David Chou - This Week in Health IT
March 21, 2020

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March 20, 2020: In some ways, the unexpected outbreak of COVID-19 is asking that health systems speed up with the implementation of IT plans that have been in the works for some time. In today’s discussion, we cover this and other related topics in the preparedness conversation with David Chou, who brings insight from the developments in Shanghai. David is the CIO of Luye Medical Group and also acts as an advisor to Fortune 500 companies and health systems on their go-to-market strategies. In our conversation today, David gives us his thoughts on what health systems could and should be doing from an IT preparedness perspective on our home turf based on his observations on how things have turned out in his home, which is about two months ahead of the US in their fight against COVID-19. He talks about how things are thankfully returning back to normal in his home, and shares some of the strategies hospitals could use that at first seemed absurd but as time passed on began to make more and more sense. We then talk about IT and focus specifically on VTI, telemedicine, and remote work, three areas which health systems have had to fast forward in implementing. The conversation then turns to the topic of an unexpected lack of agility that health systems have experienced by implementing outsourcing at this moment. David leaves us with some final words about the value of investing in platforms that will enable a smooth transition to the cloud. All of this will help mitigate operational chaos in the wake of another pandemic — get it all by tuning in.

Key Points From This Episode:

  • The two hats David wears as CIO for Luye Medical Group and advisor to health systems.
  • How life is returning back to normal after quarantines in Shanghai.
  • David’s thoughts on COVID-19 preparedness measures: identify sites for quarantine.
  • The growing sense in dedicating entire wings to quarantine which seemed absurd before.
  • How COVID-19 measures will evolve healthcare practices: remote work, telemedicine, etc.
  • Partnering and its value to healthcare providers developing the infrastructure to adjust.
  • Bill’s experiences of the challenges to implementing VDI at St Joseph’s.
  • How older health systems could handle scaling by implementing cloud for VDI in a tiered way.
  • Challenges health systems who have outsourced staff are facing; economic costs.
  • Building on top of solid platforms to allow for cloud scalability in the future. 

Health IT Coronavirus Prep with David Chou

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Health IT Coronavirus Prep with David Chou

Episode 205: Transcript – March 20, 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.

[0:00:05.0] BR: Welcome to This Week in Health IT news, were we look at the news which will impact health IT. My name is Bill Russell, healthcare CIO coach, creator of This Week in Health IT, a set of podcast videos, collaboration events, dedicated to developing the next generation of health leaders.

This week I’m doing a series of interviews with health system executives and consultants and others who are talking about COVID-19 preparedness. If your system has a best practice to share, please shoot me a note, [email protected] and we’ll do a 10 to 15 minute Zoom recording like this one to capture some of your thoughts to share with the industry.

I want to thank Sirius Healthcare who reached out to me last week and asked if they could sponsor a series of conversations to help the industry prepare and celebrate the great work that health IT is doing right now. I appreciate their foresight and their commitment to the industry that they serve. Today’s conversation is with David Chou.


[0:00:56.6] BR: Good morning David and welcome to the show.

[0:00:59.8] DC: Thanks for having me, excited to be here, always looking forward to chatting with you Bill.

[0:01:03.4] BR: Yeah, I’m looking forward to it as well, I know you’re extremely well connected. What are you doing right now? I just want to get that out there. People ask me, “What’s David doing?” What is your role and where are you spending the majority of your time?

[0:01:19.4] DC: Yeah, I have a luxury of playing two roles, first role is I’m the CIO for Luye Medical Group which is based out of Singapore and I have 50 plus sites in Australia and Singapore and China, specifically in Shanghai and we’re building out two [inaudible 0:01:36] clinic facilities in Shanghai.

Part of my time is working on that. The other part of my time, I get to be an advisor for various fortune 500 companies, also advising various health systems on their go to market strategies. I get to play both a vendor space and a decision maker.

[0:01:51.1] BR: Wow, I assume those building projects, and other things have slowed down during this time and overseas?

