Podcast with John M. Kravitz, Chief Information Officer, Geisinger Health

Welcome to the big unlock where we discuss data analytics and emerging technologies in health care. Here some of the most innovative thinkers in health care information technology talk about the digital transformation of health care and how they are driving change in their organizations.

Paddy: Hello again and welcome to our podcast. This is Paddy and it is my great privilege and honor to have as my special guest today John Kravitz CIO of Geisinger health system. Welcome to the show.

John: Thank you very much. I’m happy to participate.

Paddy: So for the benefit of our listeners why don’t we start with a little bit of a background on Geisinger.

John: Sure. So Geisinger is an integrated delivery network which also is in the process of becoming an academic medical center. We do have a medical school which has been incorporated into our organization about two and a half years ago but Geisinger consist of 13 hospitals with individual platforms over 500 clinics which are part of a system. We in two states Pennsylvania, New Jersey and we also have a health plan which has approximately 600,000 subscribers in that plan.

Paddy: And doesn’t that make you somewhat unique. You’re now going to be an academic medical center, a health plan, and a health system. And we’ll come back to that in a minute. So, how would you, as a CIO, how would you describe the technology stack at Geisinger?

John: So, I would equate that to a best of breed stack at the at the moment, but we are taking efforts and initiatives to standardize on singular platforms to be more efficient more cost effective and better information delivery service. We were a very early adopter of Epic for electronic health record of Geisinger back in 1995. So, we were one of the very early adopters. And at that time Epic didn’t have a lot of the modules that they have today. So, we had a best of breed clinical environment due to that fact so separate radiology, information systems separate, pack system of course which will still be the same, separate lab information system, and so on so forth. We have since begun to consolidate those applications within the Epic stack. And so, we are currently on pace to implement a new laboratory system in the next couple of years will take us about two years for the implementation and build lab and resolute for our billing platforms. And we are doing that across our entire organization. So, while I talk about Geisinger in Pennsylvania it is primarily Epic, Geisinger here in New Jersey which is Atlantic care is primarily Cerner. So, we will implement the same billing solution for both platforms. It’s been done before but is a little tricky. So, we’re very cautious in how we approach that before we begin the implementation work they’re really doing a detailed design understanding of all the data flows and then progressing in that environment. In addition to that we’re also implementing a new human capital management or HR payroll solution and also a CRM solution. So, we have quite a few projects that are underway but really excited about the opportunity to really bring our technology stack more on line and consolidate that stack to a platform which is much more integrated and very much holistic platform approach.

Paddy: Right. And of course, I have to ask if a between Epics and Cerner it is going to maintain both of them exactly the way they are. Or do you plan to consolidate into one.

John: I think over time we will probably make that decision whether we consolidate but at the present time we’ve just implemented the server ambulatory platform and New Jersey hospitals. That’s going extremely well. And we do have a lot of ETL activities which goes on. So, a lot of our work is not necessarily in that transactional system as an electronic health record. It’s more in our analytics engine and we could talk about that a little bit more as this interview goes on.

Paddy: Right. Now thank you for the clarification. Now of course you know all the talk in health care and indeed across most sectors is about digital transformation which means harnessing emerging technologies, harnessing innovation, and so on. So, from everything that we see on the research that we do health care system in the early stages of a digital transformation. Could you share your thoughts on what you see as the current state of health care?

John: Yeah, I’d be happy to. Oh, I’m sorry Paddy I thought you were finished.

Paddy: No no no. I was going to say specifically health systems.

John: Sure. Yeah. So, you know I think we’re excited about the opportunity for building our digital strategy and that’s the key because we’ve had so many touch points where we work with our patients, our customers closely. For example, we’ve built applications that are mobile based apps for like a patient refund app and for patients scheduling app and a lot of one off scenarios without really having a full digital transformational strategy and how we want our approach, how we want to prioritize our work how we want to reach out to the customer as well as to our providers who are really important in this entire process. So, we are just embarking upon this digital journey. I think it’s going to be one that will pay us tremendous dividends. Now getting back to the health care sector as a whole I think a lot of health care integrated living networks or health care providers even community-based providers are probably in the earlier stages for a digital transformation process and strategy. I talked to professionals from groups like HIMMS and chime and the Chief Digital Officer is becoming a transition for the Chief Information Officer to a Chief Digital Officer or could be a hybrid position between Chief Information Officer and Chief Digital Officer. But what’s really important is that there is awareness that is the needs of the customer must be met and we need to make it as easy, as smooth, and frictionless for our customers to be able to access our services and if we don’t do that the competition will certainly do that and that will take our market. So, we want to really be cognizant of it, but we don’t want to rush to market. I think you know having a methodical digital strategy where the business is very much involved in the entire evaluation and prioritization of projects and requests will be really important for us.

