Jonathan Manis on How Consumer Expectations will Change Healthcare

Jonathan Manis This Week in Health IT
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Jonathan Manis joins us to discuss digital disruption. Although he asserts, Consumer Expectation Disruption is the real driver for the changing landscape for healthcare. Are we ready, and how do we get ready? A fun discussion, hope you enjoy.

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Bill Russell:                   00:00                welcome to this week and health it influenced where we discussed the influence of technology on health with people who are making it happen. My name is Bill Russell, recovering health care CIO and creator of this week in health it, a set of podcasts and videos dedicated to developing the next generation of health it leaders. This podcast is brought to you by health lyrics. Need a health it executive coach. Let’s talk visit health lyrics .com to schedule your free consultation, shortest advertisement in all of podcasts right there. Uh, today we are joined by one of my favorite speakers and someone who has spent much of the last decade operating in and around Silicon Valley, former CIO, Sutter health and current CIO for Christus health. Jonathan Mannis. Good Morning John, and welcome to the show. Good morning.

Jonathan Manis:           00:49                Great to be here. Thank you for having me. I’m excited for, uh, for our topic.

Bill Russell:                   00:53                You know, I did not, not, not to put any pressure on you, but I’ve referred to you on previous podcasts as a quote machine because there there’ve been times where you have spoken and I, I just take the quotes and read it back because they are, uh, uh, you, you speak pretty frankly about where the industry is at and the impact that this digital transformation is having. And that’s, that’s going to be our topic for today. So I’m looking forward to that.

Jonathan Manis:           01:17                Yeah, it’s a, it’s a topic I’m very passionate about, very near and dear to my heart. And, uh, and I’m, I’m excited to have that conversation with you.

Bill Russell:                   01:26                Well, uh, you know, before we get there, um, you know, some people may not be familiar with Christus and I think it’s one of the more interesting healthcare organizations and success stories. And one of the things I think that’s really fascinating, it’s one of the largest health providers in central and South America. So tell us a little bit about Christus. Yeah.

Jonathan Manis:           01:47                Christus of course, is a Catholic health ministry. Um, we’ve got about a 70 hospitals across five states. Um, we also have about 20 hospitals in three foreign countries in South America. That being Chile, Colombia, and Mexico. Um, we do, um, we do about $8 billion in revenue. So a fairly large system, mostly serving a rural communities, some of the underprivileged and marginalized communities across those five states. We offer the full spectrum of health care services. So we’ve got clinics, hospitals, medical office buildings, I would say assisted living, nursing homes, behavioral health, some outreach, some retail pharmacies, those kinds of a, of services. So the full spectrum of, of health services, um, on the it side, uh, multiple platforms. Uh, unfortunately as part of the work that we have to do here, uh, probably have every cat and dog system. There is a but primarily metatech epic, some Athena and Tazzy down in South America. So, uh, I think that South American opportunity is one that was particularly attractive to me and I’m anxious to learn, learn about the international healthcare and what we can well, we can help and assist with and what we can all learn from their, uh, from there, uh, provision of healthcare in those, in those countries.

Bill Russell:                   03:07                Yeah, and I’m not going to put you on the spot too much cause I know you’re relatively new. You’re what, about three months into it or

Jonathan Manis:           03:13                about two months. But yes,

Bill Russell:                   03:14                two months. But you know, I’ve had some conversations with George and I know that you spent some time with George Conklin News. The uh, uh, I don’t know what his role is today, but the former Cio, uh, who you’re coming in to replace and he spent a lot of time in South America and just get so excited when he talks about that that opportunity in healthcare is a different but same. I mean it’s, it’s a, uh, each, each, uh, central and South American country is distinct in how they handle health care. And a, you guys have to be very agile in terms of, uh, in terms of how you provide services in those markets. But I imagine that’s going to present some interesting technology challenges as you look at those different countries. But you know, again, you’re two months into it. Maybe the next time you come on the show, we’ll talk more about the differences between, uh, operating in those countries in the u s so

Jonathan Manis:           04:05                well, I would like that very much. George is still here, he’s still the CIO. He’s a, he’s a legend in our industry as you know, he’s been a mentor and uh, and uh, you know, a really powerful speaker and a bright light in our industry. I’m thrilled for the opportunity to, to help, uh, build upon his legacy and continue the good work he’s done at Christus on behalf of the sisters and, and Catholic health care. That said, I know he is personally passionate about the mission in South America. Um, you know, they are in many ways, uh, coming through some of the same challenges that we have currently in our industry. Plus, um, in some, in some areas there are a little behind and we’ve come through some of those challenges. So the opportunity to learn from that experience and to share the learnings we’ve had from our experiences, part of what attracted me to the position.

