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The 229 Podcast: Technology Is Not a Strategy - the Problem-First Approach with Shane Thielman

Bill Russell: [00:00:00] Today on the 2 29 podcast.

Shane Thielman: How do we leverage the digital assets and capabilities that we have to improve quality and outcomes, reduce cost structure. And I really kind of see this as a defining moment from an IT standpoint as to how we can further enable the organization

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Bill Russell: My name is Bill Russell. I'm a former health system, CIO, and creator of this Week Health, where our mission is to transform healthcare one connection at a time. Welcome to the 2 29 Podcast where we continue the conversations happening at our events with the leaders who are shaping healthcare.

Let's jump into today's conversation.

All right, it's the 2 29 podcast, and today I'm joined by Shane Thielman, Corporate senior Vice President, chief Information Officer, and Digital Officer Scripps Health, San Diego. Shane, welcome back to the show.

Shane Thielman: Thanks, bill. Good morning. Great to be here.

Bill Russell: it's been a little while since we've chatted. Part of me wants to ask what, if anything has changed since the last time [00:01:00] we we spoke. You've been at Scripps now for what, almost 20 years?

Shane Thielman: Almost 20 years, yeah. I just had my 19 year anniversary back in July.

So, seen it through a variety of different phases and transitions and , occupied a variety of different roles along the way as well.

Bill Russell: When did you guys do your Epic implementation? Was that a while ago?

Shane Thielman: It was, we we did it in several phases across the organization starting in 2017 and we wrapped up in 2018.

So a little different than the model that Epic has been promoting more recently, which is the. Single big bango live. I'm appreciative that we had the opportunity to deploy the way that we did because we really took the lessons learned in the first deployment and applied those to the second and third in a way that made those successive rollouts much more um, palatable for the organization.

And we were able to apply all of the lessons learned in a way that by the third go live, it was more or less a non-event, which was outstanding.

Bill Russell: How much time did you [00:02:00] put in between each of those go-lives for the learning?

Shane Thielman: It was always planned as a three wave go live.

But originally we were going to give ourselves six months between the first wave and second wave. We went live across our ambulatory environment and wave one in one of our hospitals. we had some challenges that as we were digesting and working through those, we actually extended the timeline between wave one and wave two to one year.

And then um, the third go live was shortly after wave two. So we fitted in over the course of a year and a half.

Bill Russell: And how close to foundation I'm not sure that was a word in 2016, but how close to foundation were you when you went live?

Shane Thielman: we were more or less consistent with Foundation at the time.

And I think part of our planning, even for our initial go live was then thereafter to make sure that we stayed consistent with Foundation. And so we've really committed ourselves over the course of the last seven years [00:03:00] to continue. We've been on a semi-annual upgrade schedule and actually just wrapped one up this past weekend.

Again, it was, much like our third wave of the go live. It's just become something that we've been able to sort of, integrate into the organization relatively seamlessly, and it allows us to stay current and benefit from all of the latest features and workflows and the latest code that's available from Epic.

So. That's been I think an important part of our journey is just that level of consistency and and then making sure that we're staying abreast of all of the work that Epic's doing to unlock new features and capabilities.

Bill Russell: So that was a decision from the Go Live, so you didn't have to do a refuel or anything to that effect.

That was a strategic imperative of your implementation.

Shane Thielman: It was actually a guiding principle and you know, we spent a lot of time talking to other organizations about what they would do differently, not only at Go Live, but thereafter. And we suffered through you know, having two different electronic health records.

One in the ambulatory environment, one in the acute care environment, two different registration and billing systems. [00:04:00] And so when we made the decision to move forward with Epic. We determined that we were really going all in and then that ongoing commit commitment really maintained and curate the system in a way that would actually positively affect our users.

And increasingly more our patients vary directly in the context of all of the features that are available to patients through MyChart, which we've rebranded as my Scripps.

Bill Russell: All right, so I'm gonna cheat a little bit here. I have a city tour dinner tonight and 2 29 Summit this weekend.

You hosted the San Diego City tour dinner early September. What were the topics? What was what was top of mind for people in that city tour dinner?

Shane Thielman: as I'm talking to. Peers and colleagues and other organizations. I mean, I think all of the change that's coming at the federal level was a consistent theme throughout the dinner and specifically the reimbursement changes that are on the horizon.

