September 10, 2021: Brian Sterud wears many hats at Faith Regional Health. He’s the VP of IT, the CIO and the CISO. In smaller health systems everyone has to muck in. How do they cover it all? How do they manage their time and stay current? Every health system is prepared for a 24 hours or less security risk. But after that, things get complicated. How would a smaller organization handle 30 days? 40 days? What’s the biggest learning from having the ERP suite in the cloud? Can you get to the level of customization that you want? What kind of things can you do to improve clinician experience? What’s it like to do a comprehensive network upgrade with Aruba? How has that helped security and operations? And what kinds of technology priorities are on the agenda for the next 24 months?
The Many Hats of the CIO with Brian Sterud of Faith Regional Health Services
Episode 442: Transcript – September 10, 2021
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[00:00:00] Bill Russell: Today on This Week in Health IT.
[00:00:01] Brian Sterud: How do we operate if the system does go down? Everybody is prepared for 24 hours or less. Once you start getting past that threshold things get a lot more complicated.
[00:00:16] Bill Russell: Thanks for joining us on This Week in Health IT influence. My name is Bill Russell. I’m a former CIO for a 16 hospital system and creator of This Week in health IT. A channel dedicated to keeping health it staff current and engaged.
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[00:01:38] Today we are joined by Brian Sterud who is the VP of IT, CIO, CISO at Faith Regional Health Services. Good morning, Brian. Welcome to the show.
[00:01:49] Brian Sterud: Good morning. I’m excited to be on. I’ve watched a number of these and excited to participate.
[00:01:54] Bill Russell: Yeah, it’s going to be fun. I like having health systems like yours represented on the show because there [00:02:00] are what some people coin as celebrity CI.Os. You can go after the big IBMs and whatnot but I was on a panel once and one of the smaller health systems was there and it dawned on me that all the same regulations, all the same cybersecurity needs, all the same compliance things, all the same clinical aspects were required from that person who had like a 10 person IT staff as was required by me with a 700 person IT staff [00:02:30] and I was sitting there and going, I have no idea how they get all this stuff done. And you’re not quite a 10 person. So tell us, tell us a little bit about Faith Regional to start off with.
[00:02:41] Brian Sterud: So, yeah. So we’re located in Northeast Nebraska. So Norfolk Nebraska is where we’re where we’re at. We have one hospital licensed for about 129 beds. The reason I hesitate is this changed a little bit over the years and employed multi-specialty physician practice with over a hundred [00:03:00] providers across a number of specialties here.
[00:03:02] And many of them are within city limits, but probably about 12, 13 of those clinics are scattered around Northeast Nebraska and primary care locations. And we have about 1400 employees here.
[00:03:14] Bill Russell: So is that pretty rural, the location that you cover?
[00:03:18] Brian Sterud: Yeah. Yeah, it’s very rural and we cover a really wide geography, the in order to in order to really have the market share that we need.
[00:03:26] In terms of, we could have people driving almost 200 miles [00:03:30] probably to the west from us. And it’s a little, it’s a little bit different in other directions, but we cover a really wide geography.
[00:03:38] Bill Russell: Wow. All right. So I mean, your role is interesting. Tell us a little bit about the IT organization. You’re the CIO and CISO. Talk about your organization and your role specifically.
[00:03:51] Brian Sterud: I’ve been here for about nine years. And with a lot of things have changed and we’ve built it and done a lot of really great things here, I think, and built the team as obviously over [00:04:00] that course of time security has become changed quite a bit. Not that it wasn’t a focus nine years ago, but boy is it different today. And and through that process given the size of organization, we are, it’s really been you know, it would be difficult probably for us to have a full time CISO. And so through, through conversations with our CEO and how we can work together the thought was, can I fulfill that role, be in that dual role in another, there are [00:04:30] others that, that do that kind of thing.
[00:04:32] But it’s probably not the majority. And so come up with ways to do some educational things, and then there’s, there are some some other vendor arrangements that we work through that help that help through that process. So I still have that responsibility of all the things that you would assume with the CIO, but, and then also have the the security officer’s side of things as well.
[00:04:52] Bill Russell: Do you have a strong technical background? Is that your background?
