Drex DeFord visits with us to discuss Apple's big announcement this week. We also delve into the best opportunity for cost reductions in Health IT.
Bill Russell: 00:08 Welcome to this week in health where we discuss the news, information and immerging thought with leaders from across the health care industry. This is episode number 22. It's Friday, June 8th. Today we talked about apple and API Apis and what healthcare it can do about the rising costs of healthcare. This podcast is brought to you by health lyrics. Are your strategies constrained by infrastructure or are you tied in a knot of applications? We've been in your shoes. We've been moving health systems to the cloud since 2011 find out how to leverage the cloud to new levels of efficiency and productivity. So visit healthlyrics.com To schedule your free console? My name is Bill Russell. Recovering healthcare CIO, writer and consultant with the previously mentioned health lyrics. Uh, before I introduce our guests today, I want to give you guys an update on what we've been doing.
Bill Russell: 00:54 So, as I shared a couple episodes ago, we've reached some milestones and what we did is we got together with our sponsor and what we'd like to do is now that we have a quality show, quality content quality guests, we'd like to get into the hands of a more health care leaders. Uh, we would like to, uh, get it to the staffs and, and other people within healthcare within the healthcare industry. That's why I'm really excited to, to, uh, continue, uh, to give you an update on this and to announce that our sponsors agreed to give $1,000 for every hundred new youtube or podcast subscribers through episode 31. And this is episode 22 to hope builders. Hope builders is a organization in Orange County that provides life skills and job trainings to a disadvantage youth and gives them enduring professional and a personal skills to put them on the right path.
Bill Russell: 01:50 Uh, I've hired some of their graduates. It's a great program and their stories are inspiring. They're incredible. Uh, we'll hope that we hope that you join us in sharing the show with your peers, your friends, to maximize this opportunity. And again, to just to give you an update, we've already raised $1,000 over the last three weeks, but I'd like to push that number much higher. So, uh, today's guest is coming back for the second time, so that's a good thing. Today's guest is, uh, the original recovering CIO. If you go to a recovering cio.com, you will find his website, former CIO for scripts, uh, the Seattle children's, among others. Now an independent consultant with, um, who helps providers and startups across the spectrum. Uh, my good friend, Drex DeFord is in the building. Good morning Drex and welcome
Drex DeFord: 02:41 How are you?
Bill Russell: 02:41 you know, I'm doing pretty good. How are you doing?
Drex DeFord: 02:44 I'm doing good. I just came off some travel yesterday. So a, it's nice to be home in Seattle.
Bill Russell: 02:50 Yeah, I uh, I noticed that, uh, somebody did a Twitter post about the recovering CIO and gave you credit for being the first one to coin the term. And, and a, it literally you, you got the URL recovering cio.com takes you to your, your organization's website. I mean, how'd you come up with that? I mean, was that after your last CIO Gig or after, cause you've, you've done two or three.
Drex DeFord: 03:16 Yeah, I'm uh, I'm absolutely sure, uh, in the, in the sort of mode of plagiarism is the most sincere form of flattery. Thinking that I probably stole that from somebody in the past. And I don't know that I can necessarily say who, but I have had a go daddy account for a long time. So when I find a really cool or interesting phrase, I very often wind up grabbing the domain just to see if something happens with it. So that's one of those domains auto forward.
Bill Russell: 03:50 Yeah, data Hippie, a nerd herder.com. All of those forward to my,
Bill Russell: 03:57 I'm a little bit of an addict as well. I'm curious what your, your go daddy bill is up to annually. I think I've literally have about 15 to 20 domains that I've collected over the years.
Drex DeFord: 04:10 I'm probably in the same boat. I'd probably, I have a few and I let a few go every year where I'm like, okay, that's, that was never gonna go anywhere.
Bill Russell: 04:17 That was a good idea back in 1998 and maybe not so much anymore. Yeah, I'm good ones. Yeah, absolutely. So one of the things we'd like to do is just give our guests a couple of minutes and tell us what you're working on, what you're excited about, uh, today. So what's going on in your world.
Drex DeFord: 04:38 Yeah, I, um, so I, I just came back off of a travel down to the synergistic tech board meetings, synergistic of course, best in class health care security consulting firm based in Austin. We met in southern California yesterday, a board meeting. So I'm on the board of directors is synergistic, which actually has been a massive, super cool learning opportunity. A publicly traded company on the New York Stock Exchange. We rang the bell, uh, on the podium a couple of years ago, which isn't one of those things you can really put on your list to do. It just has to sort of happen to you. Um, so we've been through some m and a, we've done a bunch of stuff. I've learned a time, uh, being on that board of directors. So that's been really great. Other than that, I'm working on, uh, you know, the usual sort of stuff with health systems around the strategy and planning a lean operations implementation kind of stuff.
