Live From Becker’s – 6 CIOs Talk Digital Strategy – Part 2

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The Conclusion of our 2 part live series with Andrew Rosenberg from Michigan Medicine, David Chou with Children's Mercy, and Jake Dorst of Tahoe Forest Hospital District. A casual conversation about Digital Strategy in healthcare today.

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Bill Russell:                   00:04                Welcome to this week in health it where we discussed news information and emerging thought with leaders from across the healthcare industry. This is the second part of episode 38. Well, we’ll just call it episode 39 a special from the Becker’s conference in Chicago this past week. And a, the first episode if you missed it, had a conversation with, uh, our first three guests, our first three cios from the conference who answered a set of five questions. We had a Jason Joseph from spectrum health on that show Ed Marks from the Cleveland Clinic and Tom Barnett from University of Rochester Medical Center. On this episode, we feature Andrew Rosenberg from Michigan Medicine, uh, and David Chow with the, uh, with children’s mercy as well as Jake Dorst. I happen to have Jake and David at the same table. And uh, so those two sort of run together, you’ll see that at the end of this episode. We’re going to start this off with a, with Andrew Rosenberg. I hope you enjoy it.

Bill Russell:                   01:07                There we go. Alright. So, um, why don’t you introduce yourself and give us the scale and scope of your organization. And then we’ll go into the questions.

Andrew Rosenber:        01:16                Well, thank you. I’m Andrew Rosenberg. I’m the chief information officer for Michigan Medicine, which is the University of Michigan health system and the University of Michigan Medical School. Uh, the health system now is about a four, four and a half billion dollar in revenue health system. Our enterprise, it is about 900 staff. Uh, we are predominantly in southeast Michigan, but perhaps a distinguishing feature is because we are the state university, a tertiary quaternary care center. We get patients from every county in the state and we’re even written into the constitution of the state of Michigan. And so we have a, uh, not only a public university culture and mentality, but really without it hopefully sending like a platitude. Um, we, we affiliate, we affiliate with many other health systems in the universe, in the state of Michigan. And it’s those affiliations that really add value, but also these interesting challenges. My personal background, I’m an internist. I’m an anesthesiologist and intensivist and I’m a faculty at the University of Michigan Medical school.

Bill Russell:                   02:29                Yeah. It’s amazing. I mean, you just got done speaking here at the Becker’s conference and you were talking about just those partnerships and those, uh, you know, partnering with Trinity, which is competitor in your backyard, uh, and just about everybody in that market, we’ll use your services in some way. You’re almost like a children’s hospital and that it’s sort of like Switzerland to everybody

Andrew Rosenber:        02:48                partners and of course we have the Mott Children’s hospital that even, for example, we just literally last week opened up a health, a cyber security operation center, our h sock and we’re partnering with Beaumont Health. Uh, we’re partnering with Munson, we’re partnering with other traditional. They’re not necessarily competitors, but they’re what you might initially think of as competitors. That’s, this is this affiliation that we’re doing that’s really part of our culture,

Bill Russell:                   03:17                cybersecurity. So I’m getting into an interview here and I don’t, I don’t want to do it. So the first five questions, let’s, let’s just go through and real quick. So, um, how has your system thinking about digital and, uh, addressing the digital and healthcare right now?

Andrew Rosenber:        03:32                I don’t want to sound like a contrarian on that, but I. I try to change that question just a little bit. What I’m really trying to say is where are our varieties of strategies either completely now being done through digital platforms, methods transformation, or could be done better so that we don’t have a digital strategy. We don’t have a digital strategy officer, we don’t have a cloud strategy. It’s really recognizing how this move from analog or previous or legacy into a new way, particularly where digital will play into it is aligned to the strategy and not a digital strategy and I’m trying to distinguish that because I think it aligns more with other leaders who don’t typically think in terms of technology in it or digital not feel like they’re somehow being sold a bill of goods. Right?

Bill Russell:                   04:29                So when you think about removing the friction from transactions, when you think about improving quality outcomes through data and those kinds of things, you don’t have a digital strategy per se, but you will bring digital tools to bear.

