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 Welcome to this weekend Health. It influence where we discuss the influence of technology on health with the people who are making it happen. Today, Aaron Mary, chief Information Officer at Dell Medical School and UT Health in Austin, Texas joins us. My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health.

It a set of podcast videos and collaboration events designed to develop the next generation of health leaders. This episode is sponsored by Health Lyrics. I coach health leaders on all things health. IT Coaching was instrumental in my success and it's the, it is the focus of my work at Health Lyrics.

Today I am joined by Chief Information Officer for the Dell Medical School and University of Texas Health, Austin Aaron, Mary. Good morning Aaron. Welcome to the show. Good morning. Thank you. Appreciate you having me. Well, I'm, I'm looking forward to our conversation. You know, the Dell Medical School is really one of the first roundup medical schools in quite some time.

Give us a little, little background on the, the school itself and the UT Health system. Yeah, great question. So.

Yeah, it's about time. We have a medical school here, uh, in this area, and to work with the Texas border regions to bring a medical school here to UT Austin. Uh, there's some fantastic medical schools across the UT system if you look at UTB or what MD Anderson's doing or Southwestern's doing. But Austin being the flagship of being here in Austin did not have a medical school, so it decided to come here.

Uh, along with that comes a.

So I think one thing for certain, there voters here, this exactly what they, and. Wow. So when did you step into that role? A little over a year ago now. So it would've been about a year and three months or so. Wow. Which, in which in Ccio years is like, you know, eight years, right? Eight years degree, yeah.

Right. So, so the, so the work of the architecture and that kind of stuff was underway before you got there. It was, yeah, the building had literally just opened when I joined the medical school component with the, like the academic portion had been going, but the clinical enterprise and research buildings had just opened up, uh, maybe been open maybe six months.

So things were very much just done with substantial completion, really took early occupancy, starting to see the first patients, and it was all about layering in the systems, layering in the processes. Really getting this thing going on. Value-based care. And what was interesting about ut, which is what brought me here versus some of the other opportunities I was evaluating, was that it's a hundred percent on value-based care, the, uh, clinics are organized in a way called integrated practice units, which means that they look at a care team approach versus you bounce clinic to clinic to be seen.

And so if you present

swoop.

So what we've seen from our patients as we're survey net promoter score and whatnot, is that they love longer than your normal 15.

What? So it's balancing act. Yeah. That's a fantastic model. So that's, that's along the same lines as you see at Mayo and Cleveland as well, right? That's exactly right. And in fact, we've been, they've been great collaborators in a lot of things. Like, Hey, you know, what were some early lessons learned? What would you go back in time and change that?

You learn that. And so bringing that to Austin as a new product, especially as a new endeavor, a new enterprise, something that the city has.

Fantastic. You know, Aaron, I did some research before we got on the, the call and you, you've given a, a bunch of interviews and a lot of 'em stem around the career. I'm going to avoid that because people can, can go to health System, CIO or backers. They can listen to those podcasts where you gave those interviews.

What I'd like to do is really get pragmatic with you and cover strategy, architecture, operations, and innovation. So. Great, and, and really do an episode for other CIOs and for healthcare practitioners. If you're up for it. Are you up for it? Let's do it. Let's roll. Alright. Let's start with strategy, so interesting environment that you're in.

What have you found to be the most effective process for setting strategy within a health system? Yeah, so a couple things. One, we're talking about technology strategy. It is a process of engagement of leadership at all levels. Something with academic medicine is that you have incredibly intelligent people that are PhD MDSs or double PhDs, or you know, they wrote a book literally, or they won a Nobel Peace Prize, literally.

So you have a number of constituents that you.

So my first six months here really was a listening tour and really understanding, okay, what are people wanting to accomplish? When you say digital transformation, what does that mean? Right? What does that mean to you? What does that mean to you? What does that mean to patients? Those are the important dimensions that help you shape that strategy.

The number two is really participating, understanding, getting out there, talking to folks, working with the chairs, working with these intelligent leaders like I was mentioning. They feel heard and that they, their wants, their needs, their considerations are taken into account. What's good is that you're brought into an organization fresh to give your opinion.

