Episode Two: Wes Cronkite Get Real About Healthcare Podcast

Oh, glad to be here. Thank you for having me. Excited to study the chat. It's going to be fun.

Wintertime, I'm a snowboarder. I do love to snowboard, get out to the mountain when I can. That's definitely my winter sport. The rest of the seasons, playing guitar. A little bit of acoustic guitar out by a campfire kind of thing is definitely a hobby. And doing whatever my kids want to do honestly has become my hobbies, watching them get into theirs. But yeah, that's probably about it.

Oh, those are good questions. I'm an audiobook guy, so I try to listen on the plane, in the car, on the train when I'm coming here from New Jersey to the DC area. It's a nice little train ride. So I'm getting into Malcolm Gladwell's stuff a lot. Outliers is one of the newer ones that I've been kind of halfway through. But I'll be very honest, taking a little break from reading. The school that I just went to requires a whole ton of it, so I had stacks and stacks of books. But I'm taking my time through that one through the summer. And binging a little bit on not reading and enjoying my couch for right now.

Oh, that's an easy one. Elon Musk for me. Really, really current celebrity. I would love to dig into just how he's able to do what he does, the things he's been through, and really get the true raw story from him on how he got to where he is.

Exactly.

I think I'd like the world to look a little bit more balanced when it comes to technology. This is more on the personal home side of the fence, but I do get very concerned with the amount of technology that's embedded in children's lives and how much of that is in the culture. I'd like to get to a place where yes, it's bringing value, making things more efficient, getting opportunity in people's hands, but not having it be over the top, taking away from things we enjoy during childhood and growing up. I feel like we're starting to tip in the other direction unfortunately right now.

That wraps around even in my role today and why I'm in the healthcare space: to make a good impact with technology. If you're not, let's really start looking at what those companies and industries are doing and ensure that technology is being used for good most of the time, not for profit or evil.

In the industry, it's something that they'll put at that C-suite level, saying we are very dedicated to thinking about things differently and driving for more modern use of technology, heading where our competitors or industry needs to head in terms of not doing what we used to do for X number of years. I think that's the concept. It can be pushed from managers and supervisor levels in certain companies, but when you truly want to go all in on doing things differently, you create that role of having someone in that seat who is incentivized to do that. It shows the company and the board's commitment to going after doing things differently. In the healthcare industry, it varies a lot. There are some roles where that's what's going on and we're trying to push things forward. There are others where it's just we've got to come across as innovative but not fully fund it and not be too serious about it, more of someone that's in the newspapers talking about it a lot, but if you look behind the covers, there's not a lot of execution. I think that's a lot of what I see sometimes in the industry as well.

I think overwhelming would be the word. I don't think I'm frustrated. Coming in a year and a bit after joining here, I don't think there's that much real hard pushback or walls that have been put up. There's been a lot of support, a lot of employees that have played along. We just opened up a Dream Factory challenge for the month of August that's actually going on right now, where 144 employees have joined together to start going after new things they've never been able to get done before, whether it's healthcare regulations or not having enough resources or bandwidth. They're now at a place where they want to play along too, which is very cool to see. But it is overwhelming. There's a lot of technical debt, a lot of old systems, a lot of healthcare regulation that hits you on the side of the head. It's a tough spot to really get things moving and pushed forward, but it's a challenge that I'm used to. I've been in this industry for some time.

It is good.

I was aware of CPSI from my industry background and worked with companies that either had to integrate with their systems or knew of what their platform was. I was excited as I understood more that they aren't just an EHR platform. I think that's the thought process out there: well, CPSI builds EHRs for community hospitals. When I found out they also do the post-acute space, and we've got this awesome Get Real Health solution, we've got TruBridge revenue cycle services, and we've got a platform that surrounds that, we just picked up TrueCode, it was very exciting for me. This is not just an EHR company. They're growing and making an impact. Also, their systems are at a place where they haven't seen the unlock that can happen with modernizing, getting to the cloud, and being able to do so much with the data. From my personal perspective, there's a huge impact here. Some of that will hit the community rural space, but that's exciting for me too because those are struggling hospitals trying to deliver care out there in these islands. Thinking that through and saying this is a cool challenge, there's a lot of support, an opportunity to really do this my way, knowing the systems I want to put in and not having to replace existing ones too often, and really be able to make that happen for the enterprise was exciting for me.

