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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're joined by Jamie Nelson, the CIO for hospital for special surgery, and we actually do a, a follow up.

Conversation from the field report we did during the Covid series. The hospital for special surgery, if you're not familiar, is an orthopedic specialty surgery location in uh, Manhattan. And during the pandemic, they made a complete transition of their services for about a three month period. All of the EHR builds everything that was required.

We, we do a follow up on that. We also talk about leading an organization through the pandemic, the different management styles, communication. Just the, all the, all the transitions that, uh, were required and we also obviously take a look at the future. So great conversation. I hope you enjoy. Special thanks to our influence show sponsors, Sirius Healthcare and Health lyrics for choosing to invest in our mission to develop the next generation of health IT leaders.

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And now onto today's show. Today we're joined by Jamie Nelson, CIO, for hospital, four special surgery. Jamie, welcome back to the show. Thank you. Nice to be back. Thank you for having me. Well, you have a phenomenal background. Now, some people are gonna be listening to this as a podcast. Some people are, you're gonna be watching it on YouTube and you're in your office.

I could see New York City in the background. Looks like, well, the, the city's not as busy as I remember it, but it looks like things are. Getting back to a semblance of normal there, you know, they really are. Especially when, think about a year ago at this time when you could walk to Fifth Avenue and it was empty.

You could walk across fifth Avenue, no traffic, nothing. So, you know, we are, we are certainly back in business, um, at a reduced scale, but it, it is, it feels very good. And, and you're in the office, so, mm-hmm. . But you've, you've been in the office for a while. 'cause when we did the, the field report, you, you reported from the office way back when.

So you've been in the office the whole time? I have been, you know, uh, a lot of our staff is remote for their own personal safety and, and to not spread the virus. And I. I have a belief that leadership should be visible and onsite, especially in a hospital when you're running technology. And if I have one person onsite, I really think there should be leadership as well.

And of course our whole desktop team has been here. Our clinical teams have come in our networking team. So we have a lot of teams that come in and out. So I like to, I like to be sure that leadership is visible and I understand what's going on in the hospital. 'cause we are, you know, we're open for business.

Would've heard of it, but it it, it is one of those really special hospitals in the industry. Give us a little background on HSS. Well, the special surgery is orthopedic surgery, so that's the first thing. So we are, um, a standalone hospital. We have roughly 200 beds. Our length of stay is pretty short because it's orthopedics and you know, now a lot of orthopedics is moving to ambulatory.

You can have your hip replaced same day go home. So, you know, the busy. The clinical business model is changing, but we do only orthopedic surgery, about 35,000 a year, 11 years running. We have been ranked number one in orthopedic surgery by US News and World Reports, and we are, we don't rest on that laurel.

'cause the next year we wanna do it again. And what we wanna do is have the clinical excellence that leads to that designation. So that's, we're constantly striving. We've got. North of 120 orthopedic surgeons that operate only at our facility. We have facilities in West Palm now so that, so we are known in Florida, uh, facility in Connecticut affiliated with Stanford Hospitals.

So we are starting to expand, but you're right. Mostly we're quite well known in the Northeast. Wow. And, and you actually, I remember we talked one point and you were talking about the fact that you guys really are a global provider. People fly in from literally all over the world to have surgery done in your facility.

Does that create any special. Technology needs or requirements that you need to figure out a way to, to handle that. It's funny, we have a, we have a project we're kicking off now for some secure file transfer to the United Arab Emirates for billing for their patients. So, um, there are some technology needs, especially around registration and rep cycle, but.

You know, it's, you know, we, we treat those patients like we do everybody else with, you know, the absolute best of care, which is why pre pandemic, they came in from all over the world and I know that business is gonna come back going forward. . Well, let's, let's talk about the pandemic a little bit. 'cause you know, obviously you're in a location that was, was arguably the hardest hit of any geography in the country.

Again, arguably, I'm sure others can make a case, but New York was really hit hard and you actually transitioned the entire hospital. Over to a to, to a covid facility for the, for i I mean how long, how long did you make that transition for? For a few months. And it was at the height of the pandemic. We knew that we had to stop doing orthopedic surgery because it was not, there was no reason to for elective orthopedics.

