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

Today on This Week Health.

What are the things we do really well in the marketplace? Focus on those things. The other things that we don't, partner to provide a better service, right? That way you're keeping the folks institutional knowledge, you have the opportunity to put them into new positions and new roles that are going to be engaging and innovative. So you can reinvigorate that workforce and actually provide a better product to the people that you're serving.

It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst who are our Newsday show sponsors for investing in our mission to develop the next generation of health 📍 leaders.

All right. It is news day and I am joined by Chris Logan with Censinet. Chris welcome back to the show.

Bill. So good to see again, been too long. My friend.

Yeah. I love I love our conversations. Our team loves our conversations. they part of what they do with these shows is theyhave to create clips. And there's certain people, they like more than others because the clips are very crisp. It's like I ask a question, you get an answer And so it just, it makes their life a little easier sometimes it's a little harder to pull those clips out. So my team is happy that you're on the show and I am as well. How are things going in CNET?

Fantastic. A lot of momentum really getting the word out there about what enterprise risk management looks like in healthcare. So I'm very excited about where we are and where we're going. And I have full confidence that we're going to have a significant impact on the entire healthcare E.

Fantastic. Well, we have three and this could be just the times we're living in right now. We have three let's just call 'em negative leaning stories, negative ask stories. We have a ransomware attack. We have a layoff, and then we have 10 ways inflation is impacting. It. All right. So none of those really get people going.

Yay. We're gonna talk about fun top. We're gonna talk about digital transformation. But this is the reality people are living in. We have four events coming up. This week health, we do 2 29 group. We do a small group events about 15 people, and I've been talking to executives this week, preparing for our fall events.

This is very real. These three conversations, we're talking about inflation layoffs. And ransomware our very real conversation. So we're gonna dive into it. The first one's getting a lot of traction this morning, Ohio health announces biggest layoff in the company history. I took this from the Ohio newspaper dispatch.com is where the story comes from. Ohio health eliminates 637 jobs. In the area of information technology while the rests are coming from revenue cycle, that handle such things as billing, coding, accounts receivable, most of the jobs are based in greater Columbus, Columbus, Ohio, the it workers will remain on the payroll until January 3rd.

They will be given the opportunity for training that could make them eligible for other jobs at Ohio health workers will receive severance pay and temporary benefits after the employment ends, Ohio. Health Says it will have a job fair for those who are affected to continue to be a leading healthcare system, committed to providing the best possible patient experience.

We have made the decision to engage external partners, to provide some services that we currently provide in house, Ohio health, said in a statement. And they're essentially going to Accenture. For a lot of the it stuff. And I didn't pick up where the other stuff's going to come from. I'll give you two more bits of information.

Then I wanna give you this zinger in this whole thing, Ohio health employees, 30,000 associates and physicians across 47 Ohio counties and the healthcare provider owns 12 hospitals, more than 200 outpatient locations. So that scale, let me give you this, this line right in the middle here, Ohio health says the moves aren't meant to save money.

Instead the layouts are intended to drive improvement in patient care and services and position the healthcare system for a future where patients rely more on telemedicine and cell phones to organize their healthcare. Okay, so you and I were talking a little bit before we started this show. This feels like dejavu all over again.

But back in the day, this was about saving money and Ohio health is saying, you know what? This isn't about saving money. This is about keeping up like we're falling behind in key technology areas. Give your thoughts initially on this.

You already said we've seen this show before. It's happened a couple times. The whole insourcing go back to outsourcing, bring it back to insourcing and out. It's like an accordion at the end of the day. I find interesting the comment about this is not to save money. I think it's disingenuous because I think it is a piece of the puzzle. I think most health systems, if you were to ask any of the CFOs talking about bottom line, It's getting expensive to operate.

Right. And that's because of things like inflation and I'm sure we're gonna talk about that here in a second cost of good and services are going up. We're seeing the employees that got raises, aren't keeping up with inflation rates, right? So they're gonna have a slew of people. Most likely leave anyways, looking for something new.

I just don't understand. They want new tech talent. It sounds like to me, you could repurpose a lot of those people that you have today. There's a, there's an amount of institutional knowledge, and this is the one thing that I hate when you see these whole board outsourcing efforts go into it.

