News Day – Dealing with End of Life Equipment


Bill Russell

This Week in Health IT

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September 8, 2020: It’s Tuesday News Day. Hospital margins could sink to negative 7% this year. Walmart Health expands in Florida and Illinois. Amazon Fresh opens up their first grocery store. We explore voice assistant technology and VDI environments. And we dig into the issue of having too much end of life equipment which brings significant security and business continuity risks. How do we solve this emergency? Do we throw money at it? Is it a stop gap solution or a long term fix?

Key Points:

  • Send your feedback on our podcast – [00:05:05] 
  • Navigating the RPA landscape in healthcare [00:10:50]
  • Is your maintenance budget starved? It MUST be addressed. [00:16:15]
  • Every dollar spent in healthcare IT should return a percentage of that money to the organization today and into the future  [00:18:30]
  • Why VDI was the next logical step [00:20:00]
  • Eliminate that parts room! [00:20:40]
  • The end of life problem has multiple solutions. Some are better than others. It depends on your lens. [00:22:25]

News Day – Dealing with End of Life Equipment

Episode 300: Transcript – September 3, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[00:00:00] Bill Russell: Before we get started, I want to share with you something that we are extremely excited about here at This Week in Health IT and that is Clip Notes. Clip Notes is the fastest growing email lists that we’ve ever put together. if you can’t listen to every show, but you want to know who was on and what was said, the best thing to do is to sign up for Clip Notes.

One paragraph summary, key moments in bullet point format with timestamps and one to four video clips from the show. It’s a great way for you to stay current, share insights with your team and maintain your commitment to their development. During these [00:00:30] extraordinary times, the best way to sign up. The easiest way to sign up is just send an email to clip notes.

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Welcome to This Week in Health IT. It’s Tuesday news day where we look at the news, which will impact health [00:01:00] IT. Actually it’s Friday before a holiday weekend, and I wanted to give my team the weekend off. So we are recording early. Today, we’re going to take a look at a bunch of things. We’re going to look at the Becker’s headlines.And then I’m going to talk to you about end of life equipment. There are so few stories that are going to reveal this challenge though. So I thought I would just throw it out there and discuss it at the end of the episode. My name is Bill Russell, healthcare, CIO, coach, and creator of This Week in Health IT a set of podcasts, videos and collaboration events dedicated to developing the next [00:01:30] generation of health leaders. This episode and every episode, since we started the COVID-19 series has been sponsored by Sirius Healthcare. Now we are exiting the series and Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show’s efforts during the crisis and beyond.


if you haven’t signed up for 3xDrex yet you are missing out text Drex, D R E X two four eight four eight four eight, and received three texts every week with stories that will help you to stay current. It helps me to prepare for this show. This is a service of Drex [00:02:00] DeFord, a frequent contributor of the show.


First things first, this is episode 300. That’s right. If you’re new to the show and just found us, you have a lot of catching up to do. The first year we did roughly. 50 episodes and got about 25,000 downloads. The second year we did about a hundred. So we doubled our output and we did a hundred thousand downloads.

And this year we’ve done about 150 episodes a year to date and, which is really amazing and [00:02:30] hard to believe. but, and we’re continuing to grow. we’ve done, close to 175,000. downloads year to date  The show was born out of my experience as a CIO and CTO for a health system with 23,000 staff and an even larger community that was looking at me to make sense of the advances in technology and digital transformation in healthcare.

I couldn’t possibly speak enough or send everyone to conferences. It was an extremely challenging problem. And when I [00:03:00] left as the CIO, I chatted with a few of my peers and told them about the idea of starting a podcast for this very reason. And they were extremely supportive. Each of them has come on the show and several have come on the show multiple times.


We strive to find the best thinking and to bring it to you and your team in a way that is understandable and fosters discussion. there are new options on the market. Absolutely. covert has made everyone a podcaster and as a podcast, consumer, I’m extremely excited about this [00:03:30] development. The CHIME podcasts are good, Beckers. The CMIO podcast is one of my favorites, the Redox podcast, and a Hit Like a Girl are on my playlist. The host of Hit Like a Girl are actually coming on to record a show shortly. And I’m looking forward to that. Quite frankly, there are a ton of options and I find value in each of them. If this is your first episode, let me tell you what makes this show distinct.