Paddy: Right. Now you obviously touched upon you know the consumer engagement and patient engagement side of it which seems to be a very big focus area for the entire healthcare sector. What are some of the maybe one or two other drivers for digital transformation as you see it?

John: Well I think in our example that I can use. For us it would be providing access. Let me explain. In our environment because we have a health plan, we also have a crossover but not 100 percent crossover to our health system. So, approximately 35 to 40 percent of our patients that I should say subscriber My Health Plan actually received care in our health enterprise. So, to us that’s our sweet spot if you will where we can make sure we’re providing the ultimate care for those subscribers. By doing that we’re keeping the cost down for health care costs. And it’s an advantage to the rest of our system because it’s you know there’s premium dollars that are collected and if their care is managed effectively, we can provide a wonderful service for our subscribers. So, one of the use case scenarios that we’ve talked about early on for our digital strategy is patient outward facing appointments and the potential to use whether it’s a chat bot or a digital assistant which can assist us in those processes because we do have contact centers. And at this point in time we have about 2300 employees are tied to the contact center work. Now that’s not only scheduling patient appointments that is also we have a large mail or pharmacy business. So, we have a pharmacy contact center which has pharmacists and pharmacy technicians that are actually the people on the contacts and are addressing calls from customers. We have a nurse Tria’s contact center, we have care management contact centers. So, we have a lot of different types of contact centers but we feel that you know an area where there is a lot of attrition, a lot of turnover because they’re not you know they’re not high end positions but they’re not real low end positions either but people will have an attrition factor where there’s other jobs within the system become available and people transition those jobs or jobs outside of the system. So, for us because it’s a big turnover area because it’s so critical to our business to be able to fill those apartments especially for Medicare patients managed care. Medicare patients, medical assistance patients or even our primary care and specialty appointments. So, we’d like to leverage that as one of our first points for our digital strategy to really focus on fulfilling that need of outward facing working with our customers.

Paddy: It’s very interesting. So, clearly that’s an area of synergy between the health plan and the health system. The fact that a third of your members also happen to take health care from the system. So, can you talk about maybe a couple of other major synergies for instance is it a common IT function for instance. Do you have a common analytic function for instance? Could you talk a little bit more about the synergy?

John: Yes, actually we’re doing more synergistic approaches and centralizing as many of our support services as possible. So, IT is one particular area where we do centralized project management across the enterprise regardless if the work is done in the health plan or the health system or regardless of which platform and health system. I mentioned earlier there are 13 different hospital platforms that we support as part of Geisinger and a number of initiatives. So, we centralized our project management office and that reports directly to the CIO to myself. We also have centralized a lot of our services with development too so we could take advantage of agile development techniques. And, as well as using specific tool sets which are standardized across the enterprise. And, another area which analytics is has been a focal point to consolidate the resources with our big data platforms and bring those resources together to be able to really focus and attack large projects and have great success with those. So those are some examples Paddy of areas where we have centralized services and got some economies of scale from that. But we’ll continue to work to improve those economies of scale even further.

Paddy: Right. You know. I want to kind of dig into that the last comment a little bit more traditionally. You know we know that the interactions when you know health systems, the health plans with whom they work which is not owned by the same entity have not been as as let’s say as collaborative as we would like in areas like data sharing. For instance, if we look at the marketplace in general. So, clearly you have an advantage as you are able to share data or not. Have you seen that translate into tangible improvements in let’s say population health management? Have you been able to see that and quantify it?

John: Yes. So, we have, and I just want to be clear. There are certain data elements that we cannot share. Between the health enterprise, a clinical enterprise and the health plan and the health plan and the clinical enterprise because they have other. As an example, in our health plan there are about a hundred twenty-five thousand providers that are part of that health plan. And you know a limited segment of those maybe about thirty-five hundred are from a clinical enterprise of Geisinger. So, there are contracts and other relationships that are established to have to be kept separate and distinct by regulatory requirements and the same thing happens with different plans and information as far as other contracted services from other insurers that we have on the clinical enterprise side. So, putting that on the side just wanted to put that out so everybody knows we’re above board and doing things properly and following regulation. We do have a lot of synergies and where we’re seeing a lot of those synergies is because you know we have whether it’s a commercial insurance which is a small piece about 200,000 of our 600,000 members are under our commercial insurance plan. The rest are government sponsored managed care plans so whether it’s medical assistance I should say Medicaid or Medicare we manage those patients effectively through our health plans through the Geisinger health plan. So, where there is value that’s saying though is that we can actually use a lot of our technology to manage those patients effectively. We have developed a lot of unique programs like Geisinger at home or a physician, a pharmacist, a nurse, care manager will all travel to the patient’s homes for severe chronically disadvantaged or chronically ill patients. And these patients typically have three or more comorbidities so they may be a diabetic patient with hypertension, cornea eye disease and it could have COPD. So, those patients really need a lot of care. And as we manage to care of those patients effectively and we do have some telehealth services patient monitoring in the patient’s homes which can alert us you know back to the through the clinical enterprise and really go back to our care team. So, we’ve leveraged a lot of technology. We do a lot of predictive analytics on the patient population. And it really identifies the sickest of the sick patients that we should be focused on to care for effectively. So, there is a lot of synergy now the care management those patients really critically important that data really critically important so we can track how well patients are responding or when other interventional services we may need to provide for those patients.

