March 17, 2021

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March 17, 2021: We look to organizations like Providence with its size, scale and scope to lead the way and set the tone in healthcare. Did you know they had the first COVID patient in the US on January 20? Where were they in their tech journey when the pandemic hit? And how did that affect their response? CIO BJ Moore who hails from Big Tech with 26 years at Microsoft discusses being an Epic shop, the cloud, AI, Machine Learning and doing things the green way. How do you maintain the innovation gains from Covid and accelerate them? What workloads are the hardest to get onto a cloud architecture? How is the Providence Microsoft 5 year deal going? And what’s the most rewarding thing about switching from Big Tech over to Healthcare?

Key Points:

  • Providence has a goal of being carbon negative by 2030 [00:04:50] 
  • Digital beds are the future [00:07:10] 
  • With emerging technologies like telehealth how can we make sure we’re including poor and vulnerable communities? [00:10:30] 
  • You’ve got to have an anchor. And the anchor for our electronic health records is Epic. [00:19:35] 
  • If all of our data was locked on premise instead of the cloud we would have been stuck with traditional analytic models versus machine learning and AI [00:14:25] 
  • Enable follow the sun support by outsourcing to countries like India [00:27:47]
  • In 2020 we delivered more in 12 months than I ever saw Microsoft deliver in 3 or 4 years [00:32:43] 
  • The biggest challenge of moving from the tech industry over to healthcare is tech debt [00:36:42] 
  • Providence used to have 4,000 applications. Microsoft, a trillion dollar company doing business with 200 countries only has 1000. So that’s been a challenge. [00:37:15] 
  • Providence

Switching from Big Tech to Healthcare with Providence CIO BJ Moore

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Switching from Big Tech to Healthcare with Providence CIO BJ Moore

Episode 378: Transcript – March 17, 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.

Bill Russell: [00:00:00] [00:00:00] Thanks for joining us on This Week in Health IT influence. My name is Bill Russell, former healthcare CIO for 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged. 

[00:00:17]Today we have BJ Moore joining us with Providence Health. He is the CIO amongst other things and we always have interesting conversations. And I think you’re going to get a lot out of this one as well.

[00:00:28]Special thanks to our influence show [00:00:30] 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] 

[00:00:43]Hopefully you’ve heard our big announcement. We are introducing written content onto our site to accompany our existing four podcasts. I’m personally excited about this and it really allows us to reach a different group of people than we’ve reached in the past. I hear stories about people who listen to our shows on their [00:01:00] daily runs or their commute to work. If those things still exist. But I also know of professionals who’d rather skim an article than listened to an hour long podcast. So I’m excited to say starting next week. We’re going to be hosting news write-ups of our shows as well as feature stories on thisweekhealth.com. And we want to hear from you. So please shoot us a note and tell us what you think. If you’re excited, if you have questions or even if you’re interested in becoming a contributor. One of the things I am really excited about with this move is we opened up all new [00:01:30] avenues to allow contributors to come in to the platform. So we’re going to be able to share articles that you write. We’re going to also be able to potentially have you host podcasts and submit them to the show so that we can put them out there to our community. And we are really excited about that. So thank you for listening and joining in our mission of raising up the next generation of health leaders by amplifying great thinking to propel healthcare forward.

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[00:02:34]And now onto today’s show. 

[00:02:36] So today we are joined by BJ Moore, the CIO for Providence and much more. BJ welcome back to the show. 

[00:02:43] BJ Moore: [00:02:43] Thanks Bill. Always great to be here. Appreciate it. 

[00:02:46] Bill Russell: [00:02:46] Yeah. I’m looking forward to the conversation. Yeah. So you are more than a CIO these days.

[00:02:49] We were talking just prior to coming on there that you’ve taken on some additional operational roles and capabilities. And talk a little bit about that, and then I’m going to [00:03:00] come back and get into some of the questions I sent over. 

[00:03:03] BJ Moore: [00:03:03] Yeah, absolutely. So yeah, back in August two changes happen.

[00:03:07] One, I now report directly to our CEO Rod Hochman. So that’s great being part of the, you know, direct executive leadership team and deeply engaged with the board and our sponsors. So that, that elevation in the CIO role is kind of the Holy grail for IT leaders. But in addition, I also took on the real estate facilities for Providence.

[00:03:29] And [00:03:30] so all of the hospitals and clinics and the operations of those now roll up into me as well. And the idea is there synergies, you know, the future, isn’t just IT and tech separate from real estate facilities, right? Those lines are blurring more and more. And so you know maybe that’s something we can dive into now or dive into later. 

[00:03:49] Bill Russell: [00:03:49] Yeah you know it’s interesting. You were the third CIO I’ve spoken to this week who has taken on operational [00:04:00] capabilities. Now there’s a whole host that have gone in the digital direction. Have taken on digital roles, but the operational role really makes a lot of sense to me. When I think about, I mean, as a CIO, you have to understand and know things at such a deep level.