Bill Russell:                   04:54                Yeah. And I’m looking forward to seeing some of the things that you’re going to do down there. It is a exciting organization and exciting leadership team. It should be, it should be a lot of fun. But today when I want to talk to you, I want to take you back in time. So probably one of the first times I heard you speak was that chime maybe about two years ago. And you talked about digitization in health care and how it impacts the practice of medicine. And I particularly, I took a picture of a slide and it’s attributed to Cisco in 2016 and it had this concept of a digital hurricane, uh, the graphic had 12 industries, it had a hurricane graphic image. And you have 12 industries sorta on the, uh, on the hurricane, uh, towards the center of beating the streets that are getting the impact of the most towards the outside that the industries that are starting to feel the impact of digitization.

Bill Russell:                   05:51                And on the left side of that chart, and, and this, this really struck me. I mean it had these four things that happen as a, an industry gets digitized. The first was a, it’s a force that pulls everything to the center. So once you get started in the digital digitalization process, there really is no going back. It’s going to draw into the center. The second thing is industry’s changed pretty radically. They may dissolve and recombine. Uh, you may start to see some interesting partnerships and uh, reformations of companies at the center, all value that will be digitized is digitized. And uh, the fourth thing when you really get close to the center is it starts to feel chaotic. Objects are drawn to the center with a increasing velocity. And again, those new partnerships, new formations, new models tend to spring up, uh, pretty, uh, pretty dramatically.

Bill Russell:                   06:43                And I remember when you were talking about this, the a, it was a pretty packed house at a chime and the questions just kept coming. Cause I think, you know, you, you rewind back in I think 2017 or 2016 when you were given this talk, people were like, Oh, I’m not sure that’s going to impact healthcare as much as what you’re talking about. Um, but it, it, uh, I think you fast forward three years and I don’t think you have many people who are questioning, uh, the impact of digital on healthcare. Where do you think we’re at today with healthcare in terms of this digital hurricane?

Jonathan Manis:           07:17                Well, I think we’ve still, we’re still on the outer bands and we’re fighting it tooth and nail to not get towards, uh, uh, you know, our, our digital destiny as it were. I think, um, you know, we are in many ways a lot like other industries who, who just can’t seem to let go of our current model. Um, we’ve got so much invested in terms of capital in facilities and brick and mortar buildings, um, in an old operating model, in an old clinical delivery model and, and we don’t know how to let it go. Um, and we are, we are doomed to failure if we can’t let go of a, of the things that have made us successful for many years in order to be successful in the, in this new environment. And A, there’s no question in my mind, um, that, uh, that, you know, I think about the, the millennial generations, the gen x, or is the, the, the folks who are being born, even today, there are very different breed of people.

Jonathan Manis:           08:15                People want to know why are we on the outer band of that hurricane? And it’s because we haven’t had to change. Um, and, and nowadays in, in modern life, um, you know, there’s a different expectation for service and, uh, and people want to be served with, there’s an immediacy expectation. They want to be serviced when, where, and how they want to receive services. And, and they frankly don’t care about the convenience of the supplier. It’s all about the convenience of the customer. And a, and we have been very slow as an industry to realize that.

Bill Russell:                   08:47                It’s interesting. So let’s, let’s step back and let’s, let’s take a look at, there’s a lot of industries that have gone through this. Pick your favorite one and sort of walk us through maybe the journey that a, another industry has gone through that sort of started with sort of a traditional model. And if we were to look at it today, you have to look back and say, well, I can’t believe we once did business that way.

Jonathan Manis:           09:08                Well, you know, you look at retail, uh, you know, you remember those early days of e shopping, everybody was a banking banking. We were afraid to put our credit card number on in the, in the computer because it wasn’t going to be safe. Um, retailers thought that this might be just a fad, but the entertainment industry is a perfect example. You look at Disney, uh, you know, now it’s all streaming. They’ve started, uh, to stand up their own streaming service. ESPN, getting rid of, talking heads, moving into the streaming business on any device, anywhere. And you can catch your favorite sports. Um, you look at Netflix for example, on the, in the entertainment industry. Now they have selectable content, right? This is, I don’t know if you’ve seen the movie. Um, the, uh, it was an interactive movie, Black Mirror Bandersnatch which was, uh, allowed you to watch the movie via streaming video but select using your smart phone or your, your remote, how the movie ended.