Andrew Rosenber:        04:45                Right. Let me give you two examples that to me are superb in. They’re extremely recent in the last two years. The first was I wanted to promote much more advanced analytics and I particularly wanted to promote varieties of machine learning, so we picked two vendors, one in structured, uh, excuse me, one in supervised machine learning and another, an unsupervised machine learning advanced analytics. It’s machine learning, but it’s two particular types trying to go after two or a multitude of use cases. The one that I thought was going to work out was the unstructured form of machine learning with the idea that it would generate hypotheses that were previously not appreciated. The one that really worked out was structured because for a variety of different users, the ability to speed up algorithm development which they were already working on was significantly improved. So there was an example of trying to improve our clinical design, a initiative quality, some basic discovery in some clinical trials areas in our ecosystem.

Andrew Rosenber:        05:55                It was structured machine learning and one particular vendor that really took off. Another one now is in robotic process automation. Again, it’s not that we have a digital strategy for rev cycle, back end, it’s, we have a series of efforts and needs that fit into strategy or tactics, but, but explicitly looking for not just digital but specific elements that we know are likely to work. And then the final point, I’m actually using the RPA work, robotic process automation for invoice management and rev cycle to really try to promote real ai. So I actually in my mind have more of a digital strategy as the cio, but I’m using these more pragmatic areas in other areas of the, um, of the institution that will drive their value. But in the end I’m going to pull it back up and say, see, this is how digital and digital transformation works.

Bill Russell:                   06:54                It’s interesting. I’m wondering how much your, your culture is influenced by the university having to university right there. Keeps you. I mean, the pool’s constantly moving though the ponds constantly moving. So you may not be battling a stagnant culture as much as other organizations are. And so they’re saying, hey, we have to bring in this, these digital players from outside the industry to sort of shake things up. But with the university you might might

Andrew Rosenber:        07:21                keep things going. That’s true. I think that’s a really insightful idea. And, and what I would say though is, you know, uh, and I use this example a lot when we had a couple of very large vendors come and talk to us about analytics. They typically went right to predictive and prescriptive analytics, have a variety of types and I would say both sincerely, but somewhat to be provocative. Just realtime data would actually have more value right now than anything into predictive and prescriptive. And people would do what you’re doing right now. They would smile because I think they have been thinking about that and get it. It’s not that we don’t want and want to be planning and that’s why rev cycle. When I went to some of our other meetings, I would ask other industries, where are you seeing more advanced analytics really having value? And they would talk about a lot of the backend logistic unsexy kind of stuff. But I think even for areas where the culture is a little bit more stagnant, people will get this idea because I’m not trying to pitch to the CFO something arbitrage and global international markets. I’m saying we just want to speed up invoice management. They get that.

Bill Russell:                   08:34                Yep. Absolutely. So second question here is, how do you determine the signal from the noise? I mean, there’s a lot. You come out, come off a speaking at a podium and 10 people will hand you a card and you know, one of those is probably phenomenal. Nine might not be appropriate, be timing or whatever for your situation. Um, you know, did, how did your organization sort of sift through that to determine, hey, that that’s a problem we want to solve?

Andrew Rosenber:        09:02                When I created this new system level CIO job. And I was talking with the combined leadership group. I said to them the first order of business after just getting to know each other. Well, we’ll be portfolio management and I’m going to get to answering your question in one second. In portfolio management, the demand portfolio, the project portfolio, and the asset portfolios. One of the key things that I, that I said we have to be able to do is that this will help us prioritize those areas, of a very complex organization, which by the way, I don’t think in many ways is that much more complex than many others. In order to then say, what are our really true key priorities in? Once we started to get better at that, then when I hear different inputs, pitches, talks, reading things, the things that tend to look like they may align to those things that I know are of priority start to stand out.

