September 3, 2021: Kristin Myers, CIO at Mount Sinai brings us up to speed on her game plan for cybersecurity, digital solutions, patient experience and managing a remote team. 12% of all ransomware attacks are in healthcare. Downtime is dangerous. What kind of CISO should you hire to help defend your health system in the best way possible? What challenges has Mount Sinai been addressing through the pandemic? What’s the best way to get patient feedback? How do you determine and prioritize the best care solutions? What technology do you need to put in place? And where are we at with AI-Enhanced Medical Imaging?
Leading Through Change with Kristin Myers of Mount Sinai
Episode 440: Transcript – September 3, 2021
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: Today on This Week in Health IT.
[00:00:01] Kristin Myers: Our patients are really used to being able to have very easy experiences in other sectors, whether it’s retail or entertainment and we need to be able to bring that to healthcare.
[00:00:19] Bill Russell: Thanks for joining us on This Week in Health IT influence. My name is Bill Russell. I’m a former CIO for a 16 hospital system and creator of This Week in health IT. A channel dedicated to keeping health it staff [00:00:30] current and engaged.
[00:00:31] Special thanks to our influence show sponsors Sirius Healthcare and Health Lyrics for choosing to invest in our mission to develop the next generation of health IT leaders. If you want to be a part of our mission, you can become a show sponsor as well. The first step is to send an email to [email protected]
[00:00:46] Just a quick note, before we get to our show, we launched a new podcast Today in Health IT. We look at one story every weekday morning and we break it down from a health IT perspective. You can subscribe wherever you listen to podcasts at Apple, [00:01:00] Google, Spotify, Stitcher, Overcast. You name it, we’re out there. You can also go to todayinhealthit.com. And now onto today’s show.
[00:01:09] We have a returning guest, Kristin Myers, CIO for Mount Sinai Health System out of New York City. Good afternoon Kristin. Welcome back to the show.
[00:01:19] Kristin Myers: Glad to be here.
[00:01:20] Bill Russell: It’s been a little while. In fact, last time we talked, you were not the CIO at Mount Sinai and now you are so congratulations on making that step. [00:01:30] So is it a big step from where you were? I mean, you were over applications for the most part, which is usually one of the bigger portions of IT. Talk about the transition.
[00:01:38] Kristin Myers: Yeah. Yeah, I think that overall the transition has been really smooth. I think that given the fact that I worked at Mount Sinai for the last 17 years I was really lucky because I knew all the executives. I knew the IT team. And I was able to really [00:02:00] transition to transition into that position pretty easily. That has been fantastic. And I’ve had great support from the entire Mount Sinai community and the IT team.
[00:02:12] Bill Russell: Did it happen during the pandemic or prior to the pandemic?
[00:02:16] Kristin Myers: It actually happened around June of 2020.
[00:02:21] Bill Russell: Okay. So you were already in the middle of things. So, yeah, so the continuity probably was really welcomed given the [00:02:30] the amount of other things that were uncertain around the June timeframe in New York I would imagine.
[00:02:34] Kristin Myers: Yes, absolutely.
[00:02:36] Bill Russell: I always forget to do this and I want to do this with you. Tell us about Mount Sinai health system. The reach of it. What are some of the services that you guys offer to the community?
[00:02:46] Kristin Myers: Sure. So it’s an integrated healthcare system in regard to medical care. It also has a medical school and nursing school eight hospital campuses and a really large [00:03:00]regional ambulatory footprint. And it’s a combination actually of another entity back in July of 2013 of continuum health partners, which made up the Mount Sinai health system.
[00:03:14] Bill Russell: you guys have a a digital arm as well. You guys were doing a lot of innovation and those kinds of things.
[00:03:20] Kristin Myers: Yeah. So we have a group, actually such an amazing executive, Eric Lam oversees Mount Sinai innovation partners. So we [00:03:30] partner very closely with him.
[00:03:31] Bill Russell: Interesting. All right. So there’s so many topics we can cover. Let’s start with digital solutions. What challenges have you been addressing with digital solutions through the pandemic or moving out of the pandemic?
