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Vik Nagjee is someone who has worked with the large health systems to modernize their stack. His focus is on simplifying the architecture to reduce complexity and increase agility. Another conversation from the HIMSS floor.

Transcript

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 Welcome to this week in Health It where we discuss the news information and emerging thought with leaders from across the healthcare industry. This is Bill Russell recovering healthcare, c I o, and creator of this week in Health. It a set of podcasts and videos dedicated to training the next generation of health IT leaders.

This podcast is brought to you by health lyrics, helping you build agile, efficient, and effective health. It Let's talk visit health lyrics.com to schedule your free consultation. We are recording a series of discussions with industry influencers at the Chime HIMSS 2019 conference. Here's another of these great conversations.

Hope you enjoy. . Here we are from the HIMMS floor. Uh, why don't you go ahead and introduce yourself? Uh, sure. Bill. Hi, I am Vic Nji. Uh, I'm with Sirius Computer Solutions, um, dual role there. So I am a director on the healthcare team and I'm also the C t O for managed services, uh, at Sirius, uh, across all verticals.

Um, and I also am an advisor, uh, for the Cleveland Clinic, uh, as their Chief Enterprise Architect. That's a huge role. Yes. So are you looking at like all, all technology for Cleveland Clinic or, yes. So it's across the board? Yes, across, across the board, across institutes. So how's that different from a C T O role?

Um, the ct. So , if we go back to Gartner and we do the whole bimodal it right conversation, right? Um, I found that one person keeping those two roles like the here and now keep the lights on and the forward looking right next to impossible to do. I tried to do it. I struggled massively. So we have a C T O now that came over full-time, c t o, sit in that position, sit in that chair and take on all of the Daily Care

And feeding the block and tackling a lot of the, the more tactical stuff. Right. And this is a more of a strategic piece, so keeping the trains running on time. Exactly. Infrastructure, those kind of things. It's interesting 'cause I actually heard of a health system that, uh, did not rehire a C I O and just put a c t O in place and then hired a chief digital officer.

Okay. Right. So C t's keeping the trains running, but the c chief digital officer is really looking at, uh, the consumer experience and building out experiences and all those things. So it's just interesting. Well, I wanted to talk to you. We, we've had a bunch . Conversations with CIOs, it's been phenomenal. Um, but you're more on the technical, you're more in the weeds.

Um, what are you gonna be looking for at this conference and what have you found already as, as you've been walking around? Yeah. It's hard to imagine that this is the first day of the conference 'cause it's already been here for, for many days. But, uh, you know, the biggest thing that I look for at HIMSS is just networking, getting, getting together with a lot of the folks that I've known for years and also meeting new folks.

Right, right. Uh, trading. Trading information, trading stories. What have we learned over the last ? Years since the last time that we got together. Um, my big theme over the last several years and continues to be the same is simplicity, right? I want to get it to the point where we are able to have a very simple operating environment, simplicity, less errors, do things better, cheaper, faster, stronger, um, more on the infrastructure and services and, and so on.

So, uh, perspective. But what I'm looking for from the show is just to walk around and meet with some very large healthcare providers and see how they have been able to . Solve this whole, you know, conundrum of there's, they're drowning in data, they're drowning in all this information, and they have this big digital strategy upon them.

And how do you actually bring all of that together and make it work? Alright, so let's, let's go in two directions here. We can go, uh, infrastructure and operation side, and we can go in the, uh, in the data side. I'd like to talk about both. Sure. So from an infrastructure standpoint, you want talk about simplicity generally when people hear that they think cloud, right?

So I can, I can provision a hundred email accounts and . Five minutes from my phone. But if you go to a IT system within a healthcare, uh, organization and you say, Hey, we need a hundred new things, that's what a month long process at least. So, uh, what are some, what are some technologies or some things you're seeing out there or or exploring here that could really simplify the, uh, the role of IT infrastructure and operations?

Yeah, so really, really good question, right? So we'll start with the basics again, all of the listeners, I'm sure, or viewers, . Are familiar with this average healthcare organization has somewhere between 4 5500 applications that they're running. A vast majority of them, uh, are circa 19 70, 19 80 applications.

Right, right. Uh, token ring . Right. Uh, and you know, at least client server. Exactly. Client server. And they have some latency requirements, it's some physical requirements, and so on and so forth. So the first step that I look at is, okay, let's, let's consider our data protection. Right? Let's just make sure that our applications and services are always on.

