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The 229 Podcast: Leveraging DevOps for an Innovation Startup and Crisis Leadership with Jim Feen

Jim Feen - Southcoast Health: why is it that we only do planned downtimes on the third shift? You know, shouldn't we be thinking about exposing some of those things to the first and second?

And so yeah, it did happen as a surprise. We called a full emergency operations plan and opened a command center and we were offline that morning for two hours and simulated a full ransomware event

Bill Russell: My name is Bill Russell. I'm a former health system, CIO, and creator of this Week Health, where our mission is to transform healthcare one connection at a time. Welcome to the 2 29 Podcast where we continue the conversations happening at our events with the leaders who are shaping healthcare.

Let's jump into today's conversation.

Alright, it's the 2 29 podcast and today I am joined by Jim Fee, the Chief Digital and Information Officer at Southcoast Health. in is it mostly Massachusetts or do you guys go over, over state lines?

Bill Russell: Well, hey, by the way, welcome to the show.

Jim Feen - Southcoast Health: Thank you. Thank good to be here. Glad to be with you.

Bill Russell: That's usually how it goes. I mean, we were talking a minute ago. I was. You know, as I was doing research the crazy thing now is we used to say that the internet has memory, like, don't do anything or put it on the internet. 'cause it, it lasts forever. you know what the tool that we have now is AI that finds all that stuff. And so it was I was kind of surprised to learn about your early career and some of the stuff.

Jim Feen - Southcoast Health: Yeah,

know you, you spent a decade with Meditech.

it did.

Bill Russell: That's interesting. I thought the irony of being with Meditech for a decade and then, leading the epic migration for your health system, I thought that was interesting.

I'm curious about that. I mean, I mean, you knew Meditech very well. I mean the concepts really do work. Like if you're a CIO for Meditech, you could be a CIO for Epic. You just have

Jim Feen - Southcoast Health: Yes.

Bill Russell: learn the modules. 'cause the workflow is the workflow, right?

you know, how you work between those two, you know, well-respected companies is not dissimilar at all. The extensibility is where there's differences. But yeah, I tell you there's a lot of commonality there. And it's interesting, it was interesting to, to share a city with Meditech, a company I worked for as long as you said, and have high respect for, but at the same time, you know, had to come to the decision that we did.

She's 12, 12 years ago now to make the big switch.

Bill Russell: most of Boston is on, I'm trying to think through it. I mean, there, there's a couple Meditech clients there, but most of the Boston the larger Boston Health systems are on epic now. Right.

Jim Feen - Southcoast Health: Yeah. A lot of change there. Yep, for sure.

Like what are we talking about here in terms of this, share the story and to give us some of the background.

Jim Feen - Southcoast Health: How did I get into this craziness?

Bill Russell: Yeah.

Jim Feen - Southcoast Health: It was, she's 19 96, 97, 98. In that timeframe, trying to figure out what the heck I was gonna do. I was in business school with a focus in management, psychology and computer science. And if you had, you know, told me to fast forward and say that I'd be doing what I was doing in healthcare, I'd say you're crazy.

But I ended up. I working as a unit coordinator at a busy, city hospital in, in north central Massachusetts. And again, eyes wide open, years pinned back trying to figure out what the heck does a unit coordinator do in a busy ed. And, got assigned the third shift, having to work with a great crew up there, in the nineties and in, in working on an old mainframe.

And I'd literally be doing what you found online running downstairs into a basement, trying to find a medical record as a, you know, a, you know, critical case is coming through the door. And to say my, you know, I couldn't feel my heart pumping outta my chest as you're trying to find.

Those things in real time, in the dark and sign charts out and then run back upstairs and try and make sense of what was being asked of you, you know, as a 18, 19, 20-year-old. That was intense. And, that, that it was that experience that led me to start asking questions. There's gotta, there's gotta be a better way to do these things or there's gotta be more advances that I was a kid ex exposed to.

And of course that led to my time at Meditech and I had no idea that company existed in Massachusetts and led to a lot of great experiences that I had with them.

Jim Feen - Southcoast Health: Gotten a hundred percent all the time.

Bill Russell: give, gimme an example most recently where you thought, man, there, we have to be able to do this better. There has to be a better way to do this.

Jim Feen - Southcoast Health: Yeah, bill. Honestly, I don't, I, for any of my colleagues out there that are listening to this, we don't, there's not a day that goes by, especially now where you're not faced with that, whether you say it out loud or say it, you know, with your inside voice. That was today, you know, this morning I was listening to a gray presentation by, a clinician from our medicine group was talking about advancing healthcare proxies and, you know, that huge gap that always exists for proxies and agents. And, you know, talking about not being able to see healthcare proxies from other organizations when there's a, you know, a inpatient transfer or, you know, not having those things that are coming in through the patient portal.

