Dale Sanders is a leader in the area of applying data to improve outcomes across healthcare, however, he sees a potential to do this in a manner that may become a burden on healthcare practitioners. I always learn from Dale, hope you enjoy.
Bill Russell: 00:00 welcome to influence a production of this week in health it where we discuss the influence of technology on health with people who are making it happen. My name 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 to build agile, efficient and effective health it. Let’s talk. Visit health lyrics.com To schedule your free consultation today, Bj moore recently hired CIO for Providence Saint Joseph Health joins us. Good Morning Bj and welcome to the show.
BJ Moore: 00:40 Thank you for having me.
Bill Russell: 00:41 Wow. That is a phenomenal jacket and you wore it. You wore it at the Chime event and we did not run into each other. I can’t, can’t believe it.
BJ Moore: 00:51 I got a lot of compliments on it, so I figured if I didn’t know anything at the conference I might as well be dressed in a nicest.
Bill Russell: 00:59 Yeah, so you’re, so you’re, you’re new in the role. You’re just a couple of weeks in at this point. Three weeks in, three weeks in. So providence Saint Joseph Health for, for those people who don’t know is a fairly large 51 hospitals, 829 clinics, 119,000 caregivers, 38,000 nurses, 25,000 physicians, 2.1 million covered lives in two health plans, 1.6 billion in community benefit. And uh, yeah, so it’s, it’s, you know, by any measure that’s pretty big. You’ve been there for about three weeks. So I expect you have it all figured out, you know, exactly. Got the lay of the land, you know exactly what you’re going to be doing.
BJ Moore: 01:39 Absolutely. Totally have it down after three weeks, obviously joking.
Bill Russell: 01:45 Yeah. It’s, yeah, it’s, it’s a big role and, and uh, I don’t know what the revenue is now, but it does cover, um, you know, Texas, California, New Mexico all the way up, all the way up the coast, all the way even into Alaska. So it’s a, it’s a pretty big role.
BJ Moore: 02:04 Yeah. We’re over 23 billion at this point time. I assume I can share that. If not, and that’ll be one of my early rookie mistakes,
Bill Russell: 02:11 well, it’s, it’s public information. And, uh, you know, I was, I was at the JP Morgan conference, I heard from Vencat and he shared the numbers and uh, and so I think they are out there. So give us an idea of your background and how you, what’s the, what’s the road, how you ended up at Providence Saint Joe’s?
BJ Moore: 02:30 So did 26 years in Microsoft, uh, various roles as finance, operations, sales and marketing. It last two divisions. I was in is windows and cloud and the AI group that, um, so 26 years there, after 26 years, it was like, you know, am I going to be there for 30 years? Was I ready for a change? And the question was absolutely yes. Uh, Vancat may know, uh, we worked together at Microsoft and so he reached out to me and, and the timing was perfect. So a great run on Microsoft had a great time there. Couldn’t say enough great things about that organization, but excited to be in a new industry, excited to be in a new role, excited to be part of this digital transformation.
Bill Russell: 03:19 Yeah. I find the, it’s interesting when they pull you in for the interview and they go for the hard sell and the hard sell is essentially, you know, do you want to sell software the rest of your life or do you want to do something that’s going to make an impact on the community and the people around you and you know what To be honest with you, I think a lot of, a lot of the people I hired from outside the industry that really resonated with them of, hey, you know what, for this period of time I’d really like to do something. Uh, you know, I know that’s going to impact the local community, not that what Microsoft’s not doing, doing doesn’t impact, but just in a different way.
BJ Moore: 03:54 Yeah. Certainly the mission is super compelling and the melding of technology and that mission is just a perfect fit for me.
Bill Russell: 04:01 Yeah. You get your, bring your experience. So, um, you’ve just taken over. Here’s what I’d like to do. I’d like to talk about some, you know, the number one question people are going to ask is, you know, can a person come in from a technology company, take over a CIO role and really do the things that need to be done and, and my premises, absolutely. There’s enough things that are this, that are the same across, you know, the technology landscape and, uh, and Microsoft was clearly far ahead of where we are in healthcare. So you’ve taken over this large it shop, um, large in terms of people, systems, number of applications, uh, size of the business. Give us an idea of what, you know, the first 60 days look like for you coming in. What do you, what are you looking to get your arms around and when are you looking to accomplish?
