This Week in Health IT
October 9, 2020

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October 9, 2020: Dr. David ButlerCEO of Calyx Healthcare Partners joins us to talk Epic, physician burnout, diversity and running a consulting business during COVID. How are we doing with physician burnout? Are doctors still completely fried? Are we getting better with the technology around this? Epic has stepped up their end user training services game. How did they flip the switch from traditional classroom training to virtual? David shares the work of AMIA’s Diversity, Equity and Inclusion Task Force. What processes is your health system currently using to diversify ideas? How do we set up structures to ensure we’re not accidentally missing groups of people? Sales is the lifeblood for any consulting practice and it’s really hard at this point in time. Bill and David spill their secrets on what you should focus on for the long game.

 Key Points:

  • What’s new at Epic? [00:02:25]
  • What does the Arch Collaborative teach us about physician burnout? [00:04:51] 
  • Why Microsoft continues to be a big healthcare player [00:10:16]
  • The conversation of race [00:21:35]
  • Diversity of thought [00:24:41]
  • AMIA Diversity, Equity and Inclusion Task Force

Having a Diversity Conversation

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Having a Diversity Conversation with David Butler, MD

Episode 314: Transcript – October 9, 2020

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

[00:00:00] Bill Russell: [00:00:00] Welcome to This Week in Health IT where we amplify great thinking to propel healthcare forward. My name is Bill Russell, healthcare, CIO, coach, and creator of This Week in Health IT, I set a podcast videos and collaboration events dedicated to developing the next generation of health leaders. This episode and every episode, since we started the COVID-19 series, has been sponsored by Sirius Healthcare. Now we’re exiting that series and Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to [00:00:30] Sirius for supporting the show’s efforts during the crisis and beyond. Today, I am excited to have a returning guest, David Butler, Dr. David Butler, CEO of Calyx Partners joining us. David welcome back to the show. 

[00:00:44] David Butler, MD: [00:00:44] Thanks Bill. I’m glad to be back. It’s been a while, maybe three seven. I don’t even know how many months. This Covid thing puts us in a new time warp. 

[00:00:52] Bill Russell: [00:00:52] Well when was UGM last year?

[00:00:55] David Butler, MD: [00:00:55] Oh, UGM. That’s right. It was, August. So it’s been August, since August, right? 

[00:00:59] Bill Russell: [00:00:59] Yeah. [00:01:00] We will have to remedy this going forward. It’s been too long between the last time we talked. 

[00:01:06] David Butler, MD: [00:01:06] Yeah. 

[00:01:07] Bill Russell: [00:01:07] Yeah. And the last time you were talking about it was after the conference. So you still had your bell bottoms on, and those kind of things. 

[00:01:13] David Butler, MD: [00:01:13] I was rocking the bell bottoms. And just on that note, just so you know, those are very underrated  Take them away anyway, we’ll talk online. 

[00:01:20] Bill Russell: [00:01:20] How are they underrated? Are they’re comfortable to wear? They look good? 

[00:01:23] David Butler, MD: [00:01:23] Oh, no. I thought, honestly, I thought in my twenties, I was all Mr. Oh, I hate the seventies. The seventies was terrible. [00:01:30] They had the notebook came out in the seventies and all that, but as I become older, I realized seventies was the bomb, meaning in a, colloquial sense, but those bell bottoms, I thought, you know like the things they say, come around and come around. I thought they hit a tangent. But no, they came back and I’m rocking. That’s all I want to say, Bill, 

[00:01:47]Bill Russell: [00:01:47] Here’s the best thing about having you on the show is I don’t think I smile this much through most of the shows that I do so .. 

[00:01:54] David Butler, MD: [00:01:54] My job is to try to catch you off guard just so you know okay. If we talk about tech. Okay, cool. I know tech, [00:02:00] tech, we all know, we know tech, what this world needs now is a little bit of humor I think.

[00:02:04] Bill Russell: [00:02:04] That is true. We are going to hit some topics where we will talk Epic. We’re going to talk burnout, diversity, consulting. You and I are going to compare notes on our consulting practice and maybe that’ll help some consultants who are trying to figure this world out right now. But I want to start with Epic.

[00:02:18] You are one of my sources for what is going on at Epic these days and what’s new at Epic. So what are you, what have you got for us? 

[00:02:25] David Butler, MD: [00:02:25] Epic? What’s new at Epic? This was the first year that I actually did not attend the user’s group [00:02:30] meeting. In 17 years. Yeah. Yeah. It’s been 17 years. First time I didn’t attend, it was virtual. A lot of things are going on. So I wasn’t able to attend. Epic stack the telehealth, boom, what they’re doing with telehealth. Everybody had to move into that space Epic continues to double down the things I keep hearing from clients that call me. They want to know more about man, just keeping up with every three months, upgrade every three months patches that Epic kind of requires now. I think that seems to be taxing those companies a little bit more than, possibly than they care for  them to be [00:03:00] taxing.

[00:03:00] Bill Russell: [00:03:00] I heard a bunch of people doubling up because of COVID they doubled up and, it did essentially two, two patches this fall and they seem to be, that seems to be working. Is there any chance that people can start to take that kind of schedule as one every six months?

[00:03:16] David Butler, MD: [00:03:16] Yeah, I think so. I think Epic is really good about learning from their clients and listen to the clients. Maybe not so much the other side of the industry and that’s just fact, so whatever that is. So I think that’s one thing that as a client you’re doing, and they’re giving you feedback what they can and can’t [00:03:30] do.