You're the expert, you know, technologist, you're the expert, CI. They expect you to course correct and say, Hey, you know what? A doctor or researcher, that's a great idea, but that's not gonna jive and here's why. Okay? Teach me. So part of that process of developing trust, and then last but not least, is communication and articulating that out, right?

So considerable amount of time working people through the different nuances of the strategy to say, how does this match our strategic vision? How does this match us delivering value-based care? How does this match us in a data strategy or transformation strategy? Once you're able to articulate all of that and you're really listening, people feel heard.

Dictating pulpit, but getting in the, and we're this together matches what we, yeah, I love that. So the listening tour is a common theme for new CIOs. I'm gonna throw you a little curf here. So, so. If you're in that CIO role for 6, 7, 8, 10 years, the listening tour's pretty common. When you first start off as ACIO, do you like kick that off again every year?

Do you kick that off every three years, every five years where you just go back out into the organization and say, Hey, we're gonna, we're gonna look at it all again and see if we're still on the same path. Hit in fact, because this now going into my second year here, we're actually doings right now. Fact, I routinely meet

rounding as much as, but we again. 'cause to me, a technology roadmap's only as good as the roadmap. You have to constantly evolve and iterate to make sure that it's matching where your organization's evolving to. Uh, part of the good tenets of a good organization is to be able to fail fast. Well, if you pivot and go a different direction, you gotta make sure your tech strategy aligns with that, right?

So if you're not listening and you're not communicating that. Man, you're three years ago, we're not doing that stuff, right? We've gone different direction. So we have to constantly be evolving as much as the organization evolving. So yeah, for us its annual, but with ation, entire time you're talking to people and making sure that feeds into sort of a nex entire strategy.

You'll see that in the budgeting and the strategic planning and all things, including the technology roadmap. Yeah, it was, it was interesting. I had a pretty savvy, tech savvy board and, uh, I presented them a five year roadmap and two of the people specifically pushed back on me and they're like, can you really predict what's gonna be going on in five years?

I just looked at, said, absolutely not. Right. So, you know, every year doing the listening, figuring out where we're going makes a lot. To hear from the constituents often, but also the technology landscape, the innovation landscape's changing so rapidly. It's, and, and what's good though is I'm able to also bounce this off of peers, right?

It's like yourself and other people. I often call up and say, Hey, you know, is blockchain a thing? Right? Should we really, I mean, we're doing some blockchain things here. We've got a few grants going. So there's a way be able to work through this and use your network to help you. And then there's of course, professional services out there too, right?

Like the Gartner in the world and others that you partner with say, Hey, am I totally on the wrong track here? You know, where's the organization go? Where's the technology continuum? That's important, right? So you're able to sort of test yourself. A lot of leaders inadvertently get myopic, I view, and they're like, oh, I know it all right.

I know everything that's gonna happen. And yeah, I can predict five years from now, but the reality is you can't predict tomorrow as much as this's three to five years from now. So the sooner you accept that, the easier it's for you to be work against. Yep. You know? So if I'm reading this correctly, you have a pretty high powered board, Michael Dell, Karen DeSalvo, just slightly high powered.

Brilliant. Yeah. Oh, absolutely. And so when you're approached or you know, when you get the chance to go in into those board meetings, what kind of things are they looking for from ACIO? Yeah, great question. So a good board has excellent balance, right? And so one of our, uh, members, Jim Moba, used to be the CEO of Clinical Phillips, and of course you got Michael Dell and others.

They balance each other out in terms of the

advising on. So from a perspective of technology is really how are you helping to accelerate and get to goal and help us achieve some of the dynamics that we're looking to achieve in the market and the community and whatnot. And also, how are you helping the University of Texas? Uh, UT is incredibly proud.

There's some unbelievable people here. I mean, literally people who wrote the book here, here, and so to the degree of it, how are.

So from perspective, interacting with them, it's a lot of, here's what's going on, both at a project level and a strategic level. Here's what we're hearing. Here are some of the obstacles coming at us from the marketplace evolving, whether it's at the federal level, state level, whatever else. And then here are the things we tactically right and.

How can we use their help and their guidance and their mentorship to say, you know, what should we do here? Right? How should we interact with the patients in a way they've never been interacted before? The interesting thing about Austin is that the average age of my patients walking in the doors of my clinics is 31 years of age.

