have to manage from a cyber standpoint, but, but unintentional outcomes is absolutely something we worry about all of the time with with Gen AI. The one thing I would just add to that, and I think I said it in the earlier podcast, is this is unlike any other regulatory environment that we've, I think, that we've seen. And in the past, it's been okay for our vendors to be the advocates and be the ones writing in letters and trying to influence their senators and their congressmen.

That's not going to be enough this time, and we need to be, and we feel at rush, we need to be very proactive and very engaged in trying to Make sure that our perspective on regulation is well understood, because this could flip the other way where the regulation becomes so onerous and the definition of what is AI starts to incorporate things like robotic process automation, which is By a really broad definition, AI, but in reality, it's scripting it could involve things like sepsis protocols or order sets, or, I mean, those are all those.

That's not kind of me being fear mongering. Those are real conversations that the FDA has had about what. What do you regulate? And so, I think this is a good time for all of us to become much more active and aware of the regulations that are in discussion and to try to influence them positively.

Yeah, I'm

totally with you. I was encouraged to see a number of people that I know we know probably that we're at. Some of the meetings at the White House leading up to, I think, this executive order positions in leading health systems who, are steeped in informatics and what the issues are there with AI.

So that was good. That was good to see.

Do you have your suit? Just one other thing I'd like to just kind of add, and this is a really funny thing, and I'd be interested if any of the viewers also have the same impression, but you see all of the folks get together at the White House and the tech leaders, they're all U.

S. led, U. S. companies and U. S. CEOs, so they're having a meeting in the U. K. because Europe is trying to catch up. Right? And so they're also trying to talk about regulation and trying to understand all of this. And it's the same guys. It's all U. S. led companies, all U. S. CEOs. I do think that this is a unique moment for the United States, and, for our economy and for our, to take a leadership role in AI on a worldwide basis.

And that means, in healthcare, we'll also, I think, be in a leadership role. As long as we, again, do it safely, being out front sometimes also means you're, you get squashed. So we don't want that.

Right, right. Yeah, no, I'm encouraged by that too. I think Vice President Harris is in the UK right now at some of those meetings on the international front.

Before we move on, I just a question, and it'll be interesting to see how you answer it. How many staff do you have that are dedicated in this space? Maybe partial in the space when you talk about the four different areas.

Dedicated to the exclusion of everything else that they do. Okay. Part of the design of our process was because we're roughly a three and a half billion dollar health system.

And so, for any of you are in similar situation, that you could fit a lot of the decision makers, probably the most important decision makers would fit on. One or two city buses at the most. And so what I didn't want to do was create a new governance structure requiring new meetings for the same exact people to come to.

So we took our data governance structure, for instance, and we augmented that and create and created the Office of Responsible AI out of that. We took our digital transformation committee that was already adept at dealing with new technology and thinking different. And we expanded that to become the AI incubator, the value group.

And we took our Center for Digital Health Enablement, which already had 50 people. And we're very adept at using different technologies and integration tools and what have you, and we added to that some additional AI resources to build it out. So that was part of our strategy is what can we do with the things we already have?

And expand the focus and potentially add additional people rather than create a whole nother structure off to the side. And we think that'll be beneficial because, the AI strategy and the digital health strategy, they're not different. They complement each other. And so to do them, treat them separate felt wrong and felt like it was going to lead us into blind alleys if we did it that way.

Yeah, it makes a lot of sense. And it sounds like you're doing a lot of integration, leveraging, and what was already there. Which I love. So let's switch gears and talk about the university. Okay, So you support the Health Sciences Colleges. Tell us about your

role there.

Yeah, so I'm the CIO over the university, which includes the research group and the faculty and our, we have roughly 3000 students. And I love every one of them from as long as they don't think very long about the cyber exposure. Having 3, 000 students means every single day there's 3, 000 opportunities to leave a laptop in the back of an Uber, or to somebody to grab an unencrypted USB drive and leave it someplace.

So it's, it's a, that part is a challenge. but they add a ton of spice it is a very different business to be in higher education, right? So even though we're training clinical staff. The reality is it's a higher education process. So, we have all the same things that you would find at any other university.

