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Newsday: Hackers Outpace Healthcare Resilience and Surviving a Merger with Drex and Bill

Speaker: I'm Bill Russell, creator of this week Health, where our mission is to transform healthcare one connection at a time. Welcome to Newsday, breaking Down the Health it headlines that matter most. Let's jump into the news.

Bill Russell: All right. It is Newsday, and today it is just drex and I

Drex DeFord | This Week Health: Ta

Bill Russell: the, uh, we talked a bunch about cybersecurity and HIMSS last week.

I think we're gonna have to talk about, uh, Sutter and Allina coming. Coming together.

Drex DeFord | This Week Health: it's chilling.

Bill Russell: a, that's not a small one.

Drex DeFord | This Week Health: I can, uh, you know, uh, when you think about a merger and acquisition and the work that goes into that standardization, what ultimately is gonna happen behind the scenes, it would be a great if we could a.

Bill Russell: what happens, because I went through it. Everything grinds to a halt for at least a month, maybe three months, depending

Bill Russell: Gosh,

Drex DeFord | This Week Health: great. That'd be a great story

Bill Russell: would pay thousands of dollars to like, just mirror the two CIOs and like do, uh, I'd do, do one of like, like Netflix, like, uh, you know, drive to

Drex DeFord | This Week Health: behind the scenes. Sure. Absolutely.

Bill Russell: and

Drex DeFord | This Week Health: Great.

Bill Russell: see and just record. And the whole time I'd be like, alright, just cut, just cut. I put my arm around him. I'm like, Hey, we've all been here man.

We've all been here.

Drex DeFord | This Week Health: We can actually call it drive to survive.

Bill Russell: We, we could call it drive to survive. It's, um, yeah, I mean, just, I mean, you and I have both been through this. Uh, for me, it is the stuff of my, uh, waking, uh, nightmares. it is essentially th things do grind. Grind a halt. Everyone wants to know what. What does this mean, So as a leader, you're just constantly answering that question.

What does this mean? What does this mean for my job? What, where are we gonna be headquartered? Who's gonna be the new CEO? Who's gonna be the CIO? Are we gonna have multiple CIOs, we're gonna have divisions, or, you know, I mean, and, and God forbid you travel out to a hospital. 'cause the questions then get really gnarly.

It's Sutter's, the larger the two. And that's always the telltale. It's the larger, the two. Very rarely do you see something like, uh, Bon Corps's Mercy where the Mercy c EO actually took over. That's, that's not, um, that's not the norm. And it was very interesting to watch how that came together. You had a little bit of that uh. Uh, uh,

Drex DeFord | This Week Health: I know you're

Bill Russell: in, in, in name alone, that's how Intermountain and, gosh, was it SCL Health or

Drex DeFord | This Week Health: at CL Health. Yeah.

Bill Russell: SCL out of, uh, Colorado came together and they sort of said this, Hey, it's a merger. Be beware of the term, merger of equals. It doesn't really exist, but they came together. But what they did is they said, all right, we're gonna pick the best leaders from both like. It's like a, it's like a bake off between the leadership, which

Drex DeFord | This Week Health: Yeah.

Bill Russell: pluses and

Bill Russell: it starts with the board, right? So that's the first conversation they have is like, Hey, how many seats on the board do each get? What does the governance model look like? And you know, do the names remain the same? 'cause the names are, the branding of these hospitals is really deep. In

Drex DeFord | This Week Health: In the community. Yeah.

Drex DeFord | This Week Health: Large, super large to extra super large.

Bill Russell: large to extra, extra super large.

Yes.

Drex DeFord | This Week Health: Yeah.

Bill Russell: does this, do you think this signals a, a, a change? Are we gonna see maybe a. A a, a rash of these over the next couple years.

And so while the federal government may lean toward maybe today less strict rules around, uh, you know, maybe. Antitrust and, you know, those kinds of challenges. Uh, I don't know that the states will, um, and so there's still a lot of wrenches that could be thrown into this machine. That's not done yet, but you're right.

As soon as you put out the letter and say, we have a letter of intent of this is gonna happen to me, the thing that is really. Complicated is not only if you don't have all the decisions already made, 'cause people wanna know right away, but as you said, as you get down into the organization, people start to generate their own rumors about what's gonna happen.