I have over 50% commercial payers because this market is very high tech driven, right?

Demo

and there's with input, phenomenal advisory tells, Hey, this what we've seen industries think about this. Yep. And I'm gonna come back to that. When we talk about innovation, 'cause it's mm-Hmm, interesting to think about when you have a tech savvy, 31 year old, average age of your patient, the kind of things that you're thinking about and able to do.

But I want to jump into operations first and, and we'll Sure. We'll just get moving through. So, from an operation standpoint, let's start with people. You know, Austin's a really competitive market, as you said, you know, Silicon Hills for talent. So how do you attract and retain the top talent for your health system?

Yeah, great question. So few things. What we have found is that top talent is attractive to top talent, right? As you said earlier, I chose to come to UT because of the people are here on our board, our leadership team, people like Dr. Clay Johnston, who was at u and Now's our dean. People like Martin Harris, Dr.

Martin Harris, who is of Cleveland Clinic, who's now our chief officer. So I'm surrounded by people that are just brilliant in their field that literally wrote the book. Martin wrote the book on how to be ACIO 20 years ago, right? I mean, it's amazing the people I'm around. That's number one. Top talent's gonna wanna come to top talent.

So that's number one. Number two, your mission, right? UT's mission of the whole. What starts here, mantra really is what resoundingly makes ethos of this, of this entire university and of our health system. And so the ability to break the norm and do different things. Brings out some of the best, especially young talent that is more gravitated.

Yeah, you could pay them maybe 30, 40, 50 K more if you go work for Google. And that's great. Google's doing phenomenal things. I respect them, but sometimes they wanna come to something that's a lot more than just money. That's something about you giving back to community. You're able to give back in a way to build something.

And number three, how often do you really get a chance to start something new in a tier one R one academic world renowned university? I mean, that never happens, right? I mean, you've got the Harvards and Stanfords and the others out there that are just blisteringly amazing, but how often does this happen?

And so what I have found is that a lot of talent that is leaving their established places to come here, they're attracted to that. They're like, Hey, I get to learn from the best. I get to be a Longhorn, which is, you know, that's how I'm, and then last but not least, I get to build something new, which is again, a resume bullet that you really can't offer a lot of people, right?

So those things tend to attract the best, the best, and retain the talent that could be, and probably is being solicited by the Google world. Again, nothing wrong with them, it's what do you actually wanna do with your life? So for our listeners on the coast, the ut what starts here impacts the world. Is that what the phrase is?

That's exactly right. That's exactly right. Yeah, that's exactly right. And then every dimension of this entire system, university, our health system component of it, you can see that like it literally seeps through the people that are here. It's. I wanna do things differently. I'm going to break the classical change that have hung, you know, held the university or the organizations down.

We're gonna invent the new thing, right? Or we're gonna teach the next generation student. It's amazing. And so everybody here believes that with a resounding fashion. I owe a lot of it to president and others just really driving. So. You know, I think the answer's obvious based on that answer, but, so my next question was, you know, how do you keep the people trained and motivated as a leader?

I think the motivation is obvious. You're doing something that you believe is going to impact healthcare, the community, the world. But how do you keep 'em trained? I mean that, again, the technology's changing pretty rapidly. What's your expectation of them and what do you do to help them? Yeah, great question.

So a lot of credit to our major partners like the Microsofts of the world and others. If you collaborate with those, with your major partners in a way, and like Dell Technologies, right? We sit down and we walk through, okay, these are the components of let's say DevOps. Alright, so I have a DevOps team, which is really, you know, your classical, build an application, develop something net new in Amazon or Google or whatever, execute it to do something that, something off shelf.

In value based care, you find a lot of that. So we ended up creating a lot of custom applications to help fill the void that traditional healthcare tech can't do. So how do you keep your DevOps team up to date when every single day you're hearing about a new widget that Amazon's coming out with Microsoft is doing.

And so I partner with them. I'm like, look, I'm never gonna be able to stay ahead of curve. If I partner with 'em and say, Hey look, this is what we're doing from a technology roadmap. Help me get better. They wanna, right. 'cause they wanna learn too. I just got back from Mountain View not too long ago when I was talking to some of the Google product managers.

