Andrew Rosenberg from Michigan Medicine, David Chou with Children's Mercy, and Jake Dorst of Tahoe Forest Hospital District. A casual conversation about Digital Strategy in healthcare today.
Bill Russell: 00:06 Welcome to this week in health it where we discussed the news information emerging thought with leaders from across the healthcare industry. This is episode number 38, and this week we have a special episode from the Becker's Conference in Chicago where I interviewed six different cios and ask them a series of five questions. Jason Joseph, the spectrum health cio, Jake Dorst, Tahoe forest, David Chow, a cio for a children's mercy, Andrew Rosenberg, Michigan Medicine, Ed marks, Cleveland Clinic, and Tom Barnett, the University of Rochester. Uh, so much content that we split it across two episodes. I'm going to release them both on Friday. So you have a lot to listen to this weekend. And, uh, we're gonna start with Jason Joseph and then move to Ed marks and then Tom Barnett. And then in our next episode, we'll, we'll listen to Andrew Rosenberg and jake dorst. So without further ado, here we go.
Bill Russell: 00:57 Jason Joseph, Cio, newly minted cio for spectrum health. Give us an idea of spectrum health scope scale. Sure.
Jason Joseph: 01:05 Spectrum health is a integrated health system located in western Michigan. Uh, we serve primarily about the 13 county area surrounding grand rapids, uh, we're growing and proposing a integration down in the southeastern or the southwestern part of the state with Lakeland, uh, but we really cover a much broader scope of that from a patient population due to our children's hospitals. So we have a children's hospital that covers the majority of the state and actually beyond the walls of the state on occasion. And then we have a health plan that has a round 800,000 members and covers the state of Michigan a completely. So we're a little bit unique in that our health plan and our delivery system are similar in size from a revenue perspective and do not have a full overlap. So we have patients who are members, members who are patients, but we also have members who are not patients under our care and we have many patients who are not yet member.
Bill Russell: 02:05 So you're the cio of the system. and the health plan,
Jason Joseph: 02:08 I am the system, a cio, correct. So I have responsibility for information services across the board, which includes our hospitals, our medical group, our postacute services, our health plan, and our other corporate entities as well.
Bill Russell: 02:21 Wow. Sounds like a lot. I uh, alright. So five quick questions. I asked Ed Markey, same questions. I'm gonna ask a couple more people. So it's great. They're gonna sound side by side. So people are gonna you can compare and their relative. It's mostly just different approaches to the same sound question. So, uh, we'll start off pretty easy with the first question. How has your system thinking about digital or addressing digital in healthcare?
Jason Joseph: 02:46 So we've been in the digital business for quite a while. We've been a leader, I think our initial patient portal dates back to 2008, if I'm not mistaken. So we're 10 years into the patient facing digital tool set journey. Uh, and we've been in multiple iterations of that. Uh, our digital approach has been that of providing digital services and integrated digital services to our patients and members, uh, in the way that they need them when they need them. We have a mobile first strategy along with that, so everything that we do online, we make sure it's available on our mobile solution as well as in the, the other type of environments from an engagement perspective. But if I were to kind of zoom out and think about digital, I think of it in three categories, digital used for patient acquisition, um, digital marketing. How do we understand and manage the consumer of healthcare, how do we do outreach, how do we communicate?
Jason Joseph: 03:41 Then there's a digital engagement which is essentially in my world, you know, think, think back to the early days of Amazon, right? Amazon started selling books online and it was the online services that got you. There was still a paper book, but it was a new digital way of buying. I think our patient engagement or member engagement services really highlight the ability to interact with our health system and get the type of thing done that you need. That's becoming more and more mainstream and more common. And then I think the really third area and the emerging areas around digital health and that is actually converting the healthcare that we provide from an analog type of equivalent to a digital equivalent that can take the form of virtual, where you're removing the barrier of space between the patient and provider that can take the form of artificial intelligence where we can take some of the low acuity things offline, it can take the form of really looking at the waste and the delays in healthcare and finding ways to automate or use advanced analytics and new technologies to get in the way of those things. And I think that's the area that you're going to see the most innovation in the years to come.
