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 Welcome to this Weekend in Health, it influence where we discuss the influence of technology on health with the people who are making it happen today, Marty lik the CIO for HCA healthcare joins us and we have a really great conversation. We cover so much ground. It's really amazing and I think you're gonna really enjoy it.

My name is Bill Russell, former healthcare, C-I-O-C-I-O, coach, consultant, and creator of this week in health. it as we approach 250,000 downloads for the year, I want to thank Sirius Healthcare for supporting the mission of our show to develop the next generation of health leaders. Uh, their weekly support of the show and our channel sponsors as well has allowed us to expand and develop our services to the community.

And for that, we are incredibly grateful now onto our show. All right. Today we have Marty Ick, the CIO for HCA, healthcare with us. Good morning, Marty, and welcome to the show. Good morning. Good to be with you, bill. Wow. I, you know, I'm excited to have this conversation. This is actually the first time that, that you and I have met.

We're gonna cover a lot of ground, but before we do, I, I wanna give you the chance to really tell us a little bit about HCA healthcare. I'm sure everybody has an idea of what. But give us an idea of HCA and your role at HCA. Sure. My pleasure. Well, I. Our company was founded more than 50 years ago, and there was a, a trio of founders and two of those founders were physicians, Dr.

Fris Senior, and Dr. Fris Jr. And they had the vision, uh, 50, almost 51 years ago, that they wanted to create. A health system that really emphasized high quality and high efficiency. And so that began, uh, the journey of our company. And today, you know, I would tell you that, that the mission of the company is, is, is pretty important to us.

Matter of fact, you can almost see the sign up above my, my desk over there and, and, and, and we just really feel compelled to the mission statement, which is above all else, we're committed. To the care and improvement of, of human life. And, and some companies feel like they have to create a mission statement as a check mark or, or just, I gotta do this sort of thing.

But I would just tell you that at HCA, it, it's, it, it's much more than that. And. You got colleges that have that little phrase that connect people who support it like Auburn has War Eagle or Alabama has roll tide. Well, I would tell you inside of HCA, if one person says to the other above all else, they don't have to resay the rest of the mission statement.

It's, it's just an automatic. A connection to who we are and what we try to do. And that's why we have, we have nearly, uh, 6,000, uh, uh, IT professionals in, in the organization. But I would tell you that they would, they would tell you that they would be, they would prefer to be called a healthcare professional first before being called an IT professional.

The senior leadership team, uh, is made up a lot of of high tenured individuals. Who all started as individual contributors of the organization. And so that's a unique trait I think about our, our organization that, uh, kind of sets us apart. Look, just outta curiosity, so your, your CIO for HCA. The, the entire system because we've, we've seen you have some, some regional CIOs, is that right?

That's correct. So we, we are set up in 14 domestic, uh, US divisions today. And each of those divisions have a, uh, CIO that, uh, reports back up through the organization to me. We also have CIOs that are focused on.

So, for instance, that does our business operations has a, handles our supply chain. Uh, logistics and organization has Aon Research Institute. Also has ACIO and then we have about, uh, 4,500, 5,000 employed physicians along with Urgent Care that are on that organization called Physician Services Group, also has ACIO as well.

So you have to be thinking, I mean, the thing that's distinct about HCA has to scale everything you do.

We can do it for this one entity, but we've gotta thank, uh, a much larger organization, I would imagine. No, absolutely. I mean, I think that, especially when we work with small, innovative companies, it's one thing that we can bring to the table. Honestly, they might be bringing a great idea or a great concept, but what the organization is looking to us to do is, is hey, make sure that that thing, uh, will scale across, uh, the organization.

Yeah. And that's when you're a small organization and you're hooking up with HCA, you gotta think, yay, we got this big deal. And then you get in and you realize, oh my gosh, this is big. This is huge. I would imagine those startup entrepreneurs go through the, the range of emotions after they, after they get going.

When we, when we first started, when we first started to build our, and we'll talk, I think we'll talk about today, about data, our clinical data warehouse. We had a, a vendor working with us and we were in a meeting one day and they were struggling a little bit, and I don't think, I don't think the, the, uh, representative knew what they were saying in front of us, but she finally just stopped and said.

