FOR THE NEXT GENERATION OF HEALTH LEADERS

Myth Busting Cybersecurity and Plans for a Big Texas Merger

This Week in Health IT - Craig Richardville
CHIME CIO of the Year Craig Richardville joins us to discuss cybersecurity and innovation. We also discuss the Baylor Scott & White and Memorial Hermann mega-merger in the Lone Star state.

 

 

 

Bill Russell:                   00:01                Welcome to This Week in Healthcare where we discuss the news information, and emerging thought with leaders from across the healthcare industry. Today we ask the question What do executives need to know before they pull the trigger on mergers.

Bill Russell:                   00:13                Plus we bust some of the cyber security myths that are out there. This is episode number 40. This podcast is brought to you by Health Lyrics, Health systems are moving to the cloud to gain agility efficiency and new capabilities. Work with a trusted partner that has been moving health systems to the cloud since 2010 visit healthlyrics.com To schedule your free consultation. My name is Bill Russell recovering CIO writer and advisor with the previously mentioned health Lyrics before I get to our guest I want to thank everyone especially my guests who have made this show a success. We set a goal before we started the year to get 500 weekly downloads of the show in the first year and so that was that was our big goal and this past week we eclipsed a thousand downloads for the week. We want to thank you for making us part of your week and we hope that you will continue to share the podcast and the YouTube channel with your peers. Today’s guest is new to the show. Gosh you’re probably like the fourth CHime CIO of the year that we’ve had on here. A highly decorated industry veteran Craig Richardville joins us from North Carolina. Good morning Craig welcome to the show.

C Richardville:               01:18                Good morning Bill. Thanks for having me.

Bill Russell:                   01:20                You know I assume you’re in North Carolina but every time I check social media you seem to be in like other countries or other locations are you in North Carolina today.

C Richardville:               01:29                Today I am even though I do have New York in my background. So I think when you’re when you’re a child you know that the world is so large but as you get an adult you realize it’s very flat and you could really make yourself very mobile in any places that need you.

Bill Russell:                   01:44                Yeah I think one of the posts I saw you were you in Asia doing some things in Asia.

C Richardville:               01:49                I was I did some work in Thailand. With a very large health care system a healthcare system that was, part of the system was more of a community service system it was a 2300 bed single facility hospital with clinics, etc on it. Then they also had a private facility which has 350 beds. which catered to the to enhance the improve those that had more of a cash payment system.

Bill Russell:                   02:13                So it’s health care. So health care is pretty dramatically different. I mean Thailand’s pretty I mean if you’ve been to Bangkok it’s a pretty advanced city. I mean it is a pretty dramatically different a pretty similar to what we have here.

C Richardville:               02:27                It’s interesting you know when we’re going into I have some assumptions of what I was going to run into and some of those assumptions are wrong the way I would say it is that when you look at the U.S. healthcare system and how we advanced on the digital technology ways it’s much more advanced than what I observe. However when you look at outcomes when you look at margins when you look at all of the measurable pieces that we all aspire to be they actually were leading in many if not most all of those cases.

Bill Russell:                   02:56                Wow. That’s interesting. Well I’m going to do that for people who don’t know you do a quick flyby of your accomplishments and who you are. If they want to know more you have a website. You have craigRichardville.com.

C Richardville:               03:10                Yes I do, please come visit.

Bill Russell:                   03:11                Yeah which has a ton of stuff on there. You’ve done advocacy work in the nation’s capital. We’ve already mentioned in 2015 John Eagle Jr. CIO of the Year by Chime your 2017 Leadership Award for Charlotte CIO. Most recently you were with Carolinas HealthCare System which is now Atreim health for those who don’t know roughly. I mean that’s roughly about an eight billion dollar system is roughly right.

C Richardville:               03:42                Depends on how you measure it. Somewhere around 6 billion in terms of the owned assets that we look at. The Manage assets is right around 11 billion.

Bill Russell:                   03:51                Okay. And the geography is today is Carolina but obviously the name change sort of denotes that it’s moving outside of North and South Carolina I would assume.

C Richardville:               04:00                I think that’s the intent of the name change for my when I was there we had three hospitals when I left we had 42 all in North and South Carolina.

Bill Russell:                   04:09                So clearly you had a lot of work to do while you were there. So 14 years in a row most wired designation which is awesome. You’re a fellow at the American College of Healthcare executives fellow at healthcare, HIMMs chairman of Premier member technology improvement committee.

Bill Russell:                   04:28                You’re on several board University of North Carolina Charlotte Foundation board member of Care Connect, board member of Carolina shared services. So not only were you able to be the CEO of a rapidly growing health care system but you found time to give back and be a part of a lot of these things that were going on in the community which was which is exceptional. So you know one of the things we like to do with our guests is start with a pretty open ended question. Once you know which one thing or what are some things that you’re working out today that you’re really excited about.

C Richardville:               05:02                Well there’s probably two things on that. First and foremost I have three boys and two of them are getting married within the next year. On in 3 months and one in 7 months but so from that standpoint I like any parent that’s really on top of mind for me. But secondly professionally what I’ve been doing for the last 6 7 months is really going out and looking at different companies different companies of different sizes different companies that actually deliver across multiple industries and looking to see a handful of really golden nugget companies that I would really be interested to be part of working with and or when I was in a CIO seat I would really would have appreciated people bringing those kinds of nuggets to me.

Bill Russell:                   05:43                Yeah. You know one of the things I’ve thought about is we could do a whole show on CIOs in transition. I mean your story my story and a handful of others that I’ve had conversations with I know that a friend of mine just became a co CEO a former CIO here in Southern California, just became a co-CEO of a pretty fascinating tech startup that’s doing some really cool big data stuff in healthcare. And I think there’s a lot of different directions CEOs have ended up going. They can go in that startup route, Pervine from from Stanford went to a startup. This gentleman from Marlina went to a startup. So you can go the startup route you go back into the CIO route. You know I started a consulting practice going back out. What other directions do you think CIOs end up going at this point do you have any thoughts on that.

C Richardville:               06:42                Yeah you know I do think it’s a very interesting piece to be. I mean the role that we’ve had the science that’s behind what we’ve Done or been able to accomplish especially in healthcare in which we’ve been able to do a lot of things in a very short period of time where we look at some of the other industries where there’s retail or banking others that they’ve done some things over a couple of decades to get to their point. We’ve done things you know anywhere between 6 and 10 in some cases 12 years. And I think we really advanced the system so when you look at a CIO and look at the industries, most industries all becoming technology centric. The CIO role can actually go all the way across. So I like it when people are saying the CIO has become the CEO or the CIO within “healthcare” can be the CIO within retail or banking.

C Richardville:               07:28                I think there’s so much that we can deliver back to other industries or other companies. One thing I’ll say the most that I think for all of us that have been successful in this role. The biggest thing that I have been proud of and I’m sure you yourself and others is really just the development of people and having the ability to learn and to deal with multiple people at different levels across the organization. You don’t come in with the mindset of technology person you come in with the mindset of a business person to solve problems. And because of that you know you’re bringing in all the other senior executives able to bring them around you so that you can be part of that decision making process or part of that inner circle.

Bill Russell:                   08:05                Yeah. We’ve learned that when somebody goes hey are you going to do this. Are you going to do that EMR migration are you going to bring all those things in our first question is you know usually what problem are you trying to solve. Tell me what you know. And then and then yeah then it’s a matter of rallying people it’s really it’s a leadership and a People role much more than a technology role at this point.

C Richardville:               08:27                Yeah for me you know sometimes that answer is it’s not. I’m going to do it. We’re going to do it. Yeah. It’s all about We’re all in this together no matter what the objective is

Bill Russell:                   08:36                Yeah absolutely. It’s our show breaks down into two segments in the news and in sound bites where I ask you a series of questions we’ll start with in the news. I think the big story this week and we try not to cover every one of these that’s talked about but this one’s pretty big comes from the Houston Chronicle. It’s the Memorial Hermann to merge with Baylor Scott & White creating the largest health system in Texas and we know that in Texas they like to have the largest things and this is now a pretty significant.

Bill Russell:                   09:06                While they were they were significant health systems in and of themselves bringing them together makes them pretty big. So let me read a couple things from this. Two of the biggest hospital chains Texas announced plans Monday for a merger that would create a mega system stretching from Dallas to Austin to Houston treating patients in more than 30 counties and employing more than 73000 people across the state. Memorial Hermann Health System Houstons biggest nonprofit hospital chain and Baylor Scott & White Health the largest in Dallas have signed a letter of intent to begin negotiations with the goal of having a definitive agreement in place by next spring. And then it has the usual stuff growing national trend.

Bill Russell:                   09:46                Like minded systems economies of scale to address growing consumer trend within health care. The article actually gets a little more interesting down at the bottom. And that is you know the cost of health care is the number one issue in America whether it’s in D.C. or Austin, Texas. One of the people was quoted as saying saying so taking cost out of a system will be an important part of the journey as we come together. Actually this was the CEO I believe of Memorial Hermann. So they actually just come straight out and say taking costs out will be an important part which is actually kind of unusual for these kinds of announcements especially this early in the process. Officials said that most of the cost savings would come from a sharing of expertise collaboration and technology as is usually the case. It’s not clear whether the merger will lead to job cuts. That two systems combined have nearly 5000 current job openings so with 5000 job openings there might not be a need is what they’re essentially saying. Actually I find it interesting usually when mergers come out there’s there’s no talk of any any reductions at least for you know a good period of time to have one of the CEOs come out and start talking about reductions this early as pretty interesting. Have you seen, first of all, have you ever done a merger?

Bill Russell:                   11:16                Have you ever done a merger that hasn’t led to some aspect of restructuring or job you know attrition in the process.

C Richardville:               11:28                Yeah, no I mean when you look at the cost of healthcare. And you look at especially a healthcare provider, somewhere between 45 and 55 of all of our expenses are Labor. So from that stand point it just becomes reasonable, weather you’re doing it as a cost cutting objective or you’re doing it because of a merger or an acquisition or there is going to be some impact to your labor bottom line. But you know it depends on how you handling it. So to me the most important part is try not to affect. So the fact that they have 5000 probably budgeted job openings means they could cut several thousand jobs restructure the work the process the workflow and not impact the person and still be able to achieve their budgeted expectations of reductions. So given that Baylor Scott & White had recently done this and Memorial certainly is a very well recognized and respected organization I gotta believe with both of them coming together with their past successes they will have the opportunity to you know to make a difference and I think part of that will be to lower the cost, the expense structure. The thing that happens with that though is What are you going to do with those savings are those savings going to be reinvested back into the company to do other things with it they can go toward bonuses. You know to administrator of physicians and others or they can go back to the patients or a combination of all three. I think that’s where the rubber kinda meets the road is depending what the outcomes are gonna look like. What is going to be done with those outcomes to better the patient experience or the patient visit.

Bill Russell:                   12:56                Yeah. And actually as the story goes on towards the bottom they cover so many health care economists disagree on the notion that hospital mergers lead to better more efficient care for patients. Vivian Ho health economics professor from Rice’s Baker Institute of Public Policy said she worries the proposed merger could have the opposite effect. She pointed to research showing increase in health care costs and then they have four or five other corroborating kind of statements around that it hasn’t lead to better outcomes or lower costs in the communities that they serve. Why do you think such mergers haven’t led to either better outcomes or lower costs in the community. Is it because we’re not taking those savings and passing them on to the community. Or Is it less competition in those markets. I mean what do you think. What do you think it could be.

C Richardville:               13:59                I think that those are very valid point statements and the concern when you have something of this size coming in. I think to me most of it has to do with the art of the deal. What is the deal that is being done. What are the realistic expectations. In many cases they may overcommit a number delivery, even know that delivery might be better than what the previous requirement was, if you commit acts and you don’t achieve it it looks like it’s a failure.

C Richardville:               14:27                So for me it’s really kind trying to find the right balance of commitment of delivery and making sure that the community and the patients and the providers all experience some type of improvement.

C Richardville:               14:39                When we look at change management having been through several mergers acquisitions partnerships loss management agreements over the last two decades it’s really all about establishing the correct expectations and then realizing those expectations in many cases your goal is to overachieve what you’ve already committed to so long as you go into it.

C Richardville:               15:00                I think with a realistic understanding of what you want to try to get out of it and insure that it’s measurable. Insure that you can track against it and the other part is we’re in a very ever changing environment so as we start to shift and move things from volume to value. It’s not an experiment where today when they make this announcement, three years or five years later when they measure it. It’s not like the environments the same environment. So there could be all different kinds of aspects that may impact what those results would be and how some people may interpret those results they could have been a lot worse. They could’ve been a lot better. So to me its just kinda measuring monitoring ensuring that you’re doing the right things that before that is what the ballot or in these cases you know they are all community based so from that standpoint. What they want to do is measure the benefits back to the community.

C Richardville:               15:44                And those are, you can measure that in multiple different ways. Then change managements a big piece too. I think that’s probably one of the underlying assumptions that people don’t take seriously as they should as the change management that happens if you want to have a more efficient system more effective system that means somethings going to change and in many cases as you know Bill that means people are going to have to change. People are really hard to change. You’ve got two organizations highly respected highly decorated coming together both going to have best practices but the reality is there’s only going to be one best practice. So it’s not going to be multiple. So as you start to bring in different service lines together different areas together we’re all going to have to reassess what the next best practices are to be it could be neither of the two that they’ve been practicing but actually there’s a forward out of a state of the possible world affording it together.

C Richardville:               16:35                I think that’s the utopia that we’re all looking for.

Bill Russell:                   16:39                So here’s the good news. Good news is that Matt Chambers has been. He’s got the merit badge on him and because the Baylor Scott & White merger was something that He was present for so he said before which means he’ll have an appreciation for the complexity of org change management and all the things that you’re talking about. I know that Memorial Hermann was doing a search for CIO earlier this year so it’s not really clear to me whether they ever filled that position. So let’s I’m going to shift this towards health care I.T. now and just focus in on that and we’re onna give Matt some free consulting. Not that he’s asked for it but we’ll give it to him anyway. What do you think Matt needs to do now, They haven’t even gotten to a definitive agreement yet. What do you think Matt needs to do over the next six months or so to insure the best outcome for the merger. From you know for both organizations.

C Richardville:               17:37                Well this is the most important piece of a relationship is to really understand each organization what a combined organization might look like and identify those benefits. You see it all across the country where sometimes they do have a letter of intent to come together but they don’t make it because as they start to peel back the onion. They start seeing that there are things that maybe they had expected or unexpected things start to show up, either organization. And you try to bring it together, either its a cultural problem, it’s a financial problem, it’s a ??? whatever those things are you start to peel that back and you see some that are successful you see some that have gone on for a couple of years several years before making a decision. I think this is the most important pieces is to truly be a very open transparent in this due diligence phase where all each organization is really exposing themselves to each other.

C Richardville:               18:27                That is the opportunity to make sure that you clearly understand what you’re getting into so that hopefully when the spring comes around you have defined a definitive agreement and objective of what you want to get accomplished and a realistic expectations that you can either achieve or overachieve those expectations. So these next six months or so I think are going to be critical that everybody is over transparent there’s nothing that’s being hidden or forgotten about, but that you really know what you’re getting into. Just like any marriage you know between a husband and a wife or any other relationship you’ve got to really understand the other party coming into it if you really want a good outcome in the end.

Bill Russell:                   19:02                So is there a common mistake that CIOs make in M&A activity do you think.

C Richardville:               19:08                Yeah. Do you know.

C Richardville:               19:09                I I can’t say that as it’s always a mistake but I think there is an assumption that running on a single system or a single set of systems is the best way to go you know so whether you’re talking about the EMR whether you’re talking about you know corporate areas with ERP systems or etc. I think there is a natural tendency to say if we’re all up on the same one it’s going to be better and more effective more efficient. I think what happens is both systems in this case or in any other case have made huge investments in IT over the years. And so just to throw away that investment and merge it together that’s a big cultural issue. It’s a big financial issue. I think you’ve got to thoroughly understand which of the priorities that need to come together first so you start bringing the organization together. See things like communications systems of e-mail phone systems cetera.

C Richardville:               20:01                Some of your video conferencing all that coming together right off the bat nobody typically has a strong player or preference to what they want to use, but you want to be able to operate like one system. When you look at things like ERP systems. To me that’s probably something too that you want to start bringing together with the efficiencies and trying to get some of the tweeks out of the workplay. We did the clinical systems well those are very sensitive systems. You have people that have lot of pride and a lot of ownership of what they want and to put them all on the same system may and may not be the right thing to do at that time.

C Richardville:               20:31                I do think as time evolves. It does become the right time once you start to appreciate that investment it’s down to the point to reinvest reinvest on bringing it together but they have to be that right up front. I think you’re probably throwing away some good dollars are yet to be realized in terms of the returns. And it’s not a priority at this time because to bring those clinical service leaders together. Well those are people that are extremely bright. They are optimistic they have a lot of characteristics that are going to be you know that they have the best practice in those are gonna take some time to work through and show each other that type of respect. So I think those are things that probably lag a little bit farther down the road. But to me it’s just kind of reiterating this, really that you have to be on one system is best to really achieve you’re economy, it doesn’t it may actually cause more problems with change management education mainly, things of that nature and in many cases because we’re so immature in our market both our systems some, its like the baby some of leader. This is what they produced. They made this happen. Whether is was a Epic or a Cerner, a meditech or you name it. This is something that they really feel emotion attached to, you’ve got to remove those emotion that just comes with it.

Bill Russell:                   21:44                yeah a lot of emotion.

Bill Russell:                   21:45                It’s interesting that that does end up being one of the first questions that gets asked by everybody it gets asked by the media gets asked by all your clinicians like are we going to their system are we you know and the answer to that question is you know we’re still working on a definitive agreement. Once the definitive agreements in place and we’ve you know we’re working towards merger. We’re still not going to be able to make that decision. We’re not going to be able to make that decision until our clinicians are sitting in the room with their clinicians talking about all aspects of clinical care and what our desired outcomes are and then determining you know what’s the best system and what what drives the best thing. So if it’s usually not for another 12 months after the merger unless it’s a, I mean if it’s a merger of this size two equals sort of coming together that’s that’s a different animal than say you know large healthsystem acquiring a small whatever practice. That’s a that’s probably a different conversation. But even then it’s not the kind of thing while you’re doing initiation that’s that easy to answer whether it can be the best.

C Richardville:               22:55                And if you look at you know today’s world and the future of the delivery of healthcare and our operability become such a key concept that you know that the other providers in your market are not going to have the same “information” systems that you have. In many cases and from that standpoint you gotta start proving your ability your art your science around communicating back and forth with other providers because you’re going to have that in your ACO or other types of association that you’re grading. You’re going to have to have that core confidence of being able to integrate back and forth between multiple different vendor systems

Bill Russell:                   23:32                Yeah. You might as well figured out now I’m going to move us to the next story and we’re actually not even going to cover the next story we’re just going to use it as a backdrop for conversation. So healthcare IT news has a whole section on cybersecurity today and one of their stories they have is 10 stubborn cybersecurity myths busted and they have some things listed there that are pretty interesting but it got me to thinking it would be interesting to talk to another CIO about you know what they think are some cybersecurity myths that are out there and why they are myths. So here’s the challenge. What I’d like to do is go back and forth on some of the myths that we’ve seen in cybersecurity, myths we’ve seen in healthcare that are out there and just sort of bat them back and forth. And just to give you an idea of you know I’ll start us off.

Bill Russell:                   24:25                I was in a I was in a meeting with our internal auditor and we we were sort of presenting our security posture and they were sort of commenting on it and a former NSA person was sitting there and she looked she looked at me and she said she goes OK I’m going to give you one thing that you need to do and it’s going to change how you do all of your security. She said assume they are already in your network. And as we start talking about it I think the myth is that you can keep them out. And she said assume they’re already in your network and they might even be in with proper credentials. And she goes so now how do you design your security. And I thought wow that really does change things. Instead of that exterior being the end all be all.

Bill Russell:                   25:18                Now you have to look at a more comprehensive security posture where you’re looking at people’s activities on the wire and saying, does that activity match what they’ve been doing for the last six months and if it doesn’t that becomes a red flag. So you’re looking at behavior on the wire you’re looking at actual creation of data you’re looking at a lot of different things than just you know do we have. Do we have the wall built up and do we have policies in place. There’s you know sometimes with the walls built up as well as you can and your policies in place as well as you can. They’re still on the wire and you have to start looking for that activity. So I think that’s you know for me that was one of the biggest myths that was busted for me which is you know assume they’re on the wire and assume that you can’t keep them out. So what’s a myth that you’ve run across.

C Richardville:               26:11                Well you know interesting like for example in this article it’s in healthcare I.T. news and you know for me when you look at you know cyber security and the whole aspects around that this is not a health care issue. This is a total all industry issue. Everybody’s in it together. So the fact that we advocate on behalf of the health care financial services and retail.

C Richardville:               26:38                And this is one of the things like for example the Charlotte CIO that you mentioned at the beginning that he wanted to take that out of the church.

C Richardville:               26:42                And yet over 700 people participate. So a lot of people are interested about bringing things together across all the industries now and I’m very proud to have been part of that. When you look at cyber and next week that’s actually is our next event is we have one event every quarter is about cyber. So you’re going to have major banks in town you’re going to major retailers in town major energy in town and major health care systems in town etc. all participating on the cyber piece.

C Richardville:               27:09                So it’s really not the health care I.T. type thing. It is a IT/business so when you look at not even the CIO dot com but these are the business aspects Wall Street Journal New York Times you know the types of information that needs to be exposed to is do the board members and the senior executives.

C Richardville:               27:27                This is a business issue of having the cyber security. The one thing we don’t have the luxury of that we had you know from a physical security attack. I don’t have to put you know antimissile systems are around my facilities right. So the government protects us in certain aspects but we look at the Internet and the way that it’s set up to be a global network. The United States can’t put a border around it and provide those protections.

C Richardville:               27:50                So we’re kind of all in it right now on our own.

C Richardville:               27:52                So to me I think it would be a very nice way to move forward is to actually have multiple across industry CIO leadership getting together to start to look at how do we fight and protect our assets our data from cyber attacks as a unified industry as opposed to the different sectors

New Speaker:               28:16                I can see that as one of the myths that we probably believe is that we need to do this ourselves.

Bill Russell:                   28:20                And as you’re pointing out we all have the problem. I remember hearing a gentleman speaking and he said it actually was sort of this and the government a little bit he goes you know for cybersecurity essentially these countries these countries that are stealing the data and in this case he used China as an example he goes this is the equivalent of China parking aircraft carriers off the East Coast and West Coast. And just you know attacking on a daily basis he said you know the federal government needs to step in here he goes because almost none of you can protect against a nation attack on your individual your individual organization because those nation attacks those nation state attacks on your hospital or on your on your organization are and you know unlimited funding unlimited time unlimited unlimited resources. So you know. So how do you think we’re going to partner with how you partnered with say the FBI the with the federal government. Have you seen them sort of take a role in this.

C Richardville:               29:28                You know I’ve advocated up on Capitol Hill multiple times for multiple different conflicts and cyber was one of them.

C Richardville:               29:34                And so I represented Chime which is a fantastic organization that you know I’ve represented premier and part of those discussions when talking to the federal government is they really will say if you want us to help put some borders around we’ll probably set you back about 10 years. Given the different restrictions and the different things that they have in place there and the expertise that they don’t have so I really think it’s across all industry thing.

C Richardville:               29:58                That’s why like for example next week at the Charlotte, it’s going to be all the CIOs across multiple industries representing you know probably about 40 to 50 different major companies that are home based here in Charlotte will all be coming together to talk about cyber and things that they’re doing where we’re going.

C Richardville:               30:18                When you say you can’t do it yourself you’re 100 percent correct. I think that’s a misnomer that some of us you know may have had in the past. You know I started doing cloud computing oh you know maybe about 10 12 years ago moving things off premise moving things out knowing that I did not want to be a data center centered company nor a service but that was going to be more of a utility and it’s going to be what I’d do with that information that actually make a difference and one of the questions that came up was how are you going to have our patient data our most precious data you know off campus somewhere else being stored. You know my response to the board at that time was you know you can’t expect me with the budget and the investments that you’re making today to have a better perimeter for protection and detection when it does come in as somebody who does this as part of their core business.

C Richardville:               31:09                So actually by moving it off site or moving it up to the cloud in many cases you have a higher level of security and protection by doing it that way. And then it becomes more of a service you’ve still got to have some people on the streets of the street in your shop. but a lot of those services the 24/7 monitoring all those types of pieces need to really be helped by somebody who does it as a core component of their business. And we do it as you know as kinda almost like a insurance policy for our business. It just doesn’t have the amount of investment that others can do you know in the cyber security space.

Bill Russell:                   31:45                Yeah. And I think this that is one of the myths right. So cloud is not secure. Well you know saying Cloud is not secure is like saying healthcare I.T. is not secure. Well it depends on which one you’re talking about but you know Microsoft’s cloud Google’s cloud Amazon’s cloud boxes cloud salesforces cloud you know if they get breached that’s their core business and they will have a significant hit on their revenue. Their shareholders, their share price. I mean so you have to know that they’re spending a ton of time and a ton of money on security and probably far more than any individual health care system is spending on security so I agree with you I think that’s one of the myths is that cloud is not secure. There are many clouds that are much more secure than what we have. Here’s another myth I’m going to throw at you which is cyber security is a technology problem.

Bill Russell:                   32:38                I don’t you know cyber security has a component that’s technology. But you know at the end of the day it’s you know 70 percent of all breaches are caused by individuals either you know clicking on something doing something reusing their password all over the Internet having it hacked that way. I know that and I shared this before and that you know there’s a CIO I know went to RSA I believe and said you know we want to do an audit. We want to see if you can get some of our physician credentials on the black market and it only took him about 48 hours to come back with some actual credentials of acting physicians that they could log into their Sytrics environment get into their EMR and start viewing patients and when they did the research on why that was because those doctors used those same credentials that they used to get into the EMR they use them for their banking system. Because you know have to remember 20 things. So it remains a people challenge more than anything. How do you get. You know Baylor, Scott & White now 70000 some employees with Memorial Hermann. How are you going to get 70000 people to act in a way that’s not going to jeopardize your security position or security posture and that still remains the biggest problem within security I believe.

C Richardville:               34:06                Yeah I think part of the problem with that is when you look at in some cases I think there’s also an understanding or at least the feeling that in many cases consumers are a little bit numb to the cybersecurity number one they don’t understand it. Or number two we’ve probably all been breached. You know a handful of times in the last couple years whether that’s a target breach or the Facebook I mean you name it I’ve got several different you know monitoring services free of charge on me because I’ve been breached so many times they offer that out there and so when that does happen you need to take advantage of it getting back to the core question about the company.

C Richardville:               34:40                I think it is a people problem but a technology solution and by the solution standpoint. You know it is the people that are doing this. And when you go through we all the the education we all do the fake phishing.

C Richardville:               34:51                We all know we did all those things and when you look at it. Even when You tell the Department of the division I’m coming at you next month. You know with a bust. You see marginal improvement. People are still clicking on those phishing attacks and jumping into you know places that there really should be jumping into. I think it’s for us. You know it’s still the continuous to try to manage monitor or detect contain when it does occur because you’re right. Every system every system has been breached. If you have not been breached you just don’t know right. That’s the underlining fact, you have been breached. So once that does happen just like the question that somebody posed to you, to just assume they’re already in your spot. You have to contain it. You have to contain it so it doesn’t spread.

C Richardville:               35:35                Then you have to remove it. You have to figure out how they went in and try to plug hole again because it’s an ever changing world. You know when it comes to the expertise coming in on these attacks. The other thing I’ll say is when you look at today’s Internet population globally it’s about 4 billion. I think they’re estimating it to be 6 billion in the next five years so there’s going to be a 50 percent growth of the potential number of victims for cyber attacks. So you talk about the cyber criminals. You know they’re just kinda salivating like my number of potential attacks will go up by 50 percent of victims over the next five years. That’s a huge growth. That still isn’t even the total population yet. So from that standpoint I think they see it as the pot is keep getting bigger. That’s where I think as an individual company or an individual industry there’s only so much that we can do.

C Richardville:               36:27                I think to step it up a notch and do things that are all industry like we’re trying to do here in Charlotte if you could bumped that up in other major cities and have those cities come together I think you would see over a period of time possibly everybody working together on this because to me you know this is not a competitive component of any type of business you don’t wish this upon you know you are your worst competitor. This is not something that you play with. We all want to play in a very safe environment and have everybody’s data be protected. You know whether it’s yourself, your competitor across the street or somebody across the country so as for all of us to come together and that’s going to be I think with the leadership the boards the CEOs come together start to link things in so when you look at some of the mergers that’s probably you know one of the advantages that goes undetected is initially and look at the merger we are about in the beginning. The one thing that will say is those are two very large organizations that now will be able to share best practices among each other about how to better protect you know the assets of the data that they’re privileged to keep on behalf of their patients. And so they will end up having at the end of the day a much better detection in place than what currently have in each individual organization.

Bill Russell:                   37:37                Yeah well I’m going to move us along. This is this is the part where you’re going to end up doing the majority of the talking I’m going to. The sound bite section I’m going to toss out five different questions. Short answers 1 to 3 minute answers if you go longer I’m not going to stop you. But generally one to three minute answers on these things. We are gonna focus in on innovation. The first time I met you was at a Dreamforce event and I think we were the only two healthcare CIOs at the event and we happened to sit at a table talking to people about how healthcare could benefit from CRM and you know I think it was pretty forward thinking back then. And I was kind of surprised to even see any other health care CIOs. I think there was more. I think Dreamforce is actually going on this week or more. Yeah I think it’s going on this week. There’s probably more health care CIOs there now than there were before so. All right. So five questions. One to three minute answers. Let’s start. Question number one what industries do you look to for inspiration for innovation within healthcare.

C Richardville:               38:42                Great question. My answer would be all. I think there’s a lot of nuggets to gain from all inustries so when you look at the energy sector.

C Richardville:               38:50                There’s things that they do to try to limit the use of energy. And so from that standpoint we’re trying to limit the use of health care. So those are both two very precious resources. So I think there’s things we could learn from them. Retail obviously and how to brand how to get things out there baking services all that stuff kind brings things into patients hands or consumers hands putting things in your pocket. I think all those different industries are all things that we can learn from. We never within healthcare had to or very rarely had to focus much on the consumer aspect of delivery. People came to us because their doctors told them to come to us or people picked those Doctors because they were a part of our plans that they were in network versus out of network. You’d have an in network bank. I don’t have in network you know retail shop I can go to wherever I want. And I think now that we were continuing to move although I believe at a slower pace than expectations in terms of you know consumer directed and high deductible plans. People do have choices to go in and out of network for the best value of their dollar that’s coming out of their wallet. So from that standpoint I think there’s all those different sectors got to learn from. And I don’t think there’s a specific one that would lead all of them I do believe they all have advantages where they you know moved ahead. And that’s where I think when it looks like the Charlotte’s CIO Association you know when we started coming together half a dozen years ago or so more informally part of what we realized was 80 to 85 percent of all the work that we do was the same that there’s a there’s very few that actually of the things that we perform as a CIO that actually was different in a bank versus a energy sector versus the healthcare sector. So once we found that we’re not that “special” that we always thought we were, was really great to be able to share things back and forth and use some of the techniques that they’ve used and bring that out to the healthcare industry.

Bill Russell:                   40:46                So that’s great advice so if you’re a healthcare IT person without those relationships outside the industry and you know you might might learn some things and they might learn some things from you so it’s great to have those relationships. Second question what core technologies do you think need to be in place for health systems to become really a digital business or digital platform for business.

C Richardville:               41:11                I think what you have to do is you really have to empower the patient. Patient/consumer Im going to use that interchangeable because to me it is interchangeable. The patient actually has made a commitment to come to your organization. But the next time next week they are a consumer again making choice. So to me got to be able to put the information to make those decisions in their hands. You know when most of us do you know transfer money to our children or somebody else I need to pay a bill we pull out our phone and we make the payments that way. We want to purchase something. You’re sitting there in your car driving along in the passenger seat and somebody say hey you know we need X. You pull out your phone you buy that hat, we buy that piece of thing. You want healthcare. I don’t think its become a habit yet. Which is pull out your phone and you deliver that service. I do think it’s going to grow and that’s where I think you see some alignment with banking or banking at big banks where we have hospitals then you have branches and we have urgent care centers and physician practices and then we have you know urgent care centers and they have kiosk machines you see a lot of things that are happening that way.

C Richardville:               42:18                Now I think it’s mostly in your pocket. So for me I think the number one thing is to be able to go to the patient where they want you to be at versus the having the patient come to you.

C Richardville:               42:30                That’s going back to 10 years ago we all got into telemedicine and every article now that I read recently kind of continues to show the amount of savings that is occurring not only in terms of that actual cost for that visit but also the repeated recurring afterwards I read something this past week that talked about if somebody had a virtual visit versus a visit with a primary care physician there is less likelihood that that patient will show back up again for any kind of health care service within the next three weeks. But if you go to the primary care they’re going to want to follow up as is. So from that standpoint you know you start seeing the costs going up when you start doing it the old fashioned legacy way and the new way having it in your pocket you kind of one and done here she needs to reach you. Most of us typically have our phone in our pockets at all times.

C Richardville:               43:16                Anywhere you can access that information real time.

Bill Russell:                   43:20                There’s some interesting skills. Third question so I’ll narrow it down to three areas three areas like to get your thoughts on innovation possibilities for each. So let’s start with the clinician experience. So what are some opportunities for innovation in that in the clinician experience today.

C Richardville:               43:42                Yeah I think there’s two things. I think one is patient generated data. Let the patient do the work. You know let him or her submit online or submit via you know the Web the information that they’re gathering so if you’re monitoring somebodies vitals. You know let them take the vitals at home. Let them step on that bluetooth scale let them do the things that they need and have that information be imported back into you know the EMR for you to be able to look at. So I think putting that workload upon the patient. You know most of us if you look at banking again you know you wrote checks in the past or you went to the bank to get cash. Well now all that stuff happens to me.

C Richardville:               44:20                So let me do the work I do those clerk and those teller activities myself and I want to do it myself. So let me do that work for you and I think on the other side you hear a lot of the interaction with EMR and the glitch people measure satisfaction as a very highly correlated with the amount of clicks that they have to use on their on their mouse. Well the voice technology has certainly advanced use the voice to interact with the system just like you use it for Alexa today. Yeah I saw you can pay bills you know using the voice schedule appointments using the voice Alexa can read back the results back to you. If your in an exam room talking to a patient and you want to see their most recent results. Let your voice be the input into the system to allow it to navigate for you so you can bring that information up versus turning your back on the patient. Clicking up here clicking down here pulling things back up I think the voice will alleviate some of the frustration that people have when their providers have interacted with the EMR.

Bill Russell:                   45:17                So it is second area innovation possibilities around the consumer patient I have those listed as two separate but since you brought them together as consumer patient experience what’s I mean this is probably the most talked about area was once some of your thoughts on innovation possibilities for consumer patients.

C Richardville:               45:38                Yeah and this this will be innovative for healthcare but not innovative for other industries and you starting to see it to come out recently Walgreens announced a couple of months ago a marketplace.

C Richardville:               45:47                I mean you really have going to have to bring out cost quality be open be transparent don’t fight that don’t keep it inclosed don’t keep it as a protection for you within your healthcare system if you’re not proud of your reviews or youre not proud of your cost then fix it. Fix that problem. But I think as a consumer and you know next time I want to make a decision I want to see all the possibility just like when I purchase a product or service or I want to go to a hotel I can pick any hotel in that city. I can see what the cost is for that night. I can see what the quality reviews are you know for that hotel. I can read comments that people made about it. I can look to see if I have any other kind of points or things that I’ve earned to allow me discounts or other types of benefits before I make that decision.

C Richardville:               46:33                When you look at health care you typically go in blind with most if not all that information. So I think the marketplace is going to be a big piece for consumers. I think the health care system that says hey we’re very high quality. We have reasonable costs. I’m a great value. I’m going to go out there and compete online open Transparent with other providers and when you look at especially the telehealth type services those borders around the state. Those are going to be very soon disrupted broken out. You’ll be able to see providers across you know multiple states and so from that standpoint if I’m in California I don’t have to buy a product from California I can buy it anywhere in the United States and have it be delivered. And that’s going to same things gonna happen with health care. You’re going to have that openness that transparency when we make these decisions and it’s going to be a demand from the system I mean from the consumer they need to be able to make well informed decisions. And I think that’s going to be a driver for us in that marketplace.

Bill Russell:                   47:32                All right well let’s shift to the Fourth question is how do you engage the consumer patient when identifying innovative innovation opportunity. So I know that some health systems have patient panels that they bring in and some that will include groups of patients in their innovation sort of identifying the opportunities and checking the progress of different especially mobile technologies and those kind of things. How do you how do you engage the consumer patient in your innovation opportunities.

C Richardville:               48:11                Yeah I think those are all great ways of doing it. The one thing that you don’t want to do is you don’t want to take something that hasn’t been tested yet and beyond that the proof of concept to bring that out to the market to be exposed because that would look you know that will not be a good representation so for me going with and I call it like a dimmer switch you kinda get the idea you turned it on.

C Richardville:               48:33                You start to get feedback you keep on doing it keep turning it up but you can take that dimmer switch and once you’re ready to roll you can flip it all the way on high. So that’s not an issue the issue is how to get from the current starting point to high. And I think in a methodical yet fast way because whatever is innovator today for you tomorrow somebody else can imagine you got the on to the next thing. So once you get something there you get it rolling you’ve got to be thinking three to five years ahead of what I want to be delivering. Then when the health care system or the physician market or whatever you know whatever area that you’re working in is ready to take advantage of it. You’ve already moved on to something else. It’s up to them to change their processes to take advantage of it to modify the people to be able to take advantage of it and to bring all that together. So from a technology perspective you’ve got to be know Something in advanced, but when you look at your market. And you look at your healthcare system. It’s going to be up to them to accelerate and bring that up. When you look at with the consumer you can get one shot. You know once you kinda of mess something up the somebody they can move on to the next fighter. So from that stand point I think you’ve really got to be careful before you’ve got to be focused. You’ve got to be fast.

Bill Russell:                   49:41                Yes So, Last question you could eventually be with one of these innovation partners. The last question is what do you look for in a vendor partner that is bringing innovation into your health system. Are there certain characteristics you’re looking for. You know what are you looking for from them.

C Richardville:               49:59                I think to me probably first and foremost it’s it’s kind of having a shared vision a shared culture you know people that have the same type of relationship that you want to have together.

C Richardville:               50:09                So from that standpoint you know bringing people in that are a good “fit” within the organization I think is extremely important and equally important to me is shared risk this isn’t all upside for them and you know just downside for you if it doesn’t work. This is a shared you know we’re both gonna win it together aren’t going to make it together. This is not something that I’m here to be a test bed for you so you can go take it somewhere else. I want to be part of whatever that is I want to be part of that solution if we can make it so that it’s actually an advantage to our health care system.

C Richardville:               50:38                Let me help you be part of something else. When you look at things of that nature. You know sometimes people go back and they look at how they can almost like or “take advantage” of those relationships. I don’t like to see it that way because it’s to your advantage that that partner is successful. So it’s not squeezing everything out of them. Put all the risk upon their back. They don’t make it too bad. There’ll be another one tomorrow. I think this is something that if you do due diligence that you’re going to be working together when you have these kind of stumbling blocks that part of your culture and part of what you want to get accomplished is that you are going to be flexible enough to be able to change enough modify enough to continue to adapt to that whatever cause that you’re looking. To me it has to be a good fit.

C Richardville:               51:18                And has to be a shared risk with it.

Bill Russell:                   51:20                Absolutely. Well Craig thanks for coming on the show. Is there a good way for people to follow you on social media or other things.

C Richardville:               51:27                Yeah sure. I mean I actually think Craig Richarville is the I think I’m the only one in the world that actually has that name. So from that standpoint you know we look at Craigrichardville.com or any of my social media whether it’s on LinkedIn or whether you’re looking at Twitter or anything of that nature probably LinkedIn and craierichardville.com Is the best way to take a look at me and to see some of the things that we’re doing and I’m totally open to engaging in open discussions anybody has any questions comments thoughts and just want to kind of brainstorm some stuff like in this case with you. This has been so enjoyable and that the information that you bring back to all of us is fantastic so I certainly want to applaud you for what you’ve done over the past year. Certainly you’ll be able to double your goal as we strive to do things of that nature.

C Richardville:               52:18                So congratulations on that. But certainly if anybody has any questions thoughts anything at all send me a LinkedIn note or craigrichardville.com You know like or that contact me and be more than happy to get back to you and that’s the one thing that I will say I’ve never ignored a message in my life. I have always replied back, now the reply might not be the answer you’re looking for but I’ve always replied that so please feel free to reach out

New Speaker:               52:44                YEah and having been a cio and having reached out to CIO’s that’s no small task with the number of people and communications you have to deal with everyday.

Bill Russell:                   52:54                So awesome. You can follow me on Twitter @thepatientsCIO the Health Lyrics website for my writing. Don’t forget the show’s Twitter @thisweekinhit Check out the website thisweekinhealthit.com and the videos thisweekinhealthit.com/video will take you to our YouTube channel. Please come back every Friday for more news information and commentary from industry influencers. That’s all for now.

 

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