Both the knowns, but then some of the other. Potential reimbursement changes that are contemplated in the future. [00:05:00] But then translating that into what is the role that technology can play in helping to promote effectiveness and efficiency? How do we get to outcomes even faster? How do we leverage the digital assets and capabilities that we have to help drive continuous improvement in the organization?

Improve quality and outcomes, reduce cost structure. And I really kind of see this as a defining moment from an IT standpoint as to how we can further enable the organization, help improve workflows, quality, patient provider experience but as well identify ways in which we can use technology to, to reduce cost structure.

Bill Russell: The last conversation we had it was apparent to me that you guys are as an organization, Scripps is very disciplined in terms of their selection of projects, in terms of measuring projects defining what the objectives are, and then measuring them all along the way.

What are the things. I mean, we're digitized now. We have tools in patient's hands. We have tools for [00:06:00] clinicians. What are the things that you're focused on that you think are going to move the needle in terms of you know, cost, quality and access?

Shane Thielman: you, you hit the nail on the head at least in terms of, I think being very pragmatic and methodical about how we select initiatives as an organization that has its challenges because there's no lack of demand for it and analytics in the organization.

And so we spend a lot of time on prioritization. I think from a strategic standpoint, the philosophy really is that it should help enable the strategy as well as the operations of the organization, but it itself is not a strategy. And so there's really three key areas of focus that we have. First in no particular order of importance, but I think first is really around digital and virtual enablement and how we can use our digital and virtual assets to improve navigation for patients. Really enable personalization and then I think very importantly, help [00:07:00] reduce friction. And a big part of our focus has been around, availing appointment availability online. And so we've really been on a journey since our initial deployment to activate a lot of the self-service features both through the patient portal. But also on our Scripps.org website to give patients access to schedule their appointments online.

And it seems very foundational and simplistic. We've been on this journey for about seven years now. We have about 40% of our, appointments available to schedule online. So it really speaks to the change management. I think challenge but also imperative that we have in healthcare, which is how do we make ourselves accessible and available to patients and give them alternatives from the traditional phone call in to the physician's office or into a contact center and our patients are responding.

You know, we see. Uh, Year over year, an increase in adoption of the um, the online scheduling [00:08:00] capabilities. But we're also attracting new patients to Scripps that have choice, which I think is very important as we think about some of those. More existential challenges that we face in terms of reimbursement, particularly with government payers.

It's gonna be increasingly more important to distinguish ourselves in terms of being a provider of choice for those that, that, that have that choice. And, and so, but that extends well beyond just online scheduling. Everything from enabling, you know, patients to have visibility into wait times in our emergency departments and our urgent care centers.

Being able to hold a place at our lab draw stations and be able to see the wait times across our various draw stations. We've done a lot of work with virtual to enable on-demand virtual visits both in our equivalent of our retail clinics, but also for primary care. And then we've spent a lot of time operationalizing wait list features that are, you know, giving a.

Over a hundred thousand patients in any given 12 month period, access to appointments anywhere from 14 to 16 days in advance. And that becomes particularly important in some [00:09:00] of the specialties and subspecialty areas where we have fewer providers and we wanna make sure that our patients are getting access in a timely fashion.

So. That has been a real core area of focus for us. It will continue to be a core area of focus, and I think that there is really unlimited potential there. There's also a shift, right, in terms of giving patients more ability to self-serve. And that doesn't mean that works for every patient.

And so we also are focusing um, a lot culturally, which is less about it on this mindset of getting to yes. And how do we make sure that we're helping our patients navigate to the right services, recognizing the complexity that's one critical area of strategic importance for us.

Another has been really around operationalizing um, a command center for the organization. That command center now has several services that are co-located, and we really think about this as a hospital department that's serving all five of our hospital campuses. Um, We focused around patient [00:10:00] flow for several years and we've systematized the way in which we do bed placement, but we've seen some really demonstrable improvements in key metrics or performance.

We've been able to deliver automation and prioritization for some of our support services like EVS and transport. We're seeing improvement in the time from decision to admit to getting a patient into an acute care bed around a 20 to 25% improvement in that cycle time. And then enabling some other capabilities within the electronic health record that really create visual management for the care team around the progression of patient care through their episode of care.

Bill Russell: What,

Shane Thielman: More recently we centralized telemetry as well, and so we took really a function that existed at each of our five hospital campuses. We consolidated that technology sta stack into a single server, and then we took the telemetry technicians and we actually reorganized them, took them out of the hospital.

