CHIME James Brady, A Look Back / Forward

Bill Russell: 00:04 Welcome to this week in health it events where we amplify great ideas with interviews from the floor. My name is bill Russell healthcare CIO, coach and creator of this week in health it. A set of podcasts and videos dedicated to developing the next generation of health leaders. We want to thank our founding channel sponsors who make this content possible, health lyrics and VMware. If you want to be a part of our mission to develop health leaders, go to this week, health.com/sponsor for more information. This episode is sponsored by health lyrics. When I became a CIO, I was really overwhelmed at first and one of the first things I did was to sign a CIO coach to walk with me through the journey. This was someone who had wisdom that can only be gained through years of experience. It was invaluable to my success in the role and I now coach CIOs through health lyrics.

Bill Russell: 00:55 If you want to learn more, visit health Lyric’s.com or drop me a note at [email protected] over the next three weeks. We have a huge treat for you. I’m really excited about it. Uh, I just got back from the chime fall forum in Scottsdale, which was a great event and we caught up with 12 active CIOs from various size health systems and asked them to take a look back at 2019 and I look forward at 2020. Uh, you’re going to hear, um, what they’re excited to have accomplished last year and what they’re looking forward to accomplish next year. I asked each of them the same eight questions and I think you’re going to be fascinated to hear the similarities and the differences based on where they’re at, geography and other things. Each of these interviews is about 10 minutes long so you can listen to them really quick and some of you listen that one and a half times speed.

Bill Russell: 01:43 So it’s going to go like that. Uh, we’re going to publish one a day, uh, with a few Newsday episodes sprinkled in through the end of November. So check back every day for the next episode and don’t forget to look back to see if you missed any. I was excited to get a chance to sit down with James Brady. James and I have been CIO’s in the same market for quite some time. Uh, James is now the CIO for the LA County department of health services and uh, we had a very interesting conversation. Again, I appreciate when we get different perspectives and different health systems trying to accomplish different things. I learned a bunch. Hope you enjoy. We’re ready to go. Here we are another session

Bill Russell: 02:19 from chime fall forum. We’re here with, uh, Ascension. Uh, uh, gosh, I’m mixed mixing it up already. LA County health services,

James Brady: 02:30 Los Angeles County department of health services.

Bill Russell: 02:32 There you go. Um, four hospitals,

James Brady: 02:36 four hospitals, 23 clinics, uh, covers about 4,000 miles. Uh, population of 10 million folks, 1900 beds, uh, 6 billion in revenue. So it’s a quite a large area to cover.

Bill Russell: 02:50 significant, uh, homeless population. And I said, we were talking earlier that there’s a lot of your, a lot of you take care of the people that the other health systems aren’t taking care of essentially. Right?

James Brady: 03:04 Yeah. We are the, uh, second largest public hospital system in the country. Uh, and we are considered a safety net, although we do have folks that are about 600,000 people that are in paneled. Uh, and you know, a number of people do choose to come, uh, to the Los Angeles County hospitals. And we’re also, uh, very, very closely aligned with USC and UCLA, uh, for residency programs and also a Charles drew, uh, nursing, uh, uh, for their residency program also.

Bill Russell: 03:35 Fantastic. So what we’re doing at the conferences, uh, look back look forward kind of thing. So, uh, eight questions asking all the CIOs the same eight questions. There are no right or wrong answers. Every health system is so different. It’s, it’s been really fascinating to listen to. Um, you know, the first question is how do you think the role of the CIO has changed over the last year? Not over the last five, but just over the last year.

James Brady: 03:57 Yeah, I think over the last year, uh, definitely a more strategic thinker that can help the executives and the leaders in the boards know, Hey, what do we have to do in order to, uh, you know, achieve our, our mission. Um, and so, you know, we’ve, we’ve watched the CIO, CIO role go from the it guy or it gal in the basement, you know, to service delivery to somebody more of, uh, you know, more involved in the business. But I think the role now you really have to understand the business. And at the, at the County, we’re seeing a shift now. Uh, the way we get our funding is has largely been through federal waiver programs. And so those programs are leaving in 2020. So we now we have to move, uh, it’s, it’s being shifted more to the state who is going to be using managed care. So there’s a lot more focused on value. So we’re really concerned about how do we demonstrate value. And so that financial sustainability is one of our key initiatives. So understanding that, you know, how do we help lead the organization? There is a, it’s an important role for the CIO.