[00:03:30]I think that’s what you’ll see. I also know that Epic is also now because of the telehealth boom, everything they’re trying to get into end user training, remote end user training, because that’s also a challenge. Of some organizations training these new physicians coming out of residence or coming into their organization during this thing, these classroom training sessions that we normally would have doctors do eight hours of training of this before you can get your password.

[00:03:53]Those are the things that are no longer acceptable and converting a traditional trainer who knows classroom training to [00:04:00] something virtual is really difficult, very daunting. And that’s part of it. Some services that I, I was offering called career concierge remote EHR assistance. The first thing is to check is to make sure that folks that are traditional teachers now they have to do it virtually.

[00:04:15] It’s a lot to them. Yeah. That’s a big leap. So soft skills are, tend to be very important at that time. I’ll just leave it at that. And yeah, not just the technology or when somebody raises their hand and say, why don’t you do this? We’ll just do that. Or I have printing issues. that’s not the [00:04:30] training inside that little virtual space.

[00:04:31] So there’s a lot of things there, but I believe they’re going to target that service. I think it’s called end user, EEUS End User Training Services. These are services, Epic is now started off. So it seemed that they seem to be diversifying some things as well. 

[00:04:44] Bill Russell: [00:04:44] You think thats coming out of the arch collaborative that they’ve seen how important training is and they’re just beefing that stuff up?

[00:04:51] David Butler, MD: [00:04:51] Absolutely. Absolutely. The Arch collaborative is just, I think, invaluable to any organization that wants to understand, like how, what are, what are the frontline users really [00:05:00] feeling as far as the burn from the EHR technology and physician burnout, things like that. And we can talk about that. so yeah, I hope they’re listening to the Arch collaborative, which I’m almost sure they are. Very good Taylor and Carl and those teams, the upper level Epic, they seem to have pretty good relationships. So I’m almost sure they are, but what I just worry about as it is. It’s like you’re training somebody on Outlook and every organization has probably put in Outlook or Microsoft differently. They may not have full teams integration or they may not have, things like that old 365.

[00:05:29] They may [00:05:30] not, they may still have old 365 here, but over here they’d have the traditional Ooutlook over here. So I think that could be the biggest obstacle that I’ve seen over and over with remote training, because everyone’s Epic is a bit different. Over the years it has started coming into that whole, something of the UI, the UX user interface and user experience has been better, but it is very difficult to understand how do you teach a client how to admit a patient online, if you’re Epic, [00:06:00] Epic doesn’t see patients. In Verona that’s there. They make the software, they had the experience. So those are all processes that I know I’ve run into when trying to create services. And I’m pretty close to clients and all that. So those are the things I’m sure they’ll overcome.

[00:06:13] But right now, I believe they’re focused only for their foundation system folks who didn’t change too much. Is what the word on the street is now.  

[00:06:19] Bill Russell: [00:06:19] So talk so recently I think within the last few weeks, so Microsoft teams integration into Epic. So that can be the front end video.

[00:06:28] I’m not sure where that fits, to be [00:06:30] honest with you. I look at it and I go, Epic has a pretty good integration and front end which, I’m not, when I saw it at first, people were making hay about it and I’m like, it’s interesting to me, but I just, I don’t know that if I’m deploying it. But here’s the thing I bought Epic, so I have their stuff and I bought Microsoft team, so I have that as well. I don’t know. Maybe there’s something there in terms of I only .. 

[00:06:55] David Butler, MD: [00:06:55] You know what? You’re spot on. So I’m going to tell you a little story. It’s going to take one minute. You cut me off when I get too [00:07:00] long, I like to tell stories. Okay. But in 2006 when I went from Geisinger health systems and took over a job at Texas Children’s hospital in Houston, they were, and this is when I believe it was NetMeeting. Microsoft had NetMeeting, right? And the evolution from NetMeeting with that was a 50 megabyte download on a computer. What all we get jammed up, so you couldn’t do it. So I’ve been in this, I’ve been in this space a long time. And that’s when the Go To meeting came out. Oh, it just, it was clean, easy to use and all that, but folks had already purchased Microsoft. So Microsoft NetMeeting was the thing. I get the Texas children where [00:07:30] I had over a 180 positions that I need to communicate effectively about implementation, implementing Epic software for one, from paper to the pixels, I’ll call it right.

[00:07:39]Microsoft was a partner at Texas Children’s and I saw they had some called SharePoint. I would always read about SharePoint at Epic’s users groups, when other clients were talking about how they implement it. They always talk about this thing called SharePoint. How they would put things on SharePoint and folks would collaborate.

[00:07:54] I didn’t know what it really was until I got there I realized, Oh my gosh, SharePoint is probably something we could use to [00:08:00] collaborate internally securely, right? Cause it’s just free, quote unquote with Microsoft products. that’s when Microsoft, I invited Microsoft to come and it help us to, cause they were saying at the time like, look, we don’t want to just be Microsoft Word, Excel, this and that. We want to help. We want to make lemonade with you guys. Help us. We want to be able to something more than that. Great. You invite them in. I said, okay, there’s something called Zynx Health.

[00:08:22] You may remember Zynx Health, the order set. They create order sets and all that. And the biggest challenge was you can create them online but they couldn’t import in to [00:08:30] Epic. And also physicians were always going out there and updating and things like that. Long story short, invited Microsoft and to say, Hey, this is what we’re trying to do.

