TownHall: Technical Debt, Patient Adoption, and AI with Rick Schooler
Episode 1313th February 2024 • This Week Health: Conference • This Week Health
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Today on Town Hall

the folks at Apple take a lot of pride in. In in their history of knowing the importance of deciding what not to do, as well as what to do.

And that, I think that's something that we have to deal with as healthcare systems and CIOs in particular. Working with and coaching and influencing and steering our executive teams to know what's really worth going after and what's not.

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 town hall show is designed to bring insights from practitioners and leaders. on the front lines of healthcare. Today's episode is sponsored by ARMIS, First Health Advisory, Meditech, Optimum Health IT, and uPerform. Alright, let's jump right into today's episode.

da. Rick has been there since:

I'm really looking forward to talking with Rick today and hearing what he and his team at Lee Health are currently focusing on. So welcome, Rick.

Hello again, Sue. It's great to be with you and I look forward to our conversation

today. Great. I do as well. So let's start by having you briefly introduce yourself and tell us about Leigh Health.

've been in healthcare since:

So, Lee Health is an organization that's in southwest Florida. It's in the Fort Myers area of Lee County. It's a large area in this part of the state. We have been a public health system since the 60s. Lee Health has been in the community for over 100 years. So it is a very well established, very well known, strong brand, what I would call a mid to large size integrated health system that has been serving this community for quite a while and certainly is positioned to do so going forward.

We are a public health system in the state of Florida. And that has certain restrictions with regard to things we can and can't do, but for the most part we operate just like any other not for profit health system in the country. And we have a workforce of around 15, 000 plus employees. Our IIS organization is, I think we're budgeted this year for around 450, just to give you a sense.

For the size of the organization. so, yeah, it's a, there's a lot going on here. It's interesting in our industry how even the small, mid and large size organizations have so many things in common that, when we talk about priorities here in a minute, the things that we're all involved in that we're focused on.

The things that are important to us are often shared regardless of the geography and the size of the organization, and that's a challenge that a lot of CIOs have to deal with when they change jobs or when they're new to a job is understanding the fact that, hey, we're all in this together. We're all trying to address and solve a lot of the same problems.

Through technology and as well as through organization change and transformation as we often call it. just a little bit about Lee Health, a little bit about me. I've been around a bit and look forward to sharing some thoughts with you today.

Great. Yeah, you commented on the collegiality, I think amongst our peers in the industry, and it is so important for pushing healthcare forward.

So what are the, some of the current priorities that you and your team are working on?

Well, I thought I'd just share some thoughts around four different areas that were really focused and quite frankly consumed in, in addressing. Consumer engagement and the implementation of a new engagement platform that essentially amounts to our online presence beyond our website.

That's a really significant area of focus and change for us because we are really like most in our industry, we're now really understanding the need and the benefit. of being a consumer oriented, consumer organization, as well as, of course, being the patient care organization. And as we learn more and more about the differences between a consumer mindset and a patient mindset, right, not all consumers are patients, but all patients are consumers.

So that's a big area of interest and focus, not only from a technology standpoint, but also the business side as well. All things digital and AI, of course, are on everyone's mind and roadmap and day to day priorities as well as strategic planning and budgeting and all this. For us, we've got to get a bit more in control with regard to how we govern and how we make decisions and how we finalize The prioritization of where we quite frankly invest our money and our resources.

There are a lot of things that we can all be chasing and some of us are able and are funded in a way to chase more things right than and to adopt things that others will have to wait on. And I think it's really important, the folks at Apple take a lot of pride in. In in their history of knowing the importance of deciding what not to do, as well as what to do.

And that, I think that's something that we have to deal with as healthcare systems and CIOs in particular. Working with and coaching and influencing and steering our executive teams to know what's really worth going after and what's not. So how we govern and how we make these decisions. It's got to go to another level.

It's not that we may be bad or good or experienced or inexperienced in governance. Regardless of your state of governance for legacy and other decisions you make around technology, the whole realm of what we call digital And the advent of AI now, really beginning to move into our industry, it's pushing us to a new level of having to understand what to go after, how to govern that, how to prioritize it, and quite frankly, how to fund it.

So that's a big area for us. We've got actually a fair amount of technical debt that we're having to catch up on, and this is something that, I pound the table on, quite frankly and here at Lee Health, and that's got to do with We cannot forget all the things that we currently have, and they have to be taken care of, they have to be upgraded, they have to be refreshed.