First off, we do three shows a week. We cover the news, we do [00:04:00] solutions. So we’ll dive deep in it as a solution. And we do an influencer show. So we’ll talk to somebody who’s influencing the industry. Who’s dealing with some of the challenges firsthand. the second thing I think is, we have sponsors, but I choose the content.

And what we talk about. Even on the episodes that are paid for sponsorship, there’s no guarantee that they will air we’ve turned down shows because people couldn’t produce a client that will appear with them on the show with them. We retain full editorial control. so you know, you’re going to [00:04:30] hear what we think about the industry what’s going on.

Third thing I would say is we listened to you. we did clips early on, but it was really a burdensome process for us. I, we didn’t have a staff at the time. And so we stopped doing it for the better part of a year. you asked for them to come back and we brought them back. you asked us to have certain people on the show and we’d done, we’ve done that cover certain topics.


We’ve done that. you’ve asked us to extend the duration of the show. And, obviously we’ve just done that. we take your feedback very seriously. In [00:05:00] fact, we’ve set up a form. For you to give us some feedback, 300. If you go to that URL, you’re going to be given a form to fill out a survey.

It’s five questions. It’s real simple. and it’s a great way for you to provide us some feedback. And if you want to, you can even enter your name and email address at the bottom. It’s optional. But if you do, you’re going to be entered in a drawing to win one of 10 mole skin. This Week in Health IT notebooks. They’re black notebooks that the [00:05:30] logo’s really actually even hard to see.


So you know, it’s a really nice notebook. I use them all the time and, I think you’ll like them. I give them to a lot of our guests on the show. the fourth thing about the show, cause we make it easy for you to use the content. so of you use it to get the conversation started and some of you use it as a foundation for some training, we’ve developed clip notes around making you and your teams more effective and to share that content a lot easier.

And I think they, the last thing I would highlight is the thing which makes our show [00:06:00] unique is me. And I feel weird saying that, but so many people have said it to me that they appreciate the perspective of a former healthcare CIO, who is sharing my journey, with you, and also bring you along as I try to stay current on what’s going on.

And as I’m keeping up with my peers and you get to eavesdrop on our conversations and even participate in them from time to time. that’s all about that. We don’t celebrate the show all that much. We really don’t talk about the show that much. We’re probably gonna do this again when we get to [00:06:30] episode 400.


So if you think this is too much time spent, promoting our accomplishments or talking about the show, you may want to skip episode 400 when it comes out. As always, we appreciate all the support that you’ve given us. And if you continue, if you really want to continue to support them the best way to do that is to share it with a peer sign up for clip notes, forwarded on to someone and say, Hey, this has been great for me.

Sign up for Clip Notes or listen to this podcast. Yes, I get a lot out of it. Alright, so let’s get to the news. [00:07:00] I’m going to do this quick, so I’m just gonna look at it. The Becker’s September issue is out, which is great. It gives me some stories to look at. let’s see, they have the 10, most and least concentrated hospital markets.

I’m going to skip that now too much in the way of health I T. Hospital margins could sink to a negative 7% this year, and they talk about that a little bit. You’re going to hear that a lot. There’s financial pressures on health systems. It creates opportunity for some and. challenges for others.


Let’s [00:07:30] see some other things, seven hospitals buying land for expansions. As we’ve talked about on the show, there’s a handful of good reasons to buy land and expand. but there’s, a lot of batteries it’s to buy land and not pursue an asset light strategy, but regardless, hospitals, overbuild Medicare, $1 billion by upcoding claims, inspector general fines.

That’s going to continue to to be a problem, especially as we start to, take a look at these claims around tele-health and whatnot. [00:08:00] And hopefully they’re coded as well as they can be a Walmart health expands in Florida and Illinois. Let’s see 10 best healthcare companies for women to advance.

Again, I’m just reading the headlines at this point. I haven’t found one that I really want to dive into. Pandemic speeds up. Mayo’s digital transformation by 10 years, Dr. John Halamka, we’ll have to have John on. I want to do a platform episode. A lot of people are using the word platform and not necessarily I think using it, I think John uses it real [00:08:30] well.

I think he understands that, a platform brings together consumers and producers. the obvious ones that we are all familiar with iTunes. Uber, those kinds of things, right? You have producers, you have consumers and the platform makes those transactions easier. And the sharing of data and all the things associated with that sophistication of the transactions and those kinds of things.


That is, that’s probably an article worth taking a look at and delving into. Let’s see. [00:09:00] Anything else? Exciting. Wow. Just not a lot of exciting things going on. I guess it’s a holiday weekend. Yeah, a lot of stuff on COVID obviously. and we just don’t cover that. if technology doesn’t solve the problem, we don’t really go into it.

Advent health CEO of mid Florida, COVID-19 surge says I wouldn’t hesitate to go to Disney. Which is great. Cause I would love to go to Disney at this point. That would be a welcome respite and I hope people are going. Let’s see. Anything else? [00:09:30] No. Wow. There’s just, quite frankly, little slow time.

Let me go over to my, newsfeed here. Let’s see if I have anything else. All right. Amazon fresh opens up their first set of Amazon grocery stores outside of that, Amazon go. Now they have fresh grocery stores and there are introducing smart shopping carts with Alexa guides. I’ll tell you why this is important.


This is essentially a, implementation of IOT and it will give [00:10:00] Amazon again, a really good picture into our health. If you shop predominantly at a fresh grocery store at an Amazon Go market Amazon will have, the, essentially a list of all the things that you’re purchasing at your grocery store and be able to, cross reference that with a lot of other data sets to determine if you are eating healthy, if you’re, if you’re living in a certain place that could potentially is a food desert, those kinds of things.

So there’s a lot of things too. I [00:10:30] really delve into here. And if you’re a health system or even a payer, potential partnerships with grocery stores, I think has made sense for a long time and continues to make sense, and even becoming a technology partner with some of the grocery stores, I think might be interesting.


Let’s see. Any other stories I want to do a little bit more on this, navigating the RPA landscape. This is interesting. I think, RPA is huge and if you’re not looking at [00:11:00] RPA or haven’t looked at RPA it’s worth looking at, and David Chou put something out there and navigating the RPA landscape in healthcare, he talks about, examples of, RPA in use.

RPA is being used for a really rev cycle it’s being used around HR. it really can be used anywhere where you want to automate a process where the machines can talk to each other. You can take information from one machine process, put it through some logic and then apply it to another machine process.

[00:11:30] That’s essentially what robotic process automation is all about. And you could see it in rev cycle. If you just go and sit in your rev cycle. area for a while and you watch the number of screens and the things they’re flipping through. And they’re pulling information from one website and putting it into another website.


That’s the kind of stuff that RPA just, hits the ball out of the park with. So something that is something to, consider and take a look at. Also, as, as you’re looking at RPA solutions, I keep [00:12:00] in mind that not all RPA solutions are the same, some have some, digital vision.

I’m not sure what the terminology is, but essentially computer vision, the ability for the, for the RPA process to actually see your screen to the same way you see your screen and to identify things. So sometimes when you’re doing screen scraping and those kinds of things, the processes can be a little fragile, that kind of a digital vision and yeah.

Enables the RPA solutions to be a little bit more robust, if you will. we’ve done some episodes on RPA and [00:12:30] I suspect we’ll do more because that’s going to be continue to be something that advances, pretty significantly. let’s see. Anything else. Wow. It really is a slow week Epic’s decision to put it’s voice assistant.