[00:03:45] Kristin Myers: Yeah. So digital solutions, so broad but will speak to edge in regards to our patients. We’ve had a lot of digital solutions that really need to come together in terms [00:04:00] of having a seamless and frictionless experience for our patients. And also incorporating the omni-channe l access into that experience. Our patients are really used to being able to have very easy experiences in other sectors, whether it’s retail or entertainment and we need to be able to bring that to healthcare. And so we’ve been looking at solutions, whether it’s CRM or referral [00:04:30] management, texting solutions, telehealth making sure that we can provide this in a way that makes sense to our patients and isn’t a fragmented experience. So that’s one of our biggest challenges is really bringing it all together and we’re slowly being able to do that.
[00:04:48] Bill Russell: Yeah. You guys are really focused on the patient experience. I assume there’s digital solutions on the clinical side as well but staying with the patient side. You’re in an urban center. So the [00:05:00] demographics probably lend themselves to a pretty sophisticated set of solutions. You’re not overly worried about lack of access to due to cell phones, lack of access to broadband and those kinds of things. You’re pretty much have a, a pretty wide open canvas to work with don’t you?
[00:05:19] Kristin Myers: You know I think that Manhattan and the areas that we’re in is actually a very diverse community. And Mount Sinai, [00:05:30] our patient mix is around 65% Medicare and Medicaid. Rather than that proportion being commercial insurance, which some of our competitors have. And so there are sometimes access issues to technology. And that is an area where New York city is actually making larger investments in broadband interestingly enough, in Manhattan, upper Manhattan.
[00:05:57] Bill Russell: So as you guys are looking [00:06:00] at the patient experience, how do you determine what solutions you’re going to prioritize? What echnology, you’re going to put in place?
[00:06:08] What’s the process? What’s the team that sort of comes up with what you’re going to do next?
[00:06:13] Kristin Myers: Yeah. So I think it’s a combination of operations and clinical informatics, the technology team that rolls up into a digital governance. And then ultimately we also have outpatient experience teams that [00:06:30] help us prioritize and also really vet some of the solutions that we’re rolling out to our patients. And I think that having direct patient input into the solutions is extremely important. And just getting that feedback in a closed loop so that you can iterate is really important.
[00:06:52] Bill Russell: So how do you get the patient feedback? Are you doing focus groups? Are you bringing them in the development process?
[00:06:57] Kristin Myers: So the patient experience group [00:07:00] facilitate that which is fantastic. They have community groups that they already have outreached to and bring them in on a wide variety of topics. And technology is now just one of them, which is great.
[00:07:12] Bill Russell: But what’s your philosophy on build versus buy, especially with regard to the solutions that are in the experience area, or maybe at the edge where the clinician and patient are interacting.
[00:07:25] Kristin Myers: I think that I always go back to our application [00:07:30] portfolio. We have a large one, being an academic medical center and do we already have existing functionality? And what is on our enterprise roadmap with groups like Oracle without ERP or Epic as our EHR and billing and access system. If something is not going to be ready for the next two to three years, we have to innovate and we have to be able to get a point solution[00:08:00] or build it ourselves.
[00:08:02] And there is functionality that is out already around text to chat that we’re going to be integrating into our main, My Mount Sinai application. And so I think where we can utilize already the technology in our applications, we try to do that, but if there’s a gap, you have to be ready to pivot [00:08:30] and either find the point solution or develop it yourself.
[00:08:34] Bill Russell: So pivoting a little bit here. So cybersecurity is obviously top of mind with the recent attacks and healthcare, really being targeted. How has the conversation changed as a result of the ransomware attacks and how are you guys sort of looking at and preparing for the new world that we live in, I guess?
[00:08:55] Kristin Myers: Yeah. I think the ransomware attacks have really changed the [00:09:00]conversation. 12% of all ransomware attacks are in healthcare and downtime can be on average around 23 days. And just thinking about being down for 23 days, I think that really I mean you’ve got to be able to reduce the attack surface, but you also need to be ready in terms of an incident response. And so we’ve really been looking at both areas and making [00:09:30] sure that we would be ready. So looking at the backups, doing tabletop exercises with our executives, I think is extremely important. Also looking at your overall cyber security program and its maturity and governance.