[00:04:14] And then digital really changes the way we’ve used certain things doesn’t it? 

[00:04:19] BJ Moore: [00:04:19] Yeah, absolutely. And you know as it relates to digital and facilities, right, it’s two things. One it’s the workforce of the future, right? The planning people at a desk, I [00:04:30] think those days are behind us. So it’s really more of a melding of technology and working from home and those things.

[00:04:36] And then you know COVID has proven the success of telehealth and remote patient monitoring. And so that is tech enabled. And I guess the third bucket would be you know, as we move to become more and more green. We’ve got a goal of being carbon negative by 2030 so smart buildings, you know, how do we, you know, do things in more of a green way?

[00:04:58] How do we leverage our [00:05:00] facilities, you know, with greater capacity and a lot of that’s going to be, you know, through technology as well. So I’m excited. You know, when I took over the role, I predicted if we were the first, there would be many other companies that follow because I think those lines of digital versus physical are being blurred for sure.

[00:05:20] Bill Russell: [00:05:20] Carbon negative. That’s the first I heard that. That’s pretty, that’s a pretty aggressive goal. 

[00:05:25] BJ Moore: [00:05:25] It is. It is. And as I’ve reminded, you know, carbon [00:05:30] neutral is a goal, and then if you can just be one unit negative, you’re officially carbon negative. And so it’s more aspirational, but it’s not that much more aspirational than being carbon neutral.

[00:05:43] Bill Russell: [00:05:43] Yeah. And you were sharing a story. We were talking earlier just how being head of facilities and someone says, Hey, we need a thousand more beds. You really look at that very different than, Hey, let’s you know, let’s plow under some trees and let’s put up another building. 

[00:05:57] BJ Moore: [00:05:57] Yeah. A year ago, a thousand new [00:06:00] beds would have immediately conjured up a new hospital. And a new hospitals is a five to 10 year endeavor. A billion plus dollars. And then do you know, speaking sticking with the green theme? Yeah it would be tearing down trees and building a new building. And obviously a lot of carbon goes into a building. You know COVID has proven care can be digital. And so I think when you talk about a thousand beds that may be physical, but really here at Providence, we think a thousand beds can really be virtual, right. That care at [00:06:30] home. So real example. 

[00:06:32] At one point in time we had a thousand COVID patients we sent home and we were managing and monitoring them remotely. And for those patients they receive fantastic care. And as an individual if you weren’t acutely ill and you had the choice of staying in a hospital bed or going home to your own bed. I think most of us would choose to go home and be in your own bed.

[00:06:55] So in that case they got great care. And from our perspective, it freed up a [00:07:00] hospital bed for more acute patients that did require hospitalization. So simple example of how things are becoming more and more digital and really where at Providence where you know digital beds are the future. 

[00:07:17] Bill Russell: [00:07:17] Yeah, you guys really are leading the way in a lot of different areas. We had Amy on as well, your Chief Medical Officer. She [00:07:30] shared some just fantastic things that you’re doing there. We’ve we talked to Matt from your digital team and they produce some really interesting materials as well. I mean, you just have so many resources available to you that we are looking to organizations of your size scale scope to sort of lead the way and set the tone.

[00:07:48] But before we get there, I get in trouble all the time because my listeners have asked me to start each show by asking the guests to tell a little bit about their health system. So tell us a little bit about Providence. 

[00:08:01] [00:08:00] BJ Moore: [00:08:01] So Providence is one of the largest health systems here in the United States.

[00:08:05] We’ve got 120,000 caregivers. We do about 25 billion in revenue and we serve basically the Western United States. So we’re here in seven States. During COVID we received the first COVID patient in the United States in January 20th, that came into our Everett hospital. And I’m happy to say we successfully cared for and cured that [00:08:30] individual.

[00:08:30] And so you know as it relates to COVID Providence is at the forefront, you know receiving the first patient. So that’s a quick background on Providence. I could go on and on. 

[00:08:40] Bill Russell: [00:08:40] Yeah, we we could go on for a while, but let’s, you know I don’t usually do this, but Yeah, I can go in so many different directions with you.

[00:08:48] What are two or three things that you want to make sure we talk about today that you’re excited about that you’re working on?

[00:08:55] BJ Moore: [00:08:55] We have touched a little bit upon it? You know, we’re in this COVID [00:09:00] world. But what’s been important to us is how do we obviously serve our communities and respond to the pandemic?

[00:09:09] But how do we continue with our strategic bets? Right. We couldn’t just, it wasn’t binary, it wasn’t one or the other. It was continuous strategic bets while responding to the pandemic. And then the other one is how do we evolve healthcare? How do we you know, there’s been some positives that have come out of COVID like telehealth, like virtual care, like, you [00:09:30] know, care delivery at home.

[00:09:31] How do we maintain those gains and accelerate it? And so those are, those are two topics near and dear to my heart and be good to cover those. 

[00:09:40] Bill Russell: [00:09:40] And one of the things I loved about working at St Joe’s, which is now part of Providence was the presence of the sisters. And so especially at a time like this.