We just realized that you guys are really, really big and uh, and, uh, it was a, as an accurate statement. So, so it is, it's always a challenge, but I, I will say once we get either a workflow or a technology working here, I. It, it, it's pretty much industry ready, that's for sure. Yeah. It's vetted. So we didn't, we didn't really get the opportunity.

And give us an idea of, of how your, how your role shifted and, and what were some of the things you were being asked to do as a technology leader during that time? Wow. It's, it on one hand, it seems so long ago, and on another hand it seems like it was just yesterday. Everything changed, and I'm sure all the other CIOs and other technology leaders you've talked to basically, uh, say the same thing for me personally.

When you get to, to a place, uh, in the organization, and especially one like ours is so large, that your, your role is primarily that of a consultant. You're consulting with people, you're providing them your years of experience, your knowledge. You're helping them with decisions. And then all of a sudden and really almost that quick, you, you walk into your office and your schedule has disappeared.

It's gone. There, there, there is no governance meetings to go to, there are no other types of activities. And for me, at least personally, I rediscovered the operator inside of me. And so we had to take some fast action. We, we. Operational impact, clinical impact, technological impact. So the first thing we did was we halted more than 375 projects halted or severely slowed them down, and we pivoted to sit down with our operators.

Let's sit with our clinical operations group and really try to understand what were the, the critical things that we needed to pivot toward. Early on, you would say laboratory interfaces. So we were quickly negotiating with, uh, reference labs and we needed to construct those lab interfaces overnight and, and I think.

And as for my role, it turned out that, that I always try to emphasize a flat operating model, even though with 6,000 people, we just talked about the CIOs, there's a hierarchy. Right? Right. But operationally, I wanted to, to have a a, a flat operational model. Well, during Covid. It became as flat as flat can be because we just all became colleagues and with the collaboration tools like WebEx teams, we were just kind of all in there together.

I'll give you, I'll give you a great example in, in the, those early weeks. We were trying to build these, uh, interfaces to these reference labs, and I'm a part of each of these, uh, WebEx team rooms and one of our integration analysts just us out, out in the open. Of the room just said, Hey, hey Marty, we, we need you to contact the CEO of this reference lab.

They're telling us, and this is a Friday pm He's saying their technical staff is telling us that they'll text, they'll get, get back on this on Monday morning. Mm-Hmm. And that is not gonna work. And, and, and I. I called their CEO and, uh, said, look, God, I, I don't wanna be overdramatic here, but lives are at stake here and we need to process these labs as fast as we can as soon as we can, and we're ready to work.

We're ready to work through the weekend, do whatever we need to, but we need you to get your staff to help us. And sure enough, the CEO turned to his team and early the next week, we had those, um, those interfaces. And so for me. I became an operator again. And, uh, and I think that goes for everybody in our company.

I, it doesn't matter what your role was, all of a sudden you were very hands-on as far as our response goes, rediscovered your inner operator. That's a, that's a great, great quote. They didn't have you go back and start programming again though, right. You didn't go that far back? No, no. The developers, whenever I try to give them advice on, uh, software development, I, I get the rolling eyes pretty, pretty fast.

The, uh, it's interesting 'cause you guys have such, uh, again, scale. I can just go to scale you this, this pandemic was not experienced like we thought originally we thought it was just gonna spread all the way across the country and it turned out be really a local impact. It just, it sort of manifested itself significantly in New York, significantly in, in New Orleans, Seattle, some, some locations, but in other locations we saw a very slow ramp up.

Now it's, it's ramped up in a lot of places today. But early on, I mean, did that create some challenges for you in terms of just how it was being experienced unevenly across your system? Well, not so you, you're absolutely correct that, that it, it covid strikes in different. Degrees, but we have seen across almost all of our markets, 21 states, the ebbs and flows of, of Covid.

So when it gets back to the technology part and the things that we had to do, it really didn't matter about whether or not it was a surge or not. I, I, I'll give you a great example. Regardless of where you were, hospitals across the country went to a no visitor policy, right? Rightfully so. So we had to, uh, quickly pivot toward how do we, how do we get, uh, a connection between patients and their families?