They're like, Aaron, we're all about health, but we're looking to learn as well. We don't claim know at all. We have platform build stuff on, but we dunno how to implement the solutions.

To the degree of it, if you do those partnerships the right way, with the right people, you're training your team, you're forwarding their careers and forwarding the The Institute's best interest, and you're helping out your partners, which will be there for you when invariably you have a rainy day. So it really is that two-Way street, you know, a big part of the job of CIOs communication.

Yeah. And you now have a board member who's with Google? I guess so. Yes. Yes. Karen is with Google. Google Health. Yes, that's correct. Pretty, pretty big move. Pretty exciting. You know, one of the questions I get, so we pull our listeners pretty often. We try to be a listener directed kind of podcast, and one of the common questions I get from leaders is, is around budgeting.

And so I try to, whenever I get a leader, I try to ask some sort of budgeting question to, you know, get to how people are thinking about it. So you have a, a new entity, you're standing up a lot of things. Mm-Hmm. . So eventually all that build will become run. So you'll, you'll have to keep it running on a day in, day out basis, but you're gonna have to continue to in innovate.

So what percentage of your budget are you trying to allocate to each of those? Build, run innovation. Yeah. So traditionally the best kind of splits there are sort of that 30, 30, 30, right? With 10 kind of that, uh, you know, what do you need to do with? And that never happens, right? Usually the way it happens is you have either a 60, 30 10 or a 70 20 10 or something to that effect, right?

So you're running more than you're able to build. And so what's great about UT is that the focus on innovation. To be overlooked in terms of for running better, right? So do we run operations? Yes, absolutely. Do I have an efficiency metric I need to meet and make sure I don't blow the budget and do variance reporting every month?

Absolutely. But am I cutting my innovation budget to build net new things? No. And I'll give you an example of that. So one of the challenges that we suffered on.

You, these students that are coming up the ranks that are numerous associations and clubs and.

That's hard to do because a lot of the academic systems out there are very legacy in nature and were built for traditionally classically trained medical students. Well, we're not the medical school where. You're able to get a master's in population health, right? So you have these dynamics that are very different about our med school and the reason why kids are choosing to come here.

Well, how do you capture that in electronic systems? So we built a student information system thinking of it as ACRM for students and that we actually call limbs, like limbs, arms and legs. So each.

So it.

All these dynamics that are not, again, traditional classical medicine, we're able to build up well that costs money to build, right? We worked actually with a third party in town, so my DevOps team didn't take the total load on their shoulders. Well, that cost dollars, and so the debate was in, in our budgeting process, Hey, do we keep doing these things?

Which is the right thing to do? Or do we really focus on, you know, become more efficient? Everybody was like, no, we have to keep innovating and pushing the envelope. That's what makes ut, ut. So my hope is that as time goes on, and as you said, you know, we're still relatively new in our infancy, my budget's still relatively healthy because of it, is that we don't lose that balance and perception, I don't think.

We'll, if I look at some of the other UT systems like MD Anderson and Southwestern, which are just world renowned, they haven't lost that, right? They've kept in touch with that. Now your spirit animals always.

As long as you are articulating, having the conversations and it matches the strategy like we talked about in your first question, you don't lose sight of innovation. It's exciting. I mean, it's exciting to know that you guys are doing that kind of innovation. Is there plans to take that innovation outside of your system and I don't know, commercialize it in any way?

Yeah, actually it's exactly right. So UT is very well known for commercialization. We have a fabulous commercialization entity here. There are.

How did you guys do that? Again? Because we wanna do something similar. We how to do it and it's like, great. Now, you know, UT is not about like, some, let's become the next Amazon or whatever. You know, we're not, we're just looking really, we break even on this investment. I'm, I'm happy, right? Make a, let's do what's right for the community.

And that's what UT's ethos is, right? So if you have something that's hot and takes off, great, but that's not what drives us to drive the commercialization is to really help give back. And again, the whole point, what starts here. So if we start something that's new that is really hot and the community needs it, great, let's, how do we get it out there?

I'm sort an open source guy, so if could open source

to the, there is that take that we work through. So yes, commercialization, absolutely Horizon.