[00:04:57] Brian Sterud: Yeah. I always kind of joke with my staff. [00:05:00] I used to be really useful and I’m not as useful. But the way that I cut my teeth was being very hands-on technical was certified in a whole bunch of technologies coming up in my career and through working at resellers and that kind of thing.
[00:05:14] And so then grew into a leadership role. And so most of my, that technical expertise was done infrastructure type items.
[00:05:23] Bill Russell: Wow. So it’s I mean the, the smaller health systems, you’re really an active part. One of the [00:05:30] things when I went to my role, my team kept saying, stop trying to be the CTO.
[00:05:34] Stop trying to be the CISO. We have those within our organization. But the reality is you, you play a little of those roles in the decision-making and the technology selection process and whatever, in all aspects and really the smaller the health system, the more multifaceted you have to be and able to step into those conversations.
[00:05:52] Brian Sterud: Yeah. It just, yeah, you wear multiple hats. You hear that all the time. We have a fantastic team that we’ve really built smart [00:06:00] over the last nine years and try to grow iIn the most appropriate way. Very strong teammates and other leadership within it that, that help help us get our job done every day.
[00:06:12] But one thing I would say, Bill is that when we look at our organization compared to some of the very large organizations that we interact with, we can be really nimble because of those multiple hats that we wear. And then we can be sometimes more effective because of it. So in other words, it’s not the security guy [00:06:30] throws something over the wall to the firewall guy that has to get changed that has to where there’s all those silo teams. We really have a cohesive team that works together and I think can problem solve faster because we don’t have those different lanes so to speak.
[00:06:45] Bill Russell: Yeah. Yeah. Don’t have as many meetings. If three of you happened to go out to lunch, you can actually start talking about the redesigning the network and those kinds of things. You don’t have to say, Hey, let’s call meetings over the next three months to [00:07:00] decide if this makes sense. Talk about the CISO role and how has risk and security handled at your organization?
[00:07:10] You’re in a CISO,but is there a governing board? Is there a health system wide group that helps sort of set the direction around security?
[00:07:18] Brian Sterud: Yeah. So we worked really hard and are proud of a lot of the things that we’ve been able to do. So while I serve in that role, we have a security committee that is across the organization and involves [00:07:30] stakeholders among others, HR, our physical security, our compliance team, our risk folks, IT folks and sit on that committee and make a lot decisions there and execute on a lot of the things that we’re, that we’re looking at. A lot of what leads into that are things like are our annual risk assessment that we do.
[00:07:49] And then and that team takes that and we prioritize the work that needs to get done. And then yeah, through, up through that committee for the most part [00:08:00] being senior management, I participate in our board meetings. So at the board. They get updates quarterly. All of IT but specifically also certain metrics that we track on the security side of things, and then annually, we do a presentation on the state of specifically on cybersecurity.
[00:08:21] Bill Russell: The nature of this caused, clearly it’s caused concern for all of us. I mean you have Scripps. You have Sky Lakes Medical, you have St. [00:08:30] Laurence and others. But they went after hospitals of your size with ransomware, that has to have caused some concern. There used to be this mindset of we’re small enough. They’re not going to come after us. But they are coming after hospitals of your size at this point. Has that changed the conversation somewhat?
[00:08:48] Brian Sterud: I think due to some of the things that have gone on across the country, I think some of the things that have even happened locally here we do some work for and have relationships with some area critical access [00:09:00] hospitals as well.
[00:09:01] So it’s become apparent the target that they are. And I just don’t that the conversation about convincing our our senior executive team or our board on the threat is so much easier unfortunately than it was four or five years ago. It’s very clear and we’ve actually seen many of the things that have happened and some of them firsthand.
[00:09:27] And so the threat’s [00:09:30] always there. Right now much like this isn’t a new thought much like everybody else, our preparedness is preparing for when it’s going to happen So we’ve actually spent a better part of this year on pretty intense lessons learned on how do we operate if the system does go down?
