Newsday – Cloud, Cybersecurity, and Automation from Sirius’s Healthcare 2 Healthcare Event
Episode 46315th November 2021 • This Week Health: Conference • This Week Health
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This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

 Today, on this week in health, it, the way I look at it is the, the highly successful CIOs. Are the ones that are doing exactly what it is that they need to do and whatever they don't need to do, there's either a delegation to their team, there's a delegation to a partner, there's a delegation to the operations team, and it's because there's no time of the day to do things that are extra.

Right.

It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT at channel dedicated to keeping health IT staff current and engaged. Special thanks to Sirius Healthcare Health Lyrics and Worldwide Technology, who are our news day show sponsors for investing in our mission to develop the next generation of health IT leaders.

Just a quick note before we get to our show. We launched a new podcast today in Health it. We look at one story every weekday morning and we break it down from a health IT perspective. You can subscribe wherever you listen to podcasts at Apple, Google, Spotify, Stitcher, overcast, you name it, we're out there.

You can also go to today in health it.com. And now onto today's show. Alright, we're doing a on the site in Montana. I never thought I'd do a Newsday show for Montana. This is pretty exciting. Check that one off the list with, with a New York boy and seems like a . Where, where are you from? Uh, we got a little LA right?

LA Yeah. In Greensboro, North Carolina. Fantastic. Clearly you're the closest. He's the closest representing, sorry. So we're, we're actually at the Serious Healthcare to Healthcare event, and I have . Part of the Sirius Brain Trusts here. I don't wanna say the Sirius Brain Trust. 'cause we've had some really smart people on from Yeah, from Sirius.

This is the fun crew though. So I wanted to , I wanted to have a conversation with you guys. Actually, why don't we just go down the line, introduce yourself and what your role is at Sirius. Yeah, so Doug McMillan. I'm fairly new to Sirius. I've been here now for one month, but coming as a former CSO and CTO and right now, director of healthcare.

CSO, CTO From? From Cone Health. From Cone Health? Yes, sir. Thus the accent. Yes, sir. A deep southern accent. Fantastic. Chris , a field CTO here at Sirius. Been here about 20 years, and then I spent all my time on the road chatting with the CIOs, CTOs, CISOs, inside and outside of healthcare. Inside and outside of healthcare.

Almost a vertical agnostic, but I'd probably say 30, 33% of my time in healthcare. Fantastic. Yeah. And you, Eli Tarlow. And just quick note, why does it get a laugh? I dunno, you've been on the show before so people know who you're I was on the show with Doug actually. We did a show, we did it once together.

We, yeah, I know you remember. I'm that memorable, but, so I feel like if you're using accents, I'm from New York and so I've been, been with Sirius now for a little bit on the two years. And before that I was AC Healthcare, CIO for several hospitals in New York and the New York area, Bellevue Hospital, Brookdale Hospital, metropolitan Hospital, part of a couple of the other leadership teams there.

So the healthcare and healthcare event, we just finished a cybersecurity mm-hmm. session, which as A-C-I-O-I always got. Angst every time I sat and I've, I've sat through some interesting ones, like NSA, people like telling me what's going on. I'm like, I went home crying and my wife's like, what's wrong? Let me put my armor around you.

Like, 'cause it's a, it is a scary world out there. And these C CIOs are dealing with some, some serious stuff. What's your takeaway from like some of the things we've been hearing about cybersecurity today? Yeah, so I'll start. I mean, I obviously from healthcare ransomware, it's always the top of the list and I always like to go backwards of the chain as well.

So I was at Cone Health. Phishing was always that entry point. So you, you, you're obviously trying to make sure that you're, you have your defensive depth strategies kind of in place to be able to handle and remediate the ransomware, but you also wanna go back up of how, how did it initially come into the environment, which is, again, phish.

Uh, so we really, you know, have to take that broad look and make sure that you have really governed process for recovery. And, and that's the one that we, I don't think everyone's prepared for. Because it could go all the way down into just communication. How do you communicate with your patients? The community?

I mean, brand image. It, there's so much to it nowadays. Are we testing that from end to end? I know we do tabletops and those kind of things, but I, I heard of one organization. They had everybody at the tabletop, I mean, it was, marketing was there and operations was there. I mean, you name it, they were all there sort of going through it.

