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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. 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.

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You could also go to today in health it.com, and now onto today's show. Today we're joined by Aaron Mary. He's the CIO for UT Austin, as well as the Dell Medical School. And. Aaron is a phenomenal communicator. One of the things I like to do with my guests is to send them an email and have a conversation with 'em ahead of time.

Ask them what topics would you like to cover? And Aaron was an open book. He said, ask me anything. Let's go in whatever direction you want to go in. And that's what we do today. We really cover a lot of different topics. We go health equities, we talk innovation, we talk IT operations. Heck, we talk tech debt.

We go into . Really low level detail in health it, and we talk about leadership and leading through a crisis. Uh, again, phenomenal conversation. I think you'll get a lot out of it. Today we are joined by Aaron Mary, CIO, for UT Austin and the Dell Medical School. Good morning, Aaron, and welcome back to the show.

Good morning. Thanks for having me again. Are, are you still the CIO or have you added some roles and responsibilities? . Good, good question. So definitely still CIO, but you know, in uh, times like this you kind of do a little bit of everything from. Even helping out to register people in, you know, vaccine clinic and whatever you can do.

And so I sort of take the default, uh, all the above answer and whatever I can do to help. And so, uh, that's kind of what we try to do. I love it. And other duties as assigned I think is how every job those implied and those not so implied. Absolutely . Uh, so, so what do you think of this trend of CIOs adding new areas of responsibility?

I think it's phenomenal, and I think it goes a lot towards what the CIO role is today, say than maybe 10, 15 years ago when it was a little bit more still nebulous and still coming together. What does ACIO of healthcare actually mean? And so I think you're seeing a lot of companies go through a metamorphosis, a healthcare delivery companies looking for not just ACIO that understands informatics and workflow and systems and architecture, but understands business, understands strategy, understands

Where things are going. How does marketing play into it? How does the patient experience play into it? How do digital tools play into it? How do you better collaborate with partners across a locale or an area or state to bring better care? Those, that's the next generation of CIO. I think Chime calls it as CIO 3.0, I believe is what Russ calls it.

Um, but it's that dynamic. An individual that can sit the board level, have a discussion, go multiple directions, and then bring it all home with how tech can be the enabler. Well, I think, you know, it's, it's interesting to. Some of them have really gone in the business direction. Uh, William Walder's picked up some operation stuff.

Chad INE actually has a revenue service line that he's managing and overseeing for the health system. You know, so we're seeing that direction. We're also seeing the, the technology direction you're seeing, you know, Craig Richville has the innovation and. Information. Information. So does, uh, RESA Springman has innovation and information.

Do you naturally have those two things or, uh, do you, do you have a, a partner in innovation on your side? No, actually, so what's really cool about where, where I'm at is that most of my physician colleagues, whether they are, whether they're in a c-suite, whether they're chairs of institutes, whether they're lead surgeons or clinicians, they're all sort of technology inclined.

Which is, which is great and also can be dangerous. But it's actually a great thing because I have partners throughout the institution. So the CI role, CIO role that I hold actually has digital, has insights and analytics, has all the traditional CIO functions and then some. And so what I do is I collaborate with each of our physician leaders and making sure that you know their wants, their needs are captured.

We innovate together side by side. And within the IT team itself, I've structured it so that you have a DevOps team, you have an insight innovation team, you have a clinical informatics and customer success team. I try to take some of the lessons of my prior lives and implement them here, including all the way through Agile methodology and other development types of tool settings to make sure that as an IT team we're not so client server 2.0, but more facing 3.0 in the future of how do we innovate on the fly.

I'll give you an example. So on text and on Monday, Texas has decided that everybody 16 and older is qualified for a vaccine. That's wonderful, except 16 to 18 year olds are minors. So the consent process is different. The data capture process is different. Everything is different. 'cause you gotta make sure that.

You are following it to the t. Texas is very particular. We wanna make sure that we exceed all, all of those needs, so we need to come up with a new workflow on the fly. And so yesterday around noontime, we sketched out what we thought the right experience should be for, for next Monday. By eight o'clock last night, my DevOps team had already released a version to test today in clinic to see will it work.

That what we have today and tomorrow, uh, tomorrow being Friday, to really make sure we work out any kinks before Monday. That type of innovation doesn't happen overnight. That takes methodical planning and bringing in some true talent to the area. Give, give us an idea of what they had to touch. They, they touched the EHR, the clinical, the, the process.

Did they have to touch the interoperability and, and the HIE strategy as well? I mean, what, what kind of things did they have to touch? I mean, that timeline and, and the success of that is. Phenomenal. But I'm just wondering how many, how many different normal silos within healthcare that they had to cross?

I would probably say about a dozen, and I'll give you an example. So for our perspective, our chief clinical officer, she's all about efficiency and making it just clean for the patient. And so what we did in the early days since we were one of the first vaccine hubs. Uh, across the state of Texas was to make sure we employed QR codes and smart apps so that everything is done securely.

Everything is just a scan of a QR code and literally the patient can see a red X or a green check if they're good to go, and then they can go through the line and get their jab. Well, we had to, we had to obviously touch. The QR code application itself that is actually running that to be able to display minor or no minor on there.

