Bill Russell:                   00:10                Welcome to this week in health it influence where we discuss the influence of technology on health with the people who are making it happen. We're the fastest growing podcast in the health it space. My name is Bill Russell, recovering healthcare CIO and creator of this week in health a set of podcasts and videos dedicated to developing the next generation of health it leaders, this podcast is brought to you by health Lyrics. Does your health system need to do more with less. We've been in your shoes. Let's talk visit health lyrics.com To schedule your free consultation. If you're enjoying the show, and want to support our mission. There are five quick ways you can do that. You could share it with a peer share it on social media, follow our social accounts, linkedin, Twitter and youtube. Uh, send me feedback. I appreciate the questions and the recommendations. Bill@thisweekinhealthit.com and subscribe to our newsletter on the website. So let's get to it today. I'm excited to be in Philadelphia. I think on the hottest day I've ever been in Philadelphia, it's uh, uh, I couldn't keep my jacket on. Um, but I, I get the opportunity to visit, I think one of the most forward looking health systems in the country. Jefferson health. I'm joined by a previous guests, Nassar Nizami the CIO for the system and a CEO, doctor Stephen Klasko. Thank you for coming on the show.

Nizami :                        01:19                Great to be here. Welcome. Welcome to hot, Muggy Philadelphia. Yeah, it's amazing. I left southern California and I thought, well actually even worse, I took my daughter to orientation in Waco, Texas last week. And I thought there , couldn't be a place any hotter than Waco, Texas. And uh, I got here and it's hot here. It's just humid here.

Klasko:                         01:37                Yeah, I was gonna say, I'd love to say it's a dry heat.

Bill Russell:                   01:39                That's what Arizona always says, but you know, it's not true. It's amazing. But it's great to be a, as it's great to be here and I'm looking forward to the conversation really for two reasons. One is I think the dynamic of having both of you on at the same time. It's good to sort of get that back and forth. And I think the other thing is, I don't know if you know, episode number four, I quoted you, you're a quote machine. I pick up some of your quotes in that. Throw them out there. Usually some of them were controversial. So I'd just like to talk about it and I think on episode four, this is episode 102 on episode four. I said I'd love that Dr Klasko on the show. So it's an honor to have you on the show. Yeah, I, you know, I usually start with a pretty open ended question just to get us going. And, uh, so what are some of the exciting things that are going on at, at Jefferson health? And this is just the intro questions. So I know you can talk about this for 45 minutes. What, you know, just one or two things you're really excited about.

Klasko:                         02:30                Oh, I, I think, uh, the thing, um, absolutely most excited about is this obsession about making what's difficult in healthcare, easier using it. And, um, you know, we, we have a partnership, for example, with general catalyst, uh, we're, we're looking at a model where we'll be the ground zero along with Boston children's for creating, for lack of a better word, of fire layer on top of epic or Cerner that literally will create an APP store. I mean, I, the way I explain it to, to my colleagues is, I'm a Mac guy. I couldn't put PowerPoint on my Mac because Steve Jobs didn't want any Microsoft products. So Bill Gates had, oh yeah, oh yeah, well we're not gonna put any of your stuff on our windows. But that was unsustainable. And then people created a parallels and all those kinds of things. So literally we have a, we have a star wars technology for individual patients on a physician in a Fred Flintstone healthcare delivery system and everything else that it has done to totally change, whether it's, whether it's retail or travel, we have it really implemented. And you know, the reason I'm so excited about working with Nasser's at Jefferson, we are looking to be the places looking at what's going to be obvious 10 years from now and do it today. It's exciting.

Bill Russell:                   03:44                How about you? What's exciting on the tech, I mean? Clearly working for a CEO who's saying those words, it's

Nizami :                        03:50                I was gonna say unfortunately I have to work for doctor Classica who is starting fire.

Klasko:                         03:55                I even know how to spell it, by the way.

Nizami :                        03:59                Uh, so look, there is a lot happening in Jefferson that is incredibly exciting. So you start with the foundations, right? So we have your implementing epic across the organization. One database, one way which I think is really unique. Most implementations over time change and are customized doing various things, this allows us to build on top of epic, right? So the, the applications, the startups that we are working on, that Dr. Klasko Mentioned, uh, we'll be able to leverage what we already have built right. And that's the exciting part. All the stuff that we are working on in, whether it's imaging, whether it's Ai, whether a startup like a general catalyst and premier, uh, we are able to build on top of what we have built as a foundation. I think that's very exciting.

Klasko:                         04:47                And I think one of the cool things is that we're using it as the, as the night, as far as integration or the fastest growing academic medical center in the country and gone from two hospitals to 18 hospitals and it, that is really the key to one Jefferson.