And I think that's a new phenomenon really, unfortunately in healthcare. Are, are, are we seeing that Go on. Yeah. Yeah. So, uh, I, I think we are, and, and from what I've been with Sirius, they're definitely pushing that because again, as it really is a whole team, it takes the whole team to really respond to an event like that.

The last high build talk that we did, atone Health, what we had done is we had everybody at the table but kind of try to still split it 'cause you want know that you have a technical response. So we, we've run through the same event, but really focus with the technical responders and then brought in the leadership marketing, things like that, and did the exact same response.

To try to not get bogged down into the technicalities of how are you responding more of, well, internally, how are we continuing with operations communicating? One of the things I wanna talk to you about is obviously other industries. Healthcare has been specifically targeted over the last, i, I think it feels like a year now.

Mm-Hmm. . And it, it's, it's been targeted and . What I'm hearing, I'm hearing a lot of, yes, we need to, they're coming in very basic ways. They're coming in through email still. Eventually they'll start to come in through more sophisticated ways, but as long as they can get in the front door, there's no reason to to to climb through the window.

So that, that's one of the things. But what I'm hearing now is, you know, a lot of conversation around being able to rebuild very quickly. It's sort of a different approach to saying, look, can you rebuild your entire environment? In an automated fashion. I mean, are we seeing that in other industries? Yeah, we are.

And it's interesting today, we talked about it in one of the hot topics talking to CIOs and CISOs is you ask them how many copies or how many immutable copies, and sometimes you ask that question, you kinda get a blank stare back. And uh, I say, well, we have a copy. And, and when you then ask about regularity of immutable copies and then.

Then the next step is where are you keeping them? And by the way, what's your key management strategy, right? You don't rattle all that off at once. But if I'm kind of condensing it and all of a sudden the jaw's dropping right a little bit, and if you go, let's say to the, the finance vertical, I'd say no one has it perfect, but they definitely have it relatively locked down.

And I, I think it's just a challenge with all of the things that healthcare demands. And when you put the list of priorities up. And the budget, you kind of smash those two pivot table. You know, you make a pivot table out of that. It's a tough, it's a tough equation. Right. So, but, but now it has to be prioritized.

So you used the immutable. Yeah. And we didn't even know what immutable was until blockchain came out. We're like, immutable record. Oh, that's what, an immutable record. That's not true. Right? But, but, but along the lines, it is that same aspect of it's an unbroken chain. This is a . A good backup, but how do we know it's a good backup?

One of the stats we heard today is that they're in your network and sort of hanging out for, what was it, 80 days? I can't remember the exact number, but it was, it was fairly, and it's pretty much a quarter, and that's just an estimate. I don't even, with all of the great data that some of the ISVs have that do this XDR work, do forensics, I think they're still trying to figure out what that is, but let's just say it is 90 days.

There's going to be an increased cost on how often you're taking those copies, so at least your rollback point, you can be sure that if you're, if you get back to where you need to for a checkpoint, and you may have to go back a little further, you've got the appropriate granularity for the enterprise.

Right? So one of the things I, I tell people is you actually get smarter when you leave the CIO role and you start doing consulting. And one of the reasons you do, and I'm, I'm serious about that because you talk to a lot of different health systems. What do you know today that would maybe have informed the way you approach cybersecurity if you were still ACIO?

Excellent, uh, question something actually, I think about all the time, I, I have the advantage of speaking to CIOs, dozens, hundreds of CIOs across the country, and it's, it's eye-opening. Number one is how, where people are on their journey, right? So it's just amazing that we're not all . When, I mean, when I was A-C-I-O-I was assuming, okay, so I'm kind of running with the pack or within the boundaries, and it's just, it, it, it doesn't ever cease to amaze me about the spectrum of where people are in protecting them.

So that's number one, which I never realized. Number two is that there's a lot, a lot of learning that could be had just by opening up and joining in, in the discussions. And sometimes you stay local, right? So, okay, so I'm gonna talk to my, the CIOs that are in New York, or I'll meet up at a Chime or HIMSS or vent.