Bill Russell: 04:59 Phenomenal. So what are, I mean you probably just rattle off one of them. Yeah. So what are some of the priorities that your system is looking at that uh, health its, is looking to support over the next year?

James Brady: 05:12 Yeah, so I think in addition to that one, which is a big one, uh, we’re also looking to really re-engineer and optimize our workforce. And in the state, uh, or in the local government, uh, it’s important, uh, I believe to really invest in your employees because technology is changing and, and traditionally many of the roles might’ve been a little bit stagnant. Uh, so it’s infusing that with, uh, how can we make sure that all the employees are, are educated and trained to be able to do their job in the new era coming up. And secondly, it’s a real focus on population health and understanding our populations. Uh, you know, being able to care for them better. Uh, and as we shift more towards that value based care,

Bill Russell: 05:59 are there technology plays around, I mean there’s this, I live near your County. I live in orange County, but near next door.

Bill Russell: 06:08 And, uh, the homeless population in both of those counties is pretty significant. Is there any thing that from a technology perspective, I mean, I don’t, I can’t think of anything off the top of my head, but I was curious if there’s anything we’re doing, uh, maybe coordinating activities between different, uh, entities or those kind of things, uh,

James Brady: 06:26 between counties or,

Bill Russell: 06:28 well, just, just for the homeless population. Um, there’s a lot of times, you know, we’ll come in and we’ll go, we’re going to do these kinds of patient engagement things and people will go, yeah, but what about the people who don’t have phones? The people who don’t, and, uh, I’m just wondering how we’re applying technology to that specific problem.

James Brady: 06:48 Yeah, I think it’s, uh, interoperability is huge. Um, if we, if, if we, you know, those, uh, homeless folks, they do come in to the EDS, they present themselves, they’ll have a problem. And, uh, you know, we may admit them and then they get discharged. And oftentimes we have to, you know, they don’t have any place to go, so we’ll get a transport and we’ll take them back to where they came from. But, uh, you know, it’s really looking, uh, using technology to document and then making that available to others. And there’s a huge amount of, uh, behavioral health and mental health issues with our homeless. I mean, they’re kind of in that situation because they’ve, they’ve got really tough things going on. So, uh, so, uh, not having access to information and then being able to, uh, take them to other, uh, sites of care such as post-acute or rehab or mental health, things like that. Um, you know, that’s where they’re going to get help. And we’re actually looking at healthcare now. Health, let’s get people healthy and then also care.

James Brady: 07:44 Let’s care for people with housing and education. So it’s more of a whole person care. Matter of fact, there’s a federal program called whole person care that, uh, gives millions of dollars to many of the counties and States, you know, to work with people to go past the healthcare component and, and help them get back up on their feet again.

Bill Russell: 08:05 So we’ve been asking this question sort of a two part question, but um, w it’s a initiative that’s improving the patient experience initiative that improving the clinician experience. Um, and we’re just asking people what, what are examples of just one on the patient side? One on the clinician side?

James Brady: 08:24 Yeah. So probably on the patients that I think if we can get to Amazon and healthcare where there’s just one click and I think that’s Jeff Bezos is one of his goals. What you know, where it’s really self-service, where you know, you have a need for something, you’re able to go digitally and get to that.

James Brady: 08:41 I mean, if you need to come in and see somebody, fine, but if we can use the digital, it would be so much better. Convenience, not having to go leave work, grab your kids, drive on the freeway, wait in the waiting room, why do we have to call them waiting rooms anyway? Um, but you know, it’s being able to go ahead and do that digitally. Uh, so, so really engaging in the patient experience I think is something where it’s important on the clinic, on the clinician side, uh, we’ve gotta be able to get our, our physicians untethered from the keyboard and data entry. So that’s going to be using artificial intelligence, machine learning, natural language processing. Uh, you know, there’s a lot of advances now with voice so that you can just have a natural fluid, uh, interaction and have all that documented and available rather than your top, you know, you’re typing and you’re turning back and forth to the patient.

James Brady: 09:36 So it’s a little bit awkward. It slows things down. And you know, physician burnout is a big issue at this point. A lot of it’s because, uh, you know, docs are having to just do and providers are just having to do a lot more manual things that hopefully one day in the future, not too far, we’ll be able to get past that.

