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 Welcome to this Week in Health IT events where we amplify great ideas with interviews from the floor. My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health. It a set of podcasts and videos dedicated to developing the next generation of health leaders. We wanna thank our founding channel sponsors who make this content possible, health Lyrics and VMware if you wanna be a part of our mission to develop health leaders.

Go to this week, health.com/sponsor for more information. This episode is sponsored by Health Lyrics. When I became A-C-I-O-I was really overwhelmed at first, and one of the first things I did was to sign ACIO coach. I. To walk with me through the journey. This was someone who had wisdom that can only gained through years of experience.

Uh, you're gonna hear, um, what they're excited to have accomplished last year and what they're looking forward to accomplish next year. I asked each of them the same eight questions, and I think you're gonna be fascinated to hear the similarities and the differences based on where they're at, geography and other things.

Each of these interviews is about 10 minutes long, so you can listen to 'em really quick, and some of you listen at one and a half times speed, so it's gonna go like that. Uh, we're gonna publish one a day, uh, with a few Newsday episodes sprinkled in through the end of November. So check back every day for the next episode, and don't forget to look back to see if you missed any.

I was excited to get a chance to sit down with James Brady. James and I have been CIOs in the same market for quite some time. Uh, James is now the, uh, CIO for the LA County Department of Health Services, and, uh, we had a, a very interesting conversation. Again, I appreciate when we get different perspectives and different health systems trying to accomplish different things.

I learned a bunch. Hope you enjoy. Ready to go. Here we are. Another session from, uh, chime, fall Forum. We're here with, uh, James Brady. Uh, gosh, I'm mix mixing up already. LA County Health Services, Los Angeles County Department of Health Services. There you go. Um, four hospitals. Four hospitals, 23 clinics. Uh, covers about 4,000 miles.

Yeah. We are the uh, uh, second largest. Public hospital system in the country. Uh, and we, uh, are considered a safety net, although we do have folks that are, uh, about 600,000 people that are in paneled. Uh, and, you know, a number of people do choose to come, uh, to the Los Angeles County Hospitals. And we're also, uh, very, very closely aligned with, uh, UUSC and UCLA, uh, for residency programs.

And also, uh, Charles Drew, uh, nursing, uh, uh, for their residency program also. Fantastic. So . What we're doing at the conference is, uh, look back, look forward kind of thing. So, uh, eight questions, asking all the CIOs the same eight questions. There are no right or wrong answers. Every health system is so different.

It's, it's been really fascinating to listen to. Um, you know, the first question is, how do you think the role of the CIO has changed over the last year? Not over the last five, but just over the last year. Yeah. I think over the last year, uh, definitely a more strategic thinker that can help the executives and the leaders and the boards know, Hey,

What do we have to do in order to, uh, you know, achieve our, our mission? Um, and so, you know, we've, we've watched the C-I-O-C-I-O role go from the IT guy or IT gal in the basement, you know, into a service delivery to somebody more of, uh, you know, more involved in the business. But this, I think the role now, you really have to understand the business.

Yeah. And at the, at the county, we're seeing a shift now. Uh, the way we get our, uh, funding is, uh, has largely been through federal waiver programs. And so those programs are leaving in 20. 20. So we now we have to move. Uh, it's, it's being shifted more to the state who is gonna be using managed care. So there's a lot more focus on value.

So we're really concerned about how do we demonstrate value, and so that financial sustainability is one of our key initiatives. So understanding that and, you know, how do we help lead the organization? There's a, it's a important role for the CIO. Phenomenal. So what are, I mean, you probably just rattled off one of 'em and next one that was one.

Yeah. So yeah. What, what are some of . The priorities that your system's looking at that, uh, health it is, is looking to support over the next year? Yeah, so I think in addition to that one, which is a big one, uh, we're also looking to really, uh, re-engineer and optimize our workforce and, uh, in the state, uh, or in the local government.

Uh, it's important, uh, I believe to really invest in your employees. 'cause technology's changing and, and traditionally, uh, many of the roles might have been a little bit stagnant. So it's infusing that with, uh, how can we, uh, make sure that all the employees are, are educated and trained to be able to do their job in the new era coming up.

And secondly, it's a real focus on population health and understanding our populations, uh, you know, being able to care for them better. Uh, and NSBE shift more towards that value-based care are there technology plays, uh, around, I mean, there's this, uh, I, I live near your county, . Live in Orange County, but near county right next door.

And, uh, the homeless population in both of those counties is, is pretty significant. Are, are, is there anything that, from a technology perspective, I mean, I don't, I can't think of anything off the top of my head, but I was just curious if there's anything we're doing, uh, maybe coordinating activities between different, uh, entities or those kind of things?