Mm-hmm.

Bill Russell: I think you talked about this. The it was a preview to HIMS 24. You talked about during COVID you discovered Southcoast had 37 different call centers,

and I asked you

before this call, what did, how many call centers do you have now?

And you, you said one.

Jim Feen - Southcoast Health: Yeah. One.

Bill Russell: and that struck me as a story. People probably want to hear about, like, how, I mean, that's a heavy lift. A lot of places still have

thirty some-odd call centers.

Jim Feen - Southcoast Health: that was a big one for sure. and It led to the, you know, some of the quote unquote, downtime during the pandemic and what opportunities do you see in crisis? And that was probably the biggest one that we, you know, we did have here 37 call centers a whole slew of different, you know, management styles on top of those things.

And, you know, how often do we pick up the phone with them? 30 seconds when we're trying to manage a, you know, an out outreach on, on, on vaccines. So. There, there was the, you know, in crisis, the opportunity, and it became a pretty clear mandate that this isn't gonna jive, you know, from a scale standpoint, from a growth standpoint, from, you know, patient service standpoint.

And it led to what you saw written where we set a pretty strong goal to, get to, you know, a unified patient service center.

Bill Russell: I love the fact that you have, did you say psychology background or sociology? Psychology.

Jim Feen - Southcoast Health: Had a minor in psych. I had no clue what I was gonna do with it.

Bill Russell: I'll tell you the the minor I would tell CI if they want to be a CIO in the future. The minor is sociology, but the secondary minor would be psychology. I mean,

I mean, is that a, is that a, a process that you were asked to lead or is that a process that you were, you know, just a part of a team that was trying to figure out?

Bill Russell: What, so was it 37 distinct types of call centers with different management and different, I mean,

Jim Feen - Southcoast Health: Yes. Yeah.

Bill Russell: all, they were

Jim Feen - Southcoast Health: They. for our, a little bit of our story through, through growth and acquisitions and a lot of specialties and practices coming in under our our moniker, our Southcoast. Over the last 15 years, you had a, you know, call center operation that was running your busy cardiology practice, and you kept it.

You may have come on to Epic, but you kept the staff that were answering the phones or, you know, maybe that service was commingled with your front desk and your patient access reps. And we never took the time until, till you read what you read to, to go back and look, there's gotta be a better way to slice and dice this and to resource it.

And. That was some of the best advice we were given years ago and it was not until 2021 ish that we really decided we were gonna invest some heavy dollars in doing what we did.

Bill Russell: it leads me to ask questions about access.

Jim Feen - Southcoast Health: Mm-hmm.

Bill Russell: does that make your access work easier because you've gotten down to, I would assume it does.

Jim Feen - Southcoast Health: I'd say it, it's improved experience for sure. We're able to look holistically, you know, at performance interactions with patients. We've got, you know, technology in place that when somebody calls, there's a phone match to a patient record, and, you know, it's prompting that agent with who, who could be calling from this address.

The wrong decision would've been trying to superimpose, you know, a call center operation on top of those and en forcing practice change. And we did not take that approach.

Bill Russell: Did you bring it together physically or. did. Okay.

Jim Feen - Southcoast Health: we did, yeah. We put it under a common roof and consolidated the pods, if you will. A single patient service center director, you know, with a series of managers and team leads, common education, you name it, it functioned now as a true department that serviced and kept connectivity between the specialty based pods and the practices that they serve.

Bill Russell: Does your call center or your service desk for it, does that fall outside of that, or does that fall inside

Jim Feen - Southcoast Health: Falls outside. Yeah. That it's it is a separate function. However it, it's funny you ask that. We it's a, it has started to lend itself to moving certain functions to between the service center and you know, the traditional service desk, if you will. One, one of the things we're they're working on right now is MyChart support.

And why does that have to be a help desk function when really more of the questions that come outta appropriate use and some of the know-how is really more in line with what the service center agents do. So that's a shift that's actually taken place uh, this month.

Jim Feen - Southcoast Health: We did. We did. It was. The blood pressure rises a little bit when we talk about it, but it was a, that was an all hands on deck. It was, i, a decision that was supported all the way through

Bill Russell: leads up to that decision? Like, Hey, we need to, we need to make sure that our continuity and our recovery or, I mean, what's the thought process?

Jim Feen - Southcoast Health: it. It was I think, again, building, you know, opportunity and crisis. What happened through change. The change healthcare breach and the downtimes and, you know, everybody got affected by that a little bit differently. But the question started come up. It actually came up in a medical exec committee meeting.

And that led to. What you're reading about, where it was about a year and a half ago we made a strategic decision to, to bring in, you know, key governance groups like nurse exec, ed exec med exec. You know, you're in the know on this and we want to do this, but we also made the decision that we weren't gonna get the appropriate learnings from the activity if we told everybody this was happening.