Two, we had to make sure, to your point, the EHR had all the demographics and fields set up appropriately for it. Luckily, we do see pediatrics and adults, so we have familiarity of how to capture those data processes. Three was the consent process, making sure the right consent forms are loaded, everything referenced c Ovid 19, whether it's the Pfizer Moderna or Johnson Johnson shot, and then it was, of course, exactly what you're saying.

Making sure that we could communicate with our state immunization registry appropriately, a minor versus an adult, and then of course all the characteristics that go along with that vaccine shot all before Monday. The state of Texas is very particular about a 24 hour turnaround on their on, on their timing of submissions of.

Who did you vaccinate today? And if you miss it, they will call you the next morning going, what's going on here? So I appreciate that. It means you keep on your game. So what we try to do is get in front of a, as much of that as possible, saying, all right, what do we need to think about? What vendors do we need to engage?

Who do we need to partner with? And over the past couple of months we've, we've formed a pretty good little delta force of external partners, internal co colleagues and partners. And then of course our testing methodology and sort of, it's an iterative design on the fly that is the meaning of agile. That is exactly what development shops wanna do.

Well, that's I.

You're, you're gonna go live on Monday, what do the testing cycles look like? And do you have a a, a team dedicated to that? Or is it the operations team that is gonna start to, uh, I don't know, muck around with this to find any of the flaws? It's both actually. So I have a number of my IT team actually in clinic every single day with them.

Whether it's desktop support all the way to applications team or DevOps people and data folks. Um, so they cycle through there every single day. Members of the team. For a couple of reasons. One, I wanted to make sure the IT team was grounded in reality. They could hear from patients directly, what's going on, what's good, what's bad?

What do we need to learn, what do we need to modify? And then of course, it connects folks with the mission, right? Having your team there side by side with the actual clinicians gives you an opportunity to really understand that. So when it comes to testing, it's exactly that. It's side by side with the clinical operations team.

The clinicians, the people that are doing registration, and then of course my team listening, gathering feedback, trialing it out out there, working with various folks that come in and say, okay, let's pretend you're a pediatric patient now let's register you as a test patient. Come through the line as you, as you would mix with everybody else.

What would it look like? And we work out the operational bugs. The key to all of this is not actually the technology, it's the workflow. Having a, a clinical informatics team that understands . Touch points, nuances, decision points, decision gates, all of that is critical because it brings a sense of common language to when you're doing our, we have a daily standup with the team running the clinic and to make sure that they understand, here are the decision points we needed.

Here's what happens if you go a route or B route or C route, and they make a decision on the what they want. But at the end of the day, we're all grounded in . We want the best patient experience possible. We want the best outcome possible, and we wanna make sure this is just seamless, right? So that the patient isn't confused, isn't, isn't turned around.

They feel comfortable, they feel safe, and they want to come, uh, and get their job. You know, we, we just jumped into it and I, I forgot my, my, we did a, a survey of our listeners.

You assume we know all these people. We know, you know what they do and where they're from, and they wanted me to make sure I asked all my guests to start with this question, which is give us some background on your health system, on your medical school. Give us, give us a little background on, on UT Austin.

First of all, I gotta say hook 'em, but my, uh, Longhorns made it to Sweet 16 last night, the women's basketball team, so really proud of them. Men's team won the Big 12, but unfortunately we didn't get passed around in 64. So let's start there with UT Austin. So I am the CIO for the University of Texas, Austin, for basically the healthcare side of it with a Dell Medical School and the UT Health Austin Clinical Enterprise.

My span and control is over, like I said, obviously the, the clinic delivery perspective. The medical school research divisions and then what we call our factor health, uh, side of things, which is really our community health workers and all those sorts of things we do with the city of Austin. Uh, we recently got a, a large endowment to take care of and help, uh, the homeless population.

I'm really proud of that. And so we're doing some great things for the city of Austin. So I've been here about three years now. Which time flies. It really does. And I've seen this team just grow, uh, so fast and, and some of the things that we're able to do now just make me incredibly proud, uh, to be CIO here and it happens to be in my alma mater.

So there's a sense of personal pride in seeing a lot of these things happen and really giving back to a state that's given back so much to me. If, if only you had some energy and excitement for being a part of UT Austin. I, it's anyway, , it's unbelievable. I know. I love it. I also love healthcare. I mean, if you don't have a passion for this stuff.

It will absolutely consume you because it's a lot, but seeing the caregivers, seeing the clinicians, I mean literally going through, you know, horrific ice storms and everything else that we're, we're going through here in Austin and all the things we've managed to overcome and still managing to vaccinate.

Tens of thousands of people a week. I mean, it's, it's something else, you know? And, and I'm just so proud of the entire university for coming together. And so the way it works here at ut, let's take the vaccine hub for an instance. Our Chief Clinical Officer, Dr. Amy Young, who's, she's amazing. She actually heads up a multidisciplinary task force at a clinical level.