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All right, let's hit architecture. So, uh, all right, just outta curiosity, where does responsibility for the architecture, the system architecture network, application architecture, where does that reside in your organization? right here. My team, my teams, uh, are responsible for that. We do absolutely make sure that the users, the chairs, the clinicians, the physicians drive, what is it they wanna see happen, right?

So if we have a, one of the requests is our women's health department wants to be able to interact with their patients, whether newly expected moms or other conditions in a way that's almost like a community forum, but more engaging. And so, alright, let's partner with various folks that have done that for other industries and see what the right, uh, technology you can bring to bear for that is.

I have users dictate what?

Yeah, I don't know about you, but I used to hate when HIMSS came to Vegas and the reason I hated when HIMSS came to Vegas is 'cause it was close to my system, , which meant that more people actually went to it 'cause we had a problem. And so before I got, you know, we were a hundred year old, so odd company.

And uh, before I got there, there wasn't a lot of governance. So if a doctor saw a really cool . Thing. They brought it in and it really didn't say no a lot. And so you end up with eight, 900 applications stre across the organization and it's sort of like sending out your contractor to Home Depot and saying, Hey, just buy stuff for a house.

And they all show up at the house and go, all right, let's build a house. And that's. It took me a while. It actually took me about six months of a lot of education amongst the leadership team to get them to realize, hey, architecture's a thing. We wouldn't build a building this way and we shouldn't build our IT systems this way.

'cause if we do, we're not gonna be able to be agile. We're not gonna be able to be responsive. And quite frankly, I was brought in after a lot of outages. I'm like, and this is what happens, right? From a complexity standpoint, how are you gonna keep that from happening there? So you're early on, which is, which is great, but.

How do you keep it from being that way 10 years from now, that you're constantly bringing in new stuff and all of a sudden the architecture gets outta control? Yeah, so it goes back to what I said earlier about trust. We have phenomenally brilliant people, and I'm not saying that's not going on right, where you have those discussions and debates, but it is a process of awareness listening to people.

And it's not that, you know, Dr. Joe or Dr. Jane wants X, Y, Z tool, that's, I don't believe you're gonna find many clinicians like that. It's not just they widget for. There's, they're able do today and their course of care for a patient that's causing 'em to wanna look at something, right? Yeah. There's ways of being innovative and new and flashy.

Okay? I get all that. But for the most part, clinicians are very practical people. They actually wanna solve the problems. They just wanna do it faster, right? They wanna do it easier. They want less burden on their patients. They're seeing the rigmarole of having to go through garbage. They're like, look, this snake cut through the waste.

Right? I haven't been able to do that yet, Aaron, and, and this may do it right. It's helping them validate that right.

You only get that from all the things already talked about. And so a lot of time I spend, which is, Hey Aaron, I found this thing, or I heard about this thing. Can you tell me what you think? Yeah, it's great, right? It costs a lot of money and we can look at it, but you also have this other thing, which you could use that when you thought about it.

Oh, really? Yeah. It there. Let's try it. Right. I'll be there on Monday morning. We'll show you how to do it together. We'll figure it out. If it doesn't work, okay, then we'll go look at this other thing. That's what it takes. Yeah. That, that's really what it takes. So UT Austin, I mean, you're in Austin, so, and Michael and heck, your thing's called the Dell Medical School.

So you got Dell VMware, you're talking cloud edge computing, hyperconvergence. I mean, it's all right there. How are you viewing those emerging technologies at the medical center? Yeah, so great question. There's a, I think let's talk about healthcare in general. There's a dichotomy in terms of the way that some of the classical health healthcare applications are run versus if you look at the microservices industry and those things are being built up, you look at containerization, which is now kind of going away, right, because it's now old technology.

But if you look at like things like Kubernetes and others and docker. You typically don't see, you know, electronic medical record leveraging Kubernetes, you're just not gonna see that, right? So there is this ebb and take in terms of what you can and can't do. There's also some constraints in the real world, like your financial systems, right?

You may have an ERP that wasn't built for a medical school or health system that you're having to work through. Okay, that's what I'm doing right now, and things like that, that you're.