That's non-negotiable. A lot of folks lose sight of that. And there's some pretty basic things we can do there. Using traditional infrastructure means to be able to make that happen. Um, so that's number one. Number two, cloud, cloud is, has been around for a very long time. We're finally to the point now where within healthcare we're able to say, okay, we can actually use this to solve certain problems.

'cause all this Wild Bell, I think it was a big solution looking for a problem, right? And to solve. And now we have . A lot of things. Like for example, how do I do real quick efficient, Dr that doesn't cost me an arm as an example. What do I do in terms of being able to be scalable? I have all of these m and a activities going on.

How do I actually have predictable costs? So on, so forth. It's very hybrid environment, not moving everything to the cloud. It's not a lift and shift by any means. It's a very hybrid sort of environment. Yep. Um, so that's the, that's the second thing from a simplicity standpoint. And I think the third thing is just simplifying operations.

Uh, and that's more around the . People process, technology aspect and the organizational culture aspect of it. Getting out of the mindset of we are here, uh, to fight fires, right? And instead of that saying, okay, how can we actually work as a smooth oiled machine? How can we learn from the hyperscalers just in terms of the operations and the itil?

And how do we actually adopt processes to make us better? So are we seeing, so from a cloud standpoint, you have the, the cloud providers, you have the VMware type clouds where we build them out ourselves. Um, You see cloud native applications are where, what are we seeing in healthcare right now? Are we still building out our own on, on VMware kind of thing, or are we starting to see people start to push workloads up into, uh, traditional cloud providers, a w s and, and, uh, Azure?

Um, and are we starting to see, I doubt it, but are we starting to see some cloud native applications start to rise up and from the, maybe from the startups? We're seeing it, but, but not the traditional players? Yeah, no, definitely seeing it from the startups. So . You know, it's like I was having, uh, breakfast this morning with a gentleman from a w s actually, and he mentioned the book Crossing the Chasm, and it, I, I had read it years and years ago, but it jogged my memory a little bit.

And he also mentioned the different stages of adoption and adopters that are out there. So, uh, applies very well to the question that you just asked. So a lot of the startups that are coming in, they're cloud first, right? They have to be, they don't have the ability capabilities to be able to, you can't scale up.

Scale, right? Um, they're, they're seeing and they're running into . The problems that, that, you know, all of us, both of us for sure could have told them that they would, they would run into, which is, uh, big, burly, sort of everything is in, within my four walls. Healthcare organization with a lot of data and data all over the place.

Right. Um, and so how do you actually connect the two, uh, very poorly or, or very expensively, right? Right. Then you have organizations like Google. I don't know if you've walked around and seen their boot. The Google Cloud, the GCP boot is massive. It's about half the size of the epic. Which is saying something.

Oh, wow. Uh, and so G C P has made a big, huge investment in healthcare. So what they're trying to do is they're trying to fund, uh, healthcare organizations to try to get some of their data into G CCP so they can take advantage of some of these machine learning algorithms and so on so forth. But for the most part, we're still seeing folks trying to cobble stuff together and say, okay, how can I actually take advantage of the cloud?

What I really feel we're ready to do now is working with partners like VMware and Citrix that have been in healthcare and get healthcare for a very long . Long time and deal with all the peripherals and deal with all the stuff that you have to deal with in a healthcare environment. Working together with them to take this whole hybrid approach, right, that says, I have stuff on premises.

How can I actually start to migrate some of these things to the cloud? But things that make sense, for example, and still have a single pane of glass that's the most important. Again, operational simplicity. We talked about that. Yep. You know, the hyperscalers don't have 17 dashboards and 27 widgets that they have to deal with.

They have one. That's where we need to get to. And even automating . Workload. Exactly. Uh, movement throughout, you know, cloud in and out. Exactly, exactly. Uh, data. Yes. So we, we heard this morning, um, sense of urgency. Now is the time. Fire new, uh, regs released yesterday, really pushing the industry, uh, forward.

Um, and you know, I, I saw a, uh, post this morning from, uh, health Catalyst and others that they have taken their applications and moved them to Azure so that you can, you know, 'cause . We have a lot of Microsoft SQL kind of people in our environment. And so you get a lot of the benefits of the cloud, but you could still bring your traditional, uh, talent along with you.

You don't have to learn a whole new stack. Um, so from a data standpoint, where are we at? I mean, we still have a, as you said, 500, average 500 and uh, and I would think some CIOs would say right now, boy, you're lucky if you only have 500. Yeah, exactly. Absolutely. So where are we at? Are we breaking down those silos?

