They Thought They Had 25 AI Tools. They Had 250

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They Thought They Had 25 AI Tools. They Had 250

[00:00:06] Sarah: Hi, I'm Sarah Richardson with The 229Project and I am joined today by Christian Boucher, Healthcare CTO and partner at Island. Christian brings decades of technology leadership and works closely with health organizations navigating the tension between secure access, operational simplicity, and the realities of clinical work. I'm especially excited for this conversation because I've seen the product firsthand, I've implemented the product firsthand, and I believe Island is approaching a difficult healthcare problem in a genuinely different way. Christian, welcome to the show.

[00:00:37] Christian: Thank you for having me, Sarah.

[00:00:39] Sarah: Of course, I'm going to jump right in and say that you have spent decades helping healthcare organizations modernize their technology. What did you see in the way clinicians and staff were accessing applications that convinced you the browser itself had to be rethought?

[00:00:57] Christian: Well, there's a couple of pieces there. So, you know, I was brought into healthcare by my wife, who's a nurse. And, you know, prior to that, I worked in, you know, financial services. I worked for semiconductor firms. I did a lot of different things. But once I saw the mission of what she was doing and her friends and I really bought into it, but I realized, I mean, early on when I started in the provider side,

[00:01:21] Christian: we were just really converting over to like desktops everywhere. They may have had one or two in some specific areas, maybe at the nurse call station, but it really started to explode and they brought me on to kind of build that. And I've always been, you know, a user focused design, whether we are building out, you know, new infrastructure to support, you know, these large scale clinical systems or, you know,

[00:01:45] Christian: engineering a new network to support, you know, the growing, you know, hospital based systems into the health systems where you're reaching out to various, you know, physician practices. It was always my focus was always how can I improve this user experience, especially if you were injecting technology into things that historically have not been there. So that was my first kind of thought is, you know,

[00:02:09] Christian: if we're going to be making these drastic changes to the way clinicians are interacting with technologies or for the first time in some instances, how do we make it as as streamlined as possible? And there's been a lot of iterations of how technology has been involved. But as you've seen over the last 10 to 15 years, you know, with epics moving to web based delivery oracle and surner, they're there, you know,

[00:02:31] Christian: they're their EHR 2.0 for the last decade and a half. These systems has been migrating into web based delivery, but they're still leveraging, you know, essentially, you know, the largest free we have project on the planet with these, you know, commercial browsers. And, you know, they're not really designed to support all the various requirements that health care

[00:02:55] Christian: and financial services, all these verticals that have very, you know, hard rules and regulations around how data is transported, how users are interacting with that data, the control of what that happens. So when I first started seeing this transition, it was interesting because it's historically been a Windows based world, you know, Windows rules the world.

[00:03:18] Christian: But what the real challenge was was, hey, of course we can display web content. That's, you know, any browser can do that. But it doesn't solve the real problem. So you've seen historically where customers and inventors have come around. Let's bolt all these additional pieces onto the browser. Let's run it through a sassy network.

[00:03:38] Christian: Let's break and inspect all the traffic, which essentially the browser was designed to make it simpler and make it easier to consume those resources.

[00:03:47] Christian: But at the same time, all the mechanics you had to build behind the scenes to make it secure and to make it, you know, reliable, impacted user experience. So all of a sudden you had something that was operating in a, in a, in a, I would say the main focus was to simplify the delivery of it. And then you've added all this complexity on top of it just to make it somewhat usable.

[00:04:11] Christian: And, you know, with what we saw with a lot of the clinical workflows is they just broke. They, you know, while they could access it, it didn't work the way the clinicians needed it to work. So focusing on how do we, you know, make sure that we're working towards, you know, what are the dynamics that you need to have to happen for a nurse to do her job? Because I hear it on a regular basis from my wife about things that get in the way.

[00:04:37] Christian: And let's start there and start building out a solution from the, from the end user's perspective and make it work, you know, on the back-end side. So that was really my driving factor. First of all, you know, again, all the, all the applications, you know, primarily moving to web-based deliveries, you know, that was a big factor for, for, you know, at least from

[00:04:58] Christian: the infrastructure and support side operation side where it made sense. But we also realized very early on that it was not, it wasn't designed for healthcare. That, that was the problem.