Of medical things and all those dimensions. You know, it's funny, I don't think healthcare is used to rapid innovation cycles. So agile is a difficult thing to ingest here. It's really more of a, of a waterfall kind of model. Now I believe in agile. I think that is where we have to get to. But I don't believe that the continuum is built for that yet.

So there is that half and half point that most health systems are at. Again, I have the benefit of being able to play through some of these issues right now. More of a greenfield, which is a luxury, but the realities of healthcare apps are the healthcare apps, right? A lot of them are still dependent on Internet Explorer.

A lot of them are still dependent on Windows.

So, I mean, there's a lot of those things that are the real day-to-day of healthcare. So will we get there in terms of true virtualization? True. Bring your own device. True. Those kinds of things. We wanna do, probably will. We here at UT will get to it faster than others, most likely, but I'm still constrained by the things that healthcare is.

Get together, rally around, Hey, we're gonna become truly microservices enabled with API calls going everywhere. And you know, we can, the data's portable. It's gonna be tough. Yeah. But simple things like you talk about Windows 10. Yeah. And you know, so somebody's getting ready to do a Windows 10 migration across the board.

One of the things I found, and I'm not knocking other organizations, I'm just, one of the things I've found is that people don't think about the next migration while they're doing this migration. If you're doing this migration, shouldn't you be planning for, it would feel, to me it makes sense to go, Hey, you know what?

This is an arduous process. It took us a long time. We should probably put the foundation in so that when Windows 15 comes out, you know, we're doing it in days, not years, and it's not costing millions, it's costing hundreds of thousands. You would think. So I think though that just like we were talking about earlier with value-based care and traditional medicine being very episodic.

Technology organizations become episodic, right? I believe in this called shadow of leader. And what I mean by that is business. It tends follow healthcare institutions. Episodic windows, right windows. So you're not really thinking two steps ahead, as in the health system doesn't normally do that because it's episodic, it's fee for service, right?

So you have to change the ethos of the organization for technology teams to be thinking about that. So what you say is very logical, and I totally agree with you, but I think that's a difficult proposition when you truly are living day to day. In terms of what's being thrown at you, what curve balls are being thrown at you.

I personally believe also that your question is exactly the reason why you're seeing the rise of the chief digital officer, chief transformation officer, because a lot of CEOs and boards are getting frustrated with, why can't we move forward? Why are we stuck doing these episodic things? Why are we just talking about Windows 10?

No one cares about that, right? How does it help me fuel my mission? So the thought is, oh, I'll just bring in a new chief, whatever officer. That's not gonna change, right? Culture, it takes more than just one or two people change of people. So that's why leaders are good leaders like have here at. So I have a couple questions around innovation, and this episode's gonna go a little long, but I'd be remiss if I didn't talk to you about innovation.

So everybody wants to talk about digital innovation, they wanna talk about transformation as well. Where are you seeing the most movement in terms of digital transformation in your health system? Yeah, so a couple things. Number one was the way we interact with our patients. So I'll give you a specific example.

We build all of our care models off of patient reported outcomes and a patient reported outcome are structured series of basic questions and q&a to be able to diagnose a patient before they present to you to say, you know, are you depressed? Yeah, you may have hand pain, but are you depressed because of you never longer play rocket ball because it, right.

Do you have other conditions that are comorbidities?

So. Dynamic. Yet, if we build our practice models around it, it's important. So our patients were telling us, we just don't wanna take these surveys anymore. This stinks, right? We're saying we need a clinical decision report off the data to do something. So I partnered with a startup out of North Carolina to build an electronic version across any modalities, responsive, whether you're on your mobile device, your laptop.

That we can do this dynamically and increase our participation rates so that what we're building in terms of our case teams, our team makeup, makes sense for every morning. And so it works. Our patients are Ally telling us we like this. It's easy, it's a couple of clicks or a text message versus this long piece of paper I had to fill out and it was engagement.

So to answer your question. We're seeing it around the patient engagement perspective. You know, listening, being responsive and providing solutions to them that they wanna interact with you on, versus just giving them, well, you have to take this too bad, deal with it. A patient will do that because they're sick and they're being told thou do it.