I refer to it often as the mountain. The mountain keeps getting bigger and bigger, the more villages we add to it, right? And it takes more and more to maintain its support, both in terms of dollars Expertise and people. So however you resolve doing that technical data is something that will pull you underwater fast and will, quite frankly, really impede your ability to pursue a lot of things that are in this new realm of digital and AI and other advanced technologies.

So, I shared a diagram the other day with our executive team about the key drivers of information technology investment and sort of built it in a like a layer things that kind of build on each other and at the core.

And outside of that first layer, that middle layer, you have the first layer of legacy platforms. And then you see all the newer stuff, the digital and the other things that we'll be adding. Whether it's cloud based or hosted, on premise, doesn't matter. At the core of all this is a solid and a sound infrastructure.

And staying up to date with technical requirements, with refresh and so forth, is really important. And many organizations sacrifice The maintaining of what you have for pursuit of the new, that's a discipline that the CIO, nobody else is going to bring this. The CIO has got to bring it and it's got to be able to be understood and appropriately funded.

And I know many of our colleagues across the country. continue to battle that. It's an ongoing, it's like, gosh, we've already spent money on that. Why do we have to keep spending more and more? Well, when

it comes to, when it comes to budgeting, that, that piece you're talking about, infrastructure and the technical debt, is really that, it's what the CIO owns.

You need others within the executive suite and leadership team to be owning the other new initiatives, but you're the only one who's going to make the case relative to infrastructure.

You're right. And I tell our folks. I'll share with you any level of information detail you want, but you have to trust me on this.

As a proven CIO and a guy who's been around this stuff for 40 plus years, I'm telling you, you've got to give me the money, and if not, bad things are going to happen. So, uh, so over the years, I've been able, and I know others have been successful in getting their executive colleagues to, okay, Rick, You've got that handled.

We're not going to worry about that because we don't talk about that until something goes wrong. Right? So, and then the last thing I want to mention is something that I know we are all also dealing with, and that is managing the realities. of an increased remote workforce. And on the surface, it sounds kind of simple.

Well, just make sure you've got the technology in place. You've got a good place to work from home. It's not about that. It's quite frankly, it's not so much about productivity because we're getting all the things done and more that we did when everyone used to come into the office here at Lee Health and I'm sure other places as well.

It's the dynamic. of the relationships and the team building and the leadership and the growth and the development of everyone collectively working together. it's a different thing. And I mean, you and I have gone into offices for Our entire careers. And here I am now working. I mean, on a given week, I'm at home at least three days a week, either the whole day or for, part of it.

So we still have offices. We still go in for exec meetings. We still go in for team meetings here and there. But I think the reality of that is really something that we are evolving and growing and learning. And it's a priority for us to understand. We have to take care of And lead our teams, and it's different when we're not together.

Yep, it's, you lose something clearly when you're not together in person. And I was just talking with colleagues last night about this the value of a Chime Fall Forum that I saw you at a few weeks ago, and the in person connection that we all have together. it's that culturally, I know, for organizations as well as.

For individuals, and there are some individuals who are not as effective working in that remote environment and need, need that on site time. So, that's a common challenge, certainly, that you and many others are dealing with. So great. I, if you want to talk more about your consumer engagement and the platform and what you're doing there, I'd love to hear more about that.

Is that an area that you're getting out ahead in terms of, pushing the technology or not?

Well, yeah, let's just kind of settle that for a minute. All things virtual. In terms of what we're pushing and it's not so much again, that is the technology per se. It's also, it's more so the ramifications of workflow change of leadership perspectives.

Take virtual nursing, for example. That's a big mind shift for a lot of clinical leaders, right? Virtual patient observation, okay, versus sitters. Okay, we've recently, over the last couple of years, really kind of pushed that. But from time to time, we'll have a technology issue. That will essentially cause it to go away.

And so working with vendors, for example, to further mature their products, all things virtual, it sounds good. And for the most part, it works really well. But then the real challenges of effectively deploying and maintaining and supporting and adopting all things virtual. And I can just go on and on about all the different areas that we, as well as many across the industry are into, but that's an area where we're really pushing quite frankly, not so much the hard technology, but those who are selling it, the vendors who are providing it from whom we you know, purchase, getting them to understand if it's not a proven established vendor, what it's like to be in this business and what it means to be 724 life and death critical type capabilities.

So, as we further push all things virtual, and, it's just a, it's a common thing that we have to be prepared to deal with regardless of what avenue we may be going down. And then, back to the consumer orientation and engagement, we're banking a lot on the platforms that we're implementing. For example, things that begin to more automate an individual's care journey.

