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 Today, on this week in health, it, there's a lot of turnover right now at the CIO ranks because they don't know how to manage a hybrid workforce. If you can't engage your staff far and wide as well as onsite, you are a problem. Your your time is up.

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.

Uh, 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 could also go to today in health it.com and now onto today's show. Alright, we're doing it live Newsday actually, we're doing a Newsday show on a Wednesday here from Chime. And we are looking at a beautiful setting. I mean, we wanted to get that in the, fantastic that in the, the background, the all of San Diego.

But instead we have the conference when people actually feel like we're working, we're working, we're working hard, we're working weekends. No, we're not . Well, DRX is here with me, which is gonna be fun. And we have Colin Banis with Dr. First is the first person to drop in to have the conversation. I saw you earlier on the golf course.

I hope that doesn't get you in trouble. Yeah. Yeah. Shh. No, that was, uh, thank you for so much for having me. I'm a huge fan. It, it, it was a fundraiser, right? Correct. So the Pro Tournament was a fundraiser. Correct. That'll keep you from getting in into too much trouble. There's a lot of hard work, uh, but I do what I can.

You do . Well, I got to, got to hang out there on the 18th hole. Watch everybody hit. And I will, I, I can honestly attest to the fact that people are working hard. They're not golfing, , there's a lot of people not working on their golf game. There's a lot of, it was a, that was a heart hole. You had to hit over trees, over a ravine, over a ravine and a, a difficult approach shot.

Actually. It's a, it is a nice finishing hole actually for that course. Beautiful course, Maderis. It was very nice for, for Chime to have it held out there. It's a best ball tournament, right? It is. Absolutely. So it really is about teamwork, like everything else we do. Exactly. Absolutely. . Exactly. And how does your team do?

We did very well. Actually. I don't know, we don't know the results of the whole thing quite yet, but, uh oh, they'll announce that tonight. They'll announce. That's always a big deal. Yep. Who won the tournament? But we had a blast and I think I found some new clubs that I'm gonna purchase when I get home, because I played very well with these rentals.

So Doctor Colin Banis, doctor Internal Medicine. Hospitalist, um, reformed, CMIO, now, the chief medical officer for Dr. First. Dr first. Great. So I mean, you're, we're, we're here to chime and I, I'm just gonna open it up with what do you think people are talking about? What's the topic that everyone's bringing to this conference?

Yeah, I think, I think there's probably two biggies. The next level of interoperability is probably top of mind for a lot of folks. I think we've been dancing around interop for quite some time, and we're decent at moving chunks of data from A to B, but it still leaves a lot to be desired. And I think there's a lot of innovation around doing it better, doing it more thoughtful, doing it where semantic is preserved and it's actually functional interoperability.

And then be remiss not to mention consumerism. And I think we're a little bit past, um, digital front door, and we're seeing more and more innovation around consumer engagement. How can we engage the consumer at where they want to be met and getting their data back into a clinician hands in a meaningful way?

The, we've talked about this a bunch. The expectations have changed as a result of the pandemic. People maybe hadn't experienced telehealth before. They haven't experienced. The, you talk about just some of the digital front door stuff. We put chatbots in place to diagnose some things around Covid. We did a form collection.

I, I had somebody on who said, for literally a decade, we tried to get rid of the, uh, clipboard, Uhhuh , and we got rid of it in six months. Uhhuh . It was, I mean, there were so, so many other things that happened during the pandemic too that really drove consumerism, the reality that now I can just get groceries delivered to my front door.

I can buy almost anything I want off of Amazon or anywhere online, and it's delivered to my front door and really has become about me getting what I want when I need it. And that has definitely, yeah, splashed over into healthcare. Consumers have had a taste and, and, and they know it can be different, and now they're starting to expect it and they'll, they will, uh, march with their feet to places who can provide it.

And so I think there's a lot of competition, especially in the retail space, bleeding into traditional healthcare, the CVSs, the Walgreens, et cetera. And being able to provide some of these services and poach some of that from traditional healthcare, whether it's urgent care visits or even things like lab work or plain films, ultrasounds, things like that.

What's Dr First talking about these days? The sweet spot for the company remains medication management and really a focus in this fiscal year on adherence. So keep getting patients on therapy and keeping them on therapy. And so there's a couple of solutions we have. There's actually patient engagement solutions.

We have to, uh, make sure patients are aware of their prescriptions. So there's this phenomenon of e-prescribing where the tangible piece of paper is of course now missing. There's, you don't have that thing to take to the pharmacy to say, here's the prescription, let's have a conversation. And so we actually have, uh, a solution.

It's called RX Informant. It's a patient engagement solution that is sort of a replacement for that piece of paper, but it also does other things like offer copay assistance. Education, educational videos, a reminders, ability to set in your smartphone, your smart device, the ability to set a pickup time and things like that.

So, uh, getting patients on therapy and keeping them on therapy is a big focus for this year. And then of course, again, sweet spot. We actually have artificial intelligence, or I actually am more fond of the term augmented intelligence these days, but around the ability to clean up medication data. So if you think about medication reconciliation or you think about these CCDs or these HIEs, this huge amount of data that's coming up, providers that needs to be reconciled, a lot of it is still free text.

And so this is a solution that can actually turn free text back into structure and land that structure back into the receiving system in the nomenclature that it's expecting and needing. And that's a game changer in terms of efficiency, but probably more importantly, safety. . So we actually have, I have the, the honor of leading the applied clinical research arm of Dr.

First. And so we are actually partnered with some of our clients to do publications on some of the differences that we're making in patient safety and the throughput in efficiency. So are, are, are, are we finally, you, you talked about the dance we're doing on interoperability and you were kind, it feels like we've been doing this forever, decades, forever.

Two decades. Two decades at least. Yeah, two decades. Right. Are are, are we finally on a sort of a, a precipice here where we're gonna, we're gonna make a significant amount of changes very quickly as a result of, I don't know, the pandemic potentially? I think so, but I've been wrong, uh, a couple times now. I think we're all really optimistic, right?

This has been a thing we've been looking forward to and we see breakthroughs. You see little breakthroughs and we're like, this is it. As a clinician, this is the holy grail. My career is interesting in that I've been on paper, I've been on hybrid and I've actually led a couple of transitions, but . I remember tracking down paper records.

I remember breaking into the cardiology suite to get ahold of the echocardiogram or the cath report so that I wouldn't look like an idiot on rounds the next morning. And so I know the, the dance of trying to get this data, and to me that is the nirvana of having this data come back to me in a meaningful way where I can actually tease out the information that I need.

Uh, and I do think that we are on the, the precipice of this, but . Alright, so, so you guys are coming in here in a minute, right? You're next. Yeah. . But I, I, like I mentioned before, I have been wrong. I thought meaningful use stage two was gonna knock this thing out of the park and it still sort of fits, fits and starts.

I think we see glimmers of hope. I think the second thing that you mentioned, the pandemic, is the expectation from consumers and the 21st Century Cures Act and the, this idea that the, the data is gonna be liberalized and. The expectation is that it's gonna flow more freely. So I do have a lot of hope for the next, uh, one to two years.

In terms of interim, well, I mean, quite frankly, after that lead up we're, we're expecting an awful lot. So we will absolutely be checking back with you in the, in the coming year. I want to wanna hear how things progress. I also wanna hear how your golf game progressed. Oh, I appreciate that as well. So, hey Colin.

Thanks. Thanks for stopping by. It was a pleasure. Appreciate it. Good luck with those new clubs, . I'll let you guys know. Thank you. Thank you so much. Thank you. So this is our first like live it is thing that we've ever done. Yeah. And so you have people dancing around and we do all sorts of Oh, you're walers.

I know. I, I'm like, damnit you monkeys. Uh, they, they sort of threw us off our game there for a second. They absolutely did. Gosh, only for a second though. So what do you, what, what do you think those guys are gonna talk about? I don't know. The, the strength of the Florida CIO contingent. Is that what they're gonna say back?

That has to be part of it. I think it'll be interesting to, I kind of want to hear Aaron's like, how's it going? Like the, the first a hundred days kind of thing that they're always Yeah. So that's, that's the news. I'm sure a lot of people know that Aaron has gone from Dell Medical School, but it's UT Austin, UT Austin at Dell Medicines or something like that.

Right? Something like that. Yeah. So he went from there to Baptist and we always have to specify Baptist in Jacksonville. Yes. 'cause there are, uh, a hundred of them. There's a hundred of them. . Uh, in fact, I made a mistake. Somebody said, what, which Baptist did he go to? And I just picked one said, said he went to this Baptist.

