This Week in Health IT Vik Nagjee
February 14, 2019

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Vik Nagjee is someone who has worked with the large health systems to modernize their stack. His focus is on simplifying the architecture to reduce complexity and increase agility. Another conversation from the HIMSS floor.

Vik Nagjee CTO on the Imperative to Simplify the Architecture for Agility

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Bill Russell:                   00:11                Welcome to this week in health it where we discuss the news information and emerging thought leaders from across the health care industry. This is Bill Russell. Recovering healthcare CIO and creator of this week in health it, a set of podcasts and videos dedicated to training the next generation of health it leaders. This podcast is brought to you by health lyrics, helping you build agile, efficient and effective health It. Let’s talk visit health to schedule your free consultation. We were recording a series of discussions with industry influencers at the Chime Himss 2019 conference. Here’s another of these great conversations. Hope you enjoy.

Bill Russell:                   00:46                Here we are from the himss floor. Why don’t you go ahead and introduce yourself

Vik Nagjee:                   00:49                Sure Bill, Hi, I’m Vik Nagjee with Sirius Computer Solutions, um, dual role there. So Im director on the healthcare team and I’m also on the CTO for MAnaged Services, uh, at Sirius across all verticals. Um, and I also am an advisor for the Cleveland Clinic, uh, as their chief enterprise architect.

Bill Russell:                   01:09                That’s a huge role. So are you looking at like all, all technology for Cleveland Clinic? So it’s across the board

Vik Nagjee:                   01:16                across the board, across institutes.

Bill Russell:                   01:18                So how’s that different from a CTO role?

Vik Nagjee:                   01:20                Um, the CTO. So if you go back to Gardner and we do the whole bi-modal it conversation, right? Um, I found that one person keeping those two roles like the here now keep the lights on and the forward looking right next to impossible to do. I tried to do it, I struggled massively.

Vik Nagjee:                   01:39                So we have a CTO now that came over full time CTO sent in that position, sit in that chair and take on all of the daily care and feeding the blocking, tackling a lot of the more tactical stuff. Right. And this is a more of a strategical

Bill Russell:                   01:51                So keeping the trains running on time. The infrastructure and those kinds of things. It’s interesting because I actually heard of a health system that uh, did not rehire a CIO and just put a CTO in place and then hired a chief digital officer. Okay. CTO is keeping the trains running but the chief digital officer is really looking at uh, the consumer experience and building out experiences and all those things. So it’s just interesting. Well, I wanted to talk to you. We’ve had a bunch of conversations with CIO’s and it’s been phenomenal. Um, but you’re more on the technical, you’re more in the weeds. Um, what are you going to be looking for at this conference and what have you found already? If I’m walking around?

Vik Nagjee:                   02:26                Yeah, it’s hard to imagine that this is the first day of the conference because it’s already been here for, for many days but, uh, you know, the biggest thing that I looked for a Himss is just networking, getting, getting together with a lot of the folks that I’ve known for years and also meeting new folks, right? Uh, trading, trading information, training stories. What have we learned over the last year, since the last time that we got together? Um, my big theme over the last several years and continues to be the same is simplicity, right? I want to get it to the point where we are able to have a very simple operating environment. Simplicity, less errors, do things better, cheaper, faster, stronger, um, more on the infrastructure and services and so on.

Vik Nagjee:                   03:06                So, uh, perspective. But what I’m looking for from the show is just to walk around and meet with some very large healthcare providers and see how they have been able to solve this whole, you know, conundrum of theirs. They’re drowning in data and they’re drowning in all this information and they have this big digital strategy upon them. And how do you actually bring all that together, make it work.

Bill Russell:                   03:28                All right, so let’s, let’s go in two directions here. We can go a infrastructure and operations side and we can go in the, uh, in the data side. I’d like to talk about both. Sure. So from an infrastructure standpoint, you want to talk about simplicity generally when people hear that they think cloud, right? So I can, I can provision a hundred email accounts in five minutes from my phone. But if you go to a it system within a healthcare organization and you say, Hey, we need a hundred new things, that’s what a month long process.

Bill Russell:                   03:57                So, uh, what are some, what are some technologies are some things you’re seeing out there or exploring here that could really simplify the, uh, the role of it infrastructure. And operations.

Vik Nagjee:                   04:08                Yeah. So really, really good question. Right? So let’s start with the basics. Again, all of the listeners, I’m sure our viewers are familiar with this average healthcare organization that has a similar few 400 5,500 applications that they’re running. A vast majority of them, uh, are circa 1970, 1980 applications, right token ring, right?

Bill Russell:                   04:28                And at least client server,

Vik Nagjee:                   04:30                exactly. Client server and they have some latency requirements at some physical requirements and so on so forth. So the first step that I look at is, okay, let’s, let’s consider our data protection, right? Let’s just make sure that our applications and services are always on. That’s not negotiable. A lot of folks who lose sight of that and there’s some pretty basic things we can do.