[0:01:59.6] DC: Here’s what’s funny. I saw what we’re experiencing right now two months ago. I saw the lockdown from my peers in Shanghai. I saw how their lives were affected and now, fast forward two months later, we’re going through that in the US but now, looking back as far as how the lockdown worked, lives are actually going back to normal in Shanghai.

Just talking to a few of my colleagues last night, this past week has been the first time they’ve been able to go out for dinners, restaurants are opening back up, traffic is starting to get hectic in Shanghai so things are picking up and which is a good part so I am extremely optimistic as far as the plan that we’re facing in and we’re going through and in the US.

Hopefully we stick to that, hopefully we have some ways of just improving our clinics and vaccination just to prevent the virus and really spreading further.

[0:02:51.4] BR: Yeah, David, thanks for taking some time to be with us, I really do appreciate it. The first question in this is pretty general. And then we’ll dive into the health IT stuff. What are some things that you’re seeing health systems doing to handle the COVID-19 pandemic in their communities?

[0:03:09.3] DC: Yeah, I’ve seen a lot of various things. First is – the key is to identifying quarantine. You’re seeing lots of tents being set up, you’re seeing hospitals that are now being designated as a COVID hospital. I just saw this news from Steward Healthcare where they have designated COVID hospital. Here’s the interesting part when I was – I just tweeted about this yesterday, the last few months, helping the Shanghai project, we were going to build this new hospital with a fever clinic.

A whole dedicated state dedicated to quarantine patients coming in with a fever and I thought, that was the most ridiculous idea. Now, fast-forward two months later, probably one of the things we need to do because this virus situation can be an ongoing situation that we have to face in health systems so you do need to find ways to quarantine. 

As we’ve seen these tents, tented facilities that are being setup throughout various health systems, it may be something to think about moving forward but that’s – from a health system perspective, that is happening, trying to figure out how to quarantine, how to isolate and really, take care of the most sickest patient as soon as possible.

[0:04:18.2] BR: Yeah, I know it’s interesting, the information’s coming at us faster than I think any of us really anticipated and just the information you get today will change how you talk and think about it tomorrow. You know, yeah, sort of a whole wing for isolation and whatnot, you know, just a month ago, you just sort of scratched your head and said, that’s a waste of space and today, you’re sitting there going, wow, what foresight, how smart were we to be even thinking about that?

I mean, things really have changed, it will be interesting to see you know, what happens going forward. Do you think – I’m going to already change the format but do you think – we are moving at a pace in health IT that’s pretty unprecedented, I don’t remember us moving at this pace. I’m hearing people scale up their telehealth threefold and their VDI environments, fivefold and in timeframes that we never would have operated in before.

Do you think this will change how we operate in health IT?

[0:05:17.0] DC: Definitely. If you look at the future work, that is definitely going to change. Imagine three to four months from now telling your workforce to go back to the office where they have just adjusted to life of being working remotely. For myself, I love it personally. I don’t know how I could ever go back today eight to five sitting environment. It’s going to be very tough and it will be a big adjustment so I do foresee that changing.

I do foresee some benefits too. Hospital spaces are at a premium – the cost of the space of hospital. Now, you have this remote workforce, you realize that space for something that could provide care rather than administrative staff. Here’s the good part for health IT. I think some of the things that we’re implementing now whether it’s tele medicine, VDI, virtual desktop, things to scale out, it’s been on the top of mind for sales for quite some time but we have –they’re struggling to give whether it’s getting budget or gaining their resources and dedicate that initiative.

Unfortunately, had to take prices to move at a rapid pace but I do foresee those being the future. I do foresee VDI or desktop as a service being the standard, I do foresee tele medicine playing a bigger role in terms of providing care, it has always to this point and just a piece of care in a silo. But now, telemedicine can be part of care delivery and that is a big positive because that’s what patients, consumers have been expecting, we, as health systems have shorter bill to deliver that.

[0:06:45.9] BR: Let’s talk health IT. At this point, you know, you’re doing some work and you have some clients that you’re coaching around this. What are some things health systems are doing. I mean, you know, the tele health and the VDI are probably the two most that people have talked about but what are some maybe some of those things, what are some practices they’re doing and maybe what are some other things they’re doing to handle the requests that are coming from the organization and from the community?

[0:07:16.6] DC: Yeah, let’s look at just the virtual desktop experience? I think right now, people are either patching what they already have or trying to figure out how to create more connectivity. There’s a fundamental challenge right now. A lot of organizations’ foundational infrastructure are not up to date.

Number one there, hopefully they’re taking a time to understand that they need to upgrade their infrastructure at a core level, [inaudible 0:07:41], so that needs to happen and then number two, start thinking about how you scale fast, how do you do it with agility. Rather than deploying services or even I’ll use desktops, whether it takes a few weeks or even a few months from procurement to delivery, now think about how you can deliver in a matter of minutes or seconds.

That’s a very different mind shift. You have to also retrain your engineers rather than move them from being traditional network engineer. They probably have to become cloud engineers. Very new skillset and requires the new culture, requires a lot of retraining so that definitely needs to happen.

I’m seeing the shuffle and the scrambling for executives now where they have to scale up faster and the speed that they have never experienced before but they do understand how it works conceptually, now to really operationally, how do they drive that. Essentially, I think they have to understand and take advantage of partners because you cannot build things yourself anymore.

Traditional hospital systems are not development shops, they don’t act as the vendors. Start thinking about how you could partner. I think that’s going to be really critical task and that’s going to be a very big experience and change for a lot of healthcare decision makers.

[0:08:56.6] BR: You know, so two things I do want to talk VDI in a little more detail with you if we can. The second is that I want to talk about outsourcing. So there is organizations that have outsourced and I want to touch on that and I haven’t been able to touch on with health systems and so it’s great to have these conversations with people who operate in advisory capacity because we can get into the some of the pros and cons of outsourcing. 

The, but VDI, so for us we have 6,500 VDI work stations when I left St. Jo’s and the first thing was to get that first rack going. Well that was a herculean task because we had umpteen, a couple hundred applications we had to get to work effectively on Citrix not the least of it was Improvodo and we had to get Nuance. We had to get Dragon working on it and all of these things back in the day. These were early on in the environment. 

So we have to work very closely to vendors to get it working really well and then we got it working in one box and we made a mistake of thinking, “Oh great, we’ll just stand up a bunch of other boxes and we’ll get that to 6,500,” but scaling is a different beast. I really didn’t anticipate how many challenges we’d have to scale to 6,500 from a single centralized cloud data center and the – but you have these things like a whole bunch of workers logging in at the same time and bandwidth. 

And people a lot of times mistake bandwidth and latency and they both create different challenges and bandwidth doesn’t necessarily alleviate latency. You’ve got to address latency and I am a former CTO and so even I was kind of surprised with the number of challenges we had to scale it out to 6,500. Is that going to be even possible for some of these environments? I mean you are in a crisis mode right now, if they haven’t really thought out ahead of time, are they going to be able to scale this up then rapidly? 

[0:10:56.9] DC: Yeah, I think what you described is going to be very difficult challenge because most folks are just thinking about plugging a hole right? They are just thinking about how to provide the infrastructures to their resources. So they are probably buying the biggest bandwidth that they can to just deploying it. I think we need to – as post COVID comes, we need to really go a lot smarter. We need to probably think about different tiers of – in terms of the environment. 

For example, you could probably use a lot of the public health environments for your day to day commodity like environment where you could scale up and down in that relatively quickly, without a lot of talk leads to the – a lot of legacy applications that may not work. You could probably just put it up in a public cloud infrastructure and deploy that. Where the challenge comes in and as you had just talked about it is some of these traditional healthcare enterprise vendors who are not cloud ready. 

They are driven on legacy code has very difficult to do and deploy virtual desktop environments. So you probably need to sort through the portfolio and have a few different tiers in terms of your virtual desktop infrastructure environment. That’s how I would be thinking about it and that’s one way you can scale out quickly but you won’t have a one fit solution for everything but with the multi-tier strategy you could probably get through that and scale out as fast as you can moving forward in the future.

