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For many of these big tech companies, the innovation version that they use is go ahead and spend a lot of money and try a bunch of stuff. And if it doesn't work, that's okay. We learned something from that experiment that will roll into our next experiment.

Welcome to Newsday a this week Health Newsroom Show. My name is Bill Russell. I'm a former C I O for a 16 hospital system and creator of this week health, A set of channels dedicated to keeping health IT staff current and engaged. For five years now, we've been making podcasts to amplify great thinking to propel Healthcare forward. Special thanks to our Newsday show partners for investing in our mission to develop the next generation of health leaders now onto today's.

Alright, it's Newsday and we are gonna start the year off with Drex Ford, which I may have been the same way we ended the year. I'm not entirely sure. You may have been the last show and the first show. How is

this happening? How is this going

on? Cuz you're one of my favorite people to talk to about and healthcare guarantee.

Thanks. Same. good holiday season for.

Good. Relatively quiet. Just kind of stayed mostly in place and hung out with friends and family a little bit, but yeah, pretty, pretty quiet. How about

you? We it was not quiet and we had the house was full for the entire duration. In fact, the house is still full. We're recording on January 3rd. Mm-hmm. and so the last people leave today. . And then this is my wife and, and then the people come next weekend, . So it's like I live in Florida and one of the, one of the things about Florida is the weather we have right now for the next three and a half, four months is I mean second to none.

Essentially it is like the fall everywhere. Like the fall in the northeast is like the weather we will have for the next four months Here, it's, it's cool enough at night, it's warm enough during the day. And and people don't know this about Florida, but we actually have a dry season. Like it really doesn't rain hardly at all. Between January and April, I mean, and then all of a sudden then we get daily, we get ready

daily downpours. Yeah. Well, I'm coming down to see you soon. I'll be down for the 2 29 group at the Yeah. Middle of the month.

So forward to that. But the CIOs getting together and we'll have some good conversation, I think. Yeah, for sure. All right, so this is the Newsday show. So we talk about the news. Let's see. let's start with something that's not. Related to healthcare per se, but is related to technology a little bit. Any of your guests impacted by the southwest? What are we calling it? Snafu debacle.

What, what

was that? Yeah, definitely some kind of severe mess up, but, but definitely seems to be traceable back to sort of tech investments, right? And decisions. Not made to invest on infrastructure and other

modernizations. So the reason I love this case study is we could sort of talk about it and sort of rail on it a little bit, and it has correlations to healthcare, right?

So you had a, you had call centers go down. You had scheduling things go down. I mean, literally like people didn't, couldn't figure out whether they were gonna be scheduled for this flight. So they had people not showing. And it was a, just a series of cascading effects. You had the, the winter blast that went across most of the country, and then it got all their planes outta position, and then they just could not recover.

And then at that time when they needed it, The technology just collapsed.

Yeah. A lot of systems, it sounds like you we're getting it secondhand, but it sounds like a lot of systems that were built kind of independent from each other. So like you said, airplane scheduling versus crew scheduling versus ground crew scheduling versus lots of other things.

Put the the wrong people in the wrong place. And I guess in some cases, just things because of the amount of stress that the systems were under the system just couldn't handle capacity. And so that was a that was another problem. And it is a thing I think we see in healthcare pretty regularly.

I'll tell you that most of my c I O jobs probably result. From somebody who had made under investments in the modernization and infrastructure of those organizations. And I'm sure, I mean, this isn't usually sort of like one person's responsible for this. It's the whole organization in many cases being responsible for it.

It's definitely the CIO's job, CTO's job to. Healthy organization understand the risks associated with not making investments for modernization and infrastructure upgrades and and so this will happen eventually, right? I. Made a post on LinkedIn about this, but the CIO becomes the Chief Tech Debt Officer.

And that is really just one step away from the unemployment line. And so you've gotta make it really clear that we have these challenges. We need to continue to do modernization. This isn't the most sexy thing that we do in the organization. I know we wanna do the cool stuff, but if we don't do the modernization stuff, we're gonna wind up in a situation where, The cool stuff won't matter because the infrastructure will go down and you've gotta make those.

You gotta make those requests clear and regular and document. If the organization says no, otherwise you'll be the person who takes the fall for it. Yeah,

it's, it's, it's interesting these budget. You and I have been in the room when the budget conversation's happening, and then the invariably, if there's, let's say 25 executives, 30 executives in the room talking about budgets, eventually it'll get to it.

And they're, they're arguing with each other about everything, but they'll coalesce around this issue that it spends too much money. Ah-huh. , I mean, they, they, it tends, tends to happen. And at the end of the day, you, you really do have to be prepared to make the case and make the argument, but even more importantly, to provide the transparency.

It's like, Hey, you do realize that like 89% of my budget is spent. , the delivery of clinical care and the delivery of the patient experience and the clinician experience. And it's like, and they're like, no, you don't prove it. And you should be able to just pull out the information and look, Hey, this is what this costs, this is what this costs.

And I, I mean, I'm always telling CIOs, transparency's your friend, because for sure, because the, the, the numbers back you up. It's like your budget is not for you to go to Tahiti. Your budget is for you to. The mission and the, the ministry and the care in your local community, depending on what your orientation is as a health system.

And so, yeah. Yeah. It, you're, you're,

you're running business, clinical or research products. That's what you've been asked to do, to run those things and run them really, really well. Cost resources. And so you should be able to really clearly delineate what running these systems cost, what's attributable, what to what systems.

And some of this is just going to be underlying infrastructure stuff. And you should be able to sort of lay that out too. And like I said, like you said, I think transparency is the key to the operation. If you've got a good governance process and you are really transparent about this, then you really should have advocates.

Maintaining and modernizing that those advocates come from clinical research and business operations. They don't want their operations to go down.

Yeah. Have you, have you been a part of an organization that does chargebacks? I,

I have, I have not. No. I've, I've not, we've never done there, there have been situations where I have taken legacy systems. That have been replaced. But the c f O wants this legacy system to continue to run for a while. And we have moved the cost of managing, refreshing whatever that system to the CFO's budget because it's not really sort of general. Information services, operations requirements. At that point, we wanna make sure that the pain for that system running comes out of that cost center as opposed to the general cost center of the information services budget.

So the places where I could. Slice things off and charge them back. I did, because I want that system out of existence. I don't wanna have to run that thing for the next 10 years. And if I don't create some kind of pain, then I would, I'd be stuck with it forever.

Yeah. And that creates the problem though, doesn't it? Because if you're not doing chargebacks, it's like, Hey, I wanna spend more money. I wanna spend more money, I wanna spend more. because quite frankly, it's not on my cost center. I don't really see it. It goes on your cost center. That's where that, that challenge. But every CFO of major systems, the larger health systems that I've talked to is like, look, the administrative burden of tracking and administering chargebacks, and you're still gonna have tense conversations anyway, so you might as well avoid that cost and just have the difficult conversations.

Which is you, you, you provide the reporting and the transparency and then say, look, as a group, we have to decide where's the best investment of our money. And I think the thing that really sneaks up on people is the maintenance. Mm-hmm. , they, they, they think, well it was only, you know that that system was 2 million. I mean, why, why have we spent three and a half? It's like, well, it's 2 million to acquire and implement that system and it's another six or 700,000 to keep it running every year. Yeah. I just look at you like, oh my gosh, I,

yeah. This is why the in the governance process you're really clear about not just implementation costs, but the opex tail that goes along with, System, and that can include FTEs, maintenance costs, hardware, refresh, cloud costs, all those kinds of things.

You've, you've gotta put that in there because again, transparency and visibility, you want them to understand what they're really biting into, that it's not just the million dollar. CapEx investment or the million dollar upfront investment, but it's actually much more than that over the next five years.

And if you can lay that out for 'em, it really helps everybody make a better decision because they, it also creates the business, clinical or research leader who is the advocate, who is the lead for that project. The C F O then starts to put pressure on them for, so tell me about the roi. How many FTEs are we going to be able to eliminate in year number two?

Because you've, you've implemented the system, or how much more revenue are we gonna collect in year one because you've implemented the system that it lets the C F O also put that on the books as a prediction, which again creates much more tight ownership. By the business clinical or research leader to the system implementation to make sure that it's done quickly and it's done right.

And workflow processes are changed to help help facilitate the, the system use and system optimization that they do all the things they're supposed to do as the person who really owns those IT projects especially when it comes to. Business system or clinical system implementation? Yes, sure. You've given me, you're giving me some PTs. D man,

this is, I know. Well it it is interesting the this, this really does support the case that the CIO has to be good at, wear a lot of different hats. And one of 'em is, quite frankly, as a. Pretty sophisticated financial analyst and somebody who really understands it.

but 90.

I mean, I think you've gotta think, well what does that mean? Like 90% of nurses. Are probably thinking right now, if I had another good opportunity that was as interesting as what I do today and fit into my mission orientation, I might consider leaving nursing. Right. Or, or doing something else. So, yeah, that's, that's

huge.

Yeah. So Nursing. Let's talk about it from a health IT lens here. We know this has always been a challenge. Staffing, clinical, staffing specifically around nurses has always been a challenge. What do you I mean, I know what I'm, what I'm thinking about right now is automation.

How are we gonna automate it? How are we gonna take fewer people and still get the work done and provide the level of care that we. need to provide. I mean, I, I, I assume that's the thought process and then what areas could we potentially augment the loss of staff in the nursing arena.

Yeah. I think the other part of this too is just the amount of burnout that we see in clinical staff.

I mean, they've been Pretty severely beaten up over the last three years or so, and I think that's why a lot of them are, are thinking about leaving. There's also sort of a my wife's a nurse and so I am Do I say this? Sure. That I feel like I'm sort of pretty well integrated into the Nurse mafia in a lot of ways in the Seattle area.

And I think they they feel like they are. They're beat up, not, not just by the amount of stuff and amount of patients that are, that are coming at them, but also sometimes the abuse from patients and the lack of support that they have from their leadership. And so all of that kind of conspires to to make them think about.

what are their other options? And I think if enough of them kind of go down that path, you're right, we're gonna, ki gonna have to come up with better, more automated ways to help them to help the job get done. Maybe without Yeah, more nurses in the mix.

I did see a couple of named health systems come out throughout the year.

And essentially side very strongly with the clinical staff and say, this is the behavior. That will be acceptable towards our staff and essentially said to the patients, Hey, no more, no more just lashing out at the nurses or any of the caregivers. It's just not acceptable. It's not acceptable anywhere.

And you know what, it's, it's also not acceptable here. We're here to care for you. We're gonna do that with Compass. But if you cross a line mm-hmm. , we are going to essentially become a mash unit for you, which is stitch you up and send you somewhere else.

Mm-hmm. . Mm-hmm. . Yeah. I mean, I know there's a lot of physical and emotional abuse that occurs and, and look in the grand scheme of things, My empathy is everywhere. If you're in the hospital and you're in the I C U and your family is there, this is probably one of the worst days of their lives too. Right? So they're also emotionally distraught. They're, they're worked up. They, they're trying to get answers. They're trying to understand what's happening to their loved one, and, and I understand that, but there is definitely a, feels to me like an uptick in the in the amount of.

The amount of abuse that clinical staff takes these days? Not, not great for anyone involved, including the quality of the care for the patient.

Yeah. Here's, here's one of my favorite stories of the year. Larry Ellison on healthcare data fragmentation. We're going to solve this problem. Have to love his enthusiasm, have to really not like. Knowledge of history walking in saying he's gonna solve the problems that have failed healthcare for years. But that is one of the big stories for this year. So Oracle's acquisition of Cerner and the promises that they. Are making, what's your, what's your view of the E H R market at this point in time?

Well, I

mean, I, specific to the Oracle thing, I guess I would say I love the attitude and I hope it's true. but like you, I have a lot of. Battle scars from vendors who have said we're gonna do these things and then not actually being able to follow through on the things that they have said that they've sort of committed to, maybe for lots of reasons.

But some of it sort of boils down to this is harder than it looks. So I'm, I'm rooting for 'em. I hope they can do all the things that they say they're gonna do, but I will also kind of Hold my judgment until I actually see some of the stuff happen. The E H R market. Otherwise, what, what, where are you going with that?

What do you, what do you think? Well,

so so Allison's vision, I think that he painted back in, when was this? It was in the middle of the year. Mm-hmm. , it was like July timeframe or whatever. But his vision was essentially a national EHR database. Right. So Cerner for the most part is hosted.

They're cloud-based. They're gonna move 'em to the Oracle cloud. They know how to use data. They're gonna integrate all that data and pull it together. So if you show up at any Cerner facility, essentially you're looking at a national E H R database. That was his, his model. And we're seeing more and more of that consolidation.