That consists, of course, student health, our communications colleges, all the healthcare, little healthcare delivery entities across the university that then sort of roll up from a command and control structure underneath Dell Medical School and UT Health Austin. So it's a UT Health Austin hub that's staffed by UT Health, Austin Clinicians and Patients School of Nursing students and others, and then multiple people across the university all coming together for a common cause.

That's just cool. That's just really neat and we're able to tap into a, to a power of a, of a Longhorn network that I've never seen before in healthcare. So really neat stuff. I, I, I think Dr. Rosenberg would, would tell you that the, there's, there's a stronger network out there in Michigan. I, I, I just lost all the ut people.

But, you know, I, I wanna talk about the homeless, uh, the homeless initiative that you, you brought up and, you know, a, a, a lot of discussion around health, health equities. A lot of discussion around, you know, especially with the vaccine, you know, getting the vaccine to the homeless, getting the vaccine to those who are disenfranchised or even in rural areas.

And you have some rural areas around, around Austin

Initiative.

In this.

Great, great question. So number one, we have a phenomenal population health department. One of our lead clinicians, Dr. Tim Mercer, has been leading a number of initiatives with the city of Austin, uh, the Red Cross Homeless Shelters. And I'll tell you my first foray with that, when it came to c Ovid 19 was actually last year when we were using analytics and contact tracing.

It's to spot hotspots of where were the outbreaks occurring across the city and then proactively dispatching teams to those places, whether it's the Red Cross Salvation Army, the the homeless shelter here in Austin, and Dr. Mercer was leading a lot of that work together with my analytics team to figure out.

Where can we go best to make sure that folks have masks, they're isolated. This is before vaccines. Now, the same types of tooling that we developed over the past, call it eight months, nine months are being used for vaccination. Where are the hotspots? Where are people not getting vaccinated? What zip codes are we missing?

What county level are we missing? What portions of the city are we missing? And so we try to geo map and look at where are the parts of the city that we're just not getting enough reach to, and then send folks there. And so part of this endowment and others is to take those lessons and codify them into practice so that across all clinical care, delivery modalities, whether you're talking about your digital properties, like your websites, whether it's analytics, like I was speaking about, reporting or just partnering with the city to say, Hey,

How do we get Meals on Wheels better effectively deployed? Or how do we do colorectal screening in a better part of the city to make sure we get a better catchment rate and help make people have preventative care and wellness care versus reactionary and emergency care if they don't take care of it.

What we have found is the, the community that's sort of disenfranchised like that, whether they're disconnected or whatever else, they just want to be heard, they want to be engaged. They, a lot of times it's fear. A lot of times it's unknown and a lot of times it's a mismatch of communication, uh, mediums.

So what UT Austin has done in general. Has always been to say, how can we level the playing field and open access to all? And a lot of that comes into data. And so now diving into C Ovid 19, as I even look at who's signing up for the vaccines, I can break it into demographics, ages, races, specifics, and make sure that there our leaders, our clinical leaders, are being informed so that if we're leaving out inadvertently any segment of the population.

We can react and so we're, we're constantly evolving and learning from the data and helping people to better understand the importance of a lot of this preventative wellness and care. I. You know what's interesting to me is back in the day when we were doing pop health, we were looking at very different representation of the data than we're looking at today.

I've, I've seen some of these dashboards in terms of, uh, predicting outbreaks and I identifying populations, and they are graphical, they are, you know, we're laying 'em into those geo technologies to, to produce these maps. And now you're looking at this dashboard, you're pulling it and saying that's, that's.

So representation, very comment, anything but.

It really is coordination. I mean, you mentioned Red Cross, you mentioned the other community organizations. So population health really is about bringing all those entities together. Have you been able to, from a technology perspective, figure out how to enhance that communication or to enhance the flow of information that each of those organizations really operates at the, at the highest effectiveness for those populations?

Absolutely. Great question. So especially last year, we learned about the importance of coordination both at a county level, at a city level, and at an individual public health level. So Texas is a very decentralized model when it comes to public health entities. And so Austin Public Health tends to take the lead in partnership with the Texas Department of Health and Human Services on a lot of the

Alright, what's going on across the area and helping to almost be like the, the fulcrum of a lot of coordinating entities. UT operates as part of a collaborative in partnership with the city, with the mayor's office, and with the public health department. And so this started with contact tracing last year.

Where we were doing, sharing case data and case information and what we were learning from the community. I mean, ut when you look at, you know, faculty and students and patients that we, we have in our clinic, you know, somewhere around a hundred thousand lives, give or take at any point, just in that community and in the city of Austin and in Austin area, about two and a half million, give or take.

So it takes a lot of people to coordinate a major metropolitan city and figuring out what's going on. But . Credit to the state and credit to the city, uh, and credit to the public health departments for, for working together. Now, I will tell you that it did. There's a lot of trials and tribulations last year, including one public story that broke about May timeframe, where some of the public health authorities were still operating with fax machines.

Luckily, we're able to go beyond that and we used discreet data and really share data securely and effectively in a way that was dynamic and we tuned our systems to be able to share that so that a dashboard that we develop. A dashboard that awesome public health develops are in lockstep, right? They may be looking at a population of two and a half million.