This is healthcare, healthcare IT today, Epics decision to put its voice assistant front and center could have a big impact on health care. Okay. As some of you may know, voice assistant technology is becoming one of the hottest new applications to hit the healthcare [00:13:00] it world, to be sure many institutions are still, trailing the, trialing trials, the use of voice assistants in clinical settings.


But also, but this also points up that we’re still in the early phase of adoption and we are, and the, it might feel like voices showing up everywhere or it’s being talked about everywhere. but don’t be deceived. It’s essentially, it’s essentially at the early stages. we’ve been doing a voice for a long time with nuance, primarily with Nuance.

I’m not even sure who the other player, [00:13:30] M modal, some other players out there, but for the most part, we’ve been doing dictation and those kinds of things. we’re actually getting to the point where, we might see navigation of the EHR become much more prevalent. Again, keep in mind the limitation.

Yeah, because of that and the limitations are in order to do voice navigation, you have to speak, and there has to be, you have the challenge of you have to have the right place, to speak. You have to have privacy considerations. there’s a lot of limitations in the hospital itself, [00:14:00] in terms of how you’re going to navigate that EHR. It doesn’t mean it’s not a great technology in the right direction.


It absolutely is a great technology in the right direction. but there is going to be a lot of stuff to navigate. And then the question becomes, do you wait for Epic to come out with it? Do you, integrate with nuance? Nuance is also looking at navigating the EHR as well. And a lot of us have significant nuance, implementations and whatnot.

There’s a lot of things to look at with regard to voice. And I haven’t even touched [00:14:30] on how voice is being used for the consumer within health care. Cause we’ve actually talked about that a little bit here and there. I’m gonna make a sh it’s a holiday weekend.

You’re coming back. It’ll be Tuesday before you hear this episode. So you’re coming back. You probably want to get to work and get moving. So I’m going to hit the last topic that I wanted to talk about. And, as I said, it doesn’t show up in any news story, but I want to talk about it and it’s end of life equipment.


And when I became the CIO, I don’t remember the [00:15:00] numbers exactly. But the equipment in our data center was about 80% or I’m sorry, about 60%, end of life. So 60% of our equipment in our data center was end of life. And the equipment on the desktop, across the clinical setting in the nonclinical setting was that higher percentage than that.

Okay. So those were staggering numbers. End of life. In most cases means that the manufacturer no longer provides support for the equipment. And it is so old that again, a lot of [00:15:30] times it will no longer be patched, which means that it becomes a security issue, at a certain age. actually it absolutely becomes a security issue.

and most of the equipment, it really can’t be upgraded. it can’t be upgraded to the latest operating system and, again, it just becomes a significant security issue. We definitely have that in biomed, in spades, if you’re fronted with this problem, you have to address really two aspects of it.


You have to address the emergency that’s been created. So you have a crisis that’s been created and you have to address the [00:16:00] problem, right? The source of the problem, how did we get here? The emergency is that you have a serious gap that has been created for whatever reason, but it represents a significant security and business continuity risk.

The problem is that you got here because of, really a maintenance budget. That has been starved and that has to be addressed in some way, shape or form. it’s likely that the problem wasn’t created overnight and it’s not going to be solved overnight, although you’re going to want to solve it as quickly as [00:16:30] possible.

And, some might say, Isn’t it obvious, we need to spend, just give me $6 million. I’ll upgrade all the servers, all upgrade all the workstations. if you’ve ever had to make that request, you’ll understand why that’s a hard request. Now, somehow systems might do that.

They might just say, all Yeah, we’re going to, we’re going to bite the bullet and we’re going to upgrade and we’re going to give you $6 million to upgrade it. I think that’s a mistake by the way, but that’s one way to do it. And, but that does get us to what we, where we should start. The starting line [00:17:00] is what is the exposure?


You have to baseline the cost and the effort to remediate the risk. our number was staggering. I forget what it was, but it was a lot bigger than the $6 million number. and you have to communicate the problem effectively, the problem and how we got here, how we’re going to ensure that we don’t get here again and the options to address the problem.

