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Newsday: Application Rationalization and Hospital Hierarchy of Needs with Jason Rose

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Bill Russell: Today on Newsday.

Jason Rose: before you get into all the advanced, Tableau, Power BI, whatever visualization studio you like, or whatever tools and techniques you have in AI.

Bill Russell: Now, let's jump right in.

Drex DeFord: Hey everyone. I'm Drex DeFord. I'm a longtime healthcare CIO. This is Newsday. You expect to see Bill Russell here, but Bill's not here today. We did a little switcheroo. So I've got Newsday today and with me today is Jason Rose, who's the CEO of ClearSense.

Jason, I'm really glad you're on the show today.

Jason Rose: Nice to meet you, Drex. Looking forward to the conversation.

Drex DeFord: We've got some really interesting articles you and I have conspired to talk about today. The first one's from MedCity News, and it's about providers and payers. The title of the article, providers and payers are increasing their tech spend.

Where are they investing the most? And I like that the article, as the cyber security guy here at This Week Health, I like that they say cyber security, but they also talk a lot about AI and the challenges that are coming with AI and the investments that are being made by health systems into AI.

Jason Rose: Yeah I thought, again thought the article was fantastic as well. It really, a short article just described some of the issues that, obviously, we've changed healthcare and some of the cyber attack issues that's a big one, but there's been, really dozens of other ones that are also quite significant in recent past.

So certainly cyber is on everyone's mindset. At the same time AI is as well. And so if you think about the two those two issues, you could say maybe they're totally separate concerns, but they're actually there's one important underlying issue underneath both of them is they both include data and access to data and having good quality data, timely data and secure data, those types of issues.

It's shadow IT, as we like to talk about in the IT world. It's all those applications that are often redundant. Some people call them zombie applications. When you think about exercises such as application rationalization, which, we're going to talk about here on this discussion one of the side benefits of application rationalization processes is that Where you actually do execute on the AppRat exercise.

If you have 2000 apps and now you have 1500 apps, you have 500 or less apps that could be at risk and just naturally speaking, but you're also probably focusing on these enterprise applications that are more, hardened and more built in security of modern technology and you're naturally going to get the I'll call it the soft benefit until you actually get hit with a cyber attack.

It's a soft benefit of an app rat process.

Drex DeFord: it's interesting because we have two articles today. The other one is from Forbes, and it's called Don't Overlook IT Integrations During M& A Activity. And it talks a lot about app rationalization. There's definitely a Venn diagram between these two articles.

And that can be, great, good for them, but also creates As you said, from a cybersecurity perspective, but just from a data management and truth perspective creates another whole problem, right?

And so her answer was low single percent. And one of the points that she made, and actually I just spoke with her here in Nashville at the Nashville Healthcare Council Sessions Conference, because I'll be doing a panel with her later this year. And I brought this up to her and one of the points that she made was, before you can have really good ai, you better have really strong, boring data management underneath it.

If you don't have those three pieces in place, and that, that was my spin on it is that timely, complete, and accuracy. So that you have a really strong foundation to enable good AI. And to me that's the foundation. It's not, sexy. It's a little boring. She called, you better be a really strong, boring data management company, first and foremost.

But reality is that if you don't have that in place, you're really going to fail. Or you're not going to be as optimal as you could be. Putting that foundation in place. And then that data enablement allows you to revitalize those data opportunities for other things. It's not just AI, it's also testing out new tools.

All the analytics folks, if they just have it available to them. And I think that to me, anytime I hear about an AI article or how AI is going to change the world, I always start with, okay, let's talk about timeliness, completeness, and accuracy on the data first. And then we can actually build the AI on top of that.

Drex DeFord: So right on the money. we have four. Years and years from the beginning of the computer age, we've talked about garbage in, garbage out. If you don't have the foundation set, the other model I use in my head for this stuff and lots of other stuff all the time is Maslow's hierarchy of needs.

If you don't have the data pool figured out and you don't have it set, you can do all the cool stuff you want at the top of that pyramid, and it really doesn't matter because the data isn't set. So I love, I'm

In my talk track for decades now, and I guess I'll parlay this through our conversation too, but if you don't have you think about clinical quality outcomes. Or value based care, or all those things we all strive to do leaders in healthcare. don't just simply have things like, for patients, food, water, and shelter.

Food, water, and shelter. Maslow Heuric of Needs. That allows you to get to the next level, which might be patient safety, might be access to care, and things of that nature. It's such a good way to describe foundational areas, and you can take that same Maslow as you just did, before you get into all the advanced, Tableau, Power BI, whatever visualization studio you like, or whatever tools and techniques you have in AI.

Drex DeFord: other thing, so this helps bridges to the other article too, I think. If you don't have good data, a lot of the decisions that you make for the business can be inherently wrong because you're making those decisions based on faulty data.

So the other article is about M& A and talks about app rationalization where we we've looped all the way back around and started there again, but When you do a merger and acquisition, I've done a bunch of them as a CIO. You're trying to put things together. You have a dream when you put the deal together that because of this consolidation, you're going to be able to save this much money.

And ultimately you're going to come out this far ahead because of the deal. It's harder than it looks, right? Especially on the data part.

We put it into our SaaS We have great UIs and experience. Including at the point of care when we build in to EPIC the data from the last 20 years, as well as within the My Patient Chart, for example, also ERP systems. The technology's available but I think, One of the more important things to think about when you're doing a application rationalization program is scale and speed.

Because when you're doing app wrap, particularly with an M& A is, there is some CFO or a team of CFOs who've sat down and on some spreadsheet, it says synergies and those synergies include cost takeout for technologies. that are in this health system here that are superfluous to the acquiring parent organization.

The bigger challenge though is stakeholder engagement. It's not, this is, these are not IT projects, and I used to be a CIO way back in the day as well, and there's never, it was always, these are business projects. That may be led by IT, but they, you must have multidisciplinary cross departmental involvement in application rationalization.

So when we're going to shut these things down and go to read only. End user engagement testing with new reports and merging disparate reports to new patient matching reports within the clinical point of care. Those are not easy things and a lot of the things I just talked about wasn't even in the IT team.

The IT teams getting the data, attractions data move and but naturally, whether it be procurement or it, someone's gotta lead that effort of multidisciplinary where we see projects. fail or slow is that we don't have that multidisciplinary team that is actually going after a very rich ROI situation, whether it be the clinical ROI or the hard ROI, which is cost takeout.

And there's, certainly there's going to be a cost to the new vendor, but that is such a tiny fraction of what you're actually removing from your costs. And when there's an M& A activity we have a more sophisticated client actually placed ClearSense into the M& A activity.

Area of IT. So whenever they do M& A, we were just a natural part of how cost savings will be realized, which, oh, by the way, going back to the other article, reduces your cyber footprint and also. Now probably gives you a better handle on using that data in a different way for AI or power visualizations or things like that.

time, and maybe the wherewithal, but they definitely don't have the time to corral all of those interested parties to figure out, what and how and when we're going to do this cost takeout. So you guys actually parachute into these situations and handle that whole part of the business.

Jason Rose: Yeah, it's a turnkey solution. We come in and we provide a governance, we provide a structure, If they want us to, we can actually handle all the data extractions as well, and then we put it into our SaaS, and we guide the client health system along the way, so they can maximize at the speed that they're willing to take, because we can, again, we can do, I think we've mostly done is 40 or 45 applications currently at one point for, it was over a year, we did that with one particular client.

I noticed you did that 15 minutes ago. Another thing that I've been saying, and I've been saying this again for decades, is it's not people process technology. I think that's actually wrong, the ordering of it. And I wrote an article in Forbes about this a couple years ago what it really is, or it should be, it's process, technology, people.