We have faculty management systems and student information systems, and we actually use AI to look at applications and help us, filter out applications for review for the medical school. So it's Applying to medical school, okay. College applications or medical school applications, impossible for any human being, to staff up for it, so we're able now to accelerate and do some filtering in terms of the apps by using technology to do that, and it's been very important to me because Without that, I'm not sure we could get through all of the applications that we receive, and what a terrible thing, I mean, as a parent who had, put three children through college, to think how hard it is and how much work it takes to write an application to think that it wasn't getting adequately read would be just disheartening.

And so, I can tell you that I feel really good about some of the improvements we've made. They're Ellucient is our partner for our main student information system there, and they've been a good, partner. And then we have, medical libraries. We have a very heavy focus on audiovisual.

Like many other universities, when COVID struck, we became, remote for a lot of different things. And still today, we provide, our students are back on campus for the most part, but we also do provide, pretty rich curriculum. that's remote. our classrooms are pretty tricked out with the latest technology in terms of, being able to multiple screens and all kinds of audiovisual and markup boards and things like that.

So that's kind of fun to be part of. and it's been great to look at the integration of the patient care enterprise and the education enterprise because they're not separated. Because it all kind of rolls together there's a lot more opportunity for us to look at the university in a really unique way.

So they're not a burden. They're not, I wouldn't say, in some places, maybe people say, oh, they're the enemy, but they're not like that. In fact, what I think when we look at the university, we kind of think about, well, what does the future of patient care look like? How should we be training clinicians? And somewhat self servingly, how do we train them?

To help our future work, right? So that we are training the kinds of clinicians at the right level of staff and in the right ways and the right practices. So that they can continue to support Rush. I mean, Rush is, as an organization, we're actually older than the city of Chicago. Really? Chicago was incorporated a few years after Rush was, yeah.

And we're named after Benjamin Rush, like one of the signers of the Declaration of Independence. So, we've been around a long time. And so, the university

Sounds

Like Boston history here. Yeah, right. Yeah, so the, you know, the university is something that we look at and ourselves, this is a way of continuing to sustain us as a really vibrant organization and, and differentiator, from other schools, even in our own town, University of Chicago, there's the University of Chicago.

And there's UChicago Health. And they're connected, but they're not integrated. Not the way we are. We're more like a Mount Sinai in New York City, as an example, or an Albany Medical Center in New York.

So, that, that's a great segue to a question I wanted to ask you about advice you would have to CIOs in academic medical centers for working effectively.

With the school side, the education side, whether or not you have responsibility for it. In some cases, they don't have responsibility and they're partnering with someone. But what advice do you have? Sounds like you've got a pretty good model

and pretty effective there. Yeah, I think so. But I mean, it kind of started off with me saying, I don't know, I don't know that much about this, like, I want to learn.

And it was very important not to walk in there with the solutions that work really well in patient care. And assume that those are going to work in the higher education or research space. And so we spent a lot of time listening. I spent some time getting some help. And didn't look at the usual suspects that I would to help me on the patient care side.

We, we found a firm that has deep higher ed knowledge and we brought them in to help us put together a roadmap. And then, so we took, did that, took about four months for us to kind of put together a roadmap. And then we've been executing against. against that roadmap. And I think that would be my number one piece of advice is don't assume that it's like a hospital or like another, any other part of your business.

They're very unique. And it takes some time to really understand, even the governance structure, the chairs of departments over there and what drives them, even though those folks are clinicians as well. They're in a completely different mindset when they're working in the university and dealing with the university's business, as opposed to when they're providing care within one of our hospitals.

And have you found a peer group that is in the same situation as you managing both the education side and the patient care side that you are able to connect with and learn from? Because I know it seems like the models are different one organization

to the next. Yeah, this is, we're probably the, we're definitely the exception when you look at the academic.

Health centers, the other 128 of us across the country, model that we have is the outlier. The majority of the model is the more traditional, like a New York Presbyterian. We've got the colleges and the health system in there, some. Walls between them, they're run as separate businesses.

. Right. And for us to run integrated I mentioned two that I look to for some guidance and some thoughts. One is Albany Medical Center and the other is Mount Sinai and the CIO of Mount Sinai. Krista Myers is a long friend, long term friend, and somebody who I try to compare notes with and learn from.

That's good. She's outstanding. Yeah. Okay. I wanted to ask you about the challenges working with the education side, but you mentioned cyber to begin with. We also talked about COVID and when y'all had to move remote. Any other particular challenges you want to

comment on? Well, I mean, there's rhythms to a university that are different, right, than a health center.