Drex DeFord: 05:33 I still do work with a lot of work with vendors. I have retainers for the two vendors helping with everything from sales training to product development. I mean, you name it marketing, uh, right on down the line. It's still do some work with vcs and PE firms, uh, from time to time on thrashing through a book right now and that, I don't know if it will ever actually be finished or if it's just going to be this always pending draft a document in my, in my Microsoft word and folder. But can I curse the name of the book is you can't bullshit an old bullshiter, so we got to kind of got to see how that comes out. And, uh, you know, in the spirit of space nerd, I continue to stay plugged in NASA and space x and blue origin and all of that. As we talked about last time. Um, love the space station stuff,
Bill Russell: 06:28 big, big announcement from NASA today on the findings on Mars 3 billion year old. Um, oh gosh, I'm sorry. I read it like a half hour before the show. Like 3 billion year old findings of matter as well as they believe there's matter on Mars that can support the elements that would be required to support life. So it'll be interesting. Obviously that's, you know, if you and I were independently wealthy, that's where we'd be spending our time.
Drex DeFord: 07:01 I would definitely be a space tourist. That's no doubt.
Bill Russell: 07:04 Yeah, it is. It is so much fun. Um, and you know, one of the things we don't talk enough about on this show is security. And if, uh, if anyone wants to know why. The reason is we have a lot of CIO's, either former or current and, uh, most of them are under strict guidance from their security firms not to talk about their security posture publicly because you know, half the battle for somebody trying to hack in, it's just, you know, picking up sound bites. And so anytime we go to talk about security, a CEO's are a little leery to do that because you just don't want to, you don't want to make it easy for somebody. So you don't want to talk about, well, you know, we have a three tier architecture and we're doing this work. Yeah, for sure.
Drex DeFord: 07:44 You give away a lot of stuff when you talk about it. So yeah, that's probably for the best.
Bill Russell: 07:50 Yeah, absolutely. So, uh, so on transitioning or so on our show, we do three things we do in the news soundbites and a social media close in the news. We each pick a story and you picked the story for the week. So I'm gonna let you go ahead and kick it off with your story, gives a little background and, and we'll go back and forth on it.
Drex DeFord: 08:11 Sure. Uh, so kind of a story of the week. No worldwide developers conference in San Jose, the apple worldwide worldwide developers conference in San Jose this week announced a bunch of different cool and interesting stuff as they always do. But in particular they announced that they're making the health records API available to developers and medical researchers. And I'm reading this from, uh, from the website or from a, not from the apple website. Actually come in from a health data management. Uh, thanks guys for writing this up. Um, help consumers better manage their medications, nutrition plans, and, and diagnose diseases. So I mean, I find this really interesting because we have gone a long period of time. Uh, Google's tried to build a personal health record, uh, and, and basically bailed on it. Uh, Microsoft has, uh, a personal health record. Health Vault still not used extensively in this country, but as used in other countries.
Drex DeFord: 09:14 And so this kind of whole new approach of how do you create a personal health record, but maybe the foundation of the record is on your phone and you control it and management. And with the release of these APIs and the ability for other developers to be able to connect to that health record app and do other cool and interesting things that might ultimately drive you to stay more healthy and be more healthy, uh, is a really interesting idea. I'm concerned about a lot of things as a lot of people are always about security. I always have security and privacy in the back of my mind. But um, the opportunities there are, are, are pretty cool and it will be interesting to see what health systems and vendors come up with.
Bill Russell: 09:56 So around security, one of the things they noted is, uh, the health records data is encrypted, which we already know on the phone and protected with the consumers pass code and that technology. But they also also emphasized, and this was something I did not, I knew they would have to address. I didn't know how they were going to do it so that the data flows directly from Apple's health kit to the third party apps and that is not sent to the vendors servers. So it's not a mechanism for, uh, like a Facebook. Like, you know, Oh, I've access to this information now I can just suck all this data out from this patient and move it to our servers and start selling the data. That's not how this is designed. It just goes, it stays on the phone. It goes from, from health kit to that vendor's APP gets used there. And uh, then obviously with cloud services and then gets put right back where it was. So that's, that's one of the things I found interesting about how they're going to do security.
Drex DeFord: 10:54 Yeah, yeah, yeah. The devil's in the details. I mean, I really want to see and understand how that, how that actually works at the idea that ultimately we're creating this system where you are in control of your data and you can release what data you want to whoever you want, uh, is a really good, um, privacy strategy. I get to manage my data the way I want to manage my data and no one else has access to it. If that's ultimately what this really boils down to a I'm in. I think that's a, I think that's good strategy.
Bill Russell: 11:31 Yeah. And it looks like a lot of the rest of the industry in this article, John Halamka, guests on the show, as these API tools become more widely available, smartphones will be increasingly important. Middleware component that enables patients to be stewards of their own data. Stan Huff a chief medical informatics officer at Intermountain healthcare describes, apples initiatives as exciting and pivotal given the fact that the company is supporting HL seven fire Api Apis. Robert Wachter who, uh, wrote the book digital doctor is also very positive. Karen DeSalvo was very positive. Um, uh, and actually I'm going to focus in on two of these. So Ken Mandl, uh, of smart and smart on fire fame, uh, director of Computational Health Informatics Program at Boston Children's hospital. Uh, someone who I had come out to California and speak to our physicians on the uh, the value of interoperability within health health care. Great Guy. Extremely smart, deserves that.