We may be looking at a population of a hundred thousand, but believe it or not, the two link, right? So it fits side by side. That's critical. The last thing you want is for the public to lose trust in your data and the, and the, you know, confidence level of your data. That's the last thing you want because it adds to even more fear of the unknown.

So we spent a lot of time making that happen. And then to your. Point about deployment of technologies. Absolutely. Whether it's everything from MiFis in the field on reserve bands from the telecom companies to devices that gotta operate in a hundred degree temperatures so they don't shut down when it's the thick of summer here in Texas, whether it's devices that can handle out in the cold when we have, you know, single degree digits of temperatures, you know, whether it's analytics, whether it's workflow, whether it's whatever.

We're constantly evolving. Another thing I'm really proud of with Dell Med is that we actually run a free clinic on the weekends for the homeless every Sunday at a Catholic church here in the area that's run by our medical students right now. Of course, they also get hours in practice, but this is a way for us to also have data on the homeless community so that when events like this happen, we actually have sort of an idea of

Where are some of the areas we need to go to first? What are some of the things we should be looking at? And I'll tell you, there's a million ways to slice a data set, but the importance of it is that you have it, you can have confidence level in it, and you have the team with the ability to slice and dice and be agile on the fly.

That's where rubber meets the road. Yeah. You talked about a client success, customer success group. Is that focused more internally or externally? I, I, I would think that Austin is getting younger as a community and as they get younger, the expectations of the population from UT Austin is rising from a digital capability standpoint.

And, and so let's, let's start with the experience team. Are are, are they focused mostly on internal experience or, or external experience? Actually it's both. And so obviously you have, you know, internal customers, stakeholders, the clinics, clinic design, things you're going to be working through, but it's also external, right?

How do we partner with our, our call center, we call the AOC, to make sure that even things like routing, phone calls coming in. People have an issue with their device versus I don't know how to register for the portal versus, I don't know where to go or properly triaged, whether it's partnering with our marketing and digital communications teams, because we own development, a lot of the digital properties.

How does that engagement level work with our patients? Are there automated chat bots? Uh, is it easy to find a. Parking spot. Is it easy to pay your bill? In addition to that, as many academic health systems have it, your physicians also practice between other sites, right? That may not be your health system.

It may be an HCA site, it may be an Ascension site. We partner with them in helping to modify their workflow so that our physicians and the patients that would go between the UT Health Austin Clinical Enterprise and say the Ascension Seton Enterprise, have a similar look and feel experience. That's a lot, right?

Because now you're having to both influence. Within your organization and influence externally. And that takes a lot of partnership, um, understanding common language, goodwill. And I'm lucky to have good partners in the city, but I, I can't say that exists across the country, everywhere like that. But here, we're able to make it work and my customer success team takes the lead in partnership, uh, with everybody to make those things happen.

So let's talk about innovation. So there are a lot of different models for innovation out there. You know, some health systems operate as more of a VC or private equity, some accelerate startups and those kind of things. What's, what's your model for innovation? Are you more focused on how it gets applied within UT Austin?

No, actually we are. It's all the above. So what I think fundamentally I appreciate about UT Austin is they're all about take, take those betts, you know, take the hail Mary, uh, go for it. And so we tend to take a lot of, okay. Is, is, is everything a football analogy for you guys? It has to be. I mean, come on.

It has to be right. But, but to the degree of it, it, it's both. So let's talk about internal to, to , right? The IT team will oftentimes partner on a lot of these, can we do this? Is this possible? Should we do this? How do we do this? And then we build it, right? And. If it doesn't pan out, it doesn't pan out. I'll give you an example.

So when we first started doing contact tracing last year, we thought, yeah, we could build this ourselves, right? Then we said, well, no, that's a little difficult because there's a whole lot to contact tracing. So we partnered with a company outta Seattle. All was good until we had to do return to football and partnered with the Big 12.

And the Big 12 had very specific data parameters around it. We're like, shoot. So we contacted the World Health Organization and we stood up a whole nother app. So we could meet some of those criteria that were not on anybody's radar. So as long as you're able to iterate and fail fast, that's the nature of innovation at internal to UT Austin and also internal to Dell Med too.

We have a phenomenal UT Austin commercialization unit to where if you have good ideas that are actually working, and I talked about this, I believe on your show before about the three D printed masks, N 95 masks that we created at UT Austin because I was, I did, was determined to make sure that my clinicians were not walking around.

Without N 95 masks. So we created our own, we went through the commercialization process, like, let's get this thing patented and then send it out to the world, right? So that way anybody can, can print three d print their own N 95 mask that I hopefully buy and it's FDA certified. So there's a lot of things that we do that we trial 'em out.

Think of UT Austin as a a contained ecosystem where something is a really good idea. We want the world to be able to see that. This is why our mc McAllen lab was one of the first to help do the whole spike protein process for Covid to 19 vaccine. So we actually contributed majorly to that development of that vaccine process.

That's what UT does. So when you say innovation, we. We think really big and we also think really small. And it's not that every innovation's gonna be something that you wanna take out there and spread of the world, but it is gonna be something where if you can share it and you can teach it and you can change what starts here, then that's what the ethos of UT Austin is all about.

Yeah. So your, your mantra is like, you know what starts here changes the world? Is that, do I have that right? Exactly right. Wow. And I thought you were a Baylor fan. I mean, come on here, but good job. Nice and done. Uh, yeah, no, my, my daughter goes to Baylor and actually, I think I picked that up from the, from the commencement speech, that famous commencement speech that was done at UT Austin by the, the General.

General, yeah, yeah, yeah, yeah, yeah, yeah. That was absolutely Mcal McAllen. Yeah, I believe so. Yeah. Yeah. I'm, I'm commencement speeches.

They happen. That's one of the things I miss the most is, is picking those up and watching. They're so, uh, some of 'em are just mundane. It's like, you know, you're going into the world, you're gonna do these things, and then others are just exceptional. And that was one of the most exceptional commencement speeches I can remember.

You know what, what's really interesting is that I, I have a, I have a feeling that commencement speeches, especially when they are something of a university like UT Austin or Baylor, or whomever. Oftentimes reflect the leaders and, and the types of idealism and the mentality of the top leadership. And, you know, our, our UT president, he's phenomenal.

And so Bob Eger will actually be the, uh, commencement speech for this year, this year's class. And he just announced that I believe yesterday on, on Twitter. I'm like, that's phenomenal. I mean, you know, to understand the, the importance of thinking big and making these big betts, I mean like look at what Disney Plus has done for Disney by itself.

I mean Disney three years ago, four years ago was like, oh my goodness, they're gonna sell our assets. They're gonna sell ESPN, and then they go buy the Star Wars franchise and Lucas Arts and all these things, and Pixar and do Disney Plus, and now look at them. Right? That's. That's a different kind of leadership in saying, okay, I know the, the roads in front of me look bumpy, but I'm gonna find a way above that to succeed and propel myself going forward and reinvent myself as an organization.

If I had to say what it epitomizes. Right now, all the things we're doing across the university in partnership with the state is redesigning and redeveloping what the future should look like. So it's not just. A traditional school, but it's an opportunity to really execute on the mission of this next, of this next generation of students coming up.

I think that's also what gravitates these big businesses like Tesla and others to come here, to come to Austin. We're like, we wanna be part of that. We want students coming out of that mindset because that's what we want our companies to go, right? They always say, your workers are your most important facet of your business, so why not invest in the worker of tomorrow?

Why do you think Michael Dell gave such a giant endowment? To help kids graduate because he saw years ago what UT could be, and he also sees what UT will become. So it, it's just inevitable that healthcare, then the healthcare side of this university is the exact same thing. How do we unbreak what was done last century and make next century even better?

Well, let's, let's talk about how healthcare changed on the Today it show, I look at one news story a day, and the last two news stories I. One was hospital at home, higher level of acuity being done in, uh, out of the home. And the second was retail clinics. And really how they have, uh, continued to evolve and to, to grow and specific.

There were some stories in there of Navan Health. There were stories of Kaiser Permanente and what they're doing in retail clinics. So we had, we had a pandemic. And we're, I guess we're in pandemic talking about past,

but.

A lot of habits have changed, right? We've, we've experienced not only from the patient perspective, but from the physi physician perspective. We've, we've all experienced sort of a, a taste of what digital healthcare could look like in the future. Some of us have done, uh, some experiments with remote patient monitoring and those kind of things.

What does, you know, based on what we've learned, what does the future of healthcare look like? So it's interesting, even though I'd go today, you know, we encourage our clinicians and our clinics to try to do as much telemedicine as possible, encourage folks to not come in until we really have subsided from this, from this, you know, pandemic.

But we're still seeing a 60 40 split. We're 60% of our patients prefer to come in person. And if you look at which clinics predominantly people are very comfortable doing telemedicine, you look at psychiatric support, mental health support, mental well wellness, all these types of primary care I. These are the kinds of clinics that people absolutely want.

The on demand. Let's do a quick, Hey, you know, I feel X, Y, and z. I need assistance with this. My ear hurts. What do you think, doc? Those kinds of things people are, people want instant access to on their, on their time. What's going on for folks in the specialized clinic, like let's say women's health or others, they much prefer to come in and have a private

In-person conversation, and I can appreciate that. I can understand the nature of that. So in my belief, the, the healthcare experience of tomorrow is a hybrid model where the majority of your primary care and and conditions, like I just mentioned to you, are telemedicine primarily. And which allows better access for those needs.

'cause obviously there's a tremendous demand and your specialized clinics have got to go to the home, whether it's wellness clinics, a women's health clinic or whatever at someone's home, whatever else. It can't always be come to my location. I'm in downtown Austin. It's not fun driving around the city that has all one way streets and wasn't designed for this types of, of of traffic.

Right? It's kinda like driving in Boston like, oh my goodness. But if we can extend the, those types and capabilities to the home. That's where rubber beats the road. Now what's holding us back? I give a lot of credit to the FDA over the past couple of years. They have accelerated approval of various digital therapeutics and home monitoring solutions that give the, the type of telemetry of data necessary for our clinicians is to confidently sit behind a computer and say, yep, Aaron, I can see that your vitals are this.

I can see your O two rate is this, I can see that your glucose level's this, here's your, here's what we need to do for you. Go get this medication. And by the way, now I just saw that. Uber's partnering with like Surescripts or someone to deliver prescriptions to you. So maybe I'll send an Uber to you with your, with your prescription, right?

Something like that as what's coming down the pipe. But it's gonna take technology, it's gonna take a willingness in the healthcare community. And last but not least, it's gonna take reimbursement where I do feel that now our, our officials and others are listening and seeing that this actually saves a lot of money in addition to the right thing for the patient.

How have they been shaped? By the pandemic. And you know what, what, what do the priorities look like for UT Austin and Dell Medical School from an IT perspective? Yeah, so we haven't continued to stop growing, right? So we opened up in the middle of all these things going on an ambulatory surgery center that's completely state-of-the-art and digital.

We'll be lighting up a new couple of new ORs with robots very shortly. We've got new computational health clinics coming online. Second opinion services, a post covid clinic that's opening up that I believe now is being, uh, advertised on our, on our marketing website. So there's a number of new clinics just poised to open and, and get going.

And what's also interesting is that our community, uh, efforts are really taking hold. And so a lot of either grant funding or public health funding or whatnot has come through to really make sure that our clinicians are in the field doing some of these wellness things. And so you're gonna see continued expansion.

From the UT Health, Austin Clinical Enterprise and Dell Medical School in general, you're gonna see continued recruitment of top faculty across the country. You're gonna see openings of new pediatric hospitals, also some in partnership with our partners in the area, and you're gonna see UT Austin continue to take the lead and a lot of these statewide efforts onto how do we define better care for tomorrow.

There's two major things that concern healthcare right now. Number one is the mental wellness. Both the community and your caregivers, people are exhausted as well as the community is basically an equivalent of PTSD. We have a phenomenal chair of psych, Dr. Charlie Nemeroff, who's been quoted numerous times and and numerous times in the New York Times, stating exactly that, that we have to help people because we're seeing too much trending of.

Potential risk for suicide and other things coming back on depression screenings. That's number one. Number two, you're going to see a community that's been holding back a lot of preventative care, whether it's, my chest has been in pain for a while and I didn't go get it checked out and now maybe I have a blocked artery to pediatric wellness visits being avoided.

All right. I'm gonna take you one step further and this is, you know, not the most exciting topic, but it's this week in health it, so I think this is the kind of question people have. You know, when, when we hear you talk about innovation, um, people might get the impression that you don't have any tech debt, and the reality is you have tech debt.

What are you doing to address that tech debt? We have a lot of tech debt. So first I would say it's academic medicine and, and every CIO in an academic institution can tell you that there are things you can change and you can go all in with an Amazon or Google or Azure and, and hit the ground running and there's certain things that are still gonna be running on the mainframe and you have to figure out how to work with it.

So what we did, uh, and I said I've almost been here three years, so my first year. Uh, as it is with many new CIOs, it's sort of understanding the landscape, right? And some were very layered and complicated. Like UT Austin took almost a full year to understand, okay, who's on first base? What can I touch?

What sacred ground? And we gotta work around it. Then we figured out how to partner with those folks running sacred ground grounds. Again, we do have a mainframe for certain financial applications that I think. Everybody in the state of Texas can, can understand and appreciate, but the data was accessible.

So how could we use the data to feed our, you know, overall p and l and our overall budgets and automate a lot of those transactions so that we could see longitudinally what's going on. The enterprise could see longitudinally, right? So I didn't say, okay, I know I can't replace the mainframe, so too bad. I did say though, what can I take from the mainframe work with export out and then do some magic with it, right?

And then do some analytics with it. So we do have tech debt. We are, we are constantly evolving. We're constantly investing in the future, but there's always gonna be those things. You have to work around them and you have to understand what your limitations are, but find a way around those, those hurdles.

Yeah. So what, what's the biggest change that, uh, is going on at UT Austin from a uh, health IT operation perspective, health IT operations perspective? I would say that it's really looking at more operational IT data. Call volume, ticket volume types of tickets, where those incidents are, and almost what we've been doing on the public health and public response and, and, and clinic side.

Doing it internal to say, how do we get smarter about automating processes? E example, we were partnering this morning with legal on making sure that something as simple as when we submit our legal contracts, that there's automated reminders to everybody to say, Hey, this contract is due in a year for, uh, a renewal, or whatever it may be.

Right. Okay. That's very internal. That's not glamorous, that's not sexy. But that's important because it makes your operations efficient and it makes it run seamlessly. And it also makes partners like legal happy, which you wanna keep your legal team happy. Those things are important. So, uh, from a health IT operations perspective, you have to be willing to look yourself in the mirror and go, you know what?

That's not a good look. Let's fix this. We can use tech to fix this as well. Yeah, there's really, uh, you, you don't free up enough time to do the really fun things unless you automate the more mundane tasks. I. It's not exciting, but you don't get to do the exciting stuff unless you, you cover that ground.