Paddy: Right. Fascinating. Let’s come back to digital transformation and emerging technologies John. So, let me do this I like to do something you know which I call a lightning round if you will. I’ll kind of talk about you know four or five technology emerging technologies and then you can maybe share your top of mind parts on the maturity level of those technologies. Then we can begin to your leveraging any or all of them at Geisinger right. Ok let’s go with the first one here cloud.

John: So, we are starting to use a lot of cloud services at Geisinger. All of our new applications with the exception of our Epic because we do most Epic on premise. We have not moved to the epic cloud yet and we may or may not depending upon the cost to do it and if it makes sense as far as a total cost of ownership perspective but a lot of our newer applications I did mention human capital management HR payroll which is a workday solution definitively a cloud solution. So, we’re leveraging that our CRM at Salesforce. That will definitely be a cloud solution as well. Just on the early stage implementation for that. But there are a lot of these initiatives moving forward. We service now as our IT service manager platform definitely a cloud solution that’s worked well. We’ve deployed more and more cloud but as you do that there are certain controls that need to be thought about for cyber security and hipper data loss prevention. So, we’ve been working before we get full blown on the cloud and even Office 365 for Microsoft to migrate all of our exchange in one drive and in SharePoint locations and teams to the cloud will be really important but we want to have data loss prevention in place so certain things like a task B is extremely important for that. So, you can tie that information back to your security profile platform and surveillance and there are other initiatives and things you need to think about when you migrate to the cloud. Will you have enough bandwidth. Do you have enough separate ISPs that are disparate that can provide the service in the event you lose one ISP and you don’t lose connectivity to cloud solutions. And in some cases, even a consideration of having some data resident in a local datacenter in the event you do go offline off the cloud and say the worst-case scenario all the ISPs are down the Internet down period that remain pop what happens. How do you not disrupt your business and drop the downtime procedures if at all possible. So those are some of the considerations I think that we’ve built into ours. We want to have five nines of availability or better and so we are taking a methodical approach to cloud. I know a lot of magazines you read or articles you hear, or other podcasts say Oh you got to get out of the data center business. But you know you’ll never truly get out of that data center business migrate everything in the cloud because you still use it or as your main distribution frame tying everything together, so you still need a location for that. You may still have some straggler applications that just don’t fit into the cloud appropriately. So, that is part of our strategy though Paddy and I think it’s a solid but it’s methodical and how we’re approaching it.

Paddy: Right. So, you will remain a hybrid cloud environment which is just kind of what I hear from most health systems. And you know I’m also trying to get a sense of where you draw the line. Do you think more and more of the emerging tech solutions or emerging solutions themselves whether it’s from startups or from or from other companies. Do you think more and more of that is likely to be in the cloud whereas your core just records like your electronic health record system they’re more likely to be on. Is that kind of a broad line that you would draw between a cloud-based operation and an on prem operation.

John: Well you know the way I look at it and I’m sure others have a different perspective but you know if you look at the simplistic approach to it you have if you are a cloud based vendor that has their own private cloud or using you know AWS or Azure or Google cloud or whatever or Rackspace or one of those. You know you have one place where you need to maintain your code and make sure that code is current. It’s almost like the old RCO approach from the past where things were hosted like the old SMS way back then. So, it seems to keep things more structured in place but it also you know would have a tendency to move your upgrade paths and other things in a closer alignment not necessarily being that free open and flexible as you had with your on-premise solutions. Now a lot of the EHRs vendors are migrating to the cloud because quite frankly a data center is an expense and it is expensive to find the people to support it. And sometimes that attrition of those people makes it challenging. So, I think you know the big electronic health record vendor Cerner has been probably ninety-five plus percent of their clients are hosted in the Cerner cloud but they also have the ability to host other applications in their cloud not just the electronic health record. Epic is primarily new to the cloud but they are starting to move there and a number of their customers and some big customers have migrated to the cloud with some great success but they’re working on this at least the best that I understand it is working on their strategy for the other applications to host those. And I’m not sure I have not spoken to Epic directly about this recently. They may have made some great progress, but Athena health is primarily a cloud based EHR vendor. So, I think we’re seeing much more migration to the cloud and I think that’s going to be a direction we’ll see just continue to grow.

