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Thanks for joining us on this week in Health It Influence. My name is Bill Russell, former Healthcare, CIO for 16 hospital system and creator of this week in health. It. A channel dedicated to keeping health IT staff current and engaged today, Dr. Zafar, Shari, CIO, for Seattle. Children's joins us and we talk about a lot of stuff.

We talk about, uh, remote work priorities for the coming year cloud. We talk about tech debt, uh, a lot of great topics and we delve pretty deep. So I'm really looking forward to sharing this with you. 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.

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And now onto today's show. Today we are joined by Dr. Zafar Shari, the CIO for Seattle Children's. Good morning, Zafar. Welcome to, welcome to the show. Good morning. Thank you for having me. Yeah, I'm looking forward to this conversation. We have a lot of things on tap remote work, uh, supporting the remote workforce Telehealth app, app Rat.

We're gonna, we're gonna talk a lot of different topics, but you know, before we get there, let's, let's back up a second. I'd love to hear a little background on Seattle Children's and your role as CIO There. So Seattle Children's is a multi-state pediatric health system, so we have 46 sites across four states and primarily serving the Pacific Northwest.

At the core of that is a 400 bed hospital, and I'm the senior Vice President and Chief information officer at Seattle Children's. I've been here just over three years. Three years? Yeah. And, and the last year, we're gonna count for everybody who's in that role as, uh, three or four years, if that's okay with you.

You know, how, first of all, how much of your team went remote and how have you done with regard to productivity? So pre pre pandemic, on average, on any single day, we would have about a hundred people working remotely. And when the pandemic hit us, we had to pivot to virtual very quickly. In about 48 hours, we were at 4,000 people working remotely, and we still maintained that.

And to contextualize. We have about 12,000 people in gen in total working at Children's. So about a third of our workforce remains working remotely, but we have to pivot to that very quickly. In terms of work productivity, I think we haven't seen any dips in productivity. I would say in many cases we've been more productive because people have been able to cut out the commute.

Uh, the commute in Seattle isn't great, so people have been able to cut that out. It ended up spending more time, I would say dedicated to work. I'm not sure that that's always the best thing, 'cause I've certainly seen this work-life balance be affected by the pandemic. You know, Washington State is still pretty much locked down, so there's, besides grocery stores and a couple of key places, there's nowhere to go out to.

So people spend a lot of time sitting in front of their machines doing meetings, answering emails. But yeah, we have a large group working from home. So first, describe your, what your normal management and communication style is, and then how you've adjusted that with regard, regard to this, uh, remote work environment.

I. So, as you know, bill, in technology we, most of us, most of us are pretty introverted people. So, you know, prior to the pandemic, we would make a huge effort to bring people together. I have about 500 people in my IT business, and we would have monthly town halls and quarterly, all hands sessions, lots of face-to-face communication.

Pre pandemic post pandemic. Of course, none of that is, is possible. So we've had to pivot to running those town halls and all hands sessions virtually. I've, I started up a weekly update from me to the team, which goes out every Friday morning, which talks about not only what I feel about the surroundings, the new normal, the, the pressures I face, but at the same time.

Uh, pre pandemic. I was never cooking anything. I never have. And then I taught myself to cook as some escape from work. So I've been sharing at people's risk. I've been sharing some of the recipes with my team. We talk about books or videos. I'm a huge sci-fi nerd, so I've been rewatching all the Star Trek and all the Star Wars that I can find.

And then I've been sharing . I've been looking at them from a lessons learned perspective and then sharing that with the team, and then I give them updates on what's happening at executive level in the, in the organization. So that goes out to 500 plus people. So that's another way of communicating, and I've been popping in and checking in with the various teams at their team huddles as well to to see how they're doing, how they're feeling.

The thing I've sort of taken away from all of this is people are under a lot of emotional strain outside of work because of the uncertainties of what's happening. I've seen that level of pressure with the teams, and so I think you're gonna have to do more handholding during this process. And we've tried to do that, uh, across the board.