Bill Russell: 09:53 It’s interesting as you’re talking about that it’s like the, the object is to make it easier for the patients. The objects for the clinicians make it easier for the clinicians.

James Brady: 10:00 that supposed to have been the goal. Unfortunately most statistics and research indicate that physicians, it costs more to use an electronic health record than they were prior when they were on paper. And then they spend more time documenting and taking care of what, you know, of the administrative stuff now that they have electronic health records.

James Brady: 10:21 So it’s definitely been an issue and there’s plenty of research out on it and that’s where we have a high physician suicide rate in the country and at least in the U S so it’s a, it’s a problem. And I, I think the answer is going to be, uh, you know, that human computer interaction where it’s going to be more natural and, uh, but it takes, it’s going to take us a while to get there.

Bill Russell: 10:41 Yeah. The computer with ambient listening, you’re almost going to have a computer being ascribed, which should be interesting. Uh, what’s your greatest it success for 2019 for your team? What are you most proud of?

James Brady: 10:52 Yeah, I think, uh, I came to the Los Angeles County department health services in January. And, um, the organization is traditionally, uh, the Genesis was a number of separate acute care hospitals and clinics kind of all came together.

James Brady: 11:08 So, uh, we did implement in 2012 a electronic health record through Cerner. Uh, but in many ways, although we operate as an integrated system, uh, we’re still moving in that direction. So I think, um, from my perspective, one of the things that I’ve been working with our senior it leadership is to, how do you get, uh, all of those CIOs to come together and be one team, sort of like the Patriots before their last loss. Uh, you know, but a cohesive team where, uh, we still take care of our, our hospitals, but at the same time, we are focuses on the enterprise and it’s on the system. So I think it’s just getting that top level leadership to buy into that. And then we’re making changes where we’re, uh, you know, working in meeting together and operating more as a cohesive team. Uh, in order to, the goal would be to continue to drive towards a, uh, an integrated fully integrated system.

Bill Russell: 12:04 Yeah, that’s a, that’s a challenge. And, you know, I’ve been asking this next, next question as what’s a missed opportunity for 2019? And I’m not getting the answer I expected, so I’m going to change it a little bit. I can, I’ll be happy to answer that. But really what I’m trying to focus in on is what do you wish you had had more time to spend on over the last year that you just didn’t get to because there’s just so many other things going on.

James Brady: 12:27 Right. So, uh, I’m going to answer both questions. Thanks. Because they’re great. Uh, so, uh, you know, data is such a huge important area in healthcare. And if the, if the data doesn’t go in properly, then you can’t really get the reports. You can’t get the outcomes that you need from the data. So, uh, and so with the electronic health record and you know, the focus for us and the County is getting it in, you know, um, really have we optimized it and then are we really, uh, making sure that the data is something that we understand.

James Brady: 13:04 And so many physicians really were not taught to code properly. And so rather than going back 10 years and trying to, uh, try to teach physicians how to code, can we use some of these more advanced tools, physician aid of session coding and chart assisting and things like that. So I wish there was more time and focus to be able to, to understand what’s in the market and then being able to implement it so that we could get a better idea of our data. Because as I mentioned earlier, uh, our revenue moving forward in public hospitals in the country, particularly in California, is not going to be given to us through federal grants and waiver programs, but it’s really going to be through health plans and demonstrating value. So we really need that data. And then of course, the most important thing is to be able to care for patients. And if you don’t have the right data, then you can’t really care, uh, care for patients properly.

Bill Russell: 13:57 Right. Um, what’s one area you’d love to see more innovation that, uh, you know, if you were able to just turn the key and say, you know, we’re gonna really have a lot of progress, we’re going to move the needle in one area, what would it take?

James Brady: 14:12 Yeah, I think the biggest one, and this may have been said by others that have sat in this Nobel chair, is the EHR is really just a conversion from a paper chart to a digital chart. But it’s not, it’s not intuitive. There’s too much typing. There’s too many things on the field. You know, too many little boxes. You need a giant monitor in order to use it. But how can we, uh, it goes back to my other comment, how can we change that clinician to computer, uh, you know, interface.