[00:05:56] Sarah: Well, and having a nurse firsthand in your wheelhouse is helpful because it will definitely tell you what is and is not working. And thank you for going on that path to understand the end user experience and then building some of the solutioning around it is such a, a win in terms of adoption, utilization, and understanding the things you really needed to plan for. But when you, for an executive, when you're talking to executives who's literally still

[00:06:20] Sarah: think of the browser as a utility, what changes when it does become an enterprise control point between the user, the device, the application, and the data?

[00:06:32] Christian: Well, I think that's the, that was probably, you know, when I first started Island about two years ago, that was kind of the big conversation. Well, you know, we see the browser as utility and in some instances, it's really is still depending upon which direction you want to go. But when you start peeling back the onion on, you know, what really is happening with the

[00:06:53] Christian: data, with the network, with the user experience, the actual application delivery of these things, it all makes sense in, in a couple ways. One, you know, the browsers, I mean, you know, I think we've all, everyone on the planet now has interacted with one browser or another over the last 20 years. So it's become very simple and very user friendly. Everyone has one on their phone.

[00:07:17] Christian: They probably have multiples on their desktop. So it's something that they use in their daily life that has become, you know, second nature. I open up a browser, I type in an address or I click on a, a web link and stuff happens. So the first part was really like understanding that, you know, your users have already been trained to how to use this.

[00:07:38] Christian: Now, what if we were to take, you know, their common knowledge and their experience using this commercial environment and turn it into something that really is productive for work. You know, being able to, you know, take the utility in this out of it. All of a sudden, if I can single sign on into my browser, tying into my general identities for my, my organization, I don't have to remember passwords.

[00:08:02] Christian: If I can allow users to download the browser, just like they do at ChromaRage, and access internal secure applications without the need for jumping onto a VPN. And so I think what they've seen is that the browser to become useful, you had to, I mean, you've had to build all these utilities around it to make it useful for organizations.

[00:08:24] Christian: We thought, why don't we just build it all inside of one core piece? And all of a sudden, all those complexities around it, all the end user experience, you know, inhibitors, whether it's, again, VPN tunnels or however you want to get into your, your production environment, they go away and all of a sudden it's a simple interface. I click on a, a browser like I do with any other browser on the planet,

[00:08:47] Christian: but this time I have all the controls that I have and everything I need to work is right there, regardless of platform. If I'm working from home, I do the same thing as I do when I'm in the office. If I'm working from my private practice, I do the same thing I do wherever I'm at. I have the same process to access those, you know, critical applications and data repositories across the board.

[00:09:10] Sarah: Which you just love the fact when you tell people how simple it is to use it, you're literally creating a browser for your own organization and how many things that you can control and not control from oversight perspective as much as like that security and that experience perspective. Like everything is in one place. It's like such a simple concept, the complexity behind it, you have unwound in such a thoughtful way.

[00:09:32] Sarah: The model really does allow stronger control without additional friction for an organization, which often when we implement anything that's secure, there's going to be friction. What does it look like in the real clinical workflow and how should leaders determine whether the experience is better for users? What are some of the metrics or points that you use to know that

[00:09:55] Sarah: an organization is running better because of Ireland?

[00:10:01] Christian: We've had various conversations and because of the scope of our platform, we have, you know, dozens of customers using us in dozens of ways. Some of it's simply merger and acquisitions. Maybe we are, you know, acquiring a new hospital. We want it on board them as quickly as possible without having to, you know, have to rebuild the network or rebuild our infrastructure to support these in real time.

[00:10:25] Christian: So they've been able to onboard their new acquisition in a matter of a weekend, giving them the core access to their, you know, the tools that they need to actually participate in this new organization on day one. So that, you know, those things there are some key metrics, some KPIs. How fast can we get, you know, this group of users online in real time?