[00:09:51] You know, there’s limited vaccine, no matter what market we go to. Right? So there’s that challenge of taking that constrained resource and [00:10:00] distributing it effectively. You want to vaccinate as many people as possible, but I try to communicate this to people, it just, the sisters would be there and say always, what are we doing for the marginalized?

[00:10:13] What are we doing for that disenfranchised? What are we doing for? And they would always bring the conversation back there. So it was always top of mind at a house. Talk about that experience a little bit. 

[00:10:26] BJ Moore: [00:10:26] Yeah. I mean that’s different from coming from Microsoft. You know, that’s one of the things that [00:10:30] attracted me to Providence is that mission. And that mission is to serve our underserved community, the poor and vulnerable. 

[00:10:37] And so yeah, that the sisters are always that driving forced, right. Sometimes get involved in internal politics or administration or back office things. And the sisters are always there to remind you hey it’s not only about the patients but it’s about our underserved communities and how, what are we doing to, you know, bring them to the forefront. And COVID was no different, you know how do [00:11:00] we have these emerging technologies like telehealth and make sure we’re including these, you know, poor and vulnerable communities and not creating a digital divide.

[00:11:08] And so there they’re always our social conscience and they’re always there to remind us, you know, why we’re here and what our purpose is. 

[00:11:16] Bill Russell: [00:11:16] All right. Let’s head down. So some of this, some of this is, are the topics that you’ve given me. Some are more things I’m  reading. So you did the significant Microsoft deal. I think it was a ten-year deal. Is that correct? 

[00:11:30] [00:11:30] BJ Moore: [00:11:30] It was a five-year, five-year deal. Yeah. 

[00:11:32] Bill Russell: [00:11:32] All right. So you’ve already been out done because Kaiser did a ten-year deal with Microsoft. 

[00:11:37] BJ Moore: [00:11:37] Yeah. I don’t know if that’s a better thing or a worse thing. Five years feels like a good horizon. It’s long enough to get things done, but you’re not locked in for a decade.

[00:11:47] Bill Russell: [00:11:47] Right? Exactly. A decade is a long time in the technology world. You have to be careful with ten year bets. You know, why was that important for Providence? The Microsoft deal. 

[00:11:59] BJ Moore: [00:11:59] Well I mean, [00:12:00] it came at a time. So we signed in July of 2019. And you know, it served us well for two main reasons. One on the collaboration side of things. So we fully embrace Microsoft 365. We’re on an 18 month journey. We were about halfway through that when COVID hit. And we accelerated that. And so Teams, that whole collaborative environment proved invaluable. We sent all of our caregivers home. So boy, if we hadn’t done that, I [00:12:30] can only imagine where we would have been as a health system, you know, the hodgepodge of solutions we had just wouldn’t work.

[00:12:37] So we obviously, we didn’t know the pandemic was coming but that paid off. More strategically how it paid off is, you know, during the pandemic, if you remember early on PPE, ventilators, you know, were really in short supply. We didn’t know if we’d have enough ICU beds. And so projecting surges were invaluable.

[00:13:00] [00:13:00] We were about halfway through our journey of moving our on-premise data to the cloud, you know hazardous data lake. And because we had that data there it accelerated in COVID were able to use machine learning and artificial intelligence to predict where we needed more PPE, where we needed ventilators, where the ICU surges.

[00:13:19] And we reached a point by probably May or June that we were able to predict with about 85% accuracy, two weeks ahead, where things were going to be [00:13:30] okay. We’re anticipating in two weeks, things are going to get better here in the Northwest. We think in two weeks things are going to surge in Southern California.

[00:13:39] And so with that insight we were able to move resources and assets and these, you know, precious items like PPE around to serve those communities. And so that was a  strategic bet that proved invaluable. So I’d say Microsoft 365 and then the ML AI models that we are able to do for COVID. 

[00:13:59] Bill Russell: [00:13:59] Yeah so the [00:14:00] stack gives you so many more capabilities than you would have had on a traditional healthcare stack. 

[00:14:06] BJ Moore: [00:14:06] Yeah. I mean all of the innovation is happening in the cloud. Whether it’s healthcare or traditional companies, you know, like an ERP or a CRM vendor. Everybody is doing the innovation in the cloud. And so if we hadn’t moved to the cloud, embraced the cloud, these advanced compute capabilities just wouldn’t have been there.

[00:14:25] You know, if we were, all of our data was locked on premise, we would have been, you [00:14:30] know, stuck with traditional analytic models versus, you know, machine learning and AI really only can be done at scale. And that can only be done in the cloud. 

[00:14:38] Bill Russell: [00:14:38] Will that end up being your IoT platform for hospital at home and those kinds of initiatives?

[00:14:44] BJ Moore: [00:14:44] Yeah, absolutely. You know, the scale that we need, the volume of data that we need, when we talk about big data, you know, when I arrived here our data warehouse was about 70 terabytes. And we would call that big data but at 70 terabytes, that’s just not big data. [00:15:00] Right. Big data is majored in and petabytes or exabytes, and you’re not going to have exabytes of storage on premise.