Access to any of the pathways, even the specialists, it's very difficult to figure that out in a small rural community. Any way we can help drive for those decision points, drive for data and information that'll help them guide the right pathway, is a meaningful impact to me.

Absolutely. The Dream Factory kind of challenge month that I mentioned is a piece of it, but really what the Dream Factory is, it answers the question for both our employees, customers, and stakeholders of what is innovation. You can stand up a Chief Innovation Officer, you can have an innovation team, but what is it all about? Dream Factory is telling our employees and customers that we're committed to innovation in a way in which we want to get to a proof of concept as quickly as possible. The Dream Factory is the mechanism to do that. We've opened up ideas portals both to our internal employees and to our clients. We're allowing them to submit their ideas. People can vote up the ones that they think are really impactful, and then we have a great list to look at and say, okay, let's put some of these into the Dream Factory. That means it's not going to hit the teams working on our big platforms and systems that already have what they need to deliver on their roadmap. We're going to have a separated group that can go in and get after these things and get them to the point where it's not just talk, not enough PowerPoint, not a conversation, but a tangible demo that we take a look at and say, okay, let's take that further, that's a really good idea, or that really doesn't work in our industry or with the data we have. But it's a quick turn. We've staffed it a few different ways. We've got internal employees of CPSI working on Dream Factory approaches. We've also built out partnerships with universities, like University of Maryland and University of South Alabama, and we're growing that over time into more universities with internships. People that just want to get involved in the healthcare technology industry. From there, we're also open to opening this up to external partners, other players in the industry, other startups that have digital health concepts. Come on in, we've got a big customer base, we've got data. If you've got a great idea but you're stuck, which happens a lot in the digital health world because you don't have the connections or the amount of data you need, let's pull that into the Dream Factory and see what we can get moving. We also talked about even crazier ideas: if employee teams get to a concept that really could be a startup business, we might actually fund that through CPSI so they can get the backing they need financially to push things forward. It's going to be fun to see this progress. It's been a fun ride so far. We've had a lot of successes, and we've also had innovation where some of these things stumble for a bit and you figure out that's not the right fit. Instead of putting a team of four on it for six months, test early, fail early.

Yes, it is. I know just being a startup and moving into this, it's the kid in the garage putting something together or the guy that's so darn frustrated because something's wrong and finally comes up with that really killer app. Those are the guys we want to inspire. We want to give them the support and the ability to really get in because healthcare is hard. It's hard to break. It's the connections you need, the data you need, the ability to understand the regulations. All of those pieces coming together is a lot harder than other industries. It really is.

Coming out of what we came out of over the past couple of years and the pandemic, it showcased very quickly that we need more digital solutions in healthcare. We need more ability to have virtual visits and interact with patients in the way they're expecting. That was a big eye-opener for the industry. With some of the regulations backing up on telehealth, it was fantastic, and I don't think that door is closing again. It was a pretty bright spotlight on the fact that we need innovation badly in this part of the industry. The cool part is that a lot of investment has followed, venture capitalists, but it's going to take a multitude of different organizations and stakeholders, both public and private, across the board to really make the impacts and change we need. It couldn't be more needed than now.

