This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

 Welcome to this week in Health IT News, where we look at the news which will impact health it. My name is Bill Russell Healthcare, CI coach, creator of this week in health. It said the podcast videos, collaboration events. Dedicated to developing the next generation of health leaders. Uh, this week I'm doing a series of interviews with health system executives, uh, and, and, uh, consultants and others, uh, who are talking about Covid 19 preparedness.

Uh, if your system has its best, best practice to share, please shoot me a note. Built this week in health it.com and we'll do a 10 to, uh, 15 minute, uh, zoom recording like this one, uh, to capture some of, uh, your thoughts to share with the industry. I wanna thank Sirius Healthcare who reached out to me last week and asked if they could sponsor a series of conversations, uh, to help the industry prepare and celebrate the great work that health it is doing right now.

I appreciate their foresight and their commitment to the industry that they serve. Today's conversation is with David Chow. Good morning, David, and, and welcome to the show. Thanks for having me. Excited to be here. Always looking forward to chatting with you, bill. Yeah, I'm, I'm looking forward to it as well.

I know you're extremely well connected. Um, hey, what, what, what are you doing right now? I just wanna get that out there. People ask me, it's like, what's David doing? Uh, so what, what is your, your role and, and where are you, uh, spending a majority of your time? Yeah, I have the luxury of playing two roles.

First role is I'm the CIO for Luer Medical Group, which is based out of, uh, Singapore. And they have 50 plus sites throughout Australia, Singapore, and China, specifically in Shanghai. And we're building out two Cleveland Clinic facilities in Shanghai. So part of my time working on that and the other part of my time, I get to be advisor for various Fortune 500 companies.

Also advising various health systems on their Go-to-market strategy. So I get to play both a vendor space and a decision maker. Wow. Uh, so I assume those, those building products and other things have slowed down during this time in, uh, uh, overseas. So here's what's funny. I saw what we're experiencing right now.

Two months ago, I saw the lockdown. From my peers in Shanghai, I saw how their lives were affected. And now fast forward two months later, we're going through that in the us. But now looking back as far as how the lockdown worked, you know, the lives are actually going back to normal in Shanghai. Just talking to a few of my colleagues last night, um, this past week has been the first time they've been able to go out for dinners.

Restaurants are opening back up. Traffic is starting to get hectic in Shanghai, so things are picking up. Um, and which is a good part. So. I am extremely optimistic as far as to the plan that we're facing and we're going in the US and hopefully we stick to that. Hopefully we have some, uh, ways of just improving and finding some vaccination just to prevent the, the virus from really spreading even further.

Yeah, I, and, and David, thanks for taking some time to meet with us. I, I really do appreciate it. Um, the, the first question in, in this is, is pretty general and then we'll dive into the health IT stuff. Uh, what are some things that you're seeing health systems doing to handle the COVID 19 pandemic, uh, in their communities?

Yeah, I've seen a lot of, um, various things. First is the, the key is to identifying quarantine. So you're seeing lots of tents being set up. You're seeing hospitals that are now being designated as a covid hospital. I just saw this, uh, news from Stewart Healthcare where they have designated a Covid hospital.

And here's the interesting part, when I was, I just tweeted about this yesterday, the last few months, helping, um, the Shanghai project. We build new hospital with a fever clinic. I mean a whole dedicated space dedicated to quarantine, coming in with a, and I thought that was the most ridiculous idea. Now, fast forward two months later.

Probably one of the things that we need to do because this virus situation can be an ongoing, um, situation that we have to face in health systems. So you do need to find ways to quarantine. So as we've seen these tents, these tentative facilities that, that are being set up throughout various health systems, it may be something to think about moving forward, but that's from a health system perspective that is happening.

Um. Take care, the most sickest patient, um, as, as soon as possible. Yeah. You know, it's interesting, um, the, the information's coming at us faster than I think any of us, uh, really anticipated. And just the information you get today will change how you talk and think about it tomorrow. Um, and, you know, yeah, sort of a whole wing for isolation and whatnot.

You know, just a month ago you just would've scratched your head and said, that's a waste of space. And today you're sitting there going, wow, what foresight, how smart were we to be thinking about ? I mean, things really have changed. It'll be interesting to see, you know, what happens going forward. Do you think?

I'm, I'm gonna already change the, uh, format, but do you think we are moving at a pace in health? It that's pretty, uh, you know, unprecedented. I don't remember us moving at this pace. I'm hearing people scale up their telehealth, you know, threefold in their VDI environments, fivefold, and in timeframes that we never would've operated in before.

Uh, do you think this will change how we operate in health? It. Definitely if you look at the future work, that is definitely gonna change. Imagine three to four months from now telling your workforce to go back to the office where they have just adjusted to life of being, working remotely. For myself, I love it.