Or that more automate targeting potential, consumer markets with, listening devices that direct them into our, online presence. I mean, there's a myriad of things that we're all, industry wide, are pursuing in that regard. And we are banking on the fact that, maybe not so much the majority now, but as we move forward in time, the majority of consumer patients are going to want that kind of interaction.

We're investing heavily in these technologies and the workflow changes behind the curtain to enable and to manage. so for example, remote patient monitoring is a patient care, uh, virtual endeavor. But there's a significant amount of commitment on the part of the patient to say, you know what, I think it's okay for me to be monitored.

Virtually, instead of at in the hospital, inpatient bed, because now you've got me enrolled in a hospital home program. So we're investing in programs like hospital home, like virtual nursing, like, you know, asynchronous visits that are driven by a symptom checker that's all loaded into this online presence.

Well, I mean, we are pushing the vendors, quite frankly, and those who provide those technologies. The hard stuff, as well as the software, to, to a different reality. And many of them are learning as they go through this, Oh, wow, it means something different to be in healthcare. Absolutely. I think about some of these hosting organizations, and I won't mention any acronyms, but when they realize for example, through online forum discussions at QIIME, and they hear from us, about the reality of when your platform is unavailable for me to run my system.

What does that mean? It's not like it might be in some other industry where there's not a patient involved or maybe a patient undergoing a procedure or a patient that's come into the emergency room and there are technologies that have to be running and in play. To deliver care. So, yeah, those are the, that whole notion of online engagement and virtualization, everything around that.

I think I speak for most of our colleagues it's a push. It really is.

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there's so many things that we could talk about from what you've already said. I don't know that I've heard anybody use the term patient adoption. We talk about clinician adoption, user adoption, but now we're talking about patient adoption when you talk about, the remote monitoring hospital at home and are patients ready and willing to accept that.

You also got into just, the push on vendors. So let me flip to that question. You and I have both been around a long time. We've worked with a lot of vendors. There are vendors coming into the healthcare space for the first time with their products, others that are exclusively healthcare.

What advice do you give to vendors at this point for being effective in supporting you in healthcare?

Well, sure. The first thing I always offer and suggest and insist upon is above all things. Be honest about what you are selling and what you're offering and it's status in terms of maturity.

And as, as you well know, as we do the CIO job more and more over the years, you begin to pick up on things. You begin to know things that you didn't know prior. And so, as you get more experienced, obviously as a CIO, it's harder to get burned, but you can still get burned. Right. So, so I always insist, and I work a fair amount with.

vendors I've been on a number of advisory boards, and I'm currently on, and I've been on company boards of healthcare IT vendors, or healthcare services companies, and just, again, it's a pound the table moment. Do not oversell, do not get out ahead of what you can deliver, and I think that's just good advice for.

Quite frankly, anyone. Then, on the other side, as CIOs and as IS, and organizational leaders, buyer beware. And you better have references. If the vendor can't give you reputable or credible references, you've got to really understand what that means. The word partner, for example, is greatly overused.

Because let's face it, Sue, in any kind of relationship, if you're in a partnership, you share in the ups, and you share in the downs. Equally, right? The whole concept of being a partner. So, and I don't say this in a way that casts a negative shadow or connotation on any kind of vendor relationship, but we're not partners.

I mean, let's just, unless I'm invested in your company and I'm an owner of your company, either as an individual or as an organization, okay? Or unless we have an agreement that very specifically states that when I win, you win, and that when I lose, you lose, right? We're not partners. We're clients and we're vendors.

However, that relationship, though, has to be solid. I mean, you, we value our vendors. We value those relations, and consultants, and so forth. So you want those to be good, solid relationships, because when we need each other, man, do we need each other. Right? But at the same time, I think you just have to be really careful about, as a vendor especially, but as well as healthcare systems and provider organizations.

using the word partner when it comes to some of the products and technologies that we buy. the last thing I have to say about this really is, most of us as providers, Cannot handle high risk situations, okay? There isn't a lot of money to throw around and to blow money on.

I mean, you just, things blow money. You just, there are those type A organizations that can be out on the front, can blow a few million, can learn from their mistakes and say, well, that's okay, it was only a couple of, I mean, that, I've done that before. But most of us, particularly these days in healthcare, we cannot afford to waste precious capital dollars or operating expense on an ongoing basis.

On something that just doesn't work or that doesn't, achieve the objectives or the outcomes that we were thinking. So this is really for both provider and vendor. Right. Right. Get on the same page about what you can tolerate in the way of risk. Way of, of impact that may come as unexpected.

