Bill Russell: 00:10 Welcome to this week in health it where we discussed the news information and emerging thought with leaders from across the healthcare industry. This is episode number 46. Today. We are finishing up our three part series from the Chime fall forum. I hope you had the opportunity to listen to the other two. One was on culture and it was a phenomenal episode and the other on technology and so we did a deep dive with two very technically minded cio and associate cio. Uh, our industry has so many wonderful people for this episode I’m about to share with you. I got the opportunity to sit down with bill spooner, who’s one of those truly special people that has contributed so much to our industry. Bill was honored with the legacy award at the Chime fall forum, and I was honored to be able to sit down with him to discuss everything from the opioid epidemic to preparing for retirement. I had a great time recording it and I, I’m really excited to share it with you. So elder statesman for healthcare it. Bill spooner has decided to join us. you don’t mind going by elder statesman. At this point, you’re doing a lot of work.
Bill Spooner: 01:16 Some people say, Geezer
Bill Russell: 01:19 I’m not going to say that. So you’re doing. You’re do it a lot, a lot of different things, but you, you were honored by Chime you’re doing a lot of work for Chime. What, what kind of things are you’re working on these days?
Bill Spooner: 01:27 Well, let me talk about Chime for a minute. Okay. I’ve known that capacity for 30 years. I knew Tim when he was a little kid and that got me really motivated about the opiod issue and so I spent a lot of time in the past year or even every week. The more I learn, the more I realized I learned from I need to learn and it’s kind of frightening to me. They say, I don’t know what the end to it is. I think we have to deal with it. And so I’ve really, I’ve spent a lot of time on that.
Bill Russell: 01:55 So you’re in the opioid task force? Yes. Yes, absolutely.
Bill Spooner: 01:58 And just trying to make things better.
Bill Russell: 02:01 That was a, an amazing video this morning that, uh, I know it was Ed, who was the other
Bill Spooner: 02:08 Kristy Kindler Adventist health system.
Bill Russell: 02:08 They both shared very personal stories of how they
Bill Spooner: 02:12 They were tear jerkers
Bill Russell: 02:12 it really was
Bill Spooner: 02:13 it’s just so I am, I admire both of them. So much for even going to stand up and talk about it. And I remember the first time that Ed came to a taskforce meeting. It was really tough I mean. He wasn’t able to talk that much. I mean, what would you lose your child?
Bill Russell: 02:31 Yeah. Well I, I thought it was interesting at the beginning of that when they said, uh, everyone who’s been impacted in some way by the opioid epidemic, raise your hand and there was a significant number of hands that went up in that room. So it touches a lot of lives.
Bill Spooner: 02:47 When we had our first task force meeting back in January in DC, I can’t, there are probably 50 people there perhaps. And we broke off into groups. We started out by telling our story and I feel fortunate that I had less to tell than others, but almost everybody had a family or friend event, a brother, a child that had been contending with forever and so, this is this. I never appreciated just how many of us have been touched by it.
Bill Russell: 03:16 So if I’m a health system cio, I can I. What would I get from the Chime task force? How would you guys help?
Bill Spooner: 03:25 What we’re trying to do is to put together what we’re calling a playbook, Just To begin with, to give people to give cio’s some tools to help them engage in the efforts in their own organization and most organizations are doing something, but for those that aren’t, we’re, we’re creating a playbook that talks about how to kickoff the problem stewardship committee, provider education.