But there's so much, you know, sharing going on that it's almost like if people are not reaching out and they're not part of groups that are having these discussions through partners or through other CIOs, it's a shame because they're really missing out on, and I wouldn't call it necessarily the free help, but it's one of those things where everybody wants to everybody else be successful.

So. Something I didn't realize. Another thing also is that organizations and maturity and culture really are very different in how they approach security. We had, um, we're working with a hospital where we were talking to the CIO and the CTO and some others and talking about how to really fortify and protect everything.

And then we had a conversation with the CIO and he said, I'm sure my team's doing a great job. Here's what I want from you. I want you to tell me how quickly when we get breach, can we get back. And I'm like, well, we're working with the team and we're fortifying. It's like, okay. When we get breached, how long will it take?

So I want you to get me, I want what's my supply chain for extra desktops? Can we get staff on? So I wish I had known and, and when I was ACIO and even though it's only been two years, security was hot, but it's obviously not as hot as it is right now. I wish I had known how easy it is to get help. I'm, I'm glad to facilitate some of these conversations.

So we did the, the webinar with Sky Lakes and Asante and we, we went through that in detail. I mean, this is what the first hour looked like. This is what the second hour looked like. This is what it took. Once they disconnected, 'cause Asante was the host Mm-Hmm. for the EHR and they couldn't reconnect until they met certain criteria until they got back on there.

I love the fact that we're, we're starting to share some of that. Yeah. To that knowledge. I don't wanna spend the whole time on cybersecurity, although. It is one of the top of mind conversations. I do wanna talk about cloud 'cause you're here and I want you guys to add some color to this and at some point I wanna talk about automation and the labor shortages that are hitting healthcare.

go it was about, I think late:

Cone Health was looking at a, pretty much a complete overhaul to the infrastructure for Epic, and we had been on-prem hosting. So you had some number in front of you to replace like. A ton of end of multi, multi multimillion. So it was the Citrix, the CPUs were outdated. It was gonna be the sand storage, it was gonna be at the same host for the web service tier for Epic as well.

So it was really everything. We did have a new CIO, I think he'd only been there maybe four to six months, and he was not cloud adverse, so he was saying just, well, let's take a holistic approach to it, step back and look at everything. So we really did look at co-locations, a third party vendor hosted

Epic hosted and then really started looking at the public cloud. And obviously we led towards Azure. We already had a small presence and I'd already done some analysis to say when you start looking at ias, just based off of our Microsoft agreements, I could run it a little cheaper with the Windows license that already on.

So we started looking really heavily at Azure and the numbers kept looking like it was cheaper to do it ourselves because we already had the Epic expertise. We already had Epic staff 'cause we'd been live. For multiple, multiple years. So we were like, okay, well we think we can do this in Azure. And obviously we were one of the first ones kind of pressing epic to kind of move in that direction.

Obviously Epic was host, I would say hesitant and we had to have a lot of conversations with them, but kind of bringing Microsoft Epic ourselves. And, and then NetApp was, uh, our storage vendor, which was really critical for our blob storage, which we knew we were gonna have to replicate to the cloud as well.

Right. Uh, so we brought all of them together and like . Hey, we're, we're gonna do this. We're gonna go down a, a cloud strategy. We're gonna actually move our epic environments to Azure. Uh, so we spent about a whole year really looking at Dr. 'cause obviously that's where you can get the biggest bang for your buck 'cause you have a lot of infrastructures just sitting there and powered on, but not really being used.

So, but we went ahead and moved that, it took us about a year and the reason really wasn't because of the technology. It was unfortunately, we were a, IX had to convert to Linux, so there was a lot of complexity. But we, we did finish that move up. And after we did a actual full test, we did cut over and run in Azure, decided, nope, it's production as well.

So from:

We did go with a hybrid strategy and it was just out of caution. So the cache servers sitting in Equinix. Co-location facility and then everything else, Citrix web service tier is all running out of Azure. And then every other Epic environment is all Azure Direct. So everybody who's listening to this right now is going, what about latency?

What about latency? Is again, is if you get, uh, with your express routes and things like that. And obviously if you looking at an Equinix colo, they have that kind of sit right next door, uh, to the Azure data centers. The latency is not the issue, and I, and I would also say is just the way Epic kind of works, the latency requirement is not from the client to Citrix.