And put them into the command center. And along with that built standards around how we educate and [00:11:00] train our telemetry technicians, how we do hiring. We changed our equipment management processes and als ultimately our clinical communication pathways. And then we also enabled some technology that gave clinicians access to real-time wave forms.

So we've been using really the command center as a mechanism to leverage our human capital and our human talent differently. But then also think differently about how we leverage our technology assets to be more effective and efficient. So just a couple of examples. And then, you know, that sort of third leg of the stool, of course, would be ai, which is its own conversation.

But those are sort of three strategic areas of focus that I have and that the IT department has in really enabling the organization

Bill Russell: I wanted to go through a bunch of those. So just to give people some context here. So Scripps is pretty much San Diego County.

Are you outside of San Diego County at all?

Shane Thielman: No. So, we're specific to at to San Diego County.

Bill Russell: Would you, do you think you would still do the command [00:12:00] center approach if you were more broad based geographically?

Shane Thielman: I think the command center, based on the experience that we've had could certainly contribute.

Um. Across a, a multi region health system. I think there's complexity related to culture change that has to be accounted for, and having an underlying foundation, having a standard technology stack to begin with, would be critical I think, in order to fully realize the outcomes. But I do think that there, and I think there are many organizations that are doing this today across multiple regions successfully.

So I think the answer is yes. There's some caveats to that. I think ultimately to enable the type of outcomes that we've been able to realize to date and really sort of unlock the full potential.

Bill Russell: The uh, patient flow and improvement. I forget the exact me metric, but you were like we improved by 20%.

I mean, what does that, what does that lead to? Does that lead to is there a financial return to that? Is there an efficiency return to [00:13:00] that? is there a, a satisfaction return to that? I mean, what does that look like?

Shane Thielman: Yeah. You know, we spent a lot of time thinking about. Not just the measurement, but how does that translate to overall improvement?

I think the reality is there are so many initiatives that are occurring in most hospitals that are focused on targeting length of stay improvement. And so rather than try to attribute. These enhancements to a length of stay improvement. We've tried to look holistically across the episode of care at all of the white space where patients are waiting.

Um, and, And that's really where we focused our efforts. So we haven't translated in it into a direct length of stay improvement or a direct financial improvement for the organization. But what we have said is that we know that we have , high demand for our emergency department services. We have a need to be able to turn beds over efficiently.

And so anything that we can do to attack that white space, to free up an ed bay um [00:14:00] to free up an impatient bed. And we can hardwire our performance standards and expectations. We can train to standard work and we can embed that within our digital footprint and we can feed back performance on a realtime basis is going to contribute to an overall improvement.

So this has been a little softer in that sense, but we do have KPIs that we track to and manage to on a routine basis. And that's really done in conjunction with clinical operations who really have to be at the table in order to to support those types of process improvements.

Bill Russell: how have you guys attacked discharge time?

I, every now and then I hear stories of, you know, people waiting hours and hours in a bed that we know is in high demand.

Shane Thielman: Yeah. I think it's a great question. We actually started that was our, sort of our first step in addressing flow, which was to adopt a set of discharge milestones that were visible to the care team and created some alerting for members of the care team if.

There were delays in certain milestones being completed and [00:15:00] then the transparency within the electronic health record to identify which activities were still pending and ultimately what member or members of the care team are responsible. So that was sort of our foundational first step in addressing flow.

The other thing that we've done, we've instituted, a 10 12 2 program. And what we do is we measure ourselves discharge order written by 10:00 AM patient discharged by noon and bed cleaned and available for next patient placement by 2:00 PM And so that is another, sort of operational activity that we've hardwired into the electronic health record as part of our standard work.

And then, you know, I think, bill, the other thing that that we've done is and I think this is, you know, in the future it will be exciting to be able to deliver some um, some predictive analytics as well, is upon admission, there is an expected date of discharge that's documented in the electronic health record.

By the admitting physician. And the concept there is to try to manage to that expectation and understand where we have variation [00:16:00] against that expected date of discharge. We spent a lot of time residually in trying to reduce length of stay, and so we're relatively high performing overall when we look at national bench benchmarks in terms of our decile performance.

But really understanding those outlier cases and how we can do continuous improvement. And again, it's all about how we can utilize the technology that we have to do the visualizations to create awareness across the care team and then really build that into our daily clinical operational huddles as well.