Is fire starting to. Make a dent. Are there technologies that are starting to, I don't know, sit at a layer above all these clinical applications and pull the data up? Uh, you know, I, I think the, the good news is that we're talking about it, and I think that that's a, a really good first step. And I know that some of the stuff we've been talking about for many years, but we're starting to talk about this at the C I O and the c e o level now, where they're talking about digital innovation, right?

How do you get to digital innovation? Well, you leverage data. How do you leverage the data? Well, oh my goodness, I have all of this data all over the . The place, none of them talk to each other. Now I need a platform that actually can bring some of this stuff together. Right. Um, so there's a few different approaches and I, I've, I've recently talked with a chief data officer over at Cleveland Clinic, talked with the ex chief data officer at Intermountain Healthcare because I'm, I'm very, uh, much a fan of deep learning and, and, and really extracting meaning from data, putting data to work, is what I call it.

Right. And so they, they both have slightly different approaches, but they kind of converge in one things. You think about it in terms of data in an organization like a triangle. Uh, and the, the widest amount of data is at the bottom, and it's also the widest use case. So if we are actually able to take that and turn that into some basic automation to give you some basic KPIs to help you drive your business forward, either through clinical outcomes or financials outcomes, whatever it is, right?

We're already starting to make progress there. So this is very different than what we were talking about many years ago, which is like, oh my God, we're gonna apply machine learning and AI and solve cancer, right? But is the platform you're talking about, the e h r, are we, are we looking at, so it depends on who you ask.

Okay. Right. So if you ask the e H R vendors, they will say it's the e H R. Um, I, I still believe that the e H r they're making, you know, epic. For example, my alma mater, I came from there. I have a lot of respect for them and I talk to a lot of the folks there. Um, they're making some really good investments and really good progress in terms of native capabilities within the E H R to be able to provide these

Learning models and be able to drive meeting from the data, that's the best place for it to be. 'cause for it to be actionable, it ought to be as close to where Well, you have to get it into the workflow. Exactly right. And so, so they're making good progress there. Uh, then we have, uh, healthcare organizations or, uh, ISVs, companies out there, health Catalyst, a few others that are trying to build a platform that allows you to be able to go and extract data from various places and make meaning out of it.

And then leverage on top of that sort of a, a, a model that you can actually build. The data. Right. So there's, there's a lot of those opportunities out there. A lot of the, the various companies out there. I really think that it's sort of a hybrid model even in that world that works. Well see, I'm not sure I agree with you.

Okay. I think it's the worst place for it to be is in the E H R. Now we have to get into the workflow. I get that for the clinical, but again, outcomes, 20% is based on the, the episodic clinical events and 80% is social determinants and whatnot. Yep. It's best in the hands of the . Consumer. So you need a platform that can get it to the consumer.

And when we think about Silicon Valley, it's not that one company does everything. It's that companies enable other things to happen on top of it, right? So if we get all that data, including housing, data, education, data and whatnot, into a different platform, 'cause that's not all gonna go into the h r that is able to be accessed, you know, for, uh, utilizing a w s machine learning and AI and Google Machine learning and ai.

Um, and then bring in 30. Third party apps that are gonna be able to tap into it and those kind of things, that's gonna be far better than a, you know, again, we're talking about 19, well, maybe two thousands technology, uh, that's trying to a, a adapt instead of having something that's sort of purpose built for sharing, uh, analysis and, uh, research and discovery.

I absolutely couldn't agree with you more. Completely agree with you on there. I think that there's, you just don't want to offend your former colleagues. No, that's fine. They, they. I, I, you know, I've taken a lot of, uh, licks for, for saying other stuff too, but, um, I think Bill, we need to split this into two different areas, right?

I think one is the here and now, right? And one is the what can we do in the go forward sort standpoint. My challenge with healthcare today is that there's so much stuff that we have that we could do stuff with that we're not doing anything with today. Right? But you have to keep it running today too.

You have to keep it running, right? So have the bimodal aspect, right? Right. So you have to keep it running, but there's so much value there that we're just . Us not really taking an approach that is scalable and that we can then go from very large IDNs all the way down to community hospitals and make available Nick or Vic.

I would thank you. Yep. I, I, you know, I try to keep these things to 10 minutes. I'm sure this is gone beyond 10 minutes 'cause I just, I love this, this level of conversation. I really appreciate it. Absolutely. Thanks. Thanks. I hope you enjoyed this conversation. This show is a production of this week in health.

It. For more great content, you can check out our website at www.thisweekinhealthit.comortheyoutubechannelatthisweekinhealthit.com/video. Thanks for listening. That's all for now.

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