It's actually from Citrix to the cache, right? So as long as you keep that to a minimum, you could have upward of a 17 millisecond latency between the client to Citrix and the end user doesn. Never know what was, did you have to go with an MPLS to. So no, we, we actually, did we call just internet circuits?

No. Well, not just internet. So it was a dedicated internet circuit that was going direct connection through . ra. Uh, so we used RA and there was a direct connection going into Equinix. Drop that in. And then obviously Equinix hosted the express route to Azure. Uh, and then where we were transforming and looking at things is what we're trying to do.

Now, obviously, not, not that I'm there, but we were looking at how do we . Broaden our SD-WAN deployment to say put your primary SD-WAN inside of that co-location F facility and now have different layers of SD-WAN running to all your major campuses, maybe based off of criticality. So maybe have a 10 gig for your hospital, so five gig for your or urgent care facilities, and then a one gig maybe for your ambulatory sites.

I want to ask you about cloud strategy. Phenomenal work by the way. Thank you. Yeah, that's the triple UND right there. triple. You don't make that one. Easy. Triple. Now that is, that's pretty amazing. When, when, when we talk about cloud strategy, one of the things I think that I'm hearing is we're gonna end up in a, in a hybrid environment, and sometimes when people hear hybrid, they think, oh, we're settling.

We we're not going full cloud. But the reality is there are, there are aspects that work better in and and hybrid environment, that latency becomes an issue and costs sometimes become an issue. You look at some of the workloads that we have, it doesn't make sense. How do I keep going? You're like the inside the industry and outside the industry kind of person, but

So we don't throw this architecture word around all that much in healthcare, but if you get the architecture wrong, it would appear to me that you could line yourself up for a world of hurt. Do do other industries spend a lot of time getting the architecture right before they move? I. It's interesting, I we sometimes, it's almost become a bad word you say, you ask, Hey, do you have a enterprise architecture team?

And you ask ACIO or ACTO. Sometimes you get a immensely positive reaction, like of, of course we've got a, you know, fantastic one headed up by whoever it may be. And then other ones will say, well, we had that and we, and they usually use some expletives and, you know. Blew that up a couple of years ago because they did great work, put together three ring binders, but then the actual ops people never actually executed on, on the vision slash strategy.

And so I think what's that I see happening more now. There's maybe a remnant of that team with some people who are appropriately plugged into the entire DevOps, or let's call it platform ops side and who it may not be the shade of its former self, but it's more formidable. In the way it works today than maybe it did five years ago or even 10 years ago, and used to see these huge teams.

But I mean, you look at your undertaking that you had at Kone, that is, that is a tough maneuver. I mean, most folks don't have the appetite or the skill to go all the way where you just, you know, you just took that, right? So folks find themselves in the middle, and I think we find ourselves a lot of times just chatting with leadership.

And director level folks saying, let's just examine and make sure the architecture's extensible for not just what you're trying to do today, but let's make sure we're watching the finances and let's make sure we're watching . The right function in the right place. I don't think I can stress that enough.

A lot of folks go, well, it's gotta be in the hyperscalers, because that's where the cool functions are. And there's a lot of great stuff you can still do with that on-prem equipment that may not be fully capitalized. And we see folks optimizing it still. So, yeah. So what do you, I mean, when you talk to CIOs about cloud, what are you hearing from them?

Are, do you hear, still hear hesitancy? I, I don't think it . I think that's gone away a little bit. So Yeah. It's funny ask 'cause we actually at Chime last week, a bunch of us actually got together and we were talking about that two years ago or three years ago, cloud was bleeding edge. Right. And you were, wow.

You're forward thinking. And, and I think now if you ask somebody like, who, who's your cloud provider? And they don't and they're not in the cloud. They are. We haven't like they just, they're, yeah. And, and, or they'll come up with something. We, we just signed an agreement with somebody or we're, we're almost there.

If, if cloud is not part of your strategy and like what Doug was saying, it could be Dr. Right? It's a safe place to start, right? And, and you can, you have all the time you need to test it. You can fail back and forth and you can, it's relatively inexpensive because you don't have to go the whole full license, right?