Paddy: Right. Artificial intelligence. What are your thoughts on the current state of the eye and anything that you doing that you could share with us at Geisinger?

John: Ya sure. I think the state of AI is interesting. I think it’s going in a lot of directions. But you know if anyone’s attended the HIMSS conference that just took place at the end of February beginning of March. You hear vendors everywhere on the floor saying that they are using AI or ML. Whether they’re using it or not, whether they understand it or not I think it’s a very vast array that can be considered part of artificial intelligence and machine learning. And, so the way that I traditionally looked at this is machine learning you’re learning from historical transactions that you have and trying to assimilate that information so that it makes sense. Artificial intelligence you know from my perspective is more like yes, I’m looking at this and I can infer what may happen next. Or I can anticipate what will happen and have the machine know perform the next steps in that process and then predictive analytics are saying my probability could be 60 70 80 percent that I’m right on this and I can predict what these scenarios are. From looking at historical data again machine learning and artificial intelligence. But it’s an area that we dabble in a lot at Geisinger. We’ve been known for innovations probably 15 plus years working with innovations and especially analytics. So, we have a number of different areas that we are working on now and working with AI ML and predictive analytics and I can give you a couple of use case scenarios that we’re doing but what we do is we won’t just do this research and publish something in JAMA or Harvard Business Review or somewhere else. We typically will incorporate that into the workflow in our clinical enterprise. So, I think that’s what is important because we can develop these models but really show an improvement in the patients care that’s being provided. So, I think that’s important. And so, we have a couple of initiatives underway right now. One is on cardiology and we can literally look at the historical data for our patients. We can predict whether a patient will have a stroke in the next 12 months and it’s a very high probability it’s 90 plus percent probability of what we’ve experienced. So that’s helped a lot with cardiology and neurology patients. And so that’s one of the initiatives that we’ve had and we can and we do alert our providers when we see these trends that are happening with the patient based upon clinical factors that come back from whether it’s laboratory results or documentation and a note where we use natural language processing to pull that information out of a note and assimilate that data into a data warehouse. So, that kind of information is really valuable. And the second one is really it’s around doing overreads of radiology, images using a product called TensorFlow to determine if there are any types of nodules or early growths that may be occurring that aren’t necessarily picked up by the human eye. It’s too early.

Paddy: Right. You know I hear that the most progress that has been made in applying artificial intelligence to predict outcomes or predict disease progression or in a predicted way has been in use cases involving images that you know a lot of the published literature seems to refer to images that seems to be kind of the hotspot if you will. Or success do you get the same sense?

John: Yes. In working with our clinicians and we have data scientists that work that span between our research division we have two research divisions I did not mention that initially when I opened up as far as about Geisinger. But in working with our data scientists which are they are MDs/ PH.Ds. So, these people are they are super trained they know all the analytic tools we use are in Python and some of the other languages for this, but they know all the regression techniques you know all the comparative analysis on that data. They really go to town on this data and we have a very rich data environment because we’ve had electronic health records for twenty-two three years now. And a lot of our patients are so to speak cradle to grave. So, we have a lot of information to learn from now that’s in our corporate environment but at our other campus locations we have a lot of transient patients, so we learn a lot from that as well.

Paddy: Right. There’s a lot of emerging data sources that now are available. And you know these data sources are growing the data types are also growing. So, can you talk a little bit about how you’re integrating the genomics data or lifestyle data into let’s say your population health management programs and what are some of the typical challenges you face when you do that?

John: Yeah. So, what we’ve done we’ve genetically sequenced well over a one hundred thousand patients right now and I think the number is probably 125 to hundred fifty thousand patients. That data is not integrating the genome sequence. The Acxiom sequences not the variants are not embedded into our electronic health record yet. We kept those in a separate database, but we can tie that back to the information in our electronic health record for our patients. We are looking at the genetics module from Epic corporation and plan to implement that in order to capture some of that information. But you know it’s ironic. I just did a conference on Friday at the NIH in D.C. and one of the things that it was a predictive analytics conference and a lot of the researchers, health systems that participate all feel that genomics is a piece of the puzzle but not a large piece of the puzzle. Bigger components are your zip code the characteristics of where you live, your lifestyle of the people where they live there, eating habits you know things of that nature exercise routines all that stuff plays into your health even to a larger extent now genetics and genomics can unlock doors for opportunities that you may not have seen know in in the diagnosis process. So, there is definitely a value there. We do not have those two joined together in our workflow yet right.

