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I'm Bill Russell, creator of this week Health, where our mission is to transform healthcare one connection at a time. Welcome to Newsday, breaking Down the Health it headlines that matter most. Let's jump into the news.

Bill Russell: And we are recording to the cloud it. Here we are. It's Newsday and we are recording in the cloud. Do you feel like we're in the cloud? I'm, I'm joined by the indomitable, uh, directs to Ford and the, responsible pet owner, Sarah Richardson. Self-proclaimed responsible pet owner. Uh, you know, we just see the tail come across every now and then, clear.

Sarah Richardson: is napping right now. He wasn't really into Newsday today.

Bill Russell: Not in the news day today. All right, well, this is gonna be fun, Drex. Welcome you, enjoying life in Seattle after the, uh, victory.

Drex DeFord | This Week Health: It's good. It's great fun. Lots of blue, lots of green, all the things that are going on here. People are psyched. So it's gonna be a fun couple of weeks.

Drex DeFord | This Week Health: yeah, absolutely.

Bill Russell: I have a, Tampa city tour dinner, and then, get on a plane, head out to you guys, and we will be at the, beautiful Hotel Dell for a CISO and CIO event, which you two will be, hosting. So that should be a lot of fun, for the new day today.

Here's what I did. I went through the, JP Morgan decks in detail, and what I was looking for specifically was mentions of, technology specifically, um, things that the technology leadership is being asked to do. Things CIOs, CTOs, and CISOs are being asked to do. I have six items. I'm gonna give you the first four.

So reduce friction, improve margin, and uh, that feels like a business conversation we've been asking to get at the table. It feels like we're being asked to be at the business table. Uh, maybe not at the kids' table anymore as, uh, as they say. Um, the, the, the third is enable growth. These are, These are, these are all business kind of things.

, The fourth, not so much the fourth, uh, it came up in different ways, but essentially, uh, technology is re removing the burden from the clinicians. Uh, some of 'em were closer to don't break our clinicians, like technology is not. Uh, not, uh, overwhelming our, uh, clinicians anymore. Um, but I, you know, I ask, I give you those first four because it, it really feels like we are being asked to be at the table.

Sarah, I'm, I'm curious what your, uh, your thoughts on reduce friction, improve margin, enable growth.

Bill Russell: I mean, you've been doing this a long time. Uh, has it always been the case that the, uh, you know, the, the, uh, you know, the, the CIO and others have been at the, not at the kids table?

Drex DeFord | This Week Health: No, I, I don't think it's always been the case. I think I've been lucky enough to be at the big table for most of my career. I, I like these 'cause, uh, reduced. Friction, improve margin, enable growth are really kind of like a Venn diagram, right? And when you start to think about things like reducing friction, um, I know, uh, in your, uh, recent city tour dinner in Miami, I think access was a big part of the conversation, right?

And all that really plays into the don't overburden our clinicians, right? Don't break the clinicians because are the crazy makers. That we hear regularly, physicians get toward the end of their career and they start to say things like, I was gonna retire four years from now, but screw it. I'm gonna retire now.

It's just too much. There's too many things going on. So, um, they all really play together very well.

Bill Russell: It's, it's, it's interesting. My first interview of the year was with, uh, uh, and he talked about, uh. Of, uh, you know, improving access, reducing the amount of time. By, I think it was eight days, seven or eight days, significant amount of time. Now, he would tell you that this is the first step of many. They have a long way to go.

I was really struck with the cm IO conversation 'cause the CMIOs for. Well, e ever since I've been in the industry, which is almost a decade now, if not more, it is more than a decade, about 15 years. Uh, the CMIOs have been, EHR EHR optimizers, EHR, workflow optimizers, EHR, optimizers builders, that kind of stuff.

Um, Um, and the, the conversation I was listening to this past weekend. Was much more than that. I mean, it was, uh, they are, uh, partnered with the business. They're bringing the right people to the table. They are solving real challenges in terms of, uh, uh, you know, intake forms. And, uh, I mean, they're really digging into the process.

Drex DeFord | This Week Health: Sarah.

Sarah Richardson: I, I will say that it semi depends on the type of. Role you want that org to have? Because we still had a big conversation this past week about CDO versus CIO and CDIO and where innovation and digital and different aspects live. It's still an ongoing conversation, just like benchmarks from the CFO and what seat or responsibility, the c. technology C-suite people or persons has in terms of what they, the organization wants them to focus on, and some are very bifurcated in their approach. and others are totally combined, I would tell you the ones that are either very aligned or combined go figure are having some pretty extraordinary outcomes with the additional aspects of technology enablement beyond the EHR.

Drex DeFord | This Week Health: you know, if you're A-C-M-I-O and you're, you think that your job is. Just to continue to make the EHR suck less. That's the job that you're gonna have. You're just going to be an EHR optimizer.

Sarah Richardson: Yep.

Drex DeFord | This Week Health: A big part of this, not just for CMIOs, but for CIOs, is. You bring the value to the table.

So I think there's a great opportunity for CIOs. C-M-I-O-C-N-I-O, CFOs right across the board to, to show their value. That's how you're going to grow. And not just be, not just be a CIO, but be the innovation officer, be the digital officer, do all the other things.

Bill Russell: I, I think. Opportunity to define the job, like to define what you're going to work on. I think, uh, tech leaders who talk business outcomes are winning and, and the rest are being politely ignored. Um, is that the, is that, is that accurate? Politely ignored? Maybe they're not being politely ignored. If I thought about it.

Maybe they're just being.

ignored

And it's just kind of funny because sometimes like they wake up on Thursday and it turns out now they're in charge of a whole new department or they have a whole new role. They go from a CISO job to a CIO job. And so that whole get into it like it's yours to invent and reinvent, you should do that.

Sarah Richardson: and

be strategic about the departments that start. getting given to you

do you. have the influence and capability and air cover to make them part of the solution, not just someone else handing off a problem because, hey, go fix this dumpster fire becuase you're good at it. Sure. But is it a creative to the equation that creates what its means for technology to not only at the table, but to create this differentiating capabilities within the organization

Drex DeFord | This Week Health: I think the other interesting part of this is that if you're a CIO or C-D-O-A-C-D-I-O, you're adding value. get to continue to try to put your arms around other things too. We traditionally don't have clinical departments, but why couldn't we run pharmacy?

Bill Russell: I wanted to ask you about this 'cause I was looking for cybersecurity. Specifically for cybersecurity or, I mean, it was mentioned on a, a couple of the decks. Um, and maybe it's just the wrong forum. I mean, if you're talking to your bond holders and CFOs and whatnot, you're not gonna talk about it. I, I'm, I'm, I'm wondering if.

If I can read anything into this, is it, is it going to be under continue to be underfunded this year? Is it, um, it's not strategic 'cause it's not showing up on these decks. It is table stakes. 'cause it showed up on a couple of decks. Like, hey, you know, uh, just want, you, just want you to know we're checking this box, like we're not gonna get hacked or that kinda stuff.

I mean, sh am I reading, trying to read too much into this or it's just not the right audience to talk about this stuff.

Bill Russell: but it is, it was an awful lot about operational execution, just not cybersecurity.

Drex DeFord | This Week Health: hmm.

Was about execution, simple operations, uh, some value-based care stuff. Uh, a AI that is attached to real outcomes. AI that saves money. Uh, and uh, and I would say the adults are running the ship, you know, and, and leaders who can actually run the place is sort of like the, the, the, you know, the kids aren't running the thing anymore saying, Hey, let's do something really cool.

Drex DeFord | This Week Health: that turns out to be the case, I, I would, I mean, I would love that for a goal for 2026 for healthcare, better business, clinical and research operations like hardcore operators. Who really know how to optimize and make things run, make the sewing machine run like the sewing machine should run. Um, we've had a lot of folks in the past and, and not, this is a very broad stroke here, but there are a lot of folks in the past who have done cool projects 'cause it gets a good thing on their resume and helps them get the next job, but they've never really, they're not business. Operators, business people. And so if we can get more of that in 26, I'm all for it. And I think a lot of it from a cybersecurity perspective is it winds up embedded in all the things that we do. less special security is as a separate and different thing, and the more it's part of what we do that's better for patients and families too.[00:13:00]

Sarah Richardson: It's also the expectation we've been talking. For years about that technology's already there. is there in such an accelerated way now that it makes sense to say we're not transforming, 'cause all the transformation capabilities exist, now we have to lean into how do we optimize the operations of all of that.

So that's a little bit of why you're starting to see a different flavor of the conversation show up. Technology's there and it really is, and now they really want it to do the things that everyone else is touting even outside of healthcare.

Uh, in our long-term, two to 3% growth range. Uh, he goes on from a competitive standpoint, you CA increased hospital capacity, clinical service offerings, and outpatient facilities. This is not anything [00:14:00] new from a for-profit, from HCA. I mean, this is how they've operated and thought for years. Uh, but I do love this last paragraph.

This is, uh, from Becker's. This might be from today in fact. 43 minutes ago. In fact, In fact, uh, given what we see today, including the demand in our markets, our resiliency program, and our digital transformation initiatives, we remain confident that we will perform within our long-term plan over time. CFO, Mike Marks said on the call, um, um, it's interesting.