[00:08:38] We’re trying to create something where we were before we go live six months, the physicians can collaborate and create orders that vote on things. And, just on an async, on a site, that’s asynchronous, right? And overall, we worked a long time, but it just didn’t work. And I think at the time it’s because they didn’t have a healthcare vertical. Now get to Bon Secours four years later, when I get there, same thing. Now they moved from [00:09:00] communicator office communicator for presence indication to something called Link. Right Link was their presence indicator. 

[00:09:05] Bill Russell: [00:09:05] I hated Link  Maybe your experience was better  

[00:09:08]David Butler, MD: [00:09:08] No. I think a lot of, I think a lot of folks did too. That’s why we don’t hear it about it too much anymore. And it was too by itself, it tried to replace instant message, but it wanted to do other things. Licensing was weird. From Link they purchased Skype. Okay. Need I say more about Skype? I’ll leave that there. That wasn’t a good integration.

[00:09:27] So long story short. Now we evolve to Teams. Finally, the [00:09:30] Slack killer right. Teams is awesome. It really is. But during that whole time I described that was a 10 year period till we get the Teams integration this year. We’ll all that time healthcare clients have had time to figure out how to purchase things like whether it’s Twilio, whether it’s a video, whether it’s, one of these other kinds of, Adobe Connect t o do health care visits and things like that. They’ve had the time, they had time to integrate with Teladoc and all this. So now Teams is kind, kinda wow, if this was out, when we needed it, [00:10:00] So I think that, I think they’re behind the curve a little bit, so they’re going to have to catch up. But I do see some clients that may not be able to afford it, or if it works seamlessly, then they could replace something that they may have purchased.

[00:10:10] But I just don’t feel like that clients have that, I don’t feel like clients have that, the luxury right now to start playing. 

[00:10:16] Bill Russell: [00:10:16] Here’s my view of Microsoft, somebody asked me. I made the point that Microsoft’s a big healthcare player and they’re going to continue to be a big healthcare player. And one of the, one of the people said, Oh yeah, what about Amalga? [00:10:30] and I’m like, how do you think they’ll do, based on what they did in Amalga. And my point is, Microsoft is one of those companies had to evolve slowly, but they evolve. You could look at Vista and say, Oh man, they lost all that market share in the  operating system  No they didn’t lose any market share. They just got better and better, better.

[00:10:46]David Butler, MD: [00:10:46] Exactly. Yeah, I would not, I don’t discount Microsoft at all. I remember when I visited their reston, that was like in 2011, 2012, I worked with some of their healthcare guys. And we visited reston and I saw the cloud.

[00:10:58] I saw well, quote, unquote, [00:11:00] the tour of that place. And that’s when bells went off okay, this thing is about to get real. And so Microsoft definitely gonna be a player in this game and I wouldn’t count them out either. And I just feel like they don’t, they may not have the subject matter experts around healthcare.

[00:11:12] I spoke with a colleague of mine who, one large system that I think Microsoft was trying to get into the cloud game there, and Epic and the cloud game, that’s the game, the cloud, Microsoft dynamics, some of those things. If they can figure it out, the sweet spot with clients, cause they’re already in, they’re already paying a lot of money for certain things, but they’re not leveraging the correct [00:11:30] way.

[00:11:30] I feel like that’s what there may be missing coz understanding how healthcare systems work so that they can then deliver the right packaged up tools together. That. Epic did it with Healthy Planet. Healthy Planet is nothing but a lot of 80% of old Epic repackaged and added 20% new, in my opinion.

[00:11:49] Bill Russell: [00:11:49] Microsoft for me really was the Bill Gates era. And then you had the Steve Ballmer era, and now you have the Satya era and they’re really three different companies. And [00:12:00] this company that Satya’s leading is very responsive and doing some really, really interesting things. And by the way, we had a podcast guest from Cone Health on and they talked about, they did fail over for a full week on Epic on Azure. And I think they’re one of the first ones to do that. and so that tells us that it is possible to run it on Azure. It tells us, and I asked them about performance. All right. So you went from On Prem to Azure. How did [00:12:30] your physicians experience that? And he goes, they didn’t know. It was fine. And I’m like 

[00:12:34] David Butler, MD: [00:12:34] That is the biggest compliment you can ever hear from a physician around technology. If they don’t know and they can do their job. Beautiful. 

[00:12:41] Bill Russell: [00:12:41] Yeah. Alright. that naturally gets us into the next conversation which is burnout. And I’ll just start with scale of one to 10. How are we doing? 10 being physicians are still completely fried. One being, hey, we’ve gotten to where we wouldn’t need to get to.

[00:12:55]David Butler, MD: [00:12:55] I think, I think they’re around it. I think it probably ratcheted it up two points, whatever their [00:13:00] score was before COVID you ratchet that up two points. 

[00:13:02]Bill Russell: [00:13:02] So COVID itself, that’s an important distinction. We’ve got, there’s a COVID factor that increased. I mean it increased my stress level, probably increased yours by two points just across the board. But how much is it? Are we getting better with technology at this point with regard to the physician burnout? 

[00:13:23]David Butler, MD: [00:13:23] I think we are, but what we’re still not good at, we still haven’t gotten great at is the integration of [00:13:30] technology in the right workflow. We were barely doing that when they were in clinic settings.

[00:13:35] And right now I’m gonna focus on the ambulatory primary care type providers. These are the doctors that went into the medicine, see patients, look at you in the eye, examine the bellies and all that. This was my practice. I loved it. And if you were to say, Hey, you can work from home one or two weeks. I’d be oh, cool. That’d be awesome. Okay. 