Paddy: Now genomics data that you are keeping as a separate database. Is that mostly for regulatory reasons or is that.

John: No it’s just that we don’t have a space a location that we can really closely tie that together into our patient database yet.

Paddy: OK. And I’m assuming that these are all you know permission you know a patient.

John: Oh yes. Yes. Every every patient that has been genetically sequenced had to consent and no officially sign a consent to do that.

Paddy: OK so back to our Lightning Round. Let’s talk quickly about you know block chain and 5G. They were making a lot of waves. Blockchain has kind of dropped off the radar a little bit. OK about it last year not so much this year. This year there’s more talk about 5G for a variety of reasons. You want to powerboat and what do you. Yes. Related but don’t you know maybe just take them together so.

Well let me keep it a little bit separate because blockchain is an area that we’ve done a lot of research on and we’re looking for the appropriate use case scenarios for block chain because the ability to block chain is in theory is supposed to have a higher level of security. It’s harder to break the chain although you do reach scenarios use case scenarios internationally where the chain has been broken. Also, the value of it is the audit trail capabilities to be able to pull back every transaction that ever touched you know a patient or a financial transaction that may have occurred or whatever else. So, we’re looking at our supply chain and we’re looking at blockchain as a potential way of supporting that enhancing the supply chain experience. So, let me give an example an implantable device, an implantable life could be a pacemaker could be anything. I mean there are a lot of different it could be a new hip, a new knee or whatever. And so say there were a recall on that and if you had a blockchain with the supply chain components from a timing back to a patient from a lot of different data sources it would give you the ability to be able to just punch in a serial number and scan through the blockchain to be able to find that information at least that’s the use case that’s been explained to me by our team of engineers that want to work on this project. So, have we done a lot of blockchain? No we have not as a lot of places have seen the cool as you have stated but there is a strong potential that we may be using it for our supply chain initiatives or at least dabble in it to see if it’s really effective and then look at it for other opportunities Paddy a little further down the road.

Paddy: Right. We here that you know from some of our research that we do. Establishing the prominence of an item like an SKU seems to be one of the high value use cases in the pharma companies they are using it because they have a global supply chain which I’m sure the medical device companies also have. So, establishing the prominence helps you identify the point at which something may have gone wrong. And so that’s right to be. So great. What about 5G networks?

John: So, 5G were very much in a rural environment and I’ve talked to a couple of the major carriers specifically through my relationship with CHIME being a board member of CHIME and you know interacting with a number of different vendor opportunities. And so there seems to be an interest by a couple of the major cell phone carriers to begin to deploy 5G in a rural setting. Now, I think there’s flavors and levels of 5G that are available. I think a lot of it is enhanced 4G at this point in time although I’m no expert on 5G. I have some colleagues that are experts and I typically defer to them for deeper knowledge in those areas. It is an area that we are interested in. I think it can drive down latency, can improve bandwidth and speed a lot of opportunity especially as we do more telehealth services in the home setting. To me that’s exciting because it gives the opportunity for full motion video without latency specifically into the home setting when you are monitoring patients through telehealth even off an iPad or a mobile device in the home setting. So, I think there’s a lot of up shot with 5G. But it’s early and my knowledge is not as deep in that area.

Paddy: And from what I hear you said the only use cases that are emerging seem to be around rural Health and telehealth.

John: Yes. Those are the areas we are looking for Paddy to really leverage this. But you know a lot of our apps are moving to mobile as part of our digital strategy so I think 5G would enable that even at a faster pace.

Paddy: Right. OK. One more on that a voice enablement. There’s a lot of excitement around voice enabling you know Amazon. The Alexa service has just announced a couple of weeks ago a range of services that are enabled and HIPAA compliant and so. What do you make of all that?

John: Well I think it’s a great opportunity now. It’s been known and published that it’s HIPAA compliant. That was our concern to really go full borne on this other health systems have have gone out on the edge and are absolutely ahead of us. I know Atrium is one that I read about, and I hear great things about the work that they’ve done with Alexa and in other you know voice enabled tools. And I think you know as we get deeper into this process, we’re a little behind in that area because we’re concerned about HIPAA and protecting the privacy of our patients. But you know I think it’s one of those areas where in our hospital setting you know we want to have the ability and hopefully take some of the stress off our nurses where a patient can speak to an Alexa or Google home type device voice enable device and be able to interact with that and hopefully be able to be a customer satisfