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Bill Russell: [00:00:00] Today on Newsday.

Drex DeFord: Is there a better way to do this now? That includes have I emotionally fallen in love with this decision that I made three years ago? Is that the reason I'm thinking about not changing? Because it makes me look bad

Bill Russell: My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health. where we are dedicated to transforming healthcare, one connection at a time. Newstay discusses the breaking news in healthcare with industry experts

Now, let's jump right in.

(Main) All right. It is Newsday and it is once again, my pleasure to introduce you. This gentleman who needs no introduction, so I don't know why they say that. Needs no introduction. Okay. Here's, and then they introduce him. Yeah. Yeah. There you go.

I think I'm gonna throw out the six health AI updates from the checkup meeting that Google did, which I think are pretty interesting. you have any stories specifically? I.

Drex DeFord: [00:01:00] I think it's probably just an interesting, this whole thing that may or may not be happening at Oracle.

I talked to a CISO yesterday and there's a lot of stuff going on there. When there is not transparency, there's a lot of frustration. Isn't

Bill Russell: there,

Drex DeFord: man. I can tell you, I've talked to a few folks now who are very, perturbed at the lack of transparency and the wordsmithing that is happening that sort of all creates opaqueness to this situation at Oracle.

There's reports from several organizations now that apparently there was some kind of a breach. The login infrastructure of Oracle Cloud. And they have more than 6 million records across 140,000 customers, 140,000 tenants. Oracle denies everything they say in very plain, very clear, specific language, what has not happened, but what they haven't really explained to a lot of customers yet is , has something happened and what is it?

And they've been very tight-lipped about that. So yeah, [00:02:00] a lot of customers are spinning on that. It takes me back to the conversation about CrowdStrike last summer. And even though that wasn't a breach and it wasn't actually nefarious attack. It had a very similar effect on healthcare 'cause it took a lot of healthcare systems end points down and the amount of painful transparency that happened as the result of that breach.

All kind of in the construct of like, okay, we're probably gonna get sued. It's somebody's gonna sue us about something, but. Let's help customers understand what's going on and, help them get cleaned up and back on their feet. And then the transparency of kind of like the post action report and everything that happened and all this stuff they're doing to make it not happen again.

That still continues to me to be like the shining example, especially after last year and change and a lot of other things that were very opaque in the way that they talked about it, and now we have this Oracle thing and I'm getting the same vibe of like, come on, just tell us what happened.

Bill Russell: Change healthcare [00:03:00] people just threw up their hands. They're like, nothing I could do. I mean, same thing with the CrowdStrike thing and now with the Oracle thing, it's like what could I have done?

And one of the things you can do is you can mitigate by having multiple systems. Well, you can't do that with the EHR and you really couldn't do that with CrowdStrike and you could do it with Change Healthcare. And we saw some health systems do that. They had planned for the disaster ahead of time so that they could fail over to and scale up other systems.

Right. But in this case, There is no other thing. And it's not an outage per se, right? It's a breach. Just Right. It's just a breach of,

Drex DeFord: well, and I mean, to be clear again, these aren't medical records that have been stolen so far as we know. The reporting all points to, and the researchers who've looked into this at all points to the

identity stack, so like login information, that kind of stuff, which is still super valuable and gives you access to who knows what, depending on what identity information was [00:04:00] allegedly stolen. So there's definitely the challenge there. I think you're right from a SOA perspective, what can you do?

The only thing you can really do is be prepared to do. All the things that you would be prepared to do anytime that you had a breach, which is, okay, let's rotate passwords, let's change certificates, let's do all the things we do to try to protect ourselves, even though we don't know exactly what happened.

Bill Russell: When I walk away from those things I think it is just the known knowns, known unknowns and unknown unknowns. And so what do we know? And just work with the non anecdotal data, work with the factual data. We don't know that they're breaking in those kind of things, but we know they may have credentials, therefore, we do the things that you just talked about, which is great.

Drex DeFord: Yeah. Yeah. The, I guess, the Boy Scout motto of always be prepared, and always be. Super paranoid and suspicious about what's happening out there, so that when you think something might be happening, you can take some kind of a measure to put yourself in a better position.

Bill Russell: makes perfect [00:05:00] sense. All right, so, let's go to this Google story. It's interesting. Yeah. So they have a checkup event every year, and this is really about their health ai updates. They continue to tweak the search results and give more meaningful information.

And, one of the things they are doing now is they're connecting communities, right? So, hey, here's what some other people might be saying about staying healthy or about that illness or whatever. And so it actually. Gives you reference points to go out and find other sources of information.

This isn't necessarily medical information. They did a huge amount of work around that a long time ago where they cleaned up the medical information that you would get from a Google search. Now what they're saying is, Hey, we can help you find other sources of people who are talking about this, communities that talk about this, good information and that kinda stuff.

That was the first one. The second one is the one I want to talk to you about 'cause medical records, APIs in Health Connect. Okay. [00:06:00] Managing your health can be hard when information is spread across different apps. To help, we've launched our new medical records, API Globally in Health Connect.

These APIs enable apps to read and write medical record information like allergies, medications, immunizations, and lab results in standard fire format. With these additions, health Connect supports over 50 data types, across activities, sleep, nutrition, vitals, and now medical records, making it easier to connect your everyday health data and the data from your doctor's office on Health Connect.

Your data is stored locally on your device and you're in full control of which apps have access to your data. All right, so this is the equivalent of Apple's Health. You have Health Connect on the Android side. I'm wondering at what point in our life, hopefully in our life, that we are gonna have our entire medical record sitting on our phone?

Drex DeFord: Yeah we talked about this actually when we were at HIMSS [00:07:00] together too. This idea of we went through a period of time, I don't know, sometime in the late 2000, Early 2010 or something like that where we had personal health records. Personal health records was like a big part of the conversation.

Microsoft had a personal health record. Google had a personal health record, which ultimately failed and went defunct. And a lot of that was because it was hard to get the information in and out of these personal health records that somehow were gonna be owned by you and stored by you and managed by you.

And a lot of people, I mean the technical. Capabilities that you would need to be able to do that for a lot of people was just kind of beyond them, especially at the time, and so they weren't able to pull it off. But I think there's still, I keep talking about personal health records and they probably won't be called that at some point in the future they'll be called something else.

But that idea of being able to pull all your data from all of your, healthcare organizations where you've received treatment or you've been an inpatient, and the reality is that [00:08:00] information is only episodic care. It's not really, if you have a chronic disease and you go back to the doctor every week, that's a really good thing.

You you'll have a lot of information on yourself about that chronic disease, but there's so much more to what your health is really attributable to including your neighborhood. And I. Wealth inequity and a hundred other things, that kind of stuff. Being in a personal health record that you have access to and that you manage would be great and then you can dole out that information to the doctor or the research institute or whatever it is that you need for that.

Organization or that person to have access. Being able to handle that and manage it on your own would be really great for privacy and might even allow some patients to monetize that data in a way that they don't have control of today.

Bill Russell: think this is one of the holy grails of medicine is getting all the information into one place, and I don't think it's getting it all into one place like [00:09:00] a cosmos or something to that effect.

I understand that use case for those, but I think there's value to me. From an engagement standpoint, I will engage in my health more. If I had a complete medical record that I could utilize, I will engage a community of, let's call 'em fiduciaries, for lack of a better term. People who are going to help me with my health.

People like

Drex DeFord: me who have my same disease. And then you think about agentic AI and the capabilities that are there for an agent could be looking over your shoulder.

Bill Russell: I'm also thinking like companies who are gonna pop up and say, Hey send us your medical record and we will review it for any anomalies.

I know that when we started doing reads with AI one of the use cases, which was always interesting was to have AI go back and look at the reads and then say oh, and by the way. Your original, assessment of the image was correct, except we also saw this right.

Uhhuh. And I wouldn't mind [00:10:00] having, a second set of eyes, even AI eyes on my medical record to say, here are some potential questions you can ask. Now I know this is gonna drive some clinicians crazy. I remember one of the doctors had something like, please don't bring your Google information into my office.

Like he had a plaque,

Drex DeFord: maybe. Yeah, right. Something about their medical record. I remember seeing these from time to time as I would walk around hospitals

Bill Russell: I can see them rolling their eyes right now when I say, look, gimme my medical record.