'cause we have non-elective as well. Urgent. But there was no reason to bring patients into the city, subject them to a hospital environment during the height of the pandemic. And we actually got in front of our state, which shut down elective surgeries at some point early on. A year ago, March. So we had already started thinking about what we would do instead, how we could continue to serve our community, and where that was taking any kind of general surgical patient from another hospital or a general medical patient, how we could relieve those hospitals so they could take care of their covid patients.

And very quickly, you know, with the, in the matter of a few weeks, we realized that we had to also take care of covid patients and not just . Minorly sick covid patients 'cause they weren't getting hospitalized anyway, but then are later dependent very, very critically ill patients. So we converted hospital for special surgery, several ORs and our PACU from that type of service into ventilator.

Okay. Critical care units. And our anesthesiologists, some of our internal medical docs who also understood critical care and were were certified became . The critical care doctors within this facility. It was, it was a fascinating transformation. Yeah. I, it, it, it's amazing. I can only imagine how much work had to be done.

I'm thinking about your, your EHR implementation. Your ER implementation has to. To orthopedic, to orthopedics. So did you have to do all sorts of builds and, and whatnot to our, our epic team worked around the clock because we didn't have, uh, ventilator orders. We didn't have all the things you need around critical care.

We have a small ICU, but our, we have a. An agreement with New York Presbyterian across the street that if we have very sick patients, that they immediately get transferred over. You know, we, if they, they get that level during their stay here. So this is not something that we had built in Epic at all. So our teams had to do that.

I can still remember one day, and I may have mentioned this in our last discussion, being at the hospital on a Sunday and one of our lead surgeons looking at me and saying, Jamie, we need to have a red, green, and yellow and epic to tell us whether a patient is red Covid. Green, non covid or yellow pending.

And our team turned that around in a day and a half. Now, prior to Covid, that would've gone to clinical content board, surgical review committee, you know, all these different committees. Then we would've built it, then we would've tested it. Then we had to change bright green to dark green, you know, so what we did in a few days, we normally would take in a few weeks, and that was, that's how we had to do it, to meet the, the.

Patient demands during the peak. You know, I. Your interoperability strategy has to be really solid in order to make that transition, because you're sending those patients, obviously you have the relationship with New York Presbyterian right across the street, but those patients are going in a lot of different directions.

Is your, is your interoperability strategy predominantly around the, the Epic platform and what they provide? Yes. And we also have health Fix, which is our statewide information exchange, and we participate in that. So we, we do, a lot of those patients went to nursing homes pro prior post covid, and that's, that's less electronic.

So I would say that we can certainly improve interoperability, you know, to this . To this day with all the technology, with all the regulatory changes, it is still not the easiest thing to do. And I, I think that's an area we all need to focus on going forward. Yeah. And I think we're gonna see a lot of things post pandemic get elevated, uh, in the discussion in terms of, Hey, we didn't anticipate.

And, and all that stuff's gonna shake out I think over the next year or so. So we'll see. Are any any silver linings that you found in, in your health system going through a pandemic, maybe some learnings or some new practices that you may not have gotten to that quickly? Yeah, I think telehealth, like everybody, we had a very small level of interest in telehealth in orthopedics.

Our surgeons have become very interested in telehealth or orthopedic specific types of telehealth. and how you can actually improve patient care using telehealth. So that is, that was a big silver lining. I'm thinking about our patients that we take care of who don't have the means to often come into the city.

Transportation's an issue. They don't have the money to come in. So being able to do telehealth visits, either, you know, for physiatry, pre orthopedic surgery posts, it really will help, I think, expand our services to patients who really need us. So that, that's a big silver lining. Well, and, and one of the things I, I saw, and I don't know if, uh, and I think it's still there during the, the emergency situation, we had rehab services, also went to telehealth and.

We've now written the book. We have our rehab department, and we're, remember we're talking about, uh, not acute rehab where you're in a bed, you know, in the hospital we're talking about physical therapy, rehab. Yep. Um, post-surgery or pre-surgery. And we now have published how to do . Physical therapy versus via telehealth.

And that is, that's a, you know, our numbers are, when we looked at our volumes throughout the pandemic, physical therapy has been beating any estimate and telehealth is really part of that, that's really made that, that's probably not one of those areas. If we had sat back and made a list of, Hey, here are the things we're gonna do via telehealth, that probably wouldn't have risen to the written book.