[00:15:07] And so yeah, when you talk about IOT and streaming, you know, activity and heart rates and all these things. Yeah, it’ll all be in the cloud. And then when you’re talking about that volume of information, human beings aren’t going to be able to run a query and say, Hey, how’s bill Russell doing today. It looks like it’s temperature spiking right?

[00:15:24] It’s going to be a machine learning or AI bot. That’s monitoring your [00:15:30] health and you know, giving out instructions or actions for a nurse nurses or caregivers to respond. 

[00:15:37] Bill Russell: [00:15:37] So is you, so you, you’re if I’m hearing this correctly that platform is going to be real-time. It’s going to be an operational data store as well as a as well as analysis data store as well.

[00:15:52] BJ Moore: [00:15:52] Yeah. I mean, it’s gotta be, you know, so we’re moving here. We’re an Epic shop. So our Epic data will be in an Azure data Lake and we’ll have [00:16:00] you know, some latency on patient information. But as it relates to IOT and streaming that’s gotta be real time. And then the monitoring of that it’s gotta be real time.

[00:16:08] So use my example of the thousand COVID patients we sent home. At the time we didn’t have IOT set up, this is where we’re going. Right. You would have a A temperature monitor on you. And if your temperature change you’d want some bot monitoring your temp real time and alerting a nurse, right. It’s only valuable.

[00:16:30] [00:16:30] It’s real time. It can’t be hey yesterday at noon, you know,  Bill Russell’s got the temperature spike didn’t want it to. And the doctor’s like, Oh, I wish I would’ve known. I would’ve intervened. Right. As soon as you can get that IOT signal it would reach out to a caregiver and say, hey, Bill’s temperatures change, you know, set up a telehealth. You know, see if there’s some intervention. 

[00:16:54] Bill Russell: [00:16:54] I think that some people have this misnomer that we’re not going to be able to do [00:17:00] high transactional kinds of things in the cloud but the reality is. 

[00:17:04] BJ Moore: [00:17:04] It’s the only place they can be done.

[00:17:06] Bill Russell: [00:17:06] Yeah. I mean, if you’re going to do the AI and the machine learning stacks are going to be in the big players for the most part.

[00:17:15] BJ Moore: [00:17:15] Yeah. I mean, look at what Google does or Facebook does, or any social media platform right there. They’re getting telemetry from all their users, interacting with the platform real time. And their algorithms and models are responding to that. [00:17:30] So it’s that precedence already exists, right? They’re working with exabytes of data and in near real time able they will respond to that.

[00:17:36] So that compute capability that’s used, you know, for good or bad, then social platforms can be used for good in health systems. And it’s the only place, you know, we can do that level of scale. And as you know, burnout for our caregivers is one of the biggest issues. The last thing I can do is ask a caregiver, Oh, by the way, every hour run a query to see how Bill Russell’s doing.

[00:18:00] [00:17:59] Like it just, you can have the time to do it. So we’re going to have these proactive models that, that monitor and then alert you know, in real time to take action. 

[00:18:08] Bill Russell: [00:18:08] So you know, every now and then I’ll get an email from one of my old employees, which are now your employees. 

[00:18:16] BJ Moore: [00:18:16] Oh no. Don’t tell me any bad news Bill. Only tell me the good news.

[00:18:20] Bill Russell: [00:18:20] No, but I understand you’re finally taking the St Joe’s marketplace to to Epic. So that’s a Meditech shop and you’re gonna take [00:18:30] all those sites over to Epic. Is it, I mean what’s the thought process behind it? Just to finally get everything on the same platform.

[00:18:38] BJ Moore: [00:18:38] I mean that’s been the vision, right? Like I said, we’re primarily an Epic shop. Epic’s a good EHR. As you know, St Joe’s is on Meditech and Allscripts and old versions of those platforms, not even the modern version. So yeah in the spring, we’ll bring our Southern California [00:19:00] ministries and clinics on Epic. Northern California in October. And then March of next year, we’ll bring Texas on and we’ll have all of our, all 51 hospitals, all thousand clinics, all on Epic to the best of my knowledge we’ll be the largest Epic single instance in the world. And yeah, just having all of our patients and caregivers on a single EHR just makes sense. 

[00:19:23] Bill Russell: [00:19:23] So you have to walk and chew gum. We’re moving to the cloud or doing machine learning, AI, we’re setting up IOT hospital at home and Oh, by [00:19:30] the way, we still have to make sure that these internal systems are you know, correct.

[00:19:34] BJ Moore: [00:19:34] Yeah. You got to have an anchor. Right. And the anchor for our electronic health records will be Epic. And so having that single source of the truth then allows us to hang off the IOT data, the streaming data, the big data that we get otherwise. You know, you’re putting hodgepodge on top of hodgepodge. I’m not sure what that would look like. 