Bill Spooner: 03:50 We’re also trying to get into the, to the, uh, details of where we can apply better information, whether it’s building dashboards about prescribing patterns by your doctors. I think the whole issue of the state databases, PDMP’s, as they call them very, very difficult to integrate with. And and in many states it’s basically a web lookup, so the provider has to go through all these extra steps of going into some portal which discourages them from wanting to do it and different rules state by state. So we’re trying to put together some information help and we’re trying to exert some influence. We’ve had some influence on the legislative side in terms of recent opiod act. that was passed but we also didn’t make it in some terms of trying to make available, I think they call it Jesse’s law so that the, the substance abuse information can be, can be made available to the providers who try to influence it in a number of ways. We’ve had some successes. We still have a lot of room to grow
Bill Russell: 04:50 And I think people are now recognize this but Chimes on Capitol Hill. I mean we’re having conversations and influencing
Bill Spooner: 04:59 and we feel that we are influencing some of the things that we’ve thought that we’ve promoted have ended up in the legislation. Obviously we weren’t the only organization to promote that but. But it really all adds up. And one thing, and I think somebody said that this morning we are being asked for our opinions, so that helps. So it seemed unlikely, it seems kind of unusual for a bunch of IT people to be so involved in this thing which is a, you know, a severe medical crisis, but it’s just too important not to. And there are ways we hope that we can get information to the table.
Bill Russell: 05:34 Well it’s the very first episode I did of this was back in January, it was following the JP Morgan Conference and they have the nonprofit track where all the CEOs get up with their COOs and others and talk about their performance of their organization. They’re talking to bond holders. So they’re talking about their performance, that kind of stuff. And one of the things I took as a takeaway from that conference was healthcare is mobilized on this opioid epidemic. The Ceos are sitting up there saying this is a priority, this is what we’re doing. It was a Geisinger, it was dignity, it was the Intermountain. They’re all sitting there going, no. And this is not something we’re competing on. This is something that we’re sharing, so you know, we’re going to this, and this is a problem we can minimize. Solve might be a strong word, but we can minimize the impact. We’re still going to prescribe opioids. Hopefully we’ll get to a point where there’s nonaddictive opioids, so that would be. I guess the silver bullet
Bill Spooner: 06:32 That would be perfect. You know the, the real challenge as I see it is we each have our target. We know that that American healthcare has prescribed opioid drugs more than than European countries. Even with reductions we’ve had, I saw some data recently, they said we’re still twice as much as in Europe, but that’s not the whole problem. How do we, how do we get engaged with communities and some organizations do it. Some organizations need to, so an addicted person shows up trying to shop in the emergency room and you don’t prescribe them if they go out on the street and buy heroin and it’s laced with fentanyl and they kill themselves. That really didn’t. Wasn’t a very good solution and it’s so. It’s like how do you bring the community together? I’m participating also in the opioid taskforce for my local health system back in northeast Tennessee and I have attended a couple of meetings now. It’s really interesting because I see a whole bunch of silos, but the the really interesting thing that I saw at the end, in the most recent meeting, it was a couple of new players and I see them seeking out. They had a woman who represented a couple or three community drug stores, so you know, we need to do it that they will too, and then we had another woman from the university who is trying to do community outreach and because this is because this is kind of a where you call, the Bible belt, you know, churches have a role in it and there’s a person who is engaging the religious leaders to participate in outreach, to families that need help and to really solve the drug problem more than just reducing prescribing in the hospital setting. It really needs to be a community effort and that’s going to take a long time
Bill Russell: 08:12 it’s going to take a long time. One of the things that I think it was Ann Weiler brought up while she was on the show, and I’d never really thought about this. She goes, h caps h caps contributes to the opioid epidemic. I’m like, well, you are going to have to explain that to me? She goes, well, think about it. A manager manage pain. That’s right. There’s a checkbox and and then the doctors look at it and go, well, you know what? I just did a knee replacement. This person is not going to want to come back in and they have to come back in physically you have to be looking at the person in order to prescribe an opioid. So they go, hey, you know what, it’s gonna be hard for you to get in here. So they over prescribed
Bill Spooner: 08:45 that’s exactly right. I was just talking with Zach this afternoons said the same thing and another physician would say and I don’t get paid for another office visit for them to renew their prescription. Yeah. So I just prescribed 30 days and then they use it for five days and somebody steals the other 25. You know, it’s,
Bill Russell: 09:04 it’s there, it’s there for you or your kid or somebody else. But Other things she said is, you know, some people, they, she said they had done some a consumer questions and, and we’re talking to this one lady and they said, uh, you took all 30 days of your prescription. It’s like, were, were you in pain? She goes, no, I wasn’t in pain, but my doctor prescribed it. So I, I took it for 30 days. And you’re like, oh wow. We really need. There’s so many aspects of this closing all those gaps you talked about including the community as well as just education across the broad.
