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 Thanks for joining us on this week in Health IT Influence. My name is Bill Russell, former Healthcare CIO for 16 Hospital system and creator of this week in Health it a channel dedicated to Keeping Health IT staff current and engaged. Today we are joined by Bill Spooner, retired CIO. Spent 35 years at Sharp.

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You could also go to today in health it.com. And now onto today's show. Today we are joined by Bill Spooner, retired CIO. Spent 35 years at sharp, 35 years bill. That's an awful lot of time to spend at, at one organization, but it looks like today you're hanging out in the country with your John Deere shirt on.

And for those who are listening to this, they're, they're not getting the full experience. You have the, the picture of the countryside behind you. You have the John Deere shirt on. You really look like a retired gentleman at this point. Well, I'm mostly retired at this point, bill, I, I, I left, I retired from Sharps just about seven years ago.

I've done a, a bunch of interim leadership roles and advisory roles and different capacities since then. Haven't done much lately with, with the pandemic. We pretty well hunkered down here in northeast Tennessee after I finished an interim CIO stint last summer. But I'm leaning more towards retirement now.

Yeah. So you'll still take those phone calls and still offer your service. You're still doing stuff with Chime as well? Oh yeah. Well, there are a couple of things that you, you get passionate about. I've been part of the Chime Opioid task force since it was formed three years ago, and. You know, when something like that happens, when one of your friends loses a loved one, it it, it really does motivate you to, uh, do everything you can to help the rest of the world.

And so I've been pretty active with that and, and I've been, um, sharing the most wired program with Chime since its inception, since Chime took it over. And I find that really interesting. It helps me to stay current. The last two years, uh, when we created these levels within the most wired rankings, we wanted to validate the, the top tier of the level 10 rankings.

So the first year I went out on site to, to three great organizations and saw what they were doing, and that's just fantastic in terms of understanding the latest and greatest in HIT. Last year we did them virtually and we had another half a dozen candidates and I participated in a bunch of those. So it's really nice to just kind of what the world is about.

Yeah. It's a pretty cool program. I, I, I'm looking forward to having you on the show and in this discussion. As, as you know, I talked to CIOs and, you know, there are topics that you just aren't able to get into with active CIOs, and I'm a. Since you are retired and, and somebody inspire me, go ahead and say whatever you want.

Hey, well, all right, let, let's start with cybersecurity. You know, there's a lot going on with cybersecurity, and this is really getting serious. I If you think about your time before you retired, what, what was the greatest threat that, that your house system faced with regard to, uh, cybersecurity? Well, true, true confessions.

We knew exactly how they got in, so it didn't scare us as much as it might today, but we had a, we started a cybersecurity program with the turn of the century initially based upon hipaa, and then it started growing over time. I would say that when I left Sharp, it was more a case of. Planning for something that we didn't ever really think would happen.

And the, the debate was with the caregivers about their, how quickly their screen was to shut down and things like that because they hadn't heard of significant breaches and it wasn't real to them yet. Right. In the past several years, you bet it's real. And I. It's kind of viewing it as a necessary evil.

Back then, I'm, I'm almost, I'm just super passionate about it today with some of the opportunities I. Since then, I've seen different security programs, different philosophies of the security leadership, everything from a small shop that is so confident that nothing is ever gonna hit them, that they just are almost cocky about it.

And I just say, well, I hope and pray that you're right to some organizations that are extremely. Well organized in their cybersecurity programs. Very well disciplined. You just, you see it. Everything from soup to nuts. Yeah. That is just, it's a serious thing today, you know, we were observing last September when University of Vermont Med Center was offline for a month.

Well, my former friends at Scripps Health in San Diego are in the Nurse right now. And that's pretty scary and you gotta think about that, just the impact on getting the the IT program back in line. How about the patients that are trying to get care? And I, I've seen some comments on Facebook, patients that don't know whether their surgery is really gonna happen or not per schedule.

And then trying to find out how to reach somebody to an a, an old patient trying to get their records transferred to a, to another center for some specialized procedures, and how do I get to them? You're pretty well dead in the water without those computers these days. So how do we get ahead of this as an industry?