[00:19:54] Bill Russell: [00:19:54] Now, now just for clarity, when you say Epic is your anchor, you [00:20:00] mean like your, your grounding, not anchor, like weighing you down, right. I just want to be clear. 

[00:20:07] BJ Moore: [00:20:07] Yes. Epic is a good partner with ours, so I don’t want to be disparaging. Yeah it does a good job of capturing core electronic health record data, but you know, back to my 70 terabyte information, like 70 terabytes may be Epic data, but you know, an exabyte is going to be image data, DNA, [00:20:30] IOT streaming, and that won’t be an Epic, that’ll be all adjacent sitting on the cloud. 

[00:20:35] Bill Russell: [00:20:35] Yeah, no I just want to be clear because my team will pull out like quotes for social media.

[00:20:41] And when they pull out the quote that says Epic is our anchor. And they attribute it to you. I want to make sure they put it in the right context when they hear that so. You know, let’s talk about the, you know, you talked about you know, [00:21:00] strategic bets and those kinds of things and. Obviously one of the strategic bets is here, but I saw some business things as well.

[00:21:07] So you guys have either spun out and I’m not sure I got this right, but essentially you’ve taken capabilities you had internal, you spun them into a different organization and now they’re delivering services. Not only for you, but externally as well. Is that close? 

[00:21:22] BJ Moore: [00:21:22] Yeah. You know, you mentioned earlier the sisters and making sure we’re under serving those underserved communities.

[00:21:29] I’m happy to [00:21:30] say, you know, last year we delivered almost $2 billion in services, you know free health services to those poor and vulnerable communities. And the only way that can happen as by us being healthy financially. And so, yeah, we look at businesses like a service. Business that has higher margins.

[00:21:48] How do we, you know, we have aspirations to build a billion dollar service business. That’s called Tegria. And so yeah, we had various assets like Blue Tree. We pull [00:22:00] that, put under that for-profit company that for-profit company rolls in a Providence. And yeah, that goal is to grow that into a billion dollar services business.

[00:22:10] And then the profitability that we get from that helps fund our overall operations and helps us get back to the community. And you got that, right. 

[00:22:20] Bill Russell: [00:22:20] Yeah. So that’s, it’s Epic, Epic. go lives and implementations it’s Meditech. You also had a tech shop as well. So [00:22:30] serving some of those worlds 

[00:22:31] BJ Moore: [00:22:31] Rev cycle services. How do we optimize our own rev cycle services, but instead of BPO service that we can provide to other health systems as well. So we’re looking multi multifaceted 

[00:22:43] Bill Russell: [00:22:43] So that has its own CEO. And you now deal with them as sort of a vendor at this point? 

[00:22:49] BJ Moore: [00:22:49] I, you know, Providence is  you know, is a complex system. I think we’ve got 200 legal entities. I would think of it as just another legal entity. And so they’re on [00:23:00] our corporate network and on our Microsoft 365. So I don’t see, we’re not really a vendor to them. Right. They’re really just, you know, we provide shared services to them. Like everybody else. The Professional services, they provide to IT in my organization certainly is more of a vendor relationship where they’ll come in and we’ll pay for those services. But the goal is for them to sell services to other health systems. That’s how we generate you know, free cashflow and [00:23:30] really bring profitability to Providence versus left pocket, right pocket, you know, more services they do for me, we’re just moving, moving cash around the same end of day. 

[00:23:39] Bill Russell: [00:23:39] Right. And and they’ve really been doing this for years. I mean, they’re .. 

[00:23:43] BJ Moore: [00:23:43] They have been. So it’s nice to have a brand or, you know, you can refer to and it’s easier to say, Hey, here’s Tegria you know, potentially this billion dollar services business versus yeah referring to the sub brands. 

[00:23:57] Bill Russell: [00:23:57] So let’s talk about working with the innovation team. You [00:24:00] guys have one of the more well-known innovation teams in the healthcare space. And as I said, we had Matt on the show. I’ve talked to Sarah and Aaron and everyone over there over the years. You know, they have a stable of companies and initiatives they’re working on. You have an IT operation that you need to run. How do the two come together? I mean, how do you know they have a portfolio of companies that aren’t necessarily Providence companies. How do you work with them on that?

[00:24:30] [00:24:30] BJ Moore: [00:24:30] Yeah. So Aaron Martin is a peer of mine. I think of him as the consumer facing or patient front door. So anything that’s marketing, website, patient engagement, patient scheduling is kind of that front office component. Aaron and his team does. As it integrates into things like Epic and then obviously the core IMS infrastructure my team owns and so there’s pretty clear lines of division there. Overall, the partnership is good. You know, [00:25:00] they do invest in companies.

[00:25:02] What’s also super interesting is the incubate companies like Xealth. You know where we’ll be their first and best customer and then they’ll get spun out to be a separate entity. And so we’re also adopters of those. You know, use Xealth as an example there, one of the partners we used during the COVID crisis to do some really compelling things. So overall yeah, it’s it’s, you know, like any partnership there’s, there can be tension, but overall it’s a strong partnership in the lines [00:25:30] of division are pretty clean and clear. 

[00:25:32] Bill Russell: [00:25:32] Yeah. You know, it’s it’s, interesting to me just to ask the question and I’m not digging for anything. I’m more curious because all these innovation arms are very distinct. Like if I went, I mean yours and maybe Jefferson’s looked similar and maybe UPMC looks similar, but if I go to down to Cedars, it looks a little different than if I go over to … You know they’re all a little different in this. Some of the CIOs will say, you know, I [00:26:00] sort of feel a little pressure here and, or I had to give away some of this that I really like to have.

[00:26:06] And so anyway, I’m just, I’m more asking the question out of curiosity of how  

[00:26:12] BJ Moore: [00:26:12] I would look on the other side of the coin. As, you know, as an IT leader we’re encumbered with a lot of technical debt and baggage. And so if you’ve got an innovation team that needs to deal with network availability and outages and cyber and technical debt and moving to the cloud [00:26:30] it’s tough to prioritize.

[00:26:31] Do we do this cool new, innovative thing or I got a cyber attack going on and you know, you’re going to do cyber. And so innovation takes a back seat. So by separating us and saying, Hey, Aaron, you get to work on innovation. Poor BJ, stuck dealing with cyber attacks. It creates this nice division where Aaron you know, knows I have his back and I’m working on a cyber attack. And so I can take care of that. And it really frees his team up to focus on innovation. [00:27:00] To wear both hats, innovation is always going to get the short end of the stick. And I don’t think you, you innovate in a way that you can if they’re separate.

[00:27:07] Bill Russell: [00:27:07] Yeah. And I love their approach. I love the fact that they’re talking to the consumer, they’re getting feedback. I love the different, their their approach to it is really. Exceptional. And I seen that at other systems, I’ve seen Jefferson bring in consumer and patient groups.

[00:27:23] BJ Moore: [00:27:23] And every model has it pros and cons. Right. If there was an obvious right answer, everybody would be doing it the same way. So it’s [00:27:30] depends on the maturity, the org, the goals, the objectives they’re are trying to achieve how much technical that they do or don’t have. 

[00:27:36] Bill Russell: [00:27:36] Yeah. Well I’ll spare you a conversation around tech debt. I can only imagine how much tech debt you guys have just from sheer size. We just have to have. 

[00:27:45] BJ Moore: [00:27:45] Yeah. 

[00:27:47] Bill Russell: [00:27:47] We did, you and I talked cloud and we talked follow the sun support in our first interview. And I’d love to get an update on how that’s going. 

[00:27:57] BJ Moore: [00:27:57] Yeah. So, you know [00:28:00] US health systems by definition are 24 by 7 operations, but being in the US you end up what I found when I came into healthcare, we’re trying to staff it with US-based workforce.

[00:28:11] So, you know, a year ago we had the foresight to set up a Providence team in India. It was our first international company at Providence. So they’re sitting in Hyderabad. One of the things they’re doing is that 24 by 7 coverage network operations, cyber operations. And it’s fantastic. Yeah [00:28:30] we’re you know, hospitals are our 24 by 7at  operations, but there’s less activity three in the morning in the US than, you know seven o’clock, you know on a Friday evening, when you know maybe the ER is getting full. So having that 24 by 7 coverage is not only helpful but allows you to do some impactful things, you know, in off hours where it minimizes the impact of operations. 

[00:28:55] Bill Russell: [00:28:55] So have you expanded that then? Are they doing patches? Are [00:29:00] they doing that kind of work as well? 

[00:29:01] BJ Moore: [00:29:01] Yeah I don’t want to minimise the team. So we’re up to 300 caregivers now in India. 24 by 7 coverage is one of them. But you know, the other reason we added that team there is it didn’t have a strong engineering muscle. So we’re building an engineering team there.

[00:29:19] You know, we’re doing a lot of healthcare analytics and business intelligence in India. It wasn’t an outsource strategy. So we didn’t take a function we were doing here in the U S and move it to India. [00:29:30] We really filled in the gaps that we weren’t doing and couldn’t afford to do so as we had an attrition here in the US.

[00:29:37] You know, I took that instead of back filling in the US and I use that to fund these roles in India, but yeah, it’s 24 by 7 coverage, it’s engineering, some of our services business we’ll do out of India. So that’ll give us more and more scale from a service delivery perspective. And it’s not just an ISDN asset, right.

[00:29:56] It’s a Providence asset. So we may do [00:30:00] BPO work. We may do legal counsel work there. We could do number of things interview. 

[00:30:06] Bill Russell: [00:30:06] Yeah, that’s amazing. 300 people over there. So, yeah. 

[00:30:10] BJ Moore: [00:30:10] And hired all those people during a pandemic. Right. January of 2020, I had one person and I got an update from the team just yesterday and we’ve hired our 300th person there in India.

[00:30:23] Bill Russell: [00:30:23] Wow. That’s amazing. And that does take care of that. I mean, India is almost the exact [00:30:30] opposite.

[00:30:32] BJ Moore: [00:30:32] Yeah, here on the West coast, depending on, you know daylight savings is 12 and a half hours time zone difference. 

[00:30:41] Bill Russell: [00:30:41] Yeah. So did you have to fly over there last year or did you forego that last year? 

[00:30:45] BJ Moore: [00:30:45] I did. I flew over there. I’ve always had teams in India. So I love going to India and visiting the teams. My last trip was just as the pandemic was starting and went over there late February of 20,20. 

[00:30:59] Bill Russell: [00:30:59] Wow. [00:31:00] You know we haven’t spoken in a while. I do want to sort of get your your take on this. And I realize now you’ve been here for a couple of years. You’ve been in healthcare for a couple of years. And do you know what you can and can’t say. The thing I appreciated about your first interview is I don’t think you knew what you can or couldn’t say. You were kind of free wheeling it. It was kind of fun. But you know what has been the most rewarding thing about coming into healthcare from, you know, from literally decades in [00:31:30] in, high-tech?

[00:31:31] BJ Moore: [00:31:31] Yeah, the most rewarding is it’s crystal clear what the mission is of Providence, right? Giving back to our community, serving our patients, serving the poor and vulnerable. So having that connection to mission is super rewarding. The fact that healthcare is so far behind, you know, I estimated I think, in our first interview and it proved to be accurate we were about 15 or 20 years behind. And so accelerating the digital transformation, having that impact, getting the feedback  [00:32:00] from patients and caregivers. You know I’ve received more, you know, love emails, you know, my last two years than I you know, probably 27 years at Microsoft. And so I feel like I have a real impact and really making a difference. So I think, you know, they both are exciting. Making a difference and a difference that counts. 

[00:32:20] Bill Russell: [00:32:20] Okay. Can you move as fast as you did it at Microsoft? 

[00:32:24] BJ Moore: [00:32:24] We are moving much faster. So I think when I first talked to you, my, I can’t remember if I [00:32:30] shared in the interview, but certainly was in the back of my head. My fear was the reason healthcare was 15 or 20 years behind is because they were change averse that it would be difficult to deliver that much change.

[00:32:43] I can easily say in 2020, in that 12 month period during COVID, during a pandemic we delivered more on that 12 months than I probably ever saw Microsoft deliver in three or four years. 

[00:32:58] Bill Russell: [00:32:58] Wow. 

[00:32:58] BJ Moore: [00:32:58] And not only did we [00:33:00] deliver more change in 12 months than I ever saw Microsoft adopt. But there was less pushback. There was less noise. I mean, people, we moved a lot of cheese all at once. By necessity because of the pandemic, right? Sending people home, adopting teams, you know, new password policy to factor off new cyber policies. Like there was a three month period where we were making changes every day. And people were [00:33:30] just rolling with it and adopting it and they really, really were troopers.

[00:33:33] So yeah, I would say the opposite Bill. I wouldn’t would have thought two years later, I would have said this, but I can look you in the eyes and say, yeah. In one year in 2020, we delivered more than Microsoft ever did in three or four years. 

[00:33:46] Bill Russell: [00:33:46] Well great. So you guys, aren’t 15 years behind anymore. 

[00:33:49] BJ Moore: [00:33:49] No and  you know, if a year from now, not only will we not be 15 or 20 years behind we’ll be caught up or even ahead of others, right?

[00:33:59] A year from [00:34:00] now, we’ll be on a single instance of Epic. We’ll be on Oracle cloud. So we’ll have a single ERP, single HR system, single supply chain system in the cloud. Right? How many $25 billion companies could say they are on an ERP cloud solution, a single one end to end. You know, we may be the only ones of this scale.

[00:34:20] So yeah, we’re catching up and passing people which is exciting. 

[00:34:26] Bill Russell: [00:34:26] So this was part of your story coming in. You had taken [00:34:30] this this organization within Microsoft and you had taken the entire thing to the cloud. You still suspect that you’re going to be able to do that pretty much across the board in healthcare?

[00:34:41] BJ Moore: [00:34:41] Yeah. Yeah. Obviously there’s workloads that need to stay in a hospital or a ministry, you know, can’t afford internet outages, you know, given the criticality but from a volume and cost per sale perspective, about 98%. We’ll say 95 plus percent, we’ll be able to move it to [00:35:00] the cloud successfully.

[00:35:01] The other thing that’s been a gift and moving to the cloud is kind of like the house that you lived in for 30 years, you know, all the things in the attic and garage you thought you needed until you moved. And you decided you didn’t really need that stuff. We’re retiring 50 to 60% of the applications.

[00:35:18] We are determining, you know, what that’s not being used anymore, or we can consolidate that or we can archive that. So we’re, you know, as we move out of data centers and we’ve now moved out of two of our [00:35:30] six data centers, we’ve retired 60% of the apps in those data centers. 

[00:35:34] Bill Russell: [00:35:34] That’s amazing. Well, and I’m also looking at this IRIS foundation for Epic, and you know, if I’m reading this correctly, I mean, it’s essentially a modern stack. So they’re able to really re-architect the entire Epic platform. You could actually see at least DR into the cloud if not full-blown production to that. 

[00:35:57] BJ Moore: [00:35:57] Yeah. I mean, the partnership with Epic and [00:36:00] Microsoft has been good on this front. Our existing Epic instances actually could move to Azure now.

[00:36:06] And we’re, in the month of March, we’ll have two instances, two of our legacy instances of Epic. One legacy and one DR environment in Azure. The reason we don’t move our production instance to Azure is as you pointed out earlier, when we move, you know, St. Joseph to Epic, it’ll go from being able to fit on Azure, to being too big.

[00:36:30] [00:36:30] But we think we’re 12 to 18 months away where the volume, the virtual machines on Azure will be big enough. We’ll be able to move our Epic instances. They’re both primary as well as DR 

[00:36:42] Bill Russell: [00:36:42] If you can share it what’s been, the biggest challenge or the thing that you didn’t expect that is, that has been a struggle?

[00:36:51] BJ Moore: [00:36:51] As it relates to moving Epic or just overall?

[00:36:54] Bill Russell: [00:36:54] Moving into the CIO role, moving into into healthcare. 

[00:36:58] BJ Moore: [00:36:58] It’s the tech [00:37:00] debt. I mean, it’s across the board. It’s everything from our PBX, our networks, you know, local area networks or wireless number of applications. You know, we have 4,000, had 4,000 applications here at Providence. You know, Microsoft, a trillion dollar company doing businesses 200 countries only had a thousand applications. And so that’s been the challenge. You know, how do you keep the day-to-day operations running? How do you simplify that environment? How do you retire and [00:37:30] migrate folks off of legacy systems and still innovate? That’s  been by far the biggest challenge.

[00:37:36] Bill Russell: [00:37:36] Yeah. And I don’t think, you know, and I gave some of this to you. I mean, we had a hospital that was on a 20 some odd year old PBX. And we were buying

[00:37:47] BJ Moore: [00:37:47] That was one of the more modern ones Bill

[00:37:49] Bill Russell: [00:37:49] Well we were buying parts off of eBay to keep that thing running. And people are like, really that’s a hospital system you’re keeping running that way. It’s like, yeah, I can’t explain it [00:38:00] but there’s just so much tech debt that you have you have to bite it in chunks. You can’t take it all on it.

[00:38:06] BJ Moore: [00:38:06] Things like PBX that just work until they don’t we’re easily forgotten. Right. And so you tell executive management you’ve got a 20 year old PBX and I’m like, I haven’t had a single phone issue. Like, you know why should I worry about it? But you, and I know you’re one motherboard failure away from that whole thing coming down.

[00:38:24] And then if you can’t find that motherboard on eBay, Right [00:38:30] for 20 year old PBX, like what does that mean? So obviously we need to take care of those things and it’s important and we are, but as you take care of that 20 year old PBX system, you’re not doing IOT and big data because you just don’t have the bandwidth to do both.

[00:38:46] Bill Russell: [00:38:46] Right. And I like how you separated all that up. And it’s one of those where you say, okay the company that provides your PBX is called Nortel. Go find them on the internet. 

[00:38:58] BJ Moore: [00:38:58] Exactly. [00:39:00] Exactly. Yeah. You hire you know, young and career kids and yeah they’re like, what’s this Nortel thing you’re talking about. It doesn’t exist. 

[00:39:07] Bill Russell: [00:39:07] So hey BJ it’s always great to catch up with you. Thanks for for coming on. Do you guys have these backgrounds provided to you? Cause Amy Compton-Phillips  also came on. She had a very nice Providence background as well. 

[00:39:21] BJ Moore: [00:39:21] Yeah, that’s something my team and branding team partnered on. So we have it here in WebEx or in Zoom and we also have them for [00:39:30] Teams. And so, yeah. Why not? You know, we’ve got the, backgrounds that come with those great tools, why not have a Providence branding with it as well? 

[00:39:39] Bill Russell: [00:39:39] Oh absolutely. You know, one time I asked somebody I’m like, well, you know, what’s really behind there. They took it off and he was actually in his garage. He’s like, it’s the only quiet place in the house. He goes but with the background, you don’t know I’m in the garage. 

[00:39:52] BJ Moore: [00:39:52] I’m at work right now, but I’m social distancing. Nobody else’s here. So I have a office myself. 

[00:39:57]Bill Russell: [00:39:57] I appreciate it. Thanks for coming on the [00:40:00] show.

[00:40:00]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, Apple, Google, Overcast, which is what I use, Spotify, Stitcher. You name it. We’re out there. They can find us. Go ahead. Subscribe [00:40:30] 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.

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