Jonathan Manis:           10:15                So there’s selectable contents that’s responsive to the needs of the individual watcher almost to a virtual reality sense. And I think that’s really the difference, right? These industries are almost game like in many ways they, uh, they provide that access anywhere, anytime, any how you want to see it. And I think that’s the key. It’s not about digital so much bill as I really think it’s about, um, it’s about being responsive to the customer. I’m looking for an exceptional customer experience, not a standard customer experience. Banking is a, is is a good industry to look at. Um, used to go during banking hours, right? You use to take your check and get a cash. Used to go to the bank to get it deposited. Now all those tellers are becoming Baristas at Starbucks because we don’t need to go to the bank anymore. We do everything from Venmo or take a picture of a, of a check or we just tap and go in. In terms of, uh, of the banking industry. Retail banking is, is as we know, it is an a very steady decline. Citi banks are closing up their, their, uh, their outlets are branches almost everywhere. And we’re able to do that because they digitized. And more importantly, they are being responsive to the needs of the customer. How can we make it more convenient, more responsive to their desires? And that’s something that healthcare just has not yet done.

Bill Russell:                   11:45                And so when we digitize things, we make it a lot more portable, a lot more accessible. And, uh, you know, last week on the show I shared about a Walmart’s new model for their employees where at one point the, uh, the telehealth copay was $40. They now have gotten it down to $4. It’s a huge satisfier. Um, it helps them to really streamline the process and they can actually do primary care physician, a bunch of the primary care physician stuff through that. And one of the things that’s happening today is we’re not going to our primary care physician. The millennials are, and I, and I, I’m not either, but you know, I go to the urgent care and I go to urgent care because it’s convenient. I can get there. And, uh, but the reality is that the next generation is looking for that next thing. And we’re missing out on, on the benefits of primary care because we’re not figuring out a way to really offer it through, uh, through a virtual visits and, um, and video. Um, because it would be better if instead of going to the urgent care every time I started my journey with a primary care doc who could say, hey, you know, you know, thanks for this call because it’s 15 minutes, eight minutes, it’s 10 minutes. Um, it’s convenient. It’s accessible. So that’s what digital enables us to do.

Jonathan Manis:           13:02                But Bill, you’ve said so many important things right there in that, in that little segment. Um, you know, number one is, is, you know, the new generations and I’m talking about those generations that follow the greatest and the, and the, uh, the baby boomers. I’m the one sacrosanct relationship between a physician and his patients has become commoditized. I’m sorry to say that if you have an MD behind your name, my children will want to see you. If they have a health issue. They don’t, they don’t need a longstanding relationship with a, with a physician. They just want to see a doctor who’s qualified to see them and treat them when, where, and how they want to be treated. Um, you know, and going back to your, your, your thought about primary care, you know, every one of the health systems that you and I know or can name across the country, they’re doing telehealth.

Jonathan Manis:           13:54                They’re doing, um, televisits but they’re strapping those things on to an old system model and trying to do them in addition to doing things that we’ve always done and bolting on those, those, uh, those services to the old chassis is never going to work and it’s not going to work because we can’t really do it. Um, at the same price point as the new entrance into this market are doing it because we have these big hospitals and bricks and mortar to pay for. We can offer it for $40 or $4 a visit, but we’re not getting the contribution margin we need in order to pay for those, that big infrastructure and those large hospitals that we have, they don’t have those things. So that $40 for them, it’s a very different $40 than it is for us. And that is a very risky proposition if you look at the overall environment.

Bill Russell:                   14:45                But is that a natural sort of bolting onto the chassis? Is that just a natural evolution? I mean, when you saw, uh, you know, DVDs were being delivered, that one, that one. Dot. You could go to Walmart, you can buy a DVD and they would say it includes digital download. And so that was sort of a, let’s say you know, an evolutionary step two what we are today, which is everything’s completely digital and I’m not sure many people are, I can’t find my DVD DVD player anymore. So is bolting it on sort of, you know. So New York Presby one of the things and a hospital for special surgery and others, they, they do a lot of special surgeries and what they’re trying to do is they look at the areas where, you know, people have to take long visits from New Jersey and whatever and to New York and they’re saying, hey look, we can make this better. We’ll do the surgery. And then the followup is it’s, we can do a lot of that via telehealth. And so they bolted on, they get experience, they learn and then they expand it from there. Is that a, is it that the natural evolution for this and how we’re going to see it sort of evolved in, in health?