But evidently, I guess we're gonna hear it from the, uh, hear it from the horse's mouth. Come on over. So we were just talking about the strength of the Florida CIO contingent and how it's getting better. It is by the day. I don't know, I'm questionable still in will I? I'm, I'm not a hundred percent sold to.

Well, but I mean, I think we'll be able to work together and make this happen. I think I've lost my Ccio O card at this point with all the operations responsibilities that I have. That's true. You just keep fixing things. You keep fixing things there that, the way I happened, this is what happens when you're doing a really good job.

It's rewarded with a whole bunch of new stuff that is also broken since, since you're a proven, uh, quantity when it comes, it's just got some more on Friday. We have to remember that people aren't all gonna be watching this. Some people are actually gonna be listening to this. Oh, okay. So William Wall first has joined us.

And Aaron Mary, formerly with UT Austin Dell Medical School Health? Mm-Hmm. . I don't know. I'm just, and is now with Baptist Jacksonville. Yep. Wow. Well, so that's news in and of itself. It's, it's big news. What's interesting, again, credit to will he set a really good pace for what's going on in Northern Florida market.

And it was interesting, even when I was talking to the board and I was going through the, you know, deliberation process and considering Health First was used as an example of look at a turnaround shop as in a great job of the past couple years of really making some moves. So it says a lot about the market and whatever else.

Will you owe me a drink for that, by the way? So, but it, it says a lot about the strength of the market coming outta Texas when Texas is a fantastic market with some fantastic CIOs. But that says a lot when, when you know, the comparisons in the bar is set by, by people like Will who came into the market or actually rejoined after quite some time.

That says a lot. And and that I like that because that s up the game and means we can do collaborative things across the state that maybe other states don't have the opportunity to do. I've got some, some health systems in Naples that you could start to partner with. Um, yeah, I love Naples is beautiful, so Absolutely.

Let's do it. Oh, absolutely . So how's the first a hundred days? Yeah, so it is exactly what you've done many times, Drex. It is seek first to understand, put out any of the smoldering fires that are going on there, and then make those winds quickly and build up a coalition of the willing. We're in the process of going live with Epic next July.

We're building a new, uh, children's hospital that opens up in January. We have our new, another hospital opening up next December, brick and mortar going up as well as a strategy that's completely to evolve, as you can imagine. Yeah. One of the largest employers in northern Florida. So there's no shortage of things to do, but at the same time it is about the blocking and tackling.

We'll hit it, right? It's about operations. Yeah. Right. Can you make sure you're efficient? You're lean, you know what you're doing, what, who's on first base? And can you just galvanize folks to move forward, um, especially when they're hungry for that. Right. So that's, that's really what it's about. So it sounds like he has nothing going on.

What do you have going? Yeah, no, it's an exciting time. As, as Aaron mentioned, doing some really creative things. I've been there just over two years now. That's, so we talk about the basic blocking and tackling, what I've been calling, being brilliant at the basics. So I think we're finally brilliant at the basics.

That's great. Uh, like many of us, either I got hamstrung by covid or uses an opportunity to inject a lot of modernization. We chose the ladder. Uh, so I'm about three years into a five year plan. You know, it gave us about a year headstart and acceleration on some things. So it's fun. As I mentioned, a lot of operations responsibilities.

So supply chain is abandoned my existence right now. But your listeners don't care about me modernizing supply chain as much as maybe some of the IT stuff that we have going on, but, but it's fun. Supply chains is a, a big deal. Yeah. Right now for, that's a billion dollars a year in spend for us of, of just stuff.

Right. And another billion in people and other things. . And I think about the way we've been doing things from an IT perspective, it's no different. I'll be candid, in the operations side of foundationally, understanding what you're doing, bringing, building on the basics, taking a look at rationalization of any type, right.

As we do applications and building process and other things. Yeah. A lot of process engineering. Any process engineers looking for a job, reach out, . There's a lot of, uh, a lot of, a lot of work around that. I, I was talking to a health system in, I think it was Idaho, and they were talking about their supply chain and how they've decided to, uh, they're being very creative.

I mean it really rethinking. They might even be building warehouses. Yeah. Doing all sorts of, uh, things that they hadn't had to do before. 'cause the supply chain was pretty, it was a pretty well oiled machine. You can make it real time. Yeah. But that's not the case now. Yeah. Yeah. And we're looking at some creative things and partnerships with the bigs, and I won't plug any of the folks that you know, but you know, there's three or four large retailers in the world, right?

Mm-Hmm. , one of them. We're all pay $99 a year for Mm-Hmm. . I'm looking at some partnerships there and some of the healthcare ones to take some, take over some existing space, maybe do some co-location work, give them a footprint in places they don't necessarily have representation to then deliver that type of service to, uh, to our consumers.

That same company wants to be the world's best consumer company. And I just literally scratched that off my logo, kinda like MD Anderson did with cancer and said, put wellness above it. Right? We want to be the world's greatest wellness company and, and enabling a lot of that work. That's fantastic. But I would say will, one of the things that, that both you and direct share is your, your training and your upbringing, especially with the military background and that, that, that manic desire to be operationally efficient and make sure that it's right place, right time, uh, right location for everything.

And, and so that has gotta have been helpful as you tackle both, for both of you to tackle this kind of thing. Uh, he sort of mentioned earlier. It's the basics, it's the fundamentals. And I think of the Michael Jordan quote about, it's about passing and dribbling and like, it doesn't matter. You can be as fancy as you want, but if you don't have the basics down, your, your store is gonna fall apart.

And we definitely get that. From the military. We are every day pounded with get the fundamentals squared away. I mean, if you don't, people die. I mean, I don't want to be overly dramatic, but you know, I'm sitting six miles from where I spent eight years of my career as a nuclear engineer on submarines in Point Loma here.

that same task with probably: 1500

You know how to do a lot with, with little, and you better be good at the basics or your, you know, can I ask you two people labor? Yeah. Right. So I'm talking to some CIOs. This seems to be a top of mind issue of they're losing people. Yeah. It's getting harder, uh, because people are remote. I've heard of a team where five of their epic analysts are actually working for two health systems at the same time.

Fully payroll. I don't know how that, wow, I've got a couple stories there, . But that's, that's a potential, right? They're all working from home. You don't really know what's going on until they mess up an email and you're like, Hey, or pass away. I had an associate pass away and part of that discovery process, we learned that one, they had sold their house 14 months ago.

They moved entirely outta state to a place where you don't provide benefits. And then was also working part-time for another company. I mean, so first of all, how are you gonna fill the positions that you have open? Yeah. Are you thinking about that differently? And how are you gonna attract people? Now you're in desirable areas to live, but it's still, it's still a challenging market.

I'll go first, man. Yeah. So we're doing all the things you'd imagine. We ridiculously creative in ways that we never expected to before. We've proven that we can be more productive in this remote environment. So we're, we're recruiting in the world. I'm finding some really great talent and. Yeah. Are they able to live anywhere in the world?

Absolutely. Uh, I, I'll tell you, it took a while for our finance people to come around and not want to be experts in 49 other states, payroll, HR people. Yeah. Uh, HR was fine with benefits and other things. We've got some other stuff going on on our, on our health plan side of what we do that allows more flexibility.

But the other thing we've, I love hearing these words from our chief medical officer. He knocks on my door and says, we're having a hard time finding clinical talent. There's a ton of opportunity for automation. How can we capture the low value work of our nurses and clinicians in some way with automation?

And then leveraging it for that, right. And, and you think of things where there's some low-hanging food around tele sitting and, and some other telemetry things that a lot of folks are just scratching the surface of. But we've, we've got EVPs chasing this now and of not it. Right. And that's what, you know, trying to do everything we can there.

And then the other thing is it's your network could bring a great. Team having a good brand, but it's hard. I'll be honest, bill, we are a 90% retention rate, meaning a 10% vacancy rate, and it has never been below 98 in my two and a half year tenure. So yeah, and, and very similar to Will, we are going through the same motions, but what I appreciate is the clinical staff approaching us about robotics.

And so right now we are investigating multiple companies to try to alleviate some of the low hanging fruit and some of the vore . Remedial tasks that nursing and clinicians have to go through. So if I am trying to recruit it talent and I tell 'em, Hey, let's look at robotics and the future of automation there and what we can do in these rooms.

That's what people want to go towards. They wanna believe in something and do something that's fun. And so if you look at these and you actually shift them exactly like Will saying from a man, this is a bugaboo to something's an opportunity. That's where you're gonna have the true technologists that want to come to the door.

