A CIO & CTO Discuss Current Healthcare Challenges

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Bill Russell / Charles Boicey

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July 24, 2020: Join our role play today with Bill as CIO and our guest Charles Boicey as CTO. Together they’ll go through the hottest issues in healthcare right now. Will they give away all their secrets? What will HHS do with our data that is different to what the CDC did? What did the CDC do wrong? With significant cuts in revenue, how can CIO’s do more with less? What should we consider when outsourcing overseas? Bill and Charles also look at cloud strategy from an R and D perspective, a data science perspective and a research perspective.

Key Points:

  • HHS versus CDC reporting [00:04:30]
  • Refining the architecture of current systems to save money [00:10:00]
  • Renegotiating contracts with vendors [00:12:10]
  • What are some things we can do in data center ops? [00:13:10]
  • Hyperconverged infrastructure  [00:13:30]
  • Future proofing [00:14:50]
  • What is a good cloud strategy? [00:20:30]
  • The  21st Century Cures Act [00:25:30]

A CIO and CTO Discuss Current Healthcare Challenges

Episode 283: Transcript – July 24, 2020

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

[00:00:00] Bill Russell: Welcome to This Week in Health IT where we amplify great thinking to propel healthcare forward. My name is Bill Russell, healthcare, CIO, coach, and creator of This Week in Health IT a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders this episode.

And every episode since we started the COVID-19 series has been sponsored by Sirius Healthcare. Now we’re exiting in the series and Sirius has stepped up to be the weekly sponsor for the show. Through the end of the year, [00:00:30] special. Thanks to Sirius for supporting the show’s efforts. During the crisis and beyond, don’t forget, we’ve gone to three shows a week.

Tuesday we cover the news Tuesday News Day, and we have interviews with industry influencers on Wednesday and Friday. I am actually going to take a week off next week. However ever we have a special treat for you. And thats Drex DeFord frequent guest on the show will be in on Tuesday to cover the news.

So we are going to have a Tuesday News Day episode next week, and I’m looking forward to that. I will consume it as a listener, just like [00:01:00] you. I want to thank everyone for your support of the show. We’ve eclipsed a hundred thousand podcast downloads through the first six months of the year. And that is what continues to make this the fastest growing podcast in the health IT space.

Thanks for sharing it with your peers. To make it easier for you to share with your peers, we’ve launched Clip Notes and, I am really excited about your response to clip notes. We’ve gotten a bunch of emails from you and a ton of you have signed up. And I really appreciate that. What is Clip Notes?

Clip [00:01:30] notes is quite frankly a way for you to get a single email that condenses the entire show for you. And it gives you a, a one paragraph summary gives you bullet points with timestamps so that you can go to your favorite parts. And it has four, one to four clips from each show, which has highlights from the show that make it easy for you to share with your peers, to share with your staff, to share with other people within the, within your organization, so that you can keep them on the cutting edge of what’s [00:02:00] going on to subscribe. There’s two easy ways to do that. You could hit the website at any show and subscribe to clip notes. It’s right there on the page on the right side  You can also just send an email to [email protected] C L I P N O T E S and that will kick off kick off a workflow that gets you a link in an email that you can click on and subscribe to Clip Notes. I am really excited for today’s show. We [00:02:30] have a special guest Charles Boicey who I’ve had on the show before. Charles is one of my favorite CTOs in the industry.

He has a clinical background. He is a technology genius and, we do a little role playing here where I act as a CIO. He acts as a CTO and we go through all the things that we are facing as a health system today from 21st century cures to, the HHS and ONC, changes to, cloud to, cost reduction.

You name it. We try to tackle it [00:03:00] from a CIO CTO conversation in my office standpoint, right. I hope you enjoy. All right, today we are welcoming back Charles Boicey, the CTO for Clearsense, Charles welcome back to the show. 

Charles Boicey: Good to see ya. 

Bill Russell: You know, it’s been a while since I’ve had you on the show, we’ve had a lot of conversations, especially through the pandemic.

You’ve been a wise counsel for me, helping me to understand some of the things that are going on  but I have a special show lined up for you. As you know, I’ve, I’ve, I’ve tried to [00:03:30] hire you. on several occasions and I’ve been left at the altar. I tried to hire you when you left UCI, but you decided to go to Stony Brook.

And, then when you left Stony Brook, once again, I was left at the altar and you went to be the CTO of Clearsense. And I think that speaks for, at least to my respect for you as one of the best healthcare CTOs that I’ve ever come across. So today’s show we’re going to role play for the first time I’ve hired you.

I actually won. The competition. And what we’re going to do is we’re going to role [00:04:00] play with me as the CIO, you as a CTO. And we’re just going to run through a bunch of things that are going on in healthcare right now and see how we would, I don’t know, come up with solutions for them. Are you ready for this? 

Charles Boicey: Hey Bill. You know what they say? Paybacks are a you know what, so I guess I’m going to get my dues, so let’s go.

Bill Russell: All right. Let’s see. All right. So we’re sitting in my office. Here are some of the challenges that I’m currently looking at as the CIO and the health system. So HHS, CDC reporting, you know, this Twitter went [00:04:30] crazy on this.

The Trump administration just announced that you have to start sending your information over to HHS instead of the CDC. let me just, you’re my CTO. So how hard is it going to be for us to make this happen? 

Charles Boicey: Well Bill, you know, really who the hell cares, whether it goes to the CDC or HHS. And if you look at how many data elements are involved, you know, that’s a small effort as well. So, You know, outside of, you know, a different file format, you know, let’s just, you know, redirect to a different, you know, secure [00:05:00] file transport. you know, as far as I’m concerned, we’ll do the same. AGL will produce a, you know, basically the same file. We’ll send it somewhere else and, you know, hopefully they do a little bit better job with it.

Bill Russell: So let me let me get more specific. So, I’m actually looking at the HHS document. They have 32 data elements. So hospital information, which is pretty easy stuff, right? A lot of this stuff is just ADT feeds and stuff right out of our TeleTracking. So hospital information, pretty straightforward, number of hospital [00:05:30] beds, inpatient hospital beds, occupancy amongst those inpatient beds, ICU beds, ICU, bed occupancy, total ventilators, ventilators, and use.

So this kind of information, is it readily available to us? Are we going to have to do something special to pull it all together? 

Charles Boicey: No, it’s it’s readily available Bill, but let’s, let’s introduce what, you know, healthcare usually introduces us to these types of things. 

Bill Russell: Complexity. 

Charles Boicey: What time of day is that? Is that midnight? Is it after midnight? Is it 6:00 AM? Is it 8:00 PM? and this is kind of the [00:06:00] damage that we kind of do or do ourselves. Right? So, so yes, all those data elements are, you know, available. And, it’s just a matter of, you know, did everybody get together, you know, nationally and decide this is going to be at 12 o’clock midnight kind of a thing, or is it 6:00 AM?

So, I think those kinds of things. We kind of spin on ourselves, but from a, from a day, their perspective, you know, we should be doing this anyway you know Bill, because we really need to know from our own [00:06:30] perspective, you know, when we’re, you know, projecting now, you know, PPE and, and so forth, you know what, you know, capacity, all of that, this should be, you know, part of our DNA right now. If it isn’t, I’d be super, super surprised. 

Bill Russell: Well that’s why we hired you as a CTO. So we can get this to be part of our DNA, but let me let, so let me ask you this, that, that question is not an innocuous one because we, we do spin on some things, definitions of things. so, does it matter what time we take this inventory as [00:07:00] long as it’s consistent on a daily basis? 

Charles Boicey: No, I don’t think so, but, but again, you know, I just brought that point up to show how silly we can be at times. but no. 

Bill Russell: So are you concerned at all? I mean, this is not a CTO question, but are you concerned at all that, you know, the CDC is readily available to researchers with no skill.

That database is, is open and the HHS database may not be open. Is that a concern for you at all? 

Charles Boicey: Yeah, that’s, that’s a concern. It’s been a concern for, for most, you know, [00:07:30] AMIER put out, you know, you know, a letter if you will, the last couple of days. So, it’s a concern for many, it’s not it’s so here’s the concern Bill.

What is HHS going to do with it differently than the CDC did? Is it, you know, a benefit, will the CDC get access to that data? I have no idea. it’s interesting that what did they do wrong, you know, those types of questions, that I really don’t have the answer to. but you know, from a purposes of reporting, you know, it doesn’t really matter where it goes.

It all depends on what the use is [00:08:00] going to be with that data. 

Bill Russell: Our purposes redirecting it is, is, is really a pretty, pretty basic thing. 

Charles Boicey: Yeah. Technically for us, no deal, no, no issue, whatnot, but for the, you know, the country healthcare at large, you know, what is the difference between the CDC not having access to that? And we don’t know that answer versus, you know, health and human services. 

Bill Russell: Yeah. all right, well, let’s, let’s move on to some other, some other topics. We’ve got a tight schedule and, All right. So, we, we, [00:08:30] we just we’re coming through the pandemic. We had a significant cut in our revenue. I’m being asked to do more with less as a CIO.

I’m glad we’re playing this game of, I don’t get the questions of the CIO as I have on, but let’s look, let’s assume our health system, I’m looking at a 10 to 15% cut where as I normally get a. Three to 5% increase every year. I don’t have a lot of variable costs. So, you know, outside of cutting people, which is [00:09:00] one of the things that always sort of comes up when you’re looking at a cut of the size, what are some other things we can do, to do more with less, you know, data center operations, outsourcing overseas, are there other creative things I should be thinking about?