Bill Russell: 12:29 Apple has taken the next logical step in creating a health apps economy. And I think that's what we're all really excited about it. He goes on to say, by connecting to hundreds of electronic health record systems using the open smart on fire Api standards, apple has committed to an advanced the interoperability of health data across vendors and organizations. Uh, with this announcements, they are opening up the key health system data to their ios development community who will soon have access to blood counts and medications for apps just as they have access to calendar contacts, locations and step count. And I think he hits the nail on the head. I mean that's, we're creating a health APP economy. Uh, w when a developer used to have to develop an APP, they have to decide, you know, how are they gonna interface with the EHR? We all know there's a hundred different EHR.
Bill Russell: 13:18 You know, are they going to, you know, go through a third party and Api? Are they going to go directly through a, uh, a, you know, like an app orchard or something to that effect. And now you have this mechanism where they can, at least with the data they have and now it's not great data. And that's the next thing I wanted to sort of touch on with you. Um, but they've created this health app economy. Do you think we're gonna see an explosion, uh, like just a huge number of apps come out on top of this? I mean, we're talking about I think four, four or 500 hospitals at this point that have connected in. Yeah. Do you think we're going to see an explosion of apps on this or is it going to be sliom?
Drex DeFord: 14:00 I think what we've seen, what we see in the APP store and a lot of cases when it comes to, you know, quantified self and personal health kind of applications, there are a lot of people that download them and use them once or twice and they're not sticky or they don't do that thing that the person kind of hope that they would do or wanted them to do. And so when it comes back to sort of average daily user count for those applications, there's lots of them, lots of them that aren't used. Uh, so really very few of them are used. I think we'll probably go through a similar cycle with this. I think there's a couple of paths here, right? And I don't know that the electronic health record, vendors are going to maybe like this idea very much, but I think the idea of the health record on the consumer side, on the customer side, and you know, you've heard me rant and rave about, we really shouldn't talk about them as patients. They really are customers on the consumer side, on the customer side, I think we're going to see this path where they're going to get better access to their records, the data in their records, and then using apps that we're going to have A lot of developers are going to have to struggle through this to figure out what really works and what doesn't work, but ultimately they're going to be able to see their data in different ways that works for them. Given that we're all individuals and we all have different ways of wanting to consume data. Uh, sort of another version of personalized health, right?
Drex DeFord: 15:35 I'm going to be able to use, uh, an application that drives the data to me and the way that I needed that leaves me ultimately to live a better, more healthy lifestyle. That's one path that we're going to see. And the EHR vendors really in that scenario are just going to be that data repository for the data. I think there's going to be another version of this that happens on the, on the provider's side with fire and Api APIs and lots of other things like that. Not necessarily apple, but there could be lots of ways that this will will come about. Um, I think you'll see the same thing. There are lots of, you know, between transplant lab and rat and you know, we've all gone to or many of us have gone to um, best of suite electronic health records. What if you could layer on top of that a bunch of applications that like you as a provider see data and use data the way that you really want to use it.
Drex DeFord: 16:31 Um, and again, the Ehr just becomes the underlying infrastructure database infrastructure to feed those apps. Um, it's an interesting idea and I kind of had, I do play around with, you know, where could this go and how could it work? And you know, being here in Seattle, I worked with a lot of, a lot of startups and a lot of big thinkers. So it's, uh, it's fun to brainstorm through this. So I don't know if there'll be an explosion of apps ultimately. Um, I think there will be a, probably a lot of apps and a lot of them will be left also to the, you know, to the side of the road over time as they develop and redevelop and redevelop. But, but that's the beauty of something like an app store or something that can, can be improved on over time. It's an iterative process. You find out the things that really work and the things that don't work and you're not burdened with the giant legacy system that you've built to support it, that becomes somebody else's responsibility. In this case, the EHR vendors,
Bill Russell: 17:42 Will there be an explosion, I believe we will see an uptick. We'll see an explosion probably three years out. Um, a couple couple of hurdles we still need to get over. One is the EHR providers do not want to be relegated to a data transaction or a transactional processing system for the health systems. Um, they do make money out of the Apis, at least a one of the major vendors makes money out of their APIs. Um, they, uh, you know how I've gone on record and uh, normally, uh, you know, they've gone on record, at least the predominant Ehr provider, their leader has gone on record as saying, you know, we need to protect the patients from there, from themselves. Essentially we give them this information. It's very complex. They might make the wrong decision. I understand the sentiment of that, that the health record is very complicated and I wouldn't know what to do with my health record, but there's a whole bunch of brokers out there that could take my health record and give me a lot of insight into, um, you know, my, my maladies or disease state or my proclivity to certain things that I think is valuable.
Bill Russell: 18:50 Let me hit on this last one. So this is, this is a from someone you probably know pretty well. Eric Topol, ah, from scripts wrote the book, the patient will see you now the future of medicine is as you're in your hands. Was also quoted in this, maybe not as optimistic, optimistic, a little guarded. A Apple's continued after to get patients accessibility to their medical data is laudable. Says topple. However, he adds that we are a long way from getting a holistic comprehensive data, but this is a step in the right direction. And what he's talking about is, uh, you know, the, the, the challenge with the data itself Intermountain's huff, um, who's been an advocate for a clinical data models and terminologies says his only concern is that there's a, there's a need to further standardize the models and terminology used in fire services so that the industry ends up with true semantic interoperability across the marketplace.