Second of all, we are allowing folks to have a hybrid or work from everywhere. Of course we have a great relocation policy and all those sorts of things, but they don't have a desire to leave, which I understand that. Right. Depending on life circumstances, for the most part, we can, we can allow people to work from wherever within the, the continuous United States.

There are some states that will say that have privacy policies that are a bit ridiculous. So if there's any state, uh, legislators listening, please alleviate and allow your people to work remotely without a problem with, with privacy laws and whatever else. 'cause that does put a hamper in me trying to recruit from AKA California and other states

But, uh, for the most part, there's not a, a limitation there. It is. It is. Open. It is about talent, it's about commitment. Now are you gonna have people that do dumb things like work two jobs at once? Yes, you're gonna have that. Nothing you can do will prevent that. But if you trust your folks at first until they give you a reason not to, you tend to get good apples.

How do you, don't you lose loyalty though? I mean, if they're just at home and somebody else calls 'em up and says, Hey, you're an epic analyst, I'm gonna give you, you know, 10 bucks an hour more. Yeah. If you treat 'em like that. Yes. If you treat 'em like that. Yes. If you engage them, you treat him like a commodity.

Yeah. If you treat 'em like that, you're gonna get exactly that. Here's your hamburger sir, thank you very much for $5 and move on. I appreciate that. But if I were ACIO today, I would have to change everything about the way I manage. Absolutely. And why do you think a lot, there's a lot of turnover right now at the CIO ranks because they don't dunno how to manage a hybrid workforce.

If you can't engage your staff far and wide as well as onsite, you are problem. Your, your time is up. So this is a great topic. How do you do that? Yeah, great soundbite, Aaron. I'll let you start. I mean, I'll start it right there. Number one, set a true north. Where are you going? What are you doing? Make sure the mission resonates too.

Have a fantastic executive leadership team behind you. We have a phenomenal dynamic, CEO at Dr. Mayo. He is always out there on social media talking and, and this gentleman, he's been around for a while, but he's engaging in all the modalities, which is exactly what you wanna see from the very top executive.

Three, have a board that's committed commutative and make sure that they know they're gonna make investments in technology. Look, I've been at Baptist now in my second month, we're making major investments in infrastructure refresh. The board approved a lot of that. What that takes is a commitment, and the staff sees that.

So you tell me for your epic analyst who maybe feels like a commodity, why would you wanna leave a job where suddenly you have everybody at the top singing, we appreciate you, we know how important technology is, and here's the investment in it, and we're gonna blaze forward in the future. That's how you galvanize people and you're gonna solve those problems they've been complaining about for a decade.

And the reason healthcare, I think this is a Reagan quote in government, I used to use all the time in the military, and I think he, he said it right. He's like, smart people don't work in government, right? There's no money in it. Right. And so that, that used to be the case. It's not the case. Yeah. Not anymore.

They've done something with public, what did this group called? The digital health? The digital services. They've come in and they've really took a lot of red tape out of what government says. But similarly in healthcare, like if I'm an IT person in healthcare, I'm going to think of all the VC and private equity money that floating.

There's, there's so many other places you can work. I make a lot more money. So it's about the mission is what I'm getting at. I do wanna work for Aaron now after that. Yeah, that's his three point. I hear that a lot from people. So come work for me. Happy to know. Come work with me. Really. But you know, the health conference was hysterical.

Yeah. They would get up and say, my name's blah, blah, blah. I'm with this company and we have 150 open positions. If you can code anything, give, be, send us. Well, they should really be pitching the mission. Right. And Aaron said that in far many more words than I would be able to string together. But you know, it's just, it's about the mission.

You're here. Everybody's got a healthcare story. No one's, it's not anyone in the world, hasn't been affected by some healthcare thing. Cancer, you know, pandemic now and other things. And come do your time in the, in the healthcare mission. We'll take care of you. You're getting the resources you need, and many of us are finally getting the resources to make the modernization changes that we've discussed so far.

And, uh, why wouldn't wanna be a part of that? What, what does the information exchange look like in Florida? I mean now both in Florida, I'm curious. Yeah, and we both, we both have great interests in information exchange and, and instead a couple things to enable that. It's, it's poor today. Yeah. Um, and this is part of the partnership.

You know, there's, it is not an accident that Aaron and I were walking by here together. It's part of the partnership that we really hope, certainly for North Florida, north Central Florida, bring that together. I mean, it's, it's not an uncommon feat to get in an accident on 95 corridor and we slap your chart on your chest and put you in a helicopter and say, see you later.

endor. And that's, uh, a very: 1990

Now it's about how do you take the data, break the silos down, and make sure you can exchange it in a meaningful way. And so what I appreciate now as we go through this as a state and really have these discussions that are, that are very real and very material, exactly what Will's saying, it's about how do we do this in a dynamic way?

It's not about what vendor you are using, it's what actually matters for the patient, which changes the entire conversation. It brings clinicians to the table and it makes people think in very different ways, which is interesting because you think about all the other industries, they figured this out 20 years ago.

So we're no different. We think we're different. We think healthcare's special. It's not, it's just that the vendors have locked in a community to make you think that, so they can monetize your data in a de de-identified manner. That's the reality of the situation. So it's up to us to prove out that we can do it, do it in a way that's safe, secure, and easy, and at more importantly, effective at the bedside.

I'm looking forward to seeing the two of you drive that change in Florida, because I think sometimes that exchange structure just needs a couple of strong people to kind of make it go. Otherwise, everybody's kind of waiting on everybody else to get it done. So I, I'm looking forward to seeing how you guys are gonna pull this off.

Even though we're on the Space Coast, it's not rocket science. The, the tools exist. It's just Are you allowed been waiting all day to I have not Trademark, trademark waters. It's trademark by NASA trademark. Yeah. nasa. NASA sues me as a government agency. That might have some, some problem there, but, but genuinely you, you're a couple lever pools away from making it work.

Yeah. Like we all know that to be true and that's what the frustrating part is. Are you on the same E em r. No, sort of, so we have pieces of the same EMR. We're, we're, we're moving to one, we're moving to a new one next July. But right now, as it stands, we are on some pieces that are similar. I have seven EMRs, but the most notable ones from an acute perspective might be, I have that all, it would be all scripts.

And then on the ambulatory side is Athena. But, uh, Privia on top of that. Yeah. So we're Cerner inpatient today. We're all Allscripts and Athena and pieces of NextGen and other things. So there's Commonwealth that links says there's other things like that, that we use. Everything ever invented, but we are standardizing, simplifying.

More importantly though, from an information exchange, I'm a big believer in APIs, open access to complete CCD, and really embracing information, blocking the way it was been mutual to release the data. Release the record, the full record. All data you can do. It says the guy who sits OC committee for of course, all of these things.

Course we help write rules, but you know, I, I had Glen Tolman on the show. Yes, he was at the health conference and I said, I made some joke, like, because him and Jonathan Bush we're gonna be on a panel together. And I said, uh, hey, you know. Uh, if, if I were asking the questions, I would ask some question about if Judy Faulker were entering your business today, how would you guys feel?

And just watch the sweats sort of break out. 'cause both of them feel like they've been defeated essentially. Yeah. And I thought that was gonna be funny. And he, he took it in a direction of essentially saying, look, he goes, I believe in Open. He goes, and I was an Allscripts customer and he said, our API and their API is great.

It's phenomenal. We were able to get information in and out of it, no problem at all. And he said, I believe this epic monopoly is bad for the industry is what he said. Now you guys can't comment and I don't want you to comment. Sure. 'cause you get in trouble. But I don't, I'm on the record many times over on this, but, but I, but I can comment on it.

It that is people's strategy. Let's all get on the same thing and then we can exchange information. And it's such a bad strategy. That's not Yeah, I can't, I don't even understand. So I, I think it's, it's, it's not necessarily a bad strategy. It is, it's an antiquated strategy. Right. And, and it's the equivalent of, Hey, you, you, you, we don't actually know how to solve the problem, but somebody else solved it doing this, so we're just gonna be copycat.

But, but I will say this, I give a lot of credit to all of the founders and the VCs and the others that are trying to crack this nut. And just because someone like Judy who's brilliant said, we're gonna go this direction, doesn't mean that's the right way. It means that's a way that folks found to be, that realized success with it and said, we're gonna copy it, but there's always a better way.

There's always a better meal to cook. Believe you. Believe me. That so time a degree. It is what It's technology marketly and new opportunities that we didn't have before. Absolutely. Well, and the platforms can't keep up with the roadmap and pace that these others are nibbling on the edges. That's right.