That is core. The interoperability problem around healthcare has been around for over a decade at this point. That is the sad part of the HIMSS conference every year, walking through that wing. But as we now have the ability to do more with big data and cloud technologies, and it's not as expensive as it used to be when you had to stand up an entire on-premise server farm to try and handle gobs of data, the cloud is making it a lot easier, less painful, and quicker to get to answers. The amount of talent is why I went back to school. I was in a role prior to this where I had data scientists on my team speaking to me about Python and pandas and numbers, and I didn't really know what they were talking about. That's not good because I have to make a decision on whether this model, like a readmission model, is the right answer or not. I did a ton of research on my own because I was anxious about it, but I really knew I needed to get further in my understanding because it is such a possibility now to go in with data scientists that understand those lighter weight technologies, dig into a ton of data, access publicly available data from CMS that's pretty easy to get to now through an API, and get to a lot of insight. There's just not the technical talent in a lot of these healthcare facilities to get to that insight. The people who can help and own that data and help them unlock that insight is going to be huge for the industry.

Absolutely. Where that's happening a lot now is more in the back office of the hospital, the administrative functions like revenue cycle and coding. Those areas are very rinse and repeat, transactional roles typically, but have a lot of critical thinking within them. For our teams that run our service line that provides support for hospitals that don't want to or can't afford to staff it themselves, we've lit up robots. Robotic process automation, which is a flavor of AI, can see and understand: they're going to this website, clicking this button, going over here. As long as it stays the same every time, we can record that and have them do it at robot speed, getting that transactional piece off their plates. That helps a lot with staffing concerns because now those people are either freed up to do more critical thinking work or we can do more with less people in those back office functions because these bots can tackle that. I'm excited to see that start to turn into the clinical care component. These EHR platforms, whether CPSI or others, are not easy to navigate. There's screen after screen after screen built up over decades of all the needs that have come about for hospitals. Ways in which we can potentially use AI or tools that can understand voice recognition and be able to say, 'I want to pull up the order screen,' have a bot that goes in and fires through the six different steps you have to take to pull up the orders, and it's right there. Now you're saving a tremendous amount of time and stress on clinicians that are already super stressed because they're working longer shifts and have more full facilities than ever.

I think of the analogy of when taxicabs showed up and we were in the horse and buggy world in New York City. It didn't take the jobs away. They figured out they could become taxi drivers and worked with that technology. It's a similar situation here. It gets people out of the transactional craziness and into a place where they're doing critical thinking and decisions, which is exciting work.

It is a tough one. Regulations and the way we roll them out, and the expectations on healthcare technology organizations to keep pace with them, doesn't help. Those regulations are put in place for a reason, but they hit pretty quickly. There's an expectation that these systems are going to keep pace, and that adds a ton of work that you've got to consistently keep up with. Then another one drops and you're after that. Also, the lack of standards around data and data models. We're getting there, FHIR is helping a ton in that arena, but the lack of that for so many years and so many systems built just wild west on how they were building out their data formats or structures means nothing can talk to one another. That also prevents progress. And you also have the large corporations that don't want to share that data, the walled gardens, which is so frustrating because it should be about the patient care. They're trying to hold that data because data is worth something. Some of the regulations open it up, but we need a little stronger to make that absolutely happen.

This is the exciting stuff that's going to happen out there.

It is a difference now. With cloud technologies making things a lot easier, there's less of a need for a deep technical understanding of a programming language or a particular model. It's much more about drive, passion, and the ability to research. There's so much out there available, so much data online to teach you what you need to know. I look much less around the technical qualifications and base it more on: is this someone who can explain how they went out and figured something out on their own, researched and understood exactly what the problem was, found the particular technology that fit that problem, plugged it in, and can speak to that? That is starting to turn the heads of some universities and training institutions. They're not basing it so much on delivering an Oracle database class; they're basing it more on delivering something around database best practices, where you understand the concept and then run free on a project where you can choose whatever technology you want to solve a business problem. That shift is exciting to see. Tying that in and bringing in talent, you want those types of folks that really understand. We saw that a little bit at Maryland with the capstone projects. Our future is bright. The talent in these universities is like wow, they've been playing with computers since they were born, so they really get it.

Looking at that and keeping us at that edge, always developing, it's kind of cool.