Charles Boicey: Sure. So I think the first campaign is a smile and dial campaign to your vendors. you know, what can you do? Hey, look we’ve been in this for a long time. I’m going to need some concessions and you may or may not get it, you know, going forward even at the data center level level. I’m going to need to, for the next [00:09:30] six months, you know, decrease my, spend there by X and you can tack it on at the end of that contract here, which may be two or three years out.

So doing things like that is essential. You know, Bill. How many systems do you have running in your organization right now that you have on a lights on where you’re paying maintenance on the software and you’re paying, you’re paying for the electricity you’re paying for the, you know, the footprint.

What are the, what systems could you, you know, archive and turn off, [00:10:00] we’d given them access and so forth that they can then, you know, realize that, you know, that, that benefit that could be several hundred thousand dollars annually, from a personnel perspective, you know, what could you potentially outsource how much, how much of the work that your team is doing that, you know, could be, you know, potentially, you know, you know, done offshore.

and you know, when you talk about offshore, yes, you have skilled work. Yes. You have a lower cost, but is the work that they’re [00:10:30] doing and is your organization, at a point where, you know, somebody, you know, external can, you know, access your data. If that’s the kind of, you know, development work that they’re going to be doing, 

Bill Russell: I want to come back to offshore outsourcing because you’ve done a fair amount of that. And in healthcare there’s some interesting challenges with that, but first I want to come back to something you said earlier, which is shutting off those systems that are just sitting there with lights on. And, you [00:11:00] know, this is one of the things that you and I actually did work on. You were with a vendor and I was the CIO. And when we were moving to the cloud, we inventoried all of our systems and found out that. A good 10% of them were not being used by anyone. I mean, no one in the organization was using them anymore. And I think, you know, people think, well, application rationalization that takes a long time and you’ve got to think through, and you got to do all these things, but at the end of the day, there is a there’s low hanging fruit at almost every organization [00:11:30] of systems that are just sitting there doing nothing as has that been your experience?

Charles Boicey: Yeah, absolutely. And you know, you talk about it many times, if the, you know, from the vendor situation, it hasn’t been centralized. You could have various departments using various applications and believe it or not paying. You know, various rates for those, you know, departmental applications that actually still exists.

So, so yeah, both Bill it’s very much like, you know, back in the day [00:12:00] when, you know, orthopedic surgeons would be dealing with a vendor and each surgeon would be charged a different price for the same, No for the same implant issue. Well, so yeah, there’s, there’s a bunch we can do from, from just the software that we’re using, whether it be, you know, renegotiating contracts, you know, finding out, you know, if departments are, you know, doing things on their own and then yes, you know, what’s out there that’s that, that isn’t being used, that we can turn off and just be done with it. 

Bill Russell: Well, I’m a huge proponent in planning ahead. So I hate when you get asked, Hey, [00:12:30] you need to cut 15% this year, if you haven’t been planning for it. And so almost every year I go to my team and say, Hey, can we, can we figure out how we’re going to cut 5% next year and give them a full 12 months to think about those things? So in that vein, talk to me about data center operations. Cause one of the things that’s always shocked me when I talked to you. Is, how rearchitecting a platform gives you the ability to really cut down on the number of people that needs to [00:13:00] support a significantly large set of servers and, and storage and equipment. So, you know, what are some things we can do in data center ops? 

Charles Boicey: Sure it’s a combination  of, you know, basically, you know, hardware, as well as a combination, a different skill set, if you will, as well as, monitoring, you know, monitoring everything. And I’ll kind of get into that in a bit.

So, yeah, we are going to kind of, we unfortunately got to get into the tech. There’s no way I’m going to be able  to get away from that. [00:13:30] So you know, bringing on what’s called a hyperconverged infrastructure, and that is, you know, the ability to actually from a storage perspective and from a compute perspective, actually use that which is needed.  And from a sort perspective in particular, to be able to scale out as needed with. low cost commodity, commodity, equipment, even the introduction of, you know, low cost, you know, SSDs and so forth. So you’re really distributing from a storage [00:14:00] perspective. You’re using what you need no more than that, but you’re architected as such that you kind of keep yourself, future proven that you can expand upon that. And even in the introduction on the, on the compute side, to be able to scale, you know, on CPU, on, on Ram and if you’re now into a data science, rich environment, a GPU introduction, that’s at the base or metal level. And if you think of a hyperconverged, on top of that, where now.

[00:14:30] I’m not going to mention vendor names, but you know, now we have the ability to, in the same environment, a bare metal servers, virtual machines, which everybody’s familiar with as we move more into a containerized environment and our client and our vendors are moving that way. and then even far further advance for, you know, a serverless environment.

So this sets us up for two, two potentials. one is, I talked about, you know, for future proofing, as emerging technologies come in, this is the environment [00:15:00] for them. Let’s go, you know, if you want to go into it now, we can, you mentioned earlier, this sets us up for a hybrid, for potential of a cloud environment.

And if you want to go there, we’ll go there. But this is really setting you up for that eventuality. 