[00:13:53] You’re going into your fifth and six months because. Okay. Those are the ones that I worry about to be quite honest. And these are [00:14:00] my colleagues that I talk to every all week when I talked to my man, this is crazy. We’re still, I made, they actually may turn me into a telehealth doc.

[00:14:08] I didn’t really, I want to physically see patients. I want to interact.  That whole emotional intelligence and emotional thing that goes with being a provider. Some people like, some folks, some types of positions, they’re perfect where they love that. They’re okay with delivering care that way. And it’s great. And they do great jobs. But other physicians is, I think it adds a little bit like an extra [00:14:30] proccess. Kind of like, on your Mac when all of a sudden you’re like, Whoa, why am I at a 50% battery life? And it’s only 10:00 AM. I think that’s, what’s going on. The friction to deliver care has gone up.

[00:14:40] And I don’t really feel like they’re realizing it. Why they’re snapping at their spouses, why they’re like maybe being more curt with patients or things like that, in this environment. And it’s a lot of times it’s due to that lack of routine and sitting at the same spot for 25 patients in a row.

[00:14:55]And just what it is. So I feel like those are the type of things and they don’t have [00:15:00] the nurse that they can go in or the practice manager and things like that, all your colleagues is to chit chat with to decompress, talk about a patient easily. You can type all day but as to me, this is very easy. Now, if I had to type all of it, everything I’m saying right now that would take a lot of energy and a lot like editing. And so I think that’s, what’s going on. My thoughts. 

[00:15:17] Bill Russell: [00:15:17] Yeah. it’s interesting. The the impact of this on, we’ve gotta remember that people are still people, they could be doctors, they could be nurses. They could be ….

[00:15:26] David Butler, MD: [00:15:26] Thank you for saying that. Thank you. Yes. 

[00:15:28]Bill Russell: [00:15:28] There could be you and I. It’s interesting. [00:15:30] My wife identified that, probably one day, every two weeks I have a bout with depression. It’s not depressed and clinically, whatever, it’s just, I can’t get work done. I’m just like I, and I’m an introvert, but I still need a fair amount of people and I’m not interacting with as many people as I used to.

[00:15:49] David Butler, MD: [00:15:49] And you’re doing this every week. You’re talking to people and why Bill and you, this is so great. No, because right now there’s a, I read a really good article. I’ll send it to you. It was about Zoom, just Zoom or any kind of [00:16:00] technologies like that. They have to maximize lossless technology, right? Like certain facial nuances are removed like this and also you’re two dimensional. I can’t look over here and talk to you. Just when I’m looking here, I’m not looking in that camera. And I know that, but I want to look at your face. I don’t want to look at this camera that doesn’t, I could have a flip out there, but I don’t.

[00:16:19]But those are the types of things I feel that are wearing on us over and over. And then without the pop off vowels of say, restaurants are going to a nice dinner, relaxing seeing faces of people talking and look, [00:16:30] just, me and my wife always have a game. What do you think they do? The silly stuff like, Oh yeah, 

[00:16:35] Bill Russell: [00:16:35] That’s, that’s my game at the airport. I just sit there, I have my laptop going and I peek up over and I’m like, yeah, I wonder what they’re about. 

[00:16:42] David Butler, MD: [00:16:42] Yeah, exactly. So I’m an extrovert. So this has really been hard on me, I also know, I think I’m really good with insight and I have, I’ve talked with therapists and stuff like that too and I think every doctor should, if you don’t talk to a, and we’re , it’s really  difficult, my wife had to almost. convince me, you need to talk to someone. I was like, why? You’re like, you’re not motivated to do [00:17:00] the stuff you used to do. And I’m like, yeah, I’m good. I just don’t feel like it. What do you do? I can, as an intelligent person, those are the toughest to diagnose, with depression and dementia.

[00:17:08] The higher your IQ, the better you can come up with coming up with the reasons why you act the way you do. Two weeks ago was National Physician Suicide Awareness day. So just, I was telling folks, just remember to reach out to your doctors and, say, hey, thanks for doing a good job and try not to complain too much, but I feel 

[00:17:24] Bill Russell: [00:17:24] We did, we did a show early on in the COVID series and it was actually one of the first shows we [00:17:30] did and it was about how COVID was going to impact people from a mental health standpoint and the company that came on, talked about that they’re offering to health systems for free access to their clinical network. And I hope a lot of health systems took them up on that. And I hope that’s part of the benefits that health systems are offering at this point. 

[00:17:50] David Butler, MD: [00:17:50] I hope so too. I hope so, too. Yeah. 

[00:17:52]Bill Russell: [00:17:52] Y ou’re doing some work in diversity, right? 

[00:17:55] David Butler, MD: [00:17:55] Yeah. You know what? Just, probably, two or three months ago, AMIA, Patricia Dykes is the [00:18:00] President. Doctor Dykes, Barbara, she’s the president of AMIA, and she’s just sending out this commitment to say, look at the processes that they use to diversify their ideas.

[00:18:12]And I like to say ideas because, you can diversify ideas with the same type of people in the room, And the same type of people, then that leads to diversity equity, inclusion. So diversity is just saying, how do we make sure we have a pipeline or really cool, how do we make sure that we have structures set up so that we’re making sure we’re not [00:18:30] accidentally missing groups of people.

[00:18:31] So yeah, with the task, it’s a task force called Diversion Inclusion Task Force. It’s headed by Tiffany Bright, really bright a PhD she’s worked for IBM Watson. Now she’s really doing a good job with that.

[00:18:41] And, so we meet and, we have three or four objectives, a 30 day, 90 day and 120 day. And they seem to be serious about it. We know AMIA is traditionally, in my opinion, AMIA has always been the white academic informatics place. And, but that’s my opinion and the real question is, is that factual?

[00:18:58] And so data shows [00:19:00] us like everything else we do in healthcare, let’s look at the data. And then let the data talk. So I think that’s really what we’re about now. We’re just trying to say, what does the membership look like? Did they attend meetings? What does the meeting content, when we put on meetings do we actually make sure that there’s some content that  is relevant to everyone that we may have missed because we maybe had certain, these homogenous ideas in the room as we reviewed the presentation content. Things like that. Yeah, so we doing like, really cool work. I think we’re going to come out with some cool [00:19:30] things about it and I applaud AMIA for even attempting this. But it’s a good thing to do. 

[00:19:34]Bill Russell: [00:19:34] I’m a huge believer that you have to have conversations, right? So we have to have really constructive dialogue. And so my hesitation in having this on the podcast is the cancel culture is there. And I think it’s stifling some of the conversation like you and I could have a, I know I have some dumb ideas in my head.

[00:19:55] I know that to be a fact, I would like to be able to say something, have somebody [00:20:00] go, “Hey, bill you, I understand where you’re coming from, but you might want to check that fact. You might want to check how your, but yeah. What happens if somebody goes, boycott his podcast, no one should listen to this ever again.

[00:20:12] David Butler, MD: [00:20:12] Yeah, exactly. The cancel culture is out of control on certain issues. I’ll admit that I said. They probably said it. But there’s this some things I think that I always, I have to always reflect on myself. I was born in a small town, raised in a small town, vacation was a time of year, not a location.

[00:20:30] [00:20:30] Okay, I’m gonna say that again. Okay. Vacation was a time of year. It was summer. I grew up very country, small town, Texas, like 30 miles from Waco, 60 miles from College Station, an hour and a half from Dallas. Why the mere fact that I have to say Waco and no one knows where Waco is. That tells you how small it is. Now they know where Waco is cause of Chip and Diana.

[00:20:46] Bill Russell: [00:20:46] And my daughter goes to Baylor, so yeah. 

[00:20:48] David Butler, MD: [00:20:48] Oh really? Yeah. So yeah, Baylor Barons. That was the team we rooted for. And then I went to Texas A&M so goodbye, Baylor. Sorry, Bill. Okay. So I grew up in small town, Texas, wherever, we knew this side, the blacks that lived here, whites lived there [00:21:00] whatever.

[00:21:00] So these are the things that I think, as I had to progress through predominantly, PWI, predominately white institution to whatever. It was things that you just got used to. You just knew what it was. And my mom was just like, work hard, be smart. And, they don’t have to invite you to the table, whatever, they, and history is history, Every country. Every country, every great nation, whatever has some negative parts of their history. I think about my own self, my own. Somebody asked me to write my history, write your history, Dave. 

[00:21:29] Bill Russell: [00:21:29] There are [00:21:30] large blocks I would skip  if I was writing  my history. 

[00:21:32] David Butler, MD: [00:21:32] I know I would so my point is like every everything, America’s a great nation. We know it, no doubt. African Americans l I talk to, we’re not trying to go anywhere or anything like that. And I can only speak for black African American professionals that I interact with right now.

[00:21:45] We’re all very proud of this country. But we also, as a race, we just have to also identify our own history so that we can avoid it. And so it’s almost like the saying, whatever you love you should be able to criticize. You should be able to have constructive conversations [00:22:00] about right. In a safe way. But right now I think it’s a it’s that framework of safe conversation is a bit disruptive or has been made to be political. And it’s not because what I know is like for every silly Facebook post that I see from some of my friends from undergrad or wherever. I know that when I talk with them, if I see them in person, we could totally have a beer. Yeah, like individually, we are cool. We’re great. But when the herd mentality takes over, [00:22:30] it’s laughable. And I think that’s the human nature though. I think the tribalism and all these books have come out on this stuff. I think it’s  simple, but as complicated as that, this is a human issue. 

[00:22:39] Bill Russell: [00:22:39] Yeah. I grew up in a steel town and I grew up on the working side of that. I sorta, the steel towns grew up basically based on when people were immigrating into the country. And there was a significant Puerto Rican population that came into this steel town when I was growing up . I literally was maybe one of five [00:23:00] out of a 30 that wasn’t essentially either first or second generation in this country. So I grew up with that, but it doesn’t mean that I am, you know completely enlightened and understand . Can you really appreciate somebody else’s journey in this country? And specifically talking about black Americans, can I understand and appreciate it? 

[00:23:23] David Butler, MD: [00:23:23] It’s about exposure, right?  We call them bubbles, whatever bubble. It could be a racial bubble, thought bubble, whatever bubble it is.

[00:23:29]There’s no [00:23:30] way for us to understand or even empathize, And definitely not act, actively act against that type of behavior at a system level. And I think this is assimple as it gets. I’ve lived in four different States in 17 years and bought homes, moved my kids. They’re 25 and 21. And, we, I was in Virginia, a swing state. 