[00:09:48] And we recently brought in a new CISO from outside industry and super excited. His name is Rishi Tripathi. He started about a month ago [00:10:00] and he’s already bringing that outside expertise. I think healthcare has been a little far behind other sectors as it relates to cybersecurity maturity.
[00:10:13] Bill Russell: I felt like every hour that our EHR or a major system was down took like a year of my life away. 20 days of downtime, I’m not sure at the end of that as a CIO, I, I would have aged by 20 [00:10:30] years or so. That would be. That’d be amazing. And the Scripps one was 30 plus days.
[00:10:35] Kristin Myers: I know it’s terrible.
[00:10:37] Bill Russell: I can’t imagine that but that does change the conversation a little bit of obviously we’re prepared for a couple of days downtime, but now we’re sort of looking at it and saying, okay, how do we take a 30 day downtime and reduce it to even if you’re completely ransomed, how do you take that timeframe down to 10 days or so. As you guys look at [00:11:00] that, is that something that’s a function of the CISO or is that part of a governance committee that’s looking at security as a whole for the system?
[00:11:09] Kristin Myers: Yeah. So our CISO reports to both myself and with a dotted line to the Chief Risk Officer. And so we have an entire enterprise risk management framework and cybersecurity is one of the major risks, as it would be in any organization. So we have a whole governance structure. Whether it [00:11:30] be the monthly meetings, we have quarterly executive meetings, we report out of the IT committee of the board. I have my own committee where I meet quarterly and specifically on cyber security, as well as the audit committee. And then the full board of trustees at Mount Sinai.
[00:11:48] Bill Russell: Do you find they’re more aware, I know back when we were, I mean, when we, when we were doing this we had to convince them that cybersecurity was a major thing that we needed to invest in it and [00:12:00] whatnot.
[00:12:00] But I would imagine that conversation has gotten almost reverse. They’re looking at you going, Hey, how are we doing with cybersecurity? We want to give you money and make sure that we’re secure. It would almost feel like that pivot is happened.
[00:12:13] Kristin Myers: Absolutely. And I have to say everyone is extremely supportive of the cybersecurity program and I think it’s a journey. There’s not perfection with cybersecurity and it’s a maturity journey that everyone is on. But you know, [00:12:30] again I’m very happy that we’ve got a new CISO who has started.
[00:12:35] Bill Russell: Yeah. In some roles, when you bring somebody in from outside of healthcare, there’s a pretty significant learning curve. The CISO to me would be one that I would think there’s a lot of benefits from the experience from outside but there’s also not as steep of a learning curve. Obviously there’s the culture and an academic medical center has its own challenges as well. But for the most part, that’s probably one of the roles [00:13:00] where it would feel to me, like it’s not as steep. Is there a learning curve and how do you bring somebody in that role up to speed on healthcare and how it operates?
[00:13:09] Kristin Myers: Yeah, so I think the good news was in his previous role he actually had to deal with HIPAA also, which is fundamental to health care. We also are very lucky that we have a deputy CISO who’s been with Mount Sinai Kenny Chu for many, many years. [00:13:30] Because I agree that the fundamentals of cyber security quite interchangeable, whether you’re in healthcare or other sectors. But there are nuances. I was just in a meeting actually around research cyber security and some of the challenges that we need to really look at and potentially develop robust program around. So I think [00:14:00] that there are nuances, but again, I think that CISOs could come outside of industry and will be successful.
[00:14:09] Bill Russell: So digital and cybersecurity are probably two big buckets, but I was wondering and this question might be premature. I’ve been asking this question as we come out of the pandemic, obviously we have a Delta variant, which is upsetting things at this point. But as we hopefully move out of the pandemic. What do you see as the priorities from a health IT [00:14:30]strategies spend for say the next 18 months?
[00:14:35] Kristin Myers: Yeah. So we’re looking at all of our data centers looking at consolidation, also our overall cloud strategy. So as an academic, we have to have a multi-cloud strategy. There are different tools that we need for genomics that different cloud providers haves. We will always be multi-cloud, but you know, we need a [00:15:00] primary vendor to work with.