Andrew Rosenber:        10:02                They start to emerge like a color image in the background of a black and white. So an example would be knowing that analytics is extremely important to all of us, but making a point that I want to look at either real time where some extremely unsexy but pragmatic, uh, types of analytics in some of our backend work. When people come to me and start talking about workflow redesign for robotic process automation, that will capture my attention, frankly more than the big moonshots of, of um, neural network enabled prescriptive analytics. I don’t want to not be involved in that, but for right now I am going to be much more pragmatic, much more aligned with some of these, but it’s part of a, of a portfolio that we’ve developed that helps. It helps to reduce what I call the shiny ball because I’m, I’m as susceptible to is anyone else to, Ooh, that sounds really cool, or I know this person, so I want to get to talk to them or, or whomever. It helps.

Bill Russell:                   11:10                I get it. I was on a panel once and they asked me which one of these technologies are most attractive to you? I’m like, all of them. That’s who I am. So, uh, but yes. So third thing you know, you’re gonna be talking to a lot of CIO’s with this question. So, and uh, and I have a really good cross section of cios, you know, children’s hospitals, small, large scale of things. But one of the questions I get a lot is what’s the, what’s the one opportunity that sort of sitting there for it that they just need to grab. And, and what I hear you saying is there’s so many pragmatic opportunities right in front of all that they don’t need to worry about the crazy blockchain or this or that. I, there’s just, there’s just basic things, right?

Andrew Rosenber:        11:56                What I thought about before, and somehow it seems to be working out really well and it may have been part of my clinical background, particularly where I would be in the ICU, faced with a number of complex inputs. Why is this patient in the ICU? While they’re actually at least two or three reasons that are all pretty close. You have to pick one. And this is something I developed over time and I taught fellows and residents that even in these extremely complex situations, you still have to ground these decisions and these conversations into at least one of them. So I just say that because you said it perfectly before then. Of course the answer is that there isn’t one. And so what I start by saying is, okay, in your organization, if you can at least try to say what are your two or three top priorities, which in and of itself already very difficult,

Bill Russell:                   12:52                but when you say physician, a physician satisfaction with the Emr, so personalizing the EHR personally, I’ve been taking that on, getting them from working 12 hours a day back down to 10 hours a day would be, would be wonderful. Um, or uh, or the digital consumer or I mean, aren’t there, aren’t there like at least a couple of things that sort of bubble up every year that are just not

Andrew Rosenber:        13:17                They’re not a couple of things. There are literally dozens and dozens. So that’s why, again, I go back to this idea of portfolio management, but, but, you know, we’re all. Let me give you an example. Um, one of my colleagues, um, would talk about we need a cloud strategy. Sort of back to one of your earlier questions. And what I’d say is we certainly don’t need a cloud strategy. We need to know how already cloud which has already deeply embedded is going to be somewhat controlled as we go forward, so within that, just within that topic alone, the priority I picked was to work to get enterprise level contracts with the three big cloud providers that we have to work with at u of M that we want to work with so that dozens, if not hundreds of people could benefit in their variety of innovations in the cloud. So I didn’t worry about a single cloud provider. I didn’t worry actually even about a single use case. From my perspective, I thought the force multiplier, it’s a term we used to use in the navy and the military is to find what is that commonality among a variety of other uses and that would be one. So for me, if you said what was your, what, what was the biggest thing you did in cloud? I’d say we use the size of u of m to get best contracting for the big three for a variety of people to now use.

Bill Russell:                   14:47                Clouds interesting because it’s the core of my business and we go in and say, you got to set up a framework. For me it was I got a phone call. The first, like within the first six months of being the CIO, they go, hey, this is blah blah blah from dropbox. Congratulations. You’re one of our biggest users. I’m like, well wait a minute. We don’t have a contract with you, and so they’re going to use it. So putting that framework in place, putting the contracts in place, I’m putting the security architecture and how we’re going to audit secure that data. Gave people the ability to now say, okay, can we solve this problem with some cloud technologies and they’re out there and oh, we have a framework for engaging cloud providers

Andrew Rosenber:        15:26                and I could use dozens of examples of that, but one that I love was we put together a market map and I don’t know if you’re familiar with these, but you’ll see these with vc and private equity firms. They’ll show a variety of the vendors in particular spaces and I showed it to the president of the university and he said, wow, wow. And when I showed him where all of the cloud vendors currently being used at U of m and he said, well, and they were about 130 and this one eight by 11, and then I said that’s only four of our 19 schools. And then he really said, wow. And I said, the point is cloud is deeply here. Now the question becomes what are the problems, one of which would be how do we try to to shepherd people to be using these in a more secure manner? How do we, on the other hand, shepherd people to be using this in a cost effective manner? Because otherwise they would just chew through their money using cloud if they don’t do it. Things like that.

Bill Russell:                   16:29                So you have distributed budgeting. Some what I would assume that’s interesting. A fourth question, what, what’s the biggest threat to traditional healthcare

Andrew Rosenber:        16:38                cybersecurity? Immediately I will. I mean I didn’t even need you to finish. And, and the reason I say this is that as a clinician, one of the threats that I would have talked about would be things that were on the medical side, pandemic flu. Um, another one I would have picked probably would be the financial system itself and you know, we could go off on that forever.

Bill Russell:                   17:04                But here’s my question for you on cybersecurity because I was on a cyber panel this morning and one of the points I made was, We haven’t seen a correlation between a breach and it affecting the business right now. Clearly there’s fines and those kinds of things, but you don’t see a Mass Exodus of patients. Um,

Andrew Rosenber:        17:22                but that’s not what I’m worried about. I’ll tell you, I’m worried about something that’s a little bit more existential.

Bill Russell:                   17:26                So you’re not worried about the reputation and the.

Andrew Rosenber:        17:28                No, I’m not because of exactly what you just said, whether it’s anthem, whether it’s uclas breach, whether it, you know, just kind of keep going down.

Bill Russell:                   17:38                I’m still going to go to the University of Michigan because it has the best care.

Andrew Rosenber:        17:41                and I would say Say even at, I would say there are a few other social factors going on, but this is my best crystal balling number one. As the population migrates, more and more of our population will just be that much more comfortable with their data being public. Number one, our kids are all living in a world of infinite more public data than we ever did before, so I would say just trying to look even 10 years into the future, let alone beyond.

Andrew Rosenber:        18:11                I think people will be much more comfortable with their data. Interestingly, I think it will be dichotomous. There’ll be both more comfortable and there’ll be more attuned to when it’s being misused, but even if I’m wrong in that one, look at the breaches that have occurred now, some of which have been because of really just almost I’m neglectful potentially even that, whether it’s a smaller physician office or a large. You don’t see patients. I think leaving in mass, I don’t think, and I don’t know this as well, do you see people leaving some of the large corporations when their data has been misused and there’s been a breach of the violation of the ethics around their data, so that’s at least one reason, but more importantly to me is look at some of the attacks that have occurred, like wanna cry, non Petya, a destructive attack.

Andrew Rosenber:        19:09                Not a ransomware, but a destructive attack. We were down for over a week, uh, when one vendor was attacked, that was not us. We just assume that of course they had good business continuity and resilience and that that just took out our transcription services, you know, who would think trans well because we couldn’t then deliver notes effectively. So I’m, I’m concerned when and my point is it’s not just within healthcare, all the things that are related around it power of course, and other social services that are required for supply chain, the ability and the examples that are real world. These are not just theoretical to me. Non Petya is still probably the single best example that we’re not discussing where multiple organizations, merced shipping others, they were down for days and then of course there were actual hospitals in the UK and others with Pecha with wanna cry and even non Petya that were taken out in the speed with which it happened. Our is much faster in a try to kill this one mosquito so that we all don’t get Zika.

Andrew Rosenber:        20:25                This mosquito has destined to live. Alright, I got it. I’m sorry about that. You’re going to have to. You’re going to have to get that recording coming out. They’re not going to let someone to care and protect me. I appreciate it. These are existential threats that the only other thing I could think of in tended to be the epidemic, but so far even Ebola. Think about Ebola in the United States. How many patients were actually affected by Ebola when we were all worried about that one too.

Bill Russell:                   21:03                It was less than 10. Right? But, but it was multiple markets. We saw it in Texas. We saw it in a. well actually it was just where people visited. So you saw it up in Ohio,

Andrew Rosenber:        21:13                I mean literally a handful at most, only one of these big cyber attacks have affected millions of people and for what reason? I’m not quite sure.

