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Newsday: Retaining Clinicians and Incremental Interoperability with Melissa Pettigrew

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Today on Newsday.

If we're not arm in arm with our end users from an IT perspective to really understand these challenges, we can deliver the best EHR solution all day, but if the end users are dissatisfied, there is a disconnect there.

My [00:01:00] 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) Welcome to Newsday. In this episode, we're thrilled to welcome Melissa Pettigrew, Strategic Engagement Manager at Rackspace Technology with a wealth of experience in cloud computing, IT services, and enterprise solutions.

Melissa is a dynamic leader who helps organizations leverage cutting edge technology. to drive innovation and achieve business goals. At Rackspace, she's at the forefront of shaping strategies that enable businesses, including those in healthcare, to navigate complex digital transformations with confidence and success.

Welcome to today's episode of Newsday, Melissa.

Thank you, Sarah. Glad to be here.

So the first article I want to cover with you is about the U. S. healthcare system spending more on AI, cybersecurity, and other IT investments, which really wasn't a surprise when we found this one. The study reveals that U. S. healthcare providers and payers [00:02:00] are increasing investments in AI, cyber, and other IT areas to support innovation and improve operations.

And it highlights the growing importance of these technologies in healthcare sector and the need for the robust infrastructure to support them, which is right up your alley. So when you heard this and you think about increased IT investment, focus on AI, cybersecurity, cloud adoption growth, which is huge for you, and ROI as a core driver, what came to mind?

It's not a surprise. It's where everybody is heading right now. We can see the trends in the industry we can see that spend is going to continue to go this way. I think, the thing that gives me pause about this with anytime we talk about increased spend is making sure that we're thinking How we spend and where we spend intentionally, and I think that's one of the biggest things CIOs need to focus on and why this matters to them is they need to be able to allocate their budget in a strategic way.

I think, you can probably shed some good perspective on this, Sarah, but there's so many asks [00:03:00] coming your way as a CIO and being able to navigate what is a short term immediate need versus a long term strategic goal of the organization without spend. I think that's the first thing that came to mind, so I'd love your perspective on that too.

You're 100 percent correct, because when you have to fund high impact areas, but then you also have to balance , and you have all your maintenance and other components, and so much of that's contingent upon the payer mix, upon the margin, the reimbursement models that are facing a health system, and most of your decisions in these spaces are longer term.

These are three and five year. Runways, so you have to use the right data to make the right decisions and more and more the security needs are coming forward as the core critical item and ensuring that you've got proactive measures that are going to allow the organization to be safer, especially with all the third party risk agreements that we're seeing How much of an impact that's had even this year on so many CIOs.

So what I love about Rackspace is that you take that very seriously, that whole perspective of a third party risk agreement. Shed some [00:04:00] light on that for us because we went with your first healthcare advisory board and that was one of the forefront of the conversations.

Yes, it really does resonate. As CIOs and CTOs explore partnership opportunities to offset that day to day management of infrastructure and of IT services, one of the biggest things they're looking for is strong partners who are going to share some of that risk with them.

And so that's something Rackspace does. We take security very seriously. We continue to have a posture within security that is innovative. We're listening to our customers. We're developing new. Products and solutions to meet the evolving cyber threat and cyber challenges. And then collaborating with our customers to take on some of that risk.

I think really important, not only aligning with your partners CIOs need to align their budgets internally and their investments internally, but also align with partners who are going to come alongside them and share some of that risk with them. And also develop new solutions alongside of them,

helping as healthcare evolves. Very [00:05:00] quickly rapidly, we need to have agile partners who can come alongside customers and develop solutions and partner with them for cost savings and ROI measures on that investment.

If you're helping the CIO balance the cost of adopting the emerging technology along with the risk factor and cyber, that's such a win in the conversation in terms of why could this be the right solution for us.

When it comes to interoperability, which is always top of mind as well, what are some of the elements of integrating AI, cloud, cyber into existing systems while making sure that interoperability works too?

Yeah, that's a great question. Interoperability, just allowing the seamless exchange of data across the systems it's essential when we're implementing AI technology that we can gain those actionable insights from that streamlined data sharing.

And then I think another piece of it is, we have to be able to continue to enhance workflow efficiency. When we have integration, it really minimizes the disruption and ensures that new technologies [00:06:00] complete rather than complicate existing processes. And I think that's so important. As we continue to layer technology in, we have to ensure that we're reducing that complication for our end users and for our customers.