Jonathan Manis:           15:45                Well, it’s interesting because I think the hospital for specialist surgery as a unique, a unique example, many ways the traditional healthcare integrated delivery networks, we have been, you know, frankly we’ve been robbed of our business by a number of new entrants. And one of those I think is, um, is the model that the hospital for special surgery, it’s a focus factory, right? They do primarily hips and a, and they do an exceptional job at the high quality, low cost, high volume with uh, with the ancillary to do digital. And I think they’ve done, they’ve done remarkable work. For us in a traditional healthcare setting. Um, you know, you know, we’ve lost in many ways, dialysis. We’ve lost birthing centers, we’ve lost cancer treatment, we’ve lost cosmetic surgery and ambulatory surgery. We’ve lost urgent care, we’ve lost things to those, those focus factories as you pretty recently brought up.

Jonathan Manis:           16:46                And next will be primary care. Those things that used to feed our hospitals are being chipped away from. Our model, leaving us, holding the bag as it were with these large capital intensive hospitals. And, and, and, and our, uh, competition having taken from us all of the, you know, low risk, high margin services, leaving us with the high risk, low margin services. And I’m talking specifically about emergency department, I’m talking about complex surgery, I’m talking about ICU and I’m talking about end of life. Those things that are high risk, low margin are the things that those new entrants don’t want. And uh, and, and we can’t offer those other services at a price point that allows us to do those at, at a competitive market rate.

Bill Russell:                   17:33                So, you know, CIOs hate. It’s interesting. So I just do focus groups every now and then, not actual focus groups, just sitting around with some CIOs having drinks. And I’m like, you know, what’s, what’s the buzz word you hate? And you know, disruption is one of those things that they hate. And they’re like, you know, we’ve been talking about it for eight years, seven years, six years, and it’s just not happening. Um, and, and so they, they almost get kind of cynical towards, uh, the word disruption, although it’s happening. It’s clearly happening when you sit around CEOs and have that conversation. They are, they’re feeling it. They’re like, you know, you can’t keep taking my, uh, low risk, high margin business and leave me with a shell of an old business model. Uh, we’ve got to figure out how to, how to transform, you know. What do you think is slowing the pace or digital adoption, um, within healthcare? I mean, what is slowing down the pace of digital, uh, digital adoption?

Jonathan Manis:           18:33                Well, I think first off is demand. And I think that that’s, um, that has kept us on the outer bounds bands at that digital hurricane I talked about. And what I mean by demand is that the millennials, the Gen Xers, the Gen ys, the generations that will follow, um, they really haven’t had too much of an interaction with healthcare. Right. They’ve been on there and show their parents insurance. They really don’t have health issues primarily as a, as a population. Um, but, but now they’re coming of age. They’re starting to have their own babies. They were born into a digital age. They’re starting to, um, to have their first interactions with the healthcare because they’re coming off their parents’ insurance, starting to have their own babies. And there may be starting to take care of their parents are aging parents and they’re having their first interactions with the healthcare model.

Jonathan Manis:           19:27                And they’re saying, you have got to be kidding me. I cannot believe this is why. Or this is how we get healthcare. We do healthcare in this country. And um, and, and that demand is coming. So the more opportunity they have to deal with a health care environment, the more they’re going to demand something very different from us. And it’s also why you see organizations like Google and Amazon and those in silicon valley starting to step up and say, we can do this better. We can broker these healthcare services. We can, we’re not going to provide healthcare, but we’re going to show you how to do a Delightful customer experience. And, and in which case we’re going to delight your customers and let that become our, that relationship’s going to be ours, not yours anymore. Traditional health care system. Um, you know, if you look at the Amazon model, what they want is to provide a better customer experience.

Jonathan Manis:           20:17                They want to make it easy for individuals to take care of themselves, both their health and their, their, their health care. And then thirdly, they want a broker for services causing all of us with a, that provides services to bid for those services, um, based on quality and low cost and convenience for the customer. And, and I’ll tell you as a customer who wouldn’t want that, I personally would want that. We talk about, you talked about focus groups. Um, I’m, I’m constantly amazed by marketing teams, leadership teams who want to pull in customers and, and do a focus group. What all I say is, what do you want? Look at how you live your life. You don’t need anybody else to tell you I can do everything I want in my life, on my iPhone. I can, I can communicate with people. I can manage intimate relationships.