And, and so it, it just did in a case like that, it just, it just didn't really matter. And then when you, when you think about PUIs, you people under investigation. It without having that and not without having a good lab turnaround time. You know, the DUIs were having to be treated just like covid patients and so some of the forces, even though we didn't experience in New York per se, some of the things that we had to do were still as critical and still is time sensitive.

So.

Telehealth type technologies and those kind of things. What, so you talked about bringing patients and their families together. What, what, what kind of projects, what did that look like from a technology perspective and, and from a rollout perspective for you guys? Well, we were really fortunate to. To tell you the truth 'cause we had some great foundations.

So we, before Covid, we already had a great telehealth foundation. We had more than, um, a thousand programs that focused on things like rural outreach. Uh.

Stroke identification, behavioral health assessments. So we had a, a very solid, uh, understanding of telehealth and we were actually executing it quite well in a very, uh, decentralized way across the health system. But as . Health systems had some new use cases that amplified really fast. So I mentioned one of them, and that is we went from, we went to a no visitor policy and so, so not only did we have to figure out how to get the equipment, iPads or whatever into our ICUs or med surg rooms, but we had to train people.

We had to, you know. We had it all running basically. And so, so we, we had, we had, apple was a great partner. We're one of the largest iOS users in the, uh, in the industry, but we still didn't have enough devices. So we literally had tech analysts walking through administrative offices, grabbing whatever iPads they could going into patient's rooms.

And I'm not kidding you. Literally duct taping the iPads to IV poles. And, and it was important. It was important to create the connection between a patient Oh yeah. And their loved ones. And honestly, it created a better connection between our care teams and the families instead of, of a voice call. So that, that one in particular was.

Was, was, was pretty, pretty important to us. The other foundational thing that we had going for us was that we went down a path a few years ago that we wanted to go mobile and we wanted to supply our caregivers with a communication platform that we can not only use for voice if needed, but also use for texting and, and come covid for the video capabilities as well.

Wow. And, and if you think about the speed in which something like that happens, it's pretty important. The other big use case, which we, we, we actually had work . Done in it was, it was really the idea of the physician to patient connection, right? I mean, we had some of those, that activity occurring in our, our, our hospitals before.

Was efficient, but as you can tell, we went from a very low number of physician to patient interactions, say like your a family, um, family doctor to nearly, uh, a million, um, video telecare, uh, cases that, that's, those are some staggering and amazing numbers. I, I, I'm curious, uh. I wanna ask some sort of a following question about standards, right?

So you have those regions, you have those different entities. Do you require the same solution across the entire enterprise, or do you just, or, or do you allow some leeway in, in the time of a pandemic to say, look. We're not, we're not gonna be as stringent on standards. Let's, let's get the solutions in place and then we come back to it later.

Well, like I said, we, I thought we had, we had a good, we had a really good footprint. I mean, we had, we, we used one touch, uh, a lot across the organization, and that became the kind of the primary tool. But to your point, some vendors do dictate the tool within their system. So we use eClinicalWorks for, for our

Physicians are employed physicians. And so obviously we were leveraging their technology within their platform. So there, there might've been a variation across the enterprise, but the use cases were, uh, fairly standardized. I had this and we used for the ICU case, we used primarily WebEx and we're, uh, Cisco was a great partner through all that activity and I had the chance to speak to one of their customer advisory boards and I.

I think everybody looks at WebEx from a Covid perspective and go, wow, look at all the meetings. And sure enough, we, we use it for a lot of meetings as well. But the one thing I wanted to emphasize to, to not only other customers of WebEx but to, to the engineers at Cisco was, Hey, your technology was one of the most critical means for a patient that might for the last time talk to their family and.

And I don't think sometimes we as technologists ever come to grips with really how close we are to a patient. And in the case of, of, of what we were doing in the ICUs, WebEx was a, uh, critical, uh, component. So overall, I would say very standardized in use cases, but different tools used based on . The use case itself.