Bill Russell: 19:42 And you and I have, I mean, this is why we have less hair and gray hair is, you know, you start taking in to these various disparate Ehr and it's not so much that the EHR store data differently or, or those kinds of things, although they do. Um, but really it is that we put it in differently. You know, we put the same prescription in five different ways and it's really the same thing. And even when, when I talked to people about, um, AI models and are we going to be able to apply AI, most of these things, they're like, you know, that is one of the harder things to get through is that these five things are the same thing. It's just, it's, it's a very challenging model. So I guess the question, the question we on this one is, okay, the Fire Api, it's phenomenal.
Bill Russell: 20:35 We're getting out the basic information from the fire Api. Um, and I imagine that will continue to progress, but as we get into some of the more complex data sets and some of the unstructured data and whatnot, um, I, I would assume, I would assume that's going to slow us down. Do you think that's going to slow down this, this progress, um, or do you actually, let me rephrase this. Do you think there's going to be a push nationally to getting to that, um, to that true clinical data model that just happens now that we're, it's almost like we were going to try to get there so we can get to interoperability, but now that we're driving to interoperability, it might drive a standard data model across all of these health systems. Do you do see that happening or what do you think's going to happen in this data model space?
Drex DeFord: 21:28 Yeah. Yeah. I, so, you know, I regularly talk to clients too about sort of analytics in general on how to approach it. And so I'll tell you a short little story here and maybe it kind of ties this ties back into this. Um, when I went to one of my health systems as the CIO, um, the data and the data analysts, we're all sort of centered in the information services department. And so when my partners, clinical or business partners wanted a reports or databases or other things, they lined up outside the door and there was a long line outside the door and they would have a conversation with one of the analytics guys on my team and they would gather the requirements and they would build something in a spreadsheet and shake vigorously and give it back to the back to the partner two weeks later.
Drex DeFord: 22:26 And by then the partner would say, you know, now that I've thought more about it, maybe there's some other stuff I would like to have in there too. Then the analysts would pull their hair out and go crazy and start over again. And we ultimately evolve that to a model where the analysts in the is department for the folks who were they, they were sort of the consultants and the keepers of the data and the data governance. And we really pushed the actual analysis of the data to the front lines. We gave them tableau or clickview or you know, something like that. And what happened was instead of saying we're going to solve world hunger and build a data warehouse, we started off with let's find two or three really hard chronic problems that we have in the health system and figure out that 23 data elements that we need to solve that and what's the source of truth that we want to use for those 23 data elements from these five different systems.
Drex DeFord: 23:23 And let's build a database that pulls that data in on a regular basis, hourly, quarterly, weekly, whatever it actually takes to solve the problem. And then pushed the data visualization tools down to the frontline folks and let them figure out what's the best way for them to consume that data, change their business or clinical processes to ultimately drive better, faster, cheaper, safer, easier access to care for patients and families. And when we did that, we sort of wound up going through a process where we accidentally but very intentionally went through a process of making decisions on that's a really important data element and we use it in lots of our decision. So it's going to come from that system and it's that data element and now we're really going to go have conversations with the people who do the input of that data element to make sure that they understand why it's really important that they put in something for the dropdown menu or that they, that they actually answer the um, you know, the question or we modified the system so that it made it really easy for you to answer that question instead of bypass it.
Drex DeFord: 24:35 So the things that we needed to make better business and clinical decisions grew up the way that we ran the applications and the way that we train the personnel, they use the systems. Um, maybe there's something in that, in this larger sort of context as far as we don't have to get it all right right away and maybe we shouldn't even try. Maybe what we should focus on are the data elements in our electronic health records and other systems that all taken together are the things that are the most important data elements that drive improvements in health for patients and families.
Bill Russell: 25:14 I love that. Transparency changes things, right? So you give Tablo click view to the, uh, the front line physicians who are trying to utilize the data. They get transparency into it. They look at it and they go, hey, this data's a mess. We should talk to that medical group. We should talk to them. And I think that same thing is going to happen here. Trench transparency of the data nationally. It's going to get people to say, hey, you know what, at least for these things, we could, we could handle, you know, cancer moonshots better if the data was better along certain lines. So I think we'll see that to close out the story. The last thing I would say to people is this, uh, this has left the barn. Get connected. Get your first of all, get your Ehr fire, uh, connectors set up. You should be done by now actually. Um, uh, contact apple, get involved in this, uh, get your, get connected, get your health system connected to it. Um, you know, this horse has left the barn. If you're not on board, you could be a, it could be left behind. I think this is a, this is not a trend that's going to fail and come back. I think this is a trend that it might move slower than we think, but it's, it's a, it's going to, it's going to move.
Drex DeFord: 26:41 I agree. I think it's definitely move and uh, and it, it may be a little slower and a little more cautionary. I mean, I think Apple's learned a lot from the other tech vendors who have said, oh, hey, we're going to solve health care. And then they get into healthcare and then, you know, a year later or two with their tail between their legs, their legs, they leave saying, Oh man, that was super complicated. I had no idea what was actually happening in health care. They've been a little more cautious in their approach. Um, but you're right, this is, uh, the barn is out the door, the horses out the out of the barn door as you. So, uh, we're, we're on our way.
Bill Russell: 27:22 That's the analogy we're looking for. Nothing to anyone understands what the Horse is out of the barn means anymore, but we'll keep using. So here's my story. So the headline is you'll be shocked at the price of health care for a family of four a, it's from an MSN article, I think it was published yesterday. Uh, here's a couple of things from a healthcare costs have been increasing at the lowest rate in the past two decades. The result that's all costs of typical family of four insured by the most common health plan offered by employers will average $28,166 this year. According to the Milliman, uh, medical index, the estimate includes average costs of health insurance paid by the employer, uh, employers and employee, as well as deductibles and out of pocket expenses despite the significant expense for many households and employers, a slower rate of growth is good news. Says, Scott Wells, a principal at the consulting actuary, uh, in Brookfield office of Milliman. Um, my first question to you is, does that number surprise you? $28,166 a year for a typical family of four. Is anything surprising about that?
Drex DeFord: 28:30 Um, you know, I think it's only surprising and that, you know, when you see the number and you think about the amount of money that the average American may, uh, even at this point where we're at full employment, man, that's, it is, it's shocking. It's a, in some ways it's kind of horrifying, uh, that it costs this much, which signals to me there's still a massive amount of waste in healthcare. There's still a lot of consolidation to be done. Uh, we don't, uh, we don't operate well. And, and you know, you can't say that in every case a when it comes to health care, but, um, but man, this is a huge amount of, I mean, ultimately people are making decisions, right? About, are we going to pay the rent? Are we going to buy food or are we going to pay our healthcare premium? Didn't mean these are hard choices that most of the country are facing. Right?
Bill Russell: 29:31 Yeah. I've seen this from a lot of different angles. Obviously Cio for health system, um, had, you know, 600 some odd employees reporting in to me. So I saw it from their perspective and from the health system P and l perspective, I now have also seen this from my perspective. So one of the things that they note in this is that, uh, the total cost includes the premiums paid by the employers. And I think that the, you know, over the last two years, it was the first time I've had three consulting practices. The first two were just Bill Russell Inc. This one I've actually hired, uh, hired a team. So I have, I have employees, we have insurance. So I went out and had to buy insurance and get it all set up and that kind of stuff. That was eyeopening to me it was really eyeopening how, um, you know, I thought we'd be able to go online, selects, you know, sort of like the Geico experience.
Bill Russell: 30:27 That's, that's just not the case. I ended up with filling out the, almost looked like identical forms for three different carriers. One for dental, one for, uh, medical. Uh, vision was a different one. And, uh, you know, I'm working with a broker, I'm like, can you do this stuff online? They're like, well, you know, in a couple of years we'll be able to do this. And I'm looking at that and I'm going, all right, well that I could see the waste is right in front of me. I mean, I'm sitting here with, you know, 15 to 18 pieces of paper I have to fill out. There's the waste, in and of itself. And then you talk, just knowing what we know about billing and the average medical bill has to be sent out, uh, or generated 12 times before it actually gets paid. Well, name another industry that we generate a bill 12 times before we get paid. It just, it doesn't exist. There's, so, there's still so much, uh, so much to do. I want to transfer transition us to really our, our listeners on this show. Um, you know, health systems are continued to be under pressure for cost reductions. It remains one of the largest sources of costs. Um, you know, what are some strategies that you've done to contain or reduce it costs in the past and what do you, what do you think that CIO should be doing now?
Drex DeFord: 31:45 Uh, you know, so for me that was every time it came into a CIO job, it was a turnaround. And we may just be obvious, right? There are times that you wind up in a new CIO job where the previous CIO had simply decided to retire or they've been recruited away to another place. Very often though, it's a, it's a different situation. You have to come in and fix a lot of stuff. Often that also ties back to cost pressures. So for me, um, when I went to Seattle children's, it was, part of the reason I went was lean and Toyota production systems. It was a cultural way of making decisions about how they were going to prioritize and work they were going to do, but also driving that sorta take waste out every day. One second. At a time kind of approach that really did allow the organization to become more efficient and more cost effective. Kind of one drop at a time.
Bill Russell: 32:48 I'm a huge fan of lean and practicing lean, like our health system did it system wide. But if, if, if a CIO is in a health system, it's not doing lean, how do they get started? Where would you direct them?
Drex DeFord: 33:01 Yeah, there's like a couple of things that every place that I go that like these are just two of the things you can do, uh, and and take some waste out of the process at the same time. One of them is to do a daily huddle and, and maybe do a daily huddle and do away with the weekly or the every other week staff meeting that you have. Everybody shows up, you've got 20, 25 minutes, 15 minutes, whatever it turns out to be. And you literally go through a process of having a conversation about what are we doing today? What are the roadblocks for getting those things done? How do we overcome them? There's usually a list of things that are ongoing, pending challenging issues that you can talk about. You can talk about a safety item or something like that. But the beauty of this is that you understand every day where you're at today.