Bill Russell:                   05:03                Yeah, I mean there's so many ways I could jump off of just that. Um, we are going to have some people on from epic because there's just, there's this drive to the standard build, but what do they call it? Their Foundation. They're their foundation. There's this drive to foundation and the more CIO's I talked to, they're like, this is driving me nuts because now I have to spend literally a $100 million to get on foundation. And we just did our, we just finished our epic implementation three or four years ago. I mean, we could go off on that because that is one of the challenges that you face. One of the challenges you face as you have a, at our health system, we had 800 different applications and now it's okay, let's build this app store on top of this. But the complexity underneath this, so, uh, so, so challenging.

Bill Russell:                   05:43                So we have to abstract that complexity. Um, which was, which was a challenge, but we're not here to hear me talk. We're here to talk to you guys. You, uh, at the JP Morgan Conference, we didn't get to talk there, but you talked about making 195 year old academic medical center, a startup company, and what does it take to do that, which is, which is fascinating in and of itself. So let's explore that a little bit. I was at, uh, I was at Baylor last week and uh, this woman was not trying to be funny. She said, hey, we just redid the, uh, curriculum and a, it's been a long time coming. She goes, we started the conversations at 1960. I was like, you started in 1960 and you just did it, which, um, I, I know of no other industry that you could take 50 some odd years to make a decision and still be a leader in the, in the country, in certain areas. Um, but how do you do it? I mean your academic medical center, academics and Medical Center, these are two slow moving entities.

Klasko:                         06:39                yes. So I mean, the way you do it is, I mean, I came in as CEO and you're always straddling the line between being crazy and visionary and you know what I mean? I think 90% of my faculty felt that, you know, I'd be probably the last three months for exactly the reasons you said. I think part of the advantage I had is how, how messed up healthcare is that. But before I gave my talk, uh, before I started my job here, I gave a talk and one of the country's economists said, are the two things you don't want to be running for the next five years because they're just going to be impossible are academics and healthcare. I was, let's be aggressive. I just took a job in academia, academic healthcare, so don't listen to anything that I say. We created probably the first in the country, true four pillar model where we talked about the old math and the new math.

Klasko:                         07:21                The old math is academic and clinical and the new math is innovation, strategic ventures and, and and what was fascinating about that is it made sense to me. I mean I got, I got invited to the faculty senate. You never get invited to the faculty center for anything good. It's always to get central. Do you mean you're going to move money out of, you know, our traditional NIH funding into stuff like, like NASA is doing and I went through a sources and uses of funds. Think about this for an AMC and it's exactly the 50 year thing you brought up. The sources of funds are NIH funding that going up anytime soon where you can always make it better from the ridiculous money you make from being a safety net hospital. That's a joke now. Oh, you can always put on the back of students charged 4% more tuition a year that gigs up also.

Klasko:                         08:04                So we literally talk about how we can overcome that. And by the way, a good part of that came from, I got to be the head of the steering committee for Itunes u health right before the iPhone. And I watched them start to move money from the old math of being a computer industry to the new math of a digital lifestyle. We're going through once in a lifetime change in health care from a business to business model to a business to consumer model. And that's what we're banking on. So, so I mean it, it's not just where the finances go. Um, we acquired merged with a design and fashion design university. If you had imagined that Thomas Jefferson University, if by way, if you had bet at Thomas Jefferson University, 195 year old health sides university would be number three in the country, college and fashion design, probably even better than investing in apple back when I was there in 2000.

Bill Russell:                   08:54                So I have to stop you, Why?

Klasko:                         08:55                Why? Because of the design of the human experience. I'm going to give you a real life example where where the four pillar model works. So the academic pillar, we started the institute for Emerging Health Professions. What jobs will be needed 10 years from that don't exist today. Some jobs in it, computer science in genomics, but one of them was a master's in cannabis medical education and research beyond giving me a couple of takes with the students that got us a $5 million grant from an Australian philanthropists. Okay. Fast forward, we had merged with Philadelphia University. He calls me, he says are for profit companies called ECO fibre. It's carbonizing hemp to create wearables and the top two people in your country that are working on that are in this place called Philadelphia University. Know anything about that. So we've literally traded that Ip for 12 million shares of what is now on Australian IPO this year.

Klasko:                         09:50                For the first time, our net operating income of our new math will equal our net operating income of our old math. One more thing. A good part of the reason that we've gone from two hospitals to what will be 18 hospitals without writing a check. People have just joined with governance is currency is because we're not depressed about getting back to the old way. We did change our curriculum, our MD, curriculum. We now have an MD masters in design. We now have every one of our doctors literally are our students, has to take to creativity courses. We're doing Improv for, uh, for our students because think about it, you have to listen. You have to be able to articulate. We still accept medical students based on science, GPA, m-cats, organic chemistry grades that somehow we're amazed. Doctors are more empathetic, communicative, and creative. So I think what's happened is because we've been successful because we've grown so much, um, I'm on the right side of the line, barely on the, on the, on the wild man versus uh, uh, um, visionary side with my faculty.

Bill Russell:                   10:52                Well, you know, it's interesting when you, when you talk, I don't think there's anyone in the audience who goes, that's crazy because just in your audience. Well, yeah, but even at, even if the JP Morgan Conference, I think those people are looking at you going, yeah, yeah, yeah. And then they want to say, how do you make the math work? Because it's the math, right? It's, it's fee for service today. It's, I mean, I've been in those board meetings where you're sitting there going, we want to make this jump and you're talking about the new math, which is what you're describing, like the new boat that you need to get into. Um, but so many boards can't figure it out. They're sitting there going, ah, this is 70, 80% of our

Klasko:                         11:27                look, the math, the math is lousy. I didn't create that lousy bath.

Klasko:                         11:32                The math is lousy, but there's going to be a trillion dollar spent on healthcare transformation. So I mean, you know, you know, that's who can speak to this. But literally we hardly do any large vendor vendee dios anymore. I think that's really the key. I mean livongo is a good example. You know, livongo uh, you know, partly because of all our expansion, we become the USA Today of health systems because we take, we, we acquire these places, but because it's governance is currency, they maintain some of their personality. So Hemant came in with an it diabetes model, it was Hemant Taneja from a general catalyst. And, um, my folks at Thomas Jefferson University hospital arrogantly said, we don't need this. What we're doing with diabetes better is that, okay. So I went to Aria and Nassar knows this. We often will go to either Aria, which is northeast or Kennedy in the South Jersey.

Klasko:                         12:22                It's like Mikey will eat it, they'll, they'll try it. And they tried it. And with so much better than what we're doing at Thomas Jefferson University hospital, it became a huge enterprise client then we now we have a code development piece with him that anything new, new, they do, we get a dollar per member per month. So I can give you 10 examples of where we have either code development agreements. There's a company called ambulance. Uh, which is literally looking at, um, transportation options for patients with that. Again, we exclusive here and we own part of it. Here's, here's what I, what I believe this part with hospitals are becoming commoditized. I didn't, I didn't make that up. That's going to have standard

Bill Russell:                   13:00                whether you're in the seat or not it's happening.

Klasko:                         13:02                I gave a talk for standard pores and I mean, it was so depressing. It was like this, uh, there's a woody Allen quote, uh, where the crossroads one road leads to total destruction. The other utter despair, let's hope we choose the right one because they were saying is that that health systems revenues are going to go up 2% and their expenses are going to go up 7%. There was no good math to that. So for us is how can we be part of that trillion dollar health care transformation piece and how can we be ready? Where overcoming commoditization by differentiation. Diversification is the right way to go.

Bill Russell:                   13:34                Yeah, absolutely. So, so now, sir, um, bringing in a lot of partners from the outside, you're bringing in Livongo bringing into others and you're creating these new agreements. But again, we started with this sort of, uh, you have a legacy, much like there's a business legacy in a regulatory legacy. If there's, there's a technology legacy, how do you help those startups to plug in?

Nizami :                        13:58                So that is the challenge. I think. So, uh, uh, you know, whole premise of acting like a startup requires us to be Nimble and fast moving. But as you know, that sometimes because of the, because we are an AMC sometimes and many times because of the vendors, uh, there are tons of limitations, right? And think, our philosophy and where we have been pushing up is that we need to free data from the limitations of vendor specific technologies and from the limitations of data center and our own bureaucracy. Right? Uh, and that's where my team and myself are pushing. So interoperability is Peak bill on, um, uh, uh, on our road map, whether it's use of Apis or a was like fire and we're at a national level, at a local level, we are pushing for standards in freeing up data. Okay. Uh, data center, and this is your background, right?

Nizami :                        14:52                Uh, uh, we are is still every acquisition comes with two data centers, right? So with all the acquisitions we have now 15 data centers, right? And some of the data centers are very small. Some of them pretty big but 15 data centers. Unsustainable, right? Of our data resides in big these data centers and to get any piece of information out to let's say a vendor who we are partnering up. There are five different Emr. There's six is from revenue cycle system. There are four different pacs system. It just a nightmare right now. Right? That's when I, the reason I say that epic is going to help us or have our backs, things is standardization is going to help us there. Right? Uh, I'm big believer in cloud. I think that, uh, moving data off in a way where anyone can access anything anywhere, right? With the appropriate access. That is what we are focusing on. That's what we're getting is going to help us partner with the startups. Uh, I think automation, there's a huge push at least in a Jefferson, my team to automate. Um, and lastly, I will say that I think that in, in probably mid to longterm, uh, AI is going to be bet. I think that's where a true value is going to come by virtue of getting the data and getting the, the data to the right party interested.

Klasko:                         16:06                Yeah. It was interesting. I was on a Webinar last week I think with Peter Lee from Microsoft and uh, and the folks. And it was this funny because we were say, boy it's neat that hospital executives or health executives are thinking about this. I mean we're talking about cloud. I mean it's not, we're in the 90s, you know, and it's just, it's just funny. The, that to me is the, that I'm viewed his little bit of a Unicorn that this is what our whole strategy is, that we're going to get into the 21st century when it comes to how we deliver healthcare.