Jonathan Manis:           21:07                I can make dinner reservations, flight reservations, hotel reservations. I can, I can tell the proprietor of my lunch today whether it was good or bad based on, on, uh, on what he served for me. He can respond to it immediately. This is how we live our lives today except for health care and health care. We don’t do it this way. You go to the Palo Alto Medical Foundation in the, in Palo Alto, California, one of the most progressive, advanced clinical environments in the country, and I can get Uber to take me there. I can make that appointment online. But the first thing they’re going to do when I walk in the doors, hand me a clipboard and a piece of paper. It’s just, it’s just barbaric. And then six weeks after I get home, they’re going to send me a five page piece of paper asking me how satisfied was I with the services I received. I will have had to make that appointment two weeks prior, two weeks or more prior to when I arrived. That’s not how people want to live. I want to see a doctor right now. I want to tell you whether it was good service right now. I want to be able to pay my bill right now and then I want to be on my way. That’s the model of the future.

Bill Russell:                   22:15                If a health system’s able to do some of those things you just rattled off in terms of overall experience, do you think that’s going to create a competitive advantage for them in the markets that they serve and potentially new revenue streams and new revenue models for them?

Jonathan Manis:           22:30                There’s no question. Um, you know, you, you, uh, you talked about the two things, digital disruption, um, I’m one of those people who don’t want to really talk about digital disruption because I don’t think it’s digital. I think the real disruptions are two twofold. One is denial disruption, which is, you know, wearing a fitbit, a wearing a or ingesting a ingestible monitor or using connected devices at home, um, to maintain my health and prevent an interaction or an episode of care at a clinic or hospital. Right. Maintaining my, my, uh, my wellness and my health monitoring and curating my health. That’s denying us the opportunity to take care of a paying patient that’s very customer centric. That denial disruption denies us the opportunity to take care of a paying customer. That’s one kind of disruption. The second and that’s coming I think as a, um, we’re not there yet.

Jonathan Manis:           23:31                People are not good at taking care of themselves and doing the right things just yet. Um, but, uh, that’s self service model is coming. You see it with things like, um, uh, I would say a color guard, you know, you can, you can that 23 and me, you can do that at home. Both of those tests. You can take it home, um, fitness, uh, uh, monitor apps, um, subscription services that offer those things. All of those things are available today. There hasn’t been a huge up take just yet. We as a population are not there. The second way that we’re going to be disrupted is delight, disruption. And that’s where organizations, uh, are customer centric and focus on the convenience, access, quality, low cost experience for their customers. And frankly in healthcare, we are terrible at this. So these new entrance into the market are really disrupting us by doing the exact same offer, the exact same services we do, but doing it in such a way that absolutely delights the customer.

Jonathan Manis:           24:31                You asked for an example. Um, the, uh, I was recently a Scottsdale Institute where Ken Samet of, um, of Medstar on the east coast spoke and he gave the example of his daughter, he’s the CEO of the system. His daughter had a sore or scratchy, scratchy throat and uh, and, and went to the urgent care to have it taken care of. And Ken said that, um, he said, well, you, you went to one of our facilities, right? And his daughter said, well, actually there was a, an urgent care right on the corner and it was just so convenient I just popped in there and had a swab. It was only $30. And I needed it right then and right there. And he said the light bulb went on for him, that his own daughter of the, of the CEO of the, of the health system went to some place that was more convenient for her. And that’s when he realized our model has got to change. We have got to be focused on the convenience of our customers because that’s where they want their healthcare.

Bill Russell:                   25:30                I have a theory on what’s going to open the flood gates by the way. My theory is there’s, there’s a, there’s a a case before the supreme court in a completely different industry, but it’s around the selling of alcohol and wine across state lines. And it’s going up to the Supreme Court. And one of the things there they’re looking at is, is that interfering with interstate commerce? And if they get to the point, if the supreme court comes down on this and says, you know what, that’s against interstate commerce. Um, you’re now allowed to sell wine across state barriers across the country that will completely upset and change that industry. You know, there’s some states that have like a state stores and those kinds of things. It will completely change that industry. I think that same thing could be the catalyst. So if you have health systems that really get this consumer thing down, they really understand the experience.