I think a mobile-first approach when it comes to technology is missing. Again, something we do well here with Get Real Health and in other areas of our business, but if you look at the holistic platform set of healthcare technology companies, a lot of it was built for sitting behind the computer. Nurses don't sit behind computers, they shouldn't be. Same thing with even the back office staff. Why do they really have to be? The world has gotten so much more mobile, to a hybrid workplace or a primarily work-from-home workplace. People are on the go, doing more, and expecting to be able to do what they need to do on devices that are not tethered to desktop computers. I would say that is definitely missing across the industry. And then the unified data model is something that a few organizations are chasing, some the right way, some more selfishly. There are even public organizations that are sort of rounding this problem. I do think it's something that needs to happen shortly for us to keep pace with what is required and get more comfortable, like other industries have, in a platform model rather than having to go out and buy everything all in one big chunk of technology.

If we can get to standard models and figure out where the overlap is in those data structures and potentially the overlap in regulation, I think that's definitely a possibility.

I think that'd be incredible. In those markets and countries, everything would need to be very lightweight, very mobile friendly, very low cost, and sort of light. But it's possible. You can make things happen in those end user devices that you'd be surprised can actually do things with a camera for exams or with just a few different data points being captured. That could really make a big impact. Think about that data coming in. As world health organizations are looking for different spots that are happening, hot spots, or looking at famine in different areas, that data could be really rich and could really focus humanity on going after those problem areas. Big modern data warehouses allow for that. You can stream that data, get it off of wearable devices, off of mobile devices, and make it happen. The expense of these is going down. That is where it gets exciting when we start talking about all these new devices that can be worn or in your hand. The world is wide and exciting.

We're definitely on the data side. There is a real need to be able to bring information in and talk about care paths and share those care paths across different countries. We're all just Americans, but we're not. Everybody has the same problems. Taking some things and unifying them into a way that can be done in different languages is incredibly important. Being able to take those and repeat them so citizens feel they're getting the same thing. I do think coming up with some care paths and things that can get good results out there, that can be easily popped into EMRs, patient engagement tools, digital front doors, those kind of things. We hear that a lot from our clients: do you have care paths? Care paths that can be adjusted to follow the regulations of those countries versus building one separately for Sweden, one for Scotland, etc. Being able to take that data, especially in the EU, to figure out where we can get people healthier. Outside the US, it's all social medicine, and they want to bring their taxes down. Healthcare is not free; it's coming out of your taxes. How do we break that down in a way that's easier to use? I think data is king, and making it simple is definitely king.

I think that plays really well with the goal to unify all of this data. I know that's going to be much harder as we get out beyond the states, but that enables what you're talking about. To be able to say, okay, now that we've got this unified data set, we can analyze and understand these care paths and say, okay, this is where it gets a little wonky over here, we don't see this streamlined workflow, there's a real problem. But also to say, okay, now we've got that locked, and for anyone who's under the same regulation set, there it is. That's pretty cool stuff.

I see the world in five years in healthcare in a place where delivering care is simpler. That's winning to me. It's a very aspirational model, but getting to a place where as a care provider in any setting, whether it's a hospital, which is probably going to shrink a bit, or urgent care facilities, just have a way to make that as simple as possible so they're not burdened down by administrative tasks or clunky technology and software, and really can get to the bedside, really go after the best possible delivery of care they can. The rest is easy. That's my hope for five years. In reality, five years goes like a blink of an eye, but I do think there's enough progress out there in the industry and enough people going after this that the companies and organizations that are thinking down that road are going to start to elevate themselves amongst the rest. I'm hoping that brings a groundswell of value to those delivering care and on the patient side of the fence. I think that will also become critical. Patients are going to have very high expectations, especially as more and more of them come along from the younger generations. They will be expecting this in terms of the technology they interact with, and they're not going to put up with the status quo. The future is bright. It's an exciting time in our industry.

Thank you. It's great being here.