Are you doing anything with like RPA or anything to that effect in the IT side? I was about sell you. So we have a machine learning institute on campus. In fact, uh, we, we became a NIST site for that, for the nation. Uh, and I was actually in a conversation with 'EM yesterday figuring out how we use some of our just brilliant like computer science, like

Quadruple PhD electrical engineering students to help us create algorithms, to do some machine learning on all this data that we have, operational data, and looking at things just like this and getting in front of it, and then eventually figuring out what of that, those learnings and those algorithms, could we actually do our PA with and automate routinely, whether it's account creation, whether it is auditing of logs and QAing of logs, whether it's all these things that again, aren't glamorous.

But that's where these two technologies come in because I do believe the future is, a lot of your processes will tap into artificial intelligence and that won't be a concern, but it will be something you need to understand what goes into the black box per se, so that you can dissect it and make changes on the fly operationally.

I, I, I am a little jealous of the resources you have available to you at UT Austin to. That's really, it's amazing. It's community that, you know, every time I always ask like, does anybody here that knows X, Y, and Z? Like creating, you know, three D printing and N 95 mask, right? Like there's a million different fields you've gotta go into to figure that out.

I've never done that before. From engineering to infection prevention to quality and air quality to make sure you're filtering 0.2 microns. But the people who literally wrote the textbooks for each of those subjects came to the table with my clinicians to figure this out. I'm like. Okay. So to your point, this place is pretty interesting.

Yeah. So let's talk about data a little bit. So your approach to interoperability. So we just go through a pandemic. Uh, is there a stated strategy for interoperability at UT Austin and, and has that been impacted o over the, the events of the last year? Not only the pandemic, I guess, but the, the, the weather events as well.

I. Yeah, no, great question. So first of all, it, it is my principle that every bit of data has to be as discreet as possible. I don't like PDFs, I don't like static data. It's gotta be dynamic, uh, stored in some format, uh, no SQL database or something that's easily accessible. And then preferably if we can put it on some sort of repository, cloud, or whatever.

gated in security and control that we can then share easily. And so further to that point, we made investments with, with new interface engines and new ties into Commonwealth and other national HIEs to share the data. My, also, my principle is liberate, right? We were one of the first institutions to go live with the Apple Health kit, which then.

We were announced like two years ago when an Apple earnings calls one of the leading health systems in the country. Because we had partnered with Apple to make it happen. All I wanted to do was liberate the data. I want the patients to have their data. So with information blocking, coming live here and, and starting, you know, on here in April, it's been arm process all along to, to unleash the data right, appropriately, right.

With following HIPAA and following regulation. But release the data. And so from a technology sense, it's about release the data. We're a teaching institution, we're learning university. That's what we do. We're not gonna take it and go monetize giant data sets and sell it to big pharma. That's not what we're about.

We're about teaching. We're about moving the ball forward. And you can only do that if you have a very open book philosophy. Well, let's, let's talk leadership.

We faced a pandemic. You faced severe weather events in Texas. My daughter goes to Baylor as, as we were, uh, discussing earlier and it was amazing, uh, how much of a standstill that all came to and, and. Just the story she was telling. Waco isn't used to weather events and I doubt if Waco is, Austin's probably not used to that.

That, I mean, you're used to weather events because of hurricanes, but not used to that kind of. You know, talk about leadership, talk about the approach to crisis and, uh, maybe how your team and how the, the, the UT team approached, uh, uh, a crisis. Is it, is it a situation where, hey, you know what, we have a crisis every other year because of, of hurricanes that we're pretty ready for this kind of, or were there things sort of.

Specific events. Great, great, great question. So, uh, Austin's not ready for type those types of events. I mean, I felt like I was living back in Boston, to be quite honest with you, for that week that that occurred here. So the buildings weren't designed for that. You had water main breaks, you had food shortages, you had milk shortages.

The pediatric hospital, you had issues with making sure that buildings stayed powered, so they didn't lose vaccines that were sitting in the refrigerators. There was a lot of different nuances here, but what was great is that we have a decent command and control structure at UT Austin. Like I said, with our chief clinical officer running Point, I'm usually her counterpart of all things technology, and then we also have a facilities individual.

And so from the three of us, in partnership with our dean and our chief business officer and other major leaders across the health district partnered to make sure that patient care wasn't disrupted as much as possible. Two, any impacts locally were mitigated. Three. If buildings had issues like low water pressure across the city.

Our facilities team was all over it. Four. If vaccines were being stored in some ancillary building that lost power, could we get those vaccines deployed immediately? They did. I'll give you an example. Uh, one of the ancillary buildings happened to have one of the refrigerators that was throwing about 60 some odd Pfizer doses.

They lost power. And we're like, oh, no, we, we, we don't have time to truck those to another building, so can we go deploy them quickly before they, you know, they thaw out. Well, there was a whole bunch of students stuck in the dorm here at UT Austin. We're like, go give it to them, because that way the shot isn't wasted.

Right. We don't wanna waste any shots at all. So we did. You had nurses and doctors check out into this horrific weather. Trucker cost, you know, it's 40 acres. It was like really like 400 acres. Go to the dorms, go administer the shots, and then check back the clinics. I mean, that's leadership, that's agility.