Bill Russell: You know what's interesting earlier on you said, either technology is not a strategy or it is not a strategy. Whatever it was, is some terminology around that. If people are listening to this conversation. It's obvious, like we haven't talked about ambi. We will talk about ambient and we will talk about the technology.

We haven't talked about ai. We have, we're talking about the problem sets and we're talking about the objectives of the organization and applying the, you know, technology to, to get to those objectives. I'm gonna. Push you a little bit in the technology direction. When you guys look at [00:17:00] ambient and you evaluate ambient, I assume it's in the context of all the things that you're talking about now.

It's not just, Hey we've heard other systems are doing this. Everybody seems to be happy with it, we're gonna do ambient. How did you build that business case and what did that look like?

Shane Thielman: I think it was back in 20 18, 20 19 nuance at the time announced that.

They were developing an ambient technology solution. I distinctly remember being at HIMSS for that presentation and we sort of put it on our radar at the time. We were just coming out of our our EHR install, but I think we're really captivated by what that could mean. And fast forward to early 2020, just before the beginning of the pandemic we took a small group out to visit Nuance in Boston and learn more about.

Really their roadmap and how they envision this um, rolling out in organizations. And and then COVID descended on us and we were uh, understandably distracted and focused on other things, but we actually were early adopters of DAX back in 2022. This [00:18:00] was before it was fully automated and it was a little bit more it was probably one of those decisions that was less structured around.

Key performance indicators, but more based on I think the cognitive burden and administrative burden that our physicians were experiencing as really the justification to do an experiment. And we brought Dax into the organization. We deployed it with 50 physicians at the time. Um, We learned a tremendous amount around success factors just in terms of cultural readiness and change management, which was probably not a surprise, but obviously it's not as simple as turning it on.

If you want to get the level of adoption that really can be translated into demonstrable improvements in provider experience and patient satisfaction. One of the, probably the most interesting findings that we've had with Ambient is the quality and the fidelity of the note that's generated.

And when you think about I think some of the, just the challenges that many organizations [00:19:00] have with the potential for copying and pasting of notes and maybe the lack of personalization of notes. We actually had our internal compliance team do a review of the recording against a set of notes that had been generated.

And I like telling the story because the outcome was that the individual that completed that audit actually changed their primary care physician to a primary care physician that was using ambient listening, because the,

Bill Russell: that's classic

Shane Thielman: fidelity and the quality of the notes was outstanding and. I actually think that's probably overlooked in a lot of the conversations that are happening around ambient.

I think addressing cognitive burden is really important. Giving providers more face time with patients critical patient satisfaction is essential. But if we think about where we're going with ai. That note in many ways serves as a foundation for so many other workflows and processes. And as we [00:20:00] start to think about the role of Ag agentic ai a lower quality, lower fidelity note that wasn't generated with Ambient you know, could have some implications for some of those.

Future AI enablers that that we see on the horizon. And so, we have actually taken a pretty stepwise approach since then. We've been experimenting on the inpatient side, so specifically with a group of ed physicians and using ambient. It works for some. It's still evolving in terms of the technology itself, at least in terms of the perspective of some of our ED physicians and our as well are looking at exploring some options with our hospitalists in the future.

But we've kind of taken a wait and see since the initial deployment, we're now using the dragon copilot, which enables both the speech to text as well as the ambient. That's a very nice feature for us. But but I foresee us expanding more in the future, but we're taking a very sort of incremental approach and making sure that we're really prepared for a [00:21:00] more full scale deployment.

Bill Russell: Yeah. I'm good. You know, you just talked about the person switching their provider based on something. At UGM this year I was sitting next to, or sitting near a physician, CIO and after they showed what what was possible with Cosmos and it's sort of looking over the shoulder of the clinician and providing it like, Hey, what about this?

Maybe take a look at this. You know, outside of the alert fatigue that they already experienced and having cosmos look over your shoulder and the cul cultural change that's required. I did I asked the physician, 'cause I said, you know, my response to this as a patient watching this is, I think I want my physician.

To be somebody who is comfortable with AI and is, and utilizes ai because I don't suspect that every physician I'm gonna see has read, every journal has reviewed my entire medical record has, you know, and all those things. Whereas I know what AI [00:22:00] can do, it can digest all of those things. And if given the right context, it can provide very helpful information moving forward.