So if.

And seeing what you're seeing now where they can take you offline for 12 days or 10 days or, uh, what, whatever it is. I mean, how do, how do we get ahead of this? Well, I, first of all, I can tell you there are a lot of people smarter than I am. But you know, I really do think you've gotta take it seriously.

And one of the, one of the things we've seen in the financial world, this we've been audited forever. And I would say that. Having been through financial audits, they're not that rigorous. I, I think that organizations need to be ready to subject themselves to an external assessment, whether, whether it's annually or every two years.

You gotta do it. You, you gotta take it seriously. In the first of the year, there was a safe harbor provision in a law for organizations that are using NIST as their guideline. Just from what I've seen, there's one thing to say you're using NIST to actually rigorously following it and having yourselves, uh, um, evaluated in terms of how rigorous your security program is.

You gotta take it seriously. I. I've seen organizations that, and I will say I was on a board committee, uh, of a large health system with a very sophisticated security program, and almost in every quarterly report the CISO would recite, almost every breach involves the compromise of privilege, credentials, and multifactor authentication comes in there when you hear an organization say, well, the CEO doesn't like to have to use two factor authentication, so we turned it off for them.

That's just the wrong approach. I mean, we have to have teeth in our cybersecurity programs. Yeah. I, you know, when I was CIO, we had internal and external auditor. The internal auditor spent an awful lot of time on cybersecurity, and so it was almost on a, at least on a quarterly basis, if not more than that, I was down.

Various aspects of our cybersecurity plan and approach. And, you know, they, we had work plans. It was almost like we could dedicate a team to some of the things that they were doing. 'cause they were constantly bringing people in, doing penetration testing. They were doing, um, audits of our processes, audits of our maturity framework and those kinds of things.

A lot of health systems, you know, and again, we were six and a half billion, so we had that level of oversight and scrutiny, but a lot of health systems haven't had that level of oversight and scrutiny. So how, you know, how do we, how do you get that started? Where, how do you get going on that path? Well, I think the unfortunate thing is that organizations tend to increase their focus on cybersecurity after they've had a breach, but.

Realize that when their neighbor has a breach, that they should take that to heart as well. I, I think that you hate to ask to require some federal regulation, but if that's what it takes, then that that is what it takes. NIST is a very good framework. Some organizations use high trust, and that's an excellent framework as well.

A lot of CISOs don't like HITRUST because it costs money. On the other hand, it is, it involves a rigorous external evaluation. Yeah. We, we need, we, we need something to light a fire under as an industry. And you know, even for small organizations, there are ways for them to get support. And it's kind of interesting.

Look at a big organization and they may have 50 different tools and a small organization can afford five. And it's a question of affording, you know, picking the five that you can, that they're gonna have the most impact in one I've seen in one organization doing, uh, real serious phishing exercises monthly where they get really creative and try to really mask the source of the email and things like that.

And then another organization that where if you look at the incoming email address and it almost looks the same every month, it's hard to . Hard not to catch it. So is it a really good simulation, one organization that actually requires its employees to come and take a class if they fail a couple of, uh, phishing simulation?

That's interesting. I, you know, as we talk about this, and I'm gonna transition to telehealth it, it's a good example of what the CIO has to deal with. Its cybersecurity, foundational operations, foundational. And then on the flip side, the very next conversation is, Hey, what are we gonna do around telehealth?

How are we gonna advance business? How are we gonna, you know, fill in the blank? And so I, I, I expect our conversation to be a little bit of a taste of, of the life of ACIO. So let's talk telehealth a little bit. You. Sharp had a lot of covered lives. So you guys, that was probably part of your repertoire, but the, the level of adoption we saw last year was astronomical, obviously during the start of the pandemic and has since come down a little bit during your time there, what was the level of adoption of of telehealth at Sharp?

So they're getting paid anyway. They didn't need an on another office visit if it wasn't necessary to get their income. And it started growing from there and they were still working on it as I left. So I think it was four years ago, they did a really nice presentation for Scottsdale Institute where they showed how it had evolved and they'd moved into video visits in several areas and they were actually showing some ROI for it.