Right. And that's what's been the, the catalyst for change here in the demand signal is just all those folks nibbling on the edge of creating a, a very niche, single solution thing that happens to be the best way to do it. And then when you go to the large vendor and ask them to do is say, yep, it's on the roadmap.

In two or three years, we'll get it to you. We're not waiting. That. Right. The, the, the fact that they had to come out with 21st Century cures Right. Says that we were standing in the way somehow, some way. Yeah. The, there's a little bit of this too that I, it makes me think like back, so for the, for the guys who are over 50 years old.

W we started off with sort of best of breed, right? And we had an interface engine and it was really clunky and very painful back. And we went to best of Suite because it solved a lot of those problems and it was the most eloquent solution, elegant solution at the time. But I feel like we go all the way around on so many things and we're back to best of breed again.

And if we do the APIs, right, do EHR vendors that we have today wind up being the core database hosting, uh, a lot of the other stuff that's out there. Yeah. I like Glen Tolman's quote on this big dumb databases, right? I mean, and that's what it will remain. And then you'll have all these other folks that feed into it that present this, this data back in a way that's, that's better.

So you still, you still need the pipes. You still need the pipes. You still need that, that core EMR system, right? Sure, sure. You still need that core medical record. You still do. I have no problem with the Epic KPI. The problem I have with it is there's a toll booth on it. There absolutely is. And so if there wasn't a toll booth on it, we're on the same page.

There wasn't a toll booth on the Allscripts. API. Essentially called 'em up. They said, here's the API go for it. Connect in whatever you want, take the information out, bringing it back in. We, lemme say this, lemme challenge you with this. So, so you gotta give the Cerner board a lot of credit. They appoint Dave Feinberg, right?

Yeah. Who is a brilliant visionary. We're gonna make this happen. We're gonna liberate the data we're gonna make, uh, make it all about population health and data management and, and data liquidity. That is a tremendous like flag in the ground. This is where we're gonna go. Cerner can move the market and change the toll booth methodology to be, how do we make this about enablement of realization of value, right?

Which is a completely different ship, which is what all the startups are trying to do, but are getting lost in the sea of the hundreds of millions of dollars health systems like us are spending on the traditional players. So I do believe we are on the precipice of change and that signal right there says it's now time to turn the chapter.

And that's what I'm looking forward to. Interesting. Is that gonna be a thing that Cerner will be able to use as a competitive advantage? Hmm. I hope for the industry's sake. Yes. Yeah. Because it'll make everybody step up and go, let's really reevaluate where we are. Look, I've said it many times on your show.

If you're CIO and you don't know how to explain or communicate value, your time is up. Right? Right. If you sit in your office, your time is up. The boards are not tolerating anymore. Yeah. Period. Yeah. The same thing happens with CEOs of these companies. The boards are not gonna tolerate, it's not about earnings per share anymore.

It's not about what are your dividends every quarter. It's not about that anymore. That's important. I'm not saying it's not important. It's about do you have a sticky factor with your customers and the customers, me and Will, are tired and fed up of the way. It's always been because we're hearing it from our clinicians every day, and we're almost powerless to fix it unless we go a different way and unbreak the cycle.

I don't know where I want to go next. I know these guys better than I do. These, they're, they're a tough interview. It's hard to get 'em to talk, isn't it? We came here. We actually came here to Heckle. Drex and you. But that's fine. Yeah. We saw you guys come by. It was like, oh no, there's a tornado. Well, we were respectful.

We went behind the cameras. Good job. Golly. Best thing about moving to Florida, I would say, I know you love Texas. I love Texas and I always love Texas and I will always be a longhorns of alma mater. I have to gator. I always, obviously, I don't wanna hear it Florida Gator, but I will say this, that I have found Florida, particularly northern Florida, to be one of the most humble, hungry, hardworking group of folks I have ever managed to work with.

And not only that, they are incredibly bright and they will think of things before you even realize what they were talking about and how to solve the problem. They're like, here's a solution. I'm like, wow. So oftentimes I have three or four or five solutions presented by my staff and I'm like, whoa, whoa, whoa, whoa.

That's great. I'm glad you guys are brainstorming. Let's like focus here. Make sure we're answering the question that's actually being asked. You can't ask for a better situation than that. Alright, so UT Austin Academic Medical Center. Yes. Baptist, is it large? IDN, integrated delivery network, pediatric adult hospitals, 13,000 associates.

They're very different. Like you're not bringing the same strategies over. No. So academic medicine, you have research, you have the medical school, you of course have healthcare delivery, and then you have all the pieces in between that fall into that. With an IDN, it is about making sure that it's throughput, making sure that it's efficient.

Quality aspects. Yes, we do a little bit of research. Yes, we have a lot of those other dynamics, but they're minor compared to the overall delivery, which is about the clinical enterprise. So that digital front door, the experience and those kind of things, that's probably pretty key for an idea. Absolutely.

And what's an interesting is that with medicine, you, you often find the same themes. People want the best quality. People want the most efficient, uh, care and people wanna make sure the physicians are satisfied to deliver the best care in, in a large hospital system, it's the same except for this, that

You have patients that are coming at, at a volume and a rate that's probably two x three x, which you have in ac academic medicine, you're more willing to experiment in a, in a safe way in academic medicine with research than you are in an IDM because in IDN, it's about let's go. And being the true health system for Northern Florida and the volume of people we're seeing, I mean, that's what we have to do.

We have to make sure we're giving the most efficient, best care possible, using the best tools at our fingertips. The, the research and ex and experiments that you're doing in an IDN is about . Operational improvements. That's right. And workflow improvements and flowing patients between sites of care more efficiently so that you can deal with the volume.

That's right. Yeah. I, I totally get it. Yeah. So Florida Florida's gonna change pretty dramatically then with you guys coming together? I would say it's already been changing. If, if it's hyper accelerated because of us, great. If not, it's gonna change anyways. But I give a lot of credit to the people who blaze the trail before us.

I give a lot of credit to the CIOs who have already been there. I give a lot of credit to the, the organizations that are just growing rapidly and understanding the complex nature of the people moving to Florida. Like all of all of Massachusetts seems to be moving to Florida. Okay. Right. That changes every demographic you can possibly imagine.

Every data set, but they're on top of it. They're aware of it, and more importantly, they're embracing it. You can't put a price tag on that. Yeah. Southwest Florida is, my subdivision is a third Canadian, uh, third Midwest, upper Midwest, Ohio and that kinda stuff. And then there's a third that actually stays there year round, and.

I, I would imagine that creates its own dynamic. I mean, you have to exchange information with Yeah. Far away places. Far away places. Yeah. Our board is composed of roughly that exact same demographic, right? So they come from other health systems and have different, I dunno how many times that MyChart app was put in front of me and why can't we do this here?

Right? Or why can't I get my health first things to look like this? And the truth is, it's coming. And I, and oh, by the way, I'll get your stuff from North Carolina, Massachusetts, Canada, and, and other places, as Aaron mentioned, call it a melting pot of the, you know, continental United States, what have you.

You've got depth. Understanding of what the capabilities are from other places and these unique parts of Florida and this talent pool that, you know, are coming there. I think oftentimes I recruit people primarily because they got five more years left and they wanna get their foot in the door down there, right?

Yeah. And, and so it's, it's really raising the bar and I think in places like, you know, space Coast, in our case, pretty much everything between Aaron and whoever's in Miami, any of you down there is, is health first territory, but, and then our peers to the, to the east and, uh, pandemic seems to be winding down a little bit.

I saw the numbers before I came down here and it's uh, knock on wood almost back to pre Yeah. Knock on wood. Exactly. It, because it's interesting to me when people talk about, and I don't know why we bring politics into this, it's hard to get a group of people that big, whatever the state is to get 'em vaccinated.

Yeah. I mean, that kind of project requires a lot of outreach, a lot of communication, a lot of education. And you're still not gonna reach a hundred percent. I mean, I can't get. My three kids to all agree on where we're gonna go on vacation. I will say this though, and, and again, having been through the pandemic in Texas now comparing it to what's going on in Florida.

And so I joined re that, I guess it's the fourth wave that Florida had. Mm-Hmm. . Fourth or fifth wave. Right. I, I joined Red at that time, so I saw the coordination and boots on the ground. Florida communicates better in shares data across cities and across leaders better than Texas did. Texas is very decentralized.

Again, I'm not saying right or wrong, I'm saying the model of it, which inhibited data sharing, inhibited best practice sharing. It did. And now the governor's task force was set up. They tried to stem that in Austin and make sure that people were sharing data, especially across the, uh, public health authorities.

But in terms of what I've seen from Florida thus far. Very willing to share data sharing, best practice sharing. What's going on here is what surgeons we're seeing. We had hospitals in the area sharing data. Will and I were talking on technology systems that were going on that wasn't happening without pulling teeth from a lion in Texas.

It's just an environment. So the politics of Texas and Florida on paper looked very similar, but the operating modality is very different. Florida operates as a family. Texas operates as a business. It's very different. And because of that, I think it's why we are seeing the, the numbers go down because there is a partnership aspect that truly is something else.

Again, not disparaging Texas. I love the state. It is, it is what it is, but it's an operating model that's different. Interesting. Yeah, it's 'cause people were asking me, I say, I come in, I came in here from Florida, and they're just like, oh, that's a mess. That's a mess. I'm like, my subdivision is a lot of older people when they said, Hey, there's a vaccine available in Florida.

They were driving like two hours to get their first shot. I mean, and if, if you could give 'em 10 shots, they probably get 10 shots. . I mean, they're, they're of that age that they're like, look, I don't want to get this. This is . That's something I'm gonna recover from. And so I, my experience hasn't been. Mass amounts of people who don't want to get it.

But again, I, I'm sure I could find those pockets if I really wanted to find 'em. We're a great case study for this, for 600,000 people roughly in our area. Exactly. 50% are vaccinated and 50% are not. Right. So as we were 50 50. 50 50. Right. So when you think about. Just the perfect storm in a sense. Now there's acuity and age, you'd have to extract outta there for multivariate analysis, but we'll leave that aside.

50 50 naively is good enough. Right? And when you look at this in particular, and I was intentionally retweeting and reining and sharing our, our daily numbers are 99% of the folks who were admitted in our hospital were unvaccinated. Right? So I've seen your numbers. So 50% vaccinated in the population and 99% it's now waned to 98%.

But you know, 99%. So it tells you something. I think people caught onto that quickly. We did all the right things. Aaron was saying, Florida shots, great program. How we share data, how we do that automatically, how we communicate with each other. The emergency medicine folks were heroes during this entire time in communicating these things.

And we got the message out and we got people under understand. But what we found most recently is just this. Oh, stubbornness to do what people tell you to do. Yeah. It's nothing else. Yeah. Right. There's no politics. It's just I don't wanna be told what to do. And, and once you kinda get them to understand that it's bigger than that, and this is beneficial, we've had great success and options.

Right? So I, I give a lot of credit to the Florida governor going on TV saying, Hey, here's other ways of of getting treatment. Look, we're not telling you what to do. These are just options for you. And opening the door and making investments into opening doors. Yeah. Whether it's opening up the infusion centers and other things that they were doing, especially in Jacksonville and partnering with the health systems like Baptist to say, how can we get the word out in an effective manner and give people options so that you're not suffering in silence.

Now the best answer is get vaccinated. But if you choose not to, here are other options with varying degrees of effectiveness and success, depending on what's going on with you. That helped people begin to start making decisions on the road and empowered folks to make their independent decisions, which help us.

Really ratchet up the vaccine rate. Now a lot of health systems are mandating vaccines. A lot of health systems are, and businesses are also doing the same thing, which has also brought awareness to it. Um, I'm a big believer in sort of that, that freedom of choice, but do it with empowered information. And I saw Florida do this in a very, very well manner at Texas.

We were beginning to do that. When I left, it was coming together and I think they will absolutely get there and it's, it's gotten there. But Florida embraced that from beg from the get go, get, give 'em credit for that. We, we haven't, we haven't mentioned cybersecurity at all yet. You Oh yeah. That thing, yeah.

That's important too. I've trying to just like be cool. You just sit back and be cool. Yeah. Yeah. So how's it going from a cyber perspective? I know, uh, you have, it just seems like we're in a. We're in a storm right now and we're just getting pounded. Yeah. There's new breaches every day. Big ones. Sometimes taking health systems offline for weeks at a time.

How? How's the fight going? Yeah. You know, it's, you actually appreciate this. My prior life. I came from the DOD 22 years where you had a single issue. Right. If they would disconnect you from the network till you remediated it and then they'd bring you back on. Yeah. And this was at Walter Reed, right? Where you're delivering care.

This is not, you know, so when I got to my current organization, health First, the patching compliance goal was 50% Uhhuh , and I lost my mind. Uhhuh , you know, now that's in the nineties and we're in a much better place. But all the things we discussed earlier on the basic blocking, tackling, getting things place back to the fundamentals, right?

And then cyber hygiene. But apologies to people here who had those breaches, but . , it's really been a focusing event for our executive leadership to really take it seriously moreover than just your cyber insurance bill that pops up to the board and getting an understanding of why do we pay that much.

But really, and I applaud here in our backyard, uh, Scripps, putting it in the third quarter financial report on what that breach costs at $112 million, right? Mm-Hmm, that opens some eyes on our board and you start getting those questions and you don't get, not that I ever got no's, but resources start freeing up when people start understanding.

But moreover, as you articulate the risk over benefit and you start getting, you know, what these incremental tools get you, and I'll tell you, we never implemented MFA so fast, as fast as I thought, um, most aggressive timeline. I don't think I'd have said we were able to do it in the time in which we did across the organization for, for things like this, during, you know, one of these breaches.

So it's a challenge. You've, you've always got, never have enough resources to solve the problem. Aaron, I wanna ask you this question. 'cause I came in as a interim, CIO. And within two weeks after showing up, we had our breach. Mm-Hmm. And, and there's almost part of me that if I had to do it over again, I, I, I think I would've done something different.

We probably still would've had that breach. Mm-Hmm. because everything was in place for it to happen. But, you know, coming into an organization, you don't know what you don't know. Right. I, I, I remember when we were coming together with, with Providence, Providence at St. Joe's, and they were just like, well, let's connect up the networks.

And we were just like, whoa. And they're like, what's Providence? It's how, how insecure, how hard can it be? Right. How insecure can they be? There must be really good at this. I'm likes And our security guy, it wasn't me, it was our security guys who just came in and said, look, we've, we've gotta audit them and they've gotta audit us.

Mm-Hmm. . Before we do this. So what do you do in the first 30 days? Yeah, so I give a lot of credit to the, to the board and to Dr. Mayo, our CEO and others. So literally it's day five, right? And they're telling me that there's a board meeting on that Friday full board meeting. And Aaron, we wanna give you, we want you to give an update on three topics.

Number one, cybersecurity. Number two, our electronic medical records swap. Number three, our digital strategy going forward and what we're, and what we're gonna be doing. I said, okay, now anybody who's ever put together a board deck, you, you cannot do that in five days, which means I'm going to be doing due diligence at least 45 days prior to starting.

So even though I may have been on paid day five as CIO for Baptist, I was working on this for a month prior. Digging in, understanding what was going on now to my, to my absolute pleasure to announce we had already been doing the red team, blue team drills. We had already been doing, uh, phishing exercises and sampling across people.

We were, were customers of your company, Drex, which I won't give you know names out, but we'll give your company Drex. We have these top of mind tools. That is the feds in depth stack, but could we do be doing it better? Absolutely. Were there, was there still a high percentage of folks that were clicking the phishing links that should have known better?

Were trained, yes. But that's opportunities to get in there. More importantly was the transparency, right? Are you as a leader, as the C-I-O-C-D-O leader going to be transparent with the board and be able to explain it in a way that they understand what's actionable and Absolutely we presented that. But what I told the board and what I've always said, I believe I've said in your show before, it's not a matter of if, but when.

And so when it happens, we will have a darn good response plan and we'll know exactly what to do and we'll know exactly how to work with our insurance carriers and the FBI and whatever the situation may be to mitigate and we will have the forensics available to make sure that we mitigate that. And it doesn't happen again.

It is inevitable. Some zero day is gonna get all of us. It is inevitable. But if you do the best you can and you're transparent in your communication and you also understand what that attack vector is, you'll be able to get through it and you won't find yourself on the other side of the divide. Can we talk about It's inevitable 'cause I hate it.

Yeah, I really do hate it and the reason I hate it is 'cause it's not inevitable that you're gonna get attacked. You're getting attacked right now. You're getting attacked right now. Oh yeah. Right. Absolutely. The thing is, when they get into some of these places and they're able to go horizontally across the entire network and get to all the crown jewels and everything else and lock it all down.

That's what shouldn't necessarily be inevitable, right? Yeah. It's about a architecture. Am I, am I, am I naive? No, you're, you're right. You're spot on. But, but you just interviewed, you know, one of the most brilliant minds in, in healthcare with David Ting, right? He just told you about the new company. He started with tci Focus on EPHI.

It's those minds that are taking this saying, okay, look, it may be a matter of inevitable what's happening, but we can focus it using machine learning. We can use it analytics and heuristics. We can do things today with technology we couldn't do five, 10 years ago. These are the folks that are gonna be the game changers because Will and I are asking for that, right?

Will and I are pushing companies like Dexy Company, who's doing a phenomenal job of trying to push the envelope. But we're saying, look, we've gotta go faster. We've gotta go automate. 'cause what are we gonna do? Hire 10,000 people to sit in a sock all day and monitor and watch screens. Come on, man. That's not gonna cut it.

It's not gonna cut it, and you're not gonna outsource it. I mean, he's making the whole pitch for me. I mean, it's about speed. You are going to be breached. There are zero days that are going to happen. The important part of this is finding it fast. Killing off the bad guy, remediating the machines that have been infected, putting them back in service so that to your clinicians and to your patients and families, the disruption was so minimal.

It's like it never happened. Yeah, you're going to be breached. You just need to solve the problem really fast, and that is the key to the operation. But, but the architecture bill described is the architecture is table stakes for what it should. Segmentation, carving things out in ways. This is back to the basics of that should never happen.

Right? You should have this stuff so segmented, so, so defense in depth as Aaron mentions, but tools and physical and logical architecture that you don't have that, that horizontal approach. Again, that's table stakes. You better have it now, right? If someone's here that doesn't have that, like you, you need some help.

You, you would be surprised though, how many, this is just, I think the reality of a lot of the organizations that . Our CIOs are working in, they're burdened with legacy applications. They have inherited what they've inherited. Lots of lots of stuff that has been done but not been done well. And so when they get that, sometimes it's like, where do I even start?

And, and they struggle with it. But that's where I start flat networks because they work really well and they're give everybody domain admin layer two everywhere you're to go see people do it. But here's the thing, you, you guys have, I mean, not the biggest budgets that I've, I've talked to on the show, but Nope.

But there are, there are people who have teams, entire, IT teams, everything. Like 20 people total. Yeah, of course. I don't, how do they do it? They have the most respect for me. 'cause I, I'm not sure how you do it. Partnership, partnership, partnership, partnership. You cannot do it alone. Even if you have teams of hundreds.

You have to partner with the right companies and you have to eject those who just don't get it and will refuse to do it. Period. At the end of the day. Your, your purchasing and your buying behaviors will dictate how your third party vendors react to you. And even if you're a company of 20 people, you're still making material money to some vendor out there you're using.

So put your money where your mouth is and hold them to your standard too. Right? Right. Don't settle for less. Don't let the folks in the door who don't do it the way that they need to, you know, they don't meet your security standards, et cetera. Um, hold them to that standard. Yeah. And I would say as you saw federal guidance come out recently, it is not a violation of Stark per uh, OCR and others for you to reach out to larger health systems and say, can you help me now as a large health system, I can help the small guys without, without too much worry about stark violation.

Mm-Hmm. , those clarification rules came out about four or five months ago. Mm-Hmm. , I, I really appreciate Chime public policy pushing that to make that happen and others pushing that. So there is the ability now for the small little people to ask for help and say, Hey, Baptist, hey Health first. Hey whomever, can you give us some guidance?

And believe me, we will help anybody. Right. It it is not, it is, it is not a competition. Yes. It's a business. We're here for everybody. That, that's the beauty of healthcare is that we're all in the same boat. It doesn't matter what your size and what your complexities, it's all the same problem. Yeah. Many of these are our partners as well.

All ships rise with the tide. Right? That's that right? That's right. You're not competing on cybersecurity. No. Our health system is more secure than their health system. That's, that's never gonna be a pit. No. But if my same patient goes, treat me in health first, which is likely to happen, I wanna make sure they're secure no matter where they are.

That's the end of the day's. Having them, having their back. I like it. Here's what I know. If I'm selling a product, if I was a vendor today, I'd wanna get him as a client. 'cause he just, he pitched CrowdStrike, he pitched to site. Yeah. In a very subtle way. Yeah. But is is, but those are two, two really things.

He's, I mean, this is, he's saying exactly kind of what we all know. This is about partnerships. It is. We talk about it as the power of we, but it is, nobody can do this on their own anymore. Right. It is absolutely a team sport. And it's not just the providers that are in your health system and the people who work in the health system, but it is all of your partners that work together to provision great care to your patients and families.

And if, if you have those kinds of relationships, you can make those kinds of agreements and build that kind of partnership, you are going to win. That's what you're gonna win on. Not side. So last, last question, talking about those partnerships. So you've partnered with each other interoperability? Mm-Hmm.

partner with each other on security. Yeah. Talk about the, the, the public or the state federal partnerships. I mean, because that's also an important . Piece. It's, it's educating the state. Uh, what we find a lot when you go to states, and maybe Florida's not this way, maybe, but the people I interacted with at, at certain states, it was an education process.

They were looking at me saying, explain to me why this is so hard. Why, why can't we do interoperability? Yeah. Why can't we share this information with the state and that kinda stuff? Well, in general, we spend too much time talking about technology. Right. We spend too much time talking about APIs and HL seven interfaces and all these things that 99.9% of people out there are like, what in, what kind of gibberish are you talking?

Right? So, so find, find the technologists that talk like the business, that talk operations. Yeah. I love what Will was saying earlier about owning operational responsibility. That means he can talk. Like a human being and explain this material to what it means to the p and l, to the bottom line and the top line, and why these decisions need to happen.

Change cybersecurity from being about cyber and tech to being about quality, to being about patient care, to being material to, to the top and the bottom line. Change the dynamics. Too many technologists have become CIOs. None enough. Business people have become CIOs. Yeah, that's the problem. So it's not a state versus federal versus un misunderstanding.

We're trying to explain something technical to people that grew up in a totally different domain. So of course you're gonna look like you, like you're crazy. I, it doesn't surprise me at all. Even at a federal level with some of the most brilliant people I've ever worked with. If I start going down a technical path, there's maybe one of 10,000 that will understand what I'm talking about.

Now I can do it. I love to geek out. I'm an engineer by background. But more importantly is why does this matter and why should we care? And you have 10 seconds to explain it to me. You get, you better explain it to me like I'm five years old. End of story. Yeah. Yeah. You nailed it. You stole all my thunder there.

I mean, I happen to be at the federal level for a very long time within walking distance to the hill. And while we're all reform technologists who some point along the line learn business and operations and other things, they are 30 seconds away from the next biggest issue that will dwarf yours. Right.

So you gotta get it out, you gotta get quickly, you gotta understand what's important. It local levels, even state, federal, and, and once they get it, it'll be your biggest allies and advocates. And then four years later you get to train 'em all over again when the staff has changed and, and others. Right.

And that's unfortunately a dilemma in which we, we have, when it comes to some of those government relations, I mean, CIOs have always been sort of the world's greatest translators because we are taking technology and translating it into business speak and back. I think sometimes when it's federal and state government.

Some of what you're trying to do too is give them a way of explaining something that's really complicated that they can then go explain to others. Right. And if you make them look good, they will keep coming back to you for help. Right. And they're very smart. Remember, people do not get to these roles by being dumb.

Yeah. They may, they may have to fill a constituency and, and appease people in a certain manner and a certain type of communication style. They're not dumb. They are all brilliant and their staffers are even more brilliant. Yeah. So do not underestimate them. That's what the work is done at that staff level.

Yeah, that's right. That's right. Because the, the interesting thing that I think we learned with 21st Century Cures is we all agree on the what but not the how. Right. We agree that, hey, you know what? Patients should have their information. They should be empowered. We wanna empower people. We want that information to flow freely from your health system, to your health system.

We want people to have options for cures for . Advanced treatments and those kind of things. So we all agree on the what and then we get down into the how and we sort of get a little, a little tensed up and say, well it should be, it's the practical implementation. And then we build walls around our how and say you can't come to our how

Yeah, exactly. I always say, you wanna come to my, how it costs you, you know, two x, three x four x. Now I, I think we're gonna get there because what I see across the industry is his willingness. Will and I are a subset of a larger population of CIOs that are all doing the same thing across the entire country.

It is inevitable. That it's going to happen. It is happening. It will happen, and that patients will have their data. And I applaud CMS and ONC and, and the congress administration for signing that into law and saying, now you should do it. Here's a stick, will be reversal penalties. Hey, I want to thank you guys for, for stopping in Congress.

