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 Thanks for joining us on this week in Health IT Influence. My name is Bill Russell, former Healthcare CIO for 16 hospital system and creator of this week in Health it a channel dedicated to keeping Health IT staff current and engaged. Today we're joined by Reed Steffen. Reid is the CIO for St. Luke's out of Boise, Idaho, and he is a thoughtful leader, someone who I really appreciate and I learned a ton from, and I think you're gonna really enjoy this conversation.

Special thanks to our Influence show sponsors Sirius Healthcare and Health lyrics for choosing to invest in our mission to develop the next generation of health IT leaders. If you wanna be a part of our mission, you can become a show sponsor as well. The first step is to send an email to partner at this week in health it.com.

I ran into someone and they were asking me about my show. They are a new masters in Health Administration student, and we started having a conversation and I said, you know, we've recorded about 350 of these shows, and he was shocked. He asked me who I'd spoken with and I said, oh, you know, just CEOs of Providence and of Jefferson Health and CIOs from Cedar-Sinai Mayo.

Clinic, Cleveland Clinic, and just all these phenomenal organizations, all this phenomenal content. And he was just dumbfounded. He is like, I don't know how I'm gonna find time to listen to all these, all these episodes that I have so much to learn. And that was such an exciting, uh, moment for me to have that conversation with somebody to realize we have built up such a great amount of content that you can learn from and your team can learn from.

And we did the Covid series. We did so many great things, talked to so many . Brilliant people who are actively working in healthcare, in health. It addressing the biggest challenges that we have to face. We have all of those out on our website, obviously, and we've, we've put a search in there. Makes it very easy to find things.

All the stuff is curated really well. You can go out onto YouTube as well. You can actually pick out some episodes, share it with your team, have a conversation around those things. So we hope you'll take advantage of our website. Take advantage of our YouTube channel as well. Just a quick note before we get to our show.

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All right. Today we are joined by Reid Stefan, the CIO, for St. Luke's Health outta Boise, Idaho. Good afternoon, Reid. Welcome to the show. Yeah, thanks, bill. Good to see you and good to be here. Yeah. Actually, I guess we're, we're straddling the, uh, afternoon, morning. It's still morning your time as the, uh, people watching on the video are gonna see.

I. Any of the investment that happens within St. Luke's stays directly in the state of Idaho, and there's a lot of, of pride of community ownership and benefit that goes with that. So, so you're not outside of Idaho at all, you're just within the, the border, little bit of eastern Oregon and then southwest Idaho.

That's right. Wow. So, but you do, but you're the largest Idaho operated player. Obviously. You have, uh, Trinity's there, Intermountain's there. I think Providence is there as well. Yeah, but you're, you're the largest entity that's, that's Idaho based, correct. Wow. The largest private employer in the state. Wow.

So talk a little bit about, you know, so you guys, given, given your scope is, is it considered more, I mean, 'cause you have urban and rural, so Boise is considered urban, right? But you have an awful lot of rural, you have a lot of land in between some of the places you're talking about covering. Yeah, absolutely.

So we've got nice pockets of both. We've got three critical access hospitals. We have clinics that are in very rural settings, and so it, it really is kind of an interesting dynamic of meeting the needs of a, not just urban, but rapidly growing urban area. And so Boise in particular, the last couple of years, just really

Kind of overwhelming growth and just increases in the cost of living based on home values rising. So you've got that kind of pressure on one end and also like emerging. Entrance into the market who don't have any connection with St. Luke's, like any kind of generational or historical kind of tie to St.

Luke's. And now we've got this opportunity to capture kind of those minds and those lives as they come into the market. And then you've got these rural settings where. Their care needs and how we deliver that is just dramatically different than it is in an urban setting. So it really is kind of fascinating and, and fun to figure out how we provide for both ends and do it in a way that feels unified and harmonious.

Yeah. I'm, I'm, I'm gonna get way out of our swim lane already here, but I mean, when you have a digital strategy is the digital strategy for, for urban and rural different. Yeah, I, I think it certainly is. I think in an urban setting, you know, there's much more of a likelihood that those consumers are gonna have access to broadband coverage, cell coverage.

Some of our rural markets, you may not just have that, you may have dial up in home still, and so you've gotta figure out that kind of last mile, you know, how do we make sure they're not disadvantaged just based on where they geographically live? And so then you look at partnerships with companies to help extend that broadband connectivity.

I. Or to look at remote based care options that are maybe a combination of low tech and high tech to be able to meet the needs of the consumer and the patient, like where they live. Not fair to expect them to travel great distances or to potentially move somewhere just to have access to the, the healthcare that's offered in an urban setting.

So, so how did, how did you get into this role? How did you get to Boise and how did you get into this role as the, as the CIO? Yeah. Idaho native grew up in north Idaho, which is kind of the mecca of the state. Beautiful area. I went down to Moscow, to the University of Idaho and then outta school, settled in the Boise area where there were jobs, and I never, never set out to be ACIO.