I mean, uh, I, I mean, uh, I, I think that, especially that last statement from A CFO talking about, uh, our digital transformation initiatives, our resiliency program. Uh, this is an organization that, that did have an outage last year, a significant outage last year. And so they're highlighting, Hey, we, we are investing in technology.

Um, and some not so politely pushed aside. It's, it's like we need somebody at the table who's gonna understand how to operationalize this stuff, how to have these serious conversations. And I, it's, it's, it's gonna be interesting to see this year. Um. Um. The type of people that get hired. Because remember, during the digital transformation era, we were hiring people from Disney and we were hiring people from, you know, just these, these things, and we were bringing 'em into healthcare.

I think in, in, in this case, now we're gonna be hiring different types of people that can, that have proven chops making things happen.

Drex DeFord | This Week Health: Good operators.

Sarah Richardson: For sure. Also, I mean, let's, let's remember. And I've worked a few places, uh, HCA the longest.

Drex DeFord | This Week Health: Mm-hmm.

Drex DeFord | This Week Health: A lot of it, I think, ultimately turns to, if you reread that paragraph, and I won't ask you to do it, but he's very focused on we're gonna have these margins. We're gonna do this well financially. The ability to say, in my company, we're going to relentlessly focus on this and we're gonna build our transformation programs and our digital implementation programs and our, um, our continuity program.

Bill Russell: one of the things that's interesting to me when we talk about HCA. LifePoint and others is, uh, you know, the for-profits have not gone hog wild in the epic EHR direction. And, uh, you know, we don't talk about this on the, on the show much 'cause we get, uh, uh, it, it's interesting because people have chosen epic.

And, uh, I, I tell this story 'cause it's the, the first meeting I went to of CIOs when I, when I became A-A-C-I-O, um, we were sitting in a horseshoe and everybody went around and inter it is like, Hey, introduce yourself and the health system you're with, and the first person said, my name's blah, blah, blah.

I mean, it, it was, i, I, it was really kind of interesting, but we ran a seven and a half billion dollar health system, and quite frankly, HCA is, I forget what the number is, but it's a lot. It's.

Sarah Richardson: 60 billion

Drex DeFord | This Week Health: On Meditech.

Bill Russell: running on Meditech and every time we talk about it, those who are on Epic look down at their nose at, at them and say, well, they're, they're not practicing real medicine like you need an EHR to practice real, uh, medicine.

I'm curious, you know, as we look at this, they're, they're fairly successful operationally sound. We were very operationally sound. Meditech ran our shop very well. Uh, it was an integrated system. You know, epic is talking about having an. Uh, an ERP and all that stuff. Well, Meditech, we, we had that from end to end.

Or, you know, these physicians who are graduating, they know Epic and they don't know, uh, anything else, and so they have to, uh, run these systems. I'm curious where, where you guys fall down on, on, on this when you hear these, these kinds of conversations.

Drex DeFord | This Week Health: Uh, I, you know, we look at our experience all. Three of us have run Meditech in big places. I mean, steward was a, you know, not, doesn't exist anymore, but was a big integrated delivery network that operated across the country. And we ran Meditech. And we ran Meditech because it did not cost nearly the money that Epic was gonna cost.

And it did everything pretty okay. Like it

Bill Russell: Right

Drex DeFord | This Week Health: It

Bill Russell: that, that's a great way of saying it. It was pretty okay at everything.

I don't, get really wrapped around the axle. Like, we have to go to Epic if we're gonna be successful. And I don't know. No, no, no. Sarah, what do you think?

Sarah Richardson: I would say how many purist shops have not had to add any special accommodations. For their organizations to be more successful. And I say that because I think Kaiser is the largest implementation of Epic in the country, and they develop their own digital front door.

Bill Russell: Yeah.

Sarah Richardson: you just, you choose your foundation, you're still gonna have to make enhancements to it for it to operate based on the business outcomes that you desire.

Bill Russell: Yeah. It's, it is important to note HCA has, uh, some epic and, uh, I think the, uh, Utah markets and some other places, uh,

Bill Russell: yeah. It, it, it, it, it would cost more to migrate them to something else. There's no. Um, and it's interesting that they chose to just operate too. Life point's. The same thing. They, they have a handful, uh, that they have as well. You know, we're hearing a, you know, Sarah, you had a big old conversation about community Connect.

Uh. At your, uh, event, and I thought it was interesting that we're still talking about that, but that does showcase one of the problems we still have in healthcare, which is there's still acquisitions happening, there's still movement, there's still alignment, things happening. And when these alignment. Uh, alignments happen.

These organizations in some cases are forced to choose, like, are we going to, how, how much are we going to align? Uh, Sarah, I'm curious where, what, where did the conversation really, really stem from and where did it go?