[00:09:47] And one thing I don’t think people always do is everybody I think is prepared for 24 hours or less. Once you start getting past that threshold things get a lot more complicated. So [00:10:00]we’ve spent a lot of time across the organization, one of our project managers has led an endeavor where we’re working on that process. How would we operate? How do we get bills out the door? And then recovery. So if extended beyond 24 hours, how do we then recover from it properly?, make sure that patient care is first and foremost and then make sure that we can get bills out the door. And that kind of thing, it makes sure that we have, we don’t have an issue from a revenue perspective either.
[00:10:25] Bill Russell: Yeah. Sky Lakes was down for close to 40 days. Still not completely up. [00:10:30] Scripps down for 30 plus days. I was saying a little while ago to somebody that our plans didn’t, we didn’t have plans to be down for 30 or 40 days. And I think that’s one of the things that’s sort of changing in our mindset of what does it look like to recover when you know, core critical systems are down for multiple weeks?
[00:10:50] And how do we start to shrink that timeline from ransomware event to recovery, make it a week. Instead of [00:11:00] 40 some odd days. How does your team stay current on what’s going on in that?
[00:11:03] Do you rely on vendor partners? I mean, how do you guys stay current on all the things that are going on and morphing? I mean, you have things that are changing on the network side, infrastructure side, cloud side, cybersecurity side. I mean, there’s so many things changing. How do you stay current on all those things?
[00:11:20] Brian Sterud: Yeah, we do our best I don’t know if anybodys always, there’s always something more that you can do. But given the fact like, I guess going back to the [00:11:30]conversation about the dual role that I serve in and the fact that we’re not going to have a security team of 50 people. We leverage we think very smart contracts with other vendors and I wouldn’t necessarily always call it managed services, but advisory type services, making sure that we’re informed that.
[00:11:49] We work tightly with one vendor that really allows me to even consider having this dual role where I have access to to expertise that can help us there and that they [00:12:00] also do a number of other things for us from a vulnerability assessments and that kind of stuff.
[00:12:04] So I think that we given our size and what we’re able to do, we have to be able to piecemeal those things in and that helps us stay ahead of things, hopefully to the extent that we can to be prepared. And then, like I said we’ve taken a really good look inward on what are our processes here and how do we deal with downtimes? And that doesn’t really take any expertise other than a little bit of blood, sweat, and tears to get it done.
[00:12:28] Bill Russell: So talk about the most [00:12:30] impactful moves with regards to technology that you’ve made over the last 18 to 24 months. It’s been a pretty dynamic time in healthcare. I’m curious what moves you guys have made with regards to technology that you would highlight?
[00:12:44] Brian Sterud: So for us, the main thing, the mantra that we’ve been living, eating, breathing last couple of years has been, we made a move to Epic that went live October of 2019 across the organization.
[00:12:59] And [00:13:00] that obviously involves a lot for us to have that complete view of the patient record. We had some siloed systems before that. That’s been tremendous. Along with that, we also went to a a new cloud-based ERP platform and that’s been evolving and we did it in phases.
[00:13:20] So we had financials and supply chain that right away, and then late we’ve layered on after that payroll and HR and, and now looking at even further down the road with talent, [00:13:30]acquisition, talent management, and some other things. So that’s probably been the most, now I know, I know those are sort of black and tackle things and maybe not super interesting but
[00:13:39] Bill Russell: No, which ERP did you go with?
[00:13:42] Brian Sterud: Infor CloudSuite.
[00:13:43] Bill Russell: Okay. That’s interesting. So is this the first time you’re going to a cloud-based ERP or have you always been onsite or have you been hosted before?
[00:13:53] Brian Sterud: We had had aspects of it that were cloud but we, this is the first time having the entire fully [00:14:00] integrated product in the cloud.
[00:14:02] Bill Russell: What’s the biggest learning from really having the suite in the cloud? Do you have the level of customization that you want or or uptime and that kind of stuff? What’s the biggest learning of moving offsite?
[00:14:14] Brian Sterud: Uptime really hasn’t been much of an issue. I think the biggest learnings we do definitely have the level of customization almost to a fault. So I think that our philosophy has been to the extent that we can take that [00:14:30] foundation build or that standard Bill, that’s what we need to do. There’s too many potential room for error when you start creating variations. Now, obviously you need to in certain circumstances, but making sure, being disciplined about only making those changes that we need to make. And if the foundation build can satisfy that, and that’s what we need to take.