Vik Nagjee:                   04:50                There using traditional infrastructure means to be able to make that happen. Um, so that’s number one. Number two, Cloud, Cloud is, has been around for a very long time. We’re finally to the point now where within healthcare we’re able to say, okay, we can actually use this to solve certain problems cause it all this while Bill, I think it was a big solution looking for a problem, right? And to solve. And now we have a lot of things like for example, how do I do real quick, efficient dr? That doesn’t cost me an arm and a leg as an example. What do I do in terms of being able to be scalable? I have all of the MNA activities going on, how do I actually have predictable cost? So on so forth. It’s a very hybrid environment, not moving everything to the cloud. It’s not a lifting shift by any means.

Vik Nagjee:                   05:35                It’s a very hybrid sort of environment. Um, so that’s the, that’s the second thing from a simplicity standpoint. And I think the third thing is just simplifying operations. Uh, and that’s more around the people process, technology aspect and the organizational cultural aspect of it. Getting out of the mindset of we’re here to fight fires. And instead of that saying, okay, how can we actually work as a smooth oiled machine? How can we learn from the hyperscalers just in terms of the operations in the Itil and how do we actually adopt processes to make us about,

Bill Russell:                   06:07                so are we seeing, so from a cloud standpoint, you have the cloud providers, you have to Vm ware type clouds where we build them out ourselves. You see cloud native applications are where, what are we seeing in healthcare right now? Are we still building out our own on vmware kind of thing? Or are we starting to see people start to push workloads into a traditional cloud providers, AWS and Azure. Um, and are we starting to see, I doubt it, but are we starting to see some cloud native applications start to rise up from the, maybe from the startups we’re seeing it, but, but not the traditional player.

Vik Nagjee:                   06:43                Yeah, no, definitely seeing it from the side. So, you know, I was having breakfast this morning with a gentleman from AWS actually. And he mentioned the book crossing the Chasm. And had, I had read it years and years ago, but it jogged my memory a little bit. And he also mentioned the different stages of adoption and adopters that are out there. So, uh, applies very well to the question that you just asked. So a lot of the startups that are coming in their cloud first, right, they have to be, they don’t have the abilities and capabilities to do that.

Vik Nagjee:                   07:09                Well, you can’t scale scale, right? Um, they’re, they’re seeing and they’re running into the problems that, that, you know, all of us, both of us for short, and it told them that they will, they would run into, which is a big burly sort of, everything is in within my four walls, healthcare organization with a lot of data and data all over the place. Right. Um, and so how do you actually connect the two, a very poorly or, or very expensive, right? Then you have organizations like Google, I don’t know if you’ve walked around and seen their booth to Google cloud for GCP is massive. It’s about half the size of the epic booth, which is saying something. Oh. And uh, and so GCP has made a big, huge investment in healthcare. So what they’re trying to do if they’re trying to fund a healthcare organizations and try to get some of their data into GCP so they can take advantage of some of these machine learning algorithms and so on so forth, but for the most part we’re still seeing folks trying to cobble stuff together and say, okay, how can I actually take advantage of the cloud?

Vik Nagjee:                   08:07                What I really feel we’re ready to do now is working with partners like vmware, Citrix that have been in healthcare and get healthcare for a very long time and deal with all the peripherals and deal with all the stuff that you have to deal with in a healthcare environment. Working together with them to take this whole hybrid approach, right, that says, I have stuff I’m promises. How can I actually start to migrate some of these things to the cloud, but things that makes sense, for example, and still have a single pane of glass that’s the most important. Again, operational simplicity. We talked about that. You know, the hyperscalers don’t have 17 dashboards and 27 widgits that they have to deal with, they had one, that’s where we need to get. And even automating workload. Exactly. Uh, movement throughout, you know, in and out. That’s exactly, uh, data.

Bill Russell:                   08:52                So we heard this morning a sense of urgency. Now is the time fire, new regs released yesterday, really pushing the industry forward. Um, and you know, I, I saw a post this morning from a health catalyst and others that they have taken their applications and move them to Azure so that you can, you know, cause we have a lot of Microsoft SQL kind of people in our environment and so you get a lot of the benefits of the cloud, but you could still bring your traditional, uh, talent along with you. You don’t have to learn a whole new stack. Um, so from a data standpoint, where are we at? I mean, I do still have a, as you said, 500 average, 500. And uh, and I would think some CIOs would say right now, boy, you’re lucky if you only have 500. Exactly. Absolutely. So where are we at?

Bill Russell:                   09:43                Are we breaking down those silos? Is fire starting to make a dent? Are there technologies that are starting to, I dunno, sit at a layer above all these clinical applications and pull the data up?

