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 Today, on this week in health it, our patients are really used to being able to have very easy experiences in other sectors, whether it's retail or entertainment, and we need to be able to bring that to healthcare.

Thanks for joining us on this week in Health IT Influence. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping Health IT staff current. And engaged. Special thanks to our influence show sponsors Sirius Healthcare and Health lyrics for choosing to invest in our mission to develop the next generation of health IT leaders.

If you wanna be a part of our mission, you can become a show sponsor as well. The first step. Is to send an email to partner at this week in health it.com. 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 podcast at Apple, Google, Spotify, Stitcher, overcast, you name it, we're out there. You could also go to today in health it.com. And now onto today's show, we have a returning guest, Kristen Myers, CIO, for Mount Sinai Health System out of New York City. Good afternoon, Kristen.

Welcome back to the show. Hi, bill. Glad to be here. It's been a little while. In fact, the last time we talked you were not the CIO at Mount Sinai, and now you are so congrat. Making that. So is it a big step from where you were, I mean, you were over applications for the most part, which is usually one of the bigger portions of it.

Talk about the transition. Yeah, I think that overall the transition has been really smooth. I think that given the fact that, you know, I've worked at Mount Sinai for the last 17 years, I, I was really lucky because I knew all the executives. I knew the IT team and I was able to really transition, transition into that uh, position pretty easily.

Yes, absolutely. I always forget to do this, and I, I wanna do this with you. Tell us about Mount Sinai Health System, the reach of it. What are some of the services that you guys offer to the community? Sure. So it's an integrated healthcare system. In regard to medical care, it also has a medical school, a nursing school, eight hospital campuses, and a really large regional ambulatory footprint.

Interesting. All right, so there's so many topics we can cover. Let's start with digital solutions. What challenges have you been addressing with digital through the Pandemic Pandemic Digital Solutions? So broad. We'll speak to it in regard to our patients. We've had a lot of digital solutions that really need to come together in terms of having a seamless and frictionless experience for our patients and you know, also incorporating the onchan access into that experience.

Our patients are really used to being able to have very easy experiences in other sectors, whether it's . Retail or entertainment, and we need to be able to bring that to healthcare. And so we've been looking at solutions, whether it's CRM or referral management, texting solutions, telehealth, making sure that we can provide this in a way that make sense to our patients and isn't a fragmented experience.

So that's one of our biggest challenges is really bringing it all together and we're slowly being able to do that. Yeah. You guys are really focused on the patient experience. I assume there's digital solutions on the, uh, clinical side as well, but staying with the patient side, you're in an urban center, so the demographics probably lend themselves to a pretty sophisticated set of solutions.

You're not overly worried about lack of access to cell phones. Broadband and those kinds of things. You're pretty much have a, a pretty wide open canvas to work with, don't you? You know, I think that Manhattan and the areas that we're in is actually a very diverse community and Mount Sinai, our patient mix is around 65% Medicare and Medicaid.

Rather than that proportion being commercial insurance, which some of our competitors have. And so there are sometimes access issues to technology and that is an area where New York City is actually making larger investments in broadband, interestingly enough, in Manhattan, upper Manhattan. So. As you guys are looking at the patient experience, how do you determine what solutions you're going to prioritize and what technology you're going gonna put in place?

What's the process? What? What's the team that sort of comes up with what you're gonna do next? Yeah, so I think it's a combination of operations and clinical informatics. The technology team that rolls up into a digital governance and. We also have, you know, our patient experience teams that help us prioritize and also really vet some of the solutions that we're rolling out to our patients.

And I think that having direct patient input into the solutions is extremely important, and just getting that feedback in a closed loop. So that you can iterate is really important. So how do you get the patient feedback? Are you doing focus groups? Are you bringing them in the development process? Yeah, so the patient experience group, uh, facilitate that, which is fantastic.

They have community groups that they already have outreach to and bring them in on a wide variety of topics. And technology is now just one of them, which is great. But what's your philosophy on build versus buy, especially with regard to the solutions that are in the experience area or maybe at the edge where the clinician and patient are interacting?

Yeah. I think that I always go back to, uh, application portfolio. We have a large one being an academic medical center, and do we already have existing functionality and what is on our enterprise roadmap? I. With groups like Oracle, with our ERP or Epic as our EHR and billing and access system, if something is not going to be ready for the next two to three years, we have to innovate and we have to be able to get a point solution or build it ourselves.

And there is functionality that is out already around text to chat. That we're going to be integrating into our main, my Mount Sinai application and you know, so I think where we can utilize already the technology in our applications, we try to do that. But if there's a gap, you have to be ready to pivot and either find the point solution or develop it yourself.

So pivoting a little bit here. So cybersecurity is obviously top of mind. Mm-Hmm. . With the recent attacks and healthcare really being targeted, how has the conversation changed as a result of the ransomware attacks and, and how are you guys sort of looking at and preparing for the new world that we live in?

I guess. Yeah, I think the ransomware attacks have really changed the conversation. 12% of all ransomware attacks are in healthcare, and downtime can be on average around 23 days. And just thinking about being down for 23 days, I think that really, I mean, you've gotta be able to reduce the attack service, but you also need to be ready.

