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  Today on Keynote

(Intro)  How does it influence the workforce? How does it help the workflow? And how does it improve the well being?

If you cannot tie it back to one of those three, workforce, workflow, well being, why are we doing what we're doing?

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My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week.

Now, let's jump right into the episode.

  (Main) all right. It is keynote. And today we have a great episode. I'm really excited to be joined by Donna Roach, who is the CIO at University of Utah Health, and then Chero Goswami, who is University of Wisconsin Health as well. guys just CIOs?

Cause one of the things we're going to do is we're going to talk about, you were just chairs at a 229 event. And just going to do a recap, what's top of mind of CIOs and those kinds of things. But are you guys holding steady in a CIO role, or have you added vowels and consonants? Donna?

I'm the CIO and, now I have to say I'm the chief information officer, cause somebody was like what's the I stand for?

It's still information. And I'm really good in this role. I like it. I don't need the D added in because it's already part of my job. So yeah, I'm the CIO.

And you, Chero?

My title has the D, and like Donna, I really don't know where the D starts and the D ends, because the opposite of digital is analog.

And I don't think I've ever seen a title that says Chief Analog Officer, so I'm just going to leave it at that. In terms of roles, Thousand Consonants, I actually do have the privilege and the honor to lead about seven other departments, other than Information Systems and Digital and all that stuff, which has been really great.

A tremendous learning experience and we can talk through more about that because it has re grounded me on why I came into healthcare and be close to operations.

Let's start there actually. We're just in a room with a bunch of other CIOs having conversations. Are the demands on the role changing?

I guess is the first place I'll start with that. Donna, what are your thoughts?

I think, depends on the organization. The role has definitely evolved. I think the role has become much more strategic and insightful in terms of what's going on in the industry. It's not about being the order taker anymore.

And I think the CIO sometimes fell into that, be an order taker, be a caretaker of the data center and the applications. And it's much more than that in terms of its accountability and where it Kind of fits in the organization, but you have to look at that, the culture of your organization and trying not to, jam it into certain areas without having that really strong dialogue relationship with the area that may see you in as an order taker.

Yeah, and Chero the job of the CIO may not have changed, but they've put a lot of additional functions on top of you. Do you think that the CIO, CDO role is changing?

I like the way you said that the job may not have changed. I think the level of influence of a CIO has changed.

As Donna mentioned, we are elevating appropriately from that order taker to a value enabler concept in that matrix. And the way I've always looked at technology in healthcare is my three W's that I talk about. How does it influence the workforce? How does it help the workflow? And how does it improve the well being?

If you cannot tie it back to one of those three, workforce, workflow, well being, why are we doing what we're doing? And if the answer is because that's the way we've always done it, that's the way someone told me to do it, take a time out and ask, are you autotaker or value enabler? And technology is one of those aspects that sort of creates the 360 degree glue.

between the health system and the patients. And in many ways, we are the ones that can actually tell the left hand when the right hand is not doing something right on the repercussions of that six months later.

the one thing I would add, Gartner talks a little bit about this is exploiting technology, right?

And sometimes that has a residual impact on the well being and the patient and stuff. It's, think we're sometimes the only one at the table that can really say and push the exploitation of the technology and where we can go with it. So it's that balance, right? You're constantly like, boy, I could really, be a huge change agent, but if I do it at the expense of one of those others, I really have to keep that into a balance.

going to lead this off. So I'm going to ask each of you, what was top of mind What jumped out at you in the conversation, I thought we had a poignant moment where we were talking about well being. And we were talking about the well being of our staff, the well being of our clinicians, the well being of others that we play a part in.

Either we oversee them and they are overwhelmed and the pace of change is overwhelming them, or we provide solutions and technologies to them. And that group is overwhelmed. Talk to me about how the CIO is being approached on those topics. I, for one, when I was CIO we actually had.

Suicide on the IT team. I don't even know how to talk about it. I It was a very difficult event, especially for those people who were closest to that person because they sat with them and they talked with them every day and something happened in that person's home and it.

It essentially was too much for them and they decided to take their own life. But that had a significant impact on that team. And I'm wondering, the pace at which we're moving and those kinds of things we feeling that kind pressure within our organizations to keep up?

I can go first, Donna, unless you want to jump in. Go ahead. So Bill, unfortunately. I've had that experience in my career as well and it's one of those things that when we, within our closed network, we, one of us, share a story, we realize a lot of hands go up in the room because misery loves company. And I use the word unfortunately because there's no easy way to get out of it.

