March 24, 2021

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March 24, 2021: How do you attract major IT talent to paradise? AKA Florida? How does someone from a military background quickly scale the CIO world and also wear the hat of pseudo COO? William Walders, CIO and SVP of Operations Support at Health First gives us insights into his operations and IT roadmap including ITSM, Data Analytics, Security, IT Governance, IT Automation and App Rat. How do you measure productivity? Are your staff evolving? Do you think about succession planning? What is Digital Enablement? How do we get things into IT? How is that governed? How do we report out? Have you adjusted your hiring practices post COVID? How do you approach interoperability? And for people early on in their career, what would you tell them prepares them to be a CIO?

Key Points:

  • Some CIOs are going in a digital direction. Some are going in an operational direction. Both make sense. [00:13:00] 
  • In health systems worth 8 to 10 billion, CIOs can do a lot more than just their traditional role [00:15:40] 
  • I used to hire military people and the reason is because they’re so well-prepared and so well-trained [00:26:59] 
  • We’re looking for things that stitch IT together. Digital enablement. [00:37:18] 
  • What is a health village? [00:38:15] 
  • For tonsil removal in my zip code the prices range from $259 to $49,660! [00:44:00] 
  • Shhhhh don’t tell anyone, unless they want to come work here and change the world of healthcare – William Walders LinkedIn post 
  • Health First 

The CIO Role Building on Operational Excellence

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The CIO Role Building on Operational Excellence

Episode 381: Transcript – March 24, 2021

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

[00:00:00] Bill Russell: [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 get to catch up with William Walders. He’s the CIO at Health First. CIO on the space coast of Florida, right across the state from me and we have a fantastic conversation. I think you’ll enjoy it.

[00:00:29] Special [00:00:30] thanks to our influence show sponsors Sirius Healthcare and Health Lyrics for choosing to invest in our mission to develop the next generation of health IT leaders. If you want to be a part of our mission, you can become a show sponsor as well. The first step is to send an email to [email protected]

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[00:01:32] Just a quick note, before we get to our show, we launched a new podcast Today in Health IT. We look at one story every weekday morning and we break it down from a health IT perspective. You can subscribe wherever you listen to podcasts. Apple, Google, Spotify, Stitcher, Overcast. You name it, we’re out there. You can also go to And now onto today’s show. 

[00:01:56] Today we are joined by William Walders the CIO for Health First [00:02:00] also SVP of Operations Support, a new title that’s been added. William welcome to the show.

[00:02:06] William Walders: [00:02:06] Thanks for having me bill. I know we’ve been talking for a couple of years now and finally some holes in both our calendars to allow us to happen. 

[00:02:14] Bill Russell: [00:02:14] We have been talking for a while. I was I tell you what first struck me is your social media posts. I love how you’ve been talking about the the ease of you’re the space area of the Florida coast.

[00:02:28] And when you [00:02:30] talk about it just cracks me up. The last one was Shhh don’t tell anyone, unless you want to come here and change the world of healthcare. And it was it was an article about how wonderful the standard of living is in that area where you’re at. So tell us about Health First.

[00:02:47] Tell us about that area, where you’re situated. 

[00:02:50] William Walders: [00:02:50] Yeah, let’s start with the easy one. Right? So I mean the space coast of Florida is unique. I think most people don’t know where it is. You tell them you live in Melbourne and they think you live in [00:03:00] Australia. The Southern part of Australia. And then you start working your way up Coco Beach.

[00:03:04] And most people kind of know that one and then eventually get to Orlando and then you just can see. Yep I live in Orlando, but in reality, it’s about an hour away, right on the coast. You know it’s quickly turning into what I think at once was in the fifties and sixties right. The hub of the world space program.

[00:03:20] And I keep saying, you know we will be the space port the world launched last night. We’ve got another launch tomorrow early tomorrow morning, late tonight. And you know [00:03:30] we expect seven, eight launches a week between you know Tesla Space X right, the Elon Musk space X and Blue Origin which is you know Jeff Bezos and Amazon’s project as well as ULA and oh by the way, NASA is still here and growing, right?

[00:03:44] So it’s a really unique part of the world largely bolstered by defense industry. And we’re the health system for this community. Largely in a three counties region here, roughly 85% of the market. $2.1 billion integrated delivery [00:04:00] network. So we have our own health plan about 180,000 covered lives.

[00:04:03] We’ve made it you’re following my social, it sounds like were you saw the announcement we made in partnering with Oscar Health a couple of weeks ago, in essence, they’re going to do the administrative services of our health plan. Give us some really exceptional tools, speed to market on the consumerism proportion of what health plans are required to be doing these days for hospitals which in aggregates is about a thousand beds.

[00:04:25] Our own medical service over MSO and medical group right. For our [00:04:30] own providers. And then our community health services is everything else. I call it the cats and dogs of Health First. They probably don’t like that title, but it’s home care, it’s gyms, it’s hospice, you name it, durable medical equipment. We have 30 something things in that portfolio. 

[00:04:45] So it’s interesting. It’s one of these. I call, I also call us the Starbucks of Bravard County because having lived in Boston and Seattle and a lot of places during my military tenure you know there’s a Starbucks on every corner, not here. I think we have three or four, but there’s certainly is a [00:05:00] Health First logo on every corner.

[00:05:01] In one of those capacities, either medical office, building hospital you know home care facility or a. Long-term care facility or home care office, or even a insurance broker. Who’s selling our plan that puts our logo on the, on their signage. So it’s a really fun place. And not to mention, I mean, Bill, you and I are Florida.

[00:05:19] You know, I know this will stand the test of time when people were reviewing this. And hopefully by that point, the storms that are occurring throughout the country and the power outages in Texas and in the Midwest and others in these freezing [00:05:30] temperatures are gone but here I’m looking outside is 80 degrees sunny. I’m staring at the ocean. And you’re on the Naples you know, you’re on the other coast and it’s no different I’m sure. Right. So but they’ll all make fun of us come hurricane season.  

[00:05:42] Bill Russell: [00:05:42] Yeah it’s going to be 85 degrees here today and you know hopefully no one’s going to you know cancel the show because they’re upset that we’re talking about how beautiful this down here, but you know on Friday night my wife and I drove up to [00:06:00] Orlando when we had dinner with a friend who came over from there, he works for Boeing. He was moved from Southern California to Florida. It was interesting to talk to him. He’s like, I couldn’t be happier. I was worried about moving my high school age daughter across the country.

[00:06:17] His daughter had started in a college. That’s not too far from there. I think it’s Emory riddle or something to that effect. And and he’s just and like I thought it was gonna be horrible. And he goes within about a two or three [00:06:30] months. My girls were like, why didn’t you move us here earlier? This is amazing.

[00:06:35] They you know the one girl was 16, was under 16 years old but she’s allowed to drive a golf cart and she’s like you know I can go pretty much everywhere she wants to go she can go with a golf cart. And what are the demographics in your area? Is it young engineers or is it retirees as well? I mean what’s the demographic? 

[00:06:59] William Walders: [00:06:59] Really [00:07:00] I’m the aberration you know mid forties kind of guy. There’s a lot of older folks naturally. And a lot of younger folks, younger engineer were kind of bifurcated right down the middle there. And that gives us some you know we pull our market data all the time responsible for the data team that does that.

[00:07:14] And as part of our huge pivots, we’re making an $800 million bet on consumerism. And that’s in that post. When I say change the world of healthcare. We genuinely think we will all. And we can probably talk about that a lot later but you know these. And pulling all that data. We’re really split. Right? Young [00:07:30] engineers, defense industry is huge here, not to mention you know, the space industry, but who was it? Northrop Grumman Harris, Boeing but Northrop Grumman and Harris are headquartered here. Now L3 Harris you know and so they’re huge here. And then Boeing’s in the area, a lot of aerospace and just aeronautics, Piper, tons of places, Vivian truck you name it. Right. And Sun Bum, you know, we have all these partnerships with a lot of these brands if you wil thay are born here and growing, [00:08:00] right? So I say all that to say, this is to manage that right you know, the folks who genuinely want to come into a healthcare setting, they want to stay there all day. They want to chat. They want to interact. That’s their social setting. And none of the younger folks to do this, every something on this device for every interaction in their lives.

[00:08:18] And we’ve got to cater to that as well. So it’s fun. To be candid. So yeah, roughly the demographics it’s certainly some in the middle, but we’re the minority, you know, we’re kind of  middle aged in this community. 

[00:08:29] Bill Russell: [00:08:29] Yeah I [00:08:30] moved into the naples and they refer to me as as the, the where the young couple who just moved in. I’m in my early fifties and I haven’t been called the young couple in I don’t know 30 years. It’s crazy. 

[00:08:44] William Walders: [00:08:44] Yeah and this community reminds me. I know that Austin’s a really easy target if you’d visit it. I mean and I go to equate this Naples, cause I grew up in not too far North of Naples. We used to go down on all the time and it was just sand dunes and a handful of things right back in the early eighties.

[00:08:57] But I equate this to when I was visiting Austin, about [00:09:00] the same time and Asheville, probably 10 years after that. So you know, if I was a betting man and I am, I you know moved by family here, investment in my own real estate, whatever you know personal things, it’s going to have a similar trajectory as is those two cities right?

[00:09:12] Asheville and Austin is now blowing up with all of the tech that’s growing there outside of Dell. But but yeah it’s an exciting place to be. 

[00:09:21] Bill Russell: [00:09:21] All right. Well let’s talk about talent a little bit because a lot of your social media posts are about attracting talent. Do you find it hard to attract? I mean [00:09:30] it’s kind of funny. I mean based on what we just talked about, do you find it hard to attract people to paradise? 

[00:09:35] William Walders: [00:09:35] Yes and no. You know I just told you, my competitors is the same folks, right. You know, Northrop Grumman and we’re not I mean, IT is my passion, my love I shared with you. I’m now responsible for other aspects of operations at the idea I’m kind of a pseudo COO in a sense,= responsible for all contracting and supply chain which is another 500 staff. The contracts that do environmental services you know you get phone calls about instead of networks being down and [00:10:00] vulnerabilities. I know get them about transportation and linen as well. 

[00:10:02] Bill Russell: [00:10:02] I’m sorry so before we go to talent, how did that happen? How did you end up with those added responsibilities? That has to be an interesting story. 

[00:10:12] William Walders: [00:10:12] You know chance favors the bold, I guess you know, came here right during Dorian, if anyone remembers that storm of 2019 on our coast, that hurricane. You know as the CIO, six weeks in running a command center operation center jumped right in 22 years of military experience. [00:10:30] It’s not hard to lead people that talent was recognized, I guess, quickly it became, you know, besides them hiring me as the CIO became somebody to watch, I guess, in a sense, and these are words that were shared with me and gradually grew, it came in IT did a full contract review saved us $13 million right out of the gate. That certainly did not go unnoticed. And then our COO happened to retire and they’re looking for folks to cover down for his vacancy. And and I, you know, you get the call from the CEO who calls into the office and you’re like hair in the back of [00:11:00] your neck stands up. You’re like, this has never happened.

[00:11:02] Like is this going to be great or horrible? And it was me saying it’s great right? Mapped out an org chart. Our COO is responsible for all those things I described plus facilities and security. Those facilities, our hospital division, with the CEO and security went to our HR EVP and I got the rest. So that’s how that went. They saw my the way it was shared with me. Not me gloating. They saw how quickly I was able to scale the CIO [00:11:30] world and won’t say turn it around because it was well on its way to being turned around, but change the culture, change the perception, get the folks motivated and then do a lot of the operations, the capabilities within IT.