Because if you start with, I'm a process zealot. If you start with the process what is the process? You lay out the process, everyone agrees this is the current state. You have a future state design, but this is the current state. We're moving towards future state. Once you have that in place, then you layer on the technology to make it more effective and efficient, and you put the least number of people as possible to operate that process that you've just, technologically improved.

Drex DeFord: You're totally right. I'm a Toyota production lean guy too. have been my whole life. This idea that you take and insert technology on top of bad processes and Take a train wreck of a process and make it really fast and efficient.

Train wreck is a terrible idea. It's how we get into trouble a lot in in information services. So I love your flow. I think that's a way better way of looking at it. Let me ask one other question and then we'll wrap this, but lot of times organizations don't actually know all the things that they have, and so part of the app rationalization process is just figuring that out. how do you go about helping with that?

Jason Rose: We'll start with the IT organizational leadership. They, whether it be, depending on the size organization, the CDO, the CIO, the head of applications enterprise apps, things of that nature.

And we've got different ways of working with clients to show that whether we have a partner where we are going through a small exercise during our discovery process of saying, Hey, Here's what we typically see in cost on these software licenses. These are like a thousand different applications.

It's not just, by the way, it's not just Cerner. It's not just Athena. 300

Drex DeFord: other applications that we're using. Yeah.

Those are natural yet, but what else do they have? There's a lot. In fact, If you go to each department and you start engaging, maybe not the first thing you do, but the second thing you might do is you might go to these departments and find out what are the other IT spend that they have inside those departments too.

But to me, the finance team is the key because they're paying on the GL.

Drex DeFord: And so the big spend is, yeah.

Jason Rose: Yeah. there's a big spend and there's also a lot of small spends that you can tuck in. With the big spend because the big spend is going to, get the ROI right away, but there's so many other, like hundreds, we have one client it's a very large 20 million health system, 26 states, and they had almost 7, 500 applications.

etc., etc. But that's really, to me, you can shrink that to small regional hospitals as well, particularly those who are going through There's lots of M& A happening, and those are the natural triggers or catalysts. But there's, venture to say, and I'd love your opinion on this, I'm going to switch. believe that at least 10 percent of the portfolios are bloated for health systems, and I've seen as high as 30 percent in most of the health systems we work with, all frankly speaking, already have one of our competitors in place.

But so I'm just curious, is that a number that resonates with you in around, 20, 30 percent of the application portfolio?

Drex DeFord: It may very well be. The other thing that you said that really rang true with me is that this isn't a okay, we've done app rationalization, we're done. It is an ongoing thing because It's like everything else.

If you don't, water that garden and pull the weeds, there will be weeds that grow. New things will happen. People will find new ways to buy SaaS applications. It's a process, right? Now suddenly, you have the bloat again. So you have to stay on top of it. It has to be relentlessly attended to

Jason Rose: And the benefit is so huge.

And then even the soft ROI of the clinical access at the point of care for the last 15 years of a patient, as well as the cyber areas we talked about, and then getting the data available so you can use it for other things like AI. and visualizations and other tools you want to test out. It just makes such obvious sense.

Jason Rose: you think about the last 20 years all the EHR stimulus, meaningful use, et cetera, et cetera. There is a reason why these portfolios got so bloated. And I think that, and then you have the move towards Epic, the move towards Workday, and then the M& A. Those things are just creating this bubble that's bursting, where the health systems are hurting for money.

There's a desire to do more innovative things. But there's so much money sitting there on the table right now if they think strategically and focus on a broader based program, not a project, but a more of a pro, pro, programs are made up of a bunch of projects, right? And so instead of looking at it as a project, look at it as a program.

That you have in place, that you're just relentlessly using your words, Trax. Focus on what's the biggest thing for your bot.

Jason Rose: Thank you very much. Thanks for the opportunity. It's a pleasure to meet you.

Bill Russell: Thanks for listening to Newstay. There's a lot happening in our industry and while Newstay covers interesting stuff, another way to stay informed is by subscribing to our daily insights email, which delivers Expertly curated health IT news straight to your inbox. Sign up at thisweekealth. com slash news.

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