[00:10:47] Christian: The second piece is, you know, performance is probably the primary factor in healthcare. If I put a new piece of technology in play for physicians, and it takes an extra three seconds to load, whatever they're expecting to load, whether it's an application or data or even a simple login, that is not going to work.

[00:11:08] Christian: So what we've seen in practice with our solution is that we can significantly reduce just that dead time in between clicks and waiting for something to pop up, et cetera. So that's another KPI we monitor pretty aggressively. How long does it take you to get into your current application stack,

[00:11:29] Christian: whether it's virtualization or whatever it may be, and then we build out our proof of concept with them and say, okay, this is what it looks like here. And all of a sudden when they say we would just had a customer a couple of weeks go on site doing a deep dive session and expanding the use cases to the clinical analyst team who happened to all live out of state. So all of a sudden they're their legacy platform they were connecting to.

[00:11:53] Christian: We took them just about a minute to actually get to a usable EHR platform. We moved that EHR into our platform and we delivered it to them. We would produce that down to 20 seconds. So all of a sudden we are giving real time feedback and that we didn't have to get time and all of a sudden they launched it and they're like, this can't be real.

[00:12:15] Christian: This is literally a third of the time it takes us just to get ready to stop working. So if we try to kind of have this three points of focus for anything that we build, one, it has to be an improved user experience, not just a little bit better, but there has to be some observability to say, hey, it used to take a minute now. It takes 20 seconds.

[00:12:39] Christian: We really need to focus on how can we improve that initial user experience. The second, it has to have some ROI. Health systems are in a tough spot right now. And if they're spending tens of millions of dollars on this three or four tier architecture to support one specific application that really can be delivered securely in a browser.

[00:12:59] Christian: If it's unright, all of a sudden we are deferring costs of millions and millions of dollars for these organizations. And the last one, it has to be secure. So we try to balance those things as much as possible, but those are our three northern lights. When we're building a new integration, when we're building a new part of our platform,

[00:13:21] Christian: whether it be AI controls, et cetera, it has to fit into those boxes. If it's not, if it's degrading user experience at all, we get to go back to the drawing board and figure out a way to make it better. If it's not saving customers money, again, we've got to figure out a way to deliver it cheaper and with the same level of perfection that we design in all of our products.

[00:13:42] Christian: So it's, again, depending on the use case, we have a bunch of KPIs we track, but oftentimes those are the two biggest ones. Simplify cost, improve their security, and deliver a better user experience.

[00:13:57] Sarah: So you're telling me, and here's a lot of sharing that with me. Christian is like, okay, so I've got a major M&A coming on board. We can get all those people over in a weekend. So you can figure out all the other stuff on the back end. But sometimes integration is one of the fastest things to do to start that whole change management aspect. And in doing so, I'm going to make their logins faster. I'm going to have true opportunity for application, rationalization, cost savings, and I'm doing it securely.

[00:14:22] Sarah: That was literally the conversation I had with your team right before I left my last organization and said, this is like the most obvious thing we could ever do for ourselves is all of those things in one scenario. And it really does turn key to a degree. And so when you say it makes it a little bit better, I would say it makes it a lot of it better by what you are able to bring to the table. But what's super interesting, especially now people think about AI agents

[00:14:46] Sarah: that are acting across multiple applications. You know, you're managing more bots than you are humans in some cases. The browser will likely become more than a viewing layer. So what new risks and opportunities should CIO, CISOs, and beyond, and especially our clinical informatics leaders anticipate as AI moves super fast,

[00:15:08] Sarah: they can't always govern it in a timely manner, but they do have you as a partner. What does that relationship look like for them?

[00:15:14] Christian: Well, I think it's been a very topical conversation, especially recently. You know, every time you turn around, there's a new AI tool out there, you know, various models that, you know, different users need access to you. And how do they govern that? How do they even know which ones are right? How do they make sure that, hey, I wanted them to use our specific tenant of chat GPT or whatever it may be.

