CHIME Fall Forum – Technology – Bill Hudson and Tom Stafford


Bill Russell - Various

CHIME Fall Forum 2018

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Tom Stafford and Bill Hudson were gracious enough to sit down with me at the CHIME Fall Forum to discuss healthcare technology.  From Cloud to APIs we explore the influencing technologies.

Bill Russell:                   00:12                Welcome to this week in health it where we’re discussing the news information and emerging thought with leaders from across the healthcare industry. This is episode number 45. This week we have more discussions from the chime fall forum in San Diego where Tom Stafford and Bill Hudson join us, Tom Stafford from Halifax health and Bill Hudson from John Muir. These two gentlemen, we, uh, take some time to go into a deep dive into technology questions. Hope you enjoy.

Bill Hudson:                  00:41                Great. I’m bill Hudson I’m the social cio at John Muir health Im responsible for it operations.

Bill Russell:                   00:47                Awesome. So how long have you been there?

Bill Hudson:                  00:49                About two and a half years.

Bill Russell:                   00:51                And prior to that

Bill Hudson:                  00:52                part of the, I ran healthcare strategy for Vm ware and part of that I was the cto at kettering and Ohio.

Bill Russell:                   00:58                Yeah. And that’s, we ran into each other when you were at vm ware. So I’m going to focus in on like really the technology track with you. Sure. Everybody I’ve interviewed so far here wants to talk about culture because I think it’s potentially an easier topic to talk about right now. But the, the technology tracks pretty interesting. So we, uh, when we ran into each other, we were doing a large, when I was cio for a health system, we were doing a large cloud migration and a vm ware was obviously a part of that. What are, what are some of the things you’re thinking about or doing these days with regard to your technology stack at the John Muir?

Bill Hudson:                  01:41                So, you know, one of the things that I did when I got to John Muir, as you know, we started talking to the technology team and looked at what they had and they had, they’ve done a great job over the years and you know, they’ve got an impressive team, that great, great data center. And I looked at them and I said, guys, I, I don’t think that running a data center is necessarily strategic to healthcare. And in fact I don’t think data center management is our core competency at nor do I think it should be. I think we need to continue to focus on orchestration, application management enabling the users focus on the growing automation and integration of technology into the it and the care processes and you know, that means that maybe we don’t rack and stack servers, we don’t put memory chips and I want to be clouded. I want to be cloud first. And then I challenged them. I said, you know, in five years I’d like the data center to fit in my office. You know this is not, this is not something that I think is rocket science. This is doable. And I think it’s gonna be.

Bill Russell:                   02:39                so you have a twenty thousand square foot office?

Bill Hudson:                  02:40                No we’re in healthcare, I have, I have a normal size, normal size office, but you know, I call it, it’s our big hairy audacious goal. And you know, two and a half years later, you know, we reduced the overall footprint of the primary data center by about fifty percent in terms of, of compute stack. And in fact, I probably have more blanks in my data center right now that I have servers in the data center. You know, to keep it manage the cooling. But, you know, it’s been a, it’s been a little bit of a shift. And so, you know, we had to do a, bring some folks along and we had to get the organization used to thinking cloud first and, and you know, today two and a half years later, it is, you know, we’ve, we’ve gone through the process of tiering all of our applications tier one through three to figure out how, what’s the best right place for those applications. And it’s not like we moved forward and said, okay, we’re going to move everything off the floor today. It’s when we get to natural break points, when it makes sense when we’re moving to a new version of the application or we’re moving to a new iteration of an application echo for credentialing, for example, is something we’re looking at right now, echo is something we’ve traditionally run on prem a lot of healthcare organizations run echo on prem. We’re actually looking at moving to the cloud model with echo. Now we won’t run that in our data center. We won’t run that in the cloud data. One of our cloud data centers will run that in Echo. And we’ll get, we’ll get credentialing as a service and we’re going to, that’s going to allow us to do some things we’ve never done before, potentially we’re still working on the contract and one of those things allow us to do is be able to integrate our credentialing system with our Internet and so we do physician scheduling rather than have to maintain a separate database for that. We’re going to get it right from the source and it’s gonna allow us to do some really cool things that we haven’t done before. And that’s one of the big advantages of taking a cloud strategy is the ability to integrate applications, to be able to, for us to focus on our core has been has been really a big deal. But you know, one of the things we’ve done is we’ve looked at our, looked at applications to prem and we looked at things that make sense to move off prem and those things that make sense move on Prem today. Things that are lightly utilized are great, candidates to move off prem, gets organization, good experience. And using those applications and securing those applications and managing those applications. Um, and then we also look at things that are another other great fix. Things like disaster recovery, you know, running an application like epic fulltime in the cloud today is not cost effective. It is probably on the horizon of things as costs continue to come down for that medium. But Dr in the cloud is a wonderful solution for something like from epic or for any of your systems because you know, you’re running them on a partial basis, you’re only paying for the stuff that you’re using. So test systems, demo systems, development systems are all great candidates and those are the kinds of things we’ve been focusing on in terms of where we’re going.