[00:14:50] Bill Russell: Yeah. You have the same thing on the EHR side. Did you try to stay with a standard foundation build?
[00:14:55] Brian Sterud: Absolutely. Yeah. That’s very much standardized. We were [00:15:00]participating through a connects program there and that that actually forces some of that, but I think in a good way and make sure that we are as standardized as we possibly can be.
[00:15:11] Bill Russell: I was just reading about the VA. And they’re getting reviewed on their Cerner projects. You’re obviously an Epic shop but one of the things I sort of took exception to as I’m reading this and they said clinicians were less productive the week following the EHR implementation.
[00:15:27] And I just sort of laughed. I’m like, that’s [00:15:30] true everywhere. I mean to measure productivity the week after an EHR implementation, you really do change everything. You change the workflows, you change the system, you change the technology. Talk about the clinician experience from the point you went live in 2019 until today. What kind of things have you done to improve? Obviously, it was a jump up in terms of technology and capabilities, but what have you done to improve the experience all along that way?
[00:15:57] Brian Sterud: Yeah, that’s a great question. And I wish I [00:16:00] had this off the top of my head, but Epic measures that productivity and projects where, how long it should take you to get back to a previous.
[00:16:10] And our clinicians actually knocked it out of the park and our, I can’t remember the time frame threshold but we were back to where we needed to be much ahead of the projections. So in that regard that was fantastic. Everybody, the thing about that, I love about the Midwest to be a [00:16:30]little bit biased is that there’s a work ethic here is second to none. And there is no, there’s no failure. People will not accept it. So everybody did what they needed to do to get that going and get back up to that level. As far as optimization after that, if you think about the timeline and I forget this all the time, our CEO reminds me, we went live in October of 2019.
[00:16:51] And if it’s March 2020 is not very far after that. So we spent some time doing some optimization. [00:17:00] We spent some time all those things that go with the go live, right? It didn’t work perfectly that sometimes some of them are more minor, but they might take a little bit, a little while to, to alleviate.
[00:17:10] And so then we jumped right into COVID and everybody’s world’s been upside down ever since. So I dunno, we have regular rounding that gets done with clinicians. And we have folks out in front of them. I’m trying to make sure that it’s operating at the best of their abilities. So we really haven’t done any sort of full-scale [00:17:30] optimization relative.
[00:17:31] Bill Russell: I’m sure you’ll get back to that. Or be asked to get back to that. It’s one of those things that just never ends, right. You’re always optimizing the system. Brian, I did a little research on you prior to our discussion.
[00:17:44] And one of the articles that comes up is about your your network upgrade. You guys did a pretty comprehensive network upgrade. Tell us a little bit about that. What’d you guys do and what was the goal of that project?
[00:17:57] Brian Sterud: Yeah, so kind of started with our, on our [00:18:00] wireless side. We needed to make a change there and looked at and the vendors, I don’t know. I try to read those before my time, but if you think about it was probably 12 to 15 years ago. The vendor landscape is a lot different today than it was then. And so.
[00:18:16] Bill Russell: Oh, really? You got rid of your three comms switches. Is that what you’re? I don’t know if it goes back that far, but go ahead.
[00:18:22] Brian Sterud: Yeah, so we went through that wireless evaluation and selected a vendor and then that allowed us then to [00:18:30] do over time then converge that with our wired infrastructure that gave us a number of capabilities from a management perspective, but also really leading up to getting to a good network, access control product, and an ability to do micro-segmentation.
[00:18:47] So it led us it’s it’s taken a long time to get there but now we have the ability to pProfile devices, make sure those devices are only able to communication with [00:19:00] what they need to. The example I always give to oversimplify it for people is that my laptop has no need to talk to an IB pump.
[00:19:08] There’s there should be no purpose for that to happen. And so things like that and getting to the ability that we can and it, it really comes down to again limiting the damage in the event, we did have an attack That was probably the biggest thing other than just getting a refresh technology is getting to the point where we can do those types of things.
[00:19:28] Bill Russell: There’s a lot of power in the [00:19:30] software defined networks. And I read that article. You went in the Aruba direction. I just interviewed a CTO for Aruba and he was talking about software defined. That micro-segmentation is so different from what we used to do. I mean we’d have local rules, then we’d have port level rules, then we’d have device level. I mean, it was a team of people, a significant amount of work to maintain those rules. But now that administration become, it’s almost like a learning system as well. It’s learning as it goes, what you’re plugging into it, what kind of traffic should [00:20:00] go across it?
[00:20:00] It’s pretty interesting. How many people do you have managing this and what is the administration?
[00:20:05] Brian Sterud: It’s really only a couple people that are managing and looking at it. We leverage and work together with vendors. I will say since I I never know whether we can save vendor names or not.
[00:20:15] But since that’s out there they’ve been a fantastic partner. And when I say partner, I mean partner. There are those out there that that I think strive to have partnership with their customer. And so [00:20:30] far Aruba absolutely walks that walk and has been a great partner with us. And again, we work together with some other local vendors to make sure that we can deliver on that promise.
[00:20:45] Bill Russell: Yeah. The nice thing about this show is I talk to all my vendors, all the partners in the show before they sponsor. And I say, look, we might talk about your competitors in a positive light. And I said, because people want to know what you’re using. Hey, so you’re about the [00:21:00] same size as somebody who’s listening to this show and they might be saying, Hey our network’s gotten pretty wild. And instead of me getting emails, which I do from time to time, Hey, you talked to this person, what are they doing with this? They could just hear it from you.
[00:21:12] What kind of stuff you’re using? Aruba happens to be one of our channel sponsors as well. I’m not talking to you about it because of that. I’m talking about it because I remember how complex it got and even around the guest networks that we had to set up and being able to identify [00:21:30]what those people were doing, identify the traffic.
[00:21:33] We also took an approach of assume they’re already in your network. And now you have to find them. And we needed more sophisticated tools every day we kept bringing in third-party tools. It always kept coming back to me of why can’t my network vendor, w hy am I plugging in a sniffer to see what’s going on here and have this to do this and have this to do this. That should be built into the software. They should know what’s going on across that network. And that’s one of the [00:22:00]reasons I was I was taken by . Your approach and also to go wireless first and then go down to the wired. I think a lot of people start at the wired and then go out to the wireless. So it’s interesting that you went in that direction. Was there a reason for that?
[00:22:14] Brian Sterud: I just, just timeframe on. I wish I could give you some really great intelligent answer. Just the timeframe on the age of the equipment and what needed to be replaced first. But we did, we talked about it. We did sort of consider everything. And obviously I think I actually [00:22:30] say HPE has done a great job with that acquisition with Aruba. That’s gone well, too.
[00:22:35] Bill Russell: Do you place a lifecycle on the equipment that you purchase? You purchase new workstation and you essentially say this is a five-year device or a new access point and say, this is a six year device or that kind of stuff. Or are you not that proactive yet with regard to asset management?
[00:22:53] Brian Sterud: I gotta tip my hat to some of our finance folks. We’re really required to do a pretty good job of [00:23:00] projecting out multiple year plans for capital. And so, and then anything that comes in the door what that lifecycle might be so that we can predict when we may see those expenses.
[00:23:11] So especially when they’re not an operational expense so you can anticipate when we’re going to have years that we may spend more than others. So we do a pretty good job of projecting out those life cycles on almost everything.
[00:23:25] Bill Russell: So what’s the priorities over the next 24 months from a technology perspective?
[00:23:29] Brian Sterud: Well, I mean, I [00:23:30] think right now, a lot of the, a lot of the things that we’re working on have to do with just continuing down that ERP road and adding on some modules that we’re anticipating from a talent management and talent acquisition. We’re currently in the process of working at some of those things. And then there’s some others that come along later on to get to that fully integrated ERP system. There’s always security initiatives. So looking at taking a hard look at some endpoint protection [00:24:00] and looking at DLP and where that sits within our organization and whether we’re doing all the right things that we need to be doing.