BJ Moore: 04:52 Yeah, the first 60 days, you know, I do have a strong technology background from Microsoft. So the first 60 days is, it really to immerse myself in the technology. Certainly need to understand what is the unique things about healthcare and the systems we use. For example, epic really the first 60 days is to immerse myself in the business. I’m not going to be come a health care expert after 60 days by any stretch of the imagination. But how do I meet with the administrators and healthcare givers? How do I get out in hospitals and healthcare system? Really understand how the business works. Um, what are the unique things about this industry? What are the challenges about our particular environment? Um, so I am coming in with a lot of hypotheses on how we should be organized and what technologies we could use some of that digital transformation looks like for really the first 60 days is about learning the business, learning about how it seems, how connecting with my peers, connecting with, with other leaders in the works. So it’s really more of a business focus for the first 60 days, which is a technologist doesn’t seem, um, you know, completely natural. But anything other than immersing myself would be premature. I can’t just jump in and start making technology decisions without understanding the business.
Bill Russell: 06:10 The good news is you probably have 100,000 some odd healthcare experts around you. At that organization to help you.
BJ Moore: 06:18 Yeah. And that’s kind of when people ask, you know, a why did rod pick you know, our CEO pick somebody from the tech industry. And that’s exactly what I say. You know, we have 119,000 healthcare experts, 119,001 when I make a big difference, probably not all for bringing that fresh perspective from the outside, we’ll be able to do tech journey to the cloud. Hopefully I can have an impact greater than just, you know, hundred 19,000 plus.
Bill Russell: 06:48 Yeah. And we’ve, we’ve had ride on the show and the thing you pick up very clearly is, he’s not afraid of the future. He believes that the technology will form the foundation for where this industry is going to go. And it will change it pretty dramatically. We’re going to see new businesses spin up, we’re going to see new ways of doing business within the traditional, uh, businesses. And we’re going to see new models for going out. And so I think he’s what he’s, when I hear him talk about it, it’s, we need people from outside the industry because when you look at healthcare and the experience that people have within health care of their data, not following them and no easy access to it, and it’s, there’s a lot of friction within the experience. And then you look at these other industries where, you know, I can do my grocery shopping while we’re recording this video and have it delivered to my house this afternoon. You realize that that’s just in terms of priorities That’s just wrong and that we can do our shopping that easy. But our healthcare experiences is a challenge at this point.
BJ Moore: 07:51 Yeah. There’s really a need for consumerization of healthcare. I can see that other industry’s it is how to make it very consumer centric and focused and something that you do on your phone and iPad and healthcare’s gotten
Bill Russell: 08:04 so. So what are you hearing? So you’re out there, you know, the, your first three weeks, what are you hearing from, um, from the organization in terms of just, just right off the top that they’re saying, hey, you know what we need, we need this or we need that. I always find that the, the first couple of days you’re in that role, you get such a, because you don’t have a lot of the baggage that goes along with it, you’re able to see things through a different Lens.
BJ Moore: 08:33 Well let’s just say I’m very popular the first three weeks, almost everybody in the business has wanted to set up a one on one with me. So my calendar is, is very, very full. Giving me a lot of constructive feedback on what we could do better. Um, and it’s everything from super tactical. It’s as simple as how do we onboard new healthcare providers and create access to our tools. That’s, that’s too too difficult for them to come on board. Um, it’s a epic our use of epic. You know, I think we’re on a good journey of, of standardizing on that. How do we make that experience a simpler, more friendly workflow flows? That’s been a trend around analytics. How do we unlock the data that we’re capturing? That’s been a big theme. I’ve got a lot of islands with data that are either inaccessible or accessible that aren’t connected. And so a lot of feedback on how to broader data strategy, um, people don’t articulate it this way, but I certainly take it this way.
BJ Moore: 09:33 How do we simplify the out party environment? I have learned since I came on board and we’ve got 4,000 applications in this environment. Hopefully there’s no human being and this in this organization that’s using all 4,000 but 4,000, it’s just too big a number. And so it’s too complex a need and we need to massively simplify that. So at a macro level, those are kind of the things I’m hearing from, you know, my, my internal customers. Um, it’s, you know, it’s really these blocking and tackling that I’ve been hearing a lot about something simple. Like I said, it’s application access. It’s justthis issue that shouldn’t be a big issue.
Bill Russell: 10:13 Yeah. I think I’m going to go down the technology path with you. I mean, the great thing about the whole epic standup and those kinds of things, I mean, if you have a grade Cmio, Dr Marinow, I think he, he really gets the business and he really gets the technology and how the two can come together. And you have Aaron there who’s doing innovative. You have a lot of people that you can really lean on. So it’s, it’s, it’s going to be, so what I want to sort of explore with you is you’re coming from Microsoft. Microsoft clearly has adopted the cloud in a big way in is building the cloud for many in a big way. Um, so I think people assume that you’re going to be a, you’re going to be sorta have a bent towards, you know, how is cloud going to be applied to this, you know, 4,000 application, uh, complex, uh, environment to, to really simplify and to automate a lot of the things that were manual before. So give us an idea of what that, what you, what your premise might be of what it could look like. I realize that it’ll change as you get deeper into the business. But what’s your premise coming in?