So I expect that it has even gone well, well beyond that in the intervening time. I haven't really checked in with them, but I, I remember seeing the Scottsdale presentation and. Sending some emails out, complimenting them because they had come in enormous way in that four year period. Yeah. And so, so some of the key to that is you, you guys have capitated lives, so you're getting paid for the wellness of that population, and you're taking risk for the wellness of that population.

So as opposed to sick care. You're not getting, every time they come in, you're getting paid on a monthly basis regardless. And so you guys started pretty basic. You started with with just telephone calls, right? Telephonic, Hey, how you doing? Just following up. Wanna see how this is progressing? That's where it started.

And then that became the foundation for workflow and processes. And then you layered on some. Some of the newer technology as it moved along. I would imagine as of a few years ago, they were using, uh, video visits, uh, stroke care, a a number of domains, and typically the, their approach was to adopt telemedicine where it made sense.

I think that's the dilemma that you have today. We saw during the early times of the pandemic that every visit under the sun was done by telemedicine because. Right now we're seeing some thought into the appropriateness of different types of telehealth visits, and I just read an article over the weekend with.

There's Dr. Peter Pronos, well-known physician leader. Challenging whether telehealth in some forms doesn't compromise quality. I think that the industry's going to settle down on it. There's, there's such a demand. Just like with, uh, almost any new innovation. If you've got a hundred vendors out there trying to sell something, people are gonna try to adopt it.

And at some point you gotta find the, you know, find what is reasonable. I've had a couple telehealth visits, right. One was good, one wasn't good. And I think that leads to another element of it. A lot of the companies that are offering telemedicine where I can get any doctor, I just get a doctor, is different from me having a telehealth visit with my own established physician.

And I prefer the, the vehicle that's with my established P physician because we understand each other. I, I know. The types of things for which she's going to probably refer me to a specialist anyway, in which case I'm willing to do a telehealth visit, not to waste her time, and then she can send me on to the specialist.

Right. But then on the other hand, when I have, when I had a persistent sore throat for three months, she had to look down my throat. She wasn't gonna be able to do a very good job without my video visit. Yeah, I would imagine that some of that sorting out, that's gotta happen. I mean, we know that it's gonna be a permanent part of our repertoire.

I read another piece just yesterday or the day before UnitedHealthcare. I'm a UnitedHealthcare Medicare Advantage patient, and they were, uh, publicizing some, uh, brief, uh, bits about, uh, the use of telemedicine, what they recommended or didn't, and their recommendation was in favor of video visits and they discouraged.

Audio only. Yeah, I, I mean, that would make sense to me. I mean, if as a physician you'd wanna be able to see the person, but from a, what do we say, access challenge that we have from a, uh, disparities challenge that we have. Not everybody has broadband, not ev, everybody has access to potentially the, the video technology, or at least stable video technology to do the visit.

And I, I guess that's what we saw during the pandemic of. Just, you know, a lot of the calls that failed, they failed because of a lack of technology or the lack of infrastructure in those locations for that, and we don't. We don't think about it in major cities, but you're are, you're not in a major city anymore.

You have pretty good broadband there. this, it's my broadband is, let me pray. It's working today. I have CenturyLink , a good speed on minus seven megabits, and it occasionally fails on me. I have my iPhone here ready to turn on the hotspot if my CenturyLink fails. And interestingly, I can look out my window and and see the

Comcast cable wires down at the road. My three neighbors have Comcast, but my house was built since Comcast came into the neighborhood. They quoted me $84,000 to hook me up. No, I do not have good broadband , but that's . $84,000. 84,000? Yes. Not, not bad . I thought I'd sign them up right away. Not, not bad, I mean, not bad if you're connecting up a new hospital, but connecting up your house.

It's, uh, a little on the steep side. I mean, is this one of the areas where the, the, the government's gonna have to step in with infrastructure and help to help to build this out? I think so, yeah. I, I, I would think so. Go back to the incentives that came out in the first act, uh, action. Uh, in response to the pandemic, a lot of money came out, was put towards telehealth, but it was focused on the providers to buy the gadgets, not to the areas to put in broadband.