Drex DeFord: 33:57 Instead of having a conversation once a week where somebody has been saving up stuff for a week and they're mad and frustrated and then they barf all over the table and that's not good for anybody. So doing daily huddles and really understanding where you're at every day, where the issues are every day, every morning so that you can work them, uh, make a great amount of sense. Not just for the CIO but their direct reports and their managers and directors should be doing daily, daily huddles with their teams to the other one is going to Gimbo, you know, going to the place where the work is done and whether that means the CIO or the directors or the managers going actually out in clinics or business operations and seeing how the work is done to better understand how their delivery of health care it solutions makes it easier or harder for those partners to deliver great care to our patients and families.
Drex DeFord: 34:55 Or sometimes it comes down to me sitting down with three analysts and you know, one of the areas of the department and talking about some process that they're, that they're working on. It was not unusual for me to go in and sit down and, and pick out one particular thing and talk to an analyst on one day who drew out a diagram of how that process works and then go back the next day and talked to the next analyst about the same process, who draw out a diagram on how the process works and then getting the two or three of them together and showing them the diagrams and having them have the revelation of, man, there's no why, why are we doing this three different ways we should agree on one way and then we can all do it. And then I can go on vacation and you won't call me because there's some weird thing that I'm doing that we're not doing as a team.
Drex DeFord: 35:47 And when you develop that culture, ultimately you can drive that thinking down into the organization. And this idea of I'm unique and special to the health system and the reason that I'm valuable is that I know stuff that nobody else knows. It starts to change to creating good standard work that allows everybody to be more effective than they've ever been before, is the reason that I'm valuable from this health system. So it's, you know, lean to me is a, it is a big deal. And I understand it's kind of magical for a lot of people. Um, I know sometimes it's kind of, uh, you know, just a management term that people use, but it's a real cultural approach and it can really make a difference in how your employees engage in your health system. it can make a real difference in saving money and can make a real difference in how well you care for patients and families. So obviously I'm a fan. I've lived in Japan, I lived in Japan for three and a half years. I've been back since to, you know, meet with Yamaha and Toyota. And so, yeah, I've drank the cool aid. I'm that guy.
Bill Russell: 36:57 Our organization had lean methodology across the board. And, uh, you know, drove out millions and waste and cost and improve safety in it. We took a sort of a modified lean slash agile, uh, you know, visible management, uh, to stand up huddles, those kinds of things. All of our major projects that stand up and visual. So every one of our walls within our it building. Yeah. I had something I could just walk by and look at and say, Hey, I've got a question. What's going on? And because you're doing daily standups, you know, it's not hard to find somebody who knows what's going on. And Yeah, we talked about that this morning here. Here's what's going on. And I'll tell you the other thing that just, here's, I'll give it organizations one thing that can implement,
Bill Russell: 37:43 which is when we sat down, we had 120 projects going and I decided I'm going to bring all my, uh, my direct reports into a room and every one of the project managers was going to come in and they just had to tell us, give us an idea of how the project originated. What problem is it trying to solve? Does the problem still exists today? And uh, you know where you're at and what do you need from management to be successful? And the first meeting almost took a day and a half all hundred 20 projects to go through them. But what we were done, we cut out like 20 projects cause the problem that existed at one point did not exist anymore. And we still had it resources allocated to it where it's still generating documents, doing all sorts of stuff. And it was, it was nuts. And we just like, and that's, it's, it's, it's a logic, it's not necessarily lean per se, but it's just logic to say, hey, you know what, let's continue to ask the question of do we still need to be doing this work in this way with the changes that have happened? So
Drex DeFord: 38:45 yeah. Yeah. One of the things that lean is the five whys for anything that's going on. You ask why five times and you'll probably really get to the root problem after the fifth answer. This idea of being able to see into your organization and understand what you're doing. Many health care organizations. It's a big part of what I do, don't have great and governance processes when it comes to deciding what projects they're going to do and what they're not going to do. They don't actively kind of draw a line and say we're going to do the things above the line. And all of those things have business or clinical sponsors. These aren't is projects, their clinical projects or business projects and the things below the line we have as a group decided that we're not going to do so we're going to actively not do those.
Drex DeFord: 39:35 And that means that our business and clinical leaders aren't going to have little black operations where they try to do those projects either. And if they do, they get in trouble for trying to do that. So, um, you know, having good governance processes, understanding where all your contracts are, do you actually have all of your contracts? Most of the places I go into and have that conversation, it turns out that some significant number of contracts were signed by the CIO two CIOs ago and they don't actually have the contract anymore. Somewhere in a file, they just start paying the bill. So going through that legacy stuff, all the MNA stuff that's going on right now, right, you wind up with, uh, even when it's not an MNA thing, you wind up with a multi hospital system, um, that very often by three applications that all do almost the same thing. So this application rationalization effort that I know you work on to, let's pick one APP and kill off the other two can save a lot of money and drive a lot of standard work and improve the data that we collect. Right? So it has a whole bunch of secondary, tertiary positive impact.
Bill Russell: 40:48 Yeah. We're going to do a whole show on m and a at some point I went through one of the largestM and As in health care. Obviously the two organizations come together, formed a 22 some odd billion dollar health system. So eventually we'll get there, but I'm actually running over already. So here's what we're going to do. The second, second part of the show is, uh, we call sound bites. I want to give you five questions. You get one to three minutes to answer, um, you know, I'll cut you off. If it goes too long, we'll start with the easy ones. So kids are graduating from college. So if you had a kid going to college today, what's the major you would tell them to focus on if they were interested in healthcare I?