[00:11:41] Growing an HR component for professional development and really having a roadmap for the IT staff to evolve and develop. That was something that our surveys had said they were missing from a professional development perspective. And then again, that contracting piece building out our own contracting team, a vendor management office, I’d call it [00:12:00] if If we were to formally give it a title and then really saving those resources.

[00:12:05] So now we’re doing a similar thing in contract supply. I’ve got, you know, 400 staff there, a great Senior Vice President who’s leading that and we’re doing a similar transformation there. So that’s kind of the how. You could ask my CEO, Steve Johnson if I’m accurate or not. Maybe he’ll comment if he sees this.

[00:12:21] Bill Russell: [00:12:21] That’s you know, what’s interesting about that is we’ve, Chad Brisendine CIO at St. Luke’s up in Pennsylvania took on [00:12:30] frontline revenue. So he’s actually overseeing imaging and some of that stuff. So we see CIOs going in that direction. We also saw BJ Moore who I’m gonna interview later this week. He is at Providence and he took over facilitiess and a whole bunch of operational capabilities as well. So we see CIOs is going there. I’ve interviewed four CIOs in the past month who have all taken on Chief Digital Officer roles. So we’re seeing this hey you got IT [00:13:00] running real well. We’re gonna, we’re gonna throw some more things your way. And some are going in a digital direction some are going in an operational direction. And to be honest with you both make sense to me. 

[00:13:09] William Walders: [00:13:09] Right? Yeah. And I genuinely, we had a CDO I’m if I’m doing that job as well. We just, I hate that title. I don’t know what it is Bill. Maybe we can, you can be my therapist here but I always thought that it was funny, I even said that I feel like during my interview, like we have a CDO, this is what they do. And I’m like, that means your [00:13:30] CIO has failed. Right? Like you’re, in my mind, like the CIO is the CDO plus the Greenlight screen networks up operations guy. If you extract the CDO element from it, I’ll say this word neuter the CIO in a sense that they’re no longer the fun, cool, glamorous like technology stuff, they’re just operations. Right? 

[00:13:50] So if you want to just an it operator Greenlight screen network is on, we’re safe. We’re not, you know, not vulnerable and security’s good then. Sure. But it really [00:14:00] great CIOs, I think do both. And I do both here. You know, if we wanted to keep that EVP CDO title. When I got here, it would probably be announced introducing myself as CDO.

[00:14:09] I just don’t like the title, but I’m curious your  thoughts there Bill. I mean, we probably don’t, I don’t know if we want to get on that tangent. And in particular, since you’re interviewing interviewed quite a few of them. Quite a few of them and four of them, I think you referenced. 

[00:14:20] Bill Russell: [00:14:20] Yeah, you know it’s interesting the CIO’s that don’t have the title are still, a lot of them are doing the role. But there there [00:14:30] have been some noticeable departures from that. Ascension really put a lot of authority in their Chief Digital Officer, Eduardo Conrado and ievery time I’ve talked to him, he’s extremely impressive, heavily involved in the operations, digitizing whole hospitals and the direction they’re going, obviously leading the charge of Google. And when you have a hundred, some odd hospitals, I think you can understand how it gets split in that scenario. 

[00:14:56] William Walders: [00:14:56] Yeah, no. And I was going to say that our scale, there’s probably some sweet spot. [00:15:00] Someone can draw a Venn diagram or some slope that shows like what that crossover point is for requiring one. But absolutely in that case, I know I’m I’ve seen it go a different way actually. Thomas Jefferson Health where Steve Klasko is the CEO. They had that whole CDOs dice and divested that entity and now outsource their innovation. I mean so maybe that’s a direction that folks will be doing next.

[00:15:21] I don’t know, but I get, but yeah, you’re probably right that sweet spot of size, you know, John Hamalka at Mayo. Great, great guy. We all know John and what he did in [00:15:30] Boston and a great thing for something besides Mayo as well. Health First we’re good. 

[00:15:35] Bill Russell: [00:15:35] Well yeah I mean, I think there is the sweet spot until you get to about I’m going to, I’m going to put a number on the ground saying, let’s say about eight to 10 billion. I think the CIO can do a lot of, a lot more than they’re currently doing. And I think that’s what we’re seeing in those organizations. Plus I agree with your neuter comment wholeheartedly I think there’s so many things [00:16:00] that require the, by the way, I’m supposed to be interviewing you, this is anyway. But I think there’s so many things that require the two to be so tightly integrated. That if the CIO can do both roles, if they have the skills to cross over to digital health and really understand the customer journey and bringing those things together, that you should allow them to do that.

[00:16:19] First of all, it creates a great career path for the talent, the technical talent that you have inside the organization. I don’t think anyone understands the operations as well as the CIO. You [00:16:30] have to touch everything. I mean, they’re the, you know you’re touching, just as a CIO, you’re touching the supply chain, you’re touching the HR, you’re touching every practice within there.

[00:16:41] You’re touching ontology as well as cardiology. I mean you just, you have to be really understand it. I think outside of the CEO, the CIO probably understands the inner workings of the health system. Probably as good as anybody out there, to be honest. 

[00:16:57] William Walders: [00:16:57] Yeah. Certainly the operations and tactical, [00:17:00] right? Like the tactical I’ll call it tactile of touching like real world operates. It’s not you know sitting someplace and looking at reports and dashboards but genuinely living through the operational problems. The other folks who do it well that I think are natively the parent for COO type responsibilities are your facilities guys and gals, right? Who similarly across that horizontal plane. And you kinda, if you guess, if you look at the pedigree of CO.O’s that you don’t see too many CEOs that you’re seeing it now, a lot of our healthcare administrators are kind of bounce around [00:17:30] and run things and eventually land in operations role. But I think you’re going to start seeing it from the line service components of it, right.