So you can do like hybrid cloud and things like that. There's almost no excuse today to not have. A part of your crown jewels, your E-H-R-E-R-P in the cloud, your, your DR strategy. That, to that effect, I would say there are obviously those that are either not comfortable yet, or for other reasons, financial reasons.

They may not have moved as fast as they would like to, but I, I think it's, it's probably high percentage of CIOs and teams that are well on their way here. Here's my anecdote story and I'm gonna, I'm gonna come back to the agility that you guys were able to . To, to get my anecdote is I come into healthcare from outside of healthcare, right?

Mm-Hmm. , it's 20 years outside of healthcare. Go to my first meeting and there's, you know, 12 CIOs sitting around. They say, oh, go ahead and introduce yourself and where, what system are you from? First person goes, I'm blah, blah, blah. I'm from, and we're an epic shop. Next person goes, I'm blah, blah, blah, and I'm a Cerner shop.

And I'm like, is this like what college you went to? Right, right. And it was funny 'cause it came around to me. And I, I'm not trying to disparage anybody, but we were a Meditech shop, so we had 16 hospitals running six and a half billion dollars on a Meditech system. So I thought, well, I guess it's a, you know, so I go, I Bill Russell St.

Joe's Health, uh, Meditech, and you could see people sort of go, oh, like, like they're like rolling around. I was like, come on man. I went to a respectful school where we're serving Southern California. I'm not. Anyway, it was just, it was one of those, uh, weird moments in healthcare. Talk to me about agility. I mean, what did you learn about agility now that it was in the cloud?

Yeah, so, and I, I think I mentioned this in kind in our conversations yesterday. So as we were building out our DR things that we were cognizant of and, and I think a lot of organizations went through the same play, is when you get into having to replace core infrastructure, we always felt like we ended up in that matrix and never ending.

Oh, this has to be at this version. This has to be at this version. And then all of a sudden you found out notebook, go back. The other one has to be at this version. And you just, it was a matrix of here's how you upgrade this environment, which took months and months and months to kind of roll out. But when we actually moved into Azure, and again, we were very cognizant to build things out using, and again, I always say that crawl, walk, run, using just scripts, right?

So just automation. Not true orchestration, but just automation. Right? So we wanted just . Automate certain events, make sure that they're working. Then you orchestrate those events over top to try to build out an entire environment. So we ended up with our DR environment. We built it like a hundred times and in just a couple days, just because you could easily spend enough, easily move it down, you can fix the script, build it out again, did it work.

So it gave us the ability to really just burst and, and those were things that Cohen was not, I would say used to at that time. now where we didn't take it to, which I think is kind of moving into that agility and run, which is how do you now take these orchestrations and then tie 'em into something like a ServiceNow service platform and say, okay, self-service.

For either a development shop or maybe some shop. So I can go service now and say, set me up an instance of Epic, right? I get my own ER and you get your own, you get your own little instance. Own, but could, but you could right You and, and it could have active directory, it could have, you know, system, other systems.

I mean, you could do all of this now because you have those building blocks tackled again, when you get into the application layer, it gets a little. Right. I say you have to build out the app, but again, if you're looking at things like chef puppet Ansible, you can start to configure the environments even more.

So I wanted to talk to you guys interesting conversation upstairs about cost, cost of cloud. My history is told me that if you have that scenario that you just rattled off and you're gonna have to replace 50% end of life, 60% end of life, that kinda stuff, you can make the numbers work. Mm-Hmm, . But if you're looking at like an incremental thing.

You really do have to be thinking about agility business model where you're going and you really have a have to have a forward leaning leadership team who's sitting there going, no, no, I see where you're going. I see where you're taking us. We're gonna be able to bring on more systems. We're gonna be able to do m and a, we're gonna be able to recover from ransomware, those kinds of things.

There's also the ROI of cost for for people, right? So as you move things into the cloud, you're either raising the level of talent for your staff, right? But that, but that's a hot topic. I mean, so, so keep going down that path. So it's funny when people, when say, someone says, describe, you know, CIO role in a video or something, it's, and the first thing that comes to my mind is that I love Lucy episode with the chocolates, right?

just trying to keep up with the pace and, but it's so, it's so relevant a to, to what we're talking about, but it's really the role of CIO and the way I look at it is. The, the highly successful CIOs are the ones that are doing exactly what it is that they need to do. And whatever they don't need to do, there's either a delegation to their team, there's a delegation to a partner, there's a delegation to the operations team that should really be handling something.