So you, you, you also utilized the, the Microsoft Covid 19 chatbot self-assessment tool that was out there. How has that worked for ACA and where can you imagine that technology going next? That it was just amazing to tell you the truth is that what a great partner Microsoft was. They, they had contacted us and said, look, we've

We've, we've spent some, uh, time with some, uh, our engineering. We believe we have some technology that we think can help. Can we help you basically, and we're good partners with Microsoft already. And we said, sure, let's do this. This is just, I, I can't even, again, it's all about covid speed, right? But, but from the point we said, Hey, let's do this.

Until the point we had it operational was just a few weeks. It was, it was two to three weeks and it was operational across the enterprise. And, and I would just tell you from a patient's perspective, their alternative before that was to, uh, the, the internet Googling and things like that, or it was calling our contact center.

And our contact center was doing, its very best to keep up, but you can imagine there was cro quite the volume of calls that were coming in and here, all of a sudden we had a very structured, uh, workflow that delivered great information to the patient. And it also provided guidance at the end. You should go here or you should do this.

And so from a patient's perspective it was fantastic. And, and then from a contact center perspective, it allowed our contact centers to focus on other types of activities during, during the Covid surges. Yeah. Do you think there, so what's the follow on I'm asking you to put on your chief digital officer and say, Hey, that was a pretty successful pilot if you.

Where does it go next? Well, I, I mean, I, I think I speak for any healthcare system that you would, uh, talk to that when it comes to bots and comes to automated workflows, we're all just at the, we're in the early innings of these things, but I, I, I, I guarantee you, whoever you talk to is doubling down in that space right now.

Yeah. The one thing I would say about our patients is they really, they, during Covid and post Covid, there are two things they really want. Obviously they want quality care, but the inside of that umbrella of quality care, they want convenience and they wanna have confidence. And I really do believe. These digital bots and the digital patient journey, if we're able to digitize more and more of, of what the patient needs to achieve, those two things, then uh, we're gonna have a, a better experience.

Yeah. And that's, that's huge. Uh, I, I do want to delve into data and information and really data. During Covid, we, we, we've heard stories of people's standing up dashboards and record time and, and just the different information that was required, the information that had to be, uh, sent to the states, put into registries.

I mean, that's a, this is gonna be a huge question, but give us an idea of some of the, the work that you did around data and around visualizing the, the information for, for the caregivers and for the executives. Well. We were this a little bit of a, a little bit of a history lesson, but more than a decade ago, we made the decision as a company that we would create, uh, our own standalone, uh, clinical data warehouse that not only included EHR data, but included any other data that we wanted to assemble together in order to get those kinds of insights.

You, you, you may have heard some of my colleagues. In different other settings, refer to our company as a learning health system. And, and it really does start with, uh, the clinical data warehouse where we have nearly, uh, 45 million patients in that data warehouse, over 150 million calendars. We track more than 4,000 unique data elements for the patient.

So that's that foundation. Is, is the, is the, is the table stakes. And so going into Covid, we were already very fortunate to have just a, an unbelievable set of data to start with. Now when you have that, you gotta have somebody or some team that can leverage it. And the other thing that ACA is very fortunate and all their health systems as well have, have jumped into the data science space.

But we have a. The company has a data science team that just, they're just, they're just amazing, is all I can say. And, uh, they're magicians in, in my eyes. And, and they created a technology, a platform called, they call it Nate. And that platform, especially when it came to Covid, was highly tuned so that we could follow our patients offer

Information, insight. We could predict surges, we could predict bed statuses. We saw all of that activity all the way down to the single bed and, and it, it was just phenomenal about how it enabled us to not only. Care for our patients inside of our hospitals, but actually care for them across a marketplace as well, so we could leverage back to scale, leverage all of our assets just because of the insights that we could get.

The other area is that we. Again, before Covid, we began the creation of a product called Rhythm, which is in, in simple terms, just, just tiles that represent all kinds of different, um, metrics in our organization, from census to supply chain to lab turnaround times, and the tiles are completely configurable by the operator.

And then each tile can be set up for alerting. So if turnaround times. Increased beyond a, uh, level of acceptance. An operator would get a buzz in their pocket that says, Hey, you gotta go look at in, in the ed, or look at some something in supply chain because something's not going right. And so having that real time kind of tile based system was really, really important.