Drex DeFord: 41:30 yeah, man, you know, analytics. I think, um, it doesn't matter, uh, health care or not. I just think the idea that, um, whether you're going to be an actual data analysts, uh, professionally or you're going to be a business operator or a clinical operator in the front lines, you need to understand data and data analytics and not just that, but also, um, you know, data visualization. I'm a big fan of Edward Tufty. Uh, I read and reread his stuff all the time. You know, a picture is worth a thousand words. If you can figure out how to show data and the right way, you can convince people to do the right thing, you know, over and over and over again. Um, there's some, uh, there's some other companies that I work with that do some really awesome data visualization our kitty health solutions in Boston has a whole page on their website and data gallery that has some amazing data visualizations. So that idea of whatever it is, however you get into it, whether it's a major or a minor, you really need to understand data and how it works and at least the fundamentals of sort of database design and how you take that data and make it work for you.
Bill Russell: 42:51 Yup. And that's, that's just the results as that's digital, right. To the exhausted
Drex DeFord: 42:56 just the world that we're in now. Right. You, you, you have to know it and understand it and it almost doesn't matter what job you're doing, you have to know, you have to have a sound fundamental understanding of that. Have that capability.
Bill Russell: 43:11 Yup. So the raging role debate for healthcare technology leadership. So you have a CIO, some health systems have a c chief digital officer of CDO, right? Some of a CIO, chief innovation officer and so on. Uh, I guess my question is who's the voice of the future? For healthcare. Who is setting the course for the next 10 years of, of that group or who do you think should be?
Drex DeFord: 43:37 I think if I understand the question right for me the question is more of a question about where do you try to draw whatever the gray line is between strategy and tactics? Right. So when it comes to job titles, if you're a chief information officer and you really focus on strategy and you have a really strong chief technology officer, they keeps the trains running on time and does it efficiently and manages the budget really well and all of those kinds of things, then it doesn't matter. You can call it a chief information officer. I think we see a lot of health systems where there are strategic strategic chief information officers who try to be strategic, but because the daily operations have regular challenges, they get sucked into the tactical side of the house on a regular basis. And that can cause some significant frustration for your executive peers because the only thing you seem to be working on is that x, Y, z. That isn't working well today. So those health systems go out and hire chief digital officers or chief innovation officers to think strategically and not be mired in daily tactical operation. So I don't know that necessarily makes a difference. And you could call him purple. It doesn't really matter what the title is. I think the issue is where and how you draw the line between strategy and tactics and then when it comes to strategy, really being involved with your business and clinical partners, developing new, better creative, innovative ways to deliver care,
Drex DeFord: 45:10 great care to patients and families. And that isn't just a technology issue, that's a people and process and business and alliances and partnerships with other organizations. All that gets wrapped into it. I think those are the people who were ultimately going to help drive health care in the right direction in the future.
Bill Russell: 45:30 Yeah, I'll close that out by saying I think the leader of the digital strategy within the health system as the CEO and no exception. So that's right. So, uh, what are one or two technologies that you're keeping an eye on right now that could be disruptive to healthcare? Um, and let's just say the timeline is the next five years.
Drex DeFord: 45:53 Yeah. Because of many of the things that I write about and post about on Twitter, I have to say artificial intelligence, but artificial intelligence is one of those things that I think by the time we develop that thing that was artificial intelligence, by the time we get to it, we call it something else. So Ai has always just out of reach. So we have Siri and we have Alexa, we have self driving cars and all those things. At one point we would have described as artificial intelligence, but that's not really what they are now. You know, they're there.
Drex DeFord: 46:27 They're just a thing that we have and the thing that we use, and I think we see the same thing in healthcare when it comes to digital radiology and you know, a whole whole bunch of other stuff that's not artificial intelligence now. That's just a thing that we use, I think general artificial intelligence is a, is a long ways off. Although there's a lot of people doing a lot of cool stuff in labs around the world. But don't talk about what they're doing. So I could be wrong with that, but, um, but I think AI ultimately could be and will be one of those things that will over time incrementally continue to allow us to use our time and our brains to work on the really hard stuff because there's stuff that can be automated or, uh, put into an artificial intelligence bucket. We're going to continue to march down that road. So Ai's ones
Bill Russell: 47:25 I agree with you I think Ai and Iot for me are one and two. Being able to monitor wherever they're at. I'm going to just keep going because we're running a little over time. Okay. Uh, so the LTT job landscape continues to change. Uh, what do you tell the front line staff about how to stay current with their skills? How can they, what, what should they be doing to stay current?