'cause there's more operations. The highly successful CIOs are the ones that are really doing exactly what it is they need to do. And it's because there's not, there's no time of the day to do things that are extra. Right. So, Chris and I, uh, facilitated a conversation about . With the CIOs earlier today about shortages in staff, right?

Mm-Hmm. . And it's funny, so we asked, uh, this group, we said, well, how are you dealing with this right post? Post? Or I shouldn't say post covid, but you know, COVID brought on this where, where people can work remote and, and now that people can work remote, they have options so they might not be as loyal to their employer and, and work elsewhere.

So it was a quite a long discussion around, around that as a, as a problem. And then towards the end we said, well, hold on a second. I mean, these are, it's definitely good for group therapy, right? But hold on a second. Is this a problem or is this what we needed to actually say? We're doing things that we don't need to do, right?

So, yeah, so this, I'm now, because I, because I'm losing people in my team that they have options. Hold on a second. Why am I doing this in house? Why don't I look at another, another option so that I'm not dependent on the people in my team or the people in my team can do other things. So it, it's, yeah, I mean, what, whatever the staffing issues that we, that, that we're faced with, whether it's cloud, whether it's engineering people that are able to work in other areas, it's really about the ones that'll continue to keep up with the pace of the chocolates coming off the conveyor belt are the ones that are saying, okay, hold on a second.

There's no reason that I should be managing this. I should be doing this. There's a better option out there. So whenever we talk about this move, people are like, well, . I'm not gonna factor in the cost of reduction in staff. I get that. I understand that. But we're changing the technology. It's constantly changing.

One of the commitments I made to my staff was, as long as you're committed to learning, you will have a job. We will do things to ensure that you have a job. We'll continue your training. We'll pay for some of your training, we'll give you opportunities. But you know, if you're gonna say, look, I'm a COBOL programmer, I'm always a COBOL programmer.

The day we get rid of the last COBOL system. I don't know what Don't. A sheet cake for you . Exactly. I, I dunno what we're gonna do with you. Right. But isn't that where we're at now? It's like, I remember it, we were pushing the team, we're like, Hey, we're gonna start using Azure and we're gonna start doing some of our sql.

We're just gonna move our databases out there. And they were all like, oh, you're trying to put me out of job. I'm like, just try it. Just, just try it. And you just, you get, you get a couple of 'em doing it, going, Hmm, dude, this is this, this. Same and some better stuff that we can do up here, and then all of a sudden the, the light bulb goes on.

But I feel like we're, we're, we're still pulling it. It's not a, yeah, hey, here's some new technology. We could do this better, and that kind of stuff. What do we have to do to change the culture? Just, I'll make a comment kind of, since I'm sitting in the middle, part of what Doug said about automation and what Eli just mentioned about the conversation we had earlier today about staffing.

I, of course, you wanna protect your people, you wanna uplevel your people, but I, I almost sense maybe it's taboo, a hesitancy from a lot of the CIOs to say there's going to be 15 points gone. Right. Of the people. I mean, I'm not saying you have to use the Jack Walsh approach from, from the get go, but there, there has to be some more honesty, I think, at that executive level because if you do automate correctly mm-hmm.

Right, and, and you, and you do build the right culture and all the things that we were talking about, there are gonna folks who are gonna step up. But there are going to be roles you do not need, especially if you choose you. You look at the managed services discussions that we have. People are, don't want to be in the run business for the most part anymore.

And that's agnostic. The vertical for the most part. There's some exceptions, but Right. For the most part. And there are folks who are and aren't going to make it. And again, not, I'm not trying to be harsh, but I feel that as soon as that conversation, people tuck in and go into some HR mode. And there needs to be almost a little more honest, but every IT organization I walk into, it's like, how many open positions you got?

