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Newsday: Hackers Outpace Healthcare Resilience and Surviving a Merger with Drex and Bill

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Speaker: I'm Bill Russell, creator of this week Health, where our mission is to transform healthcare one connection at a time. Welcome to Newsday, breaking Down the Health it headlines that matter most. Let's jump into the news.

Bill Russell: All right. It is Newsday, and today it is just drex and I

Drex DeFord | This Week Health: Ta

Bill Russell: the, uh, we talked a bunch about cybersecurity and HIMSS last week.

I think we're gonna have to talk about, uh, Sutter and Allina coming. Coming together.

Drex DeFord | This Week Health: it's chilling.

Bill Russell: a, that's not a small one.

Drex DeFord | This Week Health: I can, uh, you know, uh, when you think about a merger and acquisition and the work that goes into that standardization, what ultimately is gonna happen behind the scenes, it would be a great if we could a.

Bill Russell: what happens, because I went through it. Everything grinds to a halt for at least a month, maybe three months, depending

Drex DeFord | This Week Health: we could in, if we could embed in a reporter inside of [00:01:00] that, um,

Bill Russell: Gosh,

Drex DeFord | This Week Health: great. That'd be a great story

Bill Russell: would pay thousands of dollars to like, just mirror the two CIOs and like do, uh, I'd do, do one of like, like Netflix, like, uh, you know, drive to

Drex DeFord | This Week Health: behind the scenes. Sure. Absolutely.

Bill Russell: and

Drex DeFord | This Week Health: Great.

Bill Russell: see and just record. And the whole time I'd be like, alright, just cut, just cut. I put my arm around him. I'm like, Hey, we've all been here man.

We've all been here.

Drex DeFord | This Week Health: We can actually call it drive to survive.

Bill Russell: We, we could call it drive to survive. It's, um, yeah, I mean, just, I mean, you and I have both been through this. Uh, for me, it is the stuff of my, uh, waking, uh, nightmares. it is essentially th things do grind. Grind a halt. Everyone wants to know what. What does this mean, So as a leader, you're just constantly answering that question.

What does this mean? What does this mean for my job? What, where are we gonna be headquartered? Who's gonna be the new CEO? Who's gonna be the CIO? Are we gonna have multiple CIOs, we're gonna have divisions, or, you know, I mean, and, and God forbid you travel out to a hospital. 'cause the questions then get really gnarly.

'cause it, I mean, if you, if you [00:02:00] don't have those questions answered at the top, they get really murky when you get down to the bottom. Now the nice thing is a hospital's a hospital. Right. So Sutter and Allina come together. I don't know who the controlling interest is. Probably Sutter. Um, I know it's Sutter.

It's Sutter's, the larger the two. And that's always the telltale. It's the larger, the two. Very rarely do you see something like, uh, Bon Corps's Mercy where the Mercy c EO actually took over. That's, that's not, um, that's not the norm. And it was very interesting to watch how that came together. You had a little bit of that uh. Uh, uh,

Drex DeFord | This Week Health: I know you're

Bill Russell: in, in, in name alone, that's how Intermountain and, gosh, was it SCL Health or

Drex DeFord | This Week Health: at CL Health. Yeah.

Bill Russell: SCL out of, uh, Colorado came together and they sort of said this, Hey, it's a merger. Be beware of the term, merger of equals. It doesn't really exist, but they came together. But what they did is they said, all right, we're gonna pick the best leaders from both like. It's like a, it's like a bake off between the leadership, which

Drex DeFord | This Week Health: Yeah.

Bill Russell: pluses and

Drex DeFord | This Week Health: And they want the they, you know, and in many of [00:03:00] those cases, the intention is to try to create sort of a balanced table where you've got half the leaders from one organization, half the leaders from the other, but you know, a lot of other things happen in the course of that, those decisions and who's staying and who's going so.

Bill Russell: it starts with the board, right? So that's the first conversation they have is like, Hey, how many seats on the board do each get? What does the governance model look like? And you know, do the names remain the same? 'cause the names are, the branding of these hospitals is really deep. In

Drex DeFord | This Week Health: In the community. Yeah.

Bill Russell: And so, you know, some people get a little antsy when you come in and say, Hey, we're gonna, we're gonna change the name. So it's at that level. I, here's the thing, um, the announcement comes out, it will be nine months. Until they get to the start line, six months, nine months. If, if, if they're working at breakneck pace, it'll be six months. They have a couple state, uh, attorney generals to go through. they have a federal oversight, uh, to go through as [00:04:00] well. It will, it will take a long time for them to get to the starting line. Now, between now and then. They will start the conversations, but they are actually limited by what they can actually do together. Uh, and for, for obvious reasons, uh, you know, in case the deal doesn't go through and, um, privacy of information and that kinda stuff. But it's, uh, I, you know, I hated to go this, this deep, this quick, uh, but just brings up those, those memories. I guess my question to you is. this signal a change in the, uh, merger acquisition posture of the government so that we, this could be a signal to others that we might see a couple more of these, you know, medium to large, uh, medium multi-billion

Drex DeFord | This Week Health: Large, super large to extra super large.

Bill Russell: large to extra, extra super large.

Yes.

Drex DeFord | This Week Health: Yeah.

Bill Russell: does this, do you think this signals a, a, a change? Are we gonna see maybe a. A a, a rash of these over the next couple years.

Drex DeFord | This Week Health: It makes me, it does make me wonder a little bit, I think you've talked about kind of the two tier part of this, right? So the federal government looks at it from an antitrust perspective and they put their [00:05:00] spin on it. But the state ags. Do the same thing. And so depending on what's happening, depending what the merger is, depending the coverage area, there's a whole bunch of stuff including politics that goes into all of this.

And so while the federal government may lean toward maybe today less strict rules around, uh, you know, maybe. Antitrust and, you know, those kinds of challenges. Uh, I don't know that the states will, um, and so there's still a lot of wrenches that could be thrown into this machine. That's not done yet, but you're right.

As soon as you put out the letter and say, we have a letter of intent of this is gonna happen to me, the thing that is really. Complicated is not only if you don't have all the decisions already made, 'cause people wanna know right away, but as you said, as you get down into the organization, people start to generate their own rumors about what's gonna happen.

They, they, they don't know in, in the vacuum of not knowing. The [00:06:00] rumor mills start, and those things become very distracting. I mean, of all the work that needs to be done right now, the least amount of energy we need to put into is the rumor mill, but that's what's gonna happen. There's gonna be a lot of that going on for the next several months.

Bill Russell: Yeah, I think it's a little less at the, larger organization of the two being acquired, it's a little bit more, at the other side. The attorney generals at the state level generally are looking at losing employment and losing tax revenue. And so they, uh, they, and, , public benefit as well. So they, they try to make sure that they secure those things those kinds of a deal, and they'll secure them in, in the form of, uh, you know, guarantees of, you know, I don't know, a

Drex DeFord | This Week Health: I won't close hospitals. Um, that there's a lot of,

Bill Russell: to, to, to mental health in these communities, or, uh, they won't close down the critical access hospital

Drex DeFord | This Week Health: Right.

Bill Russell: to be a part of this, uh, you know, end of the year, whatever it happens to be. and they'll try to, if they can, they'll [00:07:00] try to get, uh, agreements on staffing. Quite frankly, they'll say, Hey, no major staffing changes between, you know, the first year and the third year, or whatever it happens to be.

Drex DeFord | This Week Health: For a lot of states, these hospitals are the largest employers in the state. I don't know if that's the case for either one of these, given it's California and so, but yeah. A lot of states, when we go through these kinds of acquisitions, if you look at the largest employer in most states, it's very often a healthcare system.

Bill Russell: It is. So, uh, what's your advice to the person on the ground, the ciso on the ground, the staff? I mean, what do you, you know, either entity right now, what do you, what, what, what are you telling? If they call you up and say, man, Drex, you've been through this. I, I'm, I'm not at the senior level. I don't really know what's going on.

What, what should I be doing?

Drex DeFord | This Week Health: Uh, yeah. I think that the two of them put their heads together, you know, as soon as they can on as many items as they can, and they start to march out. What, what does the plan look like? What do we intend to do? These are [00:08:00] the things that are in the initial m and A package. This is the stuff that has to happen on day one, right?

And there's a bunch of work then up to day zero to make that happen. And then there's the stages after that and what turns out to be really important. Um, cybersecurity for me on, obviously cybersecurity is gonna be part of this conversation because it's really unlikely they'll just. Join networks on day one.

So there's gonna be stuff that, uh, you know, organization A is gonna need to cont connect to an organization B and vice versa. And they're gonna have to sort through that, um, pretty quickly because it's gonna be basic stuff like payroll and those kinds of things.

Bill Russell: Yeah. The nice thing is from the time that I had to go through this till. Today. there's, there's a lot better mechanisms for things, right? So we used to worry about how are we gonna connect up our email systems? Well, quite frankly, you can, you can operate with two separate email systems now without breaking a sweat.

I mean, you know, you send a cal [00:09:00] i, we send calendar invites to people outside of our organization all the time. It shows up on their calendar. I mean, all of that stuff used to be murky about. 10, 15 years ago, whatever it was, uh, all that stuff sort of worked out. Like you could operate as two different entities and still be able to do, uh, you know, video conferencing, file sharing.

I mean, there's a whole bunch of stuff now that. You could create these, these ways of sharing information and doing stuff outside of your entity. So that's the nice thing. I mean, my advice to these to, to the rank and file staff essentially whatever your marching orders are, come in and do those marching orders.

If it's cybersecurity, It's cybersecurity, if it's clinical informatics, It's clinical informatics, Nothing changes until it changes. In fact, this was one of my main things, that you know, until someone walks into your office and says, I need you to work on. You know, the coming together, you're gonna want to, like, your mind's gonna want to go there. Focus on, focus on what you're supposed to focus on. The other piece of advice I always give people is I've seen [00:10:00] people in these mergers, uh, have their careers go through the roof and I've seen them tank. I've seen people function, make. just bad moves as a result of this, try to position themselves, whatever, and it's tanked.

And I've seen people who, uh, really just through consistent ex execution and, and doing the right things, uh, all of a sudden you, you, you look one way and they were just right here in this organization. And then all of a sudden you look back and they're, they're like, now

Drex DeFord | This Week Health: At the top. Yep.

Bill Russell: as much as it looks like it could be the end of the world.

You might be thinking that it could be really great opportunity for you in a very large health system.

Drex DeFord | This Week Health: And look, the, the other reality is it could be a great opportunity, but if it's not. It's also not the end of the world. I mean, we're a great example of that here at this week. Health, it wasn't the end of the world. It was the start of a whole new thing.

Bill Russell: A whole new chapter A

Drex DeFord | This Week Health: yeah. And so, I'm with you.

I think a lot of this is just like, keep marching, keep marching. Try not to be distracted. Focus, focus. You're still doing [00:11:00] really good work with the resources that you have in the organization that you have, and ultimately the whole plan will get to you and you will. Sort it out. So if you're in the organization embedded somewhere in the organization, just keep doing the work and try not to be too distracted.

Bill Russell: Absolutely. right. So, uh, Drex, I'm come, coming over here under Albert. I'm gonna see what Albert has to say these days and what's going on,

Drex DeFord | This Week Health: Oh, I have a couple of really interesting ones actually.

Bill Russell: oh, what, what, what have you got?

Drex DeFord | This Week Health: So from a cybersecurity perspective, of course I wanna talk about cybersecurity. But from a cyber perspective, uh, you know, the Stryker, um, hack last week by an Iranian, it was a huge, a pretty huge deal. Got a lot of emails, a lot of text messages, a lot of late night phone calls, uh, from folks.

But this group Handala um, they were the perpetrators, right? Went in, wiped all this stuff. Uh. As it turns out, the Department of Justice and the FBI went in and, um, you know, kind of. Counter attack these guys, took down their servers, wiped them [00:12:00] out, and we all like on Thursdays two minute drill extra, I was like, yeah, this is awesome.

This is great. I love it when the bad guys get a sharp stick in the eye. Well, it turns out that kind of like by Friday morning they were back up and running, right? They, they, they, hey, they were back at, you know, they were back at full production. And there's another story this week. in security week about a, a, a gang of thugs, tycoon 2FA who help people break.

Um, two factor authentication in organizations. Same kind of thing, like went in, wiped out tons of servers, but within, you know. 10 days they were back up and, you know, 15 days they were back up and running full strength, doing more stuff than they were, uh, before they were taken down. And it all kind of boils down.

I'm gonna talk about this in a two minute drill tomorrow, but, um, well it'll be, it'll be in the past by the time you see this Newsday but talk about resilience and how the bad guys have really just sort of built this resilience model around. Um, what happens when the absolutely worst thing happens? [00:13:00] How fast can we be back up and running?

And it's, it's really interesting that they have such a good grip on that model. And we in many ways still sort of struggle with even sometimes exercises and backups and restores and let alone like true resilience. So,

Bill Russell: uh, we know how they got in right.

Drex DeFord | This Week Health: oh, we do. Well, I mean, you know, look, the, the devil's in the details and there's reporting on kind of the, the, the, the way in the, the big part of the conversation, um, so far in the news has been around the Microsoft Intune. They got to that and that's how they were able to wipe everything. They were able to wipe all those endpoint devices.

Bill Russell: Yeah, able to wipe phones.

Drex DeFord | This Week Health: Yeah, yeah. Uh, tons of phones. Um, and, and actually that's how I originally got the tip. A friend of mine sent me a note and said, and this was like early in the morning, I'm at hims. Um, I've been back in my room for a while. Don't worry, I, I've been back in my room for a while and I got a call really early, a [00:14:00] note, really early in the morning.

Hey, my daughter works for Stryker and her phone got wiped, and I think this might be a big deal. Just wanted you to know in case you wanna look into it. So when I first started looking into it, there were no news stories on this. I go to Reddit and there's a bunch of chatter in Reddit about what's happening with Stryker.

There's, you know, all these phones are getting wiped. People were reporting that their phones are being wiped. And then about the time I'm ready to push the first publish button on the first kind of LinkedIn post, um. The first story shows up, and then after that there's just a bunch of pylon people, you know, people are waking up and the story's becoming a big deal, so

Bill Russell: direction, you're. Single handedly move us into the breaking news category, which we, we have avoided for, we've avoided for a little while, yet we do not have the ground infrastructure to do that. But,

Drex DeFord | This Week Health: it, it doesn't, it doesn't happen very often. I appreciate it when folks send us, uh, sort of notes and heads up on things. It is nice.

Bill Russell: but, but I think, I think the, the moral of the [00:15:00] story is, is what you talked about earlier, which is essentially, uh, we, we used to hear all the time that phrase, uh, it's not, if they get in, it's, it's when they get in. we should assume that they, they have gotten in and they are in, and they are gonna do something.

They're gonna wipe phones, they're gonna wipe servers. I, I think the, the thing I tell, uh, security people, or CIOs when I'm talking about 'em, is, uh, the only unpardonable sin at this point of time in time, given what all the things that have happened in this industry for the last three to five years is lateral movement. You have to be able to shut down lateral movement.

Drex DeFord | This Week Health: Yeah.

Bill Russell: if, if somehow they get to all of the things across your entire network, then someone hasn't done their job for the last three years. That's, that's my, I mean, that's what I'm saying to people. Do you, do you think I'm being a little harsh.

Drex DeFord | This Week Health: No, I mean, I think, you know, look, the reason we have traditionally in healthcare had big, flat networks is that it's complicated and we have a lot of complicated stuff that runs and it's hard sometimes to figure out what's talking to what,

Bill Russell: But it's

Drex DeFord | This Week Health: but again, in these days,

Bill Russell: only flat [00:16:00] networks. They've, they've figured out ways to get across, not

Drex DeFord | This Week Health: true, true.

Bill Russell: by riding along certain protocols that happen to traverse, all that stuff

Drex DeFord | This Week Health: It, it's, it's true. Uh, but I would tell you that I think the, you know, first things first, a lot of us, I think a lot of health systems are still running big, big flat networks. And so, yeah, and, and so I think a lot of it too then is

Bill Russell: works every time

Drex DeFord | This Week Health: every time.

Bill Russell: flat network.

Drex DeFord | This Week Health: The doctor yelled at me that one time, and so now I have the, you know, I have, uh, I, I changed the network 'cause I'd never want this to happen again.

'cause he told me he would, uh, you know, stab me in the neck if this ever happened again. So.

Bill Russell: And he, and he has sharp instruments.

Drex DeFord | This Week Health: And he does. So, so I mean, it's interesting, back to your point about like there are a lot of new tools, there's a lot of new capabilities that this is sort of opening your eyes and looking at the tools and the, the partners that can do the, these kinds of things to help you segment and do better use those tools, lean into it.

Bill Russell: If I'm on a board, um, that's one of, you know, I'm on the [00:17:00] cyber, uh, security subcommittee of the board and I'm talking to these people. That's one of the first things I'm asking. Talk to me about lateral movement. Then if it happens and they get lateral movement, I'm like, okay, look, I, I'm okay that they're getting in because you can't protect everything we have.

You know, 30,000, 50,000 employees, somebody's bound to lapse somewhere along the line. Either an IT person or or they're gonna get some credentials or whatever they're gonna get in. But I don't want 'em to be able to go from this system to this system, to this system. I want them to be sort of contained, con, contain the blast radius.

Drex DeFord | This Week Health: Yeah.

Bill Russell: first thing I say to 'em. Um, the second is getting back to your point earlier, which is how quickly did we get back? I mean, that's the, I think that's the metric of, uh, resiliency and recovery is now the going to be the metric. It's like, okay, yeah. You know, we're in a war. We literally are in a war.

There

Drex DeFord | This Week Health: Mm-hmm.

Bill Russell: going on every

Drex DeFord | This Week Health: Mm-hmm.

Bill Russell: Um, and the attacks are not just, you know, nation states. It's, uh, you know, cyber criminals. It's um, it's crime families, it's, it's all that stuff. So these attacks are going on every day. [00:18:00] They're going to get in, limit the exposure, and then when they do get in, whatever they do, you know, they wipe all the phones, get all those phones back within 24 hours

Drex DeFord | This Week Health: I mean, you know, a lot of this is that. So, you know, the, the detect, respond, remediate cycle has to just continue to shorten and shorten and shorten the faster you can. Find the bad things starting to happen. I mean, this is just like a fire in your house, right? It's the reason that we have endpoint detection and response and a lot of other tools now, so that you can smell the smoke before it's actually a flame and you can go do something about it.

So this whole cycle of find it fast. Kill off the bad guy, put the system back the way it was. The faster you can do that, ideally in this situation, you can get to the point where it's like, and the end user never even knew anything happened. That's true resilience. That's an aspirational goal that we should shoot for, as opposed to, oh, the bad [00:19:00] thing's gonna happen, we're wiped out.

How do we recover from that? I mean, that's, that's one version and I hope you can eventually do that, you know, but I, what I really hope is that our aspirational vision is the kind of work that you're building a program around. Like nothing ever happened.

Bill Russell: Well, Drex, I don't wanna leave an entire show without talking about ai. Can we? Yeah. So I'm. Mean,

Drex DeFord | This Week Health: It would be nearly impossible with you.

Bill Russell: well, there's, there's two different AI stories. Uh, one's more practical for healthcare, the other's less. I'm gonna go with the less one, and then I'm gonna come back to the more one, the, the less one is, uh, there was a, uh, post from, uh, Citri. Um, that had sort of a doom scenario for, um, companies based on AI arguing that the technology would disrupt jobs faster than the economy could absorb it. Uh, this was widely read. A couple CIOs actually pointed me to this article. It was pretty interesting. Uh, Citadel responded with a grounded rebuttal, [00:20:00] basically saying adoption curves are slow.

Enterprises move like molasses, and the disruption will be gradual enough. To manage. Um, and, uh, you know, so there's, there's your two sides. By the way. I still, I see CIOs pointing the, oh my gosh. You know, if, if you read Matt Cole, he is like, oh my gosh, AI is, is really being applied here. Uh, Baylor Scott and White, the CEO talked about, uh, you know, AI is really being applied here.

There's a lot of stuff going on. Um, and then you have other people in the industry who are essentially. I don't know what all the fuss is about. I mean, it's just, you know, it's just making some things that we do a little faster, that kind of stuff. And, uh, I don't want to, I don't wanna point to those posts because I don't wanna, you know, but they, but they're out there.

I, I, I read 'em all the time and this is one of those classic cases of, oh my gosh, AI is going to replace all software. And, uh, and actually they, they cited, um, uh. Not workday. They cited, uh, ServiceNow as one of the case studies of just completely replaced by [00:21:00] AI agents along the way, way Citadel's main argument is the S-curve of adoption. Um, and the only problem I saw with that article, quite frankly, is, uh, the scur is also based on traditional S-curves. Right at at, you're gonna point AI at AI adoption. And it's going to ai, like people are learning AI through ai. Hey, how do I

Drex DeFord | This Week Health: Yeah.

Bill Russell: How do I

Drex DeFord | This Week Health: Yeah.

Bill Russell: how do I create guardrails? How do I program? And it's, it's like teaching them how to use ai.

Drex DeFord | This Week Health: I, I, I do it. I, I do it every day. I mean, when I'm using Claude, there are times where I get frustrated and I'm trying to create, you know, a prompt or a project and it's not working the way I think it should, and I basically will just ask it. Okay. You're kind of pissing me off. So what's a better way for me to say this?

So that I can make it work the way I want it to work, and it will give me like really good advice and guidance and then [00:22:00] I can say, okay, can you just go rewrite the markdown doc? The so, so that it actually works the way that we're talking about. And it does and it does. I think that that. This idea of, um, there's a lot of conversations right at city tour dinners too, about build versus buy.

You know, we've gone through this whole cycle of like, when we were kids, we built stuff. I mean like when we were kids in the IT industry, we built stuff and then eventually we started buying commercial off shelf stuff. And that worked great. And I feel like the circle has gone all the way back around now.

Folks are seriously starting to ask questions like, why am I paying for this software? Couldn't I just vibe code this? Could I not build something like this that probably works better and is more customized for me for a fraction of the price of what I pay my software as a service provider? And so that's a real conversation, not only.

I think in that article too, [00:23:00] they talk about the difference of like, is product even a thing that's gonna exist in the future? Am I gonna buy products or am I just gonna build a custom product for myself? I mean, everything's gonna be custom built for me 'cause I'm gonna be able to do it. It's gonna get easier and easier over time.

This is the hard, this is as hard as it gets right now.

Bill Russell: I, I, I, I agree with you. Let me take you to the one that's more connected to healthcare. This is Becker's story, mass ai, job replacement, not in healthcare. CI say. So this has a couple of our friends, uh, talking about this. Um, let's see. Let's get the quotes. Uh, here, here are the quotes.

And this is about, um, you know, is AI gonna take our jobs? Uh, I don't think mass job replacement in healthcare is likely said Will. Landry Senior, uh, SVP and CIO, Baton Rouge, uh, la uh, Baton Rouge, Louisiana based, uh, FMOL Health. I do, however, think, uh, we'll see duties shift. I think we'll see positions move from backend to front end. and he goes on to say some more. Scott Arnolds had this to say, uh, the work in front of us is learning how to wield automation to [00:24:00] reduce the cost of healthcare as we. Or on an unsustainable path for healthcare costs as a percentage of GGDP. He said ideally, automation done the right way should help stabilize or pull down the cost of high quality care delivery and give health systems some room to scale growth without exponential increases in labor expenses. and then, uh. Reid, uh, Stephan, CIO, uh, St. Luke's AI won't take your job. Someone using AI will is the popular, uh, line these days. He goes on to say that idea assumes AI simply makes existing workers more productive. He said, we, what we are actually seeing is that AI begins to reshape the systems. Those jobs exist within when systems change, roles naturally shift. Uh, and he, and then he goes on to say, patients still want humans involved in their care and healthcare already faces workforce shortages. uh, we're, what we're far more likely to see is a shift in where humans add value, less time spent in administrative transition work, and more [00:25:00] time focused on care, judgment and patient relationships. The organization that benefits most from ai. Won't just automate tasks, they'll rethink systems that those tasks live in. All right. So that is

Drex DeFord | This Week Health: I have so many opinions.

Bill Russell: What are your thoughts? We'll just start there.

Drex DeFord | This Week Health: I mean, so my initial sort of thinking about that is, um, the folks in New York City who had taxi medallions and they paid millions of dollars for them and they thought that was the end of the line. They had the taxi medallion and that was that, and then Uber showed up and they started taking.

Bill Russell: you could monopolize taxis by

Drex DeFord | This Week Health: Totally.

You could buy enough medallions that you could own a city, and then Uber showed up. And I feel like in healthcare we already kind of see this happening where there are big health systems, but there are innovators who are creating, uh, new ways to deliver care that are, the shark is taking little [00:26:00] bites out of the whale, you know, like, oh, here, here, that, that's a really easy piece for me to automate or change or offer in a different way to consumers.

And the consumers like it. And if the health systems don't change fast enough, the whole system is going to change. It's just, is it gonna be your health system? Who's gonna have those offerings? Or are you gonna be stuck with the most expensive, least margined, um, portion of the healthcare system as your health system?

Bill Russell: give you, I'm gonna give you the four topics real quick. And this is so we don't get in trouble with Landon. You know, Landon edits these things and he actually grades us. We've asked him to grade, you know, how good is the episode, whatnot. It's kind of fun.

Drex DeFord | This Week Health: Yeah.

Bill Russell: alright,

Drex DeFord | This Week Health: Yeah.

Bill Russell: Uh, first topic, AI workforce impact.

What do you think the AI workforce impacts gonna be,

Drex DeFord | This Week Health: i'm a big fan of the idea that the person who uses AI is probably going to be in their job longer than the person who doesn't use ai. There's definitely, parts of this are gonna be hand on, hands on for a long time until the robots get [00:27:00] there. But I think back office functions, I think there's gonna be a lot of, there can be a lot of downsizing on the back office part of this work, and that may include information services.

Bill Russell: Absolutely. Absolutely. I mean, the things that are uniquely human in healthcare will remain uniquely human. People still want care delivered by a person. I think that is absolutely true. Um, but I think we will see significant, um, changes, uh, which gets us to the next, uh, well, the next three really are kind of related, but I'm gonna start with cost reduction. as a result of ai. So there's this thing out there, Jevons Paradox everybody's talking about, which is, you know, you think you're gonna put AI in, get all this, all this, uh, uh, you know, productivity enhancements. Therefore people are gonna have more time to do our, you're gonna be able to let go of people. Jevons Paradox essentially says, no. the amount of work we haven't been doing in healthcare is massive, and so you're just gonna free them up to actually do work that we haven't done before, and hopefully you prioritize the right work, which will have, [00:28:00] you know, uh, sort of a compounding effect on our ability to deliver care in the community.

So, cost reductions in ai, how are we going to experience that in he.

Drex DeFord | This Week Health: the Jevons paradox is something that we have seen for years. Every time we automate a function in surgery or lab or radiology or any clinic or back office area.

Bill Russell: Right. Nobody

Drex DeFord | This Week Health: And they, they promised to get rid of somebody because of that. It turns out all that gets backfilled with work that should have been done, but just wasn't being done.

It was just being ignored. Happens in information services too. There's so many things we should be doing that we're basically just not doing right now. So.

Bill Russell: the argument is go ahead, keep ignoring it and get rid of people. Is that what you're telling me? No, it's not. It's not what's gonna, it's never happened.

Drex DeFord | This Week Health: I think this gets a little, gets around to the, you know, we're gonna have, we're going to have to continue to make hard decisions about what's really risk and what's really important. And we're gonna have to prioritize, prioritize those things and deprioritize the things that aren't important. And that may be the only way.

I mean, there's always more [00:29:00] work if you're willing to do it.

Bill Russell: So this, this gets

Drex DeFord | This Week Health: The leadership problem is you gotta draw a line somewhere.

Bill Russell: So point number three here is, uh, the focus right now for CIOs and other health systems is administrative, administrative automation. AI as a tool is the, that gun is being pointed at administrative overhead, administrative friction, administrative, I don't know, bloat, if you will, coding, billing, care coordination and whatnot.

I mean, um, I you hearing anything different or is that, that is where this,

Drex DeFord | This Week Health: I think that's where the initial point of the spear is, you know, being pushed.

Bill Russell: So we'll hear stories over the next year. It'll all be focused in

Drex DeFord | This Week Health: Mm-hmm.

Bill Russell: System redesign. Now you're, you're a big Toyota lean guy, and this is, this is one of those areas that I'm wondering if this is how the leaders differentiate themselves by truly rethinking, and how much of this, how much of this is going to happen and where will it, where will it happen that people rethink? uh, a [00:30:00] process within healthcare, do you think

Drex DeFord | This Week Health: You know, so I think back to Matt Cole's post about, you know, before you do something new, take something out. Like eliminate, eliminate something. And then I wrote a whole thing after reading that. I wrote a whole, wrote a whole riff on that. That I haven't published. I don't know if I will publish, but I mean, it's just a lot of it is the, the same kind of thing, just different examples.

It it's the, I I, I think that's ultimately it. We can't just, um, as I, you know, Wes has heard me, Wes Wright has heard me say a hundred times, don't pave the cow path. Like take the opportunity to screw down the process as much as you can until like it's so painful. There's nothing else you can do except automate it.

And. Those are good times to actually have those conversations around, do we even need to do this? If we automated, if we did, if we used ai, why would things look completely different? How would we throw out whole parts of the system? Big s not technology system, but why would, why wouldn't we throw out whole parts of the system and [00:31:00] make this just work better?

And that's the whole point. You can't just automate the things that you have. You really have to rethink them from scratch.

Bill Russell: I, uh, I, I believe that the patient experience will be one of those areas that we significantly, significantly change. you know, I, I'm looking for the first health system to come out with an MCP server that, uh, connects into Claude, connects into, you know, whatever your AI of choice is, that I could sit there and go, Hey, tell me what's in my medical record.

Tell me what I've been, tell me this because we're I, well, you and I are anyway. We're using MCP pretty extensively over here. In fact, when we develop our systems on the backend. Um, you know, in terms of our event management and that kind of stuff, it's connected to MCP. Like, I can sit here right now and ask questions like, who's been at the last 10 events?

And it, it spits that out to me. And so it's, it's that kind of connectivity with, uh, because my, uh, my API key is coded to me, it knows that it's me that is actually accessing this, all this other [00:32:00] stuff. You could also have, there's also log in. People are worried about security. There's also login mechanisms that you can say not only the API key, but they actually have to log into the system. Uh, and it kicks over to a, to a browser. You log in and then it comes back and now you can ask it whatever questions you want to ask it. Um, but the ability to do that, the ability to navigate the system, uh, to get an appointment to see when my next appointment is, to, I don't know what all those things through

Drex DeFord | This Week Health: I mean.

Bill Russell: front end, we're not the one you developed for me. My AI front end asking questions of your backend data, I think is a massive opportunity to redesign how patients interact with their health system. I think for the better,

Drex DeFord | This Week Health: Not just their health system, but health in general. Right. I think this idea of being able to have a, you know, 25 PhD researchers that you've created and you have a chronic. Disease, and basically they're out there [00:33:00] looking, they're reading everything that's ever been written or you know, as it's written and sending you alerts and notices and updates, maybe you should look into this, talk to your doctor about this.

This is something you need to know about. Those are the kinds of things that I think the world is changing. We're not just gonna rely on our docs to tell us what we need to know. We haven't done that for a while. Dr. Google's been around forever, but Dr. Gpt has changed everything. Dr. Claude's really changed everything.

Bill Russell: such a different, and, and the paradigm is we have to organize everything around our data system at the healthcare, uh, at, in health, in healthcare. And the reality is 80% of my care, 80% of my health outcomes are not tied to what goes on in the health system.

Drex DeFord | This Week Health: Oh, for sure.

Bill Russell: I am going to be the aggregation point.

I'm gonna go MCP server to my medical record, pull that in. I'm gonna do MCP server to my Apple Watch and pull that in. I'm gonna do MCP server to, and I'm, and by the way, that's just, it could be something else other than MCP. It's just an, an integration [00:34:00] layer that pulls this all in the, uh, to the AI model. Um,

Drex DeFord | This Week Health: So many things. You're looking at air, air quality. Is there a forest fire today? Turns out I have asthma. Here's something you know I should be thinking about or know about. There's a building being constructed next door. Maybe that puts some rust into the water. I may have some reaction to that. These are all things that you can know now that.

Bill Russell: I am, I am the constant at the point of care. If I have access to all that information and my AI model on my phone has access to all that stuff, I can say, Hey, why am I having trouble breathing today? it can look through my medical record, it can look at my Apple watch statistics, my aura ring, my sleep patterns, and it can look at the weather, it can look at the, you know, the air quality.

And it could go, I, you know what, bill? The air quality is actually pretty low in your area right now. Uh, da da da, you know, and it could respond. I mean, does that really warrant a phone call to my doctor to have, you know, and by the time I see 'em, the air quality's fine and I'm not having the issue and blah,[00:35:00]

Drex DeFord | This Week Health: a ride in an ambulance and you know, like all these things wind up manifesting themselves in expenses into the. Healthcare system, which ultimately could be avoided. I talk a lot about this personal health record of the future. You know, we had the PHRs, they went defunct. I don't think the idea was bad.

I don't think the technology had caught up, and I think this is, I mean, I'm, I'm kind of excited about this idea that this may be where we're going in the future.

Bill Russell: this is funny. 'cause you know, I, I thought, man, Landon just gave us kudos for doing a short Newsday last week. Now we just, we rattle off a 38 minute, uh, Newsday. Oh. You know, he's never gonna know what to expect. It's all good. Hey, uh, Drex, always great to catch up with you and, uh, hey everybody.

Thanks for listening. That's all for now.

That's Newsday. Stay informed between episodes with our Daily Insights email. And remember, every healthcare leader needs a community they can lean on and learn from. Subscribe at this week, health.com/subscribe. Thanks for [00:36:00] listening. That's all for now.