And then. The data also enabled us to create some great partnerships with some other companies. So I don't know if you, uh, are familiar with our relationship with Google during Covid, but we helped them create the, the, the, the overall national response system, which took data from us and included it with other types of

Healthcare systems in order to do even broader predictability. And then we worked with GE on their command center product, which not only gave us great kind of air, you're talking about dashboards, gave us some great air traffic control type of tiles. But the, but the, the, the, the residue of that benefit was that, that, that some of our data was being combined with other health systems so that we could get a better idea from

For instance, the state of Florida, to get a better idea of what the surge was doing on a broader scale by combining our data with others. You know, that's the, the, here's the thing that's fascinating to me about that, that you already mentioned eClinical work, so I'm gonna assume you're not on a single EHR from one end to the other.

In fact, you're probably pretty far from that. That nirvana if you from been able. Not only the EHR data, but probably a lot of other data sets, and create a, a really powerful and, and useful resource in that, in that data, instead of relying only on the EHR, you're able to create a, a more holistic view of, of what's going on, not only in your system, but in the communities that you serve.

You're, you're absolutely right. Now, now we're, we are fortunate that in the employed physician space, the majority. 90 plus percent of our physician practices use ECW. The majority of our hospitals, uh, use Meditech, but we have an epic presence inside of our hospitals. We have a Cerner presence. But to your point, the, the really sweet part of it all.

Is, it's all in this abstracted, uh, database. And today we're including things I mentioned, mobile heartbeat, and the, the communication platform that we have in the company. And the, the, the really, uh, cool thing is we are now taking data. From those text messages and including that in the warehouse as well, to see if we can see correlation between text message volume and outcomes.

And so the ability to take data from all the sources that, uh, that we're talking about is, it is really powerful. So I, given our time, I'm only really gonna have two questions left. I'm trying to figure out which I. Lemme see if I can squeeze these together here. So, carative distance reducing touchpoint.

We talked about chatbots, which is, which is one of those ways that we reduce the touch points. What are some other ways we, we reduce touch points in the, in the, the care workflow, in order to protect the, the caregivers and the patients? Well, I, I just would tell you that. It is. We were already in lots of different parts of the company making solid strides to improve the BA patient's digital journey.

But you, as you, as you're alluding to covid, kind of changes the game and, and we've gotta find a way to either, uh, limit or eliminate waiting rooms. We have to do our best to. Remove registration desk, we have to do our best to schedule at the convenience of the patient. And so the full digitization of the patient's journey is an obsession with us at ACA now and in in, in, in the middle of the summer, we decided instead of having one group focusing on digitizing the financial journey.

Versus a clinical journey versus an inpatient, versus an outpatient that we just bring the whole organization together. So the first time in my history here at the company, we have, uh, a team of, of more than a hundred technologists that are focused on a capability versus an kind of an organizational alignment.

So we have a team called the Patient Digital Journey, and, and their job is digitize it all. We wanna see ourselves digitizing, uh, driver's license insurance. We wanna make sure that we, uh, use messaging as a workflow. We want to. If you wanna come see, see us in an urgent care, we want you to, your waiting room should be your living room.

Yeah. And we should, based on traffic or whatever, go, Hey, we are ready to accept you. Once you're in our parking lot, text us that you're here and we will bring you into the urgent care. That's where, back to convenience and confidence for patients really matter. And so we're, I'm super excited. 35 years with a company, you can start to guess my age.

I'm quite the user of our healthcare system as well. And so, so I always look at this, Hey, this is what I want as a patient. This is how I wanna engage, uh, with the organization. And I'm just so excited that the CEO of the company feels exactly the same way. I would tell you that the, the digital journey for the patient is a top two or three technological

Priority for, for us at ATA. So actually we used to, when we said, Hey, we're bringing these teams together. We used to like fly 'em all into Nashville, put 'em in a room and have conversations. Um, but from a work, from home standpoint, you probably. They probably all are just meeting virtually. Is that essentially how you guys are, are doing it and are they coming in from all over the country or, or mostly Nashville?