Now, for me, that conversation went up pretty much all the way up to the board, in some aspect, up to the board and went up to the board from a security standpoint. But for the most part, it really stopped [00:17:30] at the president’s council, but at the president’s council, which was the highest executives within our organization, we made it clear that we’ve got a problem.

We’ve got a problem in that we did not take care of our, maintenance budget and we didn’t take care of our equipment. And because of that, we’re all driving around in Datsuns B2 10s  yeah, some of you are too young to even know what that is. Those are really old cars from back in the day. And, it’s bad. If you’ve ever operated on a four or five year [00:18:00] old computer, and that you’re not just operating with cloud apps and virtual environments, I’m doing that nuance just for you, people who are going to argue with me.

but if you’ve ever operated on a four or five year old computer, you know what I’m talking about? And especially if it’s a clinical workstation, it’s just, it’s beyond its life. It’s just barely keeping up. and so you’ve got to address that. yeah, you might be saying, we’re just coming out of COVID.


Why are you talking about spending money? And the reason I’m talking about spending money is because I believe that every dollar [00:18:30] that we spend in healthcare IT should return some percentage of that money to the organization today and into the future. Let me give you an example, clinical desktops. Our clinical desktops were on a four year, a refresh cycle, except when we had a bad year financially.

And then we would skip a year or two or whatever. I’m just keeping it real. So that’s what happens in healthcare, right? We all say, this is on a three year cycle. This is on a four year cycle. But when we have a bad year [00:19:00] financially, the maintenance budgets on the table, and sometimes it will get cut.

We could buy a bunch. So there’s a bunch of different options, right? We could buy a bunch. Of new clinical workstations and upgrade them in place and refresh them again in four years. That’s one option. the natural response was, you want how much money and you want to do it again in four years.

that’s the response you would get from an executive. They’re like, I don’t understand this. Why every four years do we have to pour out another $6 million or whatever the number is, [00:19:30] that didn’t really work for us. we did look at that option. We looked at it all this is what we have today.


We’re going to replace everything we have today. So we looked at that. We said, ah, that doesn’t make sense. And a lot of you are, have already gone down this path and said it didn’t make sense. So we presented a model to do VDI with app publishing across the entire organization. Now, a lot of you stopped at publishing for the clinical workstations.

We went full blown VDI. And it for a couple of reasons. One is, we get to the thin clients, it shifts our refresh cycles to 10 years, right? And [00:20:00] it also gave us the infrastructure and the tools to upgrade all the machines without taking any downtime. That’s where VDI came in for us. VDI was the next logical step.

We were going to do this massive upgrade. Anyway, let’s get to a situation where we’re taking very little downtime for upgrades. And the reason you can do that with VDI is because every time somebody logs out of a VDI workstation, It destroys the session and recreates it. So the next time they log in, we may have patched that entire, that entire session.

We may [00:20:30] have patched that entire server. So every time it’s spawning a new session, they are getting an upgraded system. Okay. We, there’s a couple other benefits to this as well. We eliminated the parts rooms. Every one of our hospitals had a parts room, you’d go into it. And it would look exactly what you think of what it would have hard drives.

It would have old machines, it would look like, they were just ready to replace elements in any machine that would potentially go bad. So we were able to return that real estate. We were able to get rid of [00:21:00] the parts rooms because quite frankly, when a thin client goes bad, they make a call to the help desk.


They reset the session nine times out of 10, actually. 49 times out of 50, that does solve the problem. The one time out a 50, they might need a new thin client. In which case somebody could just roll one in and plug it in and away they go. another thing we did is we reduced outages, pretty significantly, and we provided new key capabilities in the process.

The next opportunity was non it really for us. It’s nonclinical workstations, [00:21:30] and COVID has brought that opportunity front and center. Do we need thick clients for that type of work? The answer is probably likely not. And as people move to their homes, VDI and app publishing probably makes more sense.

Okay. Now, before you go down this path, you have to determine if you have to skills and capabilities to manage that environment. I’ve seen a lot of VDI environments, a virtual delivery of application, those kinds of environments, just crumble under neglect. You have to [00:22:00] keep those things maintained.