Bill Russell:                   16:38                Yeah. You know, it's interesting because with cloud, when we talk about it, cause I just talked about it last week on the podcast, it's a, it's not that you're, your users are afraid of the cloud. It's your it department. It's because your users, you're like, Hey, I use it at home. I, I use Gmail. I've got, by the way, I've got more storage at home than I have on my email at work. I can share photos, I can do all this stuff. And they'd come to work and they go, okay, why are there saying, why aren't we on cloud? And your it organization sort of recoiling saying that changes everything.

Nizami :                        17:10                Absolutely changed the way we operate. I think one of the big things for us is that our, uh, math is not working out. So interestingly, cloud has promise and lots of promise we are seeing Rois are not there, especially with our big vendors, EMR vendors, uh, et cetera. Going to cloud is more expensive than on premise. It doesn't make any sense. So cloud, the, the, the cost of cloud 11 years running according to gardener has been decreasing going down. Right. But certain vendors are not there yet. Right. But you're right. I think the biggest barrier to move to cloud is it and it culture. Absolutely.

Bill Russell:                   17:45                Let's, uh, so I come to Philadelphia and my wife says, Hey, make sure you get a cheese steak and pierogies. So let's talk about population health. Um, you know, so you have to design the health system around the consumer in order to do population health effectively. What, what digital technologies and how are you doing that so that you can reach those people in between the visits that they're with you?

Klasko:                         18:06                I think, um, so we invested early on in 2013, that 30 or $40 million in telehealth. But I think telehealth is a great example of how we've sort of messed it up. It's very similar. You know, when, when I'm old enough to remember when Emr is, we're just starting. And you know the, the epics of the world, the allscripts and cerners of the world would come to us that we want. We want you to help us do the opposite. We're fine. Our handwriting is fine. Same thing happened with tell health people are mailing it in and saying, oh I just got Merk unwell. TELADOC MD lives to some person in Ohio can add and I can say I'm doing telehealth. We took a totally different approach and one of my mentors and actually our commencement speaker this year has been John Sculley. He said, stop talking about telehealth. He said, we don't talk about telco banking, we don't get up in the mornings.

Klasko:                         18:52                I think I'm going to tell a bank. It's just the 90% of banking went from being in the bank to being at home. The same thing's going to happen. So the question for you, Steve Is, is what technologies can use to have more and more and more things for the patient happen at home so they don't have to see and, and that's how we view things. We have 24 seven telehealth virtual right now. Here's the problem. Once you get to that, it's going to become painfully obvious that if you're a provider, you have to be a payer. Also, and I'll give you a real live example of our virtual triage, given our sophistication and telehealth and it, we're now at the point where we get 60% of our patients non-trauma non ambulance out of our expensive inefficient ed and we have about half a million patients come to our Ed.

Klasko:                         19:40                Problem is I make an average of about $89 through urgent care, telehealth or an appointment next morning and average of $1,400 if somebody walks into my ED that the insurers are happy to pay, we have 32,000 employees now bill. So what we said is with our TPA partner, Aetna, we said for our 32,000 employees, if you show up to our Ed and you haven't gone through Jeff connect, virtual triage, $500 deductible, if you end up in our ed through Jeff connect, zero deductible including zero deductible. If you end up getting admitted, that's really changed behavior. So there's a great Upton Sinclair quote. It's hard to get somebody to do something when their salary depends upon them not doing it. And we do so much of that in healthcare. And I think it's especially true when you talk about population health. You're, you're sitting here in Philadelphia with five academic medical centers too, in the top 25 of us in pen.

Klasko:                         20:37                And we have the greatest discrepancy in life expectancy of any city in the country based on Zip code, based on Zip code. So baby born today at Jefferson, that goes to one nine one four, seven is about, you know, uh, three quarters of a mile from here. Will live to 2104, a baby born today that goes about three miles north of here. North Strawberry Mansion will not make it to 2090. That's a year less than Iraq and Syria. So while we talk about meds and eds in Philadelphia, we failed. And the simple answer is that 80% of a person's health, as much as we hate to admit it, has nothing to do with a doctor or the academic medical center or the research that I'm doing here at Jefferson. So that's why that whole, you know, B to B to B to c model becomes so important. You know who the greatest percentage of users of our, of Jeff connect our telehealth program is this situation we have with the homeless, with homeless shelter. Sister Mary is one of the largest. Why? Because if you think about it, most of them don't have cars. They're housed in this, in this, in this, uh, great, uh, thing called project home. If they have cars, gas is expensive. Um, but they have phones, you know, and they want their families to be healthy. So I think, I think we just haven't come close to pushing the envelope of getting away from, I'm just going to get this company so I can say I'm doing stuff versus really believing you want to do it.