Bill Russell: Yeah, I think it's a little less at the, larger organization of the two being acquired, it's a little bit more, at the other side. The attorney generals at the state level generally are looking at losing employment and losing tax revenue. And so they, uh, they, and, , public benefit as well. So they, they try to make sure that they secure those things those kinds of a deal, and they'll secure them in, in the form of, uh, you know, guarantees of, you know, I don't know, a

Drex DeFord | This Week Health: I won't close hospitals. Um, that there's a lot of,

Bill Russell: to, to, to mental health in these communities, or, uh, they won't close down the critical access hospital

Drex DeFord | This Week Health: Right.

Drex DeFord | This Week Health: For a lot of states, these hospitals are the largest employers in the state. I don't know if that's the case for either one of these, given it's California and so, but yeah. A lot of states, when we go through these kinds of acquisitions, if you look at the largest employer in most states, it's very often a healthcare system.

Bill Russell: It is. So, uh, what's your advice to the person on the ground, the ciso on the ground, the staff? I mean, what do you, you know, either entity right now, what do you, what, what, what are you telling? If they call you up and say, man, Drex, you've been through this. I, I'm, I'm not at the senior level. I don't really know what's going on.

What, what should I be doing?

And there's a bunch of work then up to day zero to make that happen. And then there's the stages after that and what turns out to be really important. Um, cybersecurity for me on, obviously cybersecurity is gonna be part of this conversation because it's really unlikely they'll just. Join networks on day one.

So there's gonna be stuff that, uh, you know, organization A is gonna need to cont connect to an organization B and vice versa. And they're gonna have to sort through that, um, pretty quickly because it's gonna be basic stuff like payroll and those kinds of things.

Bill Russell: Yeah. The nice thing is from the time that I had to go through this till. Today. there's, there's a lot better mechanisms for things, right? So we used to worry about how are we gonna connect up our email systems? Well, quite frankly, you can, you can operate with two separate email systems now without breaking a sweat.

I mean, there's a whole bunch of stuff now that. You could create these, these ways of sharing information and doing stuff outside of your entity. So that's the nice thing. I mean, my advice to these to, to the rank and file staff essentially whatever your marching orders are, come in and do those marching orders.

And I've seen people who, uh, really just through consistent ex execution and, and doing the right things, uh, all of a sudden you, you, you look one way and they were just right here in this organization. And then all of a sudden you look back and they're, they're like, now

Drex DeFord | This Week Health: At the top. Yep.

Bill Russell: as much as it looks like it could be the end of the world.

You might be thinking that it could be really great opportunity for you in a very large health system.

Drex DeFord | This Week Health: And look, the, the other reality is it could be a great opportunity, but if it's not. It's also not the end of the world. I mean, we're a great example of that here at this week. Health, it wasn't the end of the world. It was the start of a whole new thing.

Bill Russell: A whole new chapter A

Drex DeFord | This Week Health: yeah. And so, I'm with you.

Bill Russell: Absolutely. right. So, uh, Drex, I'm come, coming over here under Albert. I'm gonna see what Albert has to say these days and what's going on,

Drex DeFord | This Week Health: Oh, I have a couple of really interesting ones actually.

Bill Russell: oh, what, what, what have you got?

Drex DeFord | This Week Health: So from a cybersecurity perspective, of course I wanna talk about cybersecurity. But from a cyber perspective, uh, you know, the Stryker, um, hack last week by an Iranian, it was a huge, a pretty huge deal. Got a lot of emails, a lot of text messages, a lot of late night phone calls, uh, from folks.

This is great. I love it when the bad guys get a sharp stick in the eye. Well, it turns out that kind of like by Friday morning they were back up and running, right? They, they, they, hey, they were back at, you know, they were back at full production. And there's another story this week. in security week about a, a, a gang of thugs, tycoon 2FA who help people break.

Um, two factor authentication in organizations. Same kind of thing, like went in, wiped out tons of servers, but within, you know. 10 days they were back up and, you know, 15 days they were back up and running full strength, doing more stuff than they were, uh, before they were taken down. And it all kind of boils down.

And it's, it's really interesting that they have such a good grip on that model. And we in many ways still sort of struggle with even sometimes exercises and backups and restores and let alone like true resilience. So,

Bill Russell: uh, we know how they got in right.

Drex DeFord | This Week Health: oh, we do. Well, I mean, you know, look, the, the devil's in the details and there's reporting on kind of the, the, the, the way in the, the big part of the conversation, um, so far in the news has been around the Microsoft Intune. They got to that and that's how they were able to wipe everything. They were able to wipe all those endpoint devices.

Bill Russell: Yeah, able to wipe phones.