Were you at UGM this year?

Shane Thielman: I was, yeah,

Bill Russell: First of all, as a CIO, how do you walk away from that and sort of package that up and go back to the organization and say, okay, this is what I saw. This is what is potentially around the corner for us. And then how do you, I don't know, socialize that and get that into the process of people evaluating, you know, is this something we should prioritize?

Shane Thielman: I feel incredibly excited and enthusiastic after most egms, and at the same time I feel drained because it's so much information. And I think to your question, it's really around how do we start to plan and meter out the way in which we would adopt some of these new features and capabilities.

And you know, to your comment earlier in your observation, we really focus on problems [00:23:00] first. And then how can we use technology as part of a solution? That's usually coupled with an operational change or a business change. Maybe it's a reorientation of who's performing the work. and so I think with that as our mindset, you know, we actually came back and had a sort of a near term, midterm long-term list of opportunities and potential priorities based on our understanding today

Bill Russell: The problem with the long term is there's gonna be another UGM before you get to your long term.

Shane Thielman: Exactly. Well, and I think you're actually, you know, you're hitting on something else, which is, you know, what is, what is our ability I think as an industry really to increase the cycle time in which we do and sort of, integrate change into the organization and

almost any change that happens is dependent to a degree on the way in which we use technology or data and analytics. And I think this is, you know, again, this is where I [00:24:00] spend a lot of my time thinking and talking to my colleagues both in the organization and outside the organization. Because to your point, the, there's sort of a deluge of opportunity.

How do you select and how do you prioritize? And then what are the trade-offs, right? Because there's an opportunity cost of selecting. You know, one priority and maybe deprioritizing something else. But I think we have to do that if we're going to be successful because I, you know, my fear with ai is that.

We don't unlock the power and the potential because we don't bring our workforce along in a way that they have an understanding of how to be successful in working with AI based on their role. And ultimately based on the capabilities that we can offer them. And I think, you know, kind of starting with our physician community, I mean, I think that's a group that we absolutely want to gain familiarity and comfort in working successfully with AI and hopefully creating pull where they're reaching into the organization and saying.

This is fantastic. We learned about this and we'd really like to you know, to [00:25:00] take a next step and understand how we can integrate whatever this is into our practice and into our workflow and that's where we're spending our time right now is really how do we build the literacy of our workforce around being successful with ai.

We're not doing anything today in our organization with AI at scale. I think over this next year we're going to get there, whether it's with our nursing community or with our physicians, but that won't happen just because we make the AI available. It actually is going to take some level of effort, both on education and training, but also sort of understanding how this can be assistive and help augment the workforce.

And I think our experience has been when we've invested the time and effort, more narrowly, we've been very successful in level of adoption and receptivity and understanding and almost, you know, kind of driving that demand for more. When we've kind of parsed that against maybe a less involved approach, we don't get the same outcome.

And [00:26:00] oftentimes we get a sense of discouragement because we didn't put that additional effort in. And so I think that's a big part of the work that we're doing here at Scripps is to really. Be there and be alongside the user, whether that's a clinician or an administrative user in order to get the outcomes that we believe are available.

Bill Russell: So last UGM, they rolled out a hundred and let's just say 150 new AI features. This UGM, they rolled out a hundred and something new AI features. And you know, the first year I think they made a mistake because they sort of talked about it like, Hey, you just switch it on and we're all sitting there going.

No, no I can't just switch it on. However,

Shane Thielman: right.

Bill Russell: That is how AI is sort of showing up at every health system, including Scripps. It's like, you know, Microsoft baked it in Workday's, baked it in, ServiceNow's baked it in.

Shane Thielman: Yeah,

Bill Russell: Epic's baked it in. How do you govern that when it's like all of a sudden there's just another feature that sort of shows up in the application itself?

Shane Thielman: Yeah. You know, it's interesting. We spend some time [00:27:00] trying to understand utilization patterns, particularly when we're in a vendor relationship where that AI just suddenly appears. It's actually really interesting Bill. We don't see a lot of our employees or clinicians necessarily going to seek it out, so it really has to present.

In the context of a workflow or a process if it's just suddenly enabled. So that's kind of our first, that's our starting point. It's just understanding what are people actually discovering and finding that is available and then being very intentional about the things that we are making available.