I love the candid conversations. Fantastic. Always, brother us. Always, always, always. How are things going? Yeah. Dr. Milligan. Hey buddy. I wanted to meet you for a very long time. We have been, uh, Twitter buddies. I know, right? LinkedIn buddies for a long time. I'm always like, so it's awesome to see you in person.

Very good to meet you. I haven't seen you in person. In person for, what is it, two years. Last time I had a beard, right? Yeah. One of the things I highlighted that, that your system did extremely well was . The education of your community. So you guys were posting those, those analytics on an ongoing basis that, that was Michael Olsson, by the way, from inception to Tableau.

Everything. So he's a director of enterprise services, but it includes analytics. And what was the thought process? 'cause a bunch of health systems have done it. Mm-Hmm. , I don't know if you were the first, but it felt like you were pretty early on in the process to get those numbers out and you guys clearly were experiencing a significant spike.

Yeah, we had kind of, in hindsight looking at it, we had a report built out that had a lot of great information, had a lot of great information in it, but the report was really clunky. It was really clunky. It had a lot of data, but nobody's gonna look at it. So we thought, gosh, what is the goal here? Who do who?

Who's our audience? Who do we really wanna reach when it's all said and done? And we realized our challenge was our community was not getting vaccinated. So how can we get this message out? Let's simplify it, let's make it color coded. Let's identify kind of key elements. How many are admitted? How many ICU, how many tubed and how many are dying.

And actually the other person who was really key in this is one of the analysts named Sky Quentin. He was awesome. He's, he's a master with Tableau. The data visualization, taking complicated data and making it simple so that everybody can understand it is an amazing art into itself. Yep. And I don't know if you're a fan of Edward Tufty or if you've ever read any of Edward Tuft's work, but his work is all about taking complicated data and making it simple and easy to understand.

So when I first saw that, I thought to myself, there's a Tufty guy in that shop somewhere, and I love has figured this out. So you had your story. It's like this is for the community. Mm-Hmm. . We want people to, to hear the story and understand, to get vaccinated. And so I was able to look at it, had people on there.

Mm-Hmm. . So I could resonate with that. I guess that's a standard chart. Yeah. For that, for them. And you could see vaccinated, unvaccinated. Mm-Hmm. in the hospital. You, you're showing deaths. I believe in the ICU and the deaths are interesting 'cause we had deaths in the last seven days. But then our, our VPMA, who's also an intensivist, wanted us to have a broader view of the deaths.

And so we added on top of that in that gray box on the right deaths in the last 90 days. And so it's interesting to see kind of how the whole thing has trended out. Our deaths in the last seven days are going down, but we're still kind of catching up on all the badness that happened a few months ago.

And so our total deaths last 90 days is actually still pretty high. It's like 1, 180, I think. Are your vaccination rates going up or are they They are sort of holding. They are, and I'm happy to report now at our system, anybody within our system, whether it's a clinic or the hospital caring for a patient or cooking meals is vaccinated.

That's interesting. Was it, was that driven by the mandate? Was it driven by leadership? How, how did that . It was a combination. The executive team really wrestled with this quite a bit because we were already short staffed with nurses like everybody else right now. And so the concept of doing something that's gonna cause 300 people to leave just seemed, made us nauseous.

Frankly. On the other hand, we recognized it was the right thing to do. We really needed to have a scenario where if a patient came in, we were not putting them at risk. And we, mind you, we already had, I think, four separate outbreaks within our system where we were giving the virus to somebody else. And so we just felt like first do no harm.

And so really had to hold that up. It, it helped when the state and the government said, look, it's a mandate for sure, but we're definitely, we're on the same page. We don't talk about the vaccine much. 'cause it's such a political issue Yeah. Here. But, you know, it's one of those things, when I went to work in healthcare, I had to get like five shots before I could work.

Oh yeah. As the ccio Mm-Hmm. within, within the health system. And people were like, Hey, this Covid shot, they're, they're forcing these people to do this. I'm like, they've done this from the dawn of time. Oh yeah. Yeah, you couldn't, I can't work in the ER without my Hepatitis B series. Right. The whole series.

I mean, you have to get your TB test, right. I mean, there's like basic stuff. So you're not posing a risk to somebody else, essentially is the bottom line. I was, I spent 20 years in the military and it was, you know, if you didn't want to get vaccinations, you didn't make it past day four of basic training.

Right. But you guys have like Ebola vaccinations, right? , we had all kinds of things like yellow fever Absolutely. Depend on where you were going in the world. At any given time, there was always a public health pass that you had to go through. Yeah. Right. They shot you full of whatever it was that you needed so you didn't bleed out of your eyes or world.

Right. Right. So mandatory vaccinations have been a thing in healthcare for a long time. Yeah. Lee, I feel like we've talked about so many topics with the gentlemen who are just here, but I, I'm curious 'cause the, the one I I I'm honing in on right now is, is, is labor. Is people, it's the labor market's.

Tight. Mm-Hmm. a lot of health systems. You're not really small, rural. I mean, you're . Big, but you're not, I mean, where you're from is not overly big. So it's not like, it's not like you're in Southern California where Mm-Hmm. where you just tap into these other Right. Other pools. Right. Is this something you're keeping an eye?

I assume it's something you're keeping an eye on, but what, what are some strategies around this? Yeah, so we were already losing people before the mandate because the job market has changed so much. One of my best analysts and a friend of mine, uh, recently took a job with a consultancy where he got a 30% raise and didn't have to move.

Yeah. I can work anywhere now. Yeah. And so, I mean, it, it was just killing us for the mandate. And then with the mandate itself, I actually lost 19 people out of about 300, uh, as well. I think you have to be really, really creative on this front. You have to work with your HR department to let them know that we're gonna be looking any place in the continental United States.

And so whatever you have to do from a compliance perspective in order to make that, so, let's get that on board. I also think there's other avenues that haven't been fully explored. So for example, recently I've been reaching out to local universities, so SOU, about 5,000 students down there. I connected with their computer science chair and we had a good conversation and she invited me to guest lecture there, as well as our InfoSec, uh, director and our network director as well.

And they have a program where their students can do capstone projects. And so we submitted two, uh, potential capstone projects to them. And one so far has been accepted. And they're gonna be coming over to us for about six months working on stuff for us. We're actually gonna be building an information security dashboard Awesome.

For us. And so we're just hoping that the relationship gets established and so they think of Asante, where they think of where can these kids go? Wow. The the thing I can't get over though is hiring people anywhere. Mm-Hmm. to work in it. And Aaron sort of jumped on me a little bit here, but I mean, I, I was, I was ACIO by walking around.

I mean, my, my management style was popping into people's office. Hey, how you doing, man? Mm-Hmm. I've seen in a while. And the kids still doing good. Mm-Hmm. , I mean was Yeah, me too. Me too. I, it just, I don't know that that felt like the way to do it. How do you do that? Or do you just completely change how you approach it?

It, it's been a crazy couple years for sure. And I don't think I have anything nailed down, but I do think you have to be very proactive about how you reach out to your frontline staff. You have to let your directors and managers know that you're not serving their authority. You're simply trying to connect with your staff.

Mm-Hmm. and reach out to them. And I think unless you have some sort of a schedule in place, you're never gonna do it effectively. I've done it like you kind of sporadically, uh, in the past. And I do that via teams actually with my team. You all the time. You just pop into a teams meeting and they're like, Hey, there's Lee.

Well, I'll, I'll text them first and say, Hey, you got, you got five minutes and we'll do just that. We'll just talk about, Hey, what's new? What's going on? Just wanna check to see how you're doing and whatnot. We also have a small team of folks within it who are putting together a permanent work from home framework that we can look at, which will include ways we can stay connected.

You know, one of the, one of the things that I've seen, uh, work pretty effectively too is the CIO with a second laptop, right. And office hours booked in their calendar. Start a Zoom meeting and just continue to work on whatever it is they're working on. Unless somebody wants to literally like drop in on them.

Like office hours. Office hours, yes. Office hours and sort of check in office. That's a good idea. Hey, I got this thing, we've got this stuff going on. Yeah. I just wanted to hit you for a couple of seconds. It's literally like a virtual open door policy that is a, just being able, a great idea. Yeah. Do you mind if I steal that?

Oh, no, for sure. It's, that's plagiarism is the most sincere form of flattering. That's awesome. Yeah. The the other thing I wanted to touch on with you is you are a writer, so, I mean, I, I've seen some of the things you write for your staff and you send out and you, so you are able to connect with them on, on that level.