Bill Russell: 04:52 Digitizing health care is really interesting changes to the access method as well as the data back end. One of the things I've been sharing with people is I just read a Stephen Klasko CEO of Jefferson shared a health system without a zip code is his 10 year vision. And digital plays such a key role of kind of access, uh, you know, delivery and all sorts of things. It's just staggering to think what that might look like. Second question, how do you determine the noise from the value in the digital space? So you just finished, finished speaking at the Becker's conference and about 10 vendors surrounded you with their cards and whatnot, but one of those might be awesome and nine of them might just be noise. How do you, how does your organization do that?
Jason Joseph: 05:39 You know, I think healthcare is in such an interesting time right now. And, and in order to separate the noise or the signal from the noise, you need to separate the strategy from the things that are opportunistic. And as I think about it and look back our core, our system just went through a big epic implementation as many have and the leverage that investment, you have to understand the roadmap in the development that's going into some of your core platform vendors and for my money, if it's anywhere near that core, that's our answer. Um, and that's really the strategy that we're going to employ is do not invent what you don't need to invent.
Bill Russell: 06:14 So you're encouraging people. If, if my emr provider does this, go somewhere else,
Jason Joseph: 06:20 if my emr provider does this, I would. I wouldn't tell people in the startup space this as well. If you're trying to compete and go after other clients with functionality or tools that epic has or will be providing as part of their core in the future, you will not outrun that bear and they will supersede your functionality at some point in the future in the fact that it's all integrated is always going to trump whatever incremental functionality had so not to be disparaging and say, you know, don't innovate, but innovate in the right space. Innovate in those spaces that don't have a core adjacency to the stuff that we've all spent millions of dollars putting in and implementing and we're now trying to optimize and get our value out of. Help us in those areas where you can add on top of the value and start to think of it differently. If you'd want to compete with apple, your Samsung, and that's probably one or two or three vendors in that space that are going to be successful. However, if you want to be an APP developer on the APP store, there is a huge marketplace for you. Just recognize when you're on the platform and when you're actually selling.
Bill Russell: 07:21 Yeah, that's. No, that's really fascinating. I work with a lot of startups and they say, I don't understand why this health system doesn't buy my stuff. They need it. It's absolutely necessary, and I say, well, do you realize it will take them probably 18 months to impliment it just it just from a contracting standpoint, it's gonna be six months
Jason Joseph: 07:38 contracting, implementation, change management, understanding the workflow integration points, and then you look at whether that problem is actually the biggest problem. The healthiest may be a problem, but it doesn't mean it's the biggest problem and we all have finite resources in terms of money and time to spend on this stuff. We've got to be judicious about how we do it.
Bill Russell: 08:00 Absolutely. So what's the biggest opportunities for health it right now? You're talking to a whole bunch of CIO's potentially. What's the biggest opportunity that you see out there?
Jason Joseph: 08:08 Yeah, I think you could answer that question into two fronts. One, I think that we have a huge opportunity to leverage some of our core and it infrastructure and simplify it so that we are more digital ready. Um, I mean I am a big believer in having a few core systems that you really invest heavily in, but the pace of change as such in our business that you're still going to need to adapt and you're going to need to flex into those strategic opportunities and it's incredibly hard to do that if you've got complexity under the hood. And so I would say do not underestimate how much that complexity will hurt you in the long run if you're not ruthless and rooting it out, not only for the cost but also for the agility that is going to provide you. And so that's kind of philosophically I would say our opportunity is to get more simple so that we can be more agile so that we can innovate.
Jason Joseph: 09:00 And I think the innovation is going to come in two main areas. You've already touched on them digital and how we transform our healthcare systems digitally, some of which will be, you know, very common types of capabilities that we're all going to have in our, in our toolbox, and then there's going to be those things are true, truly differentiating. And the second is how well we use the data that we actually have in our systems to come up with new answers and new outcomes and that's where our business and our clinical competitive advantage is going to come in with advanced analytics and some of these tools, if we can apply those well, we will actually see significant changes in the core of business, of healthcare. There's other things that we do everyday that just helps us kind of make the core a little better. The things that I look for, the things that actually changed the core, the things that say you no longer need that diagnostic process.
Jason Joseph: 09:49 Um, you know, I'm looking forward to a point in time and this may be way out there where you could actually go in and have some medical imaging done. And when you walk out, you're going to get a report because it's so protocolized and the AI engine has become so strong that you're going to get a 99 point six percent accurate report out. Same thing with low acuity. Primary care these are the engines, the intelligence and machine learning is going to quickly make it so that these are, these are realities in the near future and we have to be ready to capitalize on it.
Bill Russell: 10:20 So this is me cheating, but in your, in your session, you talked about the build versus buy sort of, you know, we're going to invent new analytics versus we're going to buy new analytics and uh, you know, it's, it's interesting in this space, how much, if you were sort of to put a percentage on it, you know, it's an 80 slash 20, 90 slash 10. I mean, how much are you actually going to build because you have to, because you need to differentiate.
Jason Joseph: 10:50 Yeah. Uh, you know, I think right now it's going to be closer to 90 10. We're going to buy. Um, and I think as you get better at it, you're gonna build more a because you're going to have the tools and once the platforms are in place that you're not really building the platform, I believe customizing on top. So where I would say are our build is going to come in as our understanding of tweaking the algorithms that we have, understanding and tweaking how the data fills into theirs. But from a platform perspective, uh, you know, you can't have a analytical platform that you build yourself and then have a strategy to leverage your core common vendors. It's incongruent. And so our strategy is going to be to leverage the core to the fullest extent by what's available in terms of reports, dashboards, algorithm, and focus on getting those two actually materially improve our business. Whether that's clinical outcomes, financial outcomes, whatever it may be. And then as we get good at doing that, understanding what it will take for us to actually innovate in that space. Leveraging the same platforms but innovating in that space and actually creating something unique that we may have the ability to do.
Bill Russell: 12:00 Alright, I'll get back on script. What's the biggest threat to traditional healthcare system today? Internal or external, which
Jason Joseph: 12:08 I think it's a boiling frog complacency. Um, all health systems are going through some form of hey our volumes not going down, but we're not seeing the same level of reimbursements at this, at the same thing and we're all trying to figure out how value type engagements play into our business plans and business models. And in the meantime you've got disruptors coming in and saying, hey, we're gonna buy a population and we're going to do healthcare differently. And you know, when you look at the pool of money available in healthcare, this is the thing that fascinates me the most is we look at and we say we spend way too much money on healthcare. Yet we think there's so much money to be made in healthcare. It doesn't seem like there is, um, the way you make money is to actually reduce the cost. So the only money making opportunities are going to be things that are truly revolutionary, revolutionizing the care process and moving it out.
Jason Joseph: 12:59 I think the systems that aren't seeing that and that are just trying to optimize the business that exists today are at risk of having something blow in that they can. They can't keep pace with. I'm personally not as worried about the things that that are kind of flash in the pan. You know, hey, this is cool and you're going to get get it. a new video visit or that kind of stuff. I think we're well positioned to still compete there and there's still time to do it. I do worry a little bit about shifting the eyeballs of the consumer, owning that relationship and then taking away the things that do pay the bills for the health system in favor of the things that don't and not addressing that disparity. It's going to leave us all in a really rotton position if we don't manage the.
Bill Russell: 13:46 That's the. The challenge is you have one one foot in each boat and you're saying, okay, we're going to disrupt our current business, but when we can disrupt our current business or revenues come down, therefore our bond rating comes down. Therefore, our cost of debt goes up, you know, it's like you, you're, you're reinventing as your maintaining.
Jason Joseph: 14:03 There's a very narrow path to walk to get from here to there and there's history is riddled with examples of businesses that did not do this well. Um, you know, everybody has the Kodak moment in their mind about how do you actually go there. Um, and that's, I think the challenge for healthcare is making sure that you're both cognizant of the financial realities that we live in today, but starting to shift to take advantage of the financial realities of tomorrow. And if you're doing that well, you'll be successful if you get off track one way or the other. It's gonna hurt.
Bill Russell: 14:35 Great. Last question, if you have a new CIO here, the second new cio. So I talked to mark last night and he's only a year into it. So this question's kind of interesting, but if you could rewind the clock three years, what do you wish you had done a three years ago to really prepare your it organization for today?
Jason Joseph: 14:53 You know, um, I think we have a tremendous talented organization, especially in West Michigan. I mean, we've got great access to schools. We have a strong internship program. We really have very, very strong, very, very strong teams. If I had to rewind the clock, I would say that we could've done even more to develop leadership, talent, tech, talent, leadership, talent and moving people along very prescriptively to make sure that we always have a next layer of leaders ready to go across. Our organization is going to challenge all of us. I mean the demographics are changing. You're seeing leaders retire and move on, uh, at, at a more rapid pace and uh, you know, it's going to be incumbent on all of us to make sure that we're not only stepping into that void, but we're preparing the next layer of leaders. And so I think that you can't spend enough time really thinking through how do we develop a high talent, um, impactful organization and with within it, you've got to have the technical chops. You've got to have your it talent, but there's so much more that is going to be needed for that in the future in terms of business acumen, communication skills, strategic thinking. We got to start now and I wish I would've started even sooner. Placing more emphasis on that than we have.
Bill Russell: 16:09 Well, yeah, thanks. I will have to have you on a full show because there's like we could talk for another half hour and most things, so yeah. Thanks for your time.
Bill Russell: 16:22 Next step Ed Mark's Cio for the Cleveland Clinic,
Bill Russell: 16:26 give us an idea of the size, geography, real quick and focus. I think we assume everybody knows cleavland clinic.
Ed Marx: 16:33 Well it's about a $9,000,000,000 organization, but what we measure is lives touched not the dollar amount, not the bedsides, that lives touched. So we touch one point 8 million lives and our hope is to really triple that essentially in the next five years. So we have our, our main hospital, their original hospitals, cleveland, Ohio. Been there over 100 years and since that time we branched out Canada, we've branched out to Florida, we've branched out to Abu Dhabi, we're going live with our first hospital in London in 2020, so we continue and we have a lot of partnerships around the world in China and other areas so we continue to expand globally, but our heart and soul, it remains Cleveland and Florida and again, we have some other states too like Navada, but heart and soul will always be Cleveland and Florida.
Bill Russell: 17:27 So I got to visit you up in Cleavland and uh, your CEO gave a presentation. The one of the things that struck me is obviously the, the reach is amazing and the uh, the research and, and the workflow and the things you guys do is really amazing, but the architecture of your Nevada facility, when I saw it as a, that's unique.
Ed Marx: 17:47 Yeah, I love it. The benefactor there is quite a, has an interest in design and I think it's appropriate for what we do there specifically.
Bill Russell: 17:56 Absolutely. So here's the five questions. So the first one, how was your system thinking about a digital or addressing digital and healthcare?
Ed Marx: 18:03 So the most awesome thing, not the most awesome thing but one of the most awesome things at Cleveland Clinic is if you were to hear my boss, the CEO, Dr Tom Holiday, it's speak, you would think you're hearing a cio. So he loves, he believes in digital, he believes that's the future. So we have a lot of emphasis on it. So are we believe the future is all about digital. So everyone is really focused on taking them advantage of that.
Bill Russell: 18:32 That's awesome. The uh, uh, so second question, how did you determine the noise signal from the noise? Really in the digital space. There's so much going on. I mean, ai machine learning, you have all these murders, you have consumer yet silicon valley, Apple. I mean, how do you determine that? That's real for us, that's what we're going after. versus, that's just annoying.
Ed Marx: 18:55 Yeah, it's tough. There's a lot of good ideas out there and you don't want to miss any, so you need to have good processes. But for us, we're, we're in the midst of developing a strategy for the entire enterprise and as we're going through that process, we have nine different work streams that look up, look at everything from patient engagement, caregiver engagement, technology, growth risk, those sort of things, and all of them touch on digital. And so we're coming together now with a single vision, a single plan. So if something doesn't align with the plan, we see that as noise, we only have finite resources, we really have to focus now in order that we don't miss anything. We also have a separate innovations arm so it's quite large. So we have a separate innovations arm, we have a separate ventures arm. So we have a group of uh, individuals who invest in startups and other companies. So that's our adventures arm. And then the other arm we have is our investment arm. And so we look to them to help make sure that we don't miss anything out there. On the periphery.
Bill Russell: 20:01 Thing I like about this interview is I'm going to be talking to smaller health systems. I mean, your 9 billion, so you're gonna have a venture arm. And those kinds of things and uh, it's exciting to see what you guys are doing in providence that dignity and others that have a fair amount of resources, but those smaller players, every time you say an arm it has to be partners. They just have to go out and find people that they trust and a partner up with them. even if it's another house similar, an innovation arm or who's.
Ed Marx: 20:26 Yeah, and we've the, we do the same. So we have partnership relationships with a couple of companies or that are emerging that we're going through the process right now because we believe one is too small, number per greatness. So we can't do it all. We don't have, we don't, you know, we don't have a lock on all the innovation that's out there. So we definitely look to partner other organizations.
Bill Russell: 20:49 So a third question, if you were talking to every cio, every cio is sitting here right now. It's a chime event. What's the biggest opportunity in health it right now?
Ed Marx: 21:02 It's not blockchain. I think the greatest opportunity is for us to become better partners with the business. Said I still see a disconnect generally between it technology and all the capabilities we have and the rest of the business. So rather than telling you some sort of technology and give you a technology answer, I really think it's showing up that relationship and for us the is to step up as a business partner. I'm even still learning that. I learned it. We went through this process recently to seek funding for major project and I learned it again and as I learned more about myself, I learned more about process. I learned more about how important it is that we are seen as equivalent peers to the, to the other senior executives and that we're a partner.
Bill Russell: 21:53 Yeah. I love that answer because I think the biggest, one of the biggest opportunities we have is our awareness going from hero to teammates. Yeah. And, and that's a huge shift and for us that's a burden off of us, but it's also an opportunity to speak into strategy.
Ed Marx: 22:11 Totally. That's so much fun. Like I said, we're developing strategy now as an executive team and all of these work streams, that common thread is it technology enable that digital and so now is the time to step up and lead. It's not like. So you know, the other thing that gets me sometimes is it people say it should never be leading a project. Should we always have our business sponsor and I don't believe that at all. I think in the old days that was true, but if we're, if we consider ourselves equals at the senior table, then we better step up just like any other person at the table and lead. And so. So I took ownership actually today have a huge initiative for probably the biggest one that's going on in the health system and you know, first in my back of my mind I was like, well no, it shouldn't be this other person, this other person. But then I thought, no, no I, why? Why shouldn't it be the CIO?
Bill Russell: 23:04 Fourth question, what is the biggest threat to traditional health, the healthcare system today?
Ed Marx: 23:14 Well, I think there's a lot of things, a lot of challenges that we deal with and I think it's a little bit dependent on the organization and where it sits and, and you know, in terms of penetration of value based care and those sorts of things and the payer mix, I think we are threatened by extinction. So because we are so traditional and haven't really embraced this whole concept of digital, we're going to go away. Brick and mortar healthcare largely is going to go where their specialty need, but by and large we need to be thinking what's coming down the horizon and I think it's like three to five years away. So for instance, one of the things that we're working on now is hospital at home. So our, our tertiary care center is 100 percent occupied and that's not necessarily a good thing. So how can we keep patients from being admitted they don't want to be admitted. So what can we do to help them convalescent heal at home? So we're looking at digital in the digital space to help us with that. And so I think the biggest threat is that of extinction if we don't start thinking that way and, and picking up clues from other industries, whether it's Amazon or, you know, my, my, uh, financial insurance company, Usaa a very, very progressive. And if we don't start learning from them and making changes and then we will be extinct.
Bill Russell: 24:34 Absolutely. Dr Klasko, uh, just gave an interview and you talked about their health system talks about, uh, a health system without an address. Yes. No, no distinct physical location. He said, I, he believes that's the future. I've heard him say that. I've heard Rod Hochman says, now I'm here at Cleveland Clinic. So the leaders are really recognizing that the model is changing and that's disruptive.
Ed Marx: 24:58 Yeah. I, I call it the fourth dimension. And I always try as we're going through the strategy process, I'm always reminding myself and my peers that we need to think about this other dimension because it's so easy to focus on the brick and mortar and the way that we know practice today. But we have to be thinking in the future and it is this sort of virtual health and that will have a relationship with you even after you move away from Cleveland. So let's say you're, you're, you're a young person, you graduate and you move out. We still want to be a care provider. We can do that through virtual care.
Bill Russell: 25:30 So my last question, and I sort of had fun with this one, but may not be appropriate for you because he hasn't been there for three years, but if you could rewind the clock three years, what do you wish you had focused on three years ago that would prepare you for what's going on today? I mean, you weren't there three years ago. It's kind of an unfair question, but if you were there three years ago, what do you wish. I mean, obviously the blocking and tackling is easy stuff, but is there a, an emerging technology that you're like, man, I wish we were a little. I wish we'd gotten added on.