How do you partner with your customers? So I think about my days as a CIO and I'd be like, okay, so now I have to optimize the technologies I'm putting in place because you never put something in and walk away from it as reading about the different components that are coming into play here, the training programs, the certifications, cross functional teams, when you partner with somebody, what elements of that are top of mind You know that your product's not a one and done.

Yeah, that's a great question. I think that constant cycle of innovation, making sure that we're putting technologies in that are future proof and resilient. We shouldn't have to overhaul our infrastructure every time a new technology comes up. We should be able to enhance that.

The infrastructure work with what we have already [00:07:00] in place ensure that the technologies and solutions we're putting in place aren't going to be obsolete in a year or three years or five years. And so I think it's really important to focus on that future proofing idea of infrastructure. And that's really where Rackspace thrives and where a lot of, different vendor partners can thrive is we build our infrastructure in a way that will scale with your organization and that will create.

That kind of future of what, adding these new technologies and adding these enhancements can look like.

And then that whole access to expertise, it's going to help drive down my costs as a CIO, because you're telling me these are the latest regulatory and compliance changes that are coming.

These are the trends that are happening. This is where we can scale for you in new and effective ways. And the way that I've seen you develop relationships specifically, you're doing it as an informed advisor, or almost like a friend telling you, Hey, this is coming, be aware of it. It's not necessarily just about creating the next sale, which is going to be really important as you think about where all of this money is going in [00:08:00] healthcare and you need your partners to be ahead of you in this equation.

Yeah, very important. And that's where It is this partnership and collaboration when we can offload the day to day care and feeding of your system. When a partner can offload the day to day, keep the lights on tasks, it really does enable your team to think about what the future of your organization looks like and think about these new ideas and opportunities, and then bring that back to your partner and say, Hey, this is how we're looking at this.

What are you seeing? What are you thinking? And it really does create this amazing synergy where, your partner can come alongside and help ideate and then create and develop and implement new products and solutions that really do keep us ahead of all of these

challenges.

And sharing the risk is huge because one of the other articles that we found is about companies shifting data breach costs to customers, sparking concerns. I'm not laughing as I'm reading it and yet I'm like, oh yeah, it's like I'm in California and PG& E [00:09:00] basically set Northern California on fire, declared bankruptcy and passed all the costs onto its customers.

We're all pretty upset, but we don't have another choice. But specifically, this IBM report that says 63 percent of companies plan to pass the cost of data breaches onto customers. Up from 57 percent the previous year, likely not a surprise with the increase to breaches that we've seen, but this trend is showing a growing reliance on consumers who absorb the financial burden of security failures.

Though the report doesn't how much is going to be transferred, What I also found interesting is that experts underscore the importance of transparency in communicating these changes to avoid backlash, like on social media, and it could also provide a situation for the CISO to leverage more security funding for cyber initiatives, such as rising breach costs that justify an even greater investment in security measures, which previously we saw as increasing by up to 13 percent by 2027.

As both a consumer and a solution provider. What's your take on this?

There's a lot to [00:10:00] unpack here. As a consumer, this is really frustrating. When we entrust our health and our care and our data to people and, understanding nobody's perfect. There are going to be breaches, but to say the burden falls to me to fund some of those measures.

That's a challenge to hear, as a provider of a solution for cyber resiliency and recovery. I think this really highlights the need for healthcare organizations to really be able to tell that story about a cyber event and what the impact is in a more meaningful way. I think. Every healthcare organization every board, every leader knows that the threat is out there.

They know that the threat is elevated, and we're not quite sure how to articulate that threat in a way that translates to real dollars and real solutions that are going to keep the burden off of the patient, right? And so I think, yeah, this is just such an interesting [00:11:00] conversation, but At the forefront of this, patient trust is number one.

If you put the trust of your patient at risk or lose that trust it's a downstream effect. And so that investment in cyber, it's a really easy conversation to have when you look at what the potential impact of loss of patient and loss of trust is with a cyber event. And then saying you're going to offset or offload the cost onto the patient.

It's a conversation I would be having with my board and with my C suite to say, In this year's budget, I want to accommodate a space for the financial planning aspect of what happens if we have a data breach. And the organization may say we could just pass it on to the customer. I'll say, does that give us a competitive advantage?

Is that really going to erode patient trust? Because ideally you're putting insurance on yourself based on your performance. A breach is going to be something that happens within your own organization. So you're betting on yourself in that conversation. Of course, I always take it to the next level and say, okay, I need 5%, which is a huge number.

I also need a dollar amount [00:12:00] specifically for in case there's a breach. But then more importantly, if we don't have a breach, which means things are going well and as intended, then that money can be used for reinvestment into cyber. But it's a line item that if it doesn't get used, then gets utilized to ensure that the fabric of your security program is working.

Yeah, I think that realignment is really important. We talk about that all of the time, how we help organizations defend their IT budget and their IT spend, and cyber is going to continue to grow the need for a larger budget there. It's interesting, we led a focus group at ChimePollForum, And one of the gentlemen that attended, he's a CTO of a health system actually talked about their organization hiring a firm to come in and help them tell the story of what would happen in the event of a cyber event and what the impact of that to the organization would be and presented it to the board.

And that was a really good way for them to get awareness and funding and actually tangible documented information on, hey, this is what it looks like [00:13:00] in the event of a cyber event. And I thought that was such A great approach. Taking that storytelling aspect and really implementing it in a meaningful way that helped him defend and get his security budget increased.

And what if scenario without the sky is falling perspective? Cause if you've got insurance and you're budgeting appropriately, and you've got a great posture from your security fabric perspective, then again, having those strategic partnerships is huge. You've got RacketBait as an example to enhance infrastructure protection and share risk in theory.

My relationship with Rackspace is going to be something that helps me quote unquote, sleep better at night. And I can focus on other areas where I know there's not as much of a focus on. I'm going to go back to your shared risk statement. That's tremendous. And something that we hear often in our city tour dinners and in our summits is how important it is for the CIOs and CISOs and CMIOs as well to feel like a true partnership means that there is a failure, that it is a shared level of responsibility.

Absolutely.

It [00:14:00] is. And then I want to talk about the next one, which is healthcare facing clinician exodus amid burnout and EHR frustrations. This one specifically talks about how the healthcare sector is grappling with rising clinician turnover, which is largely attributed to burnout and dissatisfaction with EHRs.

I believe that's always been a true statement. It's a matter of how it's manifesting itself today. But the class article says that half of nurses and physicians could leave their roles by the end of this year with substantial financial implications. It can cost anywhere, this was amazing to me, 56, 000 to replace a nurse and up to a million based on the specialty level of the physician.

And most clinicians, whether that's a nurse or a doctor, they want to stay in their field. But they're becoming more selective about workplaces that prioritize their well being and their job satisfaction. And this is organizations that are successfully enhancing aspects that could improve retention rates.

So whether that's escalating turnover rate, high replacement costs, the EHR burnout, and employment [00:15:00] choices. If you're a CIO, Melissa, and even as a provider having these conversations with The CIOs, how do you optimize the environments so that the people using the products want to be there?

Yeah, that's a great question.

Addressing the EHR usability issues is really crucial to reducing the clinical burnout and retaining your staff. I think that's number one and really. It's interesting. This conversation has been going on for a long time. I remember 10 years ago Dr. Christopher Sharp from Stanford Health came and did a talk for a group here in Colorado on physician burnout.

And so again, topic that has been. Covered for years. So there are some organizations that are addressing this head on and doing some really great work in this space back to, the conversation about AI investment and IT investment, right? There's some ways that you can alleviate some of this burden, but I think from a CIO perspective, right?

Like, how do you optimize your EHR effectively to address these burnout issues? And it's more than [00:16:00] just, One project here or there, I think one of the biggest things training, right? There's a disconnect in training and how we deliver training. There's a disconnect in the user satisfaction.

What is contributing to that? If we're not arm in arm with our end users from an IT perspective to really understand these challenges, we can deliver the best EHR solution all day, but if it's not relevant and the end users are dissatisfied, there is a disconnect there.

Getting back to operational efficiency too if we look at the turnover rates you talked about the cost implication of that, but when we look at the kind of the soft side of that, the strain to existing staff that has to retrain or fill in those gaps that's a massive challenge that CIOs need to address head on.

I think the organizations that I'm seeing addressing this well really have partners from IT that are in lockstep with This is a continued conversation. It's not a one solution that fixes this. It's a day to day small step process improvement to make sure that we're addressing this challenge.

When I was a [00:17:00] CIO, my favorite place to procure my informaticists was people who were done with bedside care. And so they didn't care about the patient anymore, whether it was physical reasons or other attributes that they had in their career. They're like, my next best opportunity is to go and help people that had my job for 10, 20 plus years.

utilize this technology and whether that was through continuous learning and some scenario based training, even on demand and new hire training, which is one of the hugest aspects. These comprehensive training programs are all the time and When you can start small and go back to the aspect of optimization, integration, the human centered design element, so many of us had EMRs that were put in a very long time ago, and as the EMR matures, so do the workflows and some of the point solutions that go in and out as we move to more platform based capabilities, and every time you change one widget, It affects every other widget in the ecosystem.