Never set out to work in healthcare. I spent the first part of my career really doing high tech consulting. Spent about a decade at Hewlett Packard and when I was there, really got into cybersecurity, fell in love with it. Loved, I loved who I worked with. I loved what I did, but one night at dinner, about about 10 and a half years ago, my daughter was in kindergarten.

She came home and they had a school assignment to, you know, find out what your parents do for work and come back the next day and share it with the class . You could, and you couldn't explain it to her. Is that what Yeah. I kept like the Socratic method of, I could explain kind of what I did to a, a high level.

She kept asking me why like, okay dad, that's what you do, but why do you do it? And it kind of left me haunted realizing, you know, and this isn't a knock on hp, great company, you know, great philanthropy, great history and legacy, but a lot of what I did day to day was focus on a 90 day view of how do we make changes to bump up the stock price at the next shareholder's earning report.

So I left that conversation and talked to my wife and said, you know, again, I love, I love what I do. I love who I do it with. I really wanna love why I do it. And so, looked around, I'd actually consulted at St. Luke's years prior during the Y two K. Work that was prevalent and they had an opening for security manager and applied for it was hired, this was, uh, a little over 10 years ago, the first dedicated cybersecurity position in the health system.

So this incredible opportunity to build and grow a program from the ground up with a company that had a big enough scale and size to, to make it meaningful. And, you know, bill, you've, you've had career kind of twists and turns. There was just opportunities along the way that opened up, and as I pursued them, one thing led to another, and before I knew it, I'd left a.

A very comfortable setting in the cyber world as the ciso because I could, I could go to any place in the system, meet with any group of people and feel like, you know, I know as much, if not more than they do about cybersecurity. And then I went to a situation that was drastically different. And in most meetings I was in, I realized I know less than anybody else around this table about this topic that we're discussing.

And that's both, you know, exciting and terrifying at the same time. But it's those growth opportunities that I think really . Add to a rich and meaningful career. This is, this is probably the first time I'm gonna admit this on a show, but I, I still remember that first year I used to, I used to meet with a group of men every Friday morning outside of work, and they said, you know, how's working, going?

And I'm like, I've never been so out of my depth in my life. And this is, I'm, I'm 46, 47, very accomplished. I've done a lot of things. They're like, what do you mean? I mean, you're, you're for.

I, I, I'm taking notes. I run outta that meeting and I do tons of research. I call people, it's like, what does this mean? What's this word? What's this surgery? What's this? And I'm like, I, I just feel like, I feel like a little kid who's in charge of running something because there's just so much to learn. It was, it was kind of, it, it really was overwhelming that first year.

Yeah, that's fascinating and I totally relate to how you describe that, but I think, you know, it's, it's maybe a better leader. Like it's, it's, it's kept me hungry and it's kept me vulnerable and I think kept me authentic and so as, as uncomfortable it is at times I've recognized a great value that kind of an experience provides to and refine you as a professional.

Well actually, you know, it's interesting. I think you're the first person I. Who's gone the security route to the, to the CIO seat? I'm trying to think through all the people we've interviewed at this point. I can't remember anyone who really had a cyber background. And, and it, it's, it's really interesting.

So you come in, you have to establish the foundations for a SI cyber program, but you also step into ACIO role. Talk about that. The, the steps you have to take when you first to really establish the right environment, establish the right. Mechanisms culture and the things that you're looking for. Yeah.

Yeah. Happy to. And I, I think that as I look back on my career, I remember right outta school, like I've worked with some really brilliant technologists and people that I recognize that no matter how hard I study, no matter how hard I apply myself. I'm just, I have some internal deficiencies. I'm never going to be kind of at that level, but what I found is kind of a, an ability that I was, I've been able to develop and refine over time with great help from others is, you know, I have

An acumen for, for building high performing teams, and I enjoy doing it. And so when I started in the, in the, the, the CISO role, like building a team around me from scratch, it was really interesting to be able to apply like all of these lessons I filed the way over the years of, you know, what I would do if I were going to start over with something.

And so I really placed a premium on cultural fit. On kind of similar mindset and approach for, for how you, how you do the work and organize it and operationalize it. Certainly you have to have aptitude, but man, if you don't have some of those core foundational personality, I. Interlocking pieces in place, it makes everything else so much harder and some of the acumen, the technical skills, much easier to grow and develop that in people than more of the, the soft skills.

So I, I did that I think to a successful degree with the cyber team here at St. Luke's. And so one of the things that I kind of wondered was, you know, that's a team of 15 people. With that kind of scale to a larger, larger organization. So as I progressed through different roles within the IT department here, it went from that to a group of a couple hundred, and then now an IT department of about 450.