They'll do it. Not gonna be happy about it. So the question you gonna ask yourself is, do you want a happy and healthy patient, or do you just want a good quality outcome? Check that box. So that's what we're seeing at that level of, uh, digital revolution. So from an IT perspective or a digital transformation perspective, you focus on the patient, you focus on the clinician and the clinician experience.

You focus on the, uh, the student and then the system itself. I mean, there's innovation, RPA and whatnot around how do you determine where you're gonna spend the, the money or the time, the limited resources in terms of innovation. We have a good project team that we put together. We nstitute the PMO to be able to catalog and gather all these requests across the entire system.

So each of our divisions will have their catalog.

But to your point, you have a finite level of resources and time that you can spend. So part of it was a transparency exercise. Let's surface all these things so people can see that. Yes, you were heard. We cataloged it. And then I work with the senior leadership team and said, okay, what are the priorities?

Right? We can do 10 things and we have a list of hundred, right? So you tell me what the 10 are. Here's recommendations, but I'm one piece of the pie, right? I maybe put the Lego pieces together, but you tell me, do you wanna assemble a dinosaur? Do you wanna assemble a, a McDonald's right from Lego? So it's that partnership.

Years ago I had a mentor who's telling me that, you know, itts at the options. And that's exactly what it is. We tee up, here are the options and what our recommendations are. Here are the.

Have some fun. This is what we're constrained to. And most people understand that. I think you see a lot of resistance when you can't articulate that, right? If you can't talk in language where your end user, your clinicians and others can understand you, they'll be like, you know, heck with you. You don't understand me.

What good are you? That's the whole, no, I, your career is over as ACI. The CIO. So you know, you've gotta be able to talk to people and you've gotta be able to surface that up in a way that makes sense, and then also that you're able to deliver. So. All right. Here's my final question. It's more of a fun question for me, which is, you know, if, if you left your current role and you and I, we were going to do a startup.

Yeah. What area would you choose to do your startup? What area would you choose to innovate in? So I think this is a big need right now in the community. And so for anybody out there trying to figure out what to go build, maybe you and I go do this on something.

Value. How do you measure value? How do you actually measure community impact? What is that, right? Is it faster Meals on wheels? Is it getting in front of food deserts? Is it getting in front of people with conditions before they present? I mean, you see these wild things in the, in the media and whatever, like, oh, we achieve value.

Yeah, what is it? I.

I think there's a way to create a startup that you take multiple dimensions and you're able then to start saying, extract, okay, this is really what your return on value was and how you helped the community, and more importantly, then you can link that back to the payers and others and go, look, this is what you're getting for the dollars.

Right? Health systems have a difficult time communicating with payers saying, Hey, we're gonna change from fee for service and episodic to value based. They're like, great. Tell us what that means. I'll get back to you. Right? So there needs to be something in the community that helps connect this thing and come up with a common definition set.

I give a lot of credit to the Office of National Coordinator and HHS and others trying to do that, but it's difficult because it means different things to different people. So how do you create a common set of criteria that helps measure this? And maybe it's, I don't know, looking at social media to go, Aaron.

Like some of the early electronic health records pioneers did with saying, we're gonna create an EMR and we're gonna go along. And then at the end of it all, we're gonna have something that we all kind of look alike and feel like that's what's gonna happen here. At some point, we have to have common definitions that we all align to.

Well, don't be surprised if somebody, you know, flags you down at HIMSS and says, Hey, I heard about that and here's what we're doing. It'll be exciting. Wow. No problem at all. Love to talk to him about it. Aaron, thanks for coming on the show. I really, really enjoyed our time together. Is there a way people can follow you on social media in other ways?

Yeah, absolutely. So I'm a big social media guy, so LinkedIn, please look me up. Aaron, on Twitter, it's by name. Nothing original there. Aaron Merri, all one word. Happy to reach out or just email me. Again, I'm a public institution, so my email address, so.

I really wanna thank Aaron for taking the time to join us this week. He's so articulate and I think a good picture of what ACIO of the future looks like. It's someone who really knows technology and knows the business and the industry that they're operating in, which in this case is healthcare. Special thanks to our channel sponsors VMware and health lyrics for choosing to invest in developing the next generation of health leaders.

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