[00:17:36] Facilities, folks, IT folks, maybe contracting folks, supply chain and then maybe even a handful of them, you know. 

[00:17:45] Bill Russell: [00:17:45] That was a significant tangent but I appreciate you going down that road with me, let’s go back to attracting people. Does the social media thing work? 

[00:17:54] William Walders: [00:17:54] Absolutely does. I mean you know, for that reason that, you know, LinkedIn is the one I’ve latched on to, I think I have [00:18:00] like 500 Twitter followers or something. And if you want to see my kid or my pets, that’s probably the place for that. But LinkedIn is where I do, you know, the work stuff. Right. So a pretty great following there either from my time at Walter Reed or VMware or now. And so it genuinely gets a lot of traction. You know we’re a not-for-profit health system.

[00:18:19] We’ve got a great mission and great story. And you know for folks, I seem to find these great leaders and I feel like I’ve stolen quite a few senior leaders from like, [00:18:30] Pennsylvania, Oregon. 

[00:18:33] Bill Russell: [00:18:33] It’s like, not even fair. Yeah. It’s like just wait until this week. My you know my parents have two feet of snow in Bethlehem, Pennsylvania. So just start calling St. Luke’s and Bethlehem or Lehigh Valley. Yeah. 

[00:18:45] William Walders: [00:18:45] Yeah. I got my CTO from Providence and legacy kind of similar thing. You know, his wife the … I mean, I lived in the South North West for three years. I don’t know how you do it. But you know, they got tired of too many of those. And I just joke that I stole away [00:19:00] the next legacy CIO. A gentleman by the name of Michael Carr who’s our CTO. You know so it does work. I mean generally it gets things out there and gets eyes on it. You know I’ll be candid. It was very easy. We’ve got, I just got the report. We’re 99.8% over the last 12 months on retention. Right. So I don’t hire a ton, but it’s still on the IT side somewhere between three to four months.

[00:19:24] And we want to grow a lot of that talent from external, but we’ll naturally find it here. We partner with [00:19:30] universities. You mentioned Emery riddle, which is just north of us. FIT, Eastern Florida are here genuinely in our backyard. Starting to do all the right things with them. Building an IT track.

[00:19:40] We have nursing tracks. We have you know, medical attending and rad tech and that, and building an IT track there. So, so absolutely getting it out there. It does. It does work Bill. 

[00:19:49] Bill Russell: [00:19:49] Wow. The you know, coming from the military, do you think a lot about succession planning? I would assume you do 

[00:19:59] William Walders: [00:19:59] Yeah it really [00:20:00] weirds people out like that. You know, that I’m so open and forthcoming. Like I want, I’ve got three direct reports on the IT side who are literally or three way tie for who will be the era parents in Seattle. Like I will not hire a search firm. It’s I think it’s an inevitability that I grow out of the CIO role at Health First. I don’t want to, I love it, but I think that’s just directionally where my leadership is taking me.

[00:20:24] And you know, I’ve got the best and hardest decision to, you know, I don’t have to go outside. I got three, [00:20:30] three folks and I’m training them to that end or, you know, building my relief as we called it in the Navy. And it was weird for one of that. It was like, no one’s ever been so open. Like, you know, I guess maybe it’s natural to protect your territory but no, I absolutely do thrust them into those situations often. For COVID response I happened to be in St. Lucia for spring break almost exactly a year ago but you know, the hospitals started ramping up command centers and requiring the CIO to be present and [00:21:00] spinning up ICU’s and building hospitals and, you know, basketball stadiums, et cetera.

[00:21:04] I put two of those three in the command center while I was in my own command center in St. Lucia on the phone waiting for a flight to get back for three days. But no, they’re great. 

[00:21:13] Bill Russell: [00:21:13] So the yeah, you’re working out of your home. I got to meet your dog earlier. The you know, are you going to adjust your hiring practices going forward? I assume you guys are still out of the home. How are you thinking about that? 

[00:21:26] William Walders: [00:21:26] Yeah, we’re I go in three days a week, Monday, Wednesday, Friday. [00:21:30] Tuesday, Thursday and I love that balance. You know, I say I did not adjust my hiring practices during COVID. When I got here and I don’t wanna. It was different culture, right?

[00:21:42] People, it was competitive who got to work first, whose car was in the parking lot. And then it was a bit of a, it was game of chicken on who left last. Right. And I was very lucky, twofold. I was probably the only active duty military officer who was remote working and supported a Cerner deployment that $12 [00:22:00] billion thing that’s happening in DOD. I was in Seattle. I was across the sound, but you know, and my staff were all over the world. Right. And that happened to be where the first way went, but I worked at a home. Five out of five work days a week. So I learned that culture. Then I go to VMware for a year and you know that’s entirely remote.

[00:22:18] So when I got here, I’m like we are remote. Like we need to prove it. Now we’re in, you know, with hurricanes, with everything else. I don’t want anybody being on call. I don’t want anyone to have to drive 45 minutes into the building to reset a server. Like let’s [00:22:30] prove that we can do it. And we did. People loved it. It was a great retention too but secondary recruitment tool. And we literally flipped the switch. So so yeah to change hiring practices in a sense, right where we’re just telling them you’ll likely work remote, but network we’re poaching, people from Tampa and Orlando, who in a prior leadership regime would have said, you have to be here.

[00:22:51] Or at least come three or four times a week and we’ll give you that one day to stay home. But now I’m like stay home. Like I don’t need to see you. We were looking at [00:23:00] growing building a $6 million administrative building to house you know administrative services and guess what those plans are scrapped.