Ed Marx: 26:03 No, I think we're, you know, I. So I'll answer it from a year perspective. I think we've brought the appropriate amount of attention to emerging technologies and we're starting to push the envelope a little bit, so we're doing some pilots like hospital at home that I mentioned. We're starting to push the envelope a little bit. I think the area that I would have doubled down on, it's just the team stuff. This is all basic and everyone listening probably knows this already, but I know it too but I still suffer from it. Uh, you know, building the right team from the get go and making hard decisions right away. So I knew certain decisions in terms of developing the team and I waited and I waited, I waited and then I made it. Had some false starts. So if I could go back, that'd be really focused first on that team. Fantastic.
Bill Russell: 26:50 Well thank you for your time.
Ed Marx: 26:52 My pleasure.
Bill Russell: 26:54 And now our last guest is Tom Barnett with the University of Rochester Medical Center.
Bill Russell: 27:00 Yeah. Introduce yourself and, uh, the health system and the scope of the health system. Sure.
Tom Barnett: 27:05 Tom Barnett, a cio for the University of Rochester Medical Center. We are a six hospital with our affiliate organization. About 1400 beds a total, um, but a 900 member, um, medical faculty group. Uh, and uh, we also have our medical school and nursing school in dental school also under the umbrella. So it makes it kind of interesting.
Bill Russell: 27:30 Yeah, I would imagine. So is Rochester. I might get this wrong. Rochester were. Kodak is absolutely. It is. Yes. So you, when you guys talk about the Kodak moment, you're really, it's probably not something you guys talk about all that much given the similarities. I grew up in Bethlehem, Pennsylvania. Bethlehem steel was the largest employer, uh, up until I got to high school. And then they ceased to exist.
Tom Barnett: 27:53 Absolutely. There's a lot of, uh, there's a lot of history in a lot of deep roots with, with Kodak in Rochester area.
Bill Russell: 27:59 Although I was driving in, I was driving up towards, in the Midwest, I drove by a Kodak facility. So they're still around. They're still doing okay.
Tom Barnett: 28:08 Absolutely. It's still around now. They're not quite the size they used to be, but they, they definitely have focused on a few really specific niches right now and seemed to be, seemed to be surviving.
Bill Russell: 28:18 Alright, so I have five questions. I've, I'm, I'm talking to five different Cios while I'm here. So we'll splice these together. Um, you know, maybe we'll play family feud with somebody at some point. The top five answers from cio are on the board. All right. So first question, how has your system thinking about digital or addressing digital within healthcare?
Tom Barnett: 28:39 Uh, the digital from a patient engagement perspective.
Bill Russell: 28:41 It could be patient engagement, could be a physician experience, could be, um, you know, the, the, the first question is almost purposely vague, but to be honest with you, everybody went straight to consumer. So if you want to touch on the, you know, what, how digital is transforming the clinical experience.
Tom Barnett: 29:00 It's almost like those, those two way mirrors, if you think about it, I always think of the Emr is a panel that sits between two people and one a side event of that mirrors what the patient sees. So that's how we're asking them to interact with their healthcare through both a patient portal or or any other method that they're using to get data back to their physician. But on the other side of that panel is where the providers at the physician and we've got to balance that equation because if you focused make everything work well on the patient side, you could end up with this satisfied or or overburdened providers and we've, we've done that. Yeah. And to a certain extent and I think the Emr takes a little bit of a knock in some of those instances. It's almost a case of shooting the Messenger and not every case, but in some cases because as you know, a lot of that is regulations that are coming out either from Washington or from Medicare, Medicaid and so forth. So part of that is it's a frustration point for everybody.
Bill Russell: 30:02 The classes I think class put together, the arch collaborative published their results and it was interesting how many of these. You can actually look at it now and say alright, this much of it was self inflicted like we, we didn't train right? We didn't do it right, those kinds of things or we made wrong subjects, but then there's the the other side which is the technology just needs to come along. I mean we were on the cusp of a lot of things like voice and a voice interaction with the Emr is right there and a mobile digital experience, those kinds of things. But we're, we're just, we're on the cusp so everyone's like, hey, I could do this in my shopping experience. Why can't I do this for my clinical experience? Like, well,
Tom Barnett: 30:42 and it's very. It's very. It's a more complicated model obviously within. Oh
Bill Russell: 30:46 sure. Absolutely. If Amazon ships the wrong box, no one.
Tom Barnett: 30:50 Yeah. I had a discussion about a year back with an executive who left Amazon and he's now with a large outfit on the, on the west coast and he's in his mind, he said, I'm going to bring the Amazon model and everything I learned to healthcare and he said in The first thing I realized in the first two years into that job is that it's a very. Healthcare is people and it, it, it's a very different model from the way Amazon works.
Bill Russell: 31:15 Absolutely. A second question, how do you determine the noise from the signal, the noise to value in the digital space so clearly, or you just got done speaking with beckers. You walk off stage, you get 10 cards. Now, one of those is gonna be, you know, you should absolutely be doing it, but you've got 10 cards. So how, I mean, how do you determine which, which of these make sense? How does your organization sort of, um, uh, you know, is it supply side, demand side? Are you looking at the market and saying that's something we should be doing? Or are you just say, hey, these are the things that we need to be successful at where we're a good evaluator
Tom Barnett: 31:50 based on. I think there's a lot, as you know, that comes at you from 360 degrees. One of the things that we've found at the last health system that I was with a that I'm absolutely applying now at, at University of Rochester Medical Center is you always start with what problem are you trying to solve? So you're inundated with new technologies, with new widgets, with new everything, but if it's not playing directly into one of the use cases that we're focusing on, that's kind of not that. It's noise. It absolutely may be valuable, but it's not what is a priority for us at that point in time. Yeah.
Bill Russell: 32:24 I'm always talking to startups where they're like, they absolutely need what I have. I'm like, the timing might be wrong. It might not be the most pressing problem. I have. It's hard for people to really understand that there's a lot of problems to solve. It's not
Tom Barnett: 32:38 when you're digitizing and you have to relook at everything from the people process, tools perspective, and to end in healthcare, it's best to get one thing across the finish line and make sure it works well as opposed to have 22 different unfinished jobs.
Bill Russell: 32:51 Exactly. Uh, so third thing, uh, what are the biggest opportunities for health it right now? If you were talking to cio is across the board. Um, you know, what's the one, the one thing you'd say this is the biggest opportunity for a health system from a tech with that technology,
Tom Barnett: 33:06 from the technology perspective. Uh, I, I still believe analytics is the big one. So getting enough access to data scientists and folks not necessarily from within healthcare, uh, who bring experience and other points of view from outside of that industry, uh, is one key area that we can definitely see that, that kind of growth in.
Bill Russell: 33:26 Yeah. I'm going to want to have you on the show because we, everybody who comes on now, I talked about analytics and the reason I do is because every health system has sort of a different model for how they're implementing it and it's really fascinating
Tom Barnett: 33:38 and that that's the, I think the big area, but another area onto that that maybe might not be as sexy but can have just as big of an impact now that the Emrs, are rolled out to a large extent. A optimization is something that a lot of health systems are they need to do, but not everybody knows how to do.
Bill Russell: 33:56 Yeah, that's, that's interesting. So forth. A fourth question is, what are the biggest threat to the traditional healthcare system today?
Tom Barnett: 34:06 Uh, that can be,
Bill Russell: 34:09 yeah, you were just on a panel, Amazon, apple, and I think, I think what Scott Becker was trying to get out of you guys was, is this a threat to you? And none of you would take that bait. You're just like, well, there's so many different changing models. Is this one really the threat
Tom Barnett: 34:25 really is. And this is the one that I was thinking about. So, um, before while I was still in college, I began a job with ups and you kind of learned as you're working there, how did the united parcel service kind of model work at that point in time? Um, ups was breaking even from a cost perspective on each house delivery that they did. So the key at that point is you want more than one delivery per house because that's where the margin is made. Uh, so case in point gateway, remember gateway computers, cal colored three boxes to house, those were good deals they have back then. But then there was this company called roadway package service rps that spun up on the side and said, we're not going to do home deliveries. We're only doing business deliveries. Businesses mostly get more than one package per day.
Tom Barnett: 35:13 So they targeted right in on the most valuable aspect of upss business. Fast forward to now within the healthcare space, particularly in an integrated development or an integrated delivery network, ambulatory and inpatient. It's a very capital intensive, very costly a company or business to be in from that perspective when you seen the Walmart's or the amazons or the groups that are spinning up and trying to take, you know, telehealth or um, you know, primary care visits, urgent care visits, they're starting to peel away at things that are part of the overall health system business model. So the threat that I see as some of those, enough of those start to peel away and you're left with, in effect, the hard stuff. The is we're referred to previously the tertiary quaternary care things and once you lose that portal to the patient, the people who own the portal are going to be able to steer where the traffic goes. And I think that's our biggest threat.