We've done that before and we had certain practices, you know, go offline and stop taking patients and do administrative time, and that's the last thing we wanted. And so yeah, it did happen as a surprise. We called a full emergency operations plan and opened a command center and we were offline that morning for two hours and simulated a full ransomware event while we reverted operations to our disaster recovery data center 36 hours later.

Bill Russell: how'd it feel at that moment when you said, okay, take it down.

And so, here and now it's we've com we're transforming our approach to epic issues and those periodic downtimes, they're no longer gonna be called Epic downtimes. They're called Business Resiliency Activities. And we're gonna be doing them across all three shifts.

Bill Russell: how do you ensure. That there's no safety events. Right. So one of the things you have in, in first shift that you don't have in third is potential is most likely surgeries. Right? So you have surgeries going on that, some of which have been scheduled for a long time and whatnot.

Did you plan around that a little bit or how did you approach that?

And we, I've done a number of reference calls with organizations and we presented this at Epic. We did it at Chime in the fall. We're contemplating this and if. You know, it comes down to what policies you have in place. Are you able to educate on them and really push that out as an operations activity first?

And if you can do those things and you've got them, great, well now exercise them. Start building that muscle memory and that, that's where I think we, we felt okay doing this. And, you know, you know, my, my boss, our CEO notifying our board that this was happening and if, well, you know, if you hear Southcoast is down at 10 o'clock on a Wednesday morning, don't worry, we're under control.

Those things really had to happen with trust.

Like, how do I select the problem list? And you're like, no, you have to write it out.

Jim Feen - Southcoast Health: Yeah.

Bill Russell: It's, I mean, that experience alone for them to go, Hey, should probably know how to do this. And,

Jim Feen - Southcoast Health: You're a hundred percent right.

Bill Russell: All right. So I'm gonna talk to you a little bit about AI because mostly 'cause I want to, and I'm doing research on upcoming fiction series that I'm doing around this. I mean, talk. What are you learning about ai? I mean, epic threw a hundred, 200, 300 AI features at you. I don't know if you have ServiceNow, but they're throwing a hundred or so at people. You have Microsoft throwing a hundred at people. You have not only that, you have these other tools coming in on a regular basis. I mean, what, what are you learning? How are you managing that, that onslaught of potential? I mean, you guys have been doing this for a lot. AI is not new for you guys.

And we knew, I think we had it early on that. Sitting back and letting the projects, you know, the project intake stream, control the volume of requests and evaluations and, you know, algorithms that were coming at us was not gonna be viable. So instead it was very much approach of using that center of excellence to bring in interested, really interested providers, interested clinicians, interested administrators.

And we look at it from a risk lens, we look at it from a privacy lens and really a safety, a clinical safety lens. And if those things add up. You know, we, like, I got a great guy, Scott LaRosa, who's the chief of Analytics and Interoperability here. He had a nice risk scoring algorithm together and we risk score the different models and that committee votes on whether or not it's not a, it's not a fiduciary, you know, it's not a proving financials and contracts, but the ai, is it a smart thing to do for our patients?

It is a smart thing to do for our staff and for our docs. And if that answer yes. It moves through the process, but

Bill Russell: Do you treat each epic feature the same way you would treat a new application?

Jim Feen - Southcoast Health: so yes and no. Of course, everybody I think familiar with the Epic equation and what Nebula means and the models, you know, the. That center of Excellence did approve and vote on, you know, the function of the ai conduit, if you will, back to the epic mothership. That all went through the process.

And that's been a big part of why that COE is that backboard for us.

Bill Russell: Do you have a way of, alright, so it goes through that and they say, Hey, this is good. It has merit and those kinds of things. it then have to go through the full financial rigor of, Hey, is there ROI associated with this? Will it scale? Can all the, all those things.

Jim Feen - Southcoast Health: Yeah. And that's been we tried to actually keep that process, you know, the responsible VP having to justify a business case for a contract, do it the same way we've always done it. We didn't wanna invent something new there. The legal process is the same, you know, and now they're asking questions.

And it's not always clear. And the ambient technology was one of the bigger ones that we ran through last year where we iterated on that a lot to, to figure out, okay how are we justify this is a good idea? And, you know, that was an example where we made it more simple than hard to justify why that was gonna be a good thing for care and our docs.

Jim Feen - Southcoast Health: gotta be the way it is.

Bill Russell: talk about the project flow within your IT organization.

How do you. do you handle projects? Are you guys more of a lean shop? You're more of a waterfall shop. Are you how do you guys handle the pro and just outta curiosity, do you have like a number in your head, like, we're handling 120 projects right now, or.