Bill Russell:                   26:19                They really build out these experiences and then all of a sudden those barriers from state to state come down. Now all of a sudden you’re going to have a whole sorts of new entrance come into your markets and start to pick off things that, uh, that you didn’t think were possible before. And then be able to say, hey, you need a surgery. Uh, here’s your plane ticket. Come on up to our facility in, you know, in Utah where, wherever, and you know, we’ll, we’ll do the surgery up here and take care of you. And by the way, we’ll continue to provide, you know, telehealth and those kinds of things. And the experience will be far better than it would be. And they’ll have partnerships with urgent care facilities. I think that’s going to be one of the biggest catalyst. I mean, do you see something like that? Um, you know, really opening the floodgates for a digital disruption or just disruption in general in healthcare.

Jonathan Manis:           27:13                I would tell you you’re exactly right. And, um, maybe, maybe, I don’t know if this makes me glass half full or glass half empty, but, um, not only do I see coming up, I think it’s already here. I, um, I kind of keep a track of some of these, some of these new entrants and I’ll give you some examples. I don’t know if you’ve heard of with cove that come with cove is, um, is uh, an organization that helps you manage migraine headaches anywhere in the country. So, um, they will write your prescription. They will, uh, do a facetime with you, with a physician. If you’re having a chronic migraine problems. You don’t have to see a doctor other than right there on your couch or in your bedroom with your iPhone. Your medications come in the mail. You’re counseling is via iPhone. They are taking care of, of, um, of patients with, uh, with chronic migraine issues over

Jonathan Manis:           28:10                Site. Heartbeat, believe it or not, heartbeat is an organization out of New York, upper New York. It’s a cardiology practice that is basically using digital audio files to help patients with cardiac problems. Um, manage their cardiapathy across, uh, across the country. So you, you put your iPhone up to your heart and there’s a device that attaches to it and send them a cardiac cardiac file. Um, and, and they listened to that cardiology, uh, file digital file and adjust your medications, help you with your exercise regime. And those cardiac patients that used to be ours are not there anymore. Um, dental dnTL is a online and remote, um, a dental services smile, direct club, you get a package in your, in the mail, you make an imprint, you sent it off, you get, uh, a corrective, um, uh, prosthetic for your teeth. It’s managed by an orthodontist or a dentist remotely via your iPhone.

Jonathan Manis:           29:17                It’s all self service and you do it yourself. And then, uh, for a, for a lot of people, the, uh, erectile dysfunction. Now you can get medications for those kinds of things right off of Facebook, right off of the Internet. You have a remote physician that takes care of you and adjust your medications as required, I’m told. And, uh, and then you, uh, you, uh, you, you know, so here’s something that used to be a clinic, used to be revenue for us now being taken care of completely remotely, completely responsive to the customer need completely online or via digital conveyance. So I think that, you know, those used to be for us revenue streams and copays, and, uh, and now they’re, they’re gone from us and the convenience is through the roof. The quality is through the roof, and the patients absolutely love it.

Bill Russell:                   30:07                So let’s, let’s, let’s change the game here a little bit. And so I wouldn’t talk to you about it. Let’s hypothetically talk about the rest of your week. So you’re a CIO for a health system. We’re talking about all these things that could fundamentally change the business. But you know, probably if you’re like you’re not on the digital scale. You’re a pretty evolved in this aspect, but still about 60% of your time gonna be spent talking about the Ehr and operation systems and uh, and uh, consolidation and application rationalization and standardization. It’s still going to be talking about taking care of that traditional, uh, uh, thing. I mean, I found that to still be the case. In fact, having talked to a couple of health systems and, and CEOs, you know, what are you looking for in a CIO? And they say, well, you know, the first thing is they need to have epic experience.