And what I realized the time that had happened was as much as we talk about technology, the first role of a leader is to take care of their people. Even the best of technology is useless because it's the people that convert a technology to a solution and there's a big difference between those two worlds.

So I can speak for myself and say more than 60 percent of my time every week, including nights and weekends. is with one on one time on my staff members. And I think the well being of employees has actually gotten worse over the last five years because of our remote and hybrid work environment, because that line of separation between life and work has delineated.

Most people work from home, and there is no way the stress of your personal life when you come into work, when it's basically two rooms in your same house. Behavioral health of our employees is a significant concern, and money is not going to fix that. Time and empathy is what they need from folks to understand, recognize, and solve over there.

So as leaders, and I know Donna's cut from the same cloth, we work together, is we owe it to our team members, they are our work family, that we take the time to understand what they are looking for most. Sometimes it's just acknowledgement. Sometimes it's just intervention. But most importantly, we have to show our vulnerability to say that is an important part of our conversation and not just spend our time in talking about project statuses, budgets, contracts, and all that stuff that we normally think of when we think of work.

Maybe I'll give a slightly different view of this. So we do regular surveys of our staff. We used to do them quarterly, and now we've moved to every six months. And from an IT perspective, and my staff constantly are coming back saying, don't take away the hybrid ability for me to work at home.

And I feel that's actually my saving grace for them is that they can do it, but where also have the ability for them to come in and do work here. So I have the floor of one of my office buildings and it's still set up that people can come in and work in the office or work from home.

I think what Chero said, though, what's important is you're listening to your staff. You're hearing the message from them and you're addressing what their needs are. And that's something they're constantly saying, don't take that away. Don't, we need that. And I'm like, okay. because I think I get more out of people by them having this ability to work at home.

Now, what the downside of it is. that I don't want them to be on from six in the morning until seven o'clock, eight o'clock at night, I need them to disconnect. And part of that's on me. Like I purposely will not, unless it's a true emergency, I won't email people.

your emails to go out the next morning.

I'll schedule

it or I'll just hold it. Or I won't text somebody because I think. I remember when I was in their role and getting that text or email from the VP or the CIO and having to drop everything and address it. And it's it's just not fair to the staff because they do have time that they need to separate from work and, save it for the big things the downtimes and the go lives and stuff.

So far, I've got a really happy group of people who have this hybrid capability. Now, I still have people, I've got, Biomed that has to come in the office and, they have a whole different set of issues because they're constantly having to support the, at the elbow clinical care, and that's difficult.

And so they have different issues that I need to address. I can't treat them all the same way. and people have said so when are you going to take it away? And I'm like, as long as I'm here, we will have this, I will not take it away.

Yeah. I'm judging from the Herman Miller furniture, which I assume you don't have in your house.

You guys are both in the office. And so does that mean your executive team is required to be in, in the office? At this point, Donna,

mine is, but nobody has ever said you're required because I have an office here at the hospital and I have an office at my 102 building downtown.

Nobody has ever said be here. But, take note, everybody is coming in the office, even during COVID, everybody was coming in the office. So it's you learn from the activity going around you that's a little bit of an expectation.

And it's a treat to see you in a tie there, chero.

Is your executive team in there? The IT executive team in there?

So yeah, this is not my usual attire, as is duly noted. So I would say I measure presence by quality, not quantity. And yes, so the leadership team does come in. I don't use the word mandate. I use the word strongly encourage for them to come in on a regular basis.

And the intent of that is you can do the work from anywhere. You cannot build culture and you cannot build relationships over a video platform as much as you do in an in person setting. Even for the staff, I will say, be most productive from wherever you want to work. And do take the time to come in and actually spend time on the front lines.

If you're coming into an office and sitting and doing a Zoom or a Webex, that's useless. So actually I encourage the staff not to come into the IT building, but if you're coming in, come and spend time on the front lines, because if you don't understand workflow, then what are we coding? What are we driving?

What are we building? So that office time is, Spend in learning and building cultures, not necessarily sitting around a table doing meetings.

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  📍 📍 📍 📍 📍 📍 📍 📍 📍 📍 📍 📍 Hi, I'm Sarah Richardson, President of the 229 Executive Development Community and host at This Week Health. I'm thrilled to invite you to a must attend webinar on September 24th, where we'll be discussing the future of healthcare cybersecurity. Join me and top experts from Rubrik and Microsoft as we dive into their powerful partnership and explore how they're leading the way in protecting healthcare data.