They've actually published. It was on LinkedIn. I've, that's one of the places I saw it, but it's a manual of that's free out there, how to, how to correctly and safely do physical therapy. I can certainly after this get you that, that, yeah, we'll, we'll absolutely share the information with the podcast. You know, we move forward with wearables and with sensors.

I think the . Orthopedic side will really take up too, and that's what our clinicians are interested. How do you exploit those technologies? Layer that in with telehealth to really be able to maybe postoperatively, almost never see a patient. You know, if you're supposed to have a certain range of motion, and we can put a sensor on you that measures that, and we can see that.

Maybe you don't have to come back to Manhattan or to Palm Beach or wherever you've been for those visits. So there's all sorts of exciting things about really improving patient outcomes, um, and patient care using these technologies. What, what, what do you think the lasting impact on health it is gonna be as a result of the pandemic?

Have we, have we changed the types of conversations or maybe the expectation of what we can deliver and what timeframe? What's the lasting impact? Well, I think that if it was ever not at the table in some discussion, that won't happen again because everything we had to do around meeting the requirements of our, our per covid patients, of our telehealth patients, of, of all the things that were going on, required some sort of sophisticated IT build underneath it, and we really partnered with our clinical and our operational colleagues.

And I always think of HS as you know, we're . We're a small, we're sophisticated, we're an academic medical center, but we're, we are small. So I always felt like we were pretty tightly coordinated with our end users and our operational and clinical counterparts, but I think this really helped to tighten that.

And when you've all been through something together. Some real crisis and that's what it was. Those bonds really become much tighter. And I think that's so for it, for our hospital, and I'm sure all my colleagues across the country have extremely similar stories. They may not had to build, well, they had to build ICUs.

Many hospitals took MedSurg units in terms of ICUs. So we've all been through this and, and I think we've had, we have very similar stories to share. Yeah, it's you, you're, you're set in your facility. The last major trip I took was to your facility. You hosted an event and there.

And you were actually are, are you still building, you were building something at that point? We are putting a new building just next to the East River. So we are going to build a, a new hospital building that will provide our surgeons with a lot more office space, more radiology space, and more patient rooms that can be private.

New York City wants us to have private rooms for patients. It's much better for patient care. So we just got a, a beautiful gift to fund it. It's going to be . The Kellen Tower, um, sitting on top of the FDR drives. So those of you know who New York City, that's the, the highway that goes up and down the east side of Manhattan.

And that, I think we're ordering steel in a couple of weeks. So that's a very exciting project. Wow. And that'll help us modernize the entire campus because then we can take the existing. Inpatient inpatient on campus that we currently have and make them private rooms. It's so much better for patient care and, and, uh, recovery.

So you're one of the CIOs that's going through a building project. I went through a, a couple building projects over my years as CIO. Those are really interesting, aren't they? You, you sort of have to look at all the technology that's available today, project out what potentially you're gonna wanna do in that facility, and then make some decisions and trade off.

What really cutting edge stuff are we gonna bring in? What, what, you know, things. And you have to, that's a pretty interesting, uh, set of challenges to, to build a new building, isn't it? It, it's, it's challenging, but in a really positive way. 'cause right now we are limited by the physical buildings that we have here and, and just how they're built.

You know, we still have dead spots for wifi because of, you know, how the buildings were built 40, 50 years ago. So to have a really, a. Blank slate. And to be able to build a building that you know has almost technology first in terms of the infrastructure is gonna be really interesting. And one of our, uh, assistant directors in our clinical team recently put together a hospital in the future presentation for our head of, uh, development because we have donors that are interested in helping to fund technology really

Cutting edge technology in the new building. So it allowed us to think big and, and what would we like to see in, in a new building. So I'm really excited that we're, we can, can we implement all the technology? I don't know, but can we think about it? You know? Absolutely. Yeah. It is, it, it is an exciting time when you're building a new facility to just dream about what you.

A little bit more about leadership with you, uh, going through the pandemic. Let's start with a general question, which is, you know, what, what's the biggest, what was the, your biggest challenge as a leader as ACIO, taking the organization, your IT organization through the pandemic and serving your organization through the pandemic?

What was the greatest challenge that you faced during that time? I think that we had to assure that we could continue to deliver safe and effective patient care through the pandemic with at one point a third of our workforce being remote. While our workforce was remote. I. So meeting the challenges of our end users or our own IT staff, were experiencing some of the same challenges.