BJ Moore: 11:19 Well, first and background of what I did at Microsoft, so I was responsible for all of our commercial revenue systems. So a $70 billion business. And you asked earlier why I decide to leave Microsoft. One of the reasons is I’ve completed our cloud journey. I was happy to say as of last October I had moved to $70 billion business, could be 100% on the cloud, not a single asset on premise. And so it’s a platform that what I expect to do at providence. I expect to do a similar thing, um, you know, we’ve got various data centers, all 4,000 of these applications are hosted on brand leveraging the cloud itself the journey as I see it today, now again, three weeks in, I need to learn more is really getting out of that data, some business getting out of the business on applications and that isn’t going just be taking these 4,000 applications we have and moving it to the cloud.
BJ Moore: 12:11 First thing it’s going to be to simplify this environments immediately. And so instead of maybe 4,000 apps, maybe moving a thousand applications off premises and into the cloud, uh, yeah, it’s going to be using, you know, infrastructures and service, probably primarily the with being shipped in these applications to the cloud. Um, on the data front we talked about that for data strategies include big data and leveraging that platform as a service of the cloud offerings have you are Amazon and Microsoft and the sound data spreadsheet along that and then doctoring software as a service. And so we’ve selected oracle financials that in the, in the cloud as our Erp. And so, well in the case of Erp we’ll get away from on premises all together. Moved to a software as a service model. What it looks like to me is, I don’t know how long that journey takes two or three years, but um, you know, we’re either all infrastructure as a service, platform as a service, or software as a service. And this concept of posting with applications on premises just just took away. My team looks to me like I’m crazy, but if I can move a $70 billion, nobody would accuse Microsoft of having a simplified business model. If I can do that already, I feel at least I’ve got the chops to do that.
Bill Russell: 13:38 So let’s talk about why. So you did it for a $60 billion organization and this is just, you know, the purpose of the show is a train the next generation of health it leaders. So I would imagine even some of your staff is listening to this going, why do we need to go to the cloud? This works, this works. But cloud models are, are more agile, more efficient, more whatever. So give us an idea of what happened to that $70 billion organization as a result of your cloud booth.
BJ Moore: 14:07 Yeah. So for for one, lets just start with the infrastructure itself. It’s hard to attract the kind of talent for the Amazon and Microsoft. You’re running those gates, running those networks, securing that environment. We just can’t compete in those spaces. It’s just not the core competency. So just from a core competency perspective, it makes sense to me. You hit on the head, it’s really about agility. Using Microsoft example when I was at Microsoft, if I wanted to do a new project I’d have to plan my hardware pitches in six months, by the time I got the order and the hardware came in and got racks, um, got all the o s installed, there was a good six months right on finding the space in the data center. So six months at the latest. And then once I got on that hardware and hold onto it for dear life, you can, um, you know, if I gave it up when I have to wait another six months, but this was my dev environment my test environments, my user acceptance requirements, that concept completely went away when we moved to infrastructure as a service.
BJ Moore: 15:11 So if I wanted a new VM a new virtual machine, 15 minutes after I configure it that VM was up and running. If I wanted to create a development environment and run that for six hours, I could the end of that six hours of that Dev cycle. I can either blow that environment away and not worry about what I’m going to do with that hardware. Or I could what we called snoozing, that environment where that environment just gets written desk, I’m no longer paying compete charges to storage of that environment, that environment a care for a week, two weeks unsnooze it, five minutes later I had a dev environment up and running. And if you might develop men or task or when you add environments, some of these legacy environments, you know, even if I get down to a thousand applications and we’re not going to be engineering on those environments, and so taking these legacy environments and be able to create the environments but then just have them, you know, stored the disk waiting for three, six, 12 months before you to touch them again.