You can’t make the same mistake. Once you implement an environment like that, you can’t make the same mistake and not patch them, not fix them and not invest in the maintenance you need on that infrastructure. Cause they’re running hundreds. If not thousands of workstations, you’ve got to keep those things current.

All right. So let’s get back to the framework, the emergency and the problem. The emergency is the situation where every problem has multiple solutions and some are better than others. And it depends on your lens. Okay. So let me [00:22:30] break that down. so the emergency is you still have a ton of, end of life equipment.

You’re not going to get the full amount of money you asked for what are you going to do? What you have to look at every problem distinctly. here’s my, let me talk about the lens for a minute. If I know that I have a longterm solution in place in 12 months, if I know that I’m going to solve that, I’m going to upgrade every workstation in that environment in 12 months, then I only need really a stop gap solution.

That’s all I need today. I need something to make sure that I don’t [00:23:00] have any extended downtime and no security breach. That opens up a plethora of opportunities as opposed to, sitting there and taking a hard line and saying, no, we can’t do anything until we get there because I have a solution coming.

I can do some short term stop gap kinds of things. If I won’t have a longterm solution for several years, I’m going to have, I’m going to need something a little more substantial. The lens matters. I can serve my, I can solve my server end of life problem by upgrading the server or I can move it to a [00:23:30] VM or I can move to the cloud.


And there’s multiple options in the cloud. You see the beauty of the cloud is that it can be a temporary solution. It can also be a really a longterm fix. It’s very flexible in that way. you have a lot of options that weren’t even available five years ago to solve an emergency situation in your data center, with both capital and operating dollars, the same holds true for your clinical workstation problem.

You may upgrade a hospital at a time. And when you do, one of the things that happened for us is not all the machines that you replaced were end of [00:24:00] life. And you could actually redeploy those machines into the other hospitals that you’re not going to get to maybe for 18 months or even two years.

You could turn, you could also turn some of those older machines into thin clients. There’s a lot of options that are available to you if you have the right infrastructure in place. And if generate that story and get that movement going, let’s talk about the problem though, right?

The problem is you don’t have a mechanism to identify and protect your maintenance budget. Every organization needs a life cycle plan for equipment. Network, wireless [00:24:30] esktops, thin clients, mobile devices, biomed. When you buy it. You have to give it a lifespan and the budget should be in place for when that event happens.


So when something comes to an end of life, there should be a budget that automatically gets triggered to replace that piece of equipment on whatever cycle you determined. And I’m not even telling you what the cycle should be. Some people will say thin clients, 10 years, that’s too long. Maybe it’d be seven or eight.

I don’t care what it is. What I’m [00:25:00] saying is the problem is you haven’t identified it and you don’t protect that budget. we had a maintenance budget that was separate from our operating budget in it. And it was untouchable in any annual budgeting process. It was untouchable, it was taken out like building maintenance.

It wasn’t even on the table. We had a re refresh cycle and every hospital knew what year they were going to have their equipment upgraded. And that didn’t change because the budget couldn’t get touched. So we made a commitment [00:25:30] to the organization. That we were able to keep, because we said, we’re going to upgrade this hospital.

And in, in three years we’re going to come back or in four years, we’re going to come back. And they knew that we were going to do that because they didn’t touch that budget. you might be listening to this thinking, why are you spending so much time on this? Clearly this is an easy problem to solve.


And in 2020, we don’t have this problem. It turns out that it is actually more prevalent than you. Might even imagine today. so I wanted to share my story a little bit with you guys and [00:26:00] hopefully give you some ideas, some thoughts. And if you have any questions, bill it this week in health, it more than happy to discuss it with you a little off this week, in terms of just going through the news.

I thought I’d throw a topic out. Cause I thought about this topic. And there’s not going to be any news story that I would really talk about this topic, per se. just thought I’d share that with you. That’s all for this week. Don’t forget to sign up for clip notes, send an email, hit the website, make you and your system more productive, special.

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