Wow, we got 55 open positions. It's like, okay, what, what are we talking about? I, I tell this story a lot that my team came in once and they, I, I think it was a Google device, not the uh, Alexa, but they put the Google device in front of me. They say, Hey, say this phrase, and I'm like. Okay. Okay. Google spin me up, five instances up, blah, blah, blah, blah, blah.

And they said, all right, now let's pull up the thing. And it sure enough, it fired off instances, built 'em out. It is the same thing with ServiceNow. You're talking about we can orchestrate a significant amount of stuff. And I thought, I, I even asked the team, I was like, how long would that have taken before?

And they're like, A long time. How long would it take to get the po ? Right, right. Well, and, and, and automation. So we've talked a lot about automation. What are your thoughts on automation as you've listened to? We heard about clinical automation, we've talked about it. Automation, we've talked about security automation.

There's automation. Seems to be, uh, I don't know the, the new AI for the conversation that's going on in healthcare. So, so I'll, I'll start. Uh, it's funny, I think it was Garner or someone that basically said the role of technology is automation. So this is not really new, right? We're taking something that's a human process.

And we're making it so the lowest, the, the least, the least paid employee is doing the work, which is the computer. Right. And that's essentially, instead of having pieces of paper, we have Excel and spreadsheets, et cetera. Right. And automation is, I mean, the era of automation that we're dealing with today, it's not new, it's just at a higher level.

Uh, replacing repetitive human work. Predictive work, right. With a machine of some sort. And it's automation that it's, that's automating automation at this point, right? It's so, I mean, the things that we're talking about, and again, it, it depends where the CEOs are on the journey, right? Some people are at the phase of automation where they're just trying to figure, okay.

How do we automate, you know, turning up and down environments, right? And that's, again, as we, as the months tick off, those things are becoming more foundational, right? And then you have the CIOs that are looking at automation and saying, okay, hold on a second. How do I use automation and change the environment of my hospital so that we reduce

Readmission rate, so we reduce waste in the OR and time. But essentially what it is, it's really about saying, okay, what are we doing repetitive, where it's predictive, where it's safe, and we can now take it from the human being and have it done by a machine. There's a lot of repetitive things in the hospital and in acute care setting.

Yeah. Yeah. I, Eli I mean, it brings up another great point. We, I'm gonna veer off on a Montana road here for a moment. you every. Everything's relative with respect to automation. But those roads go on for a long time. They go for a long time. This is a three hours. This is like, yeah, Lord of the ring. So we're fine

This is wait to get the extended version that everything's relative to automation. So you look at it or you talk to ACIO and the things you just brought up, right? Or you spinning up instances that we're gonna take up manual process that's relative to it, who already has a pretty good core understanding of what automation should be, even though it's not maximized.

Let's turn our attention. To finance, let's turn our attention right to the procurement pipeline, for example. And when I have those conversations, I'll say, Hey, do you have any challenges with let's say month end, quarter end, close? And they're like, well, yeah, I mean, of course. And you dig in a little and there's 15 people still pivot, tabling their life away.

And they're like, I'm like, well, have you had a conversation? They're like, ah. I mean that's in the CFO's area. And it's a difficult conversation to have 'cause that would touch those 15 people. And it goes back to what we were just talking about. You've got to go have that difficult conversation. There is an enormous amount of manual effort.

Outside of it, it looks like rock stars compared to possibly what's going on in other parts of the business. And you find that that's the, that's the pivot and that's where it can make the bigger impact almost not, not to take anything away with automation in it, but automation at the line of business or back office is huge.

So you're telling CIOs that they should go out and look for more work by, yeah. Go dig in. They got. Tons of time, but it, it is so true. I was talking to a health system about a month ago, and I was talking to different parts of the organization that went to finance, and I said, you know, what's, what's your biggest pain point?

It's like, well, it takes us about 30 days to do a month close, month end close. And I'm like, what do you do in February? You're the next month. Right. Yeah. You can never get out the door if you take a half step to the doorway every time. Right. The old math problem and that's it. Can't catch up. Yeah. Can't catch up.

It's amazing. But what jumped out at you? So as we were sitting here thinking if, I think one of the things, as I had conversations at Cone Health, you know that obviously RPA hot topic, that's the, the buzzword everybody's throwing out. It to me is it has to be a culture of, it has to be ingrained in that DNA, that we're paying people to do productive work, so the less productive

Things that they're doing, you really wanna get off their plate. And then obviously the other thing, from an IT perspective, I, I think the businesses obviously are asking us to do more with less. So obviously there's no way of really accomplishing that unless automation is there to kind of back it up and then, and as I say, do more with less.

Obviously that's leading into the big, from a healthcare perspective, the big digital boom, the consumer, I'll say consumerism of healthcare versus just, Hey, you come in, you're a patient. Okay, well what. What about wellbeing? Those are the big topics that I think without that technology, you're, you're not gonna be able to make it.

Alright. Here's the out question 'cause we're, I'm sitting between you and, and dinner and I'm sure , you can almost see Frodo going up the mountain at this point. , right? Frodo's good. And that was like the first of the four endings. That's right. That's right. This is my first of the for close questions. . For non-IT people that are, are watching this non-healthcare, it, the healthcare practitioners, the, the people in the field, maybe finance, whatever.

What's the, what's the thing that you would tell them that we could do for them? What's the thing that, you know, one of my roles as CIO is always to let them know, Hey, do you know what's possible? What's possible? Maybe that a, somebody within an acute care setting or an ambulatory setting might not know is possible.

So I, I, I'll start off at, so my sister, it was funny, she worked at Cone Health with me. She's a director of business and finance, uh, for nursing. So me and her shared a lot of conversations and I always prompted her to say, make sure you're, you know, having that conversation with, you know, that person who's your kind of business relationship manager in it, to make sure they understand your use cases because they may not.

I would say I felt like . There was always a little bit of a disconnect. They felt like we knew everything that's going on in their area. But we didn't, it, it was like, we know once you tell us, and we're having that conversation. And from a finance perspective, my, with my sister, she used to say, well, I'm pulling data from all these various sources and trying to do it.

I was like, we can do that for you. We can automate pulling all that data together and have a report. And again, all it takes is that conversation. Yeah. I'll say if a clinician, a finance person, if they say what's possible? Everything. Mm-Hmm. , that's what I would just say. And if, and if it's not possible.

Then let's, let's create that because all of the things that we're doing today is because it bothered somebody enough to say, I mean, Uber, whatever, ev we have pizzas delivered at three in the morning. If we can have a pair of glasses and a cup in New York, do you have pizzas delivered at three in the morning where you're at?

I also, it ended here at 3:00 PM is a difference. It's a 12 hour skew here in Montana. But I, I think if, if there's something that if a clinician, a back office, whatever that is, if this, if they have that question. Then that means that there's already, they're already on their way to figuring it out. That means there's enough of a will that someone said, I just can't deal with this anymore.

Mm-Hmm. . So make it happen or find someone who can do it. But I, I think we're living in a great time where just about everything's possible. Yeah. Yeah. I agree. And just thinking about what you just said, Doug, it the proverbial olive branch. You want the clinic, if you're a clinician, . You, you, you wanna extend at least halfway.

You don't. I get it. You don't have the time. It's just the bandwidth to reach all the way across the aisle. Right. So then I'd flip your question Bill on the other side, which is it's gotta reach more across the aisle and kind of meet there at least at the, at the middle. And I think . An event like, like this that we just are at when finishing up tomorrow.

You see that happening. You've got clinicians in the room, you've got it leaders. Some are a combination or a fusion of both, but the, that bridge is being formed in the aha moments in the discussions that we're having. Unbelievable, right? Agree over the last couple of days. So I just wish we could almost encapsulate that and show that to clinicians who would say, well, how would that work?

But trust me, if you can, . So for the clinicians ask to be invited to a meeting and on the IT side invite someone who's maybe said, oh, I don't have the time. Go talk to their boss. Make the time, ingratiate them. Yeah. And it's amazing what'll happen out of those conversations. Yeah. The CIOs who have gone in and watched the operating room.

Mm-Hmm. , they walk out and go. Oh my gosh. I saw like 10 things that we could Right. Potentially automate and, and just start the conversation. Absolutely. Gentlemen, thank you very much. Appreciate it. No, you're welcome. Thank you. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions, please forward them a note.

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