You know, that you can't get into the office, that suddenly you're working and you don't have an office environment. You've got, you know, your living room. Uh, cocktail table and teenage kids walking back and forth, you know, being able to figure out how to serve our users while figuring out how to take care of ourselves.

Plus just the, the stress and the worry about covid, what's going on with relatives, what's going on with larger family members, the community. So being part of a problem and having to solve that problem was a leadership challenge, but also . Very, very gratifying. When I talk to my teams now, I meet with small random groups of IT staff just to kind of bring this together and I talk about what was good in the covid year.

'cause we all think about what we lost, but you know, what were benefits. Many of our staff say the ability to actually be part of the solution was very, very meaningful. So as a leader, making sure that we could do that while still supporting our own IT workforce needs was, was a balancing act. So I.

That's interesting. How did you keep everyone on the same page? I mean a third of the workforce at home, a third of the IT staff at home or more? Well, more, I would say 90% of our IT staff. So I know. For in it. It was a real increase in the use of, obviously Teams Zoom, you know, these types of collaborative platforms, but it was a much higher frequency of meeting.

I started meeting with my own leadership team every single day. I'm still meeting with them every single day. We have stand up at three or four o'clock every day. I know that the teams beneath me had these morning, eight o'clock, let's all get together. So I think having a more structured approach to collaboration with teams that are disparate is really important.

I have every other week it all meetings, it's half an hour, but we get everybody from it and a collaborative platform and I just talk about what's going on. The other weeks, our CEO has an HSS all meeting. Which we didn't have before. So I think that the magic key here was really, really increasing the frequency and the transparency of communications.

And even saying when we don't know something or when we are feeling stressed or worried about something, being empathetic and about our feelings of what we're going through, I think really help the teams as well. Is, is your team gonna be coming back into the office, do you think post pandemic, or do you think there there's gonna be, I have the, the fortune of being selected to be on the small leadership team reporting up to the CEO that is going to develop our work from home policy.

So we have to have a policy and philosophy statement, and then we're gonna develop policies and procedures underneath it. So we certainly had a work from home policy for the pandemic, but we are now thinking about what do we wanna do in the future? And it's really a mix bill, because we have to think about what's right for HSS, what's right for our patients, our culture here, but we also have to look at the larger environment.

You know, what's the rest of New York City doing? What are our hospital colleagues doing? Because you don't wanna be completely outta step with what others are doing. So we are formulating our plans over the summer so we can get more specifics out to teams. But you know, I I, I'm sure it will be a hybrid model.

I don't think we're ever, but I love to have everybody back in the office. Yes. I don't think that's going to happen. I think, I think the. Playing field is quite different now, and I think we'll be in some sort of a hybrid model and not only fry, but for the rest of the corporate services at the hospital that can be home.

I, I love the fact you said, being in with what's going in. Potentially your, your, your competitors for staff and whatnot. Talent. A absolutely, especially our nonclinical staff. You know, our networking team can work at, you know, Citibank or you know, any other company in, in that's in New York City. So we have to think about the whole picture.

Yeah, and I was just reading Jamie Diamond's, JP Morgan, uh, CEO of JP Morgan. I was reading his annual report and he's a strong proponent of bringing everyone back for a couple reasons. One is he believes we're, we're, we're missing out on that mentoring capability. We're missing out on the serendipity of, of innovation that happens when people in the same room.

And then the other thing, which he sort of mentioned, uh, it was a small blur, but it, it was interesting to me. He is like, if we don't bring the people back, we're gonna bankrupt a lot of restaurants in New York City. Because they, they require people walking down the street and going into those, those restaurants and stuff.

Yeah. And I'm not sure the person sitting in their home in Ron Con on Long Island is gonna go out to a restaurant to eat lunch. 'cause their kitchen's right there, they don't have the three people at the cubicles next to them that all wanna go out. So you're right, it would have a ripple effect on the city.

Many leaders are talking about that. The acculturation of young staff, of new staff coming in. How do I really differentiate the stars from the, you know, from the regular staff of I'm not . Interacting with them personally, bumping into them, having those serendipitous conversations. You know, a few years ago our IT department was spread all over the campus and we all came into this beautiful office space.

You see me in here in midtown three years ago, and we were so excited about being in one place and collaborating and having network here, and applications there, and infrastructure there. So those benefits will be lost, you know, you can do it. Virtually, virtually, but it is not the same. I, I think there's gonna be a pendulum swing.

I, my belief is that we're gonna kind of ride this, okay, everybody stay at home wave. And then we're gonna understand that there are certain things that we're missing by not having people in the same place. And it will come back to a more middle state. So I wish I had a crystal ball. This is when I think about the decisions that we make as leaders.

This is absolutely one of the most difficult. It, it's interesting. I was talking to A-C-I-O-I think two weeks ago. We were talking about like, gimme an idea of where you're spending your time. And he said, he said all about, you know, 25% of my time is spent on still on Covid. Vaccine distribution, you, you name it.

So it's about 25% of my time. He said 25% of my time is still work from home, putting policies in place. What are we gonna be doing moving forward and all that other stuff. I'm like, that's 50% of your time. I'm like, , that's, I'm, I'm thinking, I'm thinking back, I, you know, I didn't, I didn't have either of those things as ACIO and I'm thinking, how do you get the rest of your stuff done?

That's a lot of stuff. Right. And Bill, the rest of your stuff is all the stuff that didn't get done over the last year and a half. Because honestly, just when we thought we were coming out of the Covid slump and we're gonna be able to go back to regular work vaccines hit. And we too had to think about vaccinating.

All of our staff had to, we actually opened up vaccine sites for New York City. So, you know, and that is a lot of technology built behind it as well. So suddenly when we thought we could get back to, you know, doing all the projects that got delayed because of covid, we had to do those two plus vaccinations.

So it's. It's been a really busy ride, but I, I think you're, um, the person you're referring to is Right. There's a lot about covid and there's a lot about what we're gonna do in the future in terms of where and how staff are going to, to work Yeah. And collaborate effectively. Yep. All right, so let's talk technology.

I really wanna get your take. You know, what, what are the prior, and I don't wanna get ahead of ourselves. Some people hear these things and they'll shoot me a note and they'll say, Hey, the pandemic isn't over. I get the pandemic isn't over, but most CIOs I'm talking about are planning for post pandemic.

It was a year ago, and you know, so what priorities do you think are be, uh.

So three priorities for us. Number one is infrastructure. We cannot, and, and we, we, like many institutions, reduced our spending last year to deal with the financial urgency around covid. So my number one. Pro project, the number one projects for me are not to have this technical debt piling up. So we have to, you know, we have to upgrade our wireless environment.

We need a new network core. I mean, our PC refresh cycle has to continue. So these types of things, to really have a strong infrastructure on which everything else is built is really top priority. So that's number one. Number two, like many organizations, ERP has taken a backseat. Last year we were supposed to

Select our consultant to help us select our system. You know, that, that all got put off. So that is up and running. We just sent out an RFP to a down selected, uh, set of consulting vendors that will help us figure out what we're gonna be doing and who'll be doing. Come on, Jamie. You couldn't do an ERP implementation last year.

What? I, anyway, I'm just kidding. There's the other things going on. Yeah, I, I would imagine. Um, and then, and then thirdly, digital. So how do we, how do we have a platform that we can use that can bring together lots of different, we used to call it our digital front door. I still think that's an excellent analogy, but how do we have a single platform that's mobile first and can allow our patients and consumers to, uh, access all of our assets, our digital assets in one very neat place.

So that's another thing we've been really working on, and we've used . Uh, the Epic MyChart as the chassis, but we have put a beautiful overland top of it, but all sorts of great new features and functions and, you know, that's gonna be a real focus for us going forward as well. When, when you think about your community that you're building that digital front door for, do you have like a, a general age demographic that you're looking at or a, or, or a geo geography that you're looking at?

Or do you really have to consider? Uh, you know, I mean, orthopedics, I mean, that's. Kids in high kids playing sports all the way to, you know, elderly essentially. Yeah. I mean, are you, you really thinking the whole gambit? We, we absolutely are. And it's really omnichannel because some things will still be on the web, some things will still be a phone call.

Some things will be only digital. I mean, I think about my own children, we just don't wanna make a phone call. Like, why, why? So we have to really be able to, and I think omnichannel is, is the best way to describe it, because you have to have many platforms. But we really are looking at digital first. And if you think about the world, I mean, my 80 year old, 85 year old mom is on Facebook and ordering things online.