[0:12:16.7] BR: You know it is interesting, I was chatting with somebody who recently outsourced and they said, “We didn’t anticipate this.” Like, “We didn’t anticipate crisis,” because really why you outsource is to reduce costs and hopefully get some skills that you didn’t normally have so that you can really address this. You can address these kinds of scale challenges where you’d expect the scale challenges to happen over a longer period of time. 

What are you telling your clients that maybe have outsourced and find themselves with a lack of agility right now that they thought they were actually increasing with the outsource? 

[0:12:56.2] DC: You know outsourcing doesn’t mean that you could just shift the risk to a third party, right? I think you are outsourcing because you understand the capacity. If need, you are also be able to have a bigger pool of talent that you may not be able to recruit or build internally but you still have to manage them. So my central outsourcing is you treat this as your internal staff. You have to figure out how to manage them in the same way but now you have a bigger pool of talent and a company that’s standing behind you with faster innovation. 

Go to micro strategies and hopefully better technology but here is the big challenge in healthcare and hospitals that we don’t talk about. These academic medical centers, hospital systems are typically the largest employers. When you outsource and shift that work force to third party that has a big hit of the city GDP, the economic growth. So you have to figure out how to balance that and that is an unspoken area that makes it very hard for health care to take advantage of outsourced and managed services is because you’re a big economic driver. 

There is a bigger impact from outsourcing that you probably not have in other industries. So that is the biggest challenge from a political aspect but that is something I would say the CIO, the executive team needs to think through and think about how you could take advantage of the current workforce in a managed service environment. 

[0:14:15.2] BR: All right, conclusion question, potentially your mind is about two months ahead of us on this since you have been dealing with it with the hospitals that you are working with in Singapore and Shanghai. So, you know what are some things we should be thinking about? Let’s stick with health IT because that is our area of expertise. So what are some things that we should be thinking about from health IT standpoint for how this is going to play out maybe over a month, two months, three months for us and our staff?

[0:14:48.8] DC: For the last few years I think you and I have been on the same page in terms of we have to build on top of platforms. You can’t just buy enterprise apps and stick them together. I think now that people are starting to understand, you have to be able to build on a solid platform whether it is a tele-medicine platform, VDI platform, you need to have that solid foundation. 

So think about how you could build platforms to that when it comes to another crisis – hopefully it won’t happen again – we could scale a lot quicker. So get into platform development, get into platform thinking and that is going to be a really big shift also as we move towards cloud environments. It is not just about utilizing in one cloud, you got to figure out how to deal with cloud to cloud integration what it is going to be in the future. So having a solid platform to help you through that is going to be the key another big difference. 

So that is my advice, there is obviously a lot of details in terms of what we talked about when it comes to platform but buying a technology that you could rely on, develop on top of and make sure they are a solid partner is going to be the key to the future. 

[0:15:46.6] BR: We are simpatico in mindset on that. Platforms and multi-cloud are the future here. A lot of different nuance on how to implement that and how to make that happen and there’s a lot of great tools to make that happen. David thanks for taking the time. Just real quick, how can people follow you and keep up to date on what you are doing? 

[0:16:07.0] DC: Yeah, I am a big user of Twitter. So follow me @dchou1107 and also in LinkedIn, I think those are my two go-to platforms right now on terms of sharing content and then ideas. So happy to do whatever I can for the community. 

[0:16:21.4] BR: Well I appreciate it and at some when this thing calms down you got to have to teach me how to use Twitter. I figured out LinkedIn but gosh, Twitter still escapes me, who knows? Thanks again. 


[0:16:33.3] BR: Special thanks to our sponsors, VMware, StarBridge Advisers, Galen Healthcare, Health Lyrics and Pro-Talent Advisors for choosing to invest in developing the next generation of health leaders. This show is a production of This Week in Health IT. For more great content, you can check out the website at thisweekhealth.com and the YouTube channel. If you want to support the show, the best way to do it is share with a peer, however you do that, you know, send them an email, support our posts on social media, whatever, however you normally do that, just do that. 

We’ll be back again on Friday and we’ll continue to do more of these interviews over the next couple of weeks. Thanks for listening. That is all for now.


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