You lose that institutional knowledge, which is so critical for them to continue to succeed in their marketplace. And all you're doing now is taking people who are capable Especially those it folks who are in high demand across the country, and they're gonna land on their feet. They're gonna be just fine because somebody's gonna swoop them up to satisfy a need that they're missing in their health system today.

I just think it's shortsighted. What's the real story here. I mean, yeah, we want to continue on with digital. We wanna be that, that passion that people come to for that transformational patient care, that's all digital in nature. You couldn't do that with most of the people you have on staff. Now, I think you could, I think you don't have the right training or the right strategy to move forward.

Just think it's shortsighted. And again, we've seen this play out time and time again, organizations that sent everybody away and brought a big company to run. Two three years later, after that contract started to dry up, they go, maybe this wasn't a good idea. And the cost to bring those people back in house significance to the bottom line. So there there's something else brewing here.

Yeah, I'm gonna read a post here from JD Whitlock healthcare CIO and consultant. it's out on LinkedIn getting a lot of traction before I do that. Let me give you some of my background. So when I became a CIO at St. Joe. We were six, six or eight months into an an in-source.

So we had outsourced the 10 years prior to Dell per well, actually it was per pro was bought by Dell. And then, so it ended up being a Dell pro contact contract. The the outsource again was written over 10 years, hard to imagine a 10 year it strategy, but we wrote a 10, oh, they wrote a 10 year contract prior to me getting there.

one of the things is the contract was written for cost savings in mind. And so per actually lost money the first two years of the contract, but they had to make that money up at some point. And so when you, we fast forward to year eight or 7, 8, 9, and 10, the service has gotten so bad because they needed to make up the money they lost early on in the.

So it, it's hard to write these contracts. It's very hard to write these contracts. You talked about institutional knowledge. That's another challenge. Here's what JD Whitlock has to say. And again, I mean, this thing is only a couple 12 hours old and has 23 comments and 199 people that have liked or curious this whole thing. So Ohio health just announced that they are laying off their epic team in January. And I hear through the grapevine incentives are being offered for the staff to train their offshore replacements from Accenture. My crystal ball says, this is not going to end well for Ohio health. I don't mean this in the, they will regret it in a couple of years way when things slide downhill slowly because epic maintenance and optimization is just not something you completely outsource.

No, I mean, they will regret it in a month. When the entire epic team gets snapped up by every other health system in Ohio, because we are all on epic. These employees are very conveniently located in the geographic center of the state of 11 million people. Where they can work from their home and their bunny slippers.

And once a month drive an hour or two to an in person team meeting in Cincinnati, Cleveland, Dayton, or Toledo, they will not be around to train their replacements. Patient care will suffer in small, but meaningful ways. Doctors and nurses will start to leave. This will be the Harvard business review case study.

And not the good kind. All right. So that's his take on it. My take on his take is of course they're gonna regret it. I haven't done a major system that at some point you didn't regret. Hey, we're migrate. We did a consolidation wall. EHRs, absolutely the right thing. There were several points in there. I'm like, I can't believe we kicked this project off. This is the hardest thing I've ever done in my career. These people are gonna kill us. You're changing too many things. Whatever every project you do, no matter how good it is, there's a there's moments of regret. So they will regret this. They'll regret it in a month.

They'll regret it in a year. That kind of stuff. There will be some things that fall through the cl cracks. Anytime you move from. These 600 employees doing it to these 400 or even 800 employees doing it. There's things that fall through the cracks. And so they're gonna be able to point to stories that, Hey, this thing's not working and whatnot.

The thing I will say is there's a story we're not being told here. Right? And you, you sort of alluded to this. Was the leadership doing the right things ahead of time to make sure that their staff was trained to make sure that they were looking into the future to make sure that they were putting an infrastructure in place that was agile and they could move up and down looking at ways they could be more efficient in the delivery of these things, maybe they should have been doing more online training for their clinicians instead of at the elbow support, maybe their cost has gotten outta line because they had made too many of those decisions and aired too much on the side of you know what, we will always have this much money and we'll be fine.