Bill Russell:                   05:31                It’s interesting, so I think people hear us talking about the cloud and I think we oversimplify it but, but generally, I mean we’ve talked about this before. I mean there’s, when we talk about the cloud, we’re talking about there, there’s going to be legacy cloud. You can run things on a vm ware cloud or an aws cloud. You can do a, as a service, you could do a cloud native application, you can do all sorts of, when we say cloud, it’s a bunch of different architectures, but it still requires architecture because you can’t like move your data into one data center over here in one data center over here. You’ve got to start thinking through architecture. I know it’s a dirty word in a lot of areas, but you really do have to start thinking about where is this going to reside, what are the hooks into this data, how are we going to be moving it around? Or do you spend a lot of time on the. I assume you spent a lot of time with workflows when you spend a lot of time on the data architecture?

Bill Hudson:                  06:21                So the answer is yes. So kind of, absolutely. And I think one of the things I think is really important is if you have weaknesses in your, in your systems or weaknesses in your processes or weaknesses in your organizational alignment or governance, and you take a cloud first model, you’re going to find those pretty quick. And I think part of this is about operational alignment and communicating and make sure everybody understands what we’re doing, what we’re getting into, why we’re getting into it, but it also requires an intense amount of orchestration and make sure that we’re getting all the pieces and parts put together, right? The architecture if you will, right? So if I, if I take a, a haphazard approach to how I’m going to manage cloud and cloud by the way means a lot of different things, a lot of different people and you think you called it out very well, is that it is a lot of different things and it’s not just about securing stuff within, for all intents and purposes, my four walls in my organization where I can put my arms around it, a moat around it, I can guard it, um, and I can have complete total control over it.