Bill Spooner: 09:41 Going back to the beginning I don’t know if you’re following this, but going back to the beginning, a lot of this started because some parent at Boston, If you know one of the most prestigious Boston hospitals, wrote a letter to the New England Journal of Medicine. They had, we’d been tracking, patients that had been prescribed opioids in, in the house, and very, very low percentage became addicted. So, hey, apparently they’re not addictive and this got published. The drug companies latched on it as part of their marketing material. Joint Commission was complicit because that’s how pain became the fifth Right. And so hospitals were incented to make sure that patients were comfortable. One thing I’ve been wondering about it, I forgot to ask this question, is we used to be able to get those little devices where you. Were you a shot your own medication whenever you, whenever you hurt. Yeah. I need to find out if, if that, if we’re starting to remove those.
Bill Russell: 10:39 That’s interesting. Well,
Bill Spooner: 10:42 so I think I spent a lot of time on that.
Bill Russell: 10:45 I was going to say, I hate to say you’re retired because it sounds like you’re working pretty hard and it’s great. So this, conference is in San Diego you served at Sharp for for a long time.
Bill Spooner: 10:57 I, I was at Sharp for, I was in San Diego for 32 years.
Bill Russell: 11:01 Thirty-two years.
Bill Spooner: 11:02 And was at sharp all that time.
Bill Russell: 11:03 Wow.
Bill Spooner: 11:04 I was, I was CIO the last 18 years and so I know I’ve got a lot of friends here and uh, it was good to come out and see some of them
Bill Russell: 11:12 anyone who lasts that long, I have to ask this question. So I’m, oh, I’m almost always get the same answer, but CIOs don’t generally last 30 years. So what do you attribute that to?
Bill Spooner: 11:23 I came to Sharp as the CFO of their second hospital. I moved to IT back in the eighties, but. So I’ve had multiple roles over that period of time, but I have to tell you, 18 years as the cio. I had a great boss. He’s going to retire this next year. Wonderful Guy. And he’s a real team, Mike Murphy. I mean I can’t say enough good about him and the team that we were able to assemble was good. Me, I just couldn’t ask more, say more about them. We were lucky to be able to build a really great team in IT and they deserve all the credit for everything that we got, that we are able to accomplish a great place to be.
Bill Russell: 12:03 That’s, that’s interesting because it’s the same answer every time. I have somebody who has longevity, I say, what’s your longevity? I say I came in as part of a great team. We were more like a bunch of friends who worked really hard together to do great things in the community.
Bill Spooner: 12:20 It wasn’t necessarily that way to begin with.
Bill Russell: 12:23 Oh yeah. It’s hard work.
Bill Spooner: 12:27 We learn to work together. In some cases we learned these are all okay people. Yeah, and you just couldn’t ask in. The interesting thing is I spent so long here. It’s been. I’ve been. I’ve done a little bit of advisory work and consulting since then. So, I realized I appreciate this other way. The other things the other ways of doing things, people have different preferences and different communities. I can’t Find any of it that I think is anything superior to what we did and I just. I’m amazed at what we were able to accomplish. What I’ve seen elsewhere.
Bill Russell: 13:01 The team makes a huge difference, so
Bill Spooner: 13:04 we had fun together. We worked hard together,
Bill Russell: 13:07 so there are. There’s a bunch of CIOs who have had it, who are former CIOs were out there looking. What would you tell a cio who’s out there looking? Who’s interviewing with the CEO? What, what should they be looking for in that team? I mean, is there any aspects or any culture?