And so I'll give you an example, and I don't think that we're different than many organizations, but we have a um, an internal private connection to OpenAI and ChatGPT anybody can access it, we have about a thousand plus employees and physicians that are using it some more than others.

We probably have about half of those that are routine users. We've really used that as a proving ground to get people comfortable with how generative AI works, what its limitations are. We've [00:28:00] created kind of a sharing economy. We have folks that come together and share their experiences, what's working for them, what's not working.

That has actually been very powerful and it actually kind of creates this virtuous cycle where they start talking to their peers and colleagues and suddenly we have people joining these, these meetings where folks are sharing what their experience has been and then they ultimately sort start to use and adopt and start to, you know, kind of apply their creativity to generative ai.

And it's been fantastic in terms of what it's helped to facilitate across the organizations also brought very diverse roles together. Everything from. You know, you know, kind of a frontline practicing physician to administrative support, revenue cycle personnel IT folks. And so I think that's been really exciting.

Our goal is to continue to foster that, particularly over this upcoming year because to your point, the volume of opportunities that are available and many of them are just going to be enabled naturally within the software that we use. We [00:29:00] wanna make sure that folks understand that they're there and then.

Even more importantly, how they can add value.

Bill Russell: The promise of technology has always been that eventually it would become invisible, right? It would sort of go to the background and the example I give, it's not a great example, but the example I give is, in the car you're driving down the road.

All of a sudden, not only does the car beep, if you're getting close to the car in front of you, it actually steps on the brake. And if you go over the line, it sort of rumbles a little bit to sort of. Joel? Yes. It's like it's doing all that stuff in the background. I haven't looked at the stats, but I would imagine each one of these things, I know that when they put that light in the back of our in the back of our car and they elevated it, it took the number of accidents down precipitously.

And I think each one of these features takes the number of accidents down precipitously. I think the promise of AI and the promise of these tools is eventually that they are operating in the background and they are. Doing things. And the best example I could think of is you know, it's imaging reads and [00:30:00] it's essentially you have the primary read that's being done by the by the radiologist or cardiologist or whoever's being done by. And then you have the secondary reads that's being done by ai. It says, oh, hey we noticed this. Potentially those things are going on. I mean, that's the promise.

That's what we're hoping for, is that technology would, again, move more and more in the background. But there's an awful lot of design and an awful lot of work that goes around doing that. How do you, how does your team partner with the with the frontline organization? It be it administrative, be it clinical to identify the opportunities to, to roll that technology out or roll it out effectively?

Shane Thielman: By no means are we perfect. We spend a lot of time on shared governance. And even, you know, kind of preceding the genesis of generative AI and all of the excitement that's come with that over the last few years. Just really basic blocking and tackling in terms of bringing together our acute care nursing groups, bringing together our hospital-based physicians.[00:31:00]

Working collaboratively with our radiologists and support teams. And so that foundation has been very helpful as we start to more formally evaluate some of these very sophisticated AI capabilities. Just using the example that you shared, bill and imaging obviously we're constrained.

We don't have unlimited resources, and so that prioritization becomes very important. We have some, um. some capabilities that are lined up and prioritized for next year that are going to move us much closer to that sort of target state, right, of truly assistive AI that can help direct a radiologist to a potential, you know, patient concern with an imaging scan and hopefully help improve our ability to deliver a diagnosis in a more timely manner and and start a treatment process. Most of the work that we've been doing with AI to date, I think has really been focused around administrative cognitive burden and sort of the.

Operational inefficiencies that just naturally [00:32:00] exist in our healthcare system, which is a great sort of starting point and foundation. I think over the next, you know, 12 to 18 months at Scripps, we're gonna continue that work, but we're gonna start to move into how can we use AI to personalize the care experience for our patients?

And then ultimately, how is that gonna move into helping to inform diagnosis and treatment decision making. The basis for that really is how do we organize ourselves as an IT team? You know, we're not successful if we're not out in the field interacting with our counterparts and our partners. I have to be doing that at the executive level and with our physician leadership.

And so we've really kind of. Leverage that foundation that goes all the way back to pre, you know, EHR implementation and kind of road, that wave of maturity, which I think is very exciting because there's also an understanding to your earlier comment that. We could be doing a lot of things.