Therefore we're gonna do high touch, high service kind of things. And now we're in an era where, you know what all that stuff needs to be rethought. I'm not saying should be rethought. I'm saying has to be rethought because we have a clinician shortage. We have an it shortage. We have inflation, we have all these things.

We have to be thinking efficiency. And yes, we cannot compromise patient care. And, but we are going to start to make trade offs with regard to some other things in the name of EF. Instead of having patients lined up in the hallways, we need to figure out new ways to do things to make sure that we provide, continue to provide that care. This is an interesting story. There's also the thing we're not talking about. Maybe Accenture has great sales people and that's how this deal get done. I don't know

I'll say this and this is my personal opinion, obviously. Nobody's looking at it from a strategy perspective. Maybe if we took a pause in Ohio health, this isn't directed at you, but take a pause and say, what are the things we do really well in the marketplace? What are those things that we do really well, focus on those things. The other things that we don't. Partner to provide a better service, right? That way you're keeping the folks institutional knowledge, you have the opportunity to put them into new positions and new roles that are going to be engaging and innovative. So you can reinvigorate that workforce and actually provide a better product to the people that you're serving. I, I, again, I'm gonna say, I think it's shortsighted now.

I don't know all the details. Yeah. But I think it's a little shortsighted at this point and I wish there was more details on this. I know it's fresh. But there's, there's something else brewing here. We're just not made aware of it.

Yeah. Anytime something goes offshore. I agree with you. I think it's cost related and this is a high risk move. To be honest with you. I mean, I'd look at it's just high risk move. They are gonna lose all that staff. Because they're all gonna find jobs elsewhere. Not only in Ohio, as Judy Whitlock points out, they could find jobs anywhere in the country at this point. And so, yeah, it's high risk because there's, there's no coming back from this.

This is a burn, the ships kind of moment for Ohio health and their it staff.

📍 📍 We'll get back to our show in just a minute, we have a couple of webinars coming up and I don't like webinars. I think they are oversaturated at this point. And I think a lot of them are not all that good. And so that's why I think I'm the perfect person to put together webinars for you. I make sure that we have great topics.

I validate them with CIOs. I make sure we have great guests and I make sure. We actually plan ahead and we actually spend time together before the actual webinar. So it's not just spur of the moment stuff, but we make sure we identify the things that we should talk about in those webinars. And we even collect questions from you ahead of the webinar so that we can make sure to talk about the things that you want to talk about.

So let me tell you a little bit about the two webinars we have coming up. There's a global survey. That we talked about on the today show a thousand cybersecurity professionals found that 30% plan to change professions within two or more years, and cybersecurity threats are growing. And, you know, quite frankly, we need to make sure that we recruit, retain and optimize our staff so that they can be our frontline.

And so the first webinar we're doing is how's your frontline recruit. Retain and optimize your cybersecurity team. And we're gonna talk to experts from Christiana care and Seattle children's and Seuss about their thoughts on this exit of security professionals and what you can do to stay ahead of that.

You can join us August 11th. At, 1:00 PM Eastern time and you can register right on our homepage this week, health.com on the top right hand side, you're gonna have the two upcoming webinars. You go ahead and click on those again. That is August 11th at 1:00 PM Eastern time. The next one, we're going to talk about ransomware, but I've seen a lot of different ransomware, webinars.

I love this one. The topic we came up with is Don. Pay the ransom and rubric is bringing together some great leaders from Thomas Jefferson university in St. Luke's university health system and and rubric themselves. And we're gonna discuss solutions around protecting all of your healthcare data, especially as you're moving to the cloud.

And specifically, we're also gonna talk about epic. Backup in Azure. And what rubric gets doing around that, that webinar is going to be on Thursday, August 18th at 1:00 PM. You can register for both of them. Just go to our homepage this week, health.com upper right hand corner. You're gonna see both of the graphics for those click on the one you wanna attend, fill out the form. And we will see you then now back to our show. 📍

📍 alright. Let's hit PFC. So professional finance company, ransomware attack affected 600 providers, 600 providers, pretty significant. Let me give you some of the details. Ransomware attack at PFC may have exposed data from patients at about 600 healthcare providers, Greeley Colorado based PFC and accounts receivable management company discovered the ransomware attack.