What I found in both of these situations when I would come into new roles. You have to do some honest assessment of just the culture. And again, the, you think of Jim Collins, good to great, do I have the right people on the bus and are, are they on the right seats? And what I found is a lot of leaders are reluctant to, to address that.

They'd much rather kind of dive in and figure out their disaster recovery strategy and. Really kind of hone in on that. I've got smart people that will do that in spades all day long if I surround them with the right team and the right structure to get the best out of them. So that involves when you first come into a situation like this, honest assessment, having hard conversations, potentially moving people's cheese, uh, changing roles.

There were exits out of the organization. But what I, what I observed from that though is people came forward and they're like. It's so nice to feel like there's a leader now that that kind of caress and, and gets this, because for the longest time, you know, I've watched this dysfunction or whatever it might be transpire, and I thought, can no one else see this?

And if, if they don't see it, then they don't care. You know, how much should I care be kind of vested in this. So those, those conversations can be grueling and difficult, but the fruit from it, it's, you know, it can have a. A multi-month or year impact on the culture of your organization? So I always start there is assessing the culture and then not being afraid to make the changes to usher in the kind of culture and the, the unity that you need.

It's, it's interesting, there's this aspect of wanting to be liked and I, I've heard majors say, well, you know, I don't problem.

But, you know, we, we all have this aspect of wanting to be like, but the reality is if we don't address some of those hard things, I, I, I, I remember when, when we made some moves in the, in the management ranks, some of the people from that were reporting into them, just like unsolicited would walk in and say thank you.

And it's, it's, thank you for recognizing that this is really a stifling environment. I wasn't able to really do what I wanted to do, and, and the team wasn't effective. That's really the, the role of the person at the top is to make sure that all those teams are really high functioning teams and that means the right culture, the right leadership, and the right really framework for getting work accomplished.

Yep, exactly. Well, I, yeah, that wasn't a question. I'm, I'm supposed to be asking questions, so lemme go back to that. What, what are some of the signposts that you have, the right culture that, that, that you're trying to develop? Yeah, I think a, I think a couple of things. One is. I'm always big on kind of assessing and querying, whether it's a survey or some other kind of vehicle, but my immediate kind of a team, so my extended leadership team and really giving them, making sure they feel like safe to be as candid and open as they as they can be.

And so things that, that I would hear that would let me know one way or the other that we're on the right track. If I hear people saying. I'm afraid to speak up in a meeting or, you know, I don't feel like there's the right kind of level of trust we need within this, this group. Like those are huge red flags that, okay, we've gotta, gotta hit this head on the other side of that coin to me looks like this.

And I'll have people say, you know, this is the highest performing leadership team that I've ever been a part of. I genuinely look forward to the time we spend together. Uh, I look for opportunities to work with and interact with my peers rather than kind of run from it because the time we spend together, it's, it fills my cup, you know, it's got this, I.

Izing effect on me, and it brings out the best in me. So I think when you start to hear those things at kind of the executive leadership team level, that's a huge indicator. And then I think you start to hear anecdotally, and you have gotta, you have to make the effort to, to solicit the information. So I have a series of weekly, uh, small group meetings where I invite 15 to 20 folks in the department.

We meet together virtually now, and it's just an open forum. And you can draw some really interesting insights into, is that culture kind of trickling down, uh, to the organization to the degree that you would hope and want? Or are there kind of gaps in pockets that are, that are happening? But from that group, I'll hear things like, you know, I feel, I feel like I have permission.

I feel like the work I wanna do here, it's, it's safe, it's celebrated, it's encouraged. I don't feel micromanaged. You know, I don't feel like I'm gonna get my hand slapped if I take a, uh, reasonable risk to try something new. So I think those are the things you start to hear that indicate, uh, this is a culture that, that people are attracted to.

And then you can see kind of a metrics. We have a pretty low attrition rate, which I take great pride in, especially this day and age when. There's, there's opportunities, and we know in healthcare there's technology operations outside of healthcare that financially are more lucrative. And we have folks that are like, you know, I understand that, but I also understand that it's more than just the dollars on my paycheck, like there's the hidden paycheck.

That's a part of the work that I do and that's compelling to me and keeps me here. I, you know, I would imagine St. Luke's a little bit like St. Joe's in Southern California. I mean, the sisters came into that community, established a, a, you know, a mission and, and did that whole thing there. There was a certain amount when you're in the community and talking to people, they'd say, yeah, I was born in that hospital.

Yeah, I, you know, I, in, in the various, I mean, you're just such a part of the community

there. In and of itself is, is really great. Yeah, that's that's a great point. And absolutely, and like even personally for me, two of my children were born here at St. Luke's. Uh, my father and stepmother both passed away inside the walls of a St. Luke's facility. So you've got these incredibly impactful bookend events and mortality.