Where am I going? I every year I like to look at the EHR market and, and I don't think, look, I don't think people are gonna listen to this and go, oh my gosh, I gotta, I have to change my eh, r cuz you know, you're talking hundreds of millions of dollars to do that investments in time workflow and other things.

But as I look at it, it, it would, it would appear to me Epic's getting stronger. You're still reading about migrations to Epic. you had Atrium finish up an epic implementation moving away from Cerner. I, I think if anything, meditech's getting stronger. Oddly enough, I think the people who use Meditech realize that it's a, it's a very cost effective solution for running a certain size hospital.

And then to throw that into a sort of a tailspin, you have Hca, who announced, Hey, we're going with Meditech Expanse, and they're actually gonna migrate some sites off of Epic onto Metatech Expanse.

And part of that is their for-profit system. They can't afford the the ongoing, we talked about maintenance earlier. The ongoing, the, the tax of running Epic has to be offset with a lot of efficiencies and what they've done as they've looked at it and. We don't see that much efficiency gain over what we're running today in moving to Epic to really make sense to pay that tax of running it.

And I at that point I'm, I'm looking at those two horses Meditech, which has been around forever and Epic, which has been around forever. Meditech finally has an integrated ambulatory and acute system. And it's cloud-based and whatnot. So I think those two have really solid, solidified their positions and have sort of established their markets.

And I'm a little concerned for Oracle, Cerner in that. I mean, I don't hear any momentum in their direction other than the government

contract. Other than the government stuff. Yeah. So do we wind up with sort of like, Federal government, military, VA health system that runs Oracle, Cerner, and a lot of the rest of the world are ones Epic, Meditech.

And then the other thing I would say is like, there's still dozens of other little electronic health record, I mean little in comparison to the big ones. Electronic health record companies who run in clinics and surgery centers and that. That are doing quite well in their specialty niche.

And so there's still a big challenge about where most Americans get their healthcare, which is at a frontline dock somewhere. And the EHR that's used there, it's not always, we, we like to think of it as being mostly Meditech or Oracle or epic. But it's it's a whole bunch of different stuff.

And so there's still a big integration, data integration challenge is, and,

and actually you just made the case that I made when I was CIO and they were saying, look, we, we have to go to one EHR across all of. All of our practices and acute ambulatory everything, and I'm like at the end of the day, we're still gonna have to solve this problem because we're not gonna be able to dictate, especially in some of our markets, we we had a clinically integrated network that was outside.

We could not dictate this is your EHR and you must go to it in order to practice at this hospital. And so it was always gonna be. , it was always gonna be fragmented, so we still had to solve the problem. Not that it wouldn't have solved other problems, but we still had to solve that problem. Yeah the next story they have is allscripts to sell hospital and large physician practice assets.

At this point, it looks like they're just piecemealing out allscripts and selling off, selling it for parts. And I, I mean, I really have nothing to say about that other than that. Their next biggest story is why does big tech often fail in healthcare? They, they obviously talked about I B M, they talked about Google's early and Microsoft's early initiatives into healthcare and how they had health fault and whatnot, and but I, to be honest with you, They we tend to focus in on the failure of big tech in healthcare, but they keep at it.

They're like the Energizer bunny. They keep coming back with different approaches and different models and some really the Amazon acquisition of one medical, that's a pretty significant deal. Microsoft is, is heavily used by. I can't think of a health system that's not using them, but by most health systems using their platforms.

A lot of them, a lot of 'em are using Azure. We saw Epic in Azure. Take a big move. Google Search Bar is now integrated into the Meditech Expands platform. And they, they just keep coming back in a lot of different forms. It's like they're learning. And they're persistent. I think it's the

culture, right?

It, a lot of this, for many of these big tech companies, the innovation version that they use is go ahead and spend a lot of money and try a bunch of stuff. And if it doesn't work, that's okay. We learned something from that experiment that will roll into our next experiment. And so we're used to seeing, I think, in healthcare, companies come into healthcare and be in healthcare for a really long time and we wind up trusting them cuz they've been in healthcare for a really long time. But a lot of the big tech companies really are much more centered on this idea of try and try and try and try again. And it's okay if you fail. That's not really failure. That was a learning experiment that we're gonna roll into our next attempt. And so it's just a different way of looking at the.

let me, let me read off the rest of these. I'll read off some of these stories. Sure. And I, I wanna get to the poll that I put out there this morning. Cause I think I'd love, I'd love for us to just hit that cuz it's more forward looking. Epic launches SaaS aimed at independent medical groups. That's the smaller systems that you were talking about. Mm-hmm. garden plot software. IBM sold Watson to Francisco Partners. And that will reemerge likely this.