Bill Russell: Well, everything is, is software based. It’s software defined. We are, we can actually write code. We can actually have it not be written code that. The, the, the amount of volume or the, the [00:15:30] load on the server will kick in additional processes and those kinds of things.

If the software is written to take advantage of those things. 

Charles Boicey: Yeah, that’s correct. So, workloads in a containerized environment, as they increase, you know, multiple containers are, are spun up, you know, the exact you’re exactly right. It’s it goes, it gets away from how we used to do things where. Okay. We reached capacity.

Now we’ve got to throw that out and get a bigger box. Right. And then we reach capacity. Now we going to get a bigger box. It keeps the cute, it prevents that every three years [00:16:00] from having to just rip and replace. 

Bill Russell: Yeah. It’s a, what do you say to the, you know, I, I’m going to get a lot of pushback from our technical team.

I just hired you. That technical team is going to say, look, we have too much legacy. And if you’re running legacy, you got to run it on old architecture. Is that the case? 

Charles Boicey: No, it’s not the case. you know, it’s very interesting that you said that there is a lot of remedies within that hyperconverged infrastructure where we can actually bring that, bring that into, into that environment.

Is it a, is it [00:16:30] a cakewalk? Absolutely not, but it’s, you know, it’s something that can be done and it’s essential. 

Bill Russell: All right. I’m going to come back to cloud let’s let’s talk about, let’s talk a little bit about overseas. And working with overseas resources. So, you know, you have some experience there. I have some experience there.

Let’s start with, you know, what are some of the considerations when health systems outsource overseas? Just flat out that question. What are some considerations we need to talk about? 

Charles Boicey: Sure. So you have to have, you know, or some representation in the States. you have to, you know, really [00:17:00] understand, you know, what that workforce looks like, you know, what were the universities that workforce came out of?

Which is essential. and lets, you know, you can outsource the Ukraine. You can outsource to, you know, Spain, Dominican Republic, my potential, my outsourcing, you know, you know, country of choice as you know, is, is India. And it’s not as most people think because of a cost perspective and there absolutely is cost savings.

it’s the fact that it is very, very difficult to get into those top notch [00:17:30] schools. it takes. It takes a, you know, pretty much, you know, from a very young age, you know, to get into those, that is your goal. You’ve gotten into that, into those schools and as a result, you’re, you’re a hot commodity and those are the folks that I go after.

I know those universities, I recruit from those universities. And as a result, I have the best of the, of the best from an architectural perspective, all the way down to, you know, you know, hands on. 

Bill Russell: It sounds like you’re pretty [00:18:00] hands on. I mean, you are actually recruiting these people. do you spend time in India as well?

Charles Boicey: Well, I used to up until, you know, what’s going on now, where I go, you know, at least, at least three times a year, it’s not, if not for, but you know, that is, that is a group that’s, you know, that those teams, and again, they’ll all go back. I’ve I’ve been, I’ve had a team since 2007. So this has been, you know, 13 years for me, with, you know, Excellent results and success.

you know, [00:18:30] You’ve got, you know, we’re, we’re on zoom right now. So, you know, you’ve got a whole bunch of technology that assisted that, from a monitoring perspective, cost savings perspective, 24 seven monitoring. I have done an India development. Absolutely. Depending on the organization, there may be some restrictions on what they’re able to, you know, be involved with as far as, you know, data access and whatnot, but that can be mitigated as well with, the identified OBS of obfuscated data sets and so forth.

[00:19:00] Bill Russell: Yeah. It’s, you know, it’s interesting because a lot of CIO’s, so like I was, I was challenged with, follow the sun support essentially seven by 24 coverage. Cause the hospital never closes. And so you can either try to do that in the States, which is extremely hard, or you could literally get seven by 24 with just the States and India.

Charles Boicey: For the most part somebody’s looking at, you know, Zabbix or your phone or some of these monitoring the software, it’s actually people in there, [00:19:30] you know, doing maintenance as well. So if you think about what your, your networking team, what your, you know, your engineering team are doing, you know, Yeah, during the, you know, 40 hours that they’re working and now you can extend that to, you know, I did an additional 40 in those off hours in your systems are pretty much, maintain and kind of going back to that, you know, bringing in that yeah.

You know, hybrid, converged and so forth, and you know, software defined networks and the rest of it. Yes. It’s a higher skillset, but, [00:20:00] it takes less people to maintain that as long as they’re at that skillset level. 

Bill Russell: Yeah, I want to be clear. We’re not recommending that organizations do this, although we have both done it, which I think spoke to who’s talking about it. 

Charles Boicey: Yeah, I get it. 

Bill Russell: Yeah. 21st century cures. Well, let’s you know, let’s go, let’s go to cloud then we’ll come back to 21st century cures, cloud dev ops. you know, let’s just start with the flat out question. What is a cloud strategy? 

Charles Boicey: Yeah. What is the cloud strategy? So [00:20:30] I’ll give you my definition of it.