What other industry organization could have that kind of a heart to mind connection for you as an employee? None. And so that's. It's hugely compelling. So I, I'm always curious with CIOs, 'cause when I was in the role, I felt like the, the role was big and, and every time I have conversations and we do, you know, two of these interviews a week, that the role sounds like it's getting bigger and bigger and encompassing more things.

How do you determine what you're gonna do in that every week? I mean, what, what sets your priorities as a leader and, and, and what, you know, what are the drivers that are setting the agenda right now for the CIO? Yeah, well, like everyone else, for the last year, you know, COVID has been kind of a firm hand on the rudder of where we're steering.

We're starting to see that relax a little bit and a little more kind of personal choice come into to the work we're doing. I, I think for us, we're really driven by this idea of experience. Trying to enhance that, that experience, whether it's a clinician, an employee, a patient, a family member inside the hospital, outside.

So for me personally, what kind of drives the agenda, what we focus on is looking at. Just kind of instinctively whether we hear it directly from surveys we've done, whether we hear it from people in the community, what are those things that we're just missing the mark on in terms of experience? And when you start to look at it that way, it's a pretty target rich environment.

And so you look at, you know, we talk about digital so much nowadays. There's tremendous opportunity to improve that experience when you compare a, a healthcare digital experience, and I'm speaking for St. Luke's. Compared to what someone experiences in finance or banking or retail or travel, you start to see some pretty wide variation and opportunity.

So that that is really kind of the lens we look through to kind of hone in and get the clarity of what we should, we should focus on, and it, it's very easy at that point then to tie that back to the system strategic objectives that are in place. That are supporting, supporting pillars to then accelerate that work and sequence it and prioritize it in the right way.

You know, one of the beautiful things about working in healthcare at an organization we just talked about is people coming off and going, yeah, you know, I love that you work there, great event. But the downside is you go to a party and you say, yeah, I work at. You know, St. Luke's or I work at St. Joe's and they go, oh, let me tell you what happened to me.

Yep. I went to schedule an appointment. I couldn't do it through the digital tool because of da da. Then I called to talk. So you get all those stories. Yeah. And that's funny because that was new to me when I joined healthcare. But people, when you tell people that you were for St. Luke's. They automatically assume that somehow you, they have the authority to change anything from clinical practice to the billing practice, to the scheduling.

So I, I kind of cringed initially because I would have those experiences when people would, they'd share good things, but they'd also would share kind of pain points. But I've come to like really embrace those. I mean, they're a, a wealth of perspective and insight and so I'm, I'm always very inquisitive and I really try and draw out the details from people when they wanna share those with me because it's a gift.

But yeah, I, I know what you're talking about. Yeah. And, and one of the most innovative people I had would actually, uh, do handshake agreements with some of the patients where he, he was a technologist who worked for me, and he would follow the patients throughout their day and he would just talk to 'em and, you know, and they looked down and they couldn't find their next appointment, and they were looking at the signage and he made, he made suggestions for all sort of changes.

He all. I'm like, how did you get your day job done? Like, we're paying you to do it. He goes, no, you're paying me to build a better experience using digital tools. He goes, now, sometimes those tools are just signs on a wall that are better marked. But, but yeah, it was just interesting. I mean, they're listening, listening and getting that.

Are there different ways that you're getting that information out of the community of what experiences they're looking for? Yeah, and it's, it was slow down a bit by Covid because of some of the. Restrictions in terms of, you know, visitation. But what we've aligned on is this, this idea that we call go to Cambodia, and it's attached to Christopher Charles, who was the kind of the thought genius behind the, the lucky iron fish, which is the, the iron init fish that you drop into your, your pot you're cooking in, and it's a natural source of iron in your diet.

Well, he came across that . That hypothesis and proved it out when he was in Cambodia doing his research study. He could have stayed in Canada to do the study, but he wanted to immerse himself in, in the country and the culture and the people, and then came across this incredible opportunity. So we, we have that mindset here is we call the three Cs of design disease.

If all you know about the consumer or the end user and their experience. If all you know is gleaned from a conference room, a conference call, or a cubicle, you might understand the functional needs of what they're after, but you're missing kind of the social and the emotional context that might really be the driver to truly innovate or truly meet their needs in a way that they embrace.

So we're all about telling people. Just go and observe like you think. You understand how people are using the solution today, but you're probably wrong. So spend some, spend some time. Just sit and observe. Watch how they're using it. Ask questions. Be curious. Ask like what questions. Don't ask people why they're doing something, because sometimes they can feel like they have to defend what they're doing.

Ask them what? Like, I noticed you doing this. What's the reason that you do it that way, or what's good about that? And that's been a concept that's resonated powerfully in our department. It's great to get people kind of out of their normal setting and out into various backdrops to kind of better understand how technology they support truly is used and a clinical or in a patient environment.