In February after an unauthorized user accessed and disabled, some of the company's computer systems PFC disconnected the effective systems and has worked with third party forensic specialists to investigate the incident and secure its network. According to a notice from the company, PFCs investigation found that during the ransomware attack, hackers may have access files containing some patient's personal information.

The company notified healthcare providers. Whose patient data may have been exposed May 5th and last week began mailing letters to patients. The ransomware attack hit company systems that held data from facilities at dispatch, health, banner health, Renown health, and multiple other provider customers. All right. So those those are the details. This is your world. What, what strikes you about this story?

So, again, it's not stopping . This is gonna continue on. And healthcare is always gonna have a target painted on its back because the nature of the data that we have and the willingness of people to pay the ransom, to get that data back, that should be no surprise to anybody where this originated from.

It could be a nation state, could be a group, not a lot of details in the article. Here's the thing that's most striking to me. So they are servicing a number of large health systems. Where is the due diligence from those health systems to ensure that these types of attacks aren't happening with their third parties.

Now I understand you gotta make sure your house is clean as well. So everybody should be taking good steps towards things like proper side, your cyber hygiene. Proper user training. It's expanding that training in this new digital world that we're going to, as we're much more connected, but are you taking that same approach in that same level of investigation with those third parties?

We're starting to see this happen a lot more beyond the walls of the hospitals. Every other story that I read about ransomware isn't about direct hospital hit it's about some business associate. That's not doing their part to secure the healthcare ecosystem. Who's watching the wall. I can't stand this because it's not trivial.

It's tough. But at the end of the day, it's a responsibility of every health system to make sure that. Anybody, they send data to that data's protected the same level of care and diligence that they would put behind it. So why does this keep happening? Have some accountability with third parties, make sure they're doing the things that they say they do.

It is. It's just a requirement. Well, I think this is going to be. Something that changes the eyes of those in the cyber liability space, right? Because now they're seeing this new world open up where it's not just good enough, I'm only gonna increase your rates health system. But now I wanna make sure that you're doing X, Y, and Z for all your business associates, which I think has been lacking for many, many years.

So you're only gonna see this become much more. In parallel with how companies get side reliability insurance. I mean, I've seen a couple of questionnaires out of some of those bigger firms. They have a ransomware questionnaire. Now it's specific to ransomware. That's how important this is to the healthcare ecosystem. We're just still not taking it. Seriously enough. It's it's mind boggling to me, how not we're not standing up and demanding that things be done differently.

All right. I have 17 questions in three minutes. So is the questionnaire enough really? I mean, isn't there some sort of follow up. To that questionnaire. Cause I've received the questionnaires. You've seen the questionnaires you send 'em out, you fill 'em out and you go, I don't know the answer to that one. It's probably this. Yeah. It's probably maybe this and may there's trust and verify, right? There's validation that, that goes wrong with that as well.

And this. The business associate, we've talked about the business associate risk. Before in that we do send a fair amount of information out to third parties, and there are ways of doing that with thin clients and other things where they can actually operate on our systems. We keep the data. They're essentially operating from within our data center. Now we have that ecosystem instead of moving any data over to them to, to process that I'd rather have 'em operating on our systems within our firewall. Now we do have to protect those workstations that have access or those thin clients that have access.

But gosh, that's a lot easier. I can put the monitors on it and I can see what data's moving through there. I could do all sorts of different authentication on that side. So are, is it the questionnaires aren't enough? Are we doing the validation and is the validation gonna get worse as the economics of healthcare gets a little worse?

Well validation's necessary. I'll go back to this enterprise risk perspective. What data does this third party have? What are they holding in this case? It's really the crown jewels, right? This is revenue. That's direct revenue that these folks are hanging on to. There should be a deeper level of inspection that takes place on that third party.

No, if stands or butts about it, you should be validating everything that they do. I I'll go back to public law. 1 16, 3 21. Right? So what came out of HHS and the revamp behind tech, everybody needs to adopt a standard. So maybe that's CSF, maybe that's the 4 0 5 D with hiccup hold people account. So adopt the hiccup standard. Make them improve that they're putting all those control areas in place, hold them accountable for those control and coverage areas. Right?