Bill Russell:                   22:00                I, I want to come back to tell her, cause I think in the, in the near term it has the biggest potential to really change health care. But I want to, I sort of want to go to you on that as well. Cause a fair amount of your budget is spent on the internal customer. How, how does that transfer? How do you, how do you transform it? But how do, how do you get the money and the resources to start focusing and thinking about the patient and the community member as part of your consumer base?

Nizami :                        22:31                Is this part of that? Exactly. So that's a very good point. So we actually have a group does digital innovation and consumer experience that is focused on developing, designing consumer centric solutions. Right? And this was really the upper class conservation. And I'll give you perhaps one example. They have created some legal solutions with consumer in mind. One recent was, uh, an APP called my VHF. It's for expecting mothers. Uh, they can track a week to week milestones, photos, videos, communicate with the providers. So a very specific solution, uh, for a very specific patient population. Right. And they have many of, uh, consumer, uh, centric apps and solutions.

Klasko:                         23:12                Yeah, they're actually do, I'm an obstetrician, they're actually doing a match.com for obstetricians that are patients there. Yeah. If you think about 25 year old, there's very little that she does where she goes to the 65 year old male that says, congratulations you're pregnant. I'm going to send you to my obstetrician, Dr Klasko. There's nothing that a 25 year old woman today at 2019 takes from a 64 year old male for the most important thing in their life. So we're looking at how, so, yeah. And the cool thing about this, that I'm embellishing this a little bit, but there, there are people from all over industries that I kid around. They're mostly young. They mostly come in around 2:00 PM they mostly Instagram me at two AM. It's a very different culture than what we would do in a, traditionally we've done, send me on our marketing side, if you think about it, you know, if everybody in marketing looks like me and I'm trying to run a university and be cool the chances are zero, that's going to come through.

Bill Russell:                   24:01                Yeah. I might have just walked these streets. Not Everybody looks like you. Exactly. In fact, very few people,

Klasko:                         24:07                we're very young. We had an accreditor. Best compliment. I got in my six years here. Uh, you know. She goes, I don't understand it. Um, at a time where everything's changing. You're the first place that we've worked at where your faculty in your employees seem to be more optimistic about the future than the past. And it's partly because of folks like Nassar.

Bill Russell:                   24:26                Yeah, absolutely. Let's, let's talk telehealth briefly, uh, in that, you know, it does drive down the cost of increases act. We knew all these things are true. There is a change that needs to go on and, um, in our culture for people to think telehealth before, uh, before anything else. But there's, there's also regulatory barriers to that as well. I mean, we could see Jersey if I got up on top of this building, maybe not this building, but the building next to it, I could probably see Jersey from here. Can you reach into Jersey yet? Are we still have those state regulatory boundaries that are slowing us down?

Klasko:                         25:01                Yeah, look, I think it's a combination of state regulatory boundaries and the, and the guild mentality of physicians that's killing us and it's just killing us. So the, the answer to your question is that I can practice in New Jersey. I can practice in 48 states in scheduled but I can't do telehealth. And the example I gave at Becker's is it'd be like if we started atms and every state you need a different card, it probably wouldn't have taken off the way that it did. So, so we, you know, we create our own problems literally by doing that. Look, you know, telehealth is not the end all and be all, but, but it's a little bit like what you said about the cloud. I don't think it is Consumers that are reticent to use it. It's the doctors and the organizations that are saying, you look, you can use telehealth is not like seeing your real doctor.

Klasko:                         25:53                One example, since we're so into this, our head, our head of jef connect, a guy named Judd Hollander is an emergency medicine physician. He was getting as well, you know, well ask me this, answer me this Dr. Hollander or are you actually going to be able to diagnose an appendicitis by Telehealth? And he said, well actually let's try that. And he went through this thing where you know, um, so Mrs. Jones, where's your pain? Okay, it's, it's right on my left side. Mr. Jones, could you please press up on that? Does that hurt yet when you let go, does it hurt more or less, less. They don't have a ruptured appendix. That's all we do in the Er, you know, and then he went, okay, now that we know you don't have a ruptured appendix, can you do three jumping jacks, you know. Okay, the three jumping jacks, I can see you tomorrow morning. Honestly, other than unnecessary tests, that's what we do in the ER. So this whole model of everything we do is genius because my hands are magic and we can't do that in telehealth. So knowing what you can do, tele-wise, knowing what you can't, just like with retail, what things do I want to go to target for or what things can I order on a target become really important.

Bill Russell:                   27:03                So let's talk about the future. Um, you're training the next generation here and you're hiring the next generation. Has Your thinking about, uh, what are, what are some, some of the things you're looking for in the next generation of health leaders? So let's, let's say it's five to 10 years out. It's probably different than what we were looking at before. And Nassar, I'd like to start with you and start with health It is there, is there a different set of skills? Are you also looking at the design industry and other things to bring in different thoughts?