But it also helps us identify areas of non-consumption because sometimes people just struggle and they don't even think to ask for a better way. 'cause they just think this is the way it is. You know, it's just the tedious part of my job and I'm just going to suck it up and live with it. But if we're there watching, we can sometimes help identify opportunities that a clinician or a patient or a consumer wouldn't even know to ask for.

Again, I'm, I'm gonna go off-roading here, but is the tool set there? I mean, do we have the right tool sets yet that we can hear something like this and be pretty responsive and just tweak, you know, this system or tweak this digital tool? And specifically I'm talking about the consumer experience more than the clinic, but I could be talking about the clinician.

Do we, do we have the tools that we can tweak? I think yes and no. I think it's very situationally dependent. One of the, one of the principles that we're, we're advocating for, and really I. Promoting is, is not having people get tripped up with a false notion of innovation. So innovation doesn't have to be a moonshot, right?

It doesn't have to be something like, you know, Elon Musk worthy is kind of a phrase we use. Innovation is simply doing something that you have never done before. It doesn't mean that no one else hasn't done it, doesn't mean they haven't been doing it for years. But if it's new to you and if it fundamentally improves and enhances the experience.

In my book that by definition is innovation, and so we find opportunities like that where there are quick wins, there are things that we can do relatively simply, relatively quickly, and it's a great satisfier. Then for that person on the other end. We're now working through the process of. Having some more rigor around the methodology and rolling out a, a proof of concept.

This summer, I'm gonna convene a group of six VPs who are kind of like fast movers, innovative thinkers, get a core group together using a tool. To help have an intake engine for ideas around innovation and also give us a way to put out challenges for the organization of problems that we recognize at the executive level, that we want to really solicit ideas and input, uh, from frontline staff.

So I think in the course of that, I think you find those things that are kind of quick knobs. You can just kind of dial in, but you'll also identify those things that maybe are, are much broader, much more complex, uh, much more time intensive. But as you do both, I think it's, it creates a groundswell on a rising tide that benefits everyone involved.

All ri So there's, there's business priorities. You know, we talked about the experience priorities and those kind of things, but there's also IT priorities. How do you ensure that you're addressing both? Yeah, I mean, you have. You have those, those experience, but you also have tech debt, you have automation, you have new, new stuff coming in all the time and, and EHR upgrades and whatnot.

How do you, how do you balance those? Yeah, I think I'll answer that kind of two ways, and maybe I'll start with kind of a more tactical, just day to day. And then the second answer will be kind of how I personally, you know, choose to approach it. So we, you know, we carve out and we've conveyed to the organization like.

Just by virtue of St. Luke's being open for business, you know there's a baseline operational cost to that. These are a percentage of our, of our capacity of hours we have in a given year that it's untouchable. I. It's what allows us to make sure that our data center is functioning at a, a high reliability, uh, level.

It's what allows us to do break fix in a timely manner. It's what allows us to ensure that we've got good cybersecurity practices and hygiene in place that we're keeping current on our systems. Refreshing TechNet, to your point, these are things that. Can't ever be on the chopping block when it comes to prioritization or what we're gonna do and not do when we draw a line.

And so that's, that's worked fairly effectively just to ensure that we don't ever lose ground with things that we know foundationally have to be in place to operate as a health system. That then leaves us with a bucket of, of, uh, hours of time then that we can use for. System directed kind of operational initiatives and desires.

It is we're, we're evolving our maturity in this space. You know, we've got a robust intake process now, and we're really going through the idea of sequencing and prioritization. What's been great about the silver lining of Covid is for the first time ever, about a year ago, we did what we always talk about doing.

Like we said, no to things. We stopped things, we delayed things, and we focus on. These most critical elements that we knew we had to get right in a short span of time. Remote work, virtual visits. Safety practices within the walls of the hospital. And we delivered and executed as a system in a way we never have before.

And my, my goal now is to make sure that that incredible lesson is not lost. And I'm starting to already hear kind of some of the, the murmurs of, okay, great things are kind of starting to subside now. All this work, we're gonna kind of bring it back in. And if we do that and treat everything like it's important.

Nothing will be. And we'll kind of spin our wheels in spots where we have previously, and those ruts will just quickly become apparent again on the kind of the landscape. So it's uh, it's an ongoing process. We carve out a. Our operational capacity. We need to kinda keep the, the plane flying and then we continue to interact and talk with the business business and try and have a really mature, robust way to truly, uh, measure and assess priorities and sequence the work and support it with the resources it needs in a way that's, that's scalable.

Personally for me, I. I trust my lieutenants, like I take a lot of my lead from them and what they're kind of feeling and seeing and directing. I get asked on occasion, you know, what are the things that keep you up at night? And it's not, it's not a cyber breach. It's not, is Epic gonna go down? It's not, is our network gonna have an interruption?