Let me engage some people. And I realize that there's some risk associated with that. I might engage incorrectly. But that is a very real possibility for some that they will engage incorrectly, but I'm not sure that's a reason to not give the information and make the information available. So I would love it if within the next 10 years I look at my phone, I could see every encounter I've ever had. That would be fantastic. Hey, I wanted to close with this. So, I'm on part four of a five part series on the VMware Price Shock, [00:11:00] and the first article was a VMware Price Shock, a Wake Up Call for Health.

Bill Russell: It. Then I did assessing your options, the new risk equation for healthcare virtualization and that we talk about this whole idea of vendor lock-in.

But we also talk through the different options, right? We talk about OpenStack, we talk about hyper V, we talk about whatever the next one is building a multi-vendor strategy without clinical disruption.

, how do you migrate such a thing? And then the one I did this morning was the economics of Escape Building your VMware exit business case. Really emphasizing this article this morning, the need to not be so hyper-focused on the licensing cost. So people get fixated on licensing costs.

Like, we gotta get rid of this licensing costs. Well, there's all sorts of costs, right? And there's gonna be all sorts of costs in the transition as well. And so you really do have to build out a pretty comprehensive model to look at it and say, yeah, I know their price just went up 600%, but does that [00:12:00] mean it's time to throw them to the curb?

Or, is there a broader evaluation to do here? A strategic lens to look at it, a clinical lens to look at it, a integration lens, automation lens. Maybe you've automated a ton of stuff VMware over the years, and now you're gonna be throwing that out and have to rebuild it.

You're gonna have to retrain your staff anyway, we're on part four of this series, and. I don't I'll probably publish the last one next week sometime since I published two this week. But the final article, I'm gonna look at the future of where I think healthcare infrastructure is gonna go.

And that's even beyond virtualization. So I'm curious, this is a fairly hot topic in the 2 29 project and in the city tour dinners, people we're taken aback. There was the initial blow, everybody was talking about it at all times. And then the normal thing happened, which is, we resigned.

, we paid 'cause we were locked in. And we signed a new four year, or a five year or whatever year agreement. Thinking, [00:13:00] well, I'm not gonna have this happen again. The next time this comes around I'm gonna. I'll be prepared. Yeah, I'll be prepared. But I'll, what happens in healthcare is other priorities pop up and we don't get around to cleaning this up until it's like six months before the contract is due and we're sitting there going.

Oh, we can't do this in six months.

Drex DeFord: Yeah. The easiest thing is just to resign the deal again.

Bill Russell: and so that's why I'm writing this article now this series of articles now is to say, look, today's the day you're doing the work. Like if you just resigned and you have three more years, you can actually do something about this.

But six months out. that's dangerous.

Drex DeFord: I mean, I think it's one of those things that just as a good steward of the funds that are provided by the organization, you really should be looking at all the contracts that are coming up when they expire, start a year out, start 18 months out. I mean, I know it's easy for me to say this.

'cause I'm not in that seat right now, and I know there's a hundred sharks that are snapping at you. But to get on top of this, [00:14:00] you kind of have to have some reservation of time for you and your team to look at contracts that are coming up, that are going to expire to ask yourself those questions.

Is there a better way to do this now? That includes the like. Have I emotionally fallen in love with this decision that I made three years ago? Is that the reason I'm thinking about not changing? Because it makes me look bad because I'm making a different decision than I did three years ago.

And the other important part of this is as you talk about what's the transition cost, how much time and effort is that gonna take? There's a lot of costs there, but the tail of whatever the new thing is. That you're thinking about going to, don't just look at the implementation costs, look at the long term costs, what's it gonna cost us every year for maintenance contracts and all of that.

But also, as you alluded to the people time, the re automatization time, all those things are not to be overlooked and should be in the business plan.

Bill Russell: I'm a little harsher than you. If you can't keep in front of your contracts get a different [00:15:00] job in all seriousness.

I mean, it's like, I know you're busy. I know you have a lot of stuff going on, but. Budget is 25% of the job of a CIO. It's a quarter of the job of the CIO If you can't get in front of the budget, if you can't get in front of these kinds of things. Now the surprise that's not on you. I mean, we didn't really anticipate that VMware was gonna do what they did.

it happens to you three years from now and I'm the CEO, I'm looking at you going.

Drex DeFord: Why didn't we have a plan for this? Yeah.

Bill Russell: And then when you say, oh, well we're so busy, we're doing other stuff. I'm like, yeah, you've gotta learn. You as a prioritize a CIO.

You are the king of prioritization. Like, that's something you should be able to do, in your sleep. I want to close with this, which is there's a lot of moving one seat to the left happening right now in healthcare.

You just shake your head Yes. You know what phenomenon

Drex DeFord: I'm talking about. I know exactly what you're talking about. Yeah.

Bill Russell: It's CIOs are all taking the chair to the left. So they're leaving this health system going to the next one. Somebody else is going to this one, somebody else is gonna, this one, there's [00:16:00] a lot of movement.

Is that indicative of the time and space we live in, like the pandemic hit. Actually, I'm connecting it as I'm thinking about it because during the pandemic, a lot of CEOs put off retiring. I.

there's a lot of CEO change. The number one driver of changing of the CIO is when the CEO changes.

Period. I, if we just mapped it out, I'm sure the corollary it's not always the case, but in a lot of cases the CEO wants. To bring it. I want

Drex DeFord: my own person and I want my own team.

Bill Russell: Yeah. And so if I had to really look at it and try to find why this is happening, that could be why it's happening.

? What do you say to a CIO who gets a new CEO?

Drex DeFord: I've actually made this change myself when my CEO started talking about retiring. We had some really good conversations. I'd been at that organization for about four and a half years, and I decided that it was probably a good time for me to make a move.

And some of this is also, I've done this off of. Publicly traded boards too new. CEO comes in. almost feel like [00:17:00] in some ways if you have a good succession plan, you know that there's a good interim that's gonna be there, there is continuity on the board, whatever the case may be, that I.

you're almost doing them a favor by giving them some breathing room to make their own decisions so they're not stuck with some decision that somebody made in the past and that would may be a good thing to consider. But, when you get a new CEO I think you've gotta get in there and have a good conversation and understand are you on the same page?

Are you headed in the same direction? Are you compatible? I mean, a big part of any job interview is like you're not just interviewing for the organization or to see if you're gonna make more money and all that kind of stuff. A lot of the interview for the CIO going to a new organization is like looking at that team and saying, are these people I can work with?

Are these people who are gonna have my back? Can I trust them? Do they really want me to succeed? Are they gonna do the hard things to help me succeed? And if you're not feeling that. You probably shouldn't take that job as somebody [00:18:00] who's made the mistake. I can tell you that is definitely a thing that you wanna make sure that you're rock solid on.

CI think when you get a new CEO that's definitely one of the things you want to do. Just make sure that you're comfortable with the situation and if you're not, it's probably time to think about making the move.

Bill Russell: I'll speak to my mistake, my mistake.

Was staying too long. And it's a very common mistake and people hold on for whatever reason. They have kids in college and they like the paycheck. They don't know what they're gonna do next. They're not confident in their ability to get another job and that kinda stuff, so they stick around.

In a lot of cases, if you've lost your passion for the job, if you've lost your alignment as you were talking, your alignment with the vision of the leadership team and that kinda stuff really does behoove you to do serious self-assessment. And determine, is this the place for me?

And then have enough confidence to say, look, I'm gonna go do something else. The [00:19:00] reality is you may not make as much money as you did at this job. and that's okay because a lot of CIO jobs get paid extremely well. I don't think people are gonna take a massive step back, but they may take a step back to a smaller health system or whatever it happens to be.

It's a tough job. It's got a lot of responsibility, but it's fairly well compensated based on things that we see out in the market and whatnot.

So, yes, you might take a step back, but it's likely not the end of the world.

Drex DeFord: Let's talk about the passion for the job too, because I've gone through the process of, getting to a particular point in a job where it's like, okay, like a lot of things are fixed.

We're in a really good position. I've always been a turnaround guy. You start to throw a wild pitch here and there just to make things interesting. You lose passion for the, that's it, that's

Bill Russell: what happens right there.

Drex DeFord: Yeah, and so you decide to leave and you go to another organization.

Some of it is because you're looking to [00:20:00] rekindle the fire of being a CIO and you go to a new place and you have the terrible realization sort of three or four months in like, oh my gosh, this is exactly the same place I left. There's just different people in the seats around the table. That's when you really gotta think about.

Yeah, what are you doing next?

Bill Russell: Oh, and so many people, I get those phone calls. I'm sure you do too. Which is like, oh my gosh, I thought I was going to the new role and I got a better title and stuff, but it's the same stuff different organization. And I'm like, yeah and you've only been there for a couple weeks.

Imagine when you really know what's going on. It may not even be the same stuff. It might be worse. You know exactly.

Drex DeFord: I have a friend of mine who says the grass may look greener on the other side, but the reality is, as a CIO, the grass is brown everywhere.

Bill Russell: It's important to know who you are, Know what your skills are, know what drives you, what your passion is. For me it's creating and building and creating and building also. Lend itself well to turnaround, right. So a turnaround. You are creating a building, you're rebuilding, if you [00:21:00] will. For me, running and operating, if you put me in running and operating too long, I will start a fire just so I can put it out.

Drex DeFord: Yeah.

Bill Russell: It's,

Drex DeFord: Having said all that, the right person in the right place with the right team around them can make a huge difference in a community or a region. And we see that with a lot of the folks that we know. It's just it's not really a math problem. There's some magic to figuring out the right person in the right place, the right job, the right all of that Yeah.

Really does create a great environment for the community.

Bill Russell: It's interesting to me 'cause throw longevity at me like I've been successful 'cause I've been here for 15 years or 18 years or something like that. I'm like, that is not the metric.

Yeah. That is not the metric of if you've been successful, no one fired me. Is not the metric for if you've been successful, if you've been successful, has a whole bunch of metrics, like is your health system in a better place today from a cybersecurity standpoint? Are the operations being [00:22:00] standardized?

Are you doing more with less? Are you able to. Uh, to address burnout are your systems serving the clinicians? Just 'cause you lasted 20 years and everyone hates the systems. You're like, what? How is that a success? Yeah.

Drex DeFord: We couldn't find anybody else to take the job. So you stayed here?

There's a lot of great metrics that tell you whether or not, you're doing a great job. And the bottom line ultimately is the place better off than how you found it?

And how much better off is it than when you found it?

Bill Russell: I will say that very few CIOs can do the creating building and the running and operating. The very few can bounce back and forth between the two. In fact, I know very few. I don't know any, to be honest with you. I mean, usually people are like creator, builder, or runner and operator.

Now you can hire people who can do some of those things and that's great. But I would say that in the life of a health system. Every five years you need the other, like you need a [00:23:00] creator builder for a couple of years and then you put a run an operator in there. But if they run an operator for five or six years, you probably need somebody to come in there and disrupt it again 'cause , you don't wanna be running the same thing that you were running 6, 7, 8 years ago today. We'll close with this 'cause I'm sure you and I love talking. I was talking to somebody about software yesterday and how much software is changing and he was throwing out this vision of.

You're You're going to buy software and it's going to do the personalization, customization, and optimization on its own. Like you're gonna install it, it's gonna watch you, it's going to collect information on how you operate, what you're doing, and that kind of stuff. And it's gonna continue to configure itself to better serve you all along the way.

Well. That used to be the i, the IT'S job, right? We used to do optimization projects. We used to do customization, personalization. We used to do all those things. We'd be at the elbow helping a physician go, Hey, did you know you could do [00:24:00] templates? Well, now the software's gonna be smart enough to go, oh, I'm gonna give you a standard template.

Oh, you seem to see a lot of these kinds of patients. I'm gonna tweak this template and it's just gonna keep doing that for you. And I'm like, wow, that's pretty awesome. That's an interesting vision for what? Software is going to do. I don't know if that's five years away, but it's sooner than 10.

I can tell you that. I think

Drex DeFord: it's a great aspiration for folks who are out there building software right now to try to put into their plans. because I think everybody would love that kind of approach. Yep.

Bill Russell: Fantastic. Drex, always great to hang out with you and talk about the news. Same here.

Love it.

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Thanks for listening. That's all for now

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