So here's the challenge. Their cyber liability insurance is gonna go up. I'm gonna hold them accountable for putting all these things in place. There's a cost to all of those things, by the way. And they're just going to increase our rates. And a lot of times we just saw this in the last story. They went to these companies cuz they can do it more efficiently, cheaper, whatever. Now all of a sudden their rates have gone are gonna go up and it's I think we need to relook at architecture altogether. I don't think we should be shipping the data down to the business associates. I think we need to figure out a way to bring them into our data centers, into our cloud environ cloud. Environment's probably a better way of talking about it or into a because we cannot possibly fathom the number of places.

That the data's going now. So my house system doesn't exist anymore. They were required. So I can say this when I went in and said, Hey, I'd like an audit of where all of our data is. They looked at me like I was insane. Like, do you know how long that would take? And there's part of me. That's like, how can we operate that way?

Where it's like, Hey, you know what? It would be too hard to figure out where all our data is. So let's just ignore. I mean, that's,

we kind of did the same thing with application sprawl. We have seven applications that all do the same thing. Cuz different departments wanted them. You gotta reign it in at some point in time. If we're gonna grow digitally and we're gonna be furthering securing ourselves in a more meaningful way, I gotta reduce the landscape that I'm trying to secure. That's like saying, Hey, I'm gonna go secure the Pacific. Good luck. Yeah, there's too many inputs and too many outputs you need to, you need to get your arms around it and minimize that threat landscape.

That risk surface that's available there. Yeah. This gonna be a necessary evils. People are still gonna outsource those services because the cost efficiency.

You always will have business associates. I'm of the, if I were a CIO today, I'd be looking at it from an architecture perspective. Yeah. If they're looking, if they're coming to me and saying, look, you need to secure all of our BAS, I'm gonna say. You know what I'm gonna redo this architecture and here's how we share the data. They're actually coming into our environment. We're not going into their environment. I know what I can secure and I can't possibly secure. These buildings that I again, so I would redo the architecture as much as I possibly could.

And I'd look at, I'd look at some tools and whatnot to validate and verify where we're at today, but I would be pulling all that stuff back in as quickly as possible and renegotiating those contracts as you talked about. But at the end of the day, It doesn't help me at all to put them out of business.

Right I've seen BAAs. Our BAAs started with a clause in there that most of the, most of the vendors came back to me and. If I sign this and we have an event we're out of business, like I couldn't possibly pay this fine and be liable for this amount. Now you can't as a health system, cuz you're a 7 billion entity, but we can't as this. Even if it's a 200 million organization, which is a fairly sizeable organization, some of the penalties and things we're looking at would, would bankrupt these companies. All right. I wanna hit this last story.

I was about to give you double barrels with that last one. We'll move on though. Move on.

by all means, I'll give you the last word on that story.

No. I, I agree with you wholeheartedly. I think the problem that we have with the architectures is that we're trying to now blend a legacy architecture with this new modern architecture, right? So you're not just operating out of your data center. You're now pushing things out, into public cloud providers in other places. So you're creating a little bit more complexity as well. And I think I'll go back to this one thing, even as a small. If I wanna do business in this space, I have to have certain controls in place that I can attest to improve.

I don't like the fact that, oh, we're just a small company. We can't do this. You should have thought about that as you were building your product or service, because if you cannot meet that measure, you shouldn't be in business. You shouldn't be in business. End of story. Because I know who I'm supporting. I know the risk that this company's taking on. As I process these payments for a third party, I need to make sure I have all the right controls in place. So it's a tough, it's tough for that small company. Who's battling for dollars out there trying to get contracts, but it's not a nice to have. It's a necessary evil for you to be successful in this space.

Right? Tough. And by the way, a bunch of these C. That are they're spinoffs from healthcare systems. Like we spun 'em off and funded 'em and got 'em started and thought, oh, well, it's just, it's just a finance company. It's just a revenue cycle company, whatever they don't need extensive it support and that kind stuff.

Well, it turns out they do today. Yeah. So inflation. So today the inflation report came out. So we're recording on Wednesday, July 13th, the inflation number came out 41 year. high Inflation's a bad thing. I've, I'm old enough. I have enough gray hair that I can recall some of this stuff. And I've been talking to people about this because I also have my economics degree.