Speaker 2:                    07:27                I have to have, to be able to extend my virtual control to a variety of different places. So I have some stuff sitting in an office 365 with Microsoft, right? So I’ve got my email out there, we looked at doing some stuff with them, potentially run bi. Um, you know, we’ve got, we’ve got data right now, we’ve moved to workday, so hcm and Erp are sitting in a workday environment, we’re looking at, we’re implementing supply chain right now that’ll, that’ll be in that environment. And those applications have been on Prem will go away. I’ll say all of a sudden I’ve got three different locations. We’re getting data. One third of our, one third of our clinical providers, one third of our providers are community connect to users. So we’ve got the, to our surprise a little bit, Epic came out during one of the last reviews and said, you know, you guys are the fifth largest community connect site and we’re a community hospital and in East Bay and San Francisco. And were like, well no, you mean in terms of presenting providers towards our population. And No, just in terms of total transaction volume, which was, was kind of eye opening for us. And you realize that, you know, a good part of what we’re doing around it is providing service to organizations that are outside of our four walls, outside of our control, that we’re offering service to that are also kind of cloud connected to us. And so you have to have a strategy around how you can provide those services and secure those services. And so, you know, we looked for a security platform that we can manage across those layers and an orchestration platform we can manage across those. Right now vm ware is a partner in terms of how we’re managing workloads, but we’re also. We also have stuff sitting in, in Microsoft right now and we’re also looking at a growing number of our application providers who have decided that they liked the idea of cloud because it provides a nice little anunity stream for them. And so they’ve got number of those guys that are jumping into that space and saying, hey, we’re gonna offer you x as a service, which is awesome. But then we have to go back and look at it and say, are these guys really ready for this? When I look at it, I don’t want all these contracts and know offering 99 percent uptime and on a monthly basis and we won’t tell you that’s the only during what we consider core business hours and you know, and the extent and the example around what we’re trying to do with echo for example. Um, you know, that’s, that’s an integration for serving potentially inour Intranet to provide access to our patients about who are physicians are, where they’ve studied their credentials. Um, so we have one database, you know, the ability for me to have that go down at 10:00 at night when someone’s potentially sick and looking for a physician is not a good thing. So we have to help to a large extent some of these guys that are just coming into this space and moving into this, help them understand, you know, what the requirements we have as our business, things that you and I’ve gotten used to doing over our careers that these guys are just kind of stepping into it. And then they have to realize you have to support to a different level.

Bill Russell:                   10:27                Do you think, and so the buzzword over the next 24 months, I think it’s going to be DevOps, not that DevOps is new, but healthcare is healthcare is starting to acknowledge that DevOps exists, I mean, are you, do you think we’re going to see that kind of model really start to permeate the infrastructure side at least of the, of health it?

Bill Hudson:                  10:51                So I do, I do for a variety of reasons. I am, part of it is I think the lines are starting to blur. I think cloud is helping us to, you know, cloud first strategies for a lot Fraud center helping us to do that to a certain extent. And we’re getting, you know, even with epic for example, we’re getting into a quarterly upgrade cadence with epic and it’s not just for SUs anymore. It’s for, you know, for new functionality on a quarterly basis. And you know, unless that’s going to consume us, totally consume us. We have to adopt a methodology that’s much more agile, um, and helps us move to the red, no pun intended, but it helps us move down that road a much quicker because I can’t afford to have a huge team that’s spending nine months of the year doing nothing but upgrade. Right. I’ve got to get that down quick. So it’s fast. It’s iterative and it has to include robust testing has to include our end users. And you know, DevOps is a good framework the problem was that I have with the DevOps approach is everyone wants to go down this agile path and we’ve been waterfall in healthcare for so long but for good reason. And you know, when you make a, when apple has an APP or an apple application in their ecosystem, that’s the Marriott App is going to update new functionality and they updated and you know, if something breaks on it, you know, the worst thing that happens is a traveler has to call somebody or they check in manually versus checking in on their phone or they can go to a web based APP. And try to do it this way, when something doesn’t work in healthcare, you know, potentially someone’s not getting an order for something that they need. Um, and so the level of testing required is much more strenuous than it would in a normal agile environment. So you have to figure out some way to meet a happy middle between the, the detailed rigor of testing in a waterfall environment and plus the agile ongoing test as you build it approach and in a more of a, an agile methodology. And we have to merge those two things. And so I think we will do it, but I think we’ll find them a little bit of a middle ground where it comes to testing.

Bill Russell:                   12:56                And we were talking before we got on here, of a lot of healthcare organizations, don’t have the infrastructure to even do that kind of that kind of testing. I was uh, again doing consulting, traveling around a lot of, a lot of healthcare environments, have a production, EHR environment, but don’t have dev or test. Um, how, how important is that to just make that investment, get Dev test prod in place? So that you can, you can start to be more agile, but also do the, do the right testing before you put things into production.

Bill Hudson:                  13:33                You know, I, I think it’s incredibly important. You know, I think if you look at it, you know, even 10 years ago, the number of integrated systems was high. Um, but you look at your core systems and it was a, you know, it was a few things, you know, you had a test on a regular basis. You didn’t have duplicates of necessarily everything which was to some extent, you know, problematically needed testing, but this day, you know, everything is so tightly fitted against each other and, and integrated at such a tight level. You have to have those, those, those systems that you can, that you can test on and you have to be able to manage them. In a good and proper way, and I’ll give you a good extent. Uh, a good example. Um, you know, having a test environment for new code that’s being developed is not as not the same thing as having a test environment or it’s pristine. That’s a copy of prod, right?

Bill Russell:                   14:24                Dev, test, stage production.

Bill Hudson:                  14:27                We have some kind of certification environment and so that’s a whole methodology and you start looking at it’s not one extra environment. It’s probably two or three extra environments. And I think for the most part, um, you know, most folks have gone through the implementation, you know, the days of our, in the last since 2009. A lot of those guys have gone down that path of implementing them. But I think it’s important to make sure that we maintain the rigor in terms of how we support them to make sure that those environments can stay consistent. That the certification environment is in fact representative of what is in your production environment. So that when you do have something come through as a last minute what you’re testing is actually against something that you know it’s in use and everybody goes, ah, I’m sure it’s going to be fine. And you know, 99 percent of the time you’re going to be completely fine. And I can tell you that over my career, there’s only been in probably two or three times where I had this certification environment prevented us from moving forward and people look at that and go, well, two or three times. Was it worth it? And you know. Yeah, yeah. Well my comment is, yeah, absolutely it’s worth it. In one case it was, it affected revenue cycle issue and in another case effected the clinical care issue. And I can’t honestly remember the third one was, but that’s a, that’s, something that we have to, you know, I think we have to pit a little bit of attention to and make sure we’re putting in.

Bill Russell:                   15:46                I haven’t done an EHR in the cloud yet, but EHR in the cloud environment, can you get those, those different levels.

Bill Hudson:                  15:53                So we were not running. We’re not running Ehr in the cloud right now. We are, we have a partnership with a, a hosting provider that’s posting our Dr. we are actually looking at doing it in the cloud. Um, and when we go that direction it will be, we will

Bill Russell:                   16:09                I think what people think is, oh, I’m going to outsource it. And we moved, we moved to our EHR to the cloud, we have cerner in the cloud, we have epic in the cloud, but you still have to, I mean, you still have to certify the security and you still have to serve, certify the, the, uh, new code that’s coming into your environment.

Bill Hudson:                  16:25                And in fact, you mean it boils down to your responsibility is even more about application functionality and workflow than it’s ever been. And I think making sure that I’m making sure that you manage it and pay attention to that. You’re not abdicating that responsibility. You still have that responsibility. If you don’t do it, you’re going to get bit by something at some point.

Bill Russell:                   16:47                So is there a last question here? So is there a technology that your keeping your eye on that you’re saying, hey, you know, in the next three to five years, I think there’s going to be a lot of movement in this area.

Bill Hudson:                  17:01                Well, I, you know, I think we’re all on the substance of cloud. I think we talked earlier, I think there’s a number of things that make a lot of sense for us from a cloud standpoint in disaster recovery in the cloud is a, is a great use case for cloud tech. I think that we’re going to see the cost of cloud computing and the capabilities for cloud computing decrease. So as the cost decreases, the capabilities are going to increase to the point that it becomes viable for a greater number of workloads. And I think that will have the ability, I think potentially to transform healthcare technology in a very substantial way. And um, and I know everyone’s talking about cloud and we something cloud, but I can’t reiterate. I can’t overemphasize the fact that the cost is coming down and it’s google, it’s Amazon, it’s, you know, ibm’s even in the space now and it’s, you’ve got these third party guys that are trying to compete in this space. They’re driving the cost of compute and performance down. And as that cost comes down, the ability to be able to use that, that, that a platform for more and more of the applications. And that are in our clinical portfolio, it will be huge. I mean we will literally start turning the lights out in healthcare data centers over the next four or five years.

Bill Russell:                   18:21                Yeah, we, we, we built a stack and had 14 different layers and we said okay, if we move to infrastructure as a service and we just looked at it, it’s like the first six layers go away and if we do a software as a service, the first 10 layers go and then it just becomes obvious. You’re looking at it going, oh my gosh, my it organization gonna be really focused on the consumer, the internal consumer and the extra consumer because quite frankly all this stuff’s going to be handled potentially by, by external third parties or much smaller team on your side,

Bill Hudson:                  18:55                We’re going to be spending an increasingly large amount of our time as a percentage around integration and interoperability. That’ll be. It’ll be connecting the devices connecting the clinicians connecting the patients and it will be a lot more consumer focused than we are today. And you know, we’ll use that. We have, we have an e Biz functional like all organizations do. And again, we’re a community health care organizations that E business function, I can’t develop everything, but we focus on kind of that last mile that provides an additional advantage. We’ll do a lot more of that and we’re going to start, we’re going to start stitching together a variety of consumer type apps to provide that unified experience for our patients and our consumers. And that’s going to be what we’re going to focus from a tech stack standpoint. It’s going to be the orchestration and management of that layer because I’m not going to spend time anymore figuring out how many bumps I’m doing right.

Bill Russell:                   19:48                The other, the other amazing thing to me has been to just chat with people. I’m not going to ask you to reveal yours, but I ask people, you know, what’s holding you back? And invariably people will say different things, but it all comes down to legacy. So much of our environment, it’s still legacy. A significant portion of our staff are still working on legacy, maintaining legacy. And those legacy environments are not, are not highly interoperable or not architected in a way that are easy to to fail over and build a Dr and those kinds of things. So you have to be really creative around it and some of those environments last preferred in healthcare for decades. It’s amazing.

Speaker 2:                    20:28                So I honestly, I, I don’t believe that what’s holding us, what’s holding us back is a technical problem. I think what’s holding us back is good organizational, operational alignment, you know, being partners with the business being partners for the operations so that, you know, this is not an us versus them conversation. This is a we conversation, this is how we take this into the next level, how we manage the organization is all about getting this thing, getting this done. And I look at what’s different about this organization versus other organizations I’ve worked with over the years is that that operational alignment is extremely tight. And so that when we just, when we look at it and say, hey, we think there’s opportunity for us to, you know, take more costs out of this or provide additional flexibility or provide additional capability, you know, the operational team, we sit down and have that conversation engaged and sometimes that’s now we can’t really do this or maybe it’s not right now, but we put it on the roadmap and we work it.

Speaker 2:                    21:32                So I’m here today to, here a chime to talk about what we’ve done around application rationalization and latest date of retirement. And you know, one of the reasons we’ve been so successful with this and the team’s been $19,000,000 over three years, wildly successful at taking costs out of it in the last three years. It’s been because we have a tight operational alignment. We run this as a program and we’ve operationalized it in everything that we do. So we bring something in, this is part of the plan in terms of how we take that out of the system and a lot of these systems aren’t going away to different systems in our data center, a lot of these things are going away to different systems in the cloud and I’m managing it differently.

Bill Russell:                   22:10                That’s awesome. Well thanks for your time. I really appreciate it. Look forward to your session this afternoon. Thanks a lot. Appreciate it. So Tom Stafford, cio, Halifax health, Daytona Beach, Florida. Life’s hard, but you had to go from Daytona Beach, Florida to San Diego for the Chime conference.

Tom Stafford:               22:27                It’s very difficult.

Bill Russell:                   22:28                Yeah. Somebody but somebody had to do it and I appreciate you sacrificing yourself to go ahead and do that. You are actually speaking in like 20 minutes, 20 minutes, so you must be pretty confident in your talk to.

Tom Stafford:               22:40                Yeah, it’s a good story. So it’s easy to tell what,

Bill Russell:                   22:44                what’s your, what’s your talk?

Tom Stafford:               22:45                It’s a transforming it and our journey to clinical efficiency. And so essentially like seven years ago, my it department hated itself. Our attrition rate was 30 percent. And then in the last we did a bunch of initiatives. So in the last four years, uh, my attrition rates now less than five percent and we’ve been named the best place to work in it by computer world for the last four years in a row, like number 10 to five and five is our ranking and now we do some great stuff because I got a stable workforce, I got a stable infrastructure and stable systems which allows us to innovate. And so that’s really what I’m talking about.

Bill Russell:                   23:25                That’s awesome. We could probably talk about that for 10 minutes, but we’ll go down the technology question since you’re one of the bold people who actually chose the technology section. Almost everybody takes the culture one because it’s a hard thing. A lot of cIos are really focused on, on culture. Although. So are you. I mean,

Tom Stafford:               23:42                that’s why I get to come to these things because my teams run amazingly. So even when I’m gone. They’re still doing great jobs. So.

Bill Russell:                   23:51                So from a technology standpoint, four questions, first one, what technology do you think will have the greatest impact on healthcare over the next three years? Um, Apis, hands down, application programming interfaces. So, um, you know, one of the things, healthcare it came up in silos and so I got an HR system, I got a patient logistics system, I have my health care information system and they all have good data in them but nothing talks to each other and the only way we could talk was through hl seven, which is kind of clunky and unreliable. Well it’s not unreliable, it’s very expensive to set up your interfaces and things like that. And so now that Api came on the market, it changes everything.

Bill Russell:                   24:31                So are we going to see APIs from the vendors? Are we going to see the Apis from fire and standards or role

Tom Stafford:               24:37                today? I, we, I see the API from vendors and so like most of our, even on Meditech too has an API and so we use those apis just to connect things together. And so back to that golden data, the APIs, let me take the data out of the different systems and then we’ll put it in some like next Gen clinical decision support system and provide actual information to our caregivers and I’m heavy Vocera user. And so we’re fortunate because I can actually send the alerts, predictive or prescriptive alert, straight to the badge and it’s very specific so it’s the only one that gets the alerts, the nurse and the CNA for that patient. And so that’s kind of and the APIs is what allowed us to do that.

Bill Russell:                   25:23                I think people think so we had 16 hospitals running on Meditech and I think people think Meditech is pretty closed system and I wouldn’t call it the most open system.

Tom Stafford:               25:31                Yeah, they’re all kind of closed

Bill Russell:                   25:32                but, but yeah, you can get the data out and you can access a bunch it through Apis and stuff.

Tom Stafford:               25:39                And even Meditech’s becoming more open to letting data in. I was out to dinner with HODA Last night and we were talking about us so it’ll actually help us in the future too.

Bill Russell:                   25:49                I love how you say, HODA, it’s sorta like saying Judy, in the Meditech world everyone knows who you’re talking about. So a second question. So, our interaction with computers is changed over the last decade from, from laptops to mobile and now we’re seeing some voice technology sort of show up. let’s talk a little bit about voice here. So, where do you think health systems should be looking to expand their use of voice

Tom Stafford:               26:15                voice as in like speech rec or just communications in general?

Bill Russell:                   26:20                Well, interaction with interaction with technology through voice. I mean we can talk about, talk about patients using it. We can talk about, uh, clinicians using it, whatever.