Not that I don't, those things certainly occupy space in my mind, but I've got experts that they're up at night worrying about that. And so me staying up at night worrying about that. Doesn't add any value and actually probably is a disservice to them because then I'm not focused on those things that, that I really need to be doing, which is ensuring that they have the tools and resources they need, that they feel safe in their work, that they feel they have permission to make decisions, that they have the right budget to do their work.

I. That they're recognized and rewarded for the work they're doing. So in that regard, like I feel like the way I answer what I do personally to answer your question is, is I wake up every day working for these 450 people in my department because as they do the best work they can do, some of those things solve for themselves and I get great data and input from them that then arms me to have good conversations in the meetings I'm in.

Yeah, that's such, that's such a great answer.

Actually building off of that, you, you talked about the silver linings of Covid in terms of priority setting and that kinda stuff, but are, are there other key learnings that we have found moving through the pandemic or, or silver linings as you, as you refer to 'em? Yeah, I think so. And this is, you know, I'm, I'm gonna be repetitive.

I'm, I listen to your podcast. This is nothing new. But I think it helps just to reinforce. So for us, you know, we've learned that we can do remote work at a larger scale than we realize, and I think that's gonna be a benefit from a retention and a, an attraction standpoint. As an employer, I. I think personally for me, when I do these weekly kind of small group meetings, I talked about that is the number one question that is always asked is, Hey, when do I have to come back to the office?

What does that look like? And it's, it's interesting because there was never a mandate that people had to work from home. I. You know, we're critical infrastructure, so that was never a requirement. There's not gonna be this date we set when it's like, Hey, back in the office now. But I think that we'll align on this, and maybe not out of the gate, but my vision is we align on this future state where, you know, we really treat our employees like the professionals they are, you know, they understand the work they need to accomplish the outcomes expected of them.

We can give them and their leaders the space to then kind of manage what that looks like and not be overly prescriptive about when and where people are working. And I we're having really great dialogue internally about this and what a playbook looks like with HR and others and legal. I'm of the opinion of I want to trust people.

And yeah, you'll have some outliers and bad actors along the way, but you deal with those. I would rather be occasionally disappointed. Then continually suspicious. And so that's kind of my mindset is the majority of our staff are high functioning and they're gonna do great. Let's treat 'em that way. The results we're gonna get in return are gonna more than offset any of the wrinkles we've gotta, we have to smooth out.

So that's one. Uh, and telehealth is the other one I would highlight. We have really accelerated what we've done in that space, which has been super exciting for our team because we've had these tools for years and just haven't had the the right momentum or push to kind of get some of them off the ground.

And Covid has introduced that I. The communities responded. You know, there was great, certainly in the early days of covid wide adoption and great use of, of telehealth, it's, it's declined a bit because people do like that in-person experience, but I think we'll now have that at a baseline level that would've taken us so much longer to get to, and now we can kind of build on that and we've got a, a kind of a case study of data that we can rely on to help move the needle even further in that space.

Yeah, I, I mean, again, uh, great answers. I have so many more questions I wanna get to that. I, I don't wanna build off the, uh, questions I just asked. Let me ask you about partnerships, and I'm gonna leave this purposefully broad. What, what interesting partnerships are you exploring or, or, or do you have going on right now?

And the reason I.

I'm more curious about, you know, something that we wouldn't normally recognize as a, uh, traditional approach. Yeah. And maybe this isn't, kind of, doesn't address that, that last statement super acutely, but for me, when I think about the partnerships, I, you know, I have curated and I try and really cultivate a deep connection of, of peers.

In healthcare and outside of healthcare, both in the CIO role and CISO and others. So for me, when I think of partnership, my mind always goes there before I start to think about kind of vendor, uh, partnerships and collaborative opportunities. And I think that's important because, and this is me, but I, I don't have a ton of like original, you know, lightning in a bottle kind of thoughts.

I'm sure it's happened in my career, but I don't have a bunch that kind of come to mind that I can refer to. I have several experiences where I've been talking with somebody and they've kind of shared something they're doing and their inspiration then kind of superchargers mine and so I've, I. I've, I've gleaned great value from being a fast follower.

And so when I think about partnerships, it's folks in other organizations and having regular touch bases with them, sharing things we're doing, hearing from them. And in the course of that, a lot of ideas and genesis of, of inspiration come. So that's kind of my first reaction to that question is I, I, I think any CIO should be actively

Curating and cultivating kind of a virtual Rolodex of peers that they can just bounce ideas off of, share best practices, sometimes just vent to, there's tremendous value in that. When I think about more traditional kind of vendor partnerships, you know, I think voice recognition is really compelling.