Hey, my daughter works for Stryker and her phone got wiped, and I think this might be a big deal. Just wanted you to know in case you wanna look into it. So when I first started looking into it, there were no news stories on this. I go to Reddit and there's a bunch of chatter in Reddit about what's happening with Stryker.

There's, you know, all these phones are getting wiped. People were reporting that their phones are being wiped. And then about the time I'm ready to push the first publish button on the first kind of LinkedIn post, um. The first story shows up, and then after that there's just a bunch of pylon people, you know, people are waking up and the story's becoming a big deal, so

Bill Russell: direction, you're. Single handedly move us into the breaking news category, which we, we have avoided for, we've avoided for a little while, yet we do not have the ground infrastructure to do that. But,

Drex DeFord | This Week Health: it, it doesn't, it doesn't happen very often. I appreciate it when folks send us, uh, sort of notes and heads up on things. It is nice.

They're gonna wipe phones, they're gonna wipe servers. I, I think the, the thing I tell, uh, security people, or CIOs when I'm talking about 'em, is, uh, the only unpardonable sin at this point of time in time, given what all the things that have happened in this industry for the last three to five years is lateral movement. You have to be able to shut down lateral movement.

Drex DeFord | This Week Health: Yeah.

Bill Russell: if, if somehow they get to all of the things across your entire network, then someone hasn't done their job for the last three years. That's, that's my, I mean, that's what I'm saying to people. Do you, do you think I'm being a little harsh.

Drex DeFord | This Week Health: No, I mean, I think, you know, look, the reason we have traditionally in healthcare had big, flat networks is that it's complicated and we have a lot of complicated stuff that runs and it's hard sometimes to figure out what's talking to what,

Bill Russell: But it's

Drex DeFord | This Week Health: but again, in these days,

Drex DeFord | This Week Health: true, true.

Bill Russell: by riding along certain protocols that happen to traverse, all that stuff

Drex DeFord | This Week Health: It, it's, it's true. Uh, but I would tell you that I think the, you know, first things first, a lot of us, I think a lot of health systems are still running big, big flat networks. And so, yeah, and, and so I think a lot of it too then is

Bill Russell: works every time

Drex DeFord | This Week Health: every time.

Bill Russell: flat network.

Drex DeFord | This Week Health: The doctor yelled at me that one time, and so now I have the, you know, I have, uh, I, I changed the network 'cause I'd never want this to happen again.

'cause he told me he would, uh, you know, stab me in the neck if this ever happened again. So.

Bill Russell: And he, and he has sharp instruments.

Drex DeFord | This Week Health: And he does. So, so I mean, it's interesting, back to your point about like there are a lot of new tools, there's a lot of new capabilities that this is sort of opening your eyes and looking at the tools and the, the partners that can do the, these kinds of things to help you segment and do better use those tools, lean into it.

You know, 30,000, 50,000 employees, somebody's bound to lapse somewhere along the line. Either an IT person or or they're gonna get some credentials or whatever they're gonna get in. But I don't want 'em to be able to go from this system to this system, to this system. I want them to be sort of contained, con, contain the blast radius.

Drex DeFord | This Week Health: Yeah.

Bill Russell: first thing I say to 'em. Um, the second is getting back to your point earlier, which is how quickly did we get back? I mean, that's the, I think that's the metric of, uh, resiliency and recovery is now the going to be the metric. It's like, okay, yeah. You know, we're in a war. We literally are in a war.

There

Drex DeFord | This Week Health: Mm-hmm.

Bill Russell: going on every

Drex DeFord | This Week Health: Mm-hmm.

Drex DeFord | This Week Health: I mean, you know, a lot of this is that. So, you know, the, the detect, respond, remediate cycle has to just continue to shorten and shorten and shorten the faster you can. Find the bad things starting to happen. I mean, this is just like a fire in your house, right? It's the reason that we have endpoint detection and response and a lot of other tools now, so that you can smell the smoke before it's actually a flame and you can go do something about it.

How do we recover from that? I mean, that's, that's one version and I hope you can eventually do that, you know, but I, what I really hope is that our aspirational vision is the kind of work that you're building a program around. Like nothing ever happened.

Bill Russell: Well, Drex, I don't wanna leave an entire show without talking about ai. Can we? Yeah. So I'm. Mean,

Drex DeFord | This Week Health: It would be nearly impossible with you.

Enterprises move like molasses, and the disruption will be gradual enough. To manage. Um, and, uh, you know, so there's, there's your two sides. By the way. I still, I see CIOs pointing the, oh my gosh. You know, if, if you read Matt Cole, he is like, oh my gosh, AI is, is really being applied here. Uh, Baylor Scott and White, the CEO talked about, uh, you know, AI is really being applied here.