So it takes a command and control structure. It takes an understanding of who's on first base and, and what is your responsibility and what are you accountable for, and then also having communication. We have a really good leadership team at UT Austin, and we're constantly texting, calling, using Microsoft Teams.

Zooming. I mean, whatever it takes to make sure that we're in constant contact. Now, it does mean you're going round the clock 24 7, 365. It does mean you're going to give up your nights and weekends. Sometimes you're gonna give up your, you know, Christmas Eve and New Year's Eve, which was true Stories and Thanksgiving.

Okay? But what you're getting out of it is a partnership and a, and a velocity that you can't have otherwise. If you just worry about your own little plate, you're never gonna make things like this happen and go through it. I'd be remiss if I didn't ask this question. From a leadership standpoint, you are an extremely good communicator.

You're a disciplined communicator in that your answers to my questions are roughly about three minutes, which. And in, in fact, I would probably recommend this show to anyone who's coming on my show to sort of get the, the rhythm for what really works. And so they're about three minutes. You use a lot of stories.

You talk in visuals, you talk in pictures, which is also excellent. It's because people, people learn in terms of pictures and.

How did you get there? I mean, I'd be remiss if I didn't ask because somebody's gotta be sitting there going, I love the way this guy communicates. How can I become a communicator like this? Thank you. So first of all, thank you. I, I appreciate that. Sometimes I worry I go on too long, but, but thank you for the, for the, for the confidence.

A couple things. I'm a big believer in mentors and so I learned this a long time ago from, from really watching as a very early on, you know, young IT developer, which is how I started. I was a software developer watching how people communicate. Good. Orders communicate, and even growing up, my mom was going through a Adele Carnegie course and I kind of shadowed her as a kid.

I've always been fascinated by public speaking. In fact, there are potentially VHS tapes floating out there with a little errand running around, shaking hands at at parties with my parents saying, I'm gonna be the future president one day. Right. It was always ingrained in me as a kid to be able to be effective at communicating, having confidence and talking to folks.

So as I grew up and be, and I still feel like I'm growing up as an executive. It's important that people understand what you're talking about, that the message is told concisely and received appropriately. And so over my career, I spent a lot of time, you know, listening, tuning, understanding the nuances of how to effectively state a message and then make sure I understood the response appropriately so we can act.

And that's also the role of ACIO. You're not just the tech person. You are a flow of information, whether that's on social media, whether that's within your organization or whether that's externally. And that's also why I got involved in the public policy side of things of why I'm co-chair of the high tech, because I believe in moving the needle forward and telling stories at a national level to leave this place a better, a better world than I found it so that my daughters and their kids one day can benefit.

Yeah. So here's question, this question because. Really yielded some great fruit for me on the show, which is what question didn't I ask you? What topic or question didn't I ask you that, that you'd like, like to talk about? So I'll say this, I think it'd be fun for various leaders that you interviewed to ask 'em a very simple question.

What do you wanna be when you grow up? I ask this of a lot of people, especially during my interviews, that I'm hiring people. I always say, what do you wanna do when you grow up? Like, what do you see yourself one day doing? What? And, and I would say that if you were to ask me that question, first of all, I'm doing something that I absolutely love and I, I now understand why I came to Austin three years ago and why I felt compelled here.

And I chose to come here. I had numerous job offers and I chose to come to UT Austin. And now after this, going through this whole pandemic and, and helping the city, I, I know why. But I would say that if you were to ask me where do I wanna be when I grow up? I would say somewhere in the, in the lines of being able to continue to affect public change and helping healthcare continue to grow, whether that's as ACIO, whether that's in a larger role, whether that's here in Austin, whether that's at a state level or a national level.

My objective has always been to help tomorrow and to listen to communities and deliver a, a, a, and execute on a promise of better healthcare delivery, whether that's, in my case, leveraging technology or it could be affecting policy in the future. So for me. I continue to learn as a sponge here and, and mentor under phenomenal leaders and grow, and hopefully tomorrow I'll have more opportunities to do so.

Yeah, absolutely. So the, if people who are listening to this on the podcast, they're not gonna see this, but you have multiple things on your wall, are, are those diplomas or are those something else? Those are diplomas and so bachelor's, master's certificates. The on the far, I guess would be to, to your left in the black frame.

And I just, and I do this, you know, I do this at home because in my office at work is pictures of my family and, and hand drawings from my daughters and things like that because that's the most important to me, to anchor me at home. But at work, at home, I do this because I want my daughters as they go through school to see this and say, Hey,

I can do this, I can do better. I want to be better. And I'm always ingraining in them that, yeah, dad's doing these things, but you will do better. You will do bigger. I believe in you and especially for young, impressionable children who are, are growing and wanting to do more, to have that constant anchoring and positive affirmation and reinforcement will lead them one day to do much bigger things and better things than I've managed to do.

Aaron, it's always a great, uh, I mean, I love having these conversations. Fantastic. Uh.

Always open invitation to come on the show. Whenever something exciting happens, just gimme a call done. Bill, take care. Thank you again. Thank you. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions, please forward them a note. Perhaps your team, your staff.

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