Andrew Rosenber:        21:23                We tend to still not be as worried about it, so that’s why I jumped on that right away.

Bill Russell:                   21:27                Yeah, that’s interesting. It is one of those areas that I think there’s. There’s so much commonality we could. We can partner and we did in our market we did. We would sit around a table and in the in our market and talk about what are you doing in cybersecurity because it’s not a. it’s not an area of differentiation. Correct. And we can.

Andrew Rosenber:        21:46                In fact, not only that, but it’s a great example where I think everyone I’ve talked to immediately gets that only through cooperation are we. It’s one of the better examples were actually working together. We will be better off. We literally only started our health sock this week, so with all these discussions we at the University of Michigan has only started it a week ago. We only had our CSO for two years.

Andrew Rosenber:        22:12                These are still extraordinarily at the beginning of something and as we get more and more digitized as well as the rest of our infrastructure is digitized, I’m really spending a lot more time with that lever than the previous one, which was financial. I mean as a cio, you recognize probably the lever you had to deal with more than efficiencies and interoperability and reliability. Maybe I’m finding security is a much stronger lever now than even some of the financial.

Bill Russell:                   22:40                That’s interesting. So last question, if you could rewind the clock and we’ll play one of these games. If you could rewind the clock three years, what do you wish you had spent more time on three years ago to prepare your it organization for today?

Andrew Rosenber:        22:53                You know, you already talked about a few of these, but I’ll talk about one other one that we’ve not mentioned and I’ll just preface this by saying you something you’ve already mentioned. What’s very interesting about this work, and I can tell you compared to even the clinical side of healthcare, the number of choices, opportunities and things that we talk about that are new are demonstrably more than any individual person who had talked to in a clinical field. So I say that because one other one that we’ve not talked about. If I could do it a little bit better even three years ago, it would be procurement. You’d be it contracting procurement and all the workflow and underlying systems around how do we procure, have more efficient contracting and also another one would be inventories. So. So what I mean by that would be we just finished an enormous device inventory.

Andrew Rosenber:        23:49                It took us about two and a half years. We spent millions inventory, all devices that connect to our network and now we have with network access control, the ability to also a better control. We have no inventory of our applications other than knowing that we probably have about 15 to 1800 applications live in our environment, so inventory, application and other type of life cycle management and then the procurement attachment to it will help us free up resources for the new things because now increasingly we’re just trying to find enough money to manage, run. We really don’t have these opportunities for grow and transform as much as we would want because we’re spending that much more supporting our run rate. If we were better in our contracting procurement lifecycle management, I think we could be more precise to start to carve out more money for grow and transform.

Bill Russell:                   24:53                I’ve heard so many interesting answers on that, but agility seems to be a hyper efficiency and agility seems to be that commonality of people saying, I wish I could do more today than I’m able to do because there’s so many things coming at us. So many things to do. And if I had, um, if I had a more agile system, I’d be able to provision servers in a couple of hours instead of a couple of weeks I’d be able to scale up, scale down, I’d be able to move all that work, that’s the pocket protector kind of stuff that my dad grew up with, a pocket protector, but this move that all to, uh, to, you know, just run rate kind of stuff that’s handled by far fewer people and your people are spending a lot more time with the clinicians rounding and, and really solving a higher level problem.

Andrew Rosenber:        25:46                Right? And when I think about that point you just made, we could talk, I could have said, oh, we’re going to invest in Dev ops, uh, we’re going to invest in fabric data centers, whatever. I’m trying to find, again, like I talked about with portfolio management, these commonalities. And that’s why I chose this idea of contracting and procurement because I think that’s still where there is enough inefficiencies. We can find that much more money resources. Um, I, I think it also might help to also do what we all talk about doing, but I haven’t met anyone including me who’s done it well, which would be, how do you get, how do you deprecate legacy? That’s not really that helpful anymore. We all talk about it, but it’s a lot harder to clean your garage. It’s a lot harder to get rid of some of these small applications. I just keep running. It’s that process that I’m working on next.