And so honesty, buyer beware, buyer be smart tell the truth always, and understand as a vendor or a consultant, understand your client, understand that person that you really want to be a partner, understand what it is. About their culture, about what it is they can tolerate, what they can't with regard to, to risk and impact.

Great. That is excellent advice. And I, you bring up the point again in terms of funding and investments how many resources organizations like yours have for the new. Is there any technology in particular that you're keeping an eye on and think will have a much greater impact in healthcare in the next

couple of years?

Well, this is obviously kind of a layup question, but, all things AI. I mean, it's on everybody's front page. It's on everybody's mind. It's the first thing, quite frankly, that many of us talk about when we get in meetings. And it may not be something about what's going on in healthcare, because this is pervasive, right?

It's everywhere. Just yesterday morning at an exec meeting we got into this discussion about, somebody's got this new capability inside their car. Or it's something that somebody's got, I made the comment, well, it won't be long until it'll be in your refrigerator.

And everyone started laughing. I said, but it already is. You don't even, you may not even know, depending on what kind of refrigerator you have. So, it's really, I mean, we have to, as I said, we have to be very wise about this. I think that, along with enhanced virtualization of things, This whole notion of digital twins, what that can bring to not only research, but also day to day care, not only in healthcare, but also in the rest of life.

That's the interesting thing about these technologies, a bit different than what I recall throughout my career. We're talking about technologies now that are impacting the rest of the world as much as they're impacting healthcare. And a lot of times, historically, you may recall, we were pretty zeroed in on the stuff that we as healthcare providers have to worry about.

And yeah, we would use some of the core infrastructure that other industries use and pretty common stuff. But wow, I mean, this, whether you're talking about conversational or this, the chat oriented type AI, or you're talking about learning machines or deep learning, that kind of capability, I mean, whoa. So I know the president just made a directive order On AI, and I was reading through it, it's rather extensive, but I went through most of it over the past few days, and I mean, the government recognizes that this is, this is really, really something that's got to be managed.

I don't like the idea of control, quite frankly, but with some of this stuff, it may make sense to have some pretty significant, let's just talk about health care, right, some pretty serious controls on it, and policies. A word to all of my colleagues. Policies on AI adoption. If you don't have one, start working on one.

Right. Because if you don't have one, we're already behind them. Do


Do you at Lee Health have any kind of framework or structure that's managing, governing how you bring AI into the organization?

Currently, we're using our existing governance process for all things. Quite frankly, legacy digital and AI.

As I mentioned earlier, we are now having a priority of looking at how are we going to better govern this. Yet with AI, it's another level beyond that. And we are within probably a month or so of finalizing our policy that we're going to publish as a formal AI policy for lead health. And then we're going to be evolving our governance structures to ensure that we're appropriately searching and looking and evaluating, as well as when we decide to adopt something, has it been through the proper controls and the proper review?

Keep in mind, right, when it comes to AI and healthcare, most of us are receivers, meaning we're going to bring this stuff into our organization through our existing platforms and vendors. There will be some of us who actually go out and seek the raw tools and bring them in and use them to build our own solutions.

I'd look at that as the receivers and the builders, right? We're the takers. as well as some organizations are the builders and the takers. So we have to keep that in mind, but regardless, I think you have to have a sound policy and a sound structure, review structure and governance over, what do we spend our time and effort on looking at.

Evaluating, then also, what do we really agree upon that we're going to adopt? So, I think that's on everybody's sort of front page at this point, and it just is what it is.

Yeah, I would agree. I think it's an interesting way to look at it, builders and receivers. I think probably some of the builders are some of the leading academic medical centers who have those teams in place within research or wherever who can do some of that and many other organizations probably can learn from them.

I know we are at time here and I just want to check. Is there anything else that you wanted to highlight today in our conversation before we close?

Other than just, nothing other than just to say really appreciate the opportunity to share some thoughts with you, and hopefully those who watch this will either be doing a lot of this, shaking their head up and down, or maybe a little bit of this.

Hadn't thought of that. I don't know that I shared anything that is, Of such wisdom and great intelligence that other people haven't already thought about it. But at the same time, there's never really, how many times have we said this, Sue? There's never been a better time to be a CIO in healthcare.

Yeah, a harder time, never been a harder time or a better time, I would agree with you there. Well, Rick, thanks so much for your time. This has been great and love learning more about what you're doing there and some of your thoughts on healthcare IT these days. So very much. Hey, it was a


Take care.


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