[00:15:39] Christian: On top of that, you've got extensions coming into play a world that are AI, you know, essentially bots. You have every application vendor is adding some new AI layer to there. All of a sudden you do an application upgrade and now you have all these AI tools popping up. It's been one of those things where most organizations I talked to were like, right now we have a very limited scope and we're just blocking everything until we can get controls of that.

[00:16:04] Christian: One of the great pieces of what Island does is that, you know, we have the ability just to deploy our extension out into the wild. Listen, you don't know what you don't know. And one of our other CTOs had a great piece on this on a webcast. We have a customer who said, oh, we have 25 AI tools in our office and we've got it pretty much locked down. We're good.

[00:16:28] Christian: So we decided, well, it's part of our process. Let's figure out what's actually going on for us. So we can deploy our extension out to every single browser within the organization and identify what's going on. Which applications users are interacting with? Where data is moving to an application? So am I taking it from my EHR and moving it to Word or wherever you're moving data?

[00:16:50] Christian: We have, again, we have insights into everything that goes on inside the browser. We're the termination point for encryption. We understand when as soon as it gets hit the pixel, we know what's going on. And all of a sudden they realized, oh my God, we have 250 AI tools in our environment. How do we get control of this? That's where we come in.

[00:17:14] Christian: We talk about kind of the control plane. I think that is really where Island kind of sits. We deliver it through a browser, but we become this control plane. It's now what's migrated into the agenda control plane because of all the things that we've built from the end user perspective. Understanding what the user is, what device they're on. How do you want to support that device because we're doing that posture check consistently?

[00:17:39] Christian: Those things dynamically change how an organization wants to deliver security. Am I on-prem? Am I off-prem? Is this unmanaged device? Unmanaged device. All those variables change the way organizations look at them. AI brings us, you know, all of a sudden you have AI jumping into it.

[00:17:56] Christian: And not only with these tools that are just part of an EHR platform or a radiology platform, but someone downloads a new extension. We can control all of that. And all of a sudden we can say, well, this group of doctors needs access to do these two AI technologies. Whether they're LLMs or they're agentic workflows.

[00:18:18] Christian: And when that user logs in, those are the only two that they can see. And maybe they try to go to like their personal JAPET. We see that tendency difference. And we say, while you're not allowed to use, you know, public models for our clinical data, you can get, you can use this one. And we automatically redirect them.

[00:18:36] Christian: So we've gotten into this phase where we can say, yes, to a lot of these technologies and give you guardrails to say, I want to filter. I want to push the specific types of data that are important to my organization and need additional protections into governed bodies of AI. So that's really been a big conversation.

[00:18:55] Christian: I've had two of those this morning with customers who are actively pushing AI, especially with, you know, all these EHRs, and the build out AI platforms. How do we do that in a manner that is not disruptive to the organization, but also does not put us at risk for breaches where someone decides to dump a patient record into, you know, open chat GPT?

[00:19:20] Sarah: Well, you get in front of the fact that you know people want to access these other activities. Instead of having to find them roguely or wait and patch a problem after it's already been created, you know ahead of time. Christian needs access to this, Sarah needs access to this. Then you're finding a way to help them get there in a way that's not going to be a bunch of surprises or potential security threats moving forward.

[00:19:40] Sarah: So you're part of the ongoing conversation of how do we enable our organization to stay safe and access the information and a lot of the programs that we need. So, so much of that fear of shadow IT accelerating because of all these AI capabilities, you're right in front of it. So you get to help people stay informed and successful in the types of things they're endeavoring to use, which I love.

[00:20:02] Sarah: But then if that's going to come, I believe without some trade offs and also seeing what is next. So, what are some of the most important questions the healthcare executives should ask when they are evaluating an enterprise browser? And what claims should someone be listening for that requires deeper scrutiny?

[00:20:21] Christian: Well, that's, that's a loaded question. I think there is, there's a lot of, I mean, there's questions that come up to me that I don't know the answers to it on a regular basis. And what like they are, you know, there is a, in the last two years. So, you know, when I first joined Island, I was even a little bit kind of like, it's a browser. You know, I've, you know, I've built this with, with another company.