Bill Russell:                   26:45                I was talking to an ai company, machine learning. That’s where they started. I said, well, how’s the business going? Good, good. We’re not doing what we started to do. So what, what are you doing? Legacy said we have this massive back end infrastructure, and people were like, Hey, can you just take our old applications with that in create a nice front end, but we can get the data back out. I said, well, yeah, we can do that. That’s our core business. Like, yeah, but that’s what we need. And I’m like, well how much 90 percent of their business now is that. And I’m like, well that’s a neat. You found that neat, so hey, thank you very much. I appreciate that. Appreciate your bill.

Bill Russell:                   27:21                Next up, we have David Chow and Jake Dorst who were sitting nicely at a table when I inserted myself into the conversation and asked them if they would be willing to be on the show and they were both very up for it and I really appreciate them doing that. Here is that segment of the show.

Bill Russell:                   27:39                We’re wondering if you could introduce yourself.

Jake Dorst:                    27:44                Sarah. My name is Jake Dorst. I am the chief innovation and information officer at Tahoe Forest Hospital district in southern California. We’re a critical access hospital and uh, we basically have a hospital and we have another one in incline village in Nevada, which is a smaller entities.

David Chou:                  28:05                I’m David Chow. I’m the chief information and digital officer for children’s Mercy Hospital in Kansas City, or a $3,000,000,000 organization with two hospitals, 45 plus locations throughout the state of Missouri and Kansas.

Jake Dorst:                    28:19                Well, that’s good. We have an order of magnitude difference between us.

Bill Russell:                   28:23                So we’ll start with you. This is an easy question to you, how is your system thinking about digital and how are you addressing digital in health care,

Jake Dorst:                    28:34                uh, well we’re, we’re definitely moving more towards a patient centered applications technology things that our patients can actually connect back with the hospital. I think we’re going to get into this conversation on one of these other questions? But the consumerism in healthcare how are we mining that data and making it meaningful smooth experience for our patients in our area. We need. There are choices, uh, there’s other options for our patients to use. Luckily in our area, we have a good capture of our market though. We want to hang onto that market.

Bill Russell:                   29:13                We sound like we’re at a dance club. And how are you guys thinking about digital?

David Chou:                  29:16                So we’re starting to drive this digital sort by building, by building new business model, building new business models, using technology. And that’s how we’re starting to think about, I would think of managing fees and investments that we have made the last two and half years. I’m starting to get out of the weeds of core technology and really being that aggregate of all the various business models throughout the organization that’s using these technologies improve your experiences. So I’m leading that initiative, but I had to do that by get me that out of core technology in order to accomplish that.

Bill Russell:                   29:51                There’s no longer a good use of your time to sit down with this vendor and that vendor, this vendor and have those conversations.

David Chou:                  29:59                Right. But you know, you got to have the foundation. So my first two years I’ve been there for two and a half years. The first two years really building this foundation that’s not great. But solid and good enough. It’s good enough to move on and we’re at that stage now to where we’re looking at the next level. We’re looking at ways to do things differently because that’s what it’s about. its about how do you operate differently versus how you operate your five years ago,

Bill Russell:                   30:27                So second question. how do you determine the signal from the noise you’re, you’re at some conferences, you talk to people, your stuff coming at you and then theres stuff that you’re looking out in the market going, hey, we need to be doing that. So how do you determine that

David Chou:                  30:39                So for me, I keep my. I keep the pulse on what’s coming out. I keep the pulse on the trend, be aware of the trend, but just know some of the trends you can’t take advantage of today, whether it’s organizational readiness, skill set readiness with your team set, so that’s how I filter out noise by keeping track of the trends, understanding where the organization is ready, but at the same time stay true to the core, right? If you have some technology, competency is for, let’s just say your network, you gotta fix the fix the network. You can’t bypass that peice and go on to Ai. Some of these other peices, you gotta have some of these solid foundation, so really understand where is your core, what needs to be the foundation. It’s critical.

Bill Russell:                   31:24                CIOs loose their job if the netowrk doesnt work.

David Chou:                  31:24                thats Correct.

Bill Russell:                   31:26                How about you Single from noise?