[00:24:09] Bill Russell: Yeah. How do you stay up with regulatory? I mean, the Price Transparency, 21st Century Cures. Is that something that the vendors that you’ve partnered with come up with solutions around or are you, are you actively trying to pursue some of those things as well?
[00:24:24] Brian Sterud: No, those are, I mean, those certainly are things that we’re always on are not just the, if I can then throw [00:24:30] a plug in for CHIME as well. ChIME has been a tremendous resource for those things, especially from somebody in a smaller organization, I’m able to get hooked into some committees.
[00:24:41] I sit on some public policies companies and some other committees that gives me insight into what’s going on. Helps us anticipate listen to a bunch of smart people talk about their thoughts on those regulations as they’re coming, as they’re coming down. And then that’ll allows us to execute on things locally where we need to with our vendors.[00:25:00]
[00:25:00] So, so that’s one way that we tackle that. And work together with our vendors. We work together with our other partners within the community connect network that also helps as well.
[00:25:11] Bill Russell: That’s awesome. Has your staff come back to the office yet?
[00:25:15] Brian Sterud: Yeah. So this is a little bit unique. I don’t know that I’ve really talked to anybody that brought them back quite as quickly as we did. So, one thing about the Midwest was it took a little bit longer. We didn’t see the surges the same way that everybody did in the coast. Our [00:25:30] staff here are in ou r IT organization, has been a top rated employee engagement or department. Every time we’ve done our surveys since we’ve been here. And they enjoy each other, they work really hard. They play hard together. And because of that they wanted to come back to the office.
[00:25:47] We brought them back around June or July last year back into the office. And that’s pretty, I think pretty unique. I mean, there’s a lot that are not back in. And we’ve been back in the office for over a year. [00:26:00] Even in some cases we, you know we had to do that smart. We had to segregate people certain ways or to follow up protocols.
[00:26:06] But people just really want it to be around their coworkers more so than sitting in their basement. And it’s just a tremendous culture. I think that we have here that our employees want to do their work that way.
[00:26:20] Bill Russell: Yeah. Have you modified your facilities or anything at all, or just practicing good practice around there and vaccinations have really helped to [00:26:30] mitigate any, major risk of the work environment?
[00:26:34] Brian Sterud: Yeah. I mean, early on, we had some of the luxuries of we have. Within Norfolk we have two campuses right now. There were two hospitals that merged a number of years ago. So we have space that was available. So we were able to just segregate teams early on without knowing how with exposure risk and those kinds of things.
[00:26:52] We made sure to do that so that we didn’t have we didn’t have a point of failure where we’d have to send exposure home. And all [00:27:00] of a sudden we lost the two or three people that work on a certain technology. So we tried to separate those. And then, so the social distancing within the, location they were at and mask requirements. Obviously vaccines have helped the time as well.
[00:27:14] So it’s been something, like I said thats I think a little bit different than other organizations, but it really has turned out well. And we’ve had no significant issues. Certainly we’ve had some folks that have been before the [00:27:30] vaccination have actually gotten COVID, but we never had any real mass issues or any exposure issues.
[00:27:37] Bill Russell: That’s fantastic. So Brian, this will air actually after our HIMSS but we’re recording beforehand. So I’m curious, are you going to be attending HIMSS?
[00:27:45] Brian Sterud: So I’m actually not attending. I am actually on a panel through Aruba. I’ll be attending that virtually. We do have some people that are going, it just didn’t happen to work for me to attend this year.
[00:27:58] Bill Russell: Yeah. It’ll be an interesting [00:28:00] conference. I think I saw an email yesterday, 19,000 people planning to attend in person. First one I attended almost had 40,000 people at it. So that’s roughly half, but still 19,000 is 19,000 people. That’s a sizeable conference. So it’ll be interesting to see what what comes out of that conference. Brian, thanks again for your time. It was great meeting you. Great having this conversation.
[00:28:23] Brian Sterud: Yeah. It’s always fun to do these kinds of things and hopefully if there’s something that somebody can learn and wants to reach out certainly [00:28:30] I’m happy to speak with colleagues and network.
[00:28:32] Bill Russell: Sounds good. Take care.
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