Bill Russell: 36:14 I was a at a, uh, an event and we were sitting around having drinks and there was a couple of ceos at the table. I remember somebody posed the question of, what's the number one thing you're afraid of? And this one ceo just looked at us and said that somebody's going to figure out a way to empty my OR. Cause they empty my OR, I can't run the rest of it. I was like, wow, that's interesting. Now, granted that's a long way off, but I could,
Tom Barnett: 36:42 I could see not outside the realm of possibility.
Bill Russell: 36:43 Yeah, really scary. Um, how long have you been in this role? This role? Two years. Two years. There hasn't been a cio yet that has been in their role for three years, which will make sense in a minute when I asked this question, but if you could rewind the clock three years, what would, what do you wish you had done three years ago to prepare your it organization for today? So two years. Well, three years ago to prepare the current. Yeah. So you're the third CEO I've talked to so far. None of you have been in your role for three years. I don't know what that tells me, but it's.
Tom Barnett: 37:16 Well, it's the old, the old adage, Right Cio stands for career is over. Yeah. Um, I think the, the focus on from an it shop, they've been so battered I guess is the word from so many different directions. There's so much to keep up with changing technologies, increasing demand and that ability to focus on a lean workflow and throughput for an it shop. I think that ability to focus on what they're doing and how to do it in the most efficient way so that you can do smaller work efforts and deliver work quicker, um, is probably one of the biggest areas that I see the opportunities for the internal it shop.
Bill Russell: 37:58 So driving a, it's almost the conversation they were just having about Ai. It's driving the uh, efficiency higher in some areas, let's say it's provisioning servers and those kinds of things so that the team could focus on.
Tom Barnett: 38:13 Absolutely. I think, um, the industry has changed so much. The IT industry, not just in healthcare in older days, not too long ago actually. You could kind of operate in a plan, build and operate model and that's the way everything could work. Things are evolving rapidly and now it's kind of, I think the acronym that I heard is it's more in the, uh, it's broker the orchestrate and the integrate. Uh, and it's, it's this constant cycle of staying abreast of what's out there. Being able to integrate it and making sure that you're putting the right combination of technologies together to be have the biggest bang for the buck for the health system.
Bill Russell: 38:50 I was mentoring one of the people at my staff and he said, what do I have to do to be a cio? I said why do you want to be a cio? He says well because you get to make all the decisions and I'm like, and I got to step back and say, what do you think the role is it as he sort of described it, I said, you're describing the chief technology officer. You're not describing the chief information officer, but I think what was interesting is that was know three or four years ago I was having that conversation. I think even the chief technology officer is a people job now it's a people narrative. How do we, how do we orchestrate people, how do we bring people along? How do we, how do we, how do we change culture? I mean, so there's very few pure technology jobs where I got into this because I love a computer. I love making them do things. There's not as many of those roles in it anymore. It really is
Tom Barnett: 39:40 a, a, a colleague that I used to work with WHO's a, who's now a cio as well. He said five percent of this job is the technology. Yeah. 80 five percent is the politics and the people.
Bill Russell: 39:51 It's people job. Yep. Well, thanks Tom. I appreciate, appreciate the time and uh, yeah, look forward to look forward to having you on the show into the future.
Tom Barnett: 40:01 Oh, absolutely. I would love to.
Bill Russell: 40:05 Well, I hope you enjoyed that. It was a blast making it. I really appreciate these gentlemen coming on and discussing some of these topics with us given their busy schedules with most of these people on the show spoke at some point at the Becker's conference. So I really do appreciate them taking the time. Uh, that's all for this episode. Please check out the second episode where we talked to Andrew Rosenberg with Michigan medicine. Uh, Jake dorst and David Chow are also on that episode as well. And, uh, you won't want to miss that. Uh, please follow us at, uh, our website. Thisweekinhealthit.com. You can follow me @thepatientsCio, follow the show @thisweekinhit. And, uh, please come back every Friday for news information and emerging thought from leaders from across the healthcare industry.