Well, you, you can't leave me there. I got, I have to ask the question. Uh, 'cause it sounds like the, the start of a book that you're gonna write, which is leadership lessons, lessons Learned from Star Trek and, and Star Wars, uh, give us, give us a, a little sampling of, of some of the lessons that, that leaders might learn from watching those movies.

It's, it's, it's a lot about, so obviously it's, it's interesting certainly some of the leadership techniques. If we take the example of Scotty from the original Star Trek, he was the engineer on, on the enterprise, and interestingly enough, I. Every task had to be done last minute, which kind of reminds me of what happens in it.

And Scotty would always quote, I, it's a 24 hour repair, but I'll get it done in four hours. And that, that always reminds me of the things we have to do in tech. And, and so the question, the, the way I relate that back to the team is, you know, always. Under promise and over deliver. Right? When, when you're trying to deal with major projects or last minute, we've seen a lot of last minute things that we've needed to put together because of the pandemic.

So you look at that and then there's, there's things about perseverance. One of the things we've needed through this pandemic is. Emotional stability and perseverance and the ability to keep going when you don't know what the unknown is. So if you think about the mission of the enterprise to boldly go where no person has gone before, isn't that so suiting to what we're doing now?

We are going in directions that we didn't know we were going before. The new normal is, is just very difficult to describe. And so. I tried to take those and say, well, you know, these people were on this journey, meeting new people, finding new direction, and we'll keep doing that as well. As we learn more and more about how we flex in this pandemic era, I.

So those are some of the things we sort of talk about. Certainly recently there's been a lot of discussion about equity, diversity, and inclusion. So I've been sharing some books I've read on that and my own personal experience as, as a person of color and I've worked all over the world as to what my experiences have been, how to find that balance and, and so it, it becomes an interesting discussion and certainly I get lots of interactive feedback from frontline folks.

Post update on a Friday, so it gives me an opportunity to talk to some of those folks that I probably wouldn't talk to for a long period of time. That's fantastic. I, I won't go in the cooking direction with you. It sounds like you're, you're just starting out. But if, if we have you on next year, I, I'll, we will, uh, we'll start sharing some of your recipes and what you're doing.

The, uh, you know, talk about culture. You know, one of the things people worry about is, is losing that culture. You just described some areas where, yeah, you know, you're creating commonality. You're, you're bringing people together to talk about more than just work. You know, we miss going to lunch with each other.

We miss the, the, the sitting around. Just talking about things and coming up with new solutions and that kinda stuff. How do you, how do you foster culture in this remote work environment? Well, I think you have to have more fun activities, even though we're virtual, and so we've, within my own IT group, there is an employee welfare group, which is managed and run by employees.

They call it your voice. And it receives funding from, from myself to do interesting activities. So of course, in the past, they would set up barbecues and get togethers, as you said, nothing like sharing and breaking bread together to bring people closer together. But now what they're doing is they're doing competitions.

And, and charades and games on virtual meetings. We recently had a charade session where the leadership within it were to, were took a particular. A particular area and then played a charade on that. And at the same time, we shipped goodies to people's homes so that they could participate, uh, as if they were sort of in a Mardi Gras type of environment.

So we, we've tried to engage. Now it's, it's difficult sometimes to get people to engage in that. I would say it's probably a 50% engagement level that, that I've seen in that space. But those are some of the areas we are trying and . It's no different than what we're seeing in the vendor space, right? You have all these vendors who, who contact us and talk about virtual cocktail hours or they want to have a glass of wine with you, uh, after hours versus previously you might have gone to a, a corporate dinner.

Uh, so things have shifted in that space. Still a lot to learn though about how to get people to remain, I would say, emotionally happy, right? That's, that's the other component to all of this is how do people feel besides what they're doing at work. And some of those pressures are, you know, their kids, the inability to send them to school, trying to do all this work from home.

Many, many individuals don't live in very large homes. So you're sort of finding that balance between, am I in a . Am I in a closet trying to do my, my virtual calls whilst my kids are trying to do Zoom calls to school bandwidth? All of those things are causing strain on people, and the cost of living keeps going up, which is another impact.

Yeah, that's, that's been one of the oddest things I've seen is just the, the, the housing markets are just going through the roof, so to speak. Talk about post, post covid, post pandemic. Let's look at. Who, who knows when? That's going to be, hopefully sooner rather than later. But at that point, I think people wanna know what does remote work look like?

Post pandemic? What I, I assume you've had a, a lot of conversations around this. What, what do you think it might look like? So we decided at Children's to set up an independent committee to determine what the future of remote work would look like. And what we've decided to do is. Based on our learnings to date is, well, there's a certain number of people who probably should never have an office or go back into an office, and that way we.

Previously you could be hired and work in any of the four states that we would service. Washington, Alaska, Montana, and Idaho. We've now expanded that to Texas. Georgia and Florida, which means I have actually started hiring technology people in Texas, for example. So they will never come here maybe once a year.

But at the same time, I'm able to get a bigger, diverse pool of candidates that I can bring in to the, to the business, which helps us in our thinking moving forward. So a lot of change, but some permanent change as well. How did, how did.

So the HR department looked at the reporting requirements with each, within each one of those states, from an income tax perspective, from what needs to be reported to the state, what licenses we need to technically operate in those states. And those three were the next simplest in terms of paperwork to do.

First probably in the world to do a hundred percent virtual training for our clinicians. So that went very well. So we got a big project under our belt whilst trying to deal with everything as 1st of November started, we decided that from a financial perspective, you know, typically pediatric hospitals have strong margins.

Uh, on a year to year basis, but we have been impacted by Covid. You know, the census has gone down. It has now come back up, but it hadn't gone down and so we didn't make as much margin . More or less broke even in the, in our last fiscal year, we then decided that we would focus on patient safety, uh, issues first and keep the lights on, doors open.

The only major focus area for us is replacing, uh. Systems that are end of life and Children's has about 790 information systems running. The big project for us this year that we've started on is the replacement of our ERP. So we currently use Lawson version 10, and we're doing a market analysis RFP as to what that future would look like, which will culminate into a business case in the next couple of months.

A selection process, contracting agreements, and then probably an 18 month cycle of. Ripping and replacing everything that we have that's Lawson to something else, uh, that suits us better for today's world. So it'll be ERP will be the major piece. We'll continue to mop up on our Epic implementation and optimization and, and just next month we're gonna take our first Epic upgrade already.

And, and all of our Epic system itself doesn't, we don't run the system or host the system. It actually sits in the Dell Vir Stream cloud. Oh wow. Wow. There's a lot of directions. I, I wanna start with App Rat application rationalization. You said 790 applications. I assume a fair number of those came down when you did the Epic implementation.

That's what we've heard. Is that gonna, is that going to be an ongoing direction for you? Is is rationalizing applications? I think we have to for the future and the the cost improvement programs that every healthcare organization is going to have to make to survive. We started this journey just over 12 months ago and, and so we have not only closed all of our onsite data centers and moved a large majority of our applications to private cloud, but when we started this journey, we had about 840 applications and we're down to 788 applications, and we're going through each application to see whether it's valid.

Whether it's in support, whether it can be archived and decommissioned. But of course, as you know, bill, working with clinicians and when asking clinicians, can we turn the system off? The answer always is no. We need the data that's within that system. So we're also trying to figure out what level of archive will be created.

So our cerna data, for instance. Is, is built into an archive with only the most recent data converted into Epic. And so we'll, we'll start decommissioning even more systems into that same archive and then contextually link patient data together in a single view. But yeah, I think everybody's going to have to look through the applications, reduced the number of applications, and, and certainly the pandemic has done that, right?

So. Whereas people are using multiple tools, WebEx, GoToMeeting, zoom, a multitude of virtual platforms, office 365, you can't afford to do that, so you're going to have to figure out what that consolidated platform looks like, even just for your virtual meetings. Yeah, you said that you are running Epic on, on Dell's Virtue Stream cloud platform, which is, which is interesting is, is that hosted near the Seattle marketplace or is, is that Cloud hosted in, in one of Dell's data centers?

So it's hosted in their primary data center in North Las Vegas with the secondary data center in Sterling, Virginia. It's not only a hosting of . We don't own the hardware, it's their hardware and it's their fully managed service. So we don't, we don't do anything with the system besides the build component of the system.

They manage the os, the antivirus, the application itself help us with the upgrades. And we've been live on that now about seven months. And it's, it's uh, it's a guaranteed five nines uptime. And we are seeing that on the system. Yeah. And that's, I mean, that's, that's interesting in and of itself. So you're, you're, it sounds like movement to the cloud, a application rationalization.

You're really trying to avoid, uh, tech debt. Do you measure tech debt and, and try to eliminate it? Is that a, a goal? Yeah, because I think what people fail to do in the healthcare IT space, if you've got 7, 8, 900 thou a thousand applications. How often are you reviewing those applications for, for updates, upgrades, bringing it up to the right version.

You don't, you tend to run software for a really long time and then realize it's either outta date or the company was, was so small that there was three people hanging out somewhere and you can't find them anymore to even provide support. So those systems then . Generate what I would call that technical debt.

You know, technically I've got 788 systems that that require some sort of upgrade every three to five years. If I don't do that, then they will age and they will cost me more and more to support, and in some cases could fall over and I can't support them because the vendor isn't even providing support on that particular version.

So, yes. I think you have to look at that, but going to a board and saying, I need funding to refresh 700 plus systems is, isn't gonna be viewed as as the top. Well, you know, it's important especially for the clinical system, but at the same time, that price tag is so astronomical that people tend to avoid that.

And it really depends as a person leading a group of technologists, it really depends how long you are in an organization for. Because if I was in my organization and I changed my role every two years, then I probably wouldn't have to worry about that refresher systems. But if you stick around long enough, then you have to own, own that system, refresh and work with the clinicians to do that.

And every refresh turns into a, a sort of mini major project. Did. So you talked about EHR and ERP, anything with regard to pacs, CRM, digital front door, re reworking the network because of all the people being remote or any, anything to that effect? So I think we've, we've been very blessed with investment in technology.

We spent about. 7% of our annual revenue on tech and we, we have replaced those systems before Epic. So our PAC system is relatively new. We run the infinite platform. We haven't spent a lot of time on CRM. We do have Epic CRM and some pockets of Salesforce, but that hasn't really been as much of a focus area.

So we've been working through systems as and when, but we've been able to refresh. All of our hardware was refreshed across all of our sites because of Epic. And in terms of networking, we've been, we've been blessed with a relatively new Cisco wide network. But that hasn't required a refresh. Yes, we've seen some challenges in terms of remote working as to how do you connect, so we have had to spin up some VPN access for those individuals working from home.

But before that, we were a full, we were a full VDI shop. The thousands of VDI sessions running on Citrix, sitting on a Nutanix platform, which is hyper-converged. So we, we've already had that technology and had invested in it as part of our move out of our on-prem data centers. So we've, we did it about 18 months ago.

All of our hardware service storage, networking in the data center, the private cloud data center is, is all brand new. So mega investment made. So we've been lucky in that sense. Yeah. You, it's, you know, actually let's talk regulatory. I, I think people are surprised to hear how much of the projects that happen in healthcare are, are driven by regulatory, I mean, you have the projects that, that we kick off internally, and then there's the projects that are thrust upon us.

There's things like transparency rule and data blocking and whatnot. What, what? Are you looking at? What are you tracking with regard to regulatory projects right now and and what are you working on? Well, certainly there's the price transparency, which we did comply with. It's always interesting when, when you are asked to reveal data to the public, I.