Bill Russell: 14:47 And so I’ve heard some stories, uh, somewhere in Asia got to a new EHR construct where it doesn’t look anything like what we’ve got here. It’s more of just a picture of an individual’s body and you just kind of point and click and you talk to it. And it’s completely different than what we’re doing right now, which is still, we’re still tight ball and chain to that, uh, you know, fields, discrete fields and it’s very time consuming and it’s not natural. It’s not, I mean we, we talk much faster than we can, right. And we think way faster than we can talk, so. So I think it’s moving in that direction with the EHR and how we document care and during, uh, encounters.

Bill Russell: 15:30 Yes. So one of the things we’ve learned from surveying our audience is we have a bunch of college students watching this show. And it’s a, it’s fascinating to me that they are, and I think it’s because healthcare is, is an area that this next generation really wants to invest their time.

James Brady: 15:46 And I make a comment about that. Sure. All right. Yeah. So to all you college students out there with generation Z and maybe some millennials that are getting a late start.

Bill Russell: 15:55 Millennials are pretty old now.

James Brady: 15:56 So we need you, uh, you know, there’s a lot of research that is demonstrating or indicating that a large percentage of the workforce moving forward will be you guys, uh, you guys have the great ideas. Uh, and so, and if you have any, uh, passion for, uh, working for public service, go ahead and follow those passions cause we’ve got a lot of meat and in our public hospitals.

Bill Russell: 16:21 So the question they’re asking is what roles is health it? And we’ll just focus on 20, 20. What, what, what roles do you think you’re going to be hiring in 20, 20, and maybe even beyond that, that they should be focusing in on?

James Brady: 16:34 Well, definitely not COBOL and mainframe. Yeah. Although it still exists in some places, but actually that might be a good job security cause they may never know. I would say, uh, analytics data, artificial intelligence, coding, particularly data scientists roles. Uh, you know, being able to code with modern, you know, cloud-based techniques. Those are, uh, those are things that, uh, that I understand are, you know, are good. They have a good, uh, pay scale for and what, you knew what we used to do two or three years ago, it really isn’t that relevant now. It’s, it’s really moving forward into these new areas.

Bill Russell: 17:14 And, you know, and that goes back to our first question, how has the role of the CIO changed to this next generation? They’re going to have to reinvent themselves three or four times over their lifetime. Um, because just in the time, just that decade or so, I’ve been following the healthcare CIO role. Uh, it’s dramatically changed. I mean, the things you used to have to be good with technology and understand like the infrastructure that kind of stuff, then you had to be really good at organizational change management and do that EHR. Uh, and now it’s, you know, forward looking technologies, you know, cloud, ambient listening and that kind of stuff. And, and that’s just a decade. Um, I’m seeing CIOs have to reinvent themselves multiple times. This next generation is probably, I’ve probably been kind of saying three or four times in your career, you’re going to have to just keep changing.

James Brady: 17:57 Yeah. We’re seeing a lot of, uh, a lot of new physicians that are very technically savvy. You know, they’re like, what are you guys doing? I can’t believe it. You know? So the expectation from them is, I mean, they grew up with Facebook and social media and mobile devices. So I think we need to drive, continue to drive towards mobility and ease, ease of access. Um, and then another, just one final comment is, uh, I think the CIO, it’s important to be able to partner well with the other senior executives that lead the organization. Uh, and you know, you, there’s lots of different personalities in these organizations, so, you know, can you get along with all of them? Can you, can you help support and supplement where you know really where and bring people together. So I think that’s an important, it’s a team sport quality. Thank you. Thank you so much for sharing your time. Appreciate it. Thank you guys.

Bill Russell: 18:54 I hope you enjoy the conversation. Remember to check back often as we are going to drop an episode a day for most of November of 2019 following that, please come back every Friday for more great interviews with influencers and don’t forget every Tuesday we take a look at the news, which impacts health it. If you want to support the fastest growing podcast and the health it space. Here’s a few ways that you can do that. The first share it with a peer, share it with a friend, share it with somebody who’s working right there next to you. Number two, sign up for insights and staff meeting. These are services designed to help you in your career. Number three, interact with our social media content on Twitter and LinkedIn. Number four, post or repost our content. And number five, always send me feedback. [email protected] your insights continue to shape the channel. This show is a production of this week in health it for more great content. You can check out our website at this week health.com or our YouTube channel. Special thanks to our sponsors, VM-ware and health Lyrics’s for choosing to invest in developing the next generation of health leaders. Thanks for listening. That’s all for now.