[00:23:51] I’m in California now. And so now, and that means four different ways of voting. So now I realize wow, it’s easy in California just to do this or that. And that also made [00:24:00] me aware like, oh, why isn’t it like that in Texas? Or why isn’t like that wherever, but also see things that is terrible here, right? I’m like, they need to be more like Texas, or this needs to be more like Virginia or Pennsylvania.

[00:24:10] You see? It’s that exposure. And without that exposure, I wouldn’t have the diversity of ideas or to be able to reflect back on things that were good about certain organizations. We’ll use that. Leave the rest. Like that. And so I think me and you consulting when you speak with all these folks on this man, you are just, wow.

[00:24:28] I can imagine the amount of [00:24:30] ideas and new ideas, or like someone says this, you can bring them together and synthesize it and no the way that no one else could, because they may have just been over here, whatever, so 

[00:24:41] Bill Russell: [00:24:41] That I will echo, diversity of thought has been amazing. Having done 300, some odd podcasts talking to some just phenomenal leaders like yourself, just over time. I joke, from time to time, I tell people jokingly that this podcast is I should just rename it. The education of Bill Russell. 

[00:25:01] [00:25:00] David Butler, MD: [00:25:01] And that’s a very, that’s awesome. That you’re that what’s the word self-deprecating I will say, but that’s a sign of empathy and that’s beautiful. So I love your podcasts. 

[00:25:10] Bill Russell: [00:25:10] What’s the productive next step around diversity? Let’s talk specifically around healthcare and healthcare IT. So if I’m a CIO or CMIO and I have a group of people and I wanna, I want to push the envelope a little bit here. I want to have diversity of thought. I want to, maybe swap up how, what it looks, what [00:25:30] our lead executive leadership team it looks like within health IT. What are some productive next steps? 

[00:25:35]David Butler, MD: [00:25:35] One I think is, just an educating leaders educating themselves, because I think a lot of the leaders in healthcare IT right now have come up through an age where it’s get the best person. Get the best person and weed out the non-best people. what happens is like with surgical precision, sometimes those HR systems will weed out certain idea types, AKA, whether it’s race, gender, whatever. For [00:26:00] example, I don’t have a clinical informatics certification. Now, if you’re only looking for someone with a clinical informatics certification, because your HR system, has a check box, I’m not going to get in that group.

[00:26:12] Now. I don’t know the percentage of African American males like me that have one or don’t have one, but statistically informatics has been buried a certain type of demographic. So I think it’s making sure that as a leader, you just question what you never had to question before to make sure your teams [00:26:30] are, have a diverse set of ideas and that you don’t let HR and you don’t let certain HR say, we, just couldn’t find any qualified candidates. A real question is, did you look at traditionally HBCU’s? Historical black college university? They pump out some really smart folks and Google knows this.

[00:26:46] Do you really have to have a college degree for this position? Google knows this. Like 15% of Google’s employees are not, they don’t have a bachelor’s degree, but they have some really wicked certifications and can do the job. So I think it’s really a paradigm shift in the way. we always used to think. If you’re [00:27:00] really trying to get a diverse set of ideas or people, and also, and have that one person in the room that may not be afraid to raise their hand and say but why would we do that? That looks like this or that, right? 

[00:27:12] Bill Russell: [00:27:12] Should your diversity mix look like your community? Cause I’m just wondering, cause in Southern California, it’s a third, Hispanic speaking, it was a third Asian and then Other really was the other category, should I be looking for, if I like now I move and become the [00:27:30] CIO in Iowa. Am I worried about, Asian or am I trying to match really what my community looks like? 

[00:27:37] David Butler, MD: [00:27:37] You know what I think it’s two answers to that. The real question is who are you serving one. And this I’m going to approach this business. And I’m going to put on a financial hat, The question is, who is your audience that you are serving? And what you know is that audience may need, for example, so who is your customer [00:28:00] base? And also, where are you getting your funding from? It’s about money, sometimes. A lot of times business wise that’s money. The money, if the money is coming traditionally from, that the 13% of the diverse population, if you look to realize wow, we have some pretty diverse patient mix in the system. The question is, why does our staff look so that those patient mixes can be comfortable or they can relate to those staff members?

[00:28:24] For example, nursing, if a large part of your nursing is of this African [00:28:30] American, but you’re in a predominantly Asian neighborhood, but in the real question, like where are Asian nurses being trained? Maybe that’s just a simple question. it’s so easy to me to think about it but I understand how folks have gotten certain ways of thinking over the years that we call systemic now.

[00:28:49] Bill Russell: [00:28:49] The systemic problems are what you were talking about earlier. I really love that distinction of, don’t let HR rules keep you from becoming diverse. And one of those, we interviewed, a [00:29:00] couple of people have actually given me this idea of just making sure your slate of candidates is diverse. That’s what we’re looking at your recruiting firms and looking at HR and saying, look, I want at least, this many female candidates, at least this many, culturally diverse candidates, black candidates.

[00:29:16] So  depending on what you’re trying to do within your market and really putting that back to work and saying, instead of letting them get away with, look, these are the people who applied. No, that’s not good [00:29:30] enough. 

[00:29:30] David Butler, MD: [00:29:30] That’s not good enough. Exactly. Yeah. And I think over the years, I’ve, I’ve applied for so many jobs that I did not get. I did not, I have more jobs. I didn’t get Bill, CMIO opposition. I didn’t get promoted here, there, welll I could go all day on that. But I choose not to focus on that. I got a pretty good idea of maybe what happened. Maybe I was just a loud mouth, or maybe they felt like, oh, we don’t, he’s all over the place.