Personally, I don't know how I could ever go back today. Uh, eight to five sitting environment, it's gonna be very tough and it'll be a big adjustment. So I do foresee that changing. I do foresee some benefits too. Hospital space are at a premium. Right, the cost of the space in hospitals. So now you're have this remote workforce, utilize that space for something that could provide care rather than administrative staff.

Um, but here's the good part for health. It, I think some of the things that we're implementing now, whether it's telemedicine, BDI, virtual desktop, um, things to scale out, it's been on the top of mind for sales for quite some time. I've been struggling to get whether, whether it's getting the budget or getting the resources to dedicate to that initiative.

Unfortunately it had to take crisis to to move at a rapid pace. But I do foresee this being the future. I do foresee BDI or desktop as a service being a standard. I do foresee telemedicine playing a bigger role in terms of providing care. It has always traditionally been just a piece of care in a silo.

Now telemedicine can be part of care delivery. And that is a big positive because that's what patients consumers have been expecting, and we as health systems have sort of failed to deliver that. So, so let's, let's talk health it at, at this point, um, you know, you're doing some work and you have some clients that you're, you're coaching around this.

The, uh, you know, what are some things health systems are doing? I mean, the, you know, the telehealth and the, the VDI are probably the, uh, the, the two most that people have talked about. Uh, but what are some, some, maybe some of those things. What are some practices they're doing and maybe what are some other things they're doing to, to handle the, uh, requests that are coming from the organization and from the community?

Yeah. So let's, let's look at just the virtual desktop experience. I think right now people are either patching what they already have or trying to figure out how to create more connectivity, but there's a fundamental challenge right now. A lot of organizations, foundational infrastructure are not up to date.

So number one, they hopefully, they're taking the time to understand that they need to upgrade their infrastructure at a core level. Um, the blocking tackling. So that needs to happen. And then number two, start thinking about how you scale. How fast, how do you do it with agility? So rather than deploying services or even I'll use desktops, whether it takes a few weeks or even a few months from procurement to delivery.

Now think about how you can deliver one in a matter of minutes to seconds. So that's a very different mind shift. Uh, you have to also retrain your engineers rather than move them from being traditional network engineers. They probably have to become cloud engineers. Very new skillset and requires the new culture, requires a lot of retraining.

So that definitely needs to happen. Um, so I'm seeing the shuffle and the scrambling for executives now where they have to scale up faster and the speed that they have never experienced before, but they do understand the how it works conceptually now it's really operationally. And how do they drive that?

Sexing, I think they have to understand how to take advantage of, uh, partners because you cannot build things yourself anymore. Traditional hospital systems are not development shops. They, they're, they don't act as a vendor. So start thinking about how you could partner. I think that's gonna be a really critical task and that's gonna be a very big experience and change for a lot of healthcare decision makers.

I. You know, it's, uh, so two things I want, I, I do wanna talk VDI in a little more detail with you if, if, uh, if we can. And then the second is I wanna talk about outsourcing. So there's organizations that have outsourced and I wanna sort of touch on that. And I, I haven't been able to touch on it with health systems.

And so it's, it's great to have these conversations with, um, with, uh, people who operate in, in advisory capacity. 'cause we can get into, you know, some of the pros and cons of outsourcing the, um, but VDI. So for us, we had 6,500, uh, VDI workstations when I left St. Joe's, and the first thing was to get that first rack going.

That was a herculean task. 'cause we had, uh, umpteen a couple hundred applications. We had to get to work effectively on Citrix, not, not the least of which was the Imprivata. And, uh, we, we had to get, um, uh, nuance, we had to get Dragon working on it and all these things back in the day. These were early on in the, the.

The, the environments, we had to work very closely with the vendors to get it working really well. And then we got it working in, in one box and we, we made the mistake of thinking, oh, great, we'll just stand up a bunch of other boxes and we'll get up to 6,500. But scaling is a different beast. I, I, I really didn't anticipate how many challenges we'd have to scale to 6,500 from a, a single, uh, centralized cloud data center.

And the um. But you have these things like, uh, like uh, a whole bunch of workers logging in at the same time and bandwidth, and people a lot of times mistake bandwidth and latency. And they both create different challenges and bandwidth doesn't necessarily alleviate latency. You've gotta address latency in of itself.

And I, you know, and I'm a former CTO, and so even I was kind of surprised with the number of challenges we had to scale out to 6,500. Is that gonna even be possible for some of these environments? I mean, you're in a crisis mode right now. If they don't have it really thought out ahead of time, are they gonna be able to scale this up that rapidly?

Yeah, I think what you described is gonna be a very difficult challenge because most folks are just thinking about plugging a hole, right? They're just thinking about how to provide the infrastructure through their resources, so they're probably buying the biggest bandwidth that they can. And just to point it, I think we, as we need to, as post covid comes, we need to really get a lot smarter.

We need to probably think about the different tiers of the. Environment. For example, you could probably use lot of public cloud providers for day.