In terms of an incident response, and so we've really been looking at both areas and making sure that we would be ready. So looking at the backups, doing tabletop exercises with our executives I think is extremely important. Also, looking at your overall cybersecurity program and. It's maturity and governance and we recently brought in a new CISO from outside industry and super excited.

His name is Rishi T. He started about a month ago and he's already bringing that outside expertise. I think healthcare's been a little far behind other sectors as it relates to cybersecurity maturity. I felt like every hour that our EHR or major system was down took like a year of my life away. Yes. And so 20 days of downtime, uh, I'm not sure at the end of that as A-C-I-O-I-I would've aged by 20 years or.

It would be amazing. And the scripts one was 30 plus days, and I know it's terrible. I can't imagine that. But that does change the conversation a little bit of, obviously we're prepared for a couple days downtime, but now we're sort of looking at it and saying, okay, how do we take how 30 day downtime and reduce it to, even if you're completely ransom, how do you take that timeframe down to 10 days or so at.

Is that something that's function of the ciso or is that part of a governance committee that's looking at security as. Yeah, so our CISO uh, reports to both myself and with a dotted line to the chief risk officer. And so we have an entire enterprise risk management framework and cybersecurity is one of major risks as it would be in any organization.

So we have a whole governance structure, whether it be . The monthly meetings. We have quarterly executive meetings. We report out at the IT committee of the board. I have my own committee where I meet quarterly and specifically on cybersecurity as well as the audit committee, and then the full board of trustees at Mount Sinai.

Yeah. Do do you find they're They're more aware. I, I, I know back when we were. Yeah, I mean when we, when we were doing this, we had to convince them that cybersecurity was a major thing, that we needed to invest in it and whatnot. But I would imagine that conversation has gotten almost reversed. They're looking at you going, Hey, how are we doing with cybersecurity?

We wanna give you money, make sure that we're secure. I, it would almost feel like that pivot has happened. Absolutely. And I have to say, everyone is extremely supportive of the cybersecurity program, and I think it's a journey. There's not perfection with cybersecurity and it's a maturity journey that everyone is on.

But you know, again, I'm very happy that we've got a new CISO who has started in some roles. When you bring somebody in from outside of healthcare, there's a a pretty significant learning curve. The CISO to me would be one that I would think there, there's a lot of benefits from the experience from outside.

There's also not as steep of a learning curve. Obviously there's the culture and an academic medical center has its own, uh, challenges as well. But for the most part, that's probably one of the roles where it, it, it would feel to me like it's not as steep. I, I, is there a learning curve and how do you bring somebody in that role up to speed on healthcare and how it operates?

Yeah, so I think the good news was in his previous role. He actually had to deal with HIP also, which is a fundamental to healthcare. We also are very lucky that we have a deputy CISO who's been with Mount Sinai Kenny Chu for many, many years because I agree that the fundamentals of cybersecurity quite interchangeable, whether you're in healthcare or other sectors.

But there are nuances. I was just in a meeting actually around research, uh, cybersecurity and some of the challenges that we need to really look at and potentially develop robust program around. So I think that there are nuances, but again, I, I think that CISOs could come outside of industry and will be successful.

I. So digital and cybersecurity are probably two big buckets. But I, I was wondering, and this question might be premature. I've been asking this question as we come out of the pandemic. Obviously we have the Delta variant, which is upsetting things at this point, but as we hopefully move out of the the pandemic, what do you see as the priorities from a health IT spend for say, the next 18 months?

Yeah, so we're looking at. All of our data centers looking at consolidation. Also, our overall cloud strategy. So as an academic we have to have a multi-cloud strategy. There are different tools that we need for genomics that different cloud providers have. We'll always be multi-cloud, but you know, we need a primary, uh, vendor to work with.

So we're going through that analysis right now as to. Where would we transition many of our business and clinical applications? So I think that the data center facilities and the cloud strategy all comes together with business continuity and disaster recovery. I think that's a priority for me. I also have, uh, other transformational programs that are taking place.

So we had gone live actually during the pandemic with HR payroll. For Oracle, uh, cloud. And so we need to move forward with financials and supply chain and as part of that entire transformation, that's a huge project to that we need to undertake as well as access and hospital billing. We're rolling out with Epic.

We're also looking at unified communication strategy for our nurses and . Corporate team members. Our nurses have many devices, so we need to be able to, you know, streamline that. And we're looking at, uh, also cloud to potentially replace some of our life telephones. We're also looking at our clinical command center, which has been very successful and really came into its own during Covid, and how do we extend

Remote consults through telehealth throughout the system, so there's a lot going on. I'm sure there is at every institute, but again, cyber and digital are up there, as well as our enterprise data strategy, which we've been very much focused on and got funding for. Yeah. Well, that's probably where I would take you next.

Through the pandemic, the, the use of data was really instrumental in our response, and I've been hearing some really interesting and, and neat ways that data science and data has played a role in how health systems really responded to the pandemic. So I I, I was curious, where's Mount Sinai using data in new and interesting ways and, and where are you going in the future with it?