It’s not a choice. And what I, what I mean by that is you have your own on-prem cloud. You could have a private cloud located somewhere else, you know, in a cold, dedicated environment. You’ve got Google, you got Azure, you’ve got AWS. The. Whole ecosystem is a cloud. Does that make sense to you? You’re not making a choice.

[00:21:00] You’re in a cloud environment now whether you know it or not. and because of, you know, how we are doing things now from an API perspective, if I want to run a workload in Google big query, then I will run a workload in Google, big query, if from a storage perspective, active, I want to store all my data on prem.

Great. Are there some tools within AWS that I want to, to bring on? You know, I work in my environment. I can do that as well. So I can, I can move [00:21:30] workloads around as I need. Is it, is it all or none? No, it absolutely isn’t. And I think this is something that we’ll see, you know, evolve as time evolves, where I’m not making a decision to shut down my data center and move to, let’s say AWS, I’m going to do everything in AWS.

No there’s interconnectivity between all those cloud vendors and I’ve used them and they’re fast. So we are in a cloud environment, you know, it ain’t going to best utilize it. 

Bill Russell: And from a CIO perspective, what I would say a [00:22:00] cloud strategy is it is, you getting the most agility and efficiency for your organization providing the most capabilities to your organization.

Right? So, you know, the reason we talk about cloud at all is because cloud gives you the agility, the efficiency and the capabilities, right. We can spin things up. overnight that we used to have to plan six months for and order servers and put them in your data center. and so the [00:22:30] cloud, the cloud, as a, as a model for how to build out your, your infrastructure in order to S to serve the, the capabilities and the, the applications, even smaller, the services that you’re going to be providing, it’s just, it is now, table stakes. And so when I talk about a cloud strategy, I’m talking about, you know, how are you thinking about public private, a hybrid cloud? How are you thinking about, you know, cloud, apps and how do they integrate, how are you doing an [00:23:00] identity and access management as the perimeter around your cloud strategy?

It’s it’s you have to be able to answer those questions as a CIO and a CTO for your organization. Cause if you don’t answer them, then, then it’s just a, you know, it’s just another one of those hype words that gets used over and over. Yeah. We’re in the cloud. We use Workday and you’re like, okay, that, that is a cloud application, but what is your cloud strategy anyway, you and I.

[00:23:30] Charles Boicey: If you think about it from an R and D perspective, you’re absolutely right. I need to, you know, do this. And I will say from a data science perspective, from a research perspective, I can spin up an environment, do the work that I need to do and then collapse it. And then I’m on my way. And I can deploy that model within my environment.

If I have some heavy, you know, a heavy workload that’s gonna use heavy GPU just to, you know, do the, you know, You know, build out the model and, you know, I can do that in another environment [00:24:00] and then deploy in my environment, 

Bill Russell: you know, so you and I have actually talked about this and I’ve consulted with some organizations on this that are saying, Hey, you know, healthcare in an AWS cloud or in an Azure cloud, how do we ensure HIPAA?

How do we ensure the security levels and the, you know, the, the things that were normally. identified as required for, for HIPAA. Like some people think that HIPAA requires us to point to a server and say the data is on [00:24:30] that server, but in a cloud environment, we don’t do that really much anymore. So how do we, how do we ensure that, level of, compliance to those, security frameworks?

Charles Boicey: Sure. So if we’re going outside of our, if I was around outside of our private cloud, then we, you know, we have to assure that, I trust, you know, SOC to there’s a couple ISOs thrown in there and not just, you know, HIPAA. So you have to, whether, you know, it doesn’t matter what the environment is. You have to be able to not only build [00:25:00] that out or have the insurances and get that.

You know, get those certs and whatnot, those compliances, and then you have to be able to demonstrate and, you know, ongoing cause because it’s it again, it is, it is healthcare data. 

Bill Russell: Right. And you know, one of the things you put me on too, is I used to, I used to get all worked up that I’m gonna have to do all those things, but there are companies out there that build rappers just for health care to make a more, all right.

Let’s hit 21st century cures. That is right around the corner. We have a date of blocking. A challenge that we have, I have to [00:25:30] overcome. What are some of the ways that we can make sure that we’re ready to share the entire patient record digitally with the patient?

Charles Boicey: You would have to ask me that wouldn’t you?

Bill Russell: Is this a hard one to answer 

Charles Boicey: This is called, you know, thinking about a village where we’ve been trying to do since, you know, from, you know, from day one, you know, we have all kinds of standards and you know, that really is the issue.

We have all kinds of standards, right? You know, we have some definitions we’ve got to, you know, we’ve got to adhere [00:26:00] to them. You know, we have, we have some successes with, you know, health information, information exchanges, you know, some States have done very well. You know, others have done very poorly.