In all of it's glory. And then Ken Oracle makes Cerner's e h r sing. CIOs and analysts chime in. And so a lot these big tech stories get a lot of hits and I think that's one of the reasons you see you see so many of those stories out and it gets such such press. So, I put out a poll this morning, and as we look forward, Drex, here's the forward-leaning pool.

Yeah, I, I mean, I think just the financial pressure. What was, how did you phrase the first one? Yeah, financial pressure. Financial pressure. I think the financial pressure, which in the spirit of like tactics, e strategy for lunch, I think there are a lot of things that health systems want to do.

But I think the figuring out how to get through the year, depending on and, and this is really different for a lot of different health systems, is one of the things I've learned over the last several years as an independent consultant and then working with CrowdStrike is that.

Different health systems in different markets are definitely having different experiences when it comes to financial pressures and financial issues. It's easy to sort of generalize and say healthcare is under a lot of financial stress, but there are definitely health systems who are hanging in there and and doing okay.

So I think. The answer to the poll probably is, it depends on the health system and the market that you're talking about, but realistically, I know you're asking sort of a universal question, and for me, I think it's financial pressures and how the organization deals with those financial pressures will help drive their decisions.

About the other items that you have in the poll.

Yeah, it's, it's, of the four that are in there, financial pressures at 55% worker shortages and worker experiences at 31%. And I think I agree with that too. I think. Clearly we can walk and chew gum. We don't have to, but I'm just saying which of these do you think will drive the activity?

And those two make up 86%, we are six hours into the a three day poll. Wow. Yeah. So clearly that's top of mind. Our, our workers, our. We're worried about burnout. We're worried about shortages. We're worried we cannot deliver care without caregivers. And so that has to be top of mind.

But along with that has to be, Hey, you know what? We need to, we need to take care of these people, and part of taking care of these people is increases in wage. To match inflation and that will generate financial pressure. So the

spirit of everything is connected to everything else, right?

Yeah. The financial pressures are tied to the people. Are we gonna renegotiate contracts with nurses and do all the other things that we need to do to make it a great place to work? All that costs money too. Yeah. But

this makes it a great year for big tech in healthcare cuz disruption in new competition is at four. Of the, of the vote so far, which means, hey, they're gonna get another year of really not being looked at. And keep doing, keep doing what you're doing, get smarter, get better at delivering what you're delivering. Because the healthcare, it's like healthcare providers today are looking elsewhere. They have other we've

sort of talked about this as he.

Organizations in many cases are kind of like big whales. They're burdened with a lot of the things that they have built over the years from facilities to automated information system infrastructure. And a lot of the big tech companies are really like sharks. And they're, they're going to take small bites out of that whale.

In places where it makes the most sense for them. And those are things that can be highly automated and turned into routines and AI insertions can be done and, and all those kinds of things. They're not gonna take on the whole thing at once. They're, again, going back to that big tech story. I think they're gonna try a lot of stuff, figure out things that work pretty quickly and move those into their portfolio for the future.

It's always great to get together with you and I I'm gonna be wearing the glasses more so people who are watching on video. I, I've decided to stop pretending that I can see and now wear my glasses to look at my computer. Me too. Yeah, I'm at that, at that age. So, hey, now we, we both have matching glasses. We're in good, good shape. Thanks again for coming on the show. I'm looking forward to seeing you at the event in a couple of weeks. Should be should be fun.

I'll see you soon. I'm really looking forward to it. Thanks for 📍 having me.

And that is the news. If I were a CIO today, I would definitely have every one of my team members listening to the shows like these. If you wanna support the show this week, health, tell someone about our channels. We have three this week, health conference this week, health Newsroom, which is what you just listened to. And this week, health Community. Check them out today. You can find them wherever you listen to podcasts. Apple, Google Overcast, Spotify. You get the picture, we are everywhere. And you can also subscribe to our newsletter as well. You can subscribe on our website this week, health.com. We wanna thank our new state partners who invest in our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.