There's a lot of stuff going on. Um, and then you have other people in the industry who are essentially. I don't know what all the fuss is about. I mean, it's just, you know, it's just making some things that we do a little faster, that kind of stuff. And, uh, I don't want to, I don't wanna point to those posts because I don't wanna, you know, but they, but they're out there.

Drex DeFord | This Week Health: Yeah.

Bill Russell: How do I

Drex DeFord | This Week Health: Yeah.

Bill Russell: how do I create guardrails? How do I program? And it's, it's like teaching them how to use ai.

Drex DeFord | This Week Health: I, I, I do it. I, I do it every day. I mean, when I'm using Claude, there are times where I get frustrated and I'm trying to create, you know, a prompt or a project and it's not working the way I think it should, and I basically will just ask it. Okay. You're kind of pissing me off. So what's a better way for me to say this?

You know, we've gone through this whole cycle of like, when we were kids, we built stuff. I mean like when we were kids in the IT industry, we built stuff and then eventually we started buying commercial off shelf stuff. And that worked great. And I feel like the circle has gone all the way back around now.

Folks are seriously starting to ask questions like, why am I paying for this software? Couldn't I just vibe code this? Could I not build something like this that probably works better and is more customized for me for a fraction of the price of what I pay my software as a service provider? And so that's a real conversation, not only.

This is the hard, this is as hard as it gets right now.

Bill Russell: I, I, I, I agree with you. Let me take you to the one that's more connected to healthcare. This is Becker's story, mass ai, job replacement, not in healthcare. CI say. So this has a couple of our friends, uh, talking about this. Um, let's see. Let's get the quotes. Uh, here, here are the quotes.

Drex DeFord | This Week Health: I have so many opinions.

Bill Russell: What are your thoughts? We'll just start there.

Drex DeFord | This Week Health: I mean, so my initial sort of thinking about that is, um, the folks in New York City who had taxi medallions and they paid millions of dollars for them and they thought that was the end of the line. They had the taxi medallion and that was that, and then Uber showed up and they started taking.

Bill Russell: you could monopolize taxis by

Drex DeFord | This Week Health: Totally.

And the consumers like it. And if the health systems don't change fast enough, the whole system is going to change. It's just, is it gonna be your health system? Who's gonna have those offerings? Or are you gonna be stuck with the most expensive, least margined, um, portion of the healthcare system as your health system?

Bill Russell: give you, I'm gonna give you the four topics real quick. And this is so we don't get in trouble with Landon. You know, Landon edits these things and he actually grades us. We've asked him to grade, you know, how good is the episode, whatnot. It's kind of fun.

Drex DeFord | This Week Health: Yeah.

Bill Russell: alright,

Drex DeFord | This Week Health: Yeah.

Bill Russell: Uh, first topic, AI workforce impact.

What do you think the AI workforce impacts gonna be,

Bill Russell: Absolutely. Absolutely. I mean, the things that are uniquely human in healthcare will remain uniquely human. People still want care delivered by a person. I think that is absolutely true. Um, but I think we will see significant, um, changes, uh, which gets us to the next, uh, well, the next three really are kind of related, but I'm gonna start with cost reduction. as a result of ai. So there's this thing out there, Jevons Paradox everybody's talking about, which is, you know, you think you're gonna put AI in, get all this, all this, uh, uh, you know, productivity enhancements. Therefore people are gonna have more time to do our, you're gonna be able to let go of people. Jevons Paradox essentially says, no. the amount of work we haven't been doing in healthcare is massive, and so you're just gonna free them up to actually do work that we haven't done before, and hopefully you prioritize the right work, which will have, [00:28:00] you know, uh, sort of a compounding effect on our ability to deliver care in the community.

So, cost reductions in ai, how are we going to experience that in he.

Drex DeFord | This Week Health: the Jevons paradox is something that we have seen for years. Every time we automate a function in surgery or lab or radiology or any clinic or back office area.

Bill Russell: Right. Nobody

Drex DeFord | This Week Health: And they, they promised to get rid of somebody because of that. It turns out all that gets backfilled with work that should have been done, but just wasn't being done.

It was just being ignored. Happens in information services too. There's so many things we should be doing that we're basically just not doing right now. So.

Bill Russell: the argument is go ahead, keep ignoring it and get rid of people. Is that what you're telling me? No, it's not. It's not what's gonna, it's never happened.