Bill Spooner: 13:27 Right. You really do have to try to understand the dynamics and how they work together. Do they, do they just work together or you know, do they really try to respect one another and do things in the community together? I remember talking with some folks, I think it was after I left sharp and I was describing that we had some benefits, some events together where we actually, the whole executive team we’re in, it was at a party and they said my executive team doesn’t talk to one another, much less have a party. you have to try to understand that. I’m sure you go through the roots of what’s, how will you decide whether I’m successful after three months, six months, in a year? Obviously you have to go through with that, but to try and understand the style and the culture of the organization is interesting.
Bill Russell: 14:24 So, I agree with that, but part of me is like you’re sitting across from the CEO and the answer is would you want to have this person over for, for dinner? I mean, you know, because people hire in their own image if you’re interviewing with the CEO and they’ve built out a team, you’re getting sort of a glimpse into the team because that’s.
Bill Spooner: 14:41 And it’s how does this person fit within that team? Yeah, it’s, are you a team player? Are you or are you grabbing for glory?
Bill Russell: 14:50 So, uh, how do you think IT has changed, healthcare IT has changed since you’ve, since you’ve retired, do you think?
Bill Spooner: 14:57 Well, I can tell you, sort of a few things. When I left Sharp, I was, I said to myself, great, I will never in my life think about cybersecurity. That scares the daylights out of me. Well, about a year ago I was invited to join the risk, what is essentially the risk and compliance committee of a large health system and one of their focal areas was cybersecurity and they’ve got a huge initiative underway. So like, I went through a fast refresher course in my, through a daylong. I went through a daylong forum, I started reading. It’s like, oh my God, I got to catch up with this stuff. That’s a big change. I know that the information security staff at Sharp has doubled since I left there and they probably would like to have, um, I think it appears that we’re making progress in terms of bringing in some of, some more innovation. People say they’re doing it. I’m not sure how much they’re doing it. I’m sharing the most wired program and I see some of the results and Gee, there’s a lot of people are doing, some things are things we’re doing this more telehealth, et cetera. And so I think people are having some fun with that. How widely it has been quote being deployed. It’s kind of hard to tell this point, but clearly moving in the right direction. Um, I know we keep talking about CIO 2.0, 3.0. I’m not really a big.
Bill Russell: 16:19 Which one are we on now? Are we on 3.0 already?
Bill Spooner: 16:21 I don’t know. Maybe 3.1,
Bill Russell: 16:25 I may need an upgrade.
Bill Spooner: 16:26 that’s right I may need an upgrade. I don’t really buy into that. I think it’s all. We’ve always had the same responsibilities that we had. I don’t hear any too many CIOs anymore worried that they’re not at the table because I think all the CIOs are at the table and I think that they have been for a while. The one thing that makes that I do worry about is that I still see the cost of healthcare going up and I don’t fault the IT people for it. I think that IT has become a huge part of our economy and you know, there’s all the bright and shiny object syndrome and people are trying to try those things and when you talk with organizations you’ll find that we haven’t reaped the benefits and some of them we haven’ta reaped because perhaps the system didn’t work quite like we thought that it did and partly because we didn’t take the effort to implement it in a way that can be used, but the cost of healthcare is still going up and that’s not okay. You see lots of examples about how we’re getting a quality improvements, access improvements, hitting the patient safety issues that we’re not tackling the increase in cost and I think that’s got to happen.
Bill Russell: 17:49 it’s interesting
Bill Spooner: 17:51 younger people like you who have to pay off the national debt sooner or later. We appreciate it
Bill Russell: 17:57 the thing about cost reduction I think is interesting is when IT people hear that they sort of cringe because they hear that and they hear staff reduction, but at the end of the day, if you’re doing IT right with a, I mean you have the short term Lens and you have a longterm lens, you’re looking long term and you’re saying, hey, if we do our IT systems this way, we’re going to be able to do it at less cost in three years or five years. And then you, if you’re having that kind of perspective, then you can retrain these people to do other things instead of, you know,
Bill Spooner: 18:33 And there are lots of organizations who view it as IT staff reduction. That’s, we can cut the cost of IT. But that’s not that. That’s a bad thinking. It’s, how do I cut the cost of healthcare, how can I, how can I help the caregivers do it more effectively and more productively.