Vik Nagjee:                   09:53                Uh, you know, I, I think the good news is that we’re talking about it and I think that that’s a really good first step. And I know that some of this stuff we’ll be talking about for many years, but we’re starting to talk about this at the CIO and the CEO level now when you’re talking about digital innovation, right? How do you get to digital innovation while you leverage data? How do you leverage the data? Oh my goodness. I have all of this data all over the place now they’re talking to each other. Now I need a platform that actually can bring some of this stuff together.

Vik Nagjee:                   10:20                Um, so there’s a few different approaches and I, I’ve, I’ve recently talked with the Chief data officer over at Cleveland Clinic talk with the chief data officer at Inter mountain healthcare because I’m very much a fan of deep learning an really striking meaning from data, putting data to work is what I call it, right? And so they, they both have slightly different approaches, but they kind of converge in One thing. If you think about it in terms of data in an organization like a triangle and the, the widest amount of data is at the bottom and it’s also the widest use case. So if we’re actually able to take that and turn that into some basic automation to give you some basic KPIs to help you drive your business for either clinical outcomes or financials outcomes from whatever it is, right? We’re already starting to make progress there.

Vik Nagjee:                   11:07                So this is very different than what we were talking about many years ago, which was like, oh my God, we’re going to apply machine learning and AI and solve cancer. Right?

Bill Russell:                   11:16                But is the platform, you’re talking about the EHR, are we, are we looking at it?

Vik Nagjee:                   11:20                It depends on who you ask. If you ask the EHR vendors, they will say it’s the EHR. Um, I still believe that the EHR and they’re making, you know, epic. For example, if my alma mater and I came from there, I have a lot of respect for them and I talked to a lot of the folks there. Um, they’re making some really good investments and really good progress in terms of native capabilities within the Ehr to be able to provide these learning models and be able to drive meetings from the data. That’s the best place for it to be.

Vik Nagjee:                   11:50                Cause for it to be actionable, it ought to be as close while you have to get it into the workflow. Exactly right. And so, so they’re making good progress there. Uh, then we have a healthcare organizations or, uh, ISV has companies out there, health catalyst, if you, others that are trying to build a platform that allows you to be able to go and stop data from various places and make meaning out of it. And then leverage on top of that sort of a, a model that he could actually visualize the data. Right? So there’s, there’s a lot of those opportunities out there, a lot of the, the various companies out there. I really think that it’s sort of a hybrid model, even in that world that works well.

Bill Russell:                   12:29                See, I’m not sure I agree with you. Okay. I think it’s the worst place for it to be is in the EHR.

Bill Russell:                   12:33                Now we have to get it into the workflow. I get that, for clinical. But again, outcomes, 20% is based on the episodic clinical events and 80% is social determinants or whatnot. Yup. It’s best in the hands of the consumer. So you need a platform that can get it to the consumer. And when we think about silicon valley, it’s not that one company does everything if that company’s enable other things to happen on top of it, right? So if we get all that data, including housing, data, education data and whatnot into a different platform, because that’s not all going to go into, the EHR that is able to be accessed, you know, for uh, utilizing AWS machine learning and AI and Google machine learning and AI, um, and then bring in third party apps that are going to be able to tap into it and those kinds of things that’s going to be far better than a, you know, again, we’re talking about 19, maybe 2000s technology, uh, that’s trying to adapt instead of having something that’s sort of purpose built for sharing, uh, analysis and research and discovery.

Vik Nagjee:                   13:37                I absolutely couldn’t agree with you more. Completely agree with you on there. I think that there’s,

Bill Russell:                   13:42                you just don’t want to offend your former colleague.

Vik Nagjee:                   13:44                That’s fine. I, I, you know, I’ve taken a lot of licks. Fair. For saying other stuff too, but um, I think though we need to split this into two different areas, right? I think one is the here and now, right? And one is the, what can we do in the Gulf War sort of standpoint? My challenge with healthcare today is that there’s so much stuff that we have that we could do stuff with that we’re not doing anything with today,

Bill Russell:                   14:07                but you have to keep it running today.

Vik Nagjee:                   14:09                You have to keep it running. That’s as again, the bi-modal aspect, right? So you have to keep it running, but there’s so much value there and we’re just not really taking an approach that is scalable and that we can then go from very large IDN all the way down to community hospitals and make available

Bill Russell:                   14:26                Vic. I would thank you. I, you know, I try to keep these things in 10 minutes. I’m sure this has gone beyond 10 minutes cause I just, I love this, this level of conversation. I really appreciate it. Thanks.

Speaker 1:                    14:38                I hope you enjoyed this conversation. This shows a production of This Week in Health it for more great content. You can check out our website or the youtube channel Thanks for listening. That’s all for now.


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