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 Welcome to this week in Health It where we discuss the news information and emerging thought with leaders from across the healthcare industry. This is Bill Russell covering healthcare, c i o, and creator of this week in Health. It a set of podcasts and videos dedicated to training the next generation of health IT leaders.

Hope you enjoy. Here we are. Friday afternoon, still on the floor. And Thursday, yes. In fact, it's Thursday afternoon. We're still on the floor. It's been a long week. Seems like Friday. I, uh, I made the mistake of bringing shoes and thinking I was gonna break them in at the show. Oh, that's a bad, that was a really stupid idea.

So that sneakers is before they go. Yeah. Never, never do new shoes before a marathon. Yeah. And this is your marathon? That was, yeah, that was, yeah. I should have called you ahead of time, . So, uh, today we're with, uh, Wess Wright. Uh, I, I call myself . For recovering c i o, you're recovering c t o from a health system.

Now you're c t o with Impravada. Uh, yeah. Yeah. I was, uh, came outta Sutter about 10 months ago. Um, Impravada just, you know, I thought and I saw things developing at Sutter that, that told me that identity is going to be the new perimeter. And in healthcare, if you think identity, you think Imprivata and David Ting, who was a founder, c t o, left and I never considered that I'd be able to take that spot, but, uh, 'cause he was, is wicked smart and I'm not so , I didn't think I'd have a shot at that, but lo and behold, here I am.

But the thing you have is experience, right? In the uh, yeah. Yeah. I've got, uh, about 25 years of provider experience and imprivata, you know, when I was on the C T O C I O side, uh, I work with Impravada a lot and I think anybody that does work with Impravada, they'll go, oh, these guys actually get it. Yeah.

They know workflow, they know healthcare. Yeah. And that. Drove me here too. And really one of the, one of the major decision factors was, you know, they bought Paradigm two years ago. Yeah. So one that gave them 140 customers, but two, what it then allowed is that with Paradigm came a provisioning system, A G R C provisioning system.

We took it, rolled it up, modernized it, and now we have a new G R C provisioning system, which then allows me to have a suite of services so I can offer almost every . Everything in the i a M suite. That's pretty cool. So here's what we're gonna do. Okay. I, uh, recovering c i o, uh, 16 hospital systems. Mm-hmm.

So, uh, we used Rivaa pretty extensively. We, we also were one of the first, uh, clients for Paradigm. Okay. And, uh, that didn't go nearly as well as the vo Actually, when I was at Scripps, I bought Centillian so Well. There you go. There you go. We all have, we all have a history, but Yep. Um, so what I wanna talk about really leverage your c t o background, okay.

And say, um, the, the listeners are primarily, uh, health, healthcare provider, IT organizations, people. Okay. The world's changing on that, uh, big time. So especially on, so let's talk infrastructure and operations. Okay, let's talk back office. So, um, you say identity is the new perimeter. Yeah. So how, how are we gonna start seeing identity

Uh, play out in terms of provisioning of new services and those kind of things. Um, it, it will all be identity based with a, with the new Fido standards coming out too. Identity is just identity without a password. Um, everything, it's identity and data. The identity, the identity of the not, of the data, of the data producer, um, is, is where that perimeter's and it's all, and it's all being driven by security.

A hundred percent. So, How do we get to a point where there's no password? Uh, it's, uh, you know, in the cloud world, you're almost there. We've been doing a lot of work with Microsoft, had a, a conversation with them a couple weeks ago and they've got some Fido stuff. You just, you know, the Fido fob, you like the u b key or something.

You plug that sucker in, you never see, uh, a piece of, uh, a password prompt again. But that's really only aimed at the cloud application stuff. Like it doesn't work with applications that are ldap. Uh, So you probably struggled, I mean, you were c t O and Sutter was what, 10 billion? Uh, yeah, about 12 billion.

7 28 hospitals. 28 hospitals. And your your biggest security, uh, threat is people. People. Right. So, and people know their passwords and then they use it over and over again. Mm-hmm. throughout the internet. Yep. And then they create all sorts of challenges that way. Um, I mean, are you guys, are you guys looking at the larger, larger, um, identity across all the applications?

Are you . You really focusing on the clinical applications, we're laser-like focused on the clinical applications. That's what's made, made us our money. That's, that's our secret sauce. Not only from an identity perspective, but it's the, it's the, the workflow integration that really makes, in Epic, there's, I think about 140 different places in Epic where you can call for a second authentication and we know them all and can prompt for that second authentication.

So it's really the laser-like focus on the clinical applications. But what we've come to . Realize is, hey, we've set up this great SS, s o a m s S O situation for all our clinicians, and then we've got like a second tier community that has to still use username and password. So we've, we've, uh, we'd really like to see people using vota and Enterprise.

So for non-clinical users, we've really done some huge price reductions for the nonclinical users so that people like me, the operating people only have to manage one pane of glass from an . SS s o perspective. Yeah. Are you finding that, uh, are you guys able to drive higher efficiencies? I mean, clear that, that's one of the reasons we, we use was, uh, you know, you took the login times way down for us and the, the clinician experience, obviously that goes on obviously.

Yeah. But do you find cost being one of the major drivers right now within healthcare? Oh, yeah. Uh, about every other C T O C I O I talk to really . Wants to expand their V D I, but it costs a lot of money and hardware and licensing and, and they can't expand that even outside. They may even have just a little pod for a, an operating clinical section.

And that's the only people who can use it. Why? 'cause it costs, I think there's gonna be some big breakthroughs in that area here pretty soon though. Well, that's, I, it's, it's interesting. So it work, it's technology that works. It works in a lot of different areas. Mm-hmm. , it, it drives, uh, satisfaction drives

Efficiency. Um, and, you know, clinician experience is, is huge. Yeah. Physician burnout and whatnot. Yep. Yep. You would think, Hey, this, this is a working great solution. We, we roll it out. Um, are, do you guys help people to build the business case to go back in and say, look, from a V D I perspective, not really sure.

We build a heck out of the business case on the A M S SS O or E P C S or any of that, any of our product type stuff. Um, because I, I've done a bunch of V D I I'll offer, you know, Hey, I'd do it this way if you, if I were you or this way. If I were you. But yeah, other than that, nothing really formal from an r o I perspective on vdi.

I, so what's the, uh, C T O? The landscape's changing in Oh yeah. In healthcare. It, oh yeah. What are some o other areas where you're just seeing it change pretty dramatically? Uh, I'm seeing a, a real bifurcation in your IT stacks right now. Yeah. I mean, there are two camps, two really solid. You're either Dell a w s or you're on the Microsoft stack.

And, and what I see is a lot of people making what they think are tactical decisions, but are really lock in decisions in one of those camps. Yeah. Uh, so that's kind, that's a little concerning. I, and I try to talk to people enough to where they know, Hey, if you make that M D M decision, you know, you've made an M D M decision for your whole enterprise.

You can't, can't do anything . Around that, but, but it really is a data decision at this point because you're, you're trying to tap into, you're really trying to trap, tap into Azure and aws mm-hmm. machine learning AI capabilities. Right? Yeah. Um, is Google playing that or, or not as much? Well, yeah. Google plays in it.

You know, we haven't seen Google from a cloud perspective as, as much as we've seen A A W S and Azure of course, but Google's there. Google really wants to come into healthcare. Matter of fact, we just did a press announcement this at this . Sims that you can tap and go into a Chromebook now. Oh, really? Yeah.

That's pretty cool. Yeah. The, uh, so you have the three stack, or Well, you have those two stacks. Yep. And, um, you know, the Microsoft stack just ended up being a default, right? 'cause you could just, you take that m s A every year and you just go, yep, I'm just gonna add cloud, or I'm just gonna add whatever mm-hmm.

and away you go. Um, but that's, that's a really bad way to make that decision, isn't it? Uh, it is. You know, what's really driven, I think Microsoft . Uh, enterprise business in their O 365 and Azure business. It's Exchange online. I mean, that was, that was the easy decision. Yeah. And that was, I can spend a whole bunch of money and put four or five resources on prem to manage exchange, or I can just put it in the cloud.

Yeah. I wanna be real clear, 'cause I, I was a huge Microsoft, uh, fan in stack. Um, the Azure stack is, is a really good stack. Uh, a hundred percent agree. Ev everybody knows I'm a Microsoft fan boy. Yeah, yeah, yeah. But the Amazon . Stack is, is also a really, it's a really good stack. The challenge we had was talent a hundred percent.

Right. So we, we had, we just had a, a, a wealth of Microsoft talent and it was a natural progression to get here. Yep, yep. But you were in San Francisco, you couldn't get Amazon talent and I was in Sacramento. Sacra. Okay. Yeah. Um, and yeah, I guess I could have, but I think to this day, AM Amazon doesn't have a b a A in California.

Oh, okay. Yeah. That's a little concerning. And, uh, I came from Seattle Children's right across the river for seven years from Redmond. So I had developed a, a bunch of Microsoft relationships and, um, and knew I wanted to, to use the Microsoft stack 'cause I knew, I knew the Microsoft much like you. I knew that stuff.

And they just, they looked at me like I was sane, cross-eyed. And so we ended up building out our own, uh, uh, you know, essentially our own internal cloud on VMware Stack. Private cloud. Exactly. . Um, it's inter, it was a private . Cloud. And then what's interesting is VMware kept building all these other things.

And so now you can actually get out into a, into a public cloud. Um, I'm not, I'm not saying we knew that that was gonna happen. We sort of got lucky. Hey, sometimes it's better to be lucky. Pick pick the right vendors and uh, and, and they will figure out the future for you. Um, so it's, it's interesting. So Amazon, those are the stacks.

I, I think the big disruptor that's coming out, right? . Now Windows Virtual Desktop. And why is that? Um, because you only pay for compute and store in Azure and no other licensing costs. Yeah. Anything that changes the licensing model will be interesting, but I I, I can't imagine it's gonna drive down the licensing costs.

Yeah. Uh, yeah, it will for us if I don't have to pay a Citrix license or a VM tax. Oh, yeah, yeah, yeah. Okay. I see what you're saying. Yeah. So we were a significant . Citrix shop. Yeah, I I've, it sounds like we're, uh, a lot the same here. I ran. That's what I ran too. Um, well it's interesting 'cause Citrix is, so, Citrix is, is, uh, starting to get into that identity mm-hmm.

space. Mm-hmm. and essentially saying, look, uh, to, to a certain extent you can get rid of some of the licensing around badging and that kind of thing. Yep, yep. So do they end up becoming a competitor of some? Not really. We still have a pretty good relationship. Yeah. Clinical side. Yeah. Yeah. Yep, yep. Uh, we do a lot of work with them, of course.

Sorry, on the receiver and that kind of stuff. Yeah. We, our, our, with both Citrix and vm, we have a really good relationships because really it's our v d A product that allows those V D I stacks to work. So it's a pretty symbiotic relationship. So one of the interesting conversations I just had was, uh, a lot of mergers going on.

Mm-hmm. , a lot of, uh, displacement within healthcare and whatnot. Mm-hmm. , let's talk career here for a second. So you've been on . The provider side, now you're on the vendor side. Um, you know, when, when these people get displaced, there's, you could go in the vendor direction, you could, could go in the, uh, provider or con consulting mm-hmm.

Mm-hmm. backend and those kind of things. Uh, you know what, what would you tell people who are trying to make that transition? The, the just I got displaced transition? Yeah. Or the transition to the VAR side Or just 'cause it's, 'cause it's happening a, a fair amount. It is, but you know, I also . See there's a fair amount of the, you know, the old gray hairs that are retiring now too, that just don't want to mess with.

I'm not taking, I'm not gonna take it personally. No, you shouldn't , uh, you're just gray hair, not old . No, I, well, that's what, yeah, I am, uh, I am not as old as, uh, some of the CIOs who I've been talking to. Exactly. That's what I mean. Those people are starting to retire. Right. 'cause, you know, with the new high tech and the interopability, you know, they just go, no moss.

I'm just, I'm just tired of it. And that's creating a bunch of opportunity out there, I think that people need to just be aware of. Yeah. I asked, uh, John Halamka, what he's looking for in the C t o, Uhhuh . He said, I'm looking for somebody with, uh, with very little gray hair who's gonna really push the envelope?

Somebody who's gonna be, I, I think every c I o is is looking for that. Yeah. Yeah. Well, are they out there? I mean, are they? Yeah, there's a few. There's a few out there. Um, you know, I, I think somewhere I. Somewhere in our c i o career or healthcare c i o career, we decided that it was better that a c I o really know the business more than the technology.

And, and I think, I think we did ourselves a disservice. Um, you, that's why I think we see a bunch of the non-healthcare CIOs coming in 'cause Right, they, they know their technology stack really deep. Yeah. You know this and then can apply that to the business. Where we have been going, let's know the business really good and see how we can use the it stat they've, the non-healthcare world goes the opposite way.

So I, yeah. So, uh, c i o, traditional chief innovation officers mm-hmm. , we've seen come up Chief digital officers come up. Yep. And, uh, I think part of that is what you're describing is that the, uh, CIO said, Hey, I wanna be at the table and I want to, I want to know the business. Right. Well, that's all well and good, but

We need to the, we need to get stuff done faster Yes. Than we've ever had before. And so if the c I o's spending all this time on the business, somebody needs to be looking at architecture and saying, yep. Hey, you know what? In order to be agile, we need, we need architecture. Yeah. Yeah. And you know, I've worked with Drex in several different Drex to Ford in several different places.

That's exactly how we separated things. I mean, it was like, okay, he goes up, I concentrate on down. And that's the kind, that's what you need a C T O for if you're going . To focus on the business, then you need somebody focusing on operations and the IT stack and the innovation. Yeah, sure enough. Wess, thank you for your time.

Oh, my pleasure. Bill, which I grabbed you yesterday, man. You were really dressed up. You had a, I had my, A hoodie on, I had my, what I call my imprivata uniform on red shoes. Red shirt, red hoodie. Wow. Yeah, it was, it looked pretty wild. It looked very California, is what it like. Thank you. Thank you. That's what I was going for.

Great, great, great. Hanging out with you. You go. Got it. I hope you enjoyed this conversation. This show is a production of this week in Health It. For more great content, you can check out our website at www.thisweekinhealthit.comortheyoutubechannelatthisweekinhealthit.com/video. Thanks for listening.

That's all for now.