Tom Stafford:               26:32                Yeah. So it’s one of my goals as a cio is to keep clinicians away from computers, which is kind of odd. No, but you have to enter the data, but after that I should be able to give them the actual information without having them go back to the computer. Right. Because if you think about it, if you’re at a med search floor, a nurse or a physician, maybe it goes to the computer every 45 minutes to an hour. And then intensive units are like 10 to 15 minutes and ed is like three to five. So if I send something to the computer it’s not timeline. And so when it comes to voice, like I said through Vocera, it’s really easier for us to send out, you know, actionable alerts directly to the caregivers. And the other thing I’m starting to do with Vocera is through a voice command. I can change a state of another software system. Yeah. So what my current use cases right now for that as a, when we go to discharge patients from a hospital. Alright, so you’re the nurse or the transport or the auxiliary goes into the room to get the patient. Essentially they walk out, they take the patient to one of our exit points and when they come back up to the floor then they dirty the bed. So that time when that bed’s empty before it’s dirty and it’s called dead bedtime. And so what I’m working with Vocera and teletracking right now. So the future workflow would be When the nurse auxiliarying walks into the room, they click their badge and they say they want to talk to teletracking and they say dirty bed 1506. And so they’re dirtying the bed as they walk in the room. So by the time they walk out with a patient, evs is there waiting to clean the room. So if you say like you have 30 minutes of dead bedtime, that time, 22,000 discharges is over a patient year and a half, which is material. So we’re doing that sort of thing. And then the other thing too is just voice in general, we’re working with nuance and even meditechs doing this really cool thing now where you can like use speech rec to kind of set up notes for you and you can kind of talk in your own terms and then when you go back into the computer or remind you that you need to put this order in for this and that. So that’s kind of where we’re headed down the voice path.

Bill Russell:                   28:34                So what, uh, I just had a great conversation on a cloud with a gentleman. So what percentage of your infrastructure do you think is on the cloud now and know what’s the biggest challenges to growing that are utilizing the cloud more? Or is that even a goal

Tom Stafford:               28:51                it’s really not a goal for me. A lot of my peers make fun of me because I’m kind of clouded first. I Have Athena, which is cloud based, and then we also have some third party claims folks. A lot of the rev cycles already in the cloud, but that’s really about it. My challenges with the cloud is I don’t see the total cost of ownership today because I’m never going to go full cloud.

Bill Russell:                   29:12                Yeah, it’s. So it depends on the scale of the organization, whether you’re going to be able to make the numbers work. Yeah. So you know, we, we had a 40,000 square foot of data center space. We had tens of thousands of servers and at some point you see you get to a certain point and all the numbers start to work, but if it’s out there, but if it’s something, if it’s something below that and actually it’s pretty big, it’s still below that, that it’s hard to make the cloud numbers work in and of themselves. You almost have to start to layer on different kinds of use cases. And, and Dr Costs and some other things that you normally couldn’t do

Tom Stafford:               29:55                Yeah, the only thing we’re looking at in the cloud right now is to put our final copy of the data as you know, like our final Dr thing. So I’m not holding it in on wire.

Bill Russell:                   30:04                So how were you, how were you keeping up with storage and those kinds of things?

Tom Stafford:               30:08                Um, my organization’s pretty kind and I have a surplus of storage or you do really do. And so it gives me the agility to act like I’m a cloud vendor because I can pull up a server in seconds. Like

Bill Russell:                   30:22                you absolutely can build out a cloud environment internally and there’s enough of that you can go hyperconvergence, you could do tiered data storage through a lot of vendors. And a lot of those things

Tom Stafford:               30:31                So we do a lot of that in house today. And uh, even in presentation, one of the things that I’m talking about this, I have a infrastructure refresh schedule that I followed. And so every year I spend the same money on tech and I replace things when they should be replaced. And so that kind of the deal of capital or is if you let me spend the money, we don’t go down and we’ve achieved that, which is Kinda Nice. It’s interesting. I’ve been at major health systems where it’s you do the rounds and you talked to clinic clinicians and they’re on like seven year old pcs and I think I wouldn’t even give my kid a seven year old pc to go to to highschool.

Tom Stafford:               31:08                That hurts h caps by the way. Yeah, I mean their work, they get frustrated or human. That frustration is going to go into.