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📍 part of the conversation was maybe a 20, 30 minute part of the conversation, but we talked about a lot of other things. What was top of mind?

Donna, we'll start with you. What one discussion do you want to bring up and throw out there?

we all came in with kind of wanting to discuss ambient listening and what's going on in our shops and what we're trialing and what we're piloting, what's working, what isn't working.

Some rollouts than others. I think and hand in hand with that was the Champion Challenger model. Let's just say you go down the road of one ambient listening vendor. Should you have another one in the background contracted with to take over if something goes wrong?

Take the Change Healthcare. situation, right? can you have something in the background to turn on instantly and turn the other one off? It's more expensive. You have to have different workflows. You have to have potentially different workflows. You have to be able to support both systems, but that's one area that you could, I think, easily You know, push that concept out.

The ambient listening, I'm telling you in my evidence and what I've seen so far with our rollout and our pilot is that I can't take it away from physicians right now. They absolutely. Love it. I have 168 docs that are actively using it, and they want to keep it. There is a cost model that we have to address, but they see the value in it.

And all I have to do is let them speak for it. I'm actually setting up, we'll do a board demo of this to our board in the fall. And it's a game changer. And they say it's a game changer.

I'm going to drop names here.

Lori Bojali from University of Vermont. Did a really interesting way of selecting the ambient technology. She did a blind study on them. She essentially let the physicians use several of the technologies and then they just commented on them and she's willing to share that information.

And that is public. And she said there was one vendor that was, far exceeded the others. I'm not going to say who that vendor is, but I thought that was an interesting approach to say, okay, which one of these really works? I will say from my perspective on that, and we'll come back to Champion Challenger on that feels to me like Ambient is just taking off.

Like everybody's doing it and it's expanding. Very rapidly. Charo, what's your thoughts on Ambient?

So Ambient specifically, we're going through a POC with one of those two vendors, and it's one of those things, as Donna said, there's no going back. There is no going back. In fact, we met with the CEO last week and we're talking about fast tracking the rollout of it.

Generally speaking, I would say one thing I like about these sessions here, Bill, is. We don't get stuck in hype and talk about shiny objects. When I look back at the day and a half that we spent, it was about people. It was about productivity. It was about vendor management. It was about financial acumen.

It had been 10 years since I was in a room where we talked about enterprise architecture. Not armchair architects, but true enterprise architecture, domain architects, and enterprise architects and things like that, which tells me that there is a growing movement of focusing back on basics and not getting lost in the shiny object syndromes.

we have to talk about basics, don't we? The organization's looking at us saying, Hey, this change healthcare thing can't happen again. Oh, by the way, the Ascension thing can't happen. And it just goes on. And so they're saying, all right. What's going to require that? And the conversation was interesting.

I'm going to come back to Champion Challenger here, because we essentially said, okay, what's your best idea around avoiding this in the future? And here's my other name drop. So Erskine from Emory was there and he talked about the Champion Challenger model. And it's so simple that know the first time I heard it from him, I'm like, Oh my gosh, why didn't I think of that?

That's so obvious. But essentially you go out for RFP, you get it down to two companies and instead of signing a hundred percent contract, you sign a, maybe an 80, 20, or even a 90, 10 contract. You implement both. you implement them completely and 10 percent of your business is running through one, 90 percent running through another.

But contractually you can ramp one up to a hundred or, whatever you really need to do. and when you're not using it, the cost goes down and that kind of stuff. And as he was saying it, sitting there going, Oh my gosh, that makes a lot of sense for certain things.

It makes a lot of sense. And I guess you could do that with something like the services we look at for change healthcare. there's a couple others that we did talk about. was that an obvious thing to you? Or did you do the same thing I did when he said it?

Oh, I could think of some areas where we could do that.

I think the biggest thing is it's more costly. And so anytime you go into a contract, you're always looking at how can I save costs? It's a little bit more costly, but in the big picture and the big scheme of things. Is it really more costly when you have minimized the risk?

And I think entering into that kind of concept of a contract isn't always about a dollar amount, but it's also minimizing risk and how are you accepting or de escalating your risk profile. And that's what we have forgotten about a little bit in the contracting process, and we need to reintroduce that.