[00:29:50] Whatever. I blame myself a lot. Just move on. Personality. I don’t know. And I can’t prove it and nor do I have the time to go back and try to prove it. So I move on. But what I do know is [00:30:00] that they make mistakes by not hiring me. I feel because wow, they said they want to innovate. They want to think different. But then a candidate that went in was like, that’s pretty traditional. That’s all you get it. And I don’t know. I don’t feel that a lot of these healthcare institutions, whether they’re in healthcare, whatever, when I look into an informatics talent, I’m not quite sure if they know how to.

[00:30:19] Bill Russell: [00:30:19] Yeah. But I will tell you, the first thing they ask is, what’s important to you. That really comes down to the health system, the health system says, look, we’re looking for a confer, a culturally diverse [00:30:30] group of candidates. They’ll get it. 

[00:30:32] David Butler, MD: [00:30:32] Yeah. Yeah, no. And they have, historically, there is a perception that if you get, say African-Americans minorities are underrepresented  in places that they may not be as successful as traditional. I think that’s just a, that’s a fallacy that’s been stuck in our heads for too long.

[00:30:49] Bill Russell: [00:30:49] I’m going to cut you off. Cause I want to talk about the consulting business a little bit and just anyone who just listened to that. That is two people having a conversation. I started this preface [00:31:00] this by, Hey, I might have some bad thinking. David said he might have some bad thinking. If you’re upset by something, we said, just shoot us an email. 

[00:31:07] David Butler, MD: [00:31:07] Yeah, that’d be cool. Yeah. 

[00:31:09] Bill Russell: [00:31:09] Okay. All right. So let’s hit consulting. We don’t have much time left on this. COVID changed everything in terms of how we do business and how we interact. We were saying earlier, you and I were talking, I haven’t been on site of the health system since February.

[00:31:23] And I’m hearing the same things but this is impacted the consulting business. People are really struggling on that side. It’s [00:31:30] something I don’t talk about much on the show. How has COVID really changed your business? 

[00:31:34]David Butler, MD: [00:31:34] COVID is, has pretty much brought my business to its knees. I’ve been small shop, less than 10 employees but we have engaged at certain levels, but I find at certain price points, right?

[00:31:45] And that’s like executive level consulting, advising on EHR implementation, advising on physician adoption engagement, things like that. I get called in when the CIO and CEO’s are really concerned that wait, we spent a lot of money on this software, this technology, but we feel like the [00:32:00] physicians have issues there. We don’t know if this is normal or not. So I’ll go in and assess things like that. So that’s in a nutshell, what I do. Also with some CMIO coaching, individual coaching that I do, and some speaking engagements, things like that. All that has to come through a crawl. A nd so I haven’t been on site at a client since March and that has been an issue. And I think my last engagement probably was about four months ago. So for four months there’s no funds. Let’s just talk target. There’s no money coming in to [00:32:30] Calyx Partners. My a hundred percent owned company.

[00:32:32] Yeah. Now the real question is, do I go ahead and panic right now? Oh, do I tap into my rainy day funds that I made sure that were available in my a hundred percent owned company. And so I think that’s what I decided because the environment was so weird and it’s hard to predict where it’s going to go, investing a lot of time and the things that worked last year, I didn’t think and I didn’t feel like clients. And they had the clients that healthcare delivery systems, cash wouldn’t [00:33:00] really low when they had to cancel all elective surgeries and things like that. They let all consultants go. Most of them. They stopped a lot of Epic implementations right in the tracks and the cost of stopping some of these implementations up to 2 million a month. This is what it is .  It can be really expensive, but that was the decision that was made. And so what I didn’t want to do and I think consultants probably shouldn’t do is try to continue to push your healthcare network, healthcare clients network. Then they’re going through so much things within their health network. You don’t want to badger these [00:33:30] CIO. You don’t want to Badger these CMIOs. And if I can coast on, as they say in star Trek, if I can coast on impulse power, remember Star Trek Bill, I got you.

[00:33:38] Yeah, I just called in the Scotty, let’s go on impulse buyer a little bit. Let’s just close this out. That’s what we’re doing. And, that’s what I see makes sense. Other people are not. And so I’m not judging anyone. If they have to continue to hit the grind and do what you gotta do. Because I’ll work at wherever to provide for my family. So that’s just start, that’s just a generalization statements on things. What are you seeing, bill? 

[00:34:00] [00:34:00] Bill Russell: [00:34:00] Yeah it’s it’s interesting. You sales is the, yeah, sales is the lifeblood for any consulting practice. And it really is hard at this point. One of the things I’m telling people is focusing on your existing clients. 

[00:34:14] David Butler, MD: [00:34:14] Yep. 

[00:34:14] Bill Russell: [00:34:14] People are like, I need new clients. Not, now is not the time. Just try to cold call anyone, especially in healthcare. They’re just too busy. And so it’s maintain the relationships with the people. you already have give them a call. Hey, how are things going? People that’ll take your phone call [00:34:30] are the people you should be calling right now. 

[00:34:32] David Butler, MD: [00:34:32] Yeah. And I’m calling him, I’m calling my network just to check in on them or they’re texting me. Hey, Dave, how’s it going? It’s going great. I’m doing fine. How are you? Everything’s crazy inside this healthcare system. I can’t believe we’re doing this. I can’t believe we got to buy this software. I can’t believe our executives, like that. So now it’s not oh, by the way, can you put me on no,  actually literally want to know how they’re doing. And the long game is all this is going to come around. 