Jim Feen - Southcoast Health: Our brief story on project management is, it's something I is near and dear to my heart as a former PMP in a different lifetime ago. But starting a PMO, you know, in, in the IT organization 15 years ago and.

It really should be an operationally led function. You know, it's not just, even if, you know, your technology process, projects consume 95% of what happens in, in your projects why, you know, a function like that really should be an operational one. It is something I was, I felt very strongly about, so that PMO sits and reports into our COO and we're a and a party.

We're a party to it. And a big believer in what the function is.

Bill Russell: Aspiring agile

Jim Feen - Southcoast Health: Yeah.

Bill Russell: is interesting.

Jim Feen - Southcoast Health: Yep.

Bill Russell: And we were in a meeting and Laura, I think Lori Bole was there. She's a huge proponent of

Jim Feen - Southcoast Health: She was.

Bill Russell: of

Jim Feen - Southcoast Health: She is.

Bill Russell: and yeah, she is. And she's been talking to other people around it. Probably one of the few that I've talked to that has really transformed all of it in that way.

Jim Feen - Southcoast Health: probably one of the few left standing that I'd say claim. Claim that you had mentioned that it's a 2 29 event, that there were only a handful that you were aware of, but we're one we have been for a while. In fact, what you see me wearing here is is a it's a innovation company that we've started up in the last 24 months to, try and leverage a lot of what happens, and it has happened over the last 15 years with DevOps at Southcoast. So that's a, that's an exciting one for me.

Some had little projects going within it. But nobody had more than one or two people which surprised me. I, of course, I threw out as I usually do just to poke the bear. I said, I think you'll all have developers within the next two years. And they sort of looked at me like, ah, I don't think you know what you're talking about.

But there's a lot of opportunity here. What are some of the things you guys did with DevOps?

So we're not huge. We're not, but we're also not small. And as you as in our own growth aspirations it things we had to do, you know, we're bringing in practices with legacy outpatient EMR vendors, you know, all the names, they're all the common ones. What do you do with 'em, you know, as you're, as you're starting to move towards, in enterprise rollout of Epic. And for us, I, I started going to the street and quoting Legacy EMR archives years ago, and it, you know, became a seven figure problem. And I wasn't trying to solve a seven figure issue. I was trying to solve something different. And so that, that was one of our first use cases.

So that, that's a standout for us. That was a, I mean, I look at that today and that's probably a $3 million cost avoidance. That that solution's still running. It's we're marketing it, we're trying to, we're selling it, we're licensing it. And that's just, that's an example of one thing that was born outta market necessity to solve what we saw as really a simple problem that didn't have a simple solution.

Yep.

Bill Russell: wanna ask you a leadership question. How did the New England Patriots make it back to the Super Bowl? Actually, by the time this, I'm trying to think of when this will air. I don't know if this will air, this will probably air before the super Bowl, so you won't get in trouble here. How did they get there and do you think they have what it takes to pull it off?

There are underdogs going into this.

Jim Feen - Southcoast Health: They are, and I think that the one answer that everybody believes in their hearts is it's Ann Michael May.

Bill Russell: Yes I did see Drex I saw Drex. He had a Seahawks hat on he was talking something about a pope. He said, you know, every. Time. There's a new Pope, the Seahawks are in the are in the Super Bowl. And that's what he is, he's banking on. He is banking on that the Pope Super Bowl thing.

I don't know.

Jim Feen - Southcoast Health: Yeah.

Bill Russell: I'm gonna have to do research on that. I assume he's correct since they're talking about it all over the uh, the internet, about the whole Pope transition here, but, uh. it is. It, you know, this will be your first Tom Brady less Super Bowl in. I can't remember the who's, when's the time before Tom Brady that you guys were in the Super Bowl?

Jim Feen - Southcoast Health: Boy, 96 ish with blood, so I think it was.

Bill Russell: there like a really, there was a blowout year, like you guys made it to the Super Bowl and got crushed by somebody?

Bill Russell: Yeah, that was a that was a pretty good team, that bear team. Anyway. Hey, Jim, I do I appreciate you being a part of the 2 29 project meetings and I appreciate you coming on the show and sharing your experience and look forward to catching up again soon.

Jim Feen - Southcoast Health: Yeah, it was a real pleasure to be here. Bill. Thank you so much for having me.

Bill Russell: Thanks for listening to the 2 29 podcast. The best conversations don't end when the event does. They continue here with our community of healthcare leaders. Join us by subscribing at this week health.com/subscribe.

If you have a conversation, that's too good not to share. Reach out. Also, check out our events on the 2 29 project.com website. Share this episode with a peer. It's how we grow our network, increase our collective knowledge and transform healthcare together. Thanks for listening. That's all for now.