Bill Russell:                   31:15                And the simple solution is you put together a schedule and you stick to that schedule. And I did. And uh, I think people think it’s more complicated than that and it’s not,

Tom Stafford:               31:23                it was hard the first couple of years because I had to level out the expense. And so like with the pcs, we bought a bunch to kind of catch up. But then now I spend x amount of money every year and I just replaced a quarter of our pieces.

Bill Russell:                   31:35                How do you keep up with the upgrades cycle with a Microsoft and workstations and that kind of stuff that

Tom Stafford:               31:42                Well we’re moving to windows 10 now like everybody, but it’s, it’s a challenge. And so essentially when, once we see that happening, um, when we buy our pcs, obviously we licensed them for windows 10 but we downgraded and then we’re, we’re actually going to start rolling out windows 10 to the whole organization in about another two months. We have it in IT right now. It’s interesting. Everybody’s frustrated with the edge.

Bill Russell:                   32:04                So when you’re going to roll out windows 11.

Tom Stafford:               32:07                No, whenever it comes actually went and announced. Microsoft’s been coming very cloud based too. I mean OS a different story,

Bill Russell:                   32:17                but yeah, it’ll, it’ll be interesting. But you know, I was talking to somebody, I was talking to a security person today and they, and they asked me the question of uh, I think it was rhetorical, but it’s how many, how much windows xp do you think there is still in the environment and there, there is. Especially in biomed. Yeah. And I don’t think people really recognize this with some biomed devices are still running on xp.

Tom Stafford:               32:43                I have a few in mine, I can guarantee you every hospital has xp and it’s via biomed hands down you gotta. Um, so we bury it microsegmentation, you know, hide things, but it’s fun.

Bill Russell:                   32:55                Well, I asked you for 10 minutes of your time. That’s actually 10 minutes. The last question was, uh, you know, if we were to visit a clinic of the future, say in eight years, what do you think that environment might look like in that room? You think it’s going to change pretty dramatically.

Tom Stafford:               33:09                I think there’s going to be microphones, um, with ai coming to where it’s going. There’s no reason literinally eight years from now when you walk in the patient room, the physician just talks. The nurse can talk through voice. Right now they can do multiple voices in the same room. So I can pick that up and go ahead and put it in the documentation and the physician reviews everything and hits submit and done.

Bill Russell:                   33:31                I think we’ll see five g in or are we, is too much of and I cringe when I say it too, I mean from a security standpoint, we can do all

Tom Stafford:               33:41                it hops around, but um, I dunno,

Bill Russell:                   33:45                but it’s interesting when you think about the amount of bandwidth that’s going to be available through the air and we’re going to have less bandwidth available across the wire.

Tom Stafford:               33:52                Literally the wire’s going to be the choke point, but uh, that’ll come into play too because when you have that many, that many voices that you’re trying to compute and then having an ai engine decide where to put the information will be.

Bill Russell:                   34:04                But you know, it is going to be, you know, hello room. Let’s just do that. I think that’s right too. That’s why I keep talking about voice because I think voice is going to change everything, but it’s got to catch up. It still doesn’t hear everything we’re doing and

Tom Stafford:               34:18                No, but they’re getting better. I mean, nuance is definitely doing some good things

Bill Russell:                   34:22                and I can’t believe some of the words they pick up. Yeah. Especially on,

Tom Stafford:               34:25                which I can’t even spell those words, but yes, thank you very much for your time. Really appreciate it.

Bill Russell:                   34:30                Well, that was a lot of fun. I hope you enjoyed it. That was our second in a series of three recordings from the Chime fall forum. The third one will be released on Friday and that is with bill spooner and I’m looking forward to sharing that with you. And don’t forget to check out the youtube channel, the website obviously. And you can follow the show @thisweekinhit on twitter and you can follow me @thepatientsCIO. Please come back every Friday for more news, information and emerging thought with industry influencers. That’s all for now.