Nizami :                        27:35                Absolutely. So design thinking I think is being since you mentioned it, right? Uh, so look in it. One of the challenges we have had is every three to five years, technology changes, right? And, uh, I think, uh, that pace is increasing in some of, in some areas that's even more so if you think about information security or data and audience that is a relatively new field. Uh, at when I went to school, there was no such thing as like bachelors of information insurance or anything like that. Right now there are enough folks who are getting trained and that's going to change in 10 years. Exactly. Even sooner. And so now the, the folks who are coming out of college are, are not a general computer science degree. It's really very specific. I do this and this. I do programming in python and by the way, that's going to only last four more years.

Nizami :                        28:22                I need to retrain and risk, right? So, uh, I think, uh, re Skilling, retraining, hiring people, uh, we be at peace of Jefferson. Uh, right now within it are a little bit, um, on the older side meet, we have just outstanding tenure here, which I'm very proud of. Turnover is really low. Uh, that gives us a unique, different challenge in that, you know, of, we don't have as many junior level people, right? Uh, but uh, Philadelphia is also blessed with some really outstanding, uh, universities. Uh, a, we do get folks, we are able to hire folks who are fresh out of college and we can retrain and re skill. So a, the schools that we are looking for is really, uh, we, we hire for aptitude. We Don't hire for necessarily that you must know what, you know, technology. Uh, if a person can learn, if a person can, uh, uh, live in, uh, if we believe that a person can live in a dynamic environment that is continuously changing. We are growing through acquisition, we are growing. So only thing I think that is constant is change. If a person believes that in can live, that we believe we hired them, we are not really a very, very few questions that we ask. And my managers ask are around technologies. Isis, well, Microsoft for a et cetera lists mostly on a softer spots. A small, mostly around adaptation.

Bill Russell:                   29:39                Yeah. Cause most technology anymore. Or operations projects, they're very little about technology.

Nizami :                        29:46                Absolutely mean you can always train. Like, I mean we had a very generous training for around your culture, training and technologies come and go. We can always train on technologies, many people side of things that we hired for.

Bill Russell:                   29:57                So the university you're looking at the next generation there, it's the same kind of thing. I would imagine that you're, you're looking for people that realize that medicine is going to change in five years, 10 years, 15 years in their generation. They're going to practice medicine very differently over the course of their life,

Klasko:                         30:13                well I think, you know, um, the big issue is that we're not going through an incremental change and you can't think incrementally, right? I mean, getting back to my apple example, you know, pre iPhone, you know, everybody else was thinking, well what's the next cool laptop? Cause that'll be the big thing at 10 years of laptops will be smaller or what's the next cool operating system? There'll be mac os 87 but really what, what, what apple was thinking about as we're moving from a computer industry to a digital lifestyle. I try to hire hire leaders, they get that, that are willing to look at what's going to be obvious 10 years from now and do it today. And you know, if, if we have chance after this or if any of you out in the audience are in Philadelphia, you're, you're actually at the first Federal Reserve.

Klasko:                         30:52                This building is like a hundred and some years old. We have the largest vault in the country and I needed a symbol for, for being 195 year old academic medical center. Uh, you thinking like a startup coming. So in our vault is where are we do three d printing, three d bioprinting, uh, um, a lot of virtual reality. And so your, your eyebrows raised a little bit when I said we acquired a design university. So we now have a deal with Princeton where we take up to 10 students a year. They get into Sidney Kimmel medical college after their first year of Princeton. They go through the whole four years and then they get an MD masters in design, first MD, masters in design in the country. These folks will be the masters of a new kind of universe that's concentrating on how people access healthcare system. Part of the problem we have now, the average person in my job running a five to $10 billion academic medical center is 67 years old.

Klasko:                         31:48                If you're 67 years old, exactly to your point bill, and you've gone up by not doing anything differently and not upsetting the people that are competitive, autonomous, hierarchal and non creative. And you know that you have your long term retention package coming in two years and you have two choices. I can either change everything I do and really upset all those people that supported me before or I can hope that things won't change for the next two years. So some poor guy that's a lot younger than I or a woman is going to have to take over. That's what's happening.

Bill Russell:                   32:15                Yeah. There's two in the last couple minutes here. I want to talk about Philadelphia and from really two perspectives. One is, uh, you know, you talked about a 80 20 social determinants and whatnot. Um, it, so I'd like to talk a little bit about the partnerships and how you're going about addressing social determinants. And then the second thing I'd like to talk about is every city I go into says we're the next silicon valley. We're doing, you know, we're, we're doing those kinds of things. Will you have Comcast here and others? So it's, yeah, you can make that case. But I'd, I'd like to hear how your sort of facilitating that. So let's, let's start with the social determinants. There's, there's so many things that can happen. I'm curious what you guys are doing in that area.