You know, it’s out there, we’ve got to do it. you know, how much should we rely on our, EHR vendors? You know, I don’t know, but, and I’m probably give you some really crappy answers and, you know, I don’t mean to, but it does have to be more of a, an organized effort if you will, and not a organization by [00:26:30] organization trying to, you know, kind of figure this out.

Bill Russell: Right. So a lot of us are gonna rely on our EHR provider too, to meet this needs, but at the end of the day, here’s, here’s, I think what we’re required to do is if somebody requests access to their patient record a record digitally, we have to provide it. Now, typically what that, what that’s gonna look like is.

somebody is going to go out and write an App. They’re going to sign up people and those people are going to make requests through that [00:27:00] app, to our health system for their record. So that they can provide their service to that, to that patient. And we’re going to see probably a proliferation of these digital well health type, type, companies, company come to the fore.

And they’re going to hire clinicians who are going to help us to figure out care plans or you fill in the blank. I’m not really sure how that’s going to happen. I could even see the insurance companies making these requests as well. So we have a lot of mechanisms to share this, right? I mean, [00:27:30] all I have to do is put this through a standard fire server and, and put it out there, but not all the data elements are really built out in fire yet are they.

Charles Boicey: No, they’re not. And you know, are all of the ontologies properly applied, you know? and is that, you know, is that something that we need to be concerned with and, you know, the, the accuracy, the completeness, you know, those are all questions that, you know, we’ve got to answer and we don’t really have, you know, all that much time to do it.

You know, you know, right now [00:28:00] somebody comes and asks us for, you know, their record. We’re able to, you know, we’re able to accommodate that. But, you know, from a longitudinal perspective and you know, I’m thinking of other entities that are involved here, you know, we’ve got, we’ve got a considerable amount of work to do.

I, you know, if I’m a. No go to several different organizations, you know, that, you know, compounds, how do I get, how do I personally get a longitudinal record, you know, through, you know, having visited several, you know, [00:28:30] several different healthcare organizations. 

Bill Russell: So you’re now counseling me as the CIO. Are you saying I should get behind efforts that should ask for a delay? Are you saying that I need to stand up a team that really delves into this? you know, w which direction should I be going or both? 

Charles Boicey: Yeah. I’m, you know, I’m saying that Bill from your, from your HR perspective, you better have your ear to the, you know, what the vendor is doing and, you know, really pay close attention.

And, you know, what’s the heads up from, you know, from your vendor of what you’re going to have to do [00:29:00] versus, you know, what they’re going to be able to do to, you know, help you meet those requirements. And, you know, hopefully it isn’t a, you know, compete. You know, downloaded, you know, all the data elements, and then you have to have the, the onus of, you know, processing that, and then put in, you know, at the end product is the product that, you know, gets distributed because that’s a considerable amount of work.

And hopefully they’re able to do that within, within that. 

Bill Russell: Now, Charles, you have been with companies as CTO of companies that have consumed [00:29:30] whole data sets. On on the patient. I mean, how, how ugly is that? How hard is that? If you and I were gonna go out and start a new company and we were going to write a patient app and they said, look, we’re just going to give you a raw dump of the file. Could we make sense of it? 

Charles Boicey: Yeah, we can make sense of it from a, from a, you know, an EHR dump, if you will. you know, taking that and running it through a pipeline. Some of the obstacles that we’re going to run into are, you know, what I call ontological [00:30:00] rightsizing. So, you know, assurance that, you know, the various ontologies are correctly applied, assurance that, that is actually the patient that.

It stated. So the whole, the NPI needs to be part of that, you know, processing, if you will. And then from a, from an output, you know, the assurance that the Aqua is actually, you know, formatted in the form that is expected for ingestion into the next, you know, the next application or, you know, as suitable for distribution at that point, 

Bill Russell: Are you coaching me [00:30:30] to ask for a delay? Should I get on that bandwagon of people who are saying, look, we need more time. 

Charles Boicey: I’m not one for asking for more time, I’m one for, you know, getting to work and, you know, started working on, you know, what’s going to be required and that’s just, you know, beating up everybody and their brother to get as much information, you know, as you can to best position yourself.

Bill Russell: Yeah. And that’s the problem with that crowd, to be honest with you. And if somebody’s in that crowd, on the sh that’s listening to the show. I apologize. But you know, the problem with that crowd is it, it’s [00:31:00] hard to distinguish between the people who were saying, look, we’ve looked at this, we need a little bit more time, but we’re going to make progress.

And we’re going to get there. And the people who say we need more time. And then when you get to the end of that block of time, they’re saying, Hey, we need more time. And they’re going to keep doing that for the next decade. Right? So there’s those clumps of people in that. And that’s, that’s why I. I like you struggled to get into that crowd of saying, Hey, give me some more time. I want to make as much progress as we possibly can. given the time that we do have, see what we can actually do [00:31:30] to be compliant. That’s sort of how I think about it. 