[00:20:42] Christian: And, but once I realized how the browser is just, again, it's the presentation layer for the users. And, but that's where all the control happens. The amount of work that happens behind the scenes is insane. So there's a lot of things that we do that others can't just because of the way we designed our platform.

[00:21:04] Christian: We're not, you know, offloading traffic. A lot of, I think a lot of vendors that we're seeing now essentially are using the browser to then port their solutions into the back end infrastructure, which adds complexity, adds some, some user experience. You know, I've never once implemented a security project ever that improved user experience.

[00:21:25] Christian: But this is like the first time we've ever seen it where all of a sudden that we're getting as good, if not better security, but the user experience is improving. Because it's happening natively within their environment. We don't have to take that, move it to someplace else and massage the data to make sure it's protected or you haven't leaked the appropriate property that all happens locally.

[00:21:46] Christian: I think the, you know, the focus that we've had and the focus that I've had, you know, particularly in engaging with these EHR providers to make sure that their solutions work the way they're supposed to in our platform. I think that's a big one.

[00:22:03] Christian: Again, I don't care how good a security product is. If it does not improve user experience, they're going to, you mentioned that shadow a shadow it all of a sudden. This is taking me five extra seconds to do this thing that used to take me. X and so I'm going to find another way to do it.

[00:22:22] Christian: We have spent a lot of time and a lot of effort of, you know, I'm on several calls a week with various vendors to make sure that as they are building out new capabilities on their platform. You know, we're first the market day zero, you know, we are, we are delivering those capabilities. So I think that's a big piece is understanding. What are their relationships with your, with your core application stacks.

[00:22:47] Christian: Regardless if it's, you know, EHR providers or packs vendors or something as simple as sales force. Yeah. What, you know, how do you, how do your, how do your engineers and how do your developers work with those, those partners and build out what they need because everybody's a little bit different.

[00:23:06] Christian: And you have to do some really, you know, deep digging with some of these vendors to understand how we make these things work the way they're supposed to. Or hopefully work better than they've had previously.

[00:23:18] Sarah: Well, if you've seen one health system, you've seen one health system, we all like to say, and yet the ability for you to adapt to meet people where they are is also a win in the way to reduce some of that friction. Last question for you is what are you building changing or rethinking right now that you believe health care leaders should be paying attention to.

[00:23:36] Christian: I would say that, you know, right now and we're, we're, we're, we're, we're have a lot of focus on AI because of just where it is in, in, you know, in the limelight at this point.

[00:23:50] Christian: Everyone's got something everyone is, is trying to play in that, in that, in that ball field, you know, every AI tool that we see come across and I see dozens of new ones from just my health care customers. Oh, this new product.

[00:24:05] Christian: We are spending a lot of time on making sure that the same user experience that we have for standard application stacks and standard security stacks are being brought into the world, giving, giving our customers the ability to say yes to their custom to their users by giving them, you know,

[00:24:29] Christian: a better user experience of, you know, that control plane for AI and we call it the agent control plane, because a lot of this is starting to happen and, you know, it's, I think right now because it's so, it's so fast and furious. We're seeing so much development on that side from our side as well as what we're seeing in the industry.

[00:24:48] Christian: So, a lot of, a lot of the, the reasons why people love us for, you know, general secure application delivery in a road access. They're going to find all those same reasons why they love us on the, on the, on the agentic AI side of the house. So that's, that's, we're spending a lot of cycles on that right now.

[00:25:09] Sarah: Good, because you want your partners to be able to help you keep up with the pace of the change that as a CIO you're expected to know. That's the best part about having some of these really compact partnerships with different opportunities is, I depend on you to keep us safe and to keep me informed about the things I need to even be sharing at the board level.

[00:25:30] Sarah: So, such a win across the board. Christian, thank you for joining us and sharing such a practical perspective on how to healthcare can modernize access without losing side of security resilience and the people doing the work. We appreciate you. We appreciate your partnership and kudos to Island for literally being a step ahead.

[00:25:47] Christian: Thank you, Sarah. Great time.

[00:25:50] Sarah: And for all of you listening, that's all for now.