BJ Moore: 16:11 So it not only gives you agility, cost savings, security of the environment’s right. That’s one less environment for somebody to hack into or exploit. So you know, infrastructure as a service. There’s just so many variables that now one thing we should address, and Microsoft’s not going to like me saying this. If you just take your existing on premises environment let them shift it to the cloud, you’re actually going to pay more money than if you are on premises. So you can’t just take your existing practices and the way you manage hardware move it to the cloud, you know, you, you have to adopt new things. Um, so auto scaling, you know, on low load periods, maybe at night you’re down to just one or two dms to run a workload during the day during peek hours to maybebe that expanse is six, seven, eight.So it’s nice that we lost and like I said, your Dev and test environment, they don’t have to be up on and just pause or news and stuff. So yeah, that’s just a simple example of a buy one get, I see you’re trying to jump in. We’ll let you jump in here. So
Bill Russell: 17:22 I, having gone through this a little bit and uh, you know, I take some of the pushback will be, by the way, I agree with you 1000%. Some of the pushback will be around hey 4,000 applications. You’re going to have things, literally you’re going to have things that required dongles and to client server to um, all the way up to cloud native applications. You’re to have a few startups that have done cloud native applications that will be great if there was cloud native alternatives to all these applications. So it will be multiple strategies won’t it? I mean there’s not going to be like a one strategy fits all to get it all to the cloud, I would imagine.
BJ Moore: 18:05 Yeah. It’s not one size fit all. And some of the feedback I’ve got is some of these applications run on NC4 some of them are on windows XP. Some of these companies don’t exist anymore and you know, it can’t get rid of them. And you know, as the CIO, I’m thinking, Gosh, if we’ve got an APP, like they can’t be secure. Microsoft, no monitors supports it off basis. So it’s, it’s not a matter of, um, you know, the difficulty of moving that to cloud because maybe ready, I’m looking at it through a different lens in this case to say, boy, this is a huge security roles, but we do really get that out of her environment altogether. You know, it’s part of that simple find out environment. Hopefully it’s one of those 3000 I can get rid of, you know, is there an alternative is there some consolidation we can do just to get rid of that. There’s going to be a lot of triage that needs to be done. But you know, as a CIO I can’t just have a windows NT machine sitting in an environment that’s just, you know, high risk if you have.
Bill Russell: 19:15 Yeah. And NT NXP, I mean there’s not a lot of XP workstations but there’s an awful lot of XP clinical devices still out there that needs to be secured. So let’s, let’s jump over to the data side cause I’m, one of the benefits of cloud is, uh, the whole data and innovation side. So your innovation team does a lot of really interesting, cool things up in providence. Um, I’m still trying to try to get the team to come on the show, so I’ll keep sending the emails, but they, uh, but they, they’re hungry for data, they need data. Uh, they’re, they’re getting data from consumers that they want to move into your environment and they’re, um, they’re also taking information from the clinical environment, uh, applying intelligence to that and helping people to live healthier lives across the board. So what is your strategy look like?Tto give them the, the, the data and the tools they need in order to start building out those, those consumer level experiences that in building new experiences for the, uh, for the west coast.
BJ Moore: 20:16 So my three weeks I haven’t been able to dive into it, so that’s more kind of a cookie cutter answer. But I can give you that answer, which is, as I mentioned earlier, data is locked up in the silos of data, sequel pace, uh, legacy. The database legacy Databases. We need to have a data warehousing strategy, but we moved this data to the cloud. Really a big data data model right. Soon as you start taking all of that clinical data EHR data, consumer data, IOT, the medical device data. I just kinda these traditional analytics tools that they’ve been working with. And so I know we’re going to have to have a big data strategy, that big data strategy. It’s got to be cloud based. Um, and then you can, you know, have regular analytic tools, what everybody’s used. But now you can start putting these more advanced analytic tool from top of it. Like we shoot another artificial intelligence type of coaches. So I know what the pattern looks like and know what we need to move towards I did it at Microsoft. But you know, like I said, my first two months is really learning the business side of this, deep dive in with what our data infrastructure looks like other than I know it’s locked up in sequel servers are on their DB’s.
Bill Russell: 21:36 Yeah, I remember, yeah. As a CIO, I remember when they came in and said, hey, we have, and they counted the number of SQL databases and it was an exorbitant number, uh, almost, um, almost close to a thousand different data storage and you’re sitting there, gone, you know, um, you know, give me the characteristics of those. And they broke it down and it turned out that like, uh, you know, of that number, 90% had a, uh, something called a patient. So patient data in it, then you realize, my gosh, we capture patient data in almost 4,000 of those systems, maybe 3000 of them have a record called patient and they’re not tied together in any way at this point.
BJ Moore: 22:17 Not tied together in any way. And then also over time, people have taken system data and duplicated it and duplicated it and duplicated it, so there’s multiple sources of truth. That data has been transformed. Um, yeah, people were empowered. Empowerment did a fit and gives you multiple sources of truth um, that isn’t helpful when you actually tried to do that.