Whether the public will truly understand what that information means. I think that remains to be a gap. But we have complied with the price transparency work. We do comply with sharing of information. So Epic has helped us do that because the Epic platform from Epic to Epic sharing has become easy, epic to other systems.

Yes, absolutely. We've been sharing, we have a set of external physicians that. That, uh, provide services for us. And so we've, we've been using for a couple of years the well incentive platform for sort of health information exchange. Interoperability wise, we are on the InterSystems platform and have been for a while and so able to do that.

So I don't think we've had a problem sharing the information that we've needed to do. And last minute stuff has happened as well. Right? So in the pandemic. Uh, the state needs vaccination numbers, the state needs infection numbers, so we've been able to do that. Uh, we have a strong analytics function. Uh, I appreciated when I joined Children's that analytics needed to remain strong and be a strong function.

So we've hired, uh, data scientists into that function. Were a him stage seven shop. So we've done a lot of work in that space and we can comply. My big question around interoperability is, I know the, the federal government wants us to share data, which is a good thing. Question is contextually, well, what does that mean for the patient?

So my goal always is, is well, how does that benefit the patient? And can the patient understand the information that they have? So certainly Epic MyChart has helped that patient . Access and understanding. We've, we've moved to open notes as well within the platform, so you can more or less see what your doctor is saying, writing about you.

Uh, and, and that's been received well, our IT initiatives are managed by our own patient and family advisory group, which meets every month. And those parents and patients. Help us guide what's tools we should build to help them, uh, navigate the journey through Seattle Children's. And I've certainly learned in, in my career that the average 11 year old is so much smarter than I am in terms of what they want from a tech perspective.

So that's always quite interesting to hear. Their view to help us guide the future. Yeah. You know, it's, um, it, it's, it's interesting to hear you talk about price transparency. Let's, let's start there that, you know, one, one of the things that's interesting on the other side, I'm here, I'm talking to entrepreneurs and, and, and data companies that are outside of there saying, look, uh, we want to collect all that information, aggregate that information, make sense of it, and build apps that make.

That, that make that, uh, information actionable for the end user community. I'm like, all right, well that makes sense. So what's the challenge? They're like, well, not everybody has complied with the, with the rule. For starters, it's not clear whether the government is going to do any of the penalties, and the penalties aren't that great for not complying for that matter.

But then they say, you know, even if they are complying, it's hard to find. Because there was no like standard set for, Hey, share it here on your website or put it on a a, you know, it has to be on your about and about page or pricing or whatever. It's hard to find for, for many of these companies that are going out there and looking for it, and I've had some individuals say they've gone out and looked for it and can't find it.

And, and so there, there is this, this ecosystem, I think waiting to be birthed, but there's just this challenge 'cause there wasn't clarity around, you know, how that information was going to be shared and used throughout. That's sort of a comment more than a question around that. Do, do you feel like the, the information could be used if people can get access to it?

Yeah, absolutely. I, I think there is value to the information, but it, it still goes back to that context and, and at federal level setting the standards that everybody, not only us. As providers, but vendors as well, what they must comply with in terms of those standards of delivery, of interoperability and information.

But yeah, if you, if you take your price transparency list and attach it to your website, as many organizations have done. It's a very difficult thing to navigate. There's codes, the descriptions that are there are very difficult for the average person to understand because they're more or less based on ICD type descriptions versus what you would call common sense type descriptions.

So there's a lot of work to be done there, and there's, there's a lot for us to learn from other locations. You know, as they said, I've. I've worked in probably 20 different healthcare systems around the world, and certainly when you look at the, the UK model of data sharing or the Australian model of data sharing, I.

Those standards are all set by the government. So a vendor must comply with those standards just to do business in those countries. And we've just not been as heavy handed here. Right. And I think it may be time to say, if you want to be in the healthcare space, you should be able to share your data in this way, this format.