Chero, I don't know about you, but I got an email from somebody after that event the email essentially said, do you think this is possible to do with the EHR? And I'm like, I don't think it is, but it's interesting to think about it. If like you broke down certain pieces, there's so much integrated devices and connectivity and whatnot that I think that would be.

A bridge too far, but it was interesting to think about, hey, instead of when it goes down, you go to paper, you're at least collecting the information electronically and in some fashion on a different system. I was like, yeah, I don't know. It just seems like a bridge too far for me.

Here's what I would say the definition of a good conference or a good meeting is five people walk in with five ideas, but they walk out with 12 good ideas, out there, and ideas build upon ideas.

And then you start talking about redundancy as what's the value proposition of the redundancy that you need for that capability. For an EHR, maybe it's not the second vendor. But here's another phrase that we have all accepted in the last 12 months at Sierra 2 State, business continuity planning. So I took that idea and said, how do we tie it back into business continuity planning?

And maybe it's not a full blown second EHR, but explore the opportunities versus to say, it's never going to happen, or there is nothing to do about it. So without doing that, if you don't tie it back to existing initiatives, The dangers we create for ourselves is we just create one more thing, one more thing, one more thing.

And that leads to exhaustion and obviously a little bit of lack of focus. I took that and I tied it back to that capability management and back into the business continuity planning and we're exploring options.

You brought up architecture. I was pleasantly surprised how robust that conversation around architecture was in that room.

Thank you. of CIOs. It wasn't like abdicated to the chief architect or that kind of stuff. There was a pretty vibrant conversation. Specifically, it felt to me it was a lot around that business continuity, but it seems like CIOs have come up to speed and have to be up to speed. on architecture at this point.

I will say my last role as a technical, in a technical domain, was one of an architect. So I'm always nostalgic when I see that role come back. And here's why we brought it back as a vocabulary. In my simple world, you have an idea, you source resources, you launch, and then you scale and sustain.

A lot of good products can go through those first three phases of idea and source launch. Where healthcare struggles is scalability and sustainability at the right price point. What works for a 100 bed hospital does not work for a 3, 000 bed hospital. And that's where it fails. What works on a Friday afternoon does not work on a Monday morning.

And all of us at academic medical centers know what Monday mornings look like. That is where architecture, Becomes important. And now if you face it from the other side of our vendor partner community, look at the mergers and acquisitions on the vendor side and on our side. Without architecture, if we keep buying more products and then use the word of interoperability and just moving millions of dollars or you spending millions of dollars and moving things.

It's a tax we pay. So architecture is the investment to avoid the taxes of interoperability. That's my opinion, at least.

I'm going to add something to this, because I think sometimes we, in the past, we've abdicated. Not knowing that we have given the architecture away, and I think it now it's really this opportunity to bring it back in and say, and whether you wanna call it architecting or platforming the direction it those are pieces that are really owned in the it shop, right?

It's the running it like a business. so that you can plug other things in and make sure it works, right? It's as simple as when somebody says let's do cloud with this. I can't take an application that was written for an on prem solution and port it over to the cloud. It doesn't work.

And it sometimes gets sold to us that way, but it's that architecture behind it. One to make sure. And two, that as these solutions are coming up, that we're looking for Those kind of components that are going to work within the framework of what we've set up. And honestly, I think only IT can really do that.

And it speaks to, a lot of people bring the bright shiny objects in and say let's use this, but if it's not architected into the framework in which we've created, It's not going to work. And we'll spend way too much time and effort trying to make it work.

Yeah. If you don't have another topic, I want to throw out this Apple thing, which was really just so fascinating to me. So again, Alistair is essentially going to bring up a new hospital that they're building completely on Apple equipment. And I can't tell you the number of IT people that I've said that to, and they just looked at me like, that's not going to work.

That doesn't, there's no way, there's no way. He sort of laid it out and said, this is what's needed. This is what's required. This is why it makes sense. Yes, the hardware is a little bit more expensive, but the life cycle on a Mac device. is a full two years greater than a PC. And I'm like, he started going through, security of a Unix kernel versus a.

Windows kernel and a bunch of other things. And as he was doing it again, I was just sitting there going, yeah, that makes sense. That makes sense. That makes sense. But there's a lot of roadblocks to get from here to there, which they're going through. There's so many projects.

Did it surprise you that he's taking that on as a project?

I'm doing that for the last year as well. And it's another form of champion challenger, right? You don't want to put your eggs in our basket. And healthcare as an industry, if you think of most of our care teams and our providers and physicians, most of them prefer a Mac device anyway.