[00:23:08] In fact we divested ourselves of another 3 million in rental space right. So yeah this is not changing where we’re in it for the long haul and the system support. And Oh, by the way, we’ve been measuring productivity this whole time. The health plan is the easiest one to measure for me for claims processing, et cetera, but even the other stuff on average, we’re up 17%.

[00:23:26] Bill Russell: [00:23:26] Wow. How do you measure productivity in [00:23:30] IT? What would, how would that look? 

[00:23:32] William Walders: [00:23:32] Yeah, so it depends on what you’re doing, right? So it’s easy on security side patch management compliance. We watch our management. When I got here our patch goal was 80% and it just blew my mind.

[00:23:47] So we drastically reduced that gap. For system administrators we have to checklists and things you have to do for patching compliance. And the ability to take on more work as new systems are added. Help desk productivity is an easy one. [00:24:00] We, you know, 6,000 ish open tickets. Now that hovers around 200. You know, it’s just normal managers, I guess Bill from it from an IT perspective, but that’s how you see.

[00:24:10] Measure over where you were and mind you, I’ve not done multivariate analysis to extract the changes that we’ve naturally made over this time to improve that new tools, new capabilities, a lot of automation with some, you know robots and other things but I’m counting it. 

[00:24:26] Bill Russell: [00:24:26] You know I sort of joke, you know we’re leaving 20% open but that used to be the [00:24:30] mindset.

[00:24:30] If you, when I first took over a CIO back in 2011, we were worried about global threats and those kinds of things. And it was like, all right, well you know, we’re going to try to get every system patched over a one-month timeframe. And that was acceptable back in 2011. It probably wasn’t acceptable, but that was sort of the norm.

[00:24:50] And we’ve really had to adjust that especially recently. I mean, it’s just the attacks are constant and [00:25:00] getting more sophisticated by the day. So. You know, 

[00:25:05] William Walders: [00:25:05] Silver lining and that’s the you know the ransomware that came out, it’s been around for I guess, a year now, but most notably hit, you know, all the press the EDPs read and folks that sit around the horse shoe, I call it on my floor.

[00:25:18] You know when they start knocking on your door and like hey, should I be concerned about, you know, like this hospital’s hit? I’m like, no, because you know, I mean, you absolutely should be, but you know, remember all the resources we commit to security here [00:25:30] and how we’ve improved the posture over time. Like we should be okay. But but it put a spotlight on an area where to kind of justify. Cause you know, there’s security is one of those things. I was in DOD for 22 years. Right. You’re not, if you’re not a hundred percent, they will turn your network off. Right. I mean, that’s just the culture because the medical systems ride the same circuits as missile CO’s intelligence data. Right. And you’re bumping up with NSA stuff, right. And so no one there’s zero tolerance regardless of how special healthcare [00:26:00] is. And so, you know, it’s just a culture shift and you know it’s one that’s folks here are starting to learn and understand. And then when you couple that with you know, doing it for them and not to them. Cause it used to just be bringing you down and why, because we need a patch right. Not because you’re gaining functionality. You don’t have your business partner with you on the why. Once you fix that and then you build credibility that, Oh, by the way, the four hours you’re down is only the four hours you’re down.

[00:26:26] Not that it bleeds three days later and you’re scrambling as to how to get it back up. [00:26:30] And you start to build that faith and confidence back from the business. You’ll get them as partners as well on the security front. 

[00:26:35] Bill Russell: [00:26:35] I’ll say I used to hire military people. And the reason is because they’re so well-prepared are, so well-trained. The the new CEO for Ohio Health is a former military guy and he was talking about COVID and he said yeah, he said, the first thing we did now, you think okay COVID-19 the first thing we did, and he said, the first thing we did was security. He goes, cause the number one thing you have to worry about is when you’re looking the other way is [00:27:00] when they’re going to attack you go. So we got together our cybersecurity, I mean, and I’m sitting there going, okay, that’s the first, I mean, there’s a lot of CIOs who wouldn’t think that way, let alone the CEO, but  that’s what the military does for you.

[00:27:14] It’s like okay, what’s our flank. How are they? How are they positioning themselves? How are they going to attack us? How are they going to, and, and that’s, I mean, again, that’s just the training, that’s the mindset that you have to get into. It’s pretty, it was pretty fascinating to hear him talk. [00:27:30] Let me, so you have posted on LinkedIn information technology industry day on February 26th.

[00:27:39] What is the, and I apologize since this will probably go live after your technology day but for those who want to be a part of it in future, what is it and what are you doing? 

[00:27:51] William Walders: [00:27:51] Yeah. So I do I’m twice a year, so no worries. We’ll get, you know, if you’ve listened to this enroll in August, we always put the, save the date out, but [00:28:00] here’s the genesis of this.

[00:28:02] We all relate to prior things. I might sound like a broken record when I say in my military time. But when I was at Walter Reed, I was responsible for a six state region, as well as kind of a side duty that regional CIO of 32 hospitals, as well as CIO Walter Reed. And you can imagine, you know, I spent over that 10 year, about $2 billion budget and four years to do the math half, half a billion y’all are spend.

[00:28:24] You got a lot of people want to talk to you, right. And you know we all have our own strategies on how you do vendor [00:28:30] management and who your partners are et cetera. And I had this idea from another element of it, the military, who did it. It happened to be our contracting team who does, you know, wants to get small businesses and service disabled and minority owned businesses into the level of understanding of how a government contract works, how you can apply, how you can run this business. And I attended one I’m like, why don’t I do this? Right. It saves me the, I need 15 minutes. I need 30 minutes. My admin pulling her hair out [00:29:00] on scheduling an hour meeting with somebody but secondarily opens the aperture to everyone.

[00:29:04] Genuinely the world can attend this. So what I do now is I save that flyer that shows the save the date. And it’s, anytime I get a, I’ll call it unsolicited email from a vendor. Cause they all figure out our naming conventions of email and get your email and under services you sell it. I just send it to them like, Hey, I’m Nope, I’m not going to give you 30 minutes, but I’ll give you four hours.