Jake Dorst:                    31:28                I’ll echo similar to what David said, well, what we try to do at the beginning of our budget cycle, we sit down and say what are our top three things that we want to do this year? And that kind of gives me a focus. So then I’ve automatically narrowed down if I’m. If someone comes up there, Hey, I’ve got an awesome ai solution for you. That’s not on my roadmap for this year, but give me your information

Bill Russell:                   31:54                so the right thing at the wrong time

Jake Dorst:                    31:54                right

Bill Russell:                   31:55                is still the wrong thing.

Jake Dorst:                    31:55                and that makes it easier for me also to say because I’m a nice person, I like to give everybody time so it’s makes it easier for you to say, you know, at that’s not on our roadmap yet, but I’m building this foundation that David talked about is really like, we want to get there, but I’ve got certain things this year that I have to do. Then I can find those vendors and we go and we try to seek out some of that early startup type companies that are in the area that we want to move to. Like you’d like that newtanics and hyperconverged infrastructure and those types of things.

Bill Russell:                   32:29                So you’re talking to a cio is right now. What would you tell them is the biggest opportunity within health it?

Jake Dorst:                    32:35                For me, I think it gets. It’s really improving patient experience. I always tried to put the patient first, so I’ll echo ed marks on that. He is a key note here last year. Really synthesize a lot of thoughts that I had had going in here I’ve been doing this for 20 years. I’m really putting the patient first, making that experience to the patient, kind of like that Disney experience. I just got off the Disney cruise with my family. It’s fresh in my mind, but you know where they were with where you feel like you’re a special person or a special case with each one of those and that’s how we get there digitally. It’s all going to be those digital tools and building that foundation to get there and going to the digital platforms eventually getting into ai and giving them those tools to the people that interact with our patients is is where I would like to spend my money.

New Speaker:               33:33                We checked into this hotel and it’s just a barcode everythings acess keys, everythings digitized and disney is a great eaxmple. I went to Disney World and they gave you that bracelet Usually it’s unbelievable experience from end to end

Jake Dorst:                    33:44                till you get the bill.

David Chou:                  33:48                Yeah. Got It. Yeah, I do remember this. Twenty five lattes. It was easy though, right? Yeah, it was. they made it easy, so that helps

Jake Dorst:                    33:53                You don’t want to go anywhere else and that’s my point of of being a consumer driven platform that healthcare is becoming, which it hasn’t been traditionally, is to move to that and that’s how you’re going to get their digital tools.

Bill Russell:                   34:05                What are you telling Cios when they call you up and say, if I could boil it down to one thing this is what you should be focused on, if you say block chain I’m gonna hit you?

David Chou:                  34:14                No, no, no. It’s about understanding the business model, understanding how you can drive the pnl and understand how you can provide a better clinical outcome. It’s not about technology. You have to understand the business model and most cios there. They fall short of that. They understand how the business model work and that’s. That’s a detriment actually,

Bill Russell:                   34:34                so you have to understand what the economic drivers are for your business. Then you can then you can talk about the technology. This technology can be brought to bear in this way,

David Chou:                  34:44                right? Everything relates to some sort of outcome and tie that into the outcome. Even simple network upgrade, they’ll just talk about here that never upgrade. Talks about how you can improve the efficiency a few seconds shaved from a clinician logging in because of your upgrade is a financial factor that so you got to take it that next level because everything ties into some sort of outcome

Jake Dorst:                    35:03                or how that ties into maybe it’s new features where your byod for your patients in it and you have new wireless features that makes it much more seamless and smooth to deliver content to your, to your patients, which kind of has become an expectation.

Bill Russell:                   35:18                So what’s the biggest threat to traditional healthcare today?

David Chou:                  35:22                Stay traditional and not changing. I think that’s the biggest threat.

Bill Russell:                   35:26                Loose Traditional,

David Chou:                  35:27                right? you have to change, so you have to change about what is the new, future business model that you want to move towards and here’s the challenge. You have to make very strategic investment and you have to move towards that, but it’s a hard. It’s a hard thing to do. Most work, most executives, they can’t make that call or they can make that tough call and that’s a problem because we all know what we have to move to.