Those type of, of of colleagues home. You, you're exactly right. We started to work from all different directions and all different teams. I mentioned the GE command Center. Well, using WebEx teams, we, we had a team room where we had engineers from GE and engineers from HCA from all over the country. Step by step and updating each other through that teamwork, uh, team room activity.

Know one of the funniest moments was someone in one of these team rooms one day says. Hey, I'm gonna schedule a meeting next Tuesday. And I was, I was being a little bit of a smart el, like, but I, I responded, what's a meeting? ? And, and my whole, my whole point was this is the meeting, this workflow that's going on in this team room is the meeting.

Yeah. And so if you got something to say, say it in here and let's get, let's get the work done. And so my biggest worry. Is, is actually burnout. I, I think our technologists, because of the mission, they just, they'll do anything early on. I usually get this report that says. That shows any of our colleagues that have worked more than 60 hours a week for three weeks in a row, because I wanna check in, see what's going on.

Well, I asked them to run the report back in May, and we had a dozen to two dozen employees that it wasn't 60, it was 80. I called, I called them up for a little 15 minute calls, and the same response happened time and time again. And that was back to them being healthcare professionals and, and they, and they say, look, I've always felt connected to the patient.

I realized this was my moment. I had to get that lab interface up. I had to get this body of work done, and I was gonna do whatever I had to do to get it done. And so one of the things that I'm trying to stress with our, our management team is stay connected to, to these great technologists and make sure that we're, we're, we're getting the work done and we're doing it in a mission motivated way, but that we're also staying healthy.

Yeah, it's uh, it's a different work environment and they, when you don't see 'em every day and you don't talk to 'em every day, they, they can get lost. And it, it's great that we're starting to see the management structures form around, around this, but you already had experience with it. I, here's Marty, first of all, thanks again for coming on.

This has been a great conversation. I, I, I wanna close with this question. What do you think the lasting impact of covid gonna be on your organization? I wish I had a dollar for every time I've turned to the organization and I've said I'm not going back. I am not going back to pre covid. And, and when I say that I, I, I'm really talking about, we, we've had this phrase, and I'm sure every other health system says the same thing, and we call it covid speed.

And that is. How do we, what we, what did we learn? How did we become so fast at everything? Well, some of it was what we just talked about, mission motivated, right? People who saw their moment, but that's not the sustainable part, obviously. But we also discovered the power of WebEx, the power of really using a team room to have activity moving all at one time and, and really staying in sync with each other.

I do think Covid speed is real, and it's gonna allow us to say, look, you can have a portfolio back to 375 projects, but which 50 of those projects are critical for the company's success? And are we willing. To commit, commit the resources and the money to optimally move those along. I can say for HCA, that lesson learned is, is the answer to that question is absolutely yes.

And so we're seeing ourselves stratify our portfolio so that we can really concentrate on the things that make the biggest difference and then, and then make it happen at the end of the day. I don't, I don't know what else to, to say about what we've learned, except that I feel like, at least at AC, and I'm sure many other people would say the same thing, that from a technology perspective, if we thought we felt close to the patient before, before Covid, we, we found a whole, whole new level.

Whether it's digital patient journey, whether it's telehealth, we, we, we found a new connection and. I, I mentioned earlier in our conversation today about our mission statement, and I just would sum up that, that we, it all comes back to being above all else, and I think for our organization, our commitment to.

Our clinicians and our patients and the rest of our colleagues has really been amplified by Covid and we're never giving it back. Yeah, that's, that's fantastic. Well, uh, Marty, again, thank you for your time and just taking the time to share your, your experience and, and your, your expertise with the community.

It's really appreciated. Bill, thank you very much for the invitation. I really enjoyed spending time with you. What a great conversation. That's all for this week. Don't forget to sign up for CliffNotes. It's a great way to support the show. It's also a great way for you to stay current. If you're not familiar, CliffNotes is an email that we send out immediately following the show, actually 24 hours after the show airs, and it'll have a summary of the show, bullet points, key moments from the show, and also one to four video clips that you could just watch.

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