And it's nice to hear that this year there is. More discussion about broadband funding, but I'm still not sure that it's gonna be enough because there's a big broadband gap in the country. Yeah. It's, it's almost like the national Highway system, uh, of all those years ago. I mean, that, that almost needs to be the same kind of program and it needs to be built out across the country.

'cause I, I don't know how people function. Broadband, it's almost a prerequisite for anywhere we're gonna live. And, you know, how do you find a job today without broadband? How do you, uh, stay current, current events? How do you, there's just so many things that require broadband and we're creating this, uh, as people say that digital divide, if, if we don't

Address that, and I think that is one of the areas where the government could step in and provide some help that's probably needed help where it's needed in as well as oversight and existing services because the organizations that somewhat cast themselves as public utilities are not doing a good job.

Yeah. Well, talk to me about the pandemic. What do you think the long-term impact of the pandemic. Is going to be on healthcare and specifically healthcare it? Well, I think that we will be, we'll have some version of remote workforce forever. It, it's interesting that different organizations are approaching it differently.

Some organizations I've talked to have actually abandoned their real estate to get rid of office buildings, assuming that they would be permanently. Ramon, others are doing everything they can to bring people on site. I, and I think reality is that there's gonna be some combination just to the basic workforce.

The one thing that you hope happens, and we saw this up in Charleston when I was working up there last year, is that. In the case, in the time of crisis, you realize that you can make decisions a lot more quickly, and we certainly did that, and you'd like to hope that that can continue going forward because an amazing amount of work was accomplished.

And you realized that the only obstacle in the past was just getting through that decision making process and reaching agreement on how you're gonna configure X, Y, Z, and, uh. Which one you're gonna do first. When crisis hits, people realize that send business. I mean, I say if there's one thing that I hope happens, and that's it.

One of the things that, and this is outside of HIT, but I'm, I'm gonna wander anyway. One of the things I worry about is that there have been so many waivers and additional reimbursement opportunities that have emerged during the course of the pandemic. Then I worry that we'll never get healthcare costs under control again.

Because we've all lobbied our favorite congressman to get certain reimbursement privileges. The reimbursement levels for telehealth is a good example, and, and I'm waiting for a couple of years to see how it levels off. Are we gonna be still at a little under 18%? Will we be down to 60 or, or I fear we may be at 22.

And, and given the federal budget situation that that does not look good for healthcare because they'll have to squeeze it some form or, and by some form or another. Yeah. It's, it's interesting cost of healthcare. So from a health IT perspective, you know, we're, we're responding to the business for the most part.

If. At parity for a telehealth visit, I'd imagine there's gonna be a lot of demand for telehealth within your organization, and you're going to respond in in, in doing that. Are there things that health it could be focused in on to drive down the cost of healthcare for the community that they live in? I think that the work that's being pushed hard over the past.

Few years to really achieve interoperability is gonna bring good value. Just having information so that caregivers can make decisions is a world of good. And you know, not every community is going to be 100% epic, so you're not looking able to just look at one system, but those caregivers still need the information where I am.

Our, our health system has just converted to Epic, but most of its doctors are independent docs in the community. And I've got a record in two different versions of Allscripts, a Cerner remote NextGen, Athena Health Euro chart. I didn't realize they had a, even had a system dedicated for urologists and none of them talked to one another.

And you're, but you are seeing a lot better exchange going on. There's been a lot of pressure in, in that, as you know, and I, I think that's going to bring some, some good value. I think if we start looking though at some of the innovations that are out there and, and look at them thoughtfully, I it is going to help them.

I sat through a webinar last week that was a chime webinar actually, and. It was describing, you probably are already familiar with this, but it was called a reverse pitch where rather than doing the usual thing where you've got a hundred vendors that like would like to get in, have five minutes for the CIO, an organization describes, de describes its biggest priority or, or its most severe problem and post sit.

In the form of ARFP type and asks organizations, vendor, organizations, developers to propose solutions to it. And then they go with the ones on some kind of a risk sharing basis that look the most promising. And so that allows you to really focus, problem, and solution together and, and that isn't . That is an IT solution and it's, but it's enabled by the organization.