Drex DeFord: 47:43 Yeah. Um, a few things, one is n if you can go to conferences, go to conferences and talk to your peers, that personal connection to other people, building that network. And we live in a world now where it is and what you know that you have access to lots and lots of different people and things that can help you figure out those problems really quickly. Uh, so whether it's conferences or youtube, I think there's a go out and get a certification kind of thing. That also is, is really important. Staying on top of it. I think there's other things too, like follow bill on Twitter and listen to this show and play the show for your staff. Those are all things that kind of from a big industry perspective helps people stay in touch. And then I would say the other thing is don't, uh, it's not all about work. So go figure out other things that you like to do that you're interested in that helps keep your mind tuned up to think in the way that ultimately helps you at work. So for me, I mean, whether that's old cars or hiking or um, you know, those are, those are things that I do that caused me to think about how am I going to fix this problem with something that I can't just go to the store and buy. I have to, I have to sort of figure it out with the stuff that I have in this bucket, right. Or in my backpack that that's good. That's a good model to drive improvement in your thinking processes around how do you solve problems at work.
Bill Russell: 49:21 Yup. Absolutely. And then last question, we hear a lot of leaders talking about cloud first strategy. Um, what, what does a cloud first strategy and why should a health system be thinking cloud first strategy?
Drex DeFord: 49:35 Um, you know, like everything, cloud cloud isn't a silver bullet. I mean it's a new way to get services that we may have provided to ourselves and our data centers in the past. We're really risk averse in general and healthcare. So I think ultimately you have to look at what you are willing to let move to the cloud and find a way of working through that strategy at a pace that's right for you personally. I think you should hurry up. I think, you know, we're, we're kind of definitely, and the going too slow mode right now, but whether it's a software as a service provider or putting your backups into the cloud or giving your research guys and ladies access to cloud services to support scaling up and scaling down research projects without buying the infrastructure, you know, for your own data center, for your own property.
Drex DeFord: 50:38 All of those are good. Maybe not business critical or clinical critical operations if you kind of want to get started and figure out how to move. But I think it's mostly about moving. And then the other part is, and I go back to security and all of this, um, this is a new complicated architecture, right? You, you don't have this all in your data center now. So make sure that as you're thinking through this, think about what your architecture going to look like and how are you going to connect these pieces together and protect them. And what's your incident response plan when something goes down? Um, all of that is still important. Even moving to the cloud.
Bill Russell: 51:17 Yup, absolutely. Okay. I would disagree with you a little bit on that one. We're just, we're just different in terms of our, maybe our risk posture. You know, in 2011 I brought box, you know, Dropbox equivalent box into the health system and it enabled things that were not possible. Prior to that, there was nothing Microsoft offered in 2011 that even remotely got close to the amount of collaboration that happened in a secure, auditable environment. That's one aspect. When we moved to the cloud infrastructure, we went from two to three weeks to provision a server to two minutes. When we went to Dev ops, we went from 35 people running. Our Dev ops are running our infrastructure to five. I mean, there's a ton of cost savings and, and things, uh, a bunch of agility that you can get to a bunch of things. That's why I built this. I built the company that I started around these kind of structures because, um, I think, I think the number one thing holding back healthcare is this thing called architecture. And I think we've allowed ourselves to, um, you know, just a decade of this change, this change, this change without an architect looking at all of them. And so we've ended up with this mess. And instead of saying we're going to purpose build this environment to be agile, nimble, cost effective and efficient. And because we've done that, we've, uh, and we still think that that's the norm. We are way behind other industries and we don't understand why we can't move faster. And I think the cloud is the first step to a
Drex DeFord: 52:49 for sure. And I mean I'm, I am with you there. I um, I mean not, not to do a commercial for you, but I think this is a great opportunity now
Bill Russell: 53:00 commercial you've done for me. I appreciate it
Drex DeFord: 53:03 being great opportunity for health systems to actually leap frog. Um, a lot of the challenges that they have today, right? They couldn't get over it, they were willing to go in a big way. They can leave a lot of the burden, some legacy. This is how we do things in the past but is a very scary thing for a lot of folks. But I think if you sit down and talk to somebody like you and you really understand what you're doing and what the process can be and how, what's the timeline and what's it really going to cost and what's it really going to say. The scary part goes away and it really becomes just a way to execute it. Very large project that ultimately saves you money, makes you a more efficient, makes you much more secure, makes you much more agile. All the things you talked about. So I don't disagree with you. I think it's just our legacy of being risk averse keeps us from talking about something really different even though it's probably less risky than what we're doing today.
Bill Russell: 54:07 It's just so people know we don't pay our guest for this show, but I really, really appreciate you saying that. So tracks. Thanks for coming on the show, a tell people to follow you.
Drex DeFord: 54:18 Uh, you can follow me on Twitter @DrexDeford. Um, and uh, of course connect with me on linkedin and send me an email anytime. [email protected]
Bill Russell: 54:31 awesome. You're giving out your email address. That's impressive
Drex DeFord: 54:34 for sure. I can give you Number two, if you want, easy enough to find, easy enough to find.
Bill Russell: 54:40 We're getting a lot of downloads for this podcast now. I don't, I'm not sure we want to give it maybe a follow me on Twitter @thepatientcio the show @thisweekinhit the website thisweekinhealthit.com. Um, and if you want to see the videos, we're now up to over 150 videos thisweekinhealthit.com/video once we get more followers we'll get an actual, a vanity URL for youtube channel as well. Don't forget to share this with as many people as you can. We'd love to raise more money for hope builders and please come back every Friday for more news, commentary and information from industry influencers. That's all for now.