Drex DeFord | This Week Health: I think this gets a little, gets around to the, you know, we're gonna have, we're going to have to continue to make hard decisions about what's really risk and what's really important. And we're gonna have to prioritize, prioritize those things and deprioritize the things that aren't important. And that may be the only way.

Bill Russell: So this, this gets

Drex DeFord | This Week Health: The leadership problem is you gotta draw a line somewhere.

Bill Russell: So point number three here is, uh, the focus right now for CIOs and other health systems is administrative, administrative automation. AI as a tool is the, that gun is being pointed at administrative overhead, administrative friction, administrative, I don't know, bloat, if you will, coding, billing, care coordination and whatnot.

I mean, um, I you hearing anything different or is that, that is where this,

Drex DeFord | This Week Health: I think that's where the initial point of the spear is, you know, being pushed.

Bill Russell: So we'll hear stories over the next year. It'll all be focused in

Drex DeFord | This Week Health: Mm-hmm.

Drex DeFord | This Week Health: You know, so I think back to Matt Cole's post about, you know, before you do something new, take something out. Like eliminate, eliminate something. And then I wrote a whole thing after reading that. I wrote a whole, wrote a whole riff on that. That I haven't published. I don't know if I will publish, but I mean, it's just a lot of it is the, the same kind of thing, just different examples.

It it's the, I I, I think that's ultimately it. We can't just, um, as I, you know, Wes has heard me, Wes Wright has heard me say a hundred times, don't pave the cow path. Like take the opportunity to screw down the process as much as you can until like it's so painful. There's nothing else you can do except automate it.

And that's the whole point. You can't just automate the things that you have. You really have to rethink them from scratch.

Bill Russell: I, uh, I, I believe that the patient experience will be one of those areas that we significantly, significantly change. you know, I, I'm looking for the first health system to come out with an MCP server that, uh, connects into Claude, connects into, you know, whatever your AI of choice is, that I could sit there and go, Hey, tell me what's in my medical record.

Tell me what I've been, tell me this because we're I, well, you and I are anyway. We're using MCP pretty extensively over here. In fact, when we develop our systems on the backend. Um, you know, in terms of our event management and that kind of stuff, it's connected to MCP. Like, I can sit here right now and ask questions like, who's been at the last 10 events?

Drex DeFord | This Week Health: I mean.

Bill Russell: front end, we're not the one you developed for me. My AI front end asking questions of your backend data, I think is a massive opportunity to redesign how patients interact with their health system. I think for the better,

This is something you need to know about. Those are the kinds of things that I think the world is changing. We're not just gonna rely on our docs to tell us what we need to know. We haven't done that for a while. Dr. Google's been around forever, but Dr. Gpt has changed everything. Dr. Claude's really changed everything.

Bill Russell: such a different, and, and the paradigm is we have to organize everything around our data system at the healthcare, uh, at, in health, in healthcare. And the reality is 80% of my care, 80% of my health outcomes are not tied to what goes on in the health system.

Drex DeFord | This Week Health: Oh, for sure.

Bill Russell: I am going to be the aggregation point.

Drex DeFord | This Week Health: So many things. You're looking at air, air quality. Is there a forest fire today? Turns out I have asthma. Here's something you know I should be thinking about or know about. There's a building being constructed next door. Maybe that puts some rust into the water. I may have some reaction to that. These are all things that you can know now that.

Bill Russell: I am, I am the constant at the point of care. If I have access to all that information and my AI model on my phone has access to all that stuff, I can say, Hey, why am I having trouble breathing today? it can look through my medical record, it can look at my Apple watch statistics, my aura ring, my sleep patterns, and it can look at the weather, it can look at the, you know, the air quality.

Drex DeFord | This Week Health: a ride in an ambulance and you know, like all these things wind up manifesting themselves in expenses into the. Healthcare system, which ultimately could be avoided. I talk a lot about this personal health record of the future. You know, we had the PHRs, they went defunct. I don't think the idea was bad.

I don't think the technology had caught up, and I think this is, I mean, I'm, I'm kind of excited about this idea that this may be where we're going in the future.

Bill Russell: this is funny. 'cause you know, I, I thought, man, Landon just gave us kudos for doing a short Newsday last week. Now we just, we rattle off a 38 minute, uh, Newsday. Oh. You know, he's never gonna know what to expect. It's all good. Hey, uh, Drex, always great to catch up with you and, uh, hey everybody.

Thanks for listening. That's all for now.