Speaker 2: 18:51 You brought, you brought up cybersecurity, cybersecurity’s, we don’t talk about cyber security much on the, on the podcast. And the reason we don’t, is not because it’s not a huge issue, it’s because most CIOs can’t talk about it because you’re not allowed to reveal your posture and all those things. But I can talk to you about it because you’re not, you’re not, and I’m not at this point, but, the thing which just struck me about cybersecurity is you really have to pay. You have to educate that board. So people like you, there’s probably a ton of board positions. I would love someone like you because you have to educate the board on what you can actually do. So we had a scale, we had eight pillars and zero to five scale and you know, and the board when I first went in with our chief security officer said, well, we want to be five across the board. And we said, okay, do you understand what five across the board is going to cost? Is like just an astronomical number. They just looked at us like look, Cybersecurity is a series of trade offs of where, where do you want to make sure that you’re as secure as you possibly can be and what other areas can you maybe take a little risk? Because if China says we’re going to hack into that health system, it’s really hard to say, you know, we’re going to put up the same kind of barriers that you know, the US government does or somebody else. I mean, you’re sitting on a board now, so what’s the best way to sorta get the right funding, get the right message out there again, I mean, I assume it has to start at the board level
Bill Spooner: 20:28 well it does, you know, the unfortunate things though that a lot of organizations get their funding after they’ve had a breach. Yes, that’s not what you want to do
Bill Russell: 20:38 that’s probably true.
Bill Spooner: 20:39 And I was lucky at Sharp that we got, we got a few dedicated security people when Hipaa came out and we realized, you know, we’ve got to some stuff here and then we sort of learned over time. Today, If you’re not really addressing it seriously, you’ve got a big catch up to do. One thing that is good that I’m really positive about is, five years ago, I don’t think I probably could spell missed, but I didn’t understand it. Today, You’ve got a decent framework in this. You’ve got in, you’ve got high trust with some people support and they’ve all, They’ve all got reasonable skills so you shouldn’t measure yourself against them. We brought in, had an annual review from an outside firm where they did general assessments, but it wasn’t really as structured as it could be and it wasn’t as measuring you against the rest of the world. Other than that, in kind of a subjective manner by the, by the consultant who said, well, you’re about this compared to everybody else that we consult with. I think using. Having something like a NIST or a high trust, it gives you a lot better targets to shoot for so that you can know the gaps, but even with that you still have to be able to have somebody to do the assessment and be, be willing to suck it up once a year and let them see how you’re doing.
Bill Russell: 22:04 Yeah. And uh, this framework was the framework we used to come up with our pillars and our model, um, I don’t think people know this, but there’s a NIST framework for cloud computing. It’s also the framework we used back in 2000 and it was available back in 2010. So this framework we used in 2010 for the health system I was at was the nist framework. Great set of material to, to dig into. CIOs aren’t digging into that.
Bill Spooner: 22:28 And I think it varies, but I think most of them are today. I was over at,
Bill Russell: 22:34 well at least their security people definitely are, that’s for sure.
Bill Spooner: 22:39 And I was, I walked over to see some former colleagues over at the idea, they had a conference earlier, and there’s a room full, in the security one. Yeah, a lot of people are looking for education and that’s important.
Bill Russell: 22:53 So you know I’ll probably close with this question and the question is, um, let’s see. I’m probably about 15 years away from retirement. So what’s your coaching to people who are getting close to retire? CIOs who are getting closer to retirement. Do you have any, any words of wisdom? Here’s the thing. I don’t think people can grasp, and CIOs who are are listening to this sort of get it and everyone who’s in healthcare sort of gets it . But when, uh, when I left the last health system I was at, I was at a point where I was getting about 250 emails a day. Who knows how many phone calls, texts and you know, and at least one emergency a month where your response. I mean, so the pace is, is crazy when you retire, that pace goes down pretty quickly, doesn’t it?