It doesn't make me an expert, but it means I do like it. And I study it pretty extensively. I read a lot of articles around this. Inflation is not one of those things that, Hey, it popped up this month. It's going down next month. It's one of those things that builds over time. And I regardless of the party, because quite frankly, if you go back the last 20 years of presidents in Congress, they've all been overspending we print money, we print money, we print money until all of a sudden, Hey, there's an inflationary pressure. Well, we just, we did that for the last four presidencies and congresses and you name it.

We've been printing money. Well, it builds over time. It doesn't dissipate quickly. I think people who are thinking this is gonna dissipate quickly. It doesn't. So it's going to impact us for at least the next year. If not the next two years, the residual will actually last into two years. And when you think about things like wage inflation, the only way for wage inflation to come down is for people to accept less money for work.

How are they gonna accept less money for work? Well, there's gonna have to be more people, unemployed and less jobs available. Is the only way for wage inflation to come, come in. That's gonna require some very hard decisions on the part of the federal reserve on the part of our federal government. And I'm not sure.

And if they're not willing to make those decisions, by the way, it just means it becomes instead of a two year problem, it becomes a four year problem or, or worse. This is a great article, cio.com. They say 10 ways. Inflation will impact it. Number one, economic talk. So it's gonna be the talk of the town. You need to understand it need to be able to talk about it. If you're an it person. Number two is increasing labor costs. Not only within it, we're seeing it in healthcare within we're seeing wage inflation across the. Rising contract costs. And we just talked about this a little bit that everybody's costs are going up.

So you can expect when contract negotiations come back around that you're gonna see an increase in those costs. There's few if any places for cost refuge. And this one's interesting because one of the things they say is, Hey This is a global problem. So if you thought, Hey, this is the time to outsource, and we're gonna take this offshore and we're gonna go to this country or that country.

They talk about some of those key it countries. And they essentially say, Hey, you know what? Inflation setting these. And in some places it's. Doubling, if not tripling the cost of labor in some of these places. And so they used to be refuges for us and they're not anymore. We're gonna be required for more fiscal discipline across the board, hire bills down the road due to backlogs.

And we've seen this with supply chain. I talked to somebody supply chain backlog on routers and switches 18 months for key projects. And so if you have that. Then you get to number seven, which is premium prices to get needed product right away. Let's assume you're putting a hospital in the, hospital's getting ready to open.

You're not able to say, Hey, we're not gonna have any routers or switches in this hospital. For 18 months, that's just not gonna cut it. So you're gonna go out and pay a premium focus on efficiencies as well as innovation. So if we have been talking about disruption and innovation for the better part of a decade, and in the next couple of years, we're gonna be talking about efficiencies.

And then we have a few more other things around that. So that's the, that's the gist of that article? What are you seeing? What are you hearing? What are you feeling with regard to inflation in the industry?

It's starting to rear it's ugly head really badly. Nobody prepared for it. We've talked about it. Nobody's prepared to deal with it. The wage thing's real. . I think what we're we're seeing from the wage perspective is that the year of the worker or say the two years of the worker happened the last two years, they had the total upper hand to control to go where they wanted higher wages. I mean, they, it was just the perfect time if you were moving, right, because you could get more.

And have better quality of life in your job that Well's gonna dry real fast. People are gonna be locked into the place. I think the thing that really sets this apart here is that yes, we have to be fiscally responsive and responsible in this case. I think new tech and thinking about it from a demand perspective, what are we trying to solve for?

Focus hyperfocus in those areas is what's gonna solve a lot of these problems for a lot of these health systems. So looking at innovation in the space of what can I automate and we've talked about this before. I mean, we've talked about automation. What can we, and can't we automate for the past five, six years?

Here's the reality? I hope you were on a path for that, because now you're gonna have to take those pieces of the puzzle and put them in place to reengage that workforce, which is going to be minimal in new and innovative ways. Take the people outta the work. That's the day to day grind and give them something to focus on.

That's gonna move the needle for your organization while reducing your cost at the same time. Cause you're not gonna be adding heads in this space. We're gonna see more heads. Disappear from this space and you're not gonna be able to just grab the bull by the horn and move it to a different strategy just immediately.

So what are you doing today that you could do better? There's a lot of different paths we can take with this and a lot of different ways that we go, I think from a pricing perspective, not that it always got the biggest share of the wallet in a health system or in any organization for that matter.

We're gonna have to start looking at what we're spending. Start projecting what that's going to cost us over the next two to three years with some significant increases. And what are the things that we can take away because we're not gonna be able to flip the bill for everything. There's just not gonna be enough wallet left to flip that bill.

So that fiscal responsibility that's coming outta the CIO or the C's office is gonna be incredibly important to the bottom line of the health system to any industry at that matter. Not just healthcare, but yeah. I was having this conversation with a very close confound friend that we both know. And I'm a little scared this time around, like, you could see the writing on the wall.

The previous times, this one's kind of a boomerang effect, things look, good, things look bad, it keeps kind of shifting back and forth. Which means that when it finally finds its trajectory in courts, it's gonna hit us really hard where the other times, yeah, it was painful, but you could at least predict what was going to happen.

You could see what was taking shape. This one's a whole new way. If you see the currencies are starting to work themselves out across the globe. That's kind of a bad thing. You're seeing crypto take the bottom out. That's really bad thing as well. So, I mean, I don't have a crystal ball if I did. I don't know if we'd be talking, I'd probably be on some island someplace, but at the end of the day, we need to embrace this idea of that.

We have to start doing more with less. We have to be well defined in what we're doing and fiscally conservative and responsible thinking about how we're starting to move forward. Put the best product out, cuz there's still gonna be demand. The supply's still out there to demand what we, what we're serving up from a health system perspective.

That's not going away. People aren't getting any healthier today. Right. So you're still gonna have that demand. How do you meet that demand with what you have from a supply perspective?

Well, and that right there is an example of why my team loves you. Because, I mean, you encapsulate that whole thing, so well, so quickly, which is, which is fantastic.

Yeah, governance is gonna be your friend going into this. I've talked to I have some coaching clients. I've talked to one of my coaching clients and they're like we're still trying to do too many things. And that's where governance has to become your friend. You have to have alignment amongst the leadership team is inflation real.

How are we going to organize around the increase of costs and those kind of things, your efficiency platform, let's call it a platform at this point. You have to have a set of tools to apply across any aspect of the workflows that exist within healthcare or processes that exist within healthcare to drive higher level of efficiencies, just period.

You're not gonna be able to afford as many workers in it. So automation around security automation around the infrastructure, your infrastructure should be programmable at this point, whether you've decided to stay in house or go outside. If you can't provision servers with software at this point and and ramp up and ramp them down as needed.

You're probably not as agile as you're gonna need to be going forward. And you probably missed the. To be honest with you. You should have been doing this for a while. Cuz we've had cloud infrastructure for a while. You could do this with VMware pretty easily. Because you can create your own internal cloud, but you can also do this with cloud providers externally.

We've just gotta be focused in on automation. And then on the clinical side, you have to start looking at tools on the clinical side, on the revenue cycle side, everything needs to be automated. That can be automated. It used to be a conversation of, are you trying to put people out of work? That was the wrong conversation.

The right conversation is what are we gonna do today? We don't have the money to hire an additional 10 people, but we still have to do the work. And that's the environment we find ourselves in today. And it's gonna require a a lot of creative thinking. And to be honest with you, that's what I like about a downturn.

We need a downturn every now and then. Yep. Because it gets rid of all the weeds and the bad thinking and the, we can do everything. And it provides focus. The pandemic provided focus. This is gonna continue to provide focus for us. Yeah. Chris.

No better time. No better time to think strategically and what we need to become than right now.

Exactly. Chris, always fantastic to talk to you. Thanks for stopping in.

Thank you bill. I appreciate it, man. Look forward to the next time.

What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to show just like this one. It's conference level value every week. They can subscribe on our website thisweekhealth.com. They can also subscribe wherever they listen to podcasts. Apple, Google, Overcast. You get the picture. We are everywhere. Go ahead. Subscribe today. We want to thank our news day sponsors who are investing in our mission to develop the next generation of health leaders. Those are CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst. Thanks for listening. That's all for now.