Yes. And that's [00:18:00] that, feedback loop with IT and clinical that I think is so important as an IT person, I make a change and I think there's no impact and I find out it's a massive impact, back to some of the cyber conversation too we're talking. A lot with our customers about this idea of tiering applications and in the event of a cyber event what are tier zero, what is critical and, the feedback you get from the clinical side is everything, we need everything right now, all at once.

And that's overwhelming. And having that conversation all the time about what is important, what is relevant, what is critical again, so many things tie into this, the legacy technical debt, the massive application portfolios, the amount of information that our end users are required to understand and know how do we simplify that?

How do we simplify workflows? Again, get back to patient care

and what's most important. And anytime we don't believe that either watching someone's workflow or helping them with tips and tricks, I'm newer to using a Mac book. I'm comfortable with Apple products, but using a Mac [00:19:00] book for work is a totally new experience for me.

And every time I see someone with a Mac, I'm like, Hey, show me like some of your like tips and tricks. Even today I learned some new stuff and I was like, dang, that was awesome because I'm like, I didn't know it did that, and the person's looking at me. Like, how do you not know that? I'm not taking care of patients.

We're talking about some basic commands on the keyboard. And having people who can actively help others. And that's why the other aspect that is so often overlooked is how important your service desk is or your help desk expansion, making sure that staff is trained in clinical workflows, not just technical troubleshooting.

I'm not just resetting your password. I can help you place that order more effectively, or I can help you pull up that information on your patient more effectively, however you tier, just like your applications, the level of support on your desk. I'm actually a fan of the service desk. All being experts in certain content because what are you getting called about the most and how can you be most helpful to those end users and that's on every shift.

Often the [00:20:00] late shift gets ignored as well and so anytime that there's that knowledge sharing across the continuum in your organization, it's a win in terms of minimizing any of these EHR related disruptions.

I agree. And something that I've seen work really well is a rapid response team aligned with the help desk.

We actually leveraged this during training in GoLive scenarios where you had a provider or a nurse who needed help real time. Where are you? I'm going to send someone to you right now. And that kind of stops after GoLive because we assume everybody knows what they're doing. But having an elevated level.

Of care and touchpoint within your help desk organization can be so effective. Do you have people that you can actually send to walk alongside a provider for a couple hours if they're struggling with something? If you're seeing a recurring issue, do you have a tiger team that can go out on the floor and help address those real time?

It can be a very effective solution for some of these burnout challenges.

In the proactive monitoring perspective [00:21:00] really goes more towards the ability of problem avoidance. What are you seeing ahead of time by paying attention to the things that are coming up more and more frequently and having that response team available?

As we think about the hybrid work in our environment or the remote capabilities, et cetera, There's also this whole handful of individuals who, when you are on site in the hospital, being open and active in that environment is so critical. I used to round every single day, and the teams knew that I would be coming by.

And a lot of times I wanted to be able to visit patients because I wanted to see how they were experiencing our facilities. And yet, when the nurses know you're coming, they're also going to tell you the things that are broken. So that they are happier to see you and your team. I remember I got to one organization at one point, my team was terrified to go on a nursing floor.

They're going to leave us alive. Like your goal is to make sure they want to see you every day, not just something's broken. And it became a contest to a degree amongst the team about which [00:22:00] nursing floors loved which technicians the best. And that's the exact kind of healthy competition you want in your organization.

Yeah, definitely. And that's where having the clinicians involved, in the EHR design process, in that constant feedback loop it's absolutely critical and really does help build those relationships and drive trust. And that's, what it's all about. When we can collaborate and share challenges and say, Hey, this is hard.

I don't like this. I need help with this. That's really where you build that relationship. And so when they feel like they have a voice an outlet into IT, it really matters.

You and I covered some pretty key territory today. Not only spending more on AI security and other investments, we also know it's probably not such a great idea to pass that cost of an event onto your consumer, but more importantly, making sure that the environment that you do host, both for your patients, but also for your clinicians is one that helps to alleviate and actually avoid burnout.

So as the. Push for competition for hiring gets more and more. When you have a healthcare [00:23:00] system that has great partner relationships with Rackspace as an example, and the ability to provide an environment that thinks about their well being, what a win across the board. Absolutely. We always appreciate you joining us.

Thank you for your partnership. Thank you for your insights and ideas. And I look forward to doing this again with you before too long.

Thank you, Sarah. It was good to be with you.

Likewise. That's Newsday. Thanks for listening. That's all for now.

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