[00:15:02] So we’re going through that analysis right now as to where would we transition many of our business and clinical applications. So I think that the data center facilities and the cloud strategy all comes together with business continuity and disaster recovery. I think that’s a priority for me.
[00:15:23] I also have other transformational programs that are taking place. So we had [00:15:30]gone live actually during the pandemic with HR payroll for Oracle cloud. And so we need to move forward with financials and supply chain and as part of that entire transformation. That’s a huge project too, that we need to undertake as well as access and hospital billing.
[00:15:53] We’re rolling out with Epic. We’re also looking at unified communications strategy [00:16:00] for our nurses and corporate team members. Our nurses have many devices so we need to be able to streamline that. And we’re looking at also cloud to potentially replace some of our life telephones.
[00:16:19] We’re also looking at our clinical command center, which has been very successful and really came into its own during COVID. And how do we [00:16:30] extend remote consults through telehealth throughout the system. So there’s a lot going on. I’m sure there is at every institution.
[00:16:40] But again, cyber and digital are up there as well as our enterprise data strategy which we’ve been very much focused on and got funding for.
[00:16:50] Bill Russell: Yeah, well that’s probably where I would take you next. Through the pandemic, the use of data was really instrumental in our [00:17:00] response and I’ve been hearing some really interesting and neat ways data science and data has played a role and our health systems really responded to the pandemic. So I was curious where’s Mount Sinai using data in new and interesting ways? And where are you going in the future with it?
[00:17:20] Kristin Myers: Yeah. So one of the things that, you know, as an academic medical center we have is a lot of innovation and actually the Dean [00:17:30] just appointed Dr. Fukes to hit up an entire division of AI. At Mount Sinai and create an AI department. And so we’re collaborating with him on some of the imaging and what can you do around AI in imaging as one of the projects. We’re also combining clinical and claims and social determinant data to look [00:18:00] at how can we pinpoint our outreach efforts to our patients. And we have a number of predictive models in place and we want to expand those in our clinical data science team really around sepsis and malnutrition and delirium and other adverse events. So data is definitely a focus for us. We’re creating this enterprise data strategy, which just got funded really to have a foundation [00:18:30] across the health system and provide more self-service tools to our nurses and pharmacists and other groups throughout the health system. I think that we have a lot of data assets at Mount Sinai but we want to bring them all together. And as a research institution make it easier for our researchers to get access to the data appropriately.
[00:18:57] Bill Russell: Yeah. And just for [00:19:00] context here, we’re recording this on July 29th. It’ll probably air later. So the next set of questions probably will change. So some of this stuff, people sometimes they go, well that that’s changed over the last 30 days. Well, that’s how fast healthcare is moving. But I wanted to talk to you about return to the office. Have you returned your staff to the office and are your plans in terms of work? Either dynamic work environment or hybrid work environment? [00:19:30] What’s your plans moving forward around that?
[00:19:32] Kristin Myers: Yeah, so we have not officially brought anyone back into the office. I’m in the office today. I usually go in three or four times a week and have some in-person meetings, but the majority of the team completely remote and probably will be for the foreseeable future, especially with the Delta variant that we’re seeing.
[00:19:57] We’re probably moving to more of [00:20:00] a flexible remote offering for our team members. We’ve reduced our space footprint and have hoteling space rather than everyone having their own cubicle. And we’ve been doing this across the health system. Being able to add the terminate leases or leases have come up. And we haven’t renewed them. And so we’ve been consolidating in terms of space and [00:20:30] so no plans at this point to bring everyone back. As I said, I want to be able to provide that degree of flexibility. And there’s been no official policy at this point from Mount Sinai as to when people would come back I see in the news like many firms are saying, you must come after labor day but we have had no such announcements at this time.
[00:20:56] Bill Russell: Yeah. So how, I mean, one of the [00:21:00] questions and I haven’t asked this in a while, but how did you get everyone set up? Especially in New York, I would think, you have smaller living spaces. Obviously you probably have some people who are from surrounding areas, Jersey and whatnot but typically smaller living spaces. You’re trying to get people set up in a way that they can function really well. How did you and the team look at that and make those those adjustments and help people to make that adjustment to working at home?