Klasko:                         32:54                Okay. So we started the first college of population, nothing in the country. So I, by an individual named David Nash, who really sort of invented the science, but we've done a really bad job of implementing it. And part of it is because, and it's also speaks to your second question, the reputation of Philadelphia is, yes, we have five academic medical centers, but their reputation is all we do is beat each other up. And I think that, uh, one of the things that we did at Jefferson is, so if you get any academic medical center's website and Philadelphia are beyond, it's always about innovation, community engagement, diversity, social determinants. You look at how that CEO gets paid. It's about Ebidta hospital census to the doctor's I play golf with like me and US news and world report. So I wrote an article which was a bit controversial that you know, you want to look at what you're hustling is going to look like.

Klasko:                         33:39                Ignore what the board says, ignore what's on the website, ignore the mission and vision, look at how the hospital CEO is getting paid for the next 10 years. So we actually started one of the first, we're 25% of my personal incentive is, is what's happening in Philadelphia. Things I had no control control over our last gala was not to build a bigger MRI or proton machine than our competitor. It was to create the Philadelphia collaboration for health equities. And what we're doing now is starting to partner with the social agencies with, with others. We just got a $3 million grant for South Philadelphia to go after a specific community that's getting underserved. We started the first refugee clinic and whatever your views on immigration that is, there were 250 women that got no prenatal care that was showing up to emergency rooms, nine months pregnant that now get that. Now get prenatal care. Thanks. full prenatal care. Thanks to Jefferson. So I think we're, we're, we're starting to address it. What I'm really excited about is that we're having really good discussions with Penn and temple and others around how we can start to do that together. You know, that, that, that, that we're really not competing when it comes to either innovation or health equities.

Bill Russell:                   34:45                That is, that's amazing, fascinating and exciting. I hope we see you the same thing happened in Los Angeles. Um, well, I mean that's, I just flew in here from there. So, um, so how, how about partnerships that, uh, foster the development of that technology ecosystem where you can hire the next generation? I mean, you have great colleges and universities around here, so it's,

Nizami :                        35:06                I'll give you one example. So we recently partnered with an organization, local organization called Euro. And their mission is to help, um, uh, communities and young adults, uh, you know, who, uh, did they train young adults in technology, business disclosed and so forth. Right. And, uh, the event, place them into organizations like Jefferson. So we have partnered with them. We are hiring three a of the graduates, uh, coming July. Right. Um, so that's just an example, one example of how we are partnering with local organizations to recruit people. And then we have so many in our co op and internship through Drexel universities and universities around that's been going for many, many years. And that's sort of source of the staff that comes into it.

Klasko:                         35:54                The problem with the Silicon Valley of healthcare, which is generally bs, you know, I mean, so as you know, Silicon Valley happened through like this weird alchemists type thing that, that you know, is, um, is that everybody always talks about their stress and that's why the South Valley, when I was a Tampa, we're going to be the silicone valley because of weather and taxes. Cause that's really what they had. They had, whether intact and no taxes. You know, here it's because we have all these academic medical centers. What I've said to both chambers is, you know, at different times is no, we'll get why people aren't here to, you know, if you can look at why, you know, it'd be great for me to look in the mirror and you know, say, boy, I'm really six, two and I have a great head of hair in case in case you can't see it, it's not true.

Klasko:                         36:40                Um, you know, but you have to start, you have to start out out where you are. So, so to me that's what we've tried to do is how can we create partnerships. So the one other thing is also recognizing who your competitors are. My competitors, not Penn and temple at a time when CVS and Aetna have gotten together and creating the new front door. Or people always say, um, are you worried about Amazon, JP Morgan and Berkshire? And I would say, you know, to me that's like the, uh, I think I said a one thing, it's like the lochness monster. You know, I'm sort of worried about it if it ain't me, but right now I'm not sure it exists. And I think, you know, we have to start to think about what are our real competitors. It's not the hospital or the academic medical center across the street. In fact, they're actually our partners in things like health equities,

Bill Russell:                   37:21                you know, talking about things that they can't do that you can do. I'm sorry, one more question. Um, and I appreciate your time today. The A, so Mark Harrison inter mountain, they're going to start collecting 500,000. They're going to build a genomics database. 500,000 patients are going to volunteer and collect two vials of blood and do their mapping and then look at, uh, look at, look into that data and start to do predictive really, um, forward looking kind of medicine. Um, is that, what are you doing in the area of precision medicine?

Klasko:                         37:53                Well, again, mark and I had been on several panels together. We're taking a bit of a different approach I think. Um, and by the way, it's incredibly important what they're doing. It's incredibly important. Geisinger is doing and others. The problem with genomics to this point, precision medicine has been, it's either, you know, the, I'm going to get in and find out that I'm, you know, partly native American or something like that. Or it's here's where we can do things that will affect the future. We've really tried to be very practical. What are the things that could change lives today? So I've really, partnership is with a one of one of general catalysts, companies called color. You originally colored genomics, you know, it's now color. We now have the largest employer. We've taken our 32,000 employees. We've done a risk based arrangement with color. Where are we now literally offer every single one of our poise, full subtyping and genomic testing.