Bill Russell: 22:42 So what are some other practices? Uh, maybe not technologies, but what are some other practices? Um, you know, maybe around Dev ops, those kind of things that you’re, you’re thinking, um, you might bring with you or some other practices that you’ve seen outside of the industry that you think might be applicable in healthcare,
BJ Moore: 22:59 well I can speak to, you know what I’m seeing here. Um, providence stages of health. So we need a move to more modern combined engineering. Right we’re still doing, we still have a central PMO organization separate kind of configurization, separate QA organization, you know, Dev and test will need to be combined and do that combined dev function, move away from the silos. We’ve had need to move away from a PMO type function where it’s got generic pms move to really dedicated pm teams that keeps that amount of expertise that way I can have a lot of business by each one and then more advanced, might be later in the process of moving that to Dev ops versus separate support teams that really exists outside of engineering. So certainly need to modernize that workforce from engineering practice perspective. And then again in our environment, doesn’t look quite, we’ve got a really strategic outsourcing auction where we’ve looked at things and said, you know, do we have the core competencies? Are we the experts? Can we have others run that as a service on behalf? No. Do it at a cheaper or higher, higher effectiveness level. And then, you know, offshore it, we don’t have any teams in India, so whether it’s 24 by seven support coverage, um, port writing, application configuration, number of things we could lever an offshore for. So I know, hopefully my team doesn’t listen to this. I’ve been pretty transparent. I’ve already had two town halls, I’ve already talked about this. Nobody’s freaked out. But these are levers that we pulled in the tech industry 15 plus years ago. And here we are, this nonprofit struggling, you know, from a margin perspective and we haven’t, you know, done things from either an engineering practice or from astaff nurse in the afternoon.
Bill Russell: 25:05 Yeah. And you know, that’s one of the reasons we started this show was, you know, so that health it organizations would have their staff listen to it. And we have had some Cio’s say, you know, my, I’m having my direct reports, listen to them. We’re having conversations around it just because, you know, we’ll talk about RPA, we’ll talk about machine learning, we’ll bring in the experts around these things and hopefully it staff will recognize that, you know, the job they were doing yesterday, it’s not going to be the job. Definitely not going to be the job of doing five years from now. Um, but it might not be the same job they’re doing a year from now. And we, we just have to get used to the fact that including the CIO role, the job is going to change every six to 12 months based on what’s going on in the market, what new technologies are coming to play. Uh, you know, we talked to a, Oh, I forget who we talked to. We, you know, they, they talked about artificial intelligence is now writing code, actually writing code and the application. So I’m sitting there going, well that can’t make developers happy, but it’s something that you want to get out there. So developers realize, hey, I, I may have to change my skillset.
BJ Moore: 26:08 Yeah. And I hope I’ve got a workforce that’s excited about that mean these, these we’re doing a lot of things that require a lot of manual efforts. Um, that to me wouldn’t be very rewarding. And the goal is to retrain folks and do these more advanced workloads that I think are mentally more stimulating and have a bigger impact. Right. And in single eight hour day, I think you can have a bigger positive impact with these modern tools, modern practices, modern tech AI.
Bill Russell: 26:41 Yeah, absolutely. Well, you know, thanks for coming on the show. I think, you know, it’d be great to check back with you maybe towards, uh, towards the end of this year. See how you get your, get your feet under you and you come in and go, Hey, I learned a few things about health care and remember what we talked about this, this has changed a little bit of how we thought about it. It’ll be interesting to see, to just catch up on your journey as it goes forward.
BJ Moore: 27:04 It will be. And I know I’ll probably look back I was a little naiive to think that but frankly, I think that’s the value of having to come in as well, I’m not gonna be limited based on 30 years healthcare hopefully bringing a fresh approach and fresh perspective, you know, if I’m only right 51% of the time, you know, that’s still a success transform and move things quicker.
Bill Russell: 27:28 Yep. And that’s what I appreciate. I appreciate you coming on the show. Um, and I appreciate it. Ben Katz presentation pm cause he just kept asking the question of uh, you know, why can’t we do things this way in healthcare? And I think that’s, that’s what the new perspective gives is the ability to say, I think we could do it a different way and there’s probably a lot of things we should be doing a little different. So.
BJ Moore: 27:51 Well, thanks for having me on the show. I really appreciate it. Hope to connect with you in a couple of months.
Bill Russell: 27:56 Absolutely. So, uh, this show’s production of this week in health it for more great content. Check out the website, www.thisweekinhealthit.com or the youtube channel. At thisweekinhealthit.Com/Video thanks for listening. That’s all for now.
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