I think you actually, you're a pretty gifted writer. You're not gonna take this compliment. Well, but I'll give it to you anyway. I'm feeling very uncomfortable right now. Yes. . Because I mean, you, you're putting those stories out on LinkedIn. They're phenomenal as well. I, I've seen a lot of the feedback. It's great.

But those, those letters, you, you have a way of capturing what's going on, connecting them to the mission. Mm-Hmm. in the, in those letters, which I think a lot of people are struggling with. How do you, you know, keep them involved? And, I mean, do you spend a lot of time on those or is that just so easy for you to just sit and write?

I, I try to find something that I feel strongly about. It makes it easier to flow when you feel strongly about it, and then kind of focus on those things. But I also wanna see through their lens, like what are the analysts, what are the network guys? What are the engineers, what are they thinking about right now?

What's concerning them? And then try to start from that point and kind of work backwards on it. There's a couple other people out there I think do a really good job of this. The CEO of Korn Ferry, I think does an outstanding job of kind of connecting with, with his staff and kind of a similar fashion.

And then I always try to bring in some story about my life to connect with my staff. And it's the, it, it is the connection to the mission and the connection to you. We hear this all the time. People don't leave jobs because of, I mean, any number of reasons. They leave bad bosses. Yeah. And when they have a connection with you and they have a connection with that mission, I mean, we have the greatest mission.

That's our biggest advantage, right? We, we work in a mission that everybody's a part of at some point, one of the things we started doing within our, our ITS division meeting every other month is we have our CMIO present some sort of clinical scenario. Where it played a key role in a clinical outcome. So most recently it was a patient who, uh, came in with diabetic ketoacidosis.

So it's a diabetic, they have super high blood sugars, and then they get super dehydrated. And it's really, it's a, it's a near death experience with somebody who's experiencing that. And they had built out, the team had built out a, an amazing order set. The order set was so detailed and so specific, and so in line with, uh, best practice recommendations that frequently, nowadays, they turn these patients around so fast that when the hospitals come down to admit the patient, they're asking, why am I admitting uhhuh?

And so the last time the CMIO gave this example of this scenario, it was really all due to a great collaboration between the CMIO, the clinical staff, and then the Epic ASAP analyst who built this whole thing out. So I think those kinds of things really connect us to why we're in business. It's a huge thing for your team too, to, we used to do something similar.

All hands have, uh, a physician come in every time or, or a nurse or somebody from the lab come in every time, sort talk about an issue or a problem and how it, you know, not really save the day, but Yeah. But how you're connected to that. The other thing we did was take staff and send them out into the hospital.

Yeah. That's important. So that they could actually do rounds. Yeah. On the, so I'm not just a storage person, but I understand why storage is important to, why it matters Care in the ICU. Yeah. We don't have that kind of capability. Maybe it's not as easy anymore. Yeah, it is. Are you, how are you working that not terribly effectively?

It is, it is a challenge. Uh, recently our, our CEO asked us to put together a plan for what our long-term plan's gonna look like in terms of coming back to work. I. and really I think moving forward, for us, at least in my mind, it is, it's a hybrid perspective. Mm-Hmm. , it's gonna be a combination of some folks.

About 50% of my staff actually have to be on-Prem based on their job. So biomedical engineers or network folks and the data storage folks, a whole bunch can be at home. But there are times when it's gonna make sense for us all to come in. So for example, integrated testing, right? So how do we create like, you know, hotel space and, and creative options so that we can, we can do what we need to do, but also have this hybrid model in place.

In the beginning of the pandemic, it was about safety. Let's keep people home for safety. But now it's culture. Culture has changed. Mm-Hmm. people want to work for a, but I assume that's not everybody. I mean, have you like evaluated different roles or, yes. Remember my color coded functional organization chart?

Yes. So I went through that whole thing with each of my directors team by team to say who would I discuss? And even within the team, sometimes there's a scenario where the whole team should work from home or could work from home, but there's one person. It's a specific scenario. They've got four kids and they don't have a big house.

And so working from home doesn't actually work for them. And so in those cases, we try to make accommodations to be able to bring them in. So like the health system bought up a bigger house. That's one of the accommodations. one of our accommodations. Yes. . That would be exciting. We had a good year. Yeah.

When, uh, when are we gonna see a book from you? If people don't know what I'm talking about? You've written these stories of your time in the er Mm-Hmm. . And they're really, really compelling stories that I I think you've released what, four or five? Uh, five now. Five. Yeah. And you have a couple more. I'm sure anyone who's worked in ER has Right.

A lot of stories that are story hard to make. Uh, I don't know. Appropriate for general assumptions. Correct. Will we see a book or is that like a retirement thing? I would like to write a book. I don't know that I have any particular expertise. I don't know the industry at all, but I would actually would like to write a book at some point and kind of bring all those stories together.

I do think there's a, there's a need to get the story out there. I think . The kinds of things that land in the er, the situation that land in the ER most people don't know about. And they're happening every day in America. And I think there's great lessons for all of us around humanity and connecting with people.

And that's the piece that I really love to write are, are the ER visits going down with all these things that we're doing or they start to come back up? Um, it's been up and down for us. And there's a lot of, and I say it from this perspective, opinions. I would've gone to the ER if I hadn't had a phone call with you during the day.

Oh yeah. Right. So I, I called you up and I'm like, Hey, I'm feeling this pain. Yeah. I think I should go to the er. And you're like this, if it's this, go to the er. Yeah. But it's this don't, and, and I ended up not going to the er. So you saved an ER visit, I would assume, with the access to telehealth and your telehealth visits.

Mm-Hmm. are probably pretty high up that we're, we are making a dent on the, the visits to the ER that aren't necessary, I guess. Yeah, our, our numbers right now are about where they were two years ago in the er, so we've gone up and down and then up and down several times, but that's where we landed. My, my opinion is in the future we're gonna have three buckets of kind of approaches to what you do.

I think bucket A is gonna be an automated platform that allows the patient to interact with the Robbie robot that provides some direction or even a diagnosis, and ultimately a prescription or a treatment that may or may not be sanctioned by a doc. Bucket B is gonna be a traditional telehealth visit, which may or may not include kind of a verbal CDS associated with it.

And then bucket C is gonna be an actual in-person meeting. And that whole thing I think should start at a single location and then it guides you to one of those three buckets. It's possible too that . Out of those buckets, you're referred to one of the other buckets, right? That's right. Yeah, that's right.

A lot of this, we talked earlier about workflow and, you know, clinical workflow. Mm-Hmm. and having good common decision making criteria. You talked about the order set, right? Yep. But if you can figure this really complicated piece of business out and you can figure out how to workflow it out, diagram it out, you have sort of the makings for the A, b, C bucket.

Yeah, yeah. You do. I, I think we have so much discreet data available now. I think we could easily put in place a, a framework whereby it's really clear which bucket they should start in. And then to your point, at some point if they fall out of that, then they're shifted over to bucket B or bucket C, depending on kind of what's going on.

And there's tons of great process workflows in place right now. If you look at Thompson Schmidt for example, they have the, the nursing, uh, protocols. One of my good friends as one of the editors on that, and they've done great work in that, in that space. It's not so much a patient facing scenario, so I think there's work to be done on that front, but ultimately I think that's the space we're gonna get to.

And I think we need to, because we can't just do bucket C, it's just way too expensive in today's world. We've gotta leverage bucket A to some extent. Bucket B, I mean, when you talk about burnout and everything else, driving everybody into bucket C, just, there's just not enough throughput. No, that's That's right.

Wide enough to get everybody through. Yeah. Although, I will say as a provider, occasionally when you're seeing patients and it's one car crash after another, it's nice to get like a two inch laceration, and just sit there and talk to the patient. I can fell on a skateboard. Yeah, exactly. Your chin, we're gonna make you better.

Here we go. Yeah, that's, that's satisfying. Probably one of the benefits or downsides of living where you live. I'd imagine some of the car accidents and the accidents you saw were probably pretty horrific, coach. Pretty crazy. Yeah, for sure. Lee, thanks for stopping by. I'm looking forward to the book. All right.

I mean the, the ER stories are very interesting. Do you think there will be some CIO stories as well? My daughter always kids. Me that my and my stories are always way better. When I was an ER doc , she kids me that I push paperclips around nowadays. , . But your job's boring. But there's been some pretty good political Oh yeah.

Tugs of war for sure. That maybe we could, uh, and she's like, no, really? Tell me more, dad. Yeah. This is so amazing. That must a great board meeting. really a budget battle. You're kidding. Oh man. Nothing like our kids to keep us humble. That's right. That's right. Fantastic. Alright, listen, good seeing both of you.

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