Because even with simple HL seven messaging, . It's quite interesting that, you know, you can buy a connector from a vendor for, for your ADT data and you have to buy it 10 times over and it every time you buy it, it's slightly different. That doesn't make any sense, but that's the world we, we seem to live in.

Whereas in other countries, if you are selling an ADT connector, you are only allowed to sell it once as a vendor and then it is. Has to look exactly the same as the next person's ADT feed. And I think that really helps drive, uh, that patient access. Yeah. What you, you, you mentioned analytics. What, where, where's, where's analytics going?

We, we created, we generated a ton of reports. We responded to government requests. We, we responded to internal requests. We started tracking things on reports that normally we wouldn't track. Like PPE was almost disposable. And then we had to track it to the, you know, to the individual item level and those kind of things.

And we created those reports and dashboards for our organization. But what's next? Where are we going next in analytics? I think from, from a a data perspective, I is how do we then make that data transparent to the general public, right? The patient, the consumer of that data. I. You know, why aren't we taking the information we have in terms of outcomes, outcomes by physician, outcomes, by clinician, and putting them on our website?

Why can't I go to a website for a healthcare organization? You know, let's say I, I need to see a cardiologist. Why can't I transparently see the outcomes data by cardiac surgeon, by facility, and then make my informed choice? I think it's time for us to take, and we have access to all of that information.

Now, of course, people will be very unhappy. You as a physician, you, it becomes a competition if you have lead tables that are published on an open website. But I think that that's got to be the level of transparency. I should be able to, you know, if I need heart surgery, I should be able to select the best surgeon I can based on the outcomes for the type of care that I need.

And that's just not available right now in an open format. So I think this is where analytics should be driving to, is. Engaging the average population and health systems revealing all of their outcomes data, all of their infection data, all of their CLABSI data in a transparent way on their website.

That's where I think it should be going. Interesting. You know, final question really is any, any plans for AI machine learning, robotic process automation? So in terms of where our systems sit about . 15% of our systems do sit in the public cloud. So we are consumers of AWS Microsoft Azure, uh, our primary partners, and we have been using some of the AI tools to build our daily dashboards.

All of our current businesses run on Power BI dashboards, and some of those dashboards have predictive analytics built into them using some of the AI available in the cloud. But in terms of support services. Finance it, hr. We're currently testing some of the re remote process automation in the finance support service space.

So I think people will take up adoption in support services. It's a very expensive part of our business and we need to bring those costs down. And there's so many repetitive tasks that tools like RPA can help us with. But from an AI perspective, we're doing a lot of predictive modeling. So when will our hospital be full?

When will we have to turn patients away? What our census will look like on any, any given day. That's all work we have already done. And that's why I brought in a team of data scientists to help us do that. Uh, many of which are not from healthcare, many of which are from organizations X, Amazon X, Microsoft, who, who really know how to model data and present it in their format that our clinicians, uh, and, and doctors and nurses can consume.

Yeah. Well, you know, it, I mean, just to close it out, what, what, what, what do you think the lasting impact or, or the legacy of the pandemic is going to be on health it? What do you think, when we look back five years from now, we're gonna say that was the, the biggest impact to health it was that coming outta the pandemic?

Well, certainly I would say that the pandemic has, has super accelerated digital transformation. . So whereas the, the average clinician was always reluctant to use things like virtual conferencing, you know, prior to pandemic, we were a strong WebEx user, . Clinicians always hated using WebEx. And then the pandemic hit us and all of a sudden they're the number one user of, of WebEx and other tools.

Right? So I think this, the legacy of the pandemic, certainly in health it will be the speed of digital transformation being driven through not only healthcare organizations, but you know, across different industries. I think that's, that's what we will tell . Our grandkids and great grandkids if we, if we last that long, is that's what the pandemic did for us.

Prior to that. It was always hit and miss trying to get that stakeholder involvement and sponsorship. Absolutely. Dr. Shari, thank you for your time. I really, it's, it's always fantastic to spend time with you. 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.

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