I mean, they. Tech savvy is really across all age buckets. I think that's important. And socioeconomic classes as, as I mentioned earlier, you know, we have patients without the means and, and have difficulty coming to us because of financial considerations, but they still have a smartphone and they can access this digitally using telehealth book an appointment using our online facilities.

So it's really across socioeconomic and across. Age and geographies too. You know, one of our goals is to help people from all over the country in the world come to our, um, knowledge and perhaps our clinicians to really get the best orthopedic care. And that's, that's around. So it, it's interesting. I was, so where I was gonna go is I was gonna ask you to gimme a, a, your perspective on, on three areas or, or three technologies.

Me keep coming up and over and over again in these, these.

It sounds like that is, that is front and center for you guys. You guys are very focused on that. So we have a, first, we have just implemented digital pathology in February, so it's FDA approved, so it's a Leica scanner. So that histology slide is scanned in and digitized through this Leica scanner. It then goes into our sector PACS system.

So we're using Sectra for our digital radiology. Now we're using it for digital pathology. And then it's all tied together through our EMR through Epic. So this is the first in the country doing this. And um, it really allows our radiologists, our pathologists, our surgeons, and our rheumatologists to collaborate around this digital image.

They don't have to be in the same room. They don't have to be peering over a microscope. They can zoom in, zoom out, they can draw circles and label things. So this will help us because we have always been very interested in, in the, uh, interplay between the radiological image and the, the pathology image and, and how we can improve patient care by really looking at these things.

So it opens up research. So when you think about clinical care, that's digital, and that is something that we are really, really proud of. We, we had Sectra on the podcast and I'd never heard of them before and when they got done, I, I was kind of sad. I'd never heard of them. I'm in my 10th year now, so Sectra was already here as our PAC system.

I had never heard of them. And they're outta Sweden and they are a one, I think they, they have really wonderful technology and really forward thinking and we're so excited to, you know, be part of their digital pathology program now. So let me hit, let me hit the other, other two areas that I'm, I'm hearing, hearing a lot about.

One is, uh, it automation and just automation in general. Is this, is this something that you are, you're feeling as well that is, is bubbling up as a priority RPA you're talking about? Uh, it, it can be RPA. Yeah, absolutely. So we're seeing, uh, a lot of it in our finance department, revenue cycle. They're very interested, you know, looking benefits up on a website, those sorts of things that really are not valued that that robotic processor automation could help.

So the, there are several projects moving forward there. You know, the other area we're seeing it really is an it, it automation, you know, the ability to spin up additional servers, additional workloads, you know, automation around. Standing up new users within the environment because we have, we've always had a challenge of new person comes in and it takes, you know, so long to get them stood up on all the environments.

So we're seeing automation really get applied in, in, in that area as well. And I, I, I don't know if that's specifically RPA or if that's other tools that they're using, but this one, those that keeps coming up, the word automation keeps. The rev cycle and, and, and all those things, and that's really being applied.

I know Daniel's doing a ton of it over at Presbyterian, but others are starting to talk about it. Yeah. Again, we're, we're further along in interest on the. The RevCycle side. Then within it, now our chief technology officer, I'm sure of Ola, would love to do this, especially end user provisioning. A lot of these things that really are not, now we're, we're using an identity and access management system.

I am, we call it, we just implemented that a sale point. Yeah, I think vendor. So that's, that's helping us with some provisioning automation. But there's so much more we could do around service desk. So these, these are things we're getting to, but as usual, when budgets get tightened, yeah, it budgets get, and again, if I'm gonna do a wireless upgrade on a seven year old wireless system or IT automation provisioning, I need to do that infrastructure, you know, project first I.

PBX systems. I said bj, I, I had a 30 year old Nortel system in one of my hospitals. It was running one of our major hospitals, and every year it would come up and it would be on the list of things to do, and we just wouldn't do it because it, it kept functioning, it was disruptive to replace the whole thing.

And we had the parse to keep the thing running, and it just kept running. And I hope they've s been seven, six years since left would make it. 31, 32 year old system with Nortel that's no longer in business, but, but those are some of the trade-offs. You just look at something and go, that's working today.

We've gotta, we've gotta really focus in over here for the next 12 months to 18 months. It's those trade-offs are tough. What, what about cloud adoptions and, and cloud strategies are. Do you have anything in, in, in regard to that? Yeah, so we, we, through our, our money behind AWSA couple of years ago, and I, that was a great decision.

So we do have, well, let's talk about what we can do, what we can choose, what we can't. So right now most of our vendors are, are, um, gonna be cloud. So our ERP certainly will be cloud. I don't know whether you really consider . Cloud or not, but epic remote hosting we signed five, six years ago. So to me that's cloud.

So from the application side, bringing new, new software, it's almost a hundred percent cloud now. And we love that 'cause it's, it's, you know, less of a, a load on our technical, uh, staff. It's more flexible. All all the reasons you wanna go cloud, but we needed cloud for our own purposes. Number one, data analytics.

And number two, digital. So having our AWS instance and some staffing around it, um, working on the security, all these things has really allowed us to start to move in those areas because what, um, our analytics team did is basically replicated our Epic database and toss it in the cloud. So now we can do lots of fun things with it out there.

From an nalytics standpoint, we can add other data from other systems. So that's really excellent. And then our whole, the, the new technologies that we're layering on MyChart or digital are all cloud-based. So that's the direction we're going. We're try, I know we all talk about multi-cloud, but you know, with the size that we are, I think it's better to pick one.

So we're trying to keep everybody in the AWS world. So we'll see how long we can, we can pull that up. Yeah, it's interesting. I, I, I talked to, to sales organizations, they'll ask me, you know, what are CIOs thinking? I'm like, well, watch the show for starters. But second of all, one of the things I, I tell 'em is you really have to know what system you're calling on.

'cause a, you know, $30 billion health system in 50 states is very different than a you.

You know, critical, an access, critical access hospital and those kind of things. I mean, they, and you know, it's, you just can't walk in and say, Hey, we have this great widget. We think you'll need, you really have to understand who you're selling to because they're, it's very different environments, very different decisions that are being made and you being orthopedics and not necessarily all the other.

That, that, you know, that go around that, that would make a difference as well. I think as they, and we're, and we're education. And we're research Yep. Um, and clinical care, and we're $2 billion and we're one hospital. Yep. So we are the, in fact, whenever tried to do benchmarking, it's, it's. There's nothing that we look like, so it's really difficult, so.

Well, and that's interesting that you bring up a academic medical center because I, I always make that distinction for people as well. I'm like, academic medical centers are very different. It's a, it's a very different skillset for ACIO and, and recruiters know this because they, they're always looking for somebody who has specifically academic medical center background, not necessarily large.

I DM.

You know, and you're surrounded by academic medical, well, I mean, you really can you benchmark against at all or. No, 'cause it, it's very different. You know, our resident, our, our residents, I think we get a dozen orthopedic residents. So it's a highly competitive process. So it's academic, but it's, everything is on a micro scale except our patient volume because it, which just churns right through here because of the nature of what we do and for the high demand.

For our, our specialty care. So it, it's really, you know, I've worked in hospitals my entire career. I've been at NYP, I've been at Memorial, I've been at Community Hosp, Memorial Sloan, Keter. I've been at community hospitals. I mean, I've consulted in large organizations. Uh, this is a very unique organization, so it's, it's awfully hard to benchmark us.

So we, you know, we have to, I think in the end, depend on our professional knowledge, . With colleagues, understand, understanding the industries to really be able to say, this is what we need and why. Well, Jamie, we're getting close to the end here. I've my catch all question and I, I did wanna hit on analytics.

You sort of mentioned it, that we are seeing sort of a transformation happen in analytics, just in, in our capabilities, our access to new tools and. You know, where, where are you seeing analytics go and where would you like to see it go? It is gone. So when I got here, we had no analytics organization. So 4, 3, 4 years ago I hired in somebody I'd worked with before, who's a new still, who is.

From NYP. She's an excellent resource and analytics, and she built our analyst organization and at the end of last year, we decided that analytics would now, and the CEO, and I had this agreement years ago when I recruited her, that analytics would be incubated within it, but then move into operations. So we now have a group called Camp a, center for Analytics and Performance Management.

Which is now in operations reporting into the organizational operational excellence group, and they are now embedded in operations. So as clinical questions come up, as research questions come up, that's where they are. They are no longer in it. We still have very strong ties and, and, and we depend on each other.

But that is now within operations where I, I think it . It really should be. So I miss them. But I'm really proud that we built this and matured it and now it's sitting. And in fact, we're gonna have an analytic center in the hospital, not not here, off campus, where there will be staff so a clinician can walk in, have a what if question, and have somebody sit right there and you know, run some algorithms and start popping back some responses.

So it's gonna be very real time, very clinician focused. That's exceptional. I, I I love that. It, it, and it's interesting 'cause I think I've, I've seen a lot of different models, but it sounds like that was very intentional and it's really does serve the clinicians really well being, being integrated like that.

So, yeah. And for ACIO you have to be willing to give up. Significant department, something that's really exciting and challenging. But I did make that agreement with our CEO when, when he allowed me to recruit Nilu and, and build the department. And I think it's excellent 'cause it shows that we grew very quickly and mature very quickly and now can really serve our, our clinical operations.

Well, there's 10 or 15 other topics I'd love to cover with you, but since we're coming to the end, I, I, I now have this question that I, I've started to close out all my interviews with and it's been interesting because some of the best content has come in this, this last couple of minutes. I know it sounds like an odd question, but it really allows you to, to, to tell me what's on your mind and what you think we should talk about.

What, what is the question or topic that I haven't asked that you think would be interesting to discuss? You know, so that the community could hear, one of the things that we did not discuss is. The role of reimbursement in some of our new technologies. You know, when I think about telehealth, we are still riding on the the covid reimbursement wave, and I think that some of our regulatory practices, some of our reimbursement has to really adjust to new technologies and new models of patient care and.

That's a bit, that's hard for us because, you know, when you start to build things out and then suddenly we'll have a financial rug hold, you know, how, how do you deal with that? So making sure that the regulatory environment, which we in, in healthcare, it live within, making sure that that is in step with some of the technological, technological advancements that we're trying to make.

I think is something that's interesting to think about. I love Chime. I love the fact that Chime has their regulatory body and thinks about these things and updates us, but it's something I worry about. Yeah. You know, I talked to, talked to Mari about that one of the things we have to be able to do is make the case, do we have the data and the information now that this, let's just call it a telehealth experiment that's been going on for the last year.

Do we have enough data to really make the case? If. It's only been a year. We need more longitudinal data about the clinical efficacy of telehealth. And I'm, I know that's what the government's thinking about, and I completely understand that. And making sure we're not overusing services with telehealth, which I, I have a harder time with that because I think we're expanding services to patients who need them.

But I think that clinical efficacy is very important. And I know that our surgeons are quite interested in whether we're actually improving outcomes to patient care. But, you know, we only have a year's worth of data, so I, I don't think that's quite enough. Yeah. I mean, but, but anecdotally, I mean, if you, you just listen to the clinicians and you, you look at the patient, uh, satisfaction scores.

It, it seems to be working. We just don't have the, the outcome data, I guess is what we're, we're looking for. It's, I think, empirically, you know, I've raised children. I know what a ear infection is. That's easy. So for me to have to load three kids in a car, drive to a pediatrician's office, you know, at eight in the morning, be late for work, go get the amoxicillin, get home, versus having a telehealth visit, you know, the CVS is a drive-through on the way back, whatever.

That to me is such an effective, so that's empirical. It's not, you know, research based, but I'm sure, I'm sure the data will be there and we can continue with this as a new paradigm. Yeah, I agree with you. I hope, I hope. Look, look at all those frameworks coming out of this. Uh, and I just hope we pull all that data because I think there's, there's just a wealth of information.

Right now we're, we're starting to see some longitudinal studies, and, and again, we have, we have large, we have Mayo, we have Adventist. We have very large IDNs who can provide a lot of data just on their own. So I, I think it's out there. I think it's done. Yeah. I'm forward to Jamie. Always great to catch up with.

I it, it's one of my highlights to have conversations with you. We just highlighted you on, on one of our feature stories and the, the great comments that you gave us the last time we talked about women moving up in leadership roles in health it. And appreciate your contribution to that as well. You'll have to send it to me 'cause I'm not great at following myself.

So , uh, I'm sure many of us aren't . Absolutely. Well, thanks again for your time. I really appreciate it. Thanks, bill. Take care of yourself. 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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