Charles Boicey: Yeah, you’ve got the, you know, that whole thing that cloud hanging over all of this, you know, the competitive advantage, you know, cloud, you know, data’s easily exchangeable and so forth is, you know, from an organizational perspective that may be less competitive.

That the, you know, the folks down the street, you know, may, you know, have some insights into how I handle my operations, you know, clinically financial and operational. And then as you look at it from a national [00:32:00] perspective, you know, what organizations are doing, you know, better than that than others. So, I think there’s a lot of worry there, even on the vendor side.

Bill Russell: Are you familiar with CDI at this point? 

Charles Boicey: No, I am not. 

Bill Russell: Okay. All right. We’ll talk about that later. but I think that pro provides some of the framework that we need to make sense of the data. all right. So you’re, you’re my CTO. give me an idea of how you think of build versus buy. Do you favor one versus the other?

Charles Boicey: It all depends on the [00:32:30] skillset that you have incumbent and understanding. so let’s say, let’s say I want to build out a, I’m going to build out, you know, big data platform, you know, why are you going to build out that big data platform, understanding the why of it really understanding what you want to do and you know, why.

Do you need to do it versus, you know, working with a vendor to, to do that. And I’ll tell you where it gets really complicated bill. It has to do with data science as well as the skill level that it takes to build these systems out [00:33:00] and build them out properly. Many many times ago, if you don’t know the skill set that’s required, you’re going to make some mistakes in the hiring.

Even if you use somebody, to, to bring people in, you’re still gonna make those mistakes and those mistakes can be costly. And the. And from a, from a time perspective. So if I bring in, an architect, I bring in an engineer, I bring in a team that’s going to not only architect out, but [00:33:30] also, you know, do the purchasing right.

And then the build out and somewhere going to process, I realized that I probably brought the wrong people in now. I’ve architected a solution that probably isn’t the best. And now I’m in a, in a bit of a bind. And I see it the same with bringing in, you know, data scientists as well, where organizations really don’t know.

You know, what type of individual, what they’re actually going to be doing. It just sounds really good to bring one in and they bring one in and they find out, you know, later down the [00:34:00] road that they really brought in, you know, the wrong individuals. So I think, from the perspective of, personnel, I think there’s some considerations.

If you have the proper team. I think you, you you’re, you’re, you’re in a good spot if you don’t, you know, probably not. Yeah. And the most important part bill that I always talk about is we learned from COVID that the need for data and what we have to do with data is increasing exponentially. And the technology needs to follow that same type [00:34:30] of exponential growth, and it’s a time perspective so if I’m going to build something out, I’m going to build a team. Six months, eight months and a couple of team members. Weren’t quite what I thought now I’m into eight to nine months. I still don’t have anything. I got the architecture. Now I’ll go the equipment. I’ve done the racking and stacking we’re at the end of the year one.

Now I’m starting to, you know, build it, build all this out, and now I’m getting into the six months. I so don’t have any data. So we’re getting into [00:35:00] 18 months and I’m really not getting a whole lot of use. And, you know, I’m probably gonna get realized, you know, use in 18 to 24 months and, Oh my gosh. Guess what? We didn’t do so well on their, our revenue targets and we just became an M and a target, and now we’ve been acquired and. What do you know that organization already had a data platform and you know, now we’re in trouble. so yeah, so the, the build versus buy is you can do it. Excellent. If you can do it quick and you’ve got the right people, but [00:35:30] by all means, if you need to get going, you know, I would really consider the buyer.

Bill Russell: This is a, you know, it’s, it’s interesting you, and I think the same, around these things because, but we also, we also understand the value of teams. So we build out the teams. And so when I go from organization to organization, I still have teams that I can call on that can do different things like develop applications, develop websites, you and your team can, can stand up a big data, data science team.

[00:36:00] almost overnight and you keep those and you build those out. so that, that you have that value that you, you know, that whatever you do next, you can stand that stuff very standing up very quickly. Yeah. 

Charles Boicey: You just go onto the next challenge, right? 

Bill Russell: Yep. And, and you still have the tool set with you. last thing, talk to me about digital front door, build your own utilized components of the EHR provider utilize best of digital kind of approach. How are you thinking about digital front door?

[00:36:30] Charles Boicey: Bill? I want to hear your definition of digital front door.  

Bill Russell: Digital front door is how we digitally engage with our patient community actually beyond the patient community. How we. how we interact with our community to deliver health, right? So it’s everything from easing the friction, to interacting with our health systems. So, you know, digital appointments, digital scheduling, digital, visits, to, you know, to coalescing the information [00:37:00] around all the. devices that we put in the home. So the, you know, the, the patient center medical home, which has now evolved into really a usual care platform that’s delivered out of the home, but we coalesce all that information into that. It becomes the, the gateway, if you will, for sure. for more touchpoints, we are engaged with that patient, with our community. On an ongoing basis to be their, their resource for [00:37:30] health at all times. 