Jake Dorst:                    35:50                Right? The classic Kodak example, digital cameras versus film making that move.

New Speaker:               36:00                yeah so the thing about Kodak is it was the executives who said, bury that they said, we see the digital camera, we don’t like it bury it, and so does the cio lead this or is it really the entire executive team has to see, have to be a part of moving the culture and moving and changing

Jake Dorst:                    36:18                in my opinion, it’s got to be the whole team. Um, if you’ve got some folks that are sitting in a meeting saying, yes, this is great, but going back to their directors are saying, just wait, this one out, we’ll go back to things will calm down a little bit, back to normal in a year. Like it’s never gonna work. So you really have to have that supportive team that family almost environment where everybody’s got each other’s backs working towards common goal.

New Speaker:               36:42                If you’re a cio in a role where you feel like your pulling the whole thing your pushing the whole thing up hill and you’re not getting any support, you’re probably in a place that’s not gonna be around.

Jake Dorst:                    36:53                I would back off of that, could come up with something different.

David Chou:                  36:57                I’ll seek my opinion. CEO has to drive it right. Without the CEO making the push, it’s really hard. The Cio should influence that you have to figure out how to influence that decision versus taking a back seat. I think we’re in a good spot because the good one, we see all the various business models we see from this journey of the patient will start to finish. We know we need to understand that that model and we need to influence that change that need to happen.

Jake Dorst:                    37:20                I think it’s the cios job to bring the idea to the table so that idea, that’s the right idea. Get everybody on board, but also be the risk assessor because the cio should be in a unique position to understand will this work in this? If it doesn’t, what are the risks if it doesn’t?

Bill Russell:                   37:38                Alright. So we’ll start with you. If you could rewind the clock three years, what do you wish that your health system or that you had focused on three years ago that would prepare you for whats going on today?

Jake Dorst:                    37:49                Uh, I think we’ve done a really good job. We had, we had, we had some fundamentals like David was talking about, building that foundation that we had to do three years ago. Um, specifically some of the things that I, that I would have liked to focus a little bit more on is just data, help that help that data, service level agreements. Getting those type of itil systems in place where I can really have a better insight into how we’re, how efficient we are as an it department. We’re working on getting those now, but three years ago I would have liked to be a little further ahead of the game where I’m at now.

David Chou:                  38:28                Skill set training. Think about we allow, prganizations and including where I have been, I have not focused a lot on skill set training. So now you want them, you want to move towards all cloud, moves to all mobile, but you have a talent shortage, your skill set, your organization, they just don’t have it. So a lot. We did not focus a lot on that to prepare them for that future. So that’s something. Looking back I should have emphasized a lot more because now that’s my requirement. That’s the requirement now the chance, I expect them to have it. Most people would not make that personal investment. So you’re gonna Rub. Do you, do you force them to make that personal development or do you try to make that as part of your management

Bill Russell:                   39:09                So is there something you’re looking at three years from now, youre like this is what Im focused on now becasue I know three years from now the skills are gonna need to be Different.

David Chou:                  39:16                So I would say we’re still focusing on the cloud. Right? You know, getting an understanding of how do you get to the cloud. It’s not just about lifting shift. How do you use to secure an environment, secure a container. Most organizations we don’t have that. They think they can just put it up there and its magically good. No. And then thinking about mobile development because that’s your platform of choice. Are you developing mobile first solution versus traditional? Because if not you have to adjust your development platform mobile versus where it’s at.

Bill Russell:                   39:47                Thank you gentlemen. Appreciate you coming on.

David Chou:                  39:49                Thank you.

Bill Russell:                   39:51                Thank you to all the guests who came on. Jason Joseph from spectrum health, Jake dorst, Tahoe forrest hospital district David Chow, children’s mercy, Andrew Rosenberg, Michigan medicine Ed Mark’s Cleveland Clinic. And Tom Barnett, university of Rochester Medical Center. Uh, it, it, it really was. My pleasure to interview these guys. And I learned a ton. I hope you did as well. Uh, so please come back every Friday for more news, information and emerging thought with leaders from across the healthcare industry. Check us out That’s all for now.


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