What's gonna add the most value? What's gonna help move the needle for Scripps and and for our patient community and [00:33:00] ultimately what's gonna be a good investment? And I think something that you said earlier, you know, the best technology is technology that's invisible. I think we also have to make it so good that, um. our end user community and our patients feel like they can't live without it. Right. And so that's really the promise that we have to make back to the organization is we have to become really good at implementation. Right. And really understanding did we achieve our adoption metrics? And how is that translating into a process or improvement or an outcome for the organization.

Bill Russell: I run the risk of uh, PTSD question here, which is I wanna talk about the 2021 event. Now, Scripps, you guys as a leadership team have been fantastic. I mean, we have a lot of learnings as a result of how open the leadership team has been about it.

We have financials because you guys shared, you know, what the impact was financially and. Look, I think the question I wanna ask is I think one of the things we learned is you don't talk about your cyber [00:34:00] posture on a podcast, but. But I wanna talk about culture. How's it changed the culture? I mean, when you have an event like that, is it the farther away you get?

You have to go back to, like, reminding people? Or is it like always present where people go no. How are we gonna secure this? Has it changed the culture and how does distance from that event change the culture?

Shane Thielman: it was a traumatic event for the organization. So it's not lost on those that were here today. Um, And I think probably one of the most important things that we've done is we've really translated that experience into set of sort of routine clinical continuity exercises that are.

Co-facilitated by operations and is, and we are doing detailed tabletop exercises to simulate independent of whether it's a cyber incident or [00:35:00] some other sort of catastrophic event that limits access to systems in a way that ultimately could impact our ability to serve our community. And. I think that's really an extension of just our learning around what the impact was the organization, for our employees, our physicians.

Our patients others in the community, other providers so that we're more adequately prepared in the event that there is any sort of catastrophic failure that impacts script. So I don't think that we've lost that, you know, when there's some sort of network issue. I think everybody still holds their breath, hoping that they're not going to hear that, that we're dealing with a cyber issue.

And so, I think there's a deeper understanding and respect as well for the importance of having those safeguards in place and what it can mean in terms of maybe adding a little time to a particular workflow in order to ensure that it's secure or even how we onboard new medical equipment.

[00:36:00] So we've really tried to leverage all of the things that we've learned through that, both in sharing, more broadly with the healthcare community, but but as well apply those learnings internally and we still have plenty of work to do.

Bill Russell: You know what Shane the thing that surprises me still, 'cause we have these 2 29 meetings and we talk about this and the idea of business continuity and resilience.

One of the questions I always throw out there is, okay, who owns it in your health system? And if you haven't gone through an event like that, a lot of times they just sort of look at 'em like, well, I think they think it owns it. I'm like, yeah, it really can't own that. Like, I mean, they're a big part of it, obviously in cyber, but they can't own it from a, you know, from a, a hospital operations standpoint and continuity standpoint, it's got, it's almost owned by the entire organization.

it's a change in the culture and a change in the thought process.

Shane Thielman: It is we see ourselves in is as, as facilitators, but really as [00:37:00] partners to those operational leaders. And so those clinical continuity exercises that I described, we're doing those now on a quarterly basis.

We have one actually scheduled next Friday at one of our large hospital campuses. It's co-sponsored by the chief operating executive of that campus, and then our Chief Medical Officer, chief Medical and Operations Officer for the health system. And so it's gonna bring together about 25 to 30 different stakeholders from both.

That site as well as physicians. And then our IT team. And we'll work through that exercise and then we'll debrief and talk about what did we learn, what do we need to change moving forward? What do we need to do to adapt our policies and our standards in order to be successful? And then we share that more broadly across the health system as well.

Bill Russell: Fantastic. Shane, I wanna thank you for your time and I wanna thank you for, I just, all the work that you're doing it's really exciting. I mean, we talk about the fact that the CIO role is much more about organizational change management and this conversation is proof that you guys are really [00:38:00] living that out and I appreciate it.

Shane Thielman: Yeah, thanks, bill. I think it goes, uh, goes without saying that really appreciate what you're doing as well with the 2, 2 9 initiative and the way in which you're bringing together various stakeholders across the industry. Routine listener and really appreciate the way in which you sort of facilitate the dialogues and conversations and bring together unique perspectives.

It means a lot and it's certainly assistive to me in my day-to-day work. So appreciate it.

Bill Russell: Appreciate it. Look forward to the next time we get together. Thanks Shane.

Shane Thielman: Absolutely. Thanks.

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