Charles Boicey: Hey Bill as your CTO. I needed that definition first, right? Yeah. Okay. So that’s a big one. First of all, I see, let’s go look at organizations that outside of healthcare that have done this really well. So who’s done this type of thing. Well, especially in the world of COVID, who needed people in their doors, you know, to keep the revenue up and, you know, keep going, you know, you know, you can talk about Uberization is a word.

You know, what can we [00:38:00] learn? And we should learn from, you know, those in retail logistics, and how they’ve engaged and kept people engaged from a front door perspective. So, yeah, it’s great to have a blog on your website. But what’s the bot actually doing is a bot bringing somebody to a destination.

So if I log in and I’m looking at it, make an appointment, can add Bob, bring me through, all the way to an end point. And did you buy all that by the way, have self scheduling. Did you have all those components in place? So what I’m getting? [00:38:30] Yeah. Cause you really have to think this thing from end to end and not miss any of those, those component pieces.

It’s really critical that, and we all have call centers. Yeah. I’m not sure why healthcare is in the call center and their business, but we are on the call center business since we met that decision. you know, let’s take care of it. we have, you know, bots that can help us through that for call deflection.

We have, Intelligent agents that can handle a lot of those calls. Are we using them in healthcare? Absolutely not. We also have artificial [00:39:00] intelligence that can monitor those calls and score those calls so that we, again bring the level of, you know, the level of customer care, you know, to, to attire us.

We’re not utilizing any of that stuff. So first of all, I say, when they land on our site and let’s get them to where they need, secondary to that, You know, from a device in the home perspective, we did pretty damn good over the last several months, with doing telemedicine and all kinds of weird ass, you know, you know, [00:39:30] crazy kinds of ways, you know, utilizing zoom, utilizing, you know, all of these different, you know, tech, we responded pretty good with that.

So, you know, expanding that, professionalizing that a little bit, a little bit more, and then for monitoring and so forth home again, it has to be purposeful, you know, I, as a clinician, Do you not want to log into my EMR and see, you know, 1500 blood sugars from, you know, my 1500 diabetic patients, you know, that needs to be meaningful.

My team needs to be no needs [00:40:00] to know that, you know, one of my patients, is, you know, It’s a little wonky in their blood sugar, and I need to, you know, take care of that. Or from a blood pressure perspective, I don’t want to see all that stuff, but I need to be aware, so we need to make it really smart.

And we mean to make it simple for the patient population. You know, plugging stuff in and getting connectivity and all that kind of stuff, you know, it really has to be an excellent, excellent experience otherwise, you know, we’ve got a problem. And another, the last thing [00:40:30] we’ll see about this, this call center business is.

You know, when you get somebody on the line, you better know where, who they are, where they are, where in proximity they need to be, you know, for whatever the Prider and you’d better get them to that location and not be sending them all over the place, you know, over, you know, several miles and whatnot.

And one of the things that I’ve seen that just is extremely, Frustrating is I’ll do a telemedicine visit, but when all of this is over, I’m going to be followed up. [00:41:00] Oh, I’m not going to see that person because they’re 30 miles away from me. Why didn’t you connect me with somebody that I can follow up with after this is all over?

So we gotta think about it from like a, you know, really from a marketing and retail. Look what everybody else is doing and bring that into, into healthcare. And from a call center perspective, there is a lot of work we need to do. 

Bill Russell: We just give away all of our secrets when you and I get together.

We’d like to, you know, the one question we bat around is [00:41:30] where do you think the best entrepreneurial ideas? And when we, whenever we focus on healthcare, I think people will be shocked. Some of the areas we come up with. Cause you know, we have experienced fairly deep experience in a lot of different areas, but you and I agree.

That’s the one area that if you and I ever got together, we could revolutionize in healthcare IT is the call center across the board. It doesn’t matter what they’re doing. We can change it. 

Charles Boicey: And the other one is why the heck are we spending so much time and energy on, on recovery on bill collection? There’s [00:42:00] there’s far better ways to take care of that. Why are we doing that? 

Bill Russell: Yeah. Yeah. And, but even if we were doing it where we’re not using the right analytics, we’re not, 

Charles Boicey: Yeah. Who’s likely to pay you know data science project on, you know, who’s likely to pay data side project on, you know, what’s the best methodology for delivering care. I mean, there’s a lot of ….

Bill Russell: Sorry that’s way too many of our secrets here Charles. Thanks. I really appreciate you. coming on the show, I think there’s a fair amount of [00:42:30] soundbites and things for for people to take away. And I’m already looking forward to our next conversation.

Charles Boicey: Cool. I really appreciate being here. And, Bill, welcome to Florida. 

Bill Russell: Thanks. It’s rained all day today. So thanks. Thanks for the welcome. That’s all for this weeks special. Thanks to our sponsors, VMware, StarBridge Advisors, Galen Healthcare, Health Lyrics, Sirius Healthcare and Pro Talent Advisors for choosing to invest in developing the next generation of health leaders.

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