Bill Russell:                   31:00                And I sit there and go, really, you know, cause I, I’m talking to more and more people and it seems like, um, you know, that’s almost a lower level function within the it organization. Somebody who can run epic and somebody, if you keep it functioning and even give it new workflows at the CIO or even, you know, innovation officers with digital officers should really be focusing on these new business models and working with strategy and whatnot. Are, are we still, are we still saddling the CIO with, you know, 60% was being kind, 90 to 95% of their time. It’s just keep operating the old model and make sure it doesn’t break

Jonathan Manis:           31:35                well. I think the short answer is yes and I think that also is, is the challenge for people who aspire to the CIO role. This is, this is not a technology role bill. This is, this is a leadership role. This is being able to communicate the vision and then being able to lay out the, the progress and steps that an organization or an industry needs to take in order to get to that. And um, I think it’s critically important that my peers, myself and others take on that mantle of leadership and step up to this challenge. Our organizations are struggling with it every single day. They’re hiring chief innovation officers, chief transformation officers, chief digital experience officers, chief patient engagement officers. They’re all struggling with how do we harness this? And it’s out there. We don’t need innovation officers. All these innovations exist. They just don’t exist in healthcare.

Jonathan Manis:           32:30                These things are what retail and service industries have been doing for years and years. I use the example, um, and you may have heard it, that I drive past the Chili’s restaurant on my way home from work every day. And as I go pass on my gps and my in my car, it pops up and says two for one Margarita’s it’s happy hour, join us. But yet when I drive past the clinic, it never pops up and says, have you had your flu shot this season? We don’t think that way, those, that, that would be innovative in our industry. It’s not innovative. It’s taking something that already exists in the retail or service sectors and adopting it into the health care industry. My, the lady who cuts my hair, no comments, please. Um, she always sends me a text and says, Hey, your appointment is tomorrow.

Jonathan Manis:           33:17                Press one to confirm after I have my haircut. Hey, thank you for your business. Your scheduled three weeks out. I’ll send you another reminder. We don’t think that way. The lady who does. Um, the, the, the, the business that does my, my dry cleaning, they will tell me that, um, your, your order is ready for pickup, swing by and pick up my dry cleaning. Thank you for your business. We don’t think that way. Pizzas. Now they will tell you, hey, you know, uh, Tom has put your pizza into the oven. Larry is getting ready to bring it to you. I’ve got a countdown clock on my, on my monitor that tells me when my pizza’s gonna arrive. Yet my wife with her mammogram results sets anxiously by waiting for the mailman to come. And, and see if her results are going to be in there today or maybe it’ll be tomorrow. We can do all of those things in the retail and service industries, but we can’t do them in the health care. It’s not about innovation, it’s about adoption.

Bill Russell:                   34:12                So I won’t comment on your hair if you don’t comment on my hair. So the, the question becomes how do you go beyond the, you know, every CIO has in their bag of tricks to pull out the Netflix slide, you know, Netflix. Didn’t do this or the Kodak slide. But how do you go from talking about it to doing it? You know, there’s a huge difference in silicon valley has a, you know, Dev ops versus what we have is traditional it, they have know a team based model. We have a hierarchy still within it. They do agile, we do waterfall, they do fail fast. We do never fail is more our mantra. So, um, you know, from a, from a culture standpoint and a technology standpoint, how do we go beyond the slide? How do we go beyond the, the uh, uh, almost cliche slide of Netflix and Kodak and we need to change as an industry to go, all right, here are the things we need to put in place.

Jonathan Manis:           35:09                Ties into what you asked before. And I, and maybe cleverly avoided the question, which is, um, you know, how do you, how do you enable this? What do you really do? Um, and, and there’s a utility function we have to provide to our organization. The systems that they run on need to be responsive, need to be a high performance, need to be up all the time in order to do those things. But, but bill, those are transaction systems and, and as a customer, I don’t give a flip, whether you have epic, Cerner, Meditech or, or, or whatever, you’re not going to get a single additional paying customer because you’re on Cerner or because you’re on epic. It doesn’t work that way. People don’t care about your transactional system, keep it up, keep it running, make it responsive to your clinicians, but don’t think that that’s going to be a differentiator in the marketplace.

Jonathan Manis:           35:59                What I see as the CIO role for what you just described is to throw open the shutters unlocked the door. Let in some light led in, some people from, from uh, who want to partner with us from retail and the service sectors. We have been a very closed industry cause we were, we were something different. Those innovators, those millennials, those uh, those populations that want something different from health care, they want to help us. There’s an altruistic attraction about people who are called to work in healthcare. Um, and, and people would like to give us a couple of their years of time and talent. They want to help us. Um, so why do we keep them at arm’s length? We need to embrace them. We need to embrace things like the agile methodology. We need to understand that we are going to fail not on the transactional side of things but on, on whether or not, uh, you know, the pop up notification about, uh, about you getting a flu shot is, is it targeted right?