[00:29:25] Right. And here’s the day. And for four hours, I’m going to tell you the following. [00:29:30] What, just high level, what we’ve done, who we’re about what we’ve completed and what the success has been and who those partners were. I want to celebrate success but more over what’s coming, right? Here’s the RFPs we have coming out. Here’s the entire roadmap of what we’re doing. If you can do one of these things engage our BMO. We’ll get you registered. Enter our registration so you’ll get every RFP if you want it, even though, you know, you make it our linen one. You know and you’re an IT company but people  want them right. And having been on that [00:30:00] side, and maybe you got an opinion. Somebody’s got a solution on automating linen. But anyway, and that’s kind of what we do, but more importantly, having briefly been on, on the sales side of this, I tell you, what’s not real, you know, you don’t chase these things. You know, back when you know lunch and learns and, you know, line level and service level people having meals and playing golf and doing other things with sales folks, I felt like they were compelled to overshare at [00:30:30] times or to talk about things that may or may not been real yet or genuinely not real in near term. So on the sales side you start spinning up resources. Hey Health First is working on a blockchain and let’s not talk about that. It was just the, it’s the thing I hate the most in IT at the moment.

[00:30:45] But you know and then you get all these blockchain vendors coming and wasting everybody’s time or even a good partner who you know goes out and gets an overlay and starts positioning blockchain solutions. And I’m like what you’re wasting your time. Right. And that’s. Thousands tens of thousands and [00:31:00] hundreds of thousands of dollars in many cases of these partners. So genuinely 4 hours, here’s what we’re working on. Here’s what we did. Here’s who won our tease it, you know actually it’d be old at this point, but here’s a decision we made on CRM and why here’s a decision we made on cloud and why.

[00:31:16] And if you want to be a partner, here’s the things we care about. Right. And so that’s why we do it. It saves a lot of time. It’s open and transparent. We’re a non-for-profit and we have a foundation. So I like to plug the foundation there, even though we get very little traction during [00:31:30] it. But but anyway. So that’s why lots of lots of goodness from. And then I positioned my staff to present and to come out of their shell a little bit, some director level folks.

[00:31:41] Public speaking. We had 600 of the last one. So it’s great to see how they interact with an audience like this, how they think on their toes. So I also use this professional development tool as we communicate the message but it’s great. 

[00:31:52] Bill Russell: [00:31:52] So here’s what I’m going to do. I’d love to hear you discuss various technologies and priorities. And I’m going to use some [00:32:00] of the things you had listed on here. So I’m just going to rattle through them. Just your quick response, you know, is this a priority? You know, where are you guys thinking about going with it? So one of the first things on the list was ITSN. IT service  management. What, where are you heading with that? Is that a priority? 

[00:32:16] William Walders: [00:32:16] You made a selection recently with our incumbent. Modernize that tool for me. And I wish I was in my office cause I have a two foot by three foot chart that shows kind of hierarchy. In my mind when you have great IT service management, you truly become that [00:32:30] audit proof, transparent partner. And you can even call it ITBM. A lot of people do the business management of IT. So you start at the service management, the service desk. Document what you do. You understand what that is, then you extrapolate to what it costs. And then you show people. I literally handed my EVPs that two foot by three foot chart that showed every application in the portfolio. When I got here at 1200, now 434. And it was an eye chart. It was ugly via email, but when they laid it out on their desk, the hospital CEO [00:33:00] looks at it. He’s like oh, that’s the visually everything I have. That starts to tell a story, right? So for me, I’ve got four foundational bases of our strategy at Health First and one of those is IT service management. 

[00:33:11] Bill Russell: [00:33:11] Data analytics and management. I would imagine this just continues to climb the ladder of importance. So what are you looking at for this year? 

[00:33:21] William Walders: [00:33:21] That’s the second of the four foundational elements of IT. We are a holding company. And we’re a holding company in the wellness business. Right. [00:33:30] You know, we are a pillar in the community, again, 85% of the market. And so you know, everyone’s affected by Health First. So we represent that brand. We want to do right by them. So getting all that data and single data layer ingesting in a way that’s actionable being able to deliver that. So we’re all in on the data element to, you know, I don’t try to use buzzwords but the strategy is single data layer.

[00:33:56] Ubiquitous presentation layer with both data enablement people show you [00:34:00] how to use it. And it’s self-service BI right. Where you can come in and do it. We’ve got pop health folks. We’ve got finance folks. And right now everybody’s got their own ETL process and that’s them taking it from our data source and ETL it into Excel and pivot tables. 

[00:34:12] Right. And then we all know what that means. So once foundationally we’re there, I’ve got a great leader in that role Tim Boston who is building out all that maturity and we’re at the, we’ve done the plumbing. We know where everything is. We’ve now put the governance on top. We are starting down the journey [00:34:30] of truly that ubiquitous presentation layer and really enabling the business to do great things with data. So. 

[00:34:37] Bill Russell: [00:34:37] We chatted about IT security. And generally if people are wondering, I don’t ask detailed questions around IT security of CIO, because every good CIO has been already told by someone not to talk about their security publicly an reveal stuff. But, you know I’m sure it’s a priority. And I’m sure that you guys are keeping an eye on that. So let’s jump over that and just go to IT governance. Why [00:35:00] is that listed? I mean is that a technology project or what is that? 

[00:35:03] William Walders: [00:35:03] Yeah so similar on that IT service management framework, right? We right now there’s seven ways into IT. So how do you get a request in, how do you get a new initiative?