Opportunity for us going forward, especially kinda the ambient listening space. So really interested in the the Microsoft acquisition of Nuance that was announced yesterday and kind of what that's gonna mean 'cause we're partners with both, but actively looking at ways that we can better leverage those capabilities to improve the experience for the provider.

Because the number one concern I hear from providers, especially in our clinics is, you know, the worst thing that I do is I turn to the side to type in the computer and I still try and like maintain a peripheral vision with the patient. But it just, it feels so impersonal and it feels, I. It impedes with what I'm trying to do there in terms of the relationship and really seeing them and hearing them and understanding them.

So if you can take that, that experience away of having to turn and type on the keyboard and just have it, the ambient experience, capture all that, and then I. The intelligence built in to where the doctor has to do very little kind of modification. They just simply sign it. I mean, that's huge to me. Like I just, if I were a doctor, I would be all in on that kind of a, of a patient experience.

You know, we use one of the most cutting edge platforms for transcription for these episodes, and

it. Maybe 3% error rate, maybe, maybe even 2%. I mean, it's really good. I mean, from where I sit little correct.

Highlight high, but still 2% in healthcare. Yeah. That's, that's a big number. Yeah. Yep. And that, that kind of a number is, is not gonna fly. And so we're working with, with nuances set up a little like a demo room here on our floor. We've got an innovation lab where we can bring doctors through and let them experience that ambient kind of workflow.

Firsthand, but then also provide, I think, good feedback to, to nuance on ways that they can further reduce and, and fine tune their product. So that number gets to zero and it just works. Yeah, it's, it's, it's not like theory when I try and talk to it and, you know, it's an argument at the end of it. It's interesting, somebody asked me about the acquisition yesterday, like, you think this is good for healthcare?

I'm like, it's healthcare. And reason I healthcare is.

All the clinical vocabularies that they needed to develop and they were just doing them one at a time. Well, I, I think they just got access to a, uh, very wealthy grandfather who might help them to develop that a little faster. Yeah, totally agree. Like it's, it's good for healthcare. Like it all works together in a weird way.

It's, I feel like I get a little more bang from my buck in our Microsoft EA renewal and we write that huge check now that it's a little, just a tiny bit more palatable, not fully. But then it, you know, it supports the hello Epic as that functionality kind of comes out. So it it is, it is. There is some nice interconnections there that will benefit the community.

Yeah. It's, uh, I I'm not gonna push you anymore on that. I, uh, the, the Microsoft Agreement back in the day when I was doing it was one of the hardest to sign. Yeah. I just looked at it and money talking 20 users. Whatever the number is and it just, it's, it's a big number. Alright, let's talk about priorities.

2020 one's here, pandemic isn't in the rear view mirror yet, but as you know, as we're talking, you know, we're getting to the point where we're, we're getting pretty close to 200 million shots and arms at this point across the, uh, across the.

Yeah, so there's a couple things that come to mind and I, I totally agree with how you kind of characterize that. Like, we recognize we're still in a pandemic, however, we recognize that, to your point, it's getting better every day. So we don't wanna suddenly react, you know, four months from now, whenever it is.

Like, we wanna start to kind of jog into that, that entry point and be able to start running digital front door is a hugely important topic that's, that's on our radar and that we're focused on. That's been, and we've talked about it for a few years, but again, the, the experience with Covid has kind of brought it front and center and in particular in the eyes of our executives the last few months as we've tried to, like everyone else respond to the, the vaccine workflow needs, standing up, clinics adapting to, kind of shifting guidance from our local state government.

We've had to be agile and have recognized that. And Epic is a great partner, but we have, at this point, they completely own that digital front door experience with our consumers. You know, we use the stock MyChart application, which while functional, we found that there was some unique needs we had, and the ability to kind of modify the app to meet those needs, uh, in a timely manner was, was impossible.

And even sometimes a couple of things like just changing some text in a few of the screens, which you would think, you know, like on a website, you should be able to change the text, push it, and be good. Well, no, we'd have to reboot all of our MyChart servers, which is a, you don't just go and do that.

That's like a 24 hour kind of a cycle thing because you gotta do this drains drop approach where you stop all sessions on one server and once everyone's logged off, you reboot it. Then the next one, then the next one. So like it just became a. An opportunity to recognize that we need to be a little more deliberate about charting our course and and likely developing an app that kind of provides that front door experience.

So we control that and we are the one that are interacting with our community and their needs. That we know and should know better than Epic, and we would never expect Epic to know them or to tailor a tool meant for a broad population to our unique needs. So excited about that, that that work is, is actively underway.

And then really looking a lot of, of our PA kind of opportunities, we have a lot of excitement from finance and revenue cycle in this space. They feel like there's, there's so many processes today that they're doing that are manual and repetitive. So it's time intensive. It's costly, it introduces human error.

And so super excited about the, the interest and the lean in from those, those leaders to look at ways to start to use RPA in a very meaningful way that delivers operational benefit, but also bottom line benefit. Yeah. R gonna be interesting.