Klasko:                         38:46                And again, it's totally up to them as to what they share with their doctor or whatever. But we're able to do risk stratification. And this is what it means. We know there's four or five different things today that um, if you're a certain subtype, we would change the way that we treat you. If you're depressed and you're a certain subtype, we know that Serotonin agonists won't work. And the reason that's so cool for, for our employees is for those 32,000 people on their employer, on their provider and their, um, their payer. So at the end of the day, that means I'm paying for drugs for people who are depressed, who were still depressed. We're also getting the side effects of that drug and literally aren't showing up to work. And if they want us to, because it's, again, it's totally up to them, they can actually share that data with us.

Klasko:                         39:33                There's people with prostate specific antigen, PSA tests, men who literally, we know if there's certain subtypes, they're not as accurate. So we've taken the tack of, you know, a little bit different than let's get, you know, lots and lots of things and do future research. How can we prove today that precision medicine works on a population that, on the payer to the provider to the portfolio has been, wow. We've had some really, really great, uh, things written about this, a CNBC did they think about it? Um, and I think all these things need to get together. What I'd like to see in, and mark and I have talked about this and David Feinberg, when he was at Geisinger and outside of others, we need to take all of us that are doing innovative things in different ways and look at, you know, how does, how do we start to put those kinds of things together?

Bill Russell:                   40:18                That's exciting. It changes. So I'll give you the last question, which is, is this, is this week in health it, so genomics, these are massive data stores and databases. How are you preparing for that?

Nizami :                        40:31                So look, uh, right. Uh, What v we have at what we call traditional Ew, right? So that's what, uh, that's what we are using for overall current needs, which is mainly data analytics some level of prediction, predictive modeling and so forth. But then about a year ago, uh, last year we used started looking into the concept of data lake and really a data lake outside in the cloud. So we partner with a vendor. Um, and, and that, the idea is that even though today we don't have a need, you know, so what we have for currently is working for us, but as we are acquiring hospitals, we are, um, we're getting data that is just tremendous, but for the most part unusable because the formers is different, their systems are different, is the data is not clean. So the biggest challenge that we have seen, and I think this is not just Jefferson, this is across the industry, is that the data we receive is just bad data input to garbage in, garbage out when a situation, right?

Nizami :                        41:27                But there is a realization and I believe that there are technologies that are, are, are, are, are on the horizon, especially using machine learning in AI that are going to extract, be able to extract data, right? So we are preserving the data for future use there. We believe that we will be able to use them, but we cannot use today or, or we have selected views, you know, um, based on the use case and that. So the future for us on the storage of data and the processing of data I think is partnering with the Vendor. We don't have the competency, we are focusing on the people portion of it. So we have hired some, uh, some of the really outstanding data scientists. We have been fortunate to recruit just very recently, two data scientists from UC Berkeley's program. We have some, uh, from Drexel and local oncologists are very, very strong team and that's, I think instead of worrying about, you know, how to store and how to compute, they're experts doing that, I would rather focus on people who can really make value out of it.

Klasko:                         42:24                And, and maybe, you know, to put the whole it a new thing together. I mean, at Davos I gave a talk, uh, going from self driving cars to sell healing humans. And I think one of the things we have to think about in healthcare is we've spent so much time training our healthcare providers to be better robots and robots because we didn't have robots, you know, uh, you know, if I can memorize 19 reasons you had a headache and doctor and the zombies are growing, memorize 15, I was a better doctor than new cause he missed four. So memorizing the Kreb cycle really mattered. Now there's going to be a, he she or it next to me is going to be much better doing that. It's going to be incredibly important that I can be the, the, the human in the room. And I think we're spending a lot of time thinking about the human in the middle. In fact, we actually are starting the first, it took us 50 years by the way, to get doctors and nurses to work well together. Now we're going to have to get doctors and robots to work. So I will start the first institute for Intersentient Education to sentient being and the droids.

Bill Russell:                   43:26                Well, gentlemen, this was, I learned a ton. It's been a phenomenal conversation. Is there, uh, for our listeners, is there any way they can follow? You guys or follow Jefferson?

Klasko:                         43:36                Yeah, I'm, I'm @sklasko, uh, also sklasko.com. And then we have a, if you go on www.Jefferson.edu, we have a whole sort of innovation and it, uh, like,

Nizami :                        43:48                yeah. And Nassar.Nazami@Jefferson.Edu linkedin and then design me at tutor.

Bill Russell:                   43:54                Yeah. I look forward to one of these days. Getting a tour of the vault downstairs should be, should be a lot of fun. Uh, again, thank you very much. This show's production of this week in health it for more great content. You check out the website @thisweekinhealthit.com or the youtube channel @thisweekinhealthit.com/video. Thanks for listening.