[00:35:13] We’ve now narrowed that down to two, by the way, but when at the time of that writing. So what we’re doing is one asking mature partners from a consultancy perspective, even a tool, and they exist on intake. Right? How do we get things in? How is that governed? How do we report out? And we’ve [00:35:30] adopted them. I don’t call it it here, but we’ve adopted an agile methodology with a product team structure with product owners.

[00:35:37] And something, we it’s a governance council. We call it the digital enablement committee. But it’s truly IT governance. We’re not, I don’t use the G word much because we’re governed by our board but everyone hates governance. And then we don’t call it boards boards for the same reason. So it’s digital nameway committee.

[00:35:53] So we had a great partner, helped us set that up. We’re starting to look for tools and process and maybe even some [00:36:00] service provider to help manage that with us. 

[00:36:02] Bill Russell: [00:36:02] Yeah, you have digital enablement as the next one. What exactly is that? Is that enabling the underlying infrastructure to accept digital tools and that kind of stuff? Or what is that? 

[00:36:14] William Walders: [00:36:14] Sure. We are nonprofit health system. We sold off. 20 ish percent of our company to Advent Health. So our partners too, and a big partnership, it’s been great. We’ve done a lot of things with them, but we did it for one reason. It gave us [00:36:30] $800 million in what we call pivot capital to really enable consumerism to our CEO, calls it the digital pivot. I call it digital enablement. So that’s what that is. So we’ve spent with Oscar is a proof and parcel of what that looks like on how we’re gonna, you know, gain speed to market on digital tools a year and a half ago, we made a partnership with a company called Previa Health who does a similar thing for the ambulatory space.

[00:36:54] And we’re looking at the moment for things to stitch that together. And moreover and the [00:37:00] HR vendors won’t like the following words, but how do we do that in the ambulatory and the acute space rather on, you know, stop being beholden to the Cerner’s, Epics, Allscripts of the world. Because it’s our biggest spend right? I’d be hard pressed to know any CIO who doesn’t spend, you know, eight plus figures on their HR provider and for what, you know, in my opinion, and marginal value. And not to disparage those folks, some of which may be a sponsor of your show Bill but that’s what it is. Right. And so for us [00:37:30] it’s enabling that digital component. Putting healthcare tools in the hands of folks in the way they consume it.

[00:37:35] And frankly, you know, once we know you, we always know you as something, our CEO said. So how do I take that across platform? And you may be getting to it, but we’re doing a thing. On that list because I don’t have a list committed to memory, but we’re doing something very unique here called our health villages.

[00:37:51] Right. And folks are doing them around. Here’s our version. And I think it’s the best version naturally. But so imagine if you will, everybody drives [00:38:00] by a shuttered up mall these days, right? These concrete wastelands. We’re taking a couple of those, turning them back into park-like settings. Ours are happened to be connected, one to the beach and a boardwalk and other bird rookery, another to kind of a natural reservoir near to St. John’s and turning those into health villages. So imagine if you will a central location. I’ve lived in Europe whuch I call it the city center. It looks more like a park than anything. And your medical office building is there naturally fit into the environment, a Whole Foods [00:38:30] or type brochure. Is there a tropical smoothie, a Spin Cycle or an Orange Theory and integrating that into truly a wellness business.

[00:38:37] We envisioned by our studies, 90% of the people who visit there have nothing to do with health first, right? Come in there to walk the trails. Coming there to be somewhere in a social setting. So that’s pivot is where I need digital enablement. I am now going to be charged with somehow integrating system into a hotel chain who also a short stay hospital, a Whole Foods.

[00:38:57] Right. And imagine the power. Right. You know, I just, I sit [00:39:00] down with my dietician. And I joke a robot will then walk me out down the aisles of Whole Foods and tell me what to buy, but more over maybe an app, right. Or maybe the dietician herself, him or herself walks out with you, but those integrations.

[00:39:11] Right. And we all do for other things for this. And in other settings where if you’re delayed We know you’re coming because you have our app and we see driving and we tell you where to park and Oh, by the way, the doctor is delayed. So go to Tropical Smoothie and get a smoothie on us. Like that’s, those are table stakes at this point.

[00:39:26] Right? I think folks are starting to figure out that consumer as an owner, [00:39:30] we want to take it to that next step. And that’s why the data component is so important as well. 

[00:39:34] Bill Russell: [00:39:34] Yeah. Gosh, we’re coming up, we’re coming up on the end and I could talk to you for another two hours, but it automation, RPA is that something that’s on your radar?

[00:39:44] William Walders: [00:39:44] Yeah we’re all in and this is a coin, a term I coined in the DOD, which sounds harsh, but we’ll paint the picture. Once I say it, we’re capturing every bit of low value work. We can. Right. So, you know, we’re spinning up robots left and right to do the simple stuff right now with claims and [00:40:00] other things. We’re taking in a finance patient reg. A lot of places where there’s genuine new, low value work, and there’s a whole nuance on how you get folks to adopt that. And we figured it out here. One, it’s not calling it low value work but let folks get it. You know they’re always afraid. Many of them are afraid. Like, do you remember the dictations folks? So the transcription folks of the past right. With those technologies is, Hey, you’re ignoring stuff every day.

[00:40:24] We need you to do the high value work and we’re doing a lot of it and we love it. You know, I’ve got a couple of providers, there are great [00:40:30] partners, but the ones, you know, look at, look in the upper right-hand corner. Gartner’s magic quadrant. You’ll know who we’re working with there. 

[00:40:36] Bill Russell: [00:40:36] So  app rat has been a pretty key since you’ve gotten there. Has that been a focus and you just gonna keep your foot on that gas pedal? 

[00:40:43] William Walders: [00:40:43] Yeah. I mean, no one hires a new CIO and says. Here’s all the money you need to transform and here’s all the time to do it. So I think how I’ve been so successful is I started with a financial background and contracting flavor. I can look through contracts, I can cut fat. I can do [00:41:00] app rat. And that gives an all I say, when I get here just let me keep my savings. Right. You know, all the performance improvements we have, that is my innovation budget. That is my transformation budget. So in essence, let me run a PNL and not have to give back every time we save something to the greater number.