Bill Spooner: 23:42 I’m still getting a lot of emails, a lot of is a lot of it’s stuff that I just hit delete with, I think there’s a couple of things you want. I think many, we all work too long. I’ve seen too many people who are who retire and then their health doesn’t allow the to do things they want to do, so it tells you to do some realistic financial planning so that you really know when you could retire. I probably could’ve retired sooner than I did, but I was cautious. I am cautious mean, so yeah, that’s important. But then the other thing is to be thinking about what you’re going to do after retirement because all of a sudden you’ve got a lot of time on your hands and I will say I didn’t do a good job of that and so I did a lot of work for the first three years. It was Wonderful. and I’m still continuing to do it, but you have to be thinking about how you want to spend the time, whether you’re gonna travel, where am I going to travel? I mean, let’s plan it. Make sure that you. And your spouse, if you have a spouse, are somewhat in agreement, make sure that you’ve reached agreement about how much you want to be under each others.
Bill Russell: 24:50 How much you want to be together?
Bill Spooner: 24:52 How much time you want to be together. All of a sudden.
Bill Russell: 24:55 My dad retired from 3M and I love my dad, but the amazing thing to me was he told me the story the year he was getting ready to retire, 3m sends out a counselor to their upcoming retirees and they do this little thing where they sit across from you and they say, okay, what’s your plan for retirement? But if you say things like, I’m going to do stuff to my house, they say, okay, that’s one year. And then they say, well, we’re going to travel to say, okay, how much are you going to travel? How much money do you have? And they’re like, you know, any, any redoing your house, traveling. It’s like all these things cost, money. And then the other thing people. So do you have enough money? And then the second thing is you overestimate, you think, oh, I’m going to work on my house for the next five years. Well, unless you have a farm in acreage that’s, Yeah, your house is done in a year.
Bill Spooner: 25:43 You know, there’s a couple things. One, like I did when I did my financial planning, the planner forced us to put in a travel budget to make sure that you’ve got the money there and then you’re going to spend it, you have to do that. or you go crazy. But then the other thing is all of us are pretty talented professionals. We’ve got a lot to give. And so think about what else you can do. I have a friend who’s retired and unfortunately has a lot more money than I do, I think. But, uh, you know, he’s got involved in his community, non for profit organization and helping the elderly and bringing some leadership to them, in the terms of their fundraising and in some of their community mission. And that’s, that’s just a really good example, but through something that we all feel strongly about, different things, but literally everybody feels strongly about something figure out how you can get back.
Bill Russell: 26:36 you’re still gonna work, you just don’t get paid anymore.
Bill Spooner: 26:38 Some of them do it through churches, some of them do it through community clubs some of them do it through various other non for profits. Absolutely. I’m sure, you know, my Kiwanis back in Jonesborough, Tennessee. There’s a group of people who just go in to the elementary schools and do reading program to help the teachers out so the kids learn to read better and all of that. Those things are important. It’s just a question of what you, what you are inclined to do.
Bill Russell: 27:06 I don’t think people realize that Kiwanis is still out there. Rotary still out there, now rotary is doing some great work on. I mean they’ve always on polio and other things,
Bill Spooner: 27:15 lions and there are some clubs that I never heard of until I moved to the east, Civitan and Ruitan, And I still don’t know what they do, but they’re very, very active.
Bill Russell: 27:24 A lot of great stuff. Well, Bill, as always, a pleasure. I really appreciate it. We’ll definitely have to do this next conference this is a lot fun.
Bill Spooner: 27:33 great stuff.
Bill Russell: 27:33 Thank you.
Bill Russell: 27:35 Wow. I really want to thank bill spooner for coming on the show. I learned something every time I sit down with him and I hope you really enjoyed the show. As always, you can pick up more episodes on the website. thisweekinhealthit.com. You can follow the show on twitter @thisweekinhealthit. You can follow me on twitter @thepatientsCIO and you can follow my writings on the Health lyrics website as well, and please come back every Friday for more news, information and commentary from industry influencers. That’s all for now.