[00:21:28] Kristin Myers: Yeah. So interestingly enough, [00:21:30] we had started exploring more remote work options actually before the p andemic because Manhattan space is at a premium. And so we already had I think before the pandemic, it was around a thousand people who were logging in remotely each day from home as part of corporate services.
[00:21:54] So we scaled that up and we were able to scale up that infrastructure up [00:22:00] to 10,000, I believe was at the height that were logging in per day in the pandemic. We did have to scale up our help desk and make sure that they were able to handle all of the calls. And also our technology team.
[00:22:19] We did have to bring in additional resources to manage that. But we’ve been working with the departments making sure that they have all of the equipment that they need at [00:22:30] home. I think some of them, some of the team members have said we need two monitors. We’ve been being able to send those to the team members. That we’re working department by department to really make sure that all of their needs are going to be met working remotely.
[00:22:48] Bill Russell: Yeah. So talk to me about adjusting maybe your management style or your team helping them to adjust their management style with work from home. This is very different meeting people in this format. Very [00:23:00] different than meeting in a room and the energy that can get bBrainstorming ideas and meeting and going out to lunch and those kinds of things. So how did your team adjust from a management approach?
[00:23:10] Kristin Myers: Yeah, I think that the key to remote working is really communication and being transparent and making sure that you’re available to your team. And checking in with them and making sure that everything’s okay, that [00:23:30] they’re not struggling. I think that a lot of things happened last year, whether it was the pandemic, I mean people were impacted by the loss of loved ones. We had social upheaval. I mean, there was so much going on that it was very stressful for many of the team members. So I think as managers making sure that we checked in with them constantly I think is [00:24:00] important, but being transparent, communicating, I think always important, but doing it more frequently.
[00:24:08] Bill Russell: Yeah. It’s interesting. I was just reading a study. Microsoft came out with their annual study on work and the work trend index for 2021. And it predicts that 41% of workers are considering leaving their current employers. When you hear those kinds of statistics[00:24:30] does that create concern for you or do you feel like you’re on top of the retention aspect?
[00:24:37] Kristin Myers: No I think that what we have learnt in the pandemic is it doesn’t matter where you work really. And I think that our employees have choices. They could apply for jobs in Texas and still live in New York if they wanted to. Or move wherever they want to and work at any facility in the country.[00:25:00]
[00:25:00] So we have to be competitive with that and that’s why I still want to while I want to hybrid work environment and I definitely see the value of meeting people in person like I did even today. We need to be flexible also because there are some employees who do you not want to come back to the office and want to continue to work remotely. So [00:25:30] we’ll have to have that flexibility to be competitive.
[00:25:33] Bill Russell: Yeah, absolutely. So let’s have a little fun to close this out. If I gave you a million dollars right now to place a bet in some area of digital health what’s an area that you think would have the greatest return over the next five years. And you would say, I wanna play in this area of digital health, I’m gonna place a million dollars.
[00:25:54] Kristin Myers: I think probably remote patient monitoring. I think that the [00:26:00]institutions are being paid by CMS. I think that it’s going to be something that patients adopt more readily and just be part of patient care moving forward.
[00:26:12] Bill Russell: That will be very interesting. I think you’re going to see hospitals who used to say, yeah, we’re a 300 bed hospitals say, but we’re a 6,000 bed hospital and they’re going to be like, well, you don’t have enough real estate. They’re going to say, well we’re monitoring beds all over the city, essentially. It’s going to be really interesting. [00:26:30] Kristen, thank you very much for your time. I really appreciate it. I know that you are incredibly busy, so thanks again for coming on the show.
[00:26:37] Kristin Myers: Thank you Bill.
[00:26:38] Bill Russell: What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to this show. It’s conference level value every week. They can subscribe on our website thisweekhealth.com or they can go wherever you listen to podcasts, [00:27:00] Apple, Google, Overcast, which is what I use, Spotify, Stitcher. You name it. We’re out there. They can find us. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders. Those are VMware, Hill-Rom, StarBridge Advisers, Aruba and McAfee. Thanks for listening. That’s all for now.