I think that's got huge promise if organizations truly follow it. Oh, so you've been in Health IT 35 some odd years or more, actually, you were at Sharp for 35 years. If I asked you to pull together your longitudinal patient record, do you think, how long do you think it would take you to do that? It won't that long.

Given your age? Probably a, a bunch of it's in paper still, right? It hasn't been digitized. Yeah. If I think of my birth record, it's probably not digitized, so there's gonna be paper and, and digital aspects of that. I mean, how hard is that to do? I'd say it's probably impossible because organizations will purge the records, but there's a little bit of good news because I'm on two versions of all scripts here and I.

Sharp Daily in San Diego. I was also on Allscripts, coincidentally both Sharpe Daily and the local providers went up on Follow My Health on the same day. And I can actually see some of my history from San Diego on Follow My Health still. And, and that helps and I've used it at different time to time. Doc wants to, is interested in, uh, certain lab readings and, well, how's that happened over time?

I'd pull it up and follow my health and show it to him. So that, that's somewhat of a narrow scope of my longitudinal record, but it's a start. It's gonna be interesting you talk about purging records, but I mean, we were both in the state of California. We had to keep our records for, my gosh, I, I, I might get these years wrong, but I think it was 28 years.

Or something like that was our 26 or 28 in some cases. And then the other issue was that when you look at looking at images, we didn't really have early on a discreet way to purge specific images because you had to keep some images for the 26 years while others you could, might be able to get rid of in seven.

But because you didn't have the technology, you kept everything right.

Long term storage is pretty inexpensive at this point. Uh, although the image sizes keep keep getting bigger and bigger and bigger and taking up more space. We were exchanging stuff in, in email prior to this, and you threw out this concept of digital thrust. I've never heard it before. So what is this concept?

Gimme an idea of what digital thrust is. He was referring to it Bill as a, as marketing hype . Alright, you go to the conference. There's the, the, the term du jour, that that's, that the vendors are using to sell their products, whether it's HIPAA or you name it, and artificial intelligence today, it's digital health.

And I think I replied in my response that. Ada Loveless and, uh, who, the other guy were working on the, they call it the, uh, analytical engine back in the early 18 hundreds. And that was, that was ones and zeros. And so it's always been digital. I find some cynical humor and all of a sudden it's digital.

And so instead of being ACIO, I'm a digital health leader. So my goal in life is to live long enough. I wanna be the first quantum health leader as quantum computing becomes, well, let's just make you that now. You're the first quantum health leader that we've ever interviewed on the show, so I, I appreciate that.

I

found. You know, we can, we can talk about where this is all going. I mean, data is a data analytics. We used to talk about, you know, getting from reactive analytics to predictive models for analytics. Now we're getting into realtime predictive models for analytics and whatnot. But, you know, quantum computing has the potential to.

Research at a level we've never even considered before. Where, where's all this taking us healthcare.

I had a call one time asking me to start taking a certain medication 'cause they thought some of my readings were off. I talked them out of it, but that's just the beginning. And as it relates to chronic care, I think that. We'll be spending a lot less time in the doctor's office themselves because we're gonna have those attached devices.

But you mentioned analytics. I'm really impressed by what I've seen. It might come from the days where I did spreadsheets by hand in, in budget models by doing alternate 13 column pads. And watching it go into Quatro Pro and Excel, and now you've got organizations like Epic that claim that they have a hundred million patient records in their Cosmos database.

I don't want, I'm not selling Epic, it's just a good example. A neurologist friend in San Diego, oh, 15 or 20 years ago, talked about having a, a patient with a really strange condition that he didn't understand, and so he went on to pub. Service and just started scanning through record by record to find a patient that looked like his, and then finding the doctor and calling the, the, the treating physician up and say, well, what did you do with this guy as opposed to now being able to match your patient up with maybe a dozen other patients in this huge database that's got the similar conditions, and here are the treatments that work best.

Yeah, it just, it seems to me that there will be far fewer patient situations where you're saying, oh, this is some esoteric disease that we've never seen before, because we probably have seen it before. Yep. I think that that bodes great for pa, for the patient population. Yeah. So we're gonna be able to find matches based on a lot of different factors.