Uh, a lot of legacy applications that may not work. You could probably just put it up in a public cloud infrastructure and deploy that. Where the challenge comes in, as you had just talked about, is some of these traditional healthcare enterprise vendors who are not cloud ready, they're driven on legacy code and it's very difficult to do and deploy in a virtual desktop environment.

So you probably need to sort through the, the portfolio and have a few different tiers in terms of your virtual desktop infrastructure environment. That's how I would be thinking about it. And that's the only way you could scale out, um, quickly, but you won't have a one fit solution for everything. But with the multi-tier strategy, you could probably get through that and scale out as fast as you can, um, moving forward in the future.

You know, it's interesting, I I, I was chatting with somebody who, who, uh, recently outsourced and they said, uh, we, we didn't anticipate this like we did. We didn't anticipate crisis. Uh, 'cause you know, really why you outsource is to reduce costs and hopefully get some skills that you didn't normally have, uh, so that you can really address this.

Uh, you can address these kinds of scale challenges, but you expect the scale challenges to happen over a longer period of time. Uh, what, you know, what are you telling your clients that maybe have outsourced and find themselves sort of with a lack of, uh, agility right now that they thought they were actually increasing with the outsource?

You know, outsourcing doesn't mean that you could just shift the risk to a third party, right? I think you're, you're outsourcing because you understand the capacity you need. You're also be able to have a bigger pool of talent that you may not be able to recruit or build internally. You still have to manage them.

So my, my, my tip for outsourcing is you treat this as your internal staff. You have to figure out how to manage them the same way. But now you have a bigger pool of talent and a company that's standing behind you with faster innovation, go to market strategies and hopefully better technology. Um, but here's, here's the very, here's the big challenge in healthcare and hospital systems that we don't talk about.

These academic medical centers, hospital systems are typically the largest employers. When you outsource and shift that workforce to a third party, it has a big hit on the city's GDP, the economic growth. So you have to figure out how to balance that, and that's the unspoken area that makes it very hard in healthcare to take advantage of outsource and managed services.

Because you're a big economic driver. There's a bigger impact from outsourcing that you would probably not have in other industries. So that's the biggest challenge from a political aspect. Um, but that's something I would say the CIO, the executive team needs to think through and think about how you could take advantage of the current workforce in the managed service environment.

All right. Closing question. Uh, you, you potentially, your mind is about two months ahead of us on this since you've been, uh, dealing with it with the hospitals that you're working with in, uh, Singapore and Shanghai. So, um. What are some things we should be thinking about from, let's, let's stick with health it, uh, because that's our area of expertise.

So what are some things we should be thinking about from a health IT standpoint for how this is gonna play out? Maybe over a month, two months, three months? Uh, for, for us and our staff. For the last few years, I think you and I have been on the same page in terms of we have to build on top of platforms.

You can't just buy enterprise apps and stick 'em together. I think now, as people are starting to understand, you have to be able to build on a solid platform, whether it's a telemedicine platform, BDI platform, you need to have that solid foundation. So think about how you could build platforms for that.

When it comes to. Another crisis, hopefully won't happen again. You could scale a lot quicker. So get into platform development, get into platform thinking, and that's gonna be a big, really big shift. Uh, as also as we move towards cloud environments, it's not about just utilizing one cloud. You're gonna have to figure out how to deal with cloud to cloud integration, which is gonna be the future.

So having a solid platform to.

That's my advice. There's obviously a lot of details in terms of what, what we talk about when it comes to platform, but buying a technology that you could rely on, develop on top of, and make sure they're solid partners gonna be the key to future. We, we are, uh, simpatico and mindset on that. Platforms and multi-cloud are, uh, are, are the future here.

Uh, a lot of . Different nuances of how to implement that and how to make that happen. And there's a lot of great tools to make that happen. Uh, David, thanks for taking the time. Uh, just real quick, how can people follow you, keep up to, up to date on what you're doing? Yeah, I, I'm a big user of Twitter, so follow me at D-C-H-O-U 1 1 0 7 and also LinkedIn.

I think those are my two go-to platforms right now, uh, in terms of sharing content and ideas. So, happy to do whatever I can for the community. Well, I appreciate it, and at some point when this thing calms down, you're gonna have to teach me how to use Twitter. I, uh, , I, I, I figured out LinkedIn, but gosh, Twitter still escapes me.

Who knows? Um, thanks again. Uh, special thanks to our sponsors, VMware Servers advisors, Galen Healthcare Health and Pro Talent Advisors for choosing to invest in developing next generation of health leaders. Uh, this shows production of this week in Health It. For more great content, check out the website this week, health com and the YouTube channel.

If you wanna support the show, best way to do it. Share it with a peer, however you do that. I'm, you know, send 'em an email, uh, you know, support our, uh, posts on social media, whatever, however you normally do that. Just do that. Uh, we'll be back again on Friday and we'll continue to do more of these interviews over the next couple weeks.

Thanks for listening. That's all for now.