I actually asked the question, is there a question I haven't asked? Is there something that, you know, there's a, a topic or something that you're either surprised I didn't ask or that you think, hey, this the, the community would benefit from talking about this? Yeah, it's not something I'm surprised you didn't ask and I guess I'm not quite sure how I wanna approach this.

I'm just gonna kind of, I'm just gonna start talking and then, you know, you can edit this with your magic. This last year has been really fascinating. Kind of a human experiment, observational opportunity in particular around Covid. So generally people that are your friends, people that you interact with on a regular basis.

You're fairly aligned on your life perspective, how you kind of view things and assess things. And this year, more than any ever other has kind of introduced this. It's not really a rift, but just kind of, you know, showing that there's a little bit of separation in how people think and in particular when it comes to, to covid the virus, the vaccine.

And it's been, I, I've had a lot of conversations with people about this because I. You know, I talked to our CMO and really respect him, and he shares that he's like a hundred years ago, the average life expectancy was in the mid forties. In the a hundred years since then, he's like 30 years have been added to that average life expectancy, and he says, we've done that through public health initiatives and through medical science.

And yet right now in this very hour of need, those two things will help us get through this pandemic and continue to improve and expand on the length and quality of life people are turning away from based on. Bad science based on conspiracy theories. And so what's been personally interesting to me is watching that come into like my circle of close friends and acquaintances where I, I never would've thought people would, would believe some of the things they do.

So I have a friend who was sharing that his son right now is doing a research paper about how mRNA vaccines are not safe and not effective. And he's telling me how his son has 11 pages of, of references. He is found already and we're kind of talking through it. And I left there realizing, and his son is in high school.

He is a, I think he's a, a sophomore. And so he is, he is banking more on his, his sophomore son's perspective and these internet website articles. Then like a licensed . Certified respected medical professional, and I just, I think we need to talk about that because it's, it's not unique and I think within our department, we likely have these kind of different viewpoints on this as well.

And I think it's gonna be an interesting journey to navigate going forward because that, that potential misalignment or kind of a different viewpoint. It, it could be something that, that erodes culture. It could be something that causes contention and friction that is counter, uh, to what we're trying to accomplish as a team.

So I'm just mindful of that and wanna make sure that, um, again, I'm not talking about group think or forcing ideas on people, but how do we talk about this in a way that's not combative, that doesn't try and have either side trying to win based on their position, but just. Open conversation and kind of finding that middle ground where we can accept the different viewpoints, but still be united in our purpose.

You know, you you, this is a, a great topic. I mean the, the, it's impossible for me not to say anything at this point. If, if that's alright. Yeah. The, you know, I'm, I'm looking, I'm getting ready to prepare for. And tomorrow, tomorrow or Friday, we'll be on, uh, covid and vaccine update. And the, the biggest story right now is why Mississippi has fewer takers for 73,000 covid shots.

And you go to the next story, vaccine supply increases all demand falters in Ohio. You go to the next story and it's. 19 vaccine supply starting to exceed demand in Fargo. And by the way, there's six of these, I mean, you know, state supplies of the Covid vaccine are now being sent, sent to primary care doctors because supply outpaces demand.

And same thing in Kentucky, we're seeing this and, and this is just, you know, there's, there's people that are, that are making decisions based on, on politics. They're making decision based on. Now there's people making decisions based on history. We have, we have populations of people that have not been treated well by the, by the healthcare community over mm-hmm, over the, over the years.

And that has, that has really saturated that culture. And we have some work to do there. And, and so, and then there's, there's people that have, uh, concerns around vaccinations and those kind of things. But I think that group has actually grown Yeah, as a result of the pandemic, which is really interesting.

But I, you know, rather than go down that path, I will say this, I think it's more important today than ever to. Remind yourself of why you like these people and why you respect these people. I have people that I vehemently disagree on a lot of things that are are happening like Vaccine Passport and a couple of my ongoing guests on the news show.

We're just on completely polar opposite sides of that. Yeah. But at the end of the day, I respect who they are. I respect their opinion, how they gotta that opinion, and I respect the work they do in healthcare. And so I, I'm not just gonna shut 'em off and say, because you believe that, I can't listen to you on any other topic, because that would just be that it's, it's, it's somehow we have to re maintain Yeah.

And re rebuild the lines of communication. That's exactly right. That diversity of thought can actually make us stronger and better. To your point, I just wanna make sure it doesn't become divisive and so that, that just occupies some thoughts in my mind. Thanks for bringing that up. I, you know, to be honest with you, I normally wouldn't bring that up with ACIO 'cause I don't wanna put you in that spot to talk about this stuff.

Yeah. So, well, I introduced it, so There you go, . Well, I appreciate it. Thanks. Thanks,

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