Uh, between counties or, well, just, just for the homeless population. Okay. Um, because a lot of times, you know, we'll come in and we'll go, uh, we're gonna do these kinds of patient. Engagement things and people would go, yeah, but what about the people who don't have phones, the people who don't? And, and, uh, I'm just wor wondering how we're applying technology to that specific problem.

Yeah, I, I think it's, uh, interoperability iss huge. Um, if we, if, if we, you know, those ho uh, homeless folks. They do come into the eds, they present themselves, they'll have a problem, and uh, you know, we may admit them and then they get discharged. And oftentimes we have to, you know, they don't have any place to go.

So we'll get a transport and we'll take them back to where they came from. But, uh, you know, it's really looking, uh, using technology to document and then making that available to others. And there's a huge amount of, uh, behavioral health and mental health issues with our homeless. I mean, they're kind of in that situation because they've, they've got really tough things going on.

So, uh, so . Uh, not having access to that information and, and then being able to, uh, take them to other, uh, sites of care such as post-acute or, uh, rehab or mental health, things like that. Um, you know, that's where they're gonna get help. Uh, and we're actually looking at healthcare now. Health. Let's just get people healthy and then also care.

Let's care for people with housing and, uh, education. So it's more of a whole person care. Matter of fact, there's a federal program called Whole Person Care that, uh, . It gives millions of dollars to many of the counties and states, you know, to work with people to go past the healthcare component and help them get back up on their feet again.

So we've been asking this question sort of a two part question, but, um, it's initiative that's improving the patient experience and initiative that's improving the clinician experience. Um, and we're just asking people what, what are examples of just one on, on the patient side and one on the clinician side.

Yeah, so probably on the patient side, I think if we can get to Amazon and healthcare where there's just one click, and I think that's Jeff Bezos, that's one of his goals. Uh, where, you know, it's where it's really self-service where you know you have a need for something, you're able to go digitally and get to that.

I mean, if you need to come in and see somebody, fine. Uh, but if, if we can use the digital, it would be so much better. Uh, convenience, not having to go leave work, grab your kids, drive on the freeway. Wait in the waiting room. Why do we have call them waiting rooms anyway? Um, but, you know, being able to go ahead and, and do that digitally.

Uh, so, so really engaging in the patient experience I think is something where it's important on the clinic. On the clinician side, uh, we've gotta be able to get our, our physicians untethered from the keyboard and data entry. So that's gonna be using artificial intelligence, machine learning, natural language processing, uh, you know, there's a lot of advances now with voice, uh, so that you

Can just have a natural fluid, uh, interaction and have all that, uh, documented, uh, and available rather than your top, you know, you're typing and you're turning back and forth to the patient, so it's a little bit awkward. It slows things down. And, you know, physician burnout is a big issue at this point. A lot, A lot of it's because, uh, you know, docs are having to just do, and providers are just having to do a lot more manual things that hopefully one day in the future, not too far, we'll be able to get past that.

It's interesting as you're talking about that. It's like the, the object is to make it easier for the patients. The object for the clinicians is make it easier for the clinicians. It's, that's supposed to have been the goal. Yes. Unfortunately, most statistics and research indicate that physicians, uh, it costs more to use an electronic health record than they were prior when they're on paper and then they spend more time documenting and taking care of what, uh, you know, of the administrative stuff.

Uh, now that they have electronic health record. So it's definitely been an issue and there's plenty of research. Out on it. And that's why we have a high physician suicide rate in the country, uh, in, at least in the us. So it's a, it is a problem. And I, I think the answer is gonna be, uh, you know, that human computer interaction, uh, where it's gonna be more natural.

So I think from, from my perspective, one of the things that I've . Of working with our senior IT leadership is to how do you get, uh, all of those CIOs to come together and be one team, sort of like the Patriots before their last loss. Uh, you know, but a cohesive team where, uh, we still take care of our, our hospitals, but at the same time we, our focus is on the enterprise and it's on the system.

So, so I think it's just getting that top level leadership to buy into that. And then we're making changes where we're, uh, you know, working and meeting together and operating more as . A cohesive team, uh, in order to, the goal would be to continue to drive towards a, uh, an integrated, fully uh, SY integrated system.

'cause there's just so many other things going on, right. So, uh, I'm gonna answer both questions thankfully. 'cause it dovetails great. Uh, so, uh, you know, data is such a huge important area in healthcare and if the, if the data doesn't go in properly, uh, then you can't really get the reports. You can't get the outcomes that you need from the data.

So, uh, and so with the electronic health record and, you know, the focus for us in the county is getting it in . And, you know, um, really have we optimized it? And then are we really, uh, making sure that the data is, uh, something that we understand? And so many physicians really were not taught to code properly.