Yeah, so one of the things that, you know, as an academic medical center we have is a lot of innovation. And actually the dean just appointed, uh, Dr. Fuchs to head up an entire division of AI at Mount Sinai and create an AI department. And so, you know, we're collaborating with him on some of the . Imaging and what can you do around AI and imaging as one of the projects.

We're also combining clinical and claims and social determinant data to look at how can we pinpoint, you know, our outreach efforts to our patients. And we have a number of predictive models in place and we wanna expand those in. Really around, uh, sepsis and malnutrition and delirium and other adverse events.

So data is definitely a focus for us. We're creating this enterprise data strategy, which just got funded really to have a foundation across the health system and provide more self service tools to our nurses and pharmacists and.

So we have a lot of data assets at Mount Sinai, but we wanna bring them all together and as a research institution to make it easier for our researchers to get access to the data appropriately and safely. Yeah, and, and just for context here, we're recording this on July 29th. It'll.

Yes. You know, so, so some of this stuff, people sometimes they go, well, that, that's changed over the last 30 days. Well, that's how fast healthcare is moving. But I, I wanted to talk to you about return to the office. Have you returned your staff to the office? And what are your plans in terms of work, either dynamic work environment or hybrid work environment?

What's your plans moving forward around that? Yeah, so we have not officially brought anyone back into the office. I'm in the office today. I usually go in three or four times a week and have some in-person meetings, but the majority of the team completely remote and probably will be for the foreseeable future, especially with the Delta variant that we're seeing.

We're probably moving to more of a. Flexible remote offering for our team members. We've reduced our space footprint and have hoteling space rather than everyone having their own cubicle. And we've been doing this across the health system, being able to. Either terminate leases or leases have come up and we haven't renewed them.

And so we've been consolidating in terms of space. And so no plans at this point to bring everyone back. As I said, I wanna be able to provide that degree of flexibility and there's been no official, um, policy at this point from Mount Sinai as to when people would come back I see in the news. Like many firms are saying, you must come after Labor Day, but we have had, uh, no such announcements at this time.

Yeah. So how, I mean, one of the questions, and I haven't asked this in a while, but how did you get everyone set up, especially in New York, I would think you have smaller living spaces, obviously. You probably have some people who are from surrounding typically. You're trying to get people set up in a way that they can function really well, how did you and the teams look at that and make those, those adjustments and help people to make that adjustment to working at home?

Yeah, so interestingly enough, we had started exploring more remote work options actually before the pandemic, because Manhattan space is at a premium, right? And so we already had. I think before the pandemic, it was around a thousand people who were logging in remotely each day from home as part of corporate services.

So we scaled that up and we were able to scale up that infrastructure up to 10,000. I, I believe, was at the height that we're logging in per day in the pandemic. We did have to scale up our help desk and make sure that they were able to handle all of the calls. And also our technology team, we did have to bring in additional resources to, you know, manage that.

But we've been working with the departments, making sure that they have all of the equipment that they need at home. I think some of them, some of the team members have said, we need two monitors. We've been being able to send those to the team members, but we're working department by department to really make sure that all of their needs are going to be met working remotely.

Yeah. So talk to me about adjusting maybe your management style or your team helping them to adjust their management style with. This is very different meeting people in this format. Very different than meeting in a room and the energy that can get brainstorming ideas and meeting and going out to lunch and those kind of things.

So how did your team adjust from a management approach? Yeah, I think that the key to remote working is really communication and being transparent and making sure that you are available to your team. And checking in with them and making sure that everything's okay, that they're not struggling. I think that a lot of things happened last year, whether it was the pandemic, I mean, people were impacted by the loss of loved ones we had.

Social upheaval. I mean, there was so much going on that it was very stressful for many of the team members. So I think as managers and making sure that we checked in with them constantly, I think is important. But being transparent, communicating, I think always important, but doing it more frequently.

I think that what we have learned in the pandemic is it doesn't matter where you work really. And I think that our employees have choices. They could apply for jobs in Texas and still live in New York if they wanted, or move wherever they want to and work at any facility in the country. So we have to be competitive with that, and that's why I still want to.

While I want a hybrid work environment, and I definitely see the value of meeting people in person like I did even today. We need to be flexible also because there are some employees who do not want to come back to the office and want to continue to work remotely, so we'll have to have that flexibility to be competitive.

Yeah, absolutely. So let, let's have a little fun to, uh, close this out. Uh, if, if I gave you a million dollars right now to place a bet in some area of digital health, what's an area that you think would've the greatest return over the next five years that you would say, I wanna play in this area of digital health?

I'm gonna place a million dollar bet. I think probably remote patient monitoring. I think that the institutions are being paid by CMS. I think that it's going to be something that patients adopt more readily and just be a part of, uh, patient care moving forward. That will be very interesting. I think you're gonna see hospitals who used to say, yeah, we're a 300 bed hospital, say.

All over the.

Kristen, thank you very much for your time. I really appreciate it. I know that you are incredibly busy, so thanks again for coming on the show. Thank you, bill. 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, perhaps your team, your staff.

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