I would imagine. I. Potentially in the, in the future, you could be looking at genetic markers and those kind of things in real time to identify, I don't know, I identify people that are similar in, in, in terms of the same disease state that you're fighting and addressing those things. Just outta curiosity, where do you think innovation's gonna come from?

I mean, this is the age old argument we have. Health systems have innovation arms. They're, they're doing their part in the innovation world. Big tech is doing innovation. We have health, uh, tech startups and just all the money flowing into to healthcare startups and those kind of things. Where do you envision that we are going to see a significant amount of innovation come from?

Well, I think, I think all of the above, and I, and I would rather than label it health systems versus anything else, it's creative people. I, I know a couple of CIOs of small or mid-sized medical groups that have, that are this one person font of knowledge and then in a small enough environment, they're able, they've been able to develop, uh, uh, really interesting effective programs, analytics types of, of programs.

Remote patient monitoring programs because they were creative and clever and they were able to convince their bosses that was a good idea to try. So I would say it's more from a creative forward thinking organization, whether it be a, an insurance company or a health system, or a large medical practice.

It's more, it's more the attitude and the risk aversion state of mind to me that that will bring the innovation. There's always going to be the, the vendor community. We, we know that. The doc that's not satisfied practicing medicine because he thinks that his system, his organization doesn't give him, uh, him or her enough support and they go out and invent something.

They, they will always be there. And it's a question of matching all of the, the parties together and finding what works, finding the organization that's willing to take the risk on them. Yeah. And as you know, there, when you look at the health systems, there's some really interesting things happening within a number of health systems.

Yeah, absolutely. So, so what's next for you? We probably talked with Darren Kin from time to time. Wow. Your, your broadband has gotten, your, your broadband has gotten really slow. I see the red signal there and it's really slowed down. Is, is that because the clouds are going over right now? I think that's it.

I think that's it. I think maybe, uh. My cat answered the phone or something. I was having a period of time that when the phone rang, my internet would cut out what's next for me. I'm continuing to. Do do things with Chime and continue to to, to be involved with the local health system to some extent, and from time to time doing projects through a consulting company.

About the time that I retired from Sharp, our longtime friend Ivan Nelson had this idea to bring. Some semi-retired CIOs together and we, we worked together for a couple of years until Ivo decided they really wanted to retire. So he found us a new home with a group out of Pennsylvania Hunt Singer Management Group.

And so instead of being Next Wave Advisors, we are now Hunt Singer advisors. And from time to time projects pop up. They're always interesting. One of the nice things about being retired is that if things interest you, you jump into them and if they don't, you just shy away. Yeah. So is that your property we're looking at in the background?

That's a picture I took. Oh, last fall off my back deck. Yes, man, that's fantastic. My property line is the second, you see the second line fence hedgerow up there. My property line is up there. So do you actually have to cut that grass? There is a local hobby farmer who cuts the hay and takes it off twice a year.

Oh, well that's the next thing for me is to get back on the road and do some traveling. I really miss having a trip or two abroad every year. So will I see you in San Diego? I believe so. My, my plans are now that I will get to San Diego. To visit to the industry friends have to have a great opportunity to see San Diego friends.

Yeah, I, yeah, I hope to see you, uh, down there at the chime fall forum. I think that'll be, uh, wonderful to get back and, and get in front of everybody again. It's been over a year since we've all been together. The virtual forums are. Interesting. But they're nothing like face-to-face. I think we've all got to get through and, uh, see how comfortable we are with travel.

Do I want to sit in a group of people not knowing if they're all vaccinated or not, et cetera. But I think by the fall we'll have it worked out. I'm optimistic about it. Yeah, absolutely. Well, I'm sorry for the, the delayed reaction and hearing things. It's been a little tough, but hopefully our conversation will get up to to DC and they'll start funding some connectivity to your part of the country.

Yeah, please tell 'em to send lots of money. We can use it. , thanks for coming on the show. Appreciate it. Great to talk with you, bill. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions, please forward them a note. Perhaps your team, your staff.

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