The university is not open 24 7. That's, one thing to think about. When the students come back in August and September, that is a big thing. That's there's a gigantic sort of identity management thing that has to happen at that time. But actually that's, to be honest with you, Sue, the biggest challenge when you're in a fully integrated organization, leaving cyber aside and the nuances of running a student.

and faculty system is identity management. So even though we're not the biggest university in the world or the biggest health center in the world, we have 39 different personas across our organization. And it's not an unusual thing for somebody to be a nurse in one of our hospitals, taking classes, so they're also a student, teaching classes in the graduate school, so they're also a faculty member, and they're an employee.

So in one day, within a matter of hours, they have four different personas, each one of which have their own set of, identity management challenges. Identity management's kind of the key, right, to doing all of this stuff safely, and it's the key to driving a really good digital experience. If I know who you are, and what you're trying to do, I can personalize that experience for you.

If I can't manage your identity That's a really, first, it's dangerous, but secondly, it makes it really hard for me to give you something that is really tailored to you. And I'd say the university adds You know, at least a third or maybe half of those personas, it complicates those things, which is, makes it fascinating to work on, to be honest with you, but but definitely more challenging than if all I was really dealing with was a health system.

Yeah,

so I'm smiling because it's kind of deja vu from my days at Michigan Medicine. At the time, I didn't have responsibility for the medical school, though they've now merged it with the patient care side. And our conversations On the patient care side for the hospitals and health centers, and then with the medical school, and then with the university about identity management were amazingly complex.

So my question to you is, do you think you do it well?

Not as well as we need to go forward. I mean, I, we're in the process of replacing a lot of our underlying technology and confronting some long standing processes that just haven't been confronted in the past. So that number of personas is not the optimized number.

It's probably A third, that number that would be the right number, but you know, they've just popped up over the years as programs have come up or CME created, a separate set of personas and we have personas that are associated with some of the organizations that we, acquired or integrated and later and didn't do the work to standardize.

So there's a big process standardization. Job there involves HR as well as the individual departments, and then the technology sits on top of it. And there's no remedy for that. Like, there's no tech layer that you can put in that can match up all of those personas and make them consistent so that you could use, like, an Okta or a.

SailPoint in front of it, you have to do the hard work. That's a bummer because that's not fast work either. But you got to do it. Yeah.

Yeah. Well, I thank you for your honest answer about where you're at with that. So I know mindful of the time here. Anything else you want to highlight before we close Jeff?

nO, just what a pleasure it is to have a chance to talk to you about these things. And I really do, I know I closed the last podcast with this, but I would say this also to my colleagues, we are at probably one of the most difficult times, and I was sharing with Sue earlier, it's ironic, I waited so long to do this job, and I love it.

Like I really love it. I wish I'd done it years, decades earlier. But it's also a super hard time to do it. And while all of that demand is being generated to do things like AI and so forth, we're also sitting at a time where most of us are under intense financial pressures and we're looking at, continuing staffing shortages.

Those haven't gone away. And we're trying to expand into an area, AI, that the whole world's expanding into. Like, we're not just, we're competing with everybody for qualified AI people. And so, so as hard as that is, this is like really our moment to shine. Like, this is really our moment where we can help the health systems that we work for transition to a different business model.

Find a different way to do things. using technology. I really believe that. I, there's no other path through that. Like, we're not, minting more people. Like, so we have to come up with things like tele sitting and virtual nursing and AI assistance. We've got to find ways to extend the workforce and expand the care because the number of people who need care is increasing.

The number of people who can provide that care is decreasing. The only solution for that is technology. And I really believe that we'll be. Stretched in, we'll be called on to be more creative than we've ever been. But I also think, like, that this is really our moment. I really do think that the next three to five years is our moment as an IT function within our health system.

To make a huge mark in the communities that we serve. Like, to really ensure that the quality of care that our friends, our families, the people that we live near. receive the best possible care that they can and the safest care that they can. I'm very excited to see what the next three or five years bring and I love every chance I get to talk with you, Sue, because I, I always learn something and it's just good to talk to a an old friend, too.

All right. Well, thank you so much. I love your positive attitude and words of inspiration, I think, for the future. It is a hard time to be in this business, but it's a really important work that we do. So thank you so much, Jeff. Thanks. All right.

You too.

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