And so rather than going back 10 years and trying to con uh, try to teach physicians how to code, can we use some of these, uh, more advanced tools, physician aid of physician coding and chart assisting and things like that. So I, I wish there was more time and focus to . Able to, to understand what's in the market and then being able to implement it so that we could get a better idea of our data.

Because as I mentioned earlier, uh, our revenue moving forward in public hospitals in the country, particularly in California, is not gonna be given to us through federal grants and waiver programs, but it's really going to be, uh, through health plans and demonstrating value. So we really need that data.

Right? And then of course, to prove the value, the most important thing is to be able to care for patients. And if you don't have the right, uh, data, then you . Can't really care, uh, care for patients properly. Right. Um, what's one area you'd love to see more innovation that, uh, you know, if you were able to just turn the key and say, you know, we're gonna really have a lot of progress, we're gonna move the needle in one area, what would it be?

Yeah. I think the biggest one, and this may have been said by others that have sat in this noble chair, , is the EHR is really just a conversion from a . Paper chart to a digital chart, but it's not, it's not intuitive. There's too much typing, there's too many things on the field. Uh, you know, too many little boxes.

You need a giant monitor in order to use it. But how can we, uh, it goes, goes back . To my other comment, how can we change that clinician to computer, uh, you know, interface? And so I've heard some stories, uh, somewhere in Asia, they've got a, a new EHR construct where it doesn't look anything like what we've got here.

It's more of just a picture of a, of an individual's body and you just kind of point and click and you talk to it. And it's completely different than what we're doing right now, which is still, we're still tied, uh, ball and chain to that . Uh, you know, fields, discreet fields, and it's very time consuming.

And it's not natural. It's not, I mean, we, we talk much faster than we can write, and we think way faster than we talk. So, so I think it's moving in that direction with the EHR and how we document care and during, uh, encounters. Yeah. So one of the things we, we've learned from surveying our audience is we have a bunch of college students watching this show and it's.

Uh, it's fascinating to me that they are, and I think it's 'cause healthcare is, is an area that this next generation really wants to invest their time. Can I, uh, make a comment about that? Sure. Alright. Yeah. So to all you college students out there, generation Z and maybe some millennials that are getting a late start.

Millennials are pretty old now. Yeah. So we need you, you, uh, you know, there's a lot of research that is demonstrating or indicating that a large percentage of the workforce moving forward will be you guys. Uh, you guys have the, the great ideas. Uh, and so, and if you have any, uh, passion for, uh, working for public service, go ahead and follow those passions.

Yeah. Although it still exists. . In some places, but, but not much. And actually that might be a good job security to get those because, no, I would say, uh, analytics data, artificial intelligence, coding, particularly data scientists roles, uh, you know, being able to, uh, code and with modern, you know, cloud-based techniques.

Those are, uh, those are things that, uh, that I understand are, you know, are good set, they have a good, uh, pay scale for and what you knew, what we . Used to do two or three years ago. It really isn't that relevant now. It's, it's really moving forward into these new areas. You know, and that goes back to our first question.

How's the role of the CIO changed and this to this next generation? They're gonna have to reinvent themselves three or four times over their lifetime. Um, because just in the time, just in the decade or so, I've been following the healthcare CIO role, uh, it's dramatically changed. I mean, the things you used to have to be good with technology and understand like the infrastructure and that kinda stuff, then you had to be really good at organizational change management.

Do that EHR, uh, and now it's, you know, forward looking technologies, you know, cloud ambient listening and that kind of stuff. And, and that's just a decade. I'm, I'm seeing CIOs have to reinvent themselves multiple times. This next generation's probably, I'm probably being kind to saying three or four times in your career, you're gonna have to just keep changing.

Yeah. We're seeing a lot of, uh, a lot of, uh, new physicians that are very technically savvy. You know, they're like, what are you guys doing? I can't believe it. You know, so the . Expectation from them is, I mean, they grew up with Facebook and, and social media and mobile devices. So I think we need to drive, continue to drive towards mobility and, uh, you know, ease, ease and of access.

Um, and then another, just one final comment is, uh, I think the CIO it's important to be able to partner well with the other senior, uh, executives that lead the organization. Uh, be, and you know, you, there's lots of different personalities in these organizations. So, you know, can you get along with all of them?

Following that, please come back every Friday for more great interviews with influencers. And don't forget, every Tuesday we take a look at the news, which impacts health it. If you wanna support the fastest growing podcast in the health IT space, here's a few ways that you can do that. The first . Share it with a peer, share it with a friends, share it with somebody who's working right there next to you.

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