So why wouldn't we do that?

I remember my first executive meeting and I looked around the room and there's all these iPads, a couple of Mac books and stuff. And so I went back to my team cause they'd give me a PC. I'm like, Hey, I want a Mac. They're like, Oh, that's not a standard. Like you can't get one of those here.

I'm like, What are you talking about? The entire executive team is on them. we're not securing that, then our stuff is going all over the place. You might want to get in front of this. And they were just like, what do you mean they have these devices? I don't think it's already out there.

It's a mind shifter from an or to an and.

That's what it is. We have used the word standardization. We've overused the word standardization sometimes in our industry. We have to give preferences within the right domains.

one thing, so you've got a great opportunity where, what Alistair's doing, a brand new hospital, that's the time to do it, right?

To set that up like that. In looking at Apple, The sustainability model and the power usage of those devices it's unbelievable in comparison to a regular PC. So the power savings is key. And I think that's, we lose that a little bit in what we're going to talk about it, but. It's like we're all living through a very hot summer, right?

Will we be entirely Apple? That's still left for, the negotiations. Let's

see how it goes for Alistair first.

Yeah, I want, go ahead Alistair, I want to see how it goes, and then I'll follow suit. I'll tell you,

that sustainability every time get the Academic Medical Center CIOs together, that the call for greater sustainability is upon you.

It's hey, your data centers are using too much power. How do we reduce that? How do we reduce greenhouse gas? , and I think this is one of the areas we're going to be looking to you as the AMCs. to lead the way and say, okay how do we think about this?

It's funny you mentioned it because we had one of these a year ago too, right?

In California. And I have such great appreciation for Dr. Pfeffer over at Stanford. And he really got me thinking about, Wait a minute, in our digital strategy at our, we have a one pager. We need to incorporate sustainability in that and make sure that we're bringing that to the forefront of how are we doing this and it shouldn't be creating an environment that now my kids or my grandkids have to clean up after us.

Mike is great and his focus and what he thinks about. And I think we all need to consider that as we move forward with, are we going to leave this, earth better off than how, we came into it? it is our job we have to incorporate it in.

So you go back to, okay, what's the role of the CIO? Part of it is being sustainable in what we do. We should not be a junk warehouse of, old devices and things that just are drained on our power grids. Yeah,

Chero , I'll give you the last word since you have a tie on. It seems official to give you the last word.

Wow, the closer my reputation continues. would echo my comments and gratitude to Pepper. It was at the same conversation where I came back enlightened and This year, fiscal year 25, which for us is day 16 I've actually added environmental sustainment as one of our focus areas for the IS and informatics leadership team.

not embarrassed to admit that I did not know the term ESG as an environmental, social, and governance data 15 months ago. And as the line goes the first step to addressing any problem is to acknowledge we have a problem. And for all the conversations, and I'm so excited we made through 29 minutes without using the word AI, with all the conversations about AI, where is the conversation about what's the impact of all the GPUs?

On the environment. So that's a perfect example when we say, or at least I say, innovation leads to disruption. We are creating disruption, not necessarily in a positive way. And sustainment is the litmus test that we have to hold ourselves to, because we can't leave the world in a worse place than the one we inherited.

So one thing, can I bring, and I don't mean to step over Chero as the last, one of the things Chero brought up in our meeting was talking about having a personal board of directors, which I find fascinating. But when I reflect upon that, a lot of what we do here, like with the three, three of us, even the 229, that is our personal board of directors.

I get so much out of it and have to acknowledge, Bill, you're You set the stage to have this perfect union of people coming together and then letting us just talk in dialogue. The thank you goes to you. We should let you have the last word and and everything that you brought back into the industry.

Thank you.

I appreciate it. And I appreciate you guys chairing that event. And I had the privilege of going to three different weekends of events. And in some cases, the children's CIOs listening to their distinct challenges. And the cool thing is that, and I think Judy Faulkner feels this way. When you get to go to three different events, you get to be the one taking, Oh, I just heard this at this event to the next one.

And they go, Oh, that's a really good idea. end up being bumblebee, if you will, who's just. dropping ideas in these rooms and people are like, Bill's really smart. I'm like no. I was just in the room with Chero and Donna and Alistair and some others. And these are just some of the things I was privileged to get to hear.

appreciate you guys being a part of it and making it work. And thank you for coming on the show and sharing some of your insights with the community. Really appreciate it.

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