[00:41:18] And that’s how we innovate. So that’s how I’ve done it everywhere. I’ve been, you almost say cut the fat, but you eliminate you do duplicative things. And then you guess what? You saved 20 million bucks who wouldn’t want [00:41:30] that right. To innovate, to update, to adjust. So that’s why it’s always been a priority for me and how I’ve always I think been successful in some of these emerging.

[00:41:39] Bill Russell: [00:41:39] That’s an exceptional approach, by the way, just let me keep my savings. And and we’ll be able to, we’ll be able to create a digital budget and that transformation budget and those kinds of things. That’s really interesting. And any regulatory priorities that you’re tracking right now?

[00:41:54] William Walders: [00:41:54] Yeah. All of them. Right. So for us [00:42:00] Florida house vill, and I forget the number of this now, CMS requirement in order for you to do Virtual visit at the bedside and acute and ambulatory and build that gap there. We’ve got a couple of technologies and we’re bridging that, all the information, blocking information, sharing things, you know, we’ve we’ve all vacillated on the regional sharing. And we do that well with some partners in poorly with others. So, so absolutely all of them, we’ve got a compliance team that tracks us through those. The biggest one for me  on the interoperability side and selfishly I know blue buttons coming and having [00:42:30] lived in the blue button, the world you know, in the DOD VA information sharing.

[00:42:34] That’s the one I focus on cause I know we can do it pretty, I won’t say easily, but DOD and VA can figure it out. We can figure it out at Health First so yep. 

[00:42:42] Bill Russell: [00:42:42] Price transparency, anything going on there? Are you guys. 

[00:42:45] William Walders: [00:42:45] We have it. We’re making it better. So again, we have many different service lines. We’ve captured most of those things. We meet the need with partners on the urgent care and ambulatory side. I want to take that to this higher [00:43:00] level. Kind of like billing is starting to do right now. We get 20 bills right. Now you get 20 ways to get price transparency. If you want to go to the surgery center you get it there.

[00:43:08] If you want to know your urgent care, you have to go there. Right. So taking it one level higher integrating all our price, transparency tools. So. 

[00:43:15] Bill Russell: [00:43:15] You know, it’s interesting. Gosh, it was the wall street journal article said, you know, they’re doing it for you. Right. So I went out and looked at this Turquoise Health [00:43:30] has gone and scoured everybody’s website because you’re required to put 300 shoppable services out there. They pulled all this stuff in. So I just went in and did tonsil removal in my zip code. And the prices range from $259 to $49,660 for a tonsil removal. That’s like, you gotta be kidding. And by the way, the 49,000 is an outlier for sure. But there’s, there is 19,000, 20,000. 

[00:43:58] William Walders: [00:43:58] Yeah or [00:44:00] someone’s pounding you know, worst case you, you have to get in the hospital cause he did it at an ambulatory surgery center and you get an ambulance rather, and they rushed you somewhere and you have some ER visits, but yeah, that is high. Obviously not outlier but that’s the problem bill is this rationalization of these stories, right? Dartmouth Atlas, trying to figure this out a long time ago, literally in a book. You know, and that was my go to for a while. And I always love the story. If you were in your part of the word bill, it was, you know, three grand a year for capitated patient.

[00:44:26] If you were in Rochester, Minnesota getting carrot, the police [00:44:30] based in Rochester, Minnesota it was a third of it. Right. And it’s just it’s crazy. But healthcare is from a pricing and transparency perspective, but. 

[00:44:40] Bill Russell: [00:44:40] All right well I’m going to close this out with more of a philosophical question. I’d love to hear you. And I’ve been asking a lot of CIOs, this. What do you think the lasting impact on health IT is going to be as a result of the pandemic? 

[00:44:55] William Walders: [00:44:55] Oh, it’s going to be, I mean, largely that how much of a partner, [00:45:00] they are not an inhibitance. I love saying this expression that IT is done for you, not to you from that but genuinely that IT is a partner and they are there to help. You know, what it was able to do and scaling ICU’s and building applications. I mean, most recently with the vaccine and being able to quickly turn that and registration so genuinely IT is a partner. I think a lot of people shook their fist at it and said, Oh, you know IT is horrible. Or it is a black hole and they never get what I need for those. Good Seattle is overcome that.

[00:45:29] And you know, your [00:45:30] goal is to shake that well before a pandemic, but for those who may be still have that perception, I think they quickly saw what a great partner it is. And and to involve them in some of those things we were talking about earlier, there’s more strategic decisions. These are bright folks with operations mindset, or certainly can think outside of the walls of IT. So. 

[00:45:49] Bill Russell: [00:45:49] But William we still have like another hour of our show but but we only have like 30 seconds. So I just want to thank you for your time. This was incredibly insightful. We’ll have to do [00:46:00] this again in the in the fall. Do we have fall in Florida? 

[00:46:04] William Walders: [00:46:04] Yeah, I think, you know, the leaves fall a little differently and you know, like sometimes you run your heat like one or two days in the fall, but otherwise I don’t. I don’t know, growing up here.

[00:46:14] And you know, the only thing that took me away from Florida was the Navy. There’s a reason I came back. And so, no, I don’t know that we do, but yeah, part two in the fall. Happy to chat. 

[00:46:22] Bill Russell: [00:46:22] Yeah, absolutely. Hey, thanks again for your time. Appreciate it.

[00:46:25]What a great discussion. If you know someone that might benefit from our channel, from these kinds of [00:46:30] 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 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 today. Send a note to someone and have them subscribe as well. We want to thank our channel sponsors who are [00:47:00] 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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