[00:34:54] Bill Russell: [00:34:54] Yep. And every conversation you should be adding value, you should be providing that. Hey, I read something. It, look, if you [00:35:00] have time, you should be reading like crazy. I read for about an hour and a half, two hours a day. Yeah. And so when people call me and say, hey, what’s new. I’m like on what topic would you like to talk about? 

[00:35:11] David Butler, MD: [00:35:11] Exactly. Yeah. I’ve honestly, I revamped my resume cause I realized as I looked at wow, that was pretty rookie and not rookie, but I just didn’t have time to keep touching the resume. It was not adding the value cause I was getting business. But now I finally have time to Oh, let me relook look at my res and make sure I actively reflect things on there that I’ve done. And I [00:35:30] realized there was a lot of gaps in there. And I’m like, oh, I’ve done that before. I’ve done that before I didn’t call, we didn’t call it that we call it this at the time. Right. so just updating with the new terms. LinkedIn, I’m about to update my LinkedIn I’ll copy and paste some of those central my resume over to LinkedIn. That makes sense. I’ve now rebranded my business a little bit where I’m, Calyx is more about Dave. Now it’s more Dave branding, right?

[00:35:50] Because I realized that before years, That’s probably what they want me a lot of times, if they, once I’m in and they say, Hey Dave, do you know someone? Sure. This company can do that. Sure. That company can do that. Or [00:36:00] you know. So I think those are the things that I’m preparing for the next wave of this. And I think that’s smart business in general, investing in yourself, learning how to do podcasts, learning how to lighting, stuff like that. These are the things I just felt like this could last a while. Even if it doesn’t, this still is going to be around. 

[00:36:16] Bill Russell: [00:36:16] Yeah, I tell you the other thing is you got to put yourself in their place. One of the things I did early on was I offered free consulting, especially during COVID. I do coaching. If somebody wants coaching during COVID, [00:36:30] I’m willing to do it for free for a period of time. 

[00:36:32] David Butler, MD: [00:36:32] I saw that. that was huge. That was huge. You’re doing your part, right? 

[00:36:36] Bill Russell: [00:36:36] Yeah. and quite frankly, it’s, it’s not that hard. it’s and it started at one of those led to a client and we essentially, we started off as, hey, what are you seeing in the industry? What he appreciated was during COVID I was doing an interview a day. And so I was able to say, hey, this health system did this one did this one did this. And he had direct access to me to have those [00:37:00] conversations. And then over time he was like, Hey, can you put me in touch with that person? I’m like, yeah, probably. And so you’re constantly adding value. Put yourself in their space. They may not have money for you today, but if you’re adding value not today, they’ll probably have money for you next year.

[00:37:15] David Butler, MD: [00:37:15] That’s it. That’s it’s always the law. I always say it’s always the long game in any company. All companies right now should be preparing for a long game, just the first down. And don’t think about the end zone, right? I’m always thinking about the end zone. You gotta have your tactics. My tactics right now is [00:37:30] just a rebate, rebrand revamp some things. Make it image, branding, stuff like that I just never had time for while I was so busy doing the work. And now I’m actively, I’ve actually had to, I’ve not accepted certain gigs cause I didn’t feel like it was. Oh, I didn’t feel they asked me to do things. I felt ah, that’ll take 25 hours a week and it’s remote is I don’t really know the client.

[00:37:53] I don’t. And so how do I think it would be more stressful and less beneficial for them if I hadn’t taken it. So that’s sad to say, who [00:38:00] can afford to do that? I’ve been blessed last year. I can’t really, but I didn’t want to lie.

[00:38:04] Bill Russell: [00:38:04] But I love your impulse power thing because I think, as things go through a difficult stretch, what happens is people will fall out. So you’re going to have less competitors come this time next year. And if you’re still around, still standing, adding value to your clients, next year, next month next, whatever, that will bode well for you. I think David. This was a great conversation. I appreciate all the different directions we went. 

[00:38:29] David Butler, MD: [00:38:29] Sorry. I [00:38:30] hate that. Sorry. It’s just caffeine. 

[00:38:32] Bill Russell: [00:38:32] No part of me, we haven’t talked in a year. So this is like our one year catch-up call. We’ll have to do this a little bit more often. So we’re we get a little more disciplined in focusing on maybe one or two topics each time we get together.

[00:38:43] David Butler, MD: [00:38:43] I agree. I agree. Discipline is a huge. 

[00:38:47] Bill Russell: [00:38:47] Thanks. Thanks for your time today. I appreciate it. 

[00:38:50] David Butler, MD: [00:38:50] Okay, thank you. Thank you. 

[00:38:51] Bill Russell: [00:38:51] That’s all for this week. Don’t forget to sign up for a clip notes. Send an email, hit the website we want to make you and your system more productive. Special. thanks to our [00:39:00] sponsors, our channel sponsors, VMware, Starbridge Advisors, Galen Healthcare, Health Lyrics, Sirius Healthcare, Pro Talent Advisors, HealthNXT, and our newest channel sponsor mcAfee solutions for choosing to invest in developing the next generation of health leaders. This show is a production of This Week in HealthIT. For more great content. You check out our website this or the YouTube channel. If you want to support the show, the best way to do that, share it with peer in fact, sign up for clip notes. Get those emails, send them on to your team members, [00:39:30] peers within the industry and let them know, things that you have been getting value out of. Please check back every Tuesday, Wednesday, and Friday for more shows. Thanks for listening. That’s all for now.

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