Jonathan Manis:           36:57                Is it worded right? That’s where we need to be doing our innovations and our, and our, and, and investing in not in the transactional infrastructure. That said, I would also tell you that if all of our money and it is being dumped into 20 year old, um, legacy transaction systems and not more responsive to the marketplace, then, then this is, this is a dying. We’re dying spot. The, the future is an operating expense, not a capital cost to be depreciated over 15 or 20 years. Um, the world moves at a different clock speed and we’ve got to pick up the pace in order to be more responsive to those who are paying the bills. The insurance, clearly we’re failing insurance companies, a large organizations are saying they can do it better and they’re partnering to do just that. The googles, the Amazons, the Microsofts of the world are saying it can be done better. We want a piece of this, you know, almost 20% of the GDP spent on health care. These costs are unsustainable. We can do it better. It’s not, uh, it’s not impossible. We just need to let go of what you’ve been doing so long in order to do something different.

Bill Russell:                   38:07                And it’s really interesting. We’ve actually, we’ve come to the end of our time. I could talk to you for another 45 minutes. Um, uh, you know, I think the last, if I could throw out one more question, it’s, um, no, you just took on this new role and I think that the question, cause we have a lot of different viewers, I know that we have some college and university students watching a whatnot. Um, what, what type of advice would you give to an aspiring CIO? Somebody who’s in college just coming out and saying, I want to get on that path to be somebody who’s, uh, you know, mapping out the future of the business and how technologies going to support that. What would you say to them?

Jonathan Manis:           38:50                Well, like you, I, um, I wish we had more time. I could speak, uh, talk to you about this bill for another hour or two to tell you the truth. Um, what I would say to those who aspire to this position, I would tell you that, um, there’s not a better job in the world. Uh, this is absolutely the place to be. If you want to make a difference. If you want to make an impact on society and you want, you want to be a leader, this is the place to do it. Our industry needs leadership now more than ever before. And what you need to do is be decisive. Take the initiative, be bold, be aggressive. You know, you don’t get to these positions by fitting in. You get to these positions by standing out, speak up, be heard, you know, take the initiative. Um, if that’s what you want and you aspire to be a leadership to make a difference, there’s not a better job in the world. Yep,

Bill Russell:                   39:44                absolutely. Well, you know, we’ll give you a little bit more time in the chair there and then we’ll have to have you back and uh, we’ll, we’ll finish this conversation up. Love to hear some of the things that you’re, you’re able to do once you get your feet on the ground, you have a great market there. I mean, you’re, you’re in Dallas, Texas. You should be able to hire some really good talent. I would imagine from that market it was probably pretty hard. But I mean, it was great to be in Silicon Valley because there’s so much talent, but it’s probably pretty hard to hire that talent because the, you know, you didn’t have stock options to give them and, and the kind of salaries they were getting from, from there, you might have a little bit more of a fighting chance in Dallas, I would imagine.

Jonathan Manis:           40:19                Right. It’s a good thought and, and I know we don’t have time, but I would love to talk to you about it. The uh, yeah, the truth is that, you know, healthcare has become stayed. My, my incentive program used to be on, on how I kept turnover low. Um, you know, keep a, a one, two, 3% turnover rate. The truth is with these new generations, they want to give you a two or three years and then they want to move on to something else, but they want to give you their best two or three years, learn and contribute the best they can. And we should have a 12 or 15% turnover rate and celebrate those folks for coming in, doing good work and then moving on. And uh, and maybe that’s a topic for another time.

Bill Russell:                   40:57                Absolutely. Well, Jon, thank you very much. Um, do you, I mean, do you write a, you have a full time job, do you write a lot or do you have a way that people can follow you if you’re putting stuff out there?

Jonathan Manis:           41:08                I will get that to you. Bill. There’s been a, I’ve written a couple of articles for, uh, for Becker’s. I’ve done that on occasion. One is, uh, uh, healthcare needs to stop dodging, denying and delaying their digital destiny. Um, and then the second one is, um, let’s stop talking about digital disruption. I would encourage you and, and your, uh, viewers to take a look cause I think a lot of what we’ve been talking about today you’ll find in those, but I will get you my contact information if you’d be interested.

Bill Russell:                   41:37                That would be great. Um, thanks for coming on the show. The show is a production of this week in Health it for more great content check out the website, this week in health or the youtube channel slash video. Thanks for listening. That’s all for now.


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