Bill Russell: 'cause you're trying to manage it outside of your building. That's really hard stuff.

Sarah Richardson: tough. And then even last night I had a CIO call me and said, can you help me with a conversation for my board? Because I've got this tiny community connect partner who is taking up 40% of my time. And if I use your equation of. What percent do they contribute to margin should be the percent amount of time I spend on them.

It should be like 4%. And I was like, well tell anybody, I don't care what they are. They're not unicorn enough to be able to deviate from the community connect model that you're providing to them. And so it's that tough. It's the human conversation versus the I'm so special, I have to have my own design instance of connect.

Bill Russell: I'm almost over time, but here's what I'd love to do with y'all. Uh, have you guys been keeping up on the hostage crisis? The

Sarah Richardson: that you're writing about?

Bill Russell: Exactly

Sarah Richardson: Yes.

Bill Russell: I have. Okay. Well, we're, we're three chapters in. We had the, uh, we realization of the problem. We had the conversation with the CTO. About the, uh, hostage situation.

Then we had the presentation to the board. Um, next week it's, uh, negotiations. So they sit down and have some negotiations with the, uh, with the partner. Um, I mean, what are your thoughts on the, on the next chapter? I mean, where, where, where should we go with this?

Drex DeFord | This Week Health: I think the partner probably you know, this is one of those things you're always, whenever you watch a TV show, and I know this is a written thing that you're doing, but

Bill Russell: It's,

Drex DeFord | This Week Health: head

Drex DeFord | This Week Health: episode of, it's a little like, I'm watching an episode of 24. Remember that old show, like there's a bomb about ready to go off and you don't exactly know who has it or where it is. There's a part of me that now I'm looking at this and I'm kind of going like, I don't know. I think the, I think the vendor's gonna be pretty hard core here. I think they're gonna kind of stand their ground and they're gonna force the health system to make a really hard decision. I think the whole conversation though, about we gotta go back, we gotta look at. This, uh, annual recurring expense. This a RE. You know, the vendors look at a RR, we look at a RE. It's a, you know, transparency and spending and contracts and all those kinds of things. If you can get there, it really helps you understand like, maybe if I don't do this, I can have more money for this. don't know how this is all gonna play out.

I'm interested to see what's happening inside your head for the next episode.

I mean, nothing says operations like App Rat. Um, and, uh, you know, it's one of those things we're doing application rationalization. It's, it feels like the right thing. Platform first, cloud first all feels like the right thing, but we're, we're setting up. The exact scenario I'm writing about, which is, you know, we're putting all of our eggs in one basket or multiple baskets, right?

There's an EHR basket, there's an ERP ba, but, well, today there's two baskets. There could be one in the future. Um, but there's, uh, you know, there's the Microsoft basket. Everybody has a Microsoft basket. It's one of the few. Things that you just say, there is a Microsoft basket for every health system. Um, and, uh, and every couple of years you have to sit, sit across from that table and realize, I can't get out of this contract even if I tried.

Sarah Richardson: Yes, because if. takes me back to like 30, over 30 years ago when we had a partner vendor actually in the hotel business in Vegas, and they tried to significantly. us, for lack of a better term, on something that we needed. And I never forget my, my boss at the time who was the VP of basically operations for the whole casino said, if you do not make this right and figure this out with us, we will ruin you That company was outta business within five years because of the way that they structured it and how quickly word gets out from an industry. And you think of a town like Las Vegas, that's pretty easy to get the word out to this day even. But I also think about some of the things we've heard from part, uh, from, uh, executives like Zaffer at Seattle Children's where he, he likens a financial decision by [00:27:00] a partner to how many people they might potentially. Kill or not provide care to. 'cause he'll say in his, in his very, I always say Attenborough voice, that if you do this to us, this means X amount of children. die and not get care from us because we have to pay you instead of giving them what they deserve and they need. And so that's what I feel like gets missed by a PE firm, owning some outcome that they desire and then literally holding that organization hostage.

What is the patient impact and what if your child, as an example, was at that facility?

Bill Russell: It has been fun to write. It's been fun to have conversations. I'm looking forward to the city tour. Or in Tampa going out to, uh, San Diego and, uh, having those conversations. Um, it's interesting.

I think the CISOs are burdened. I think a, a significant amount of expectations have been hoisted on their shoulders, uh, to carry. So, um. Love what we do. Love that we get to come alongside these people and, uh, you know, take the, the successes in one place and spread 'em to another and, and keep doing that.

So, uh, appreciate you two being in it and, uh, look forward to being with you this week.

That's Newsday. Stay informed between episodes with our Daily Insights email. And remember, every healthcare leader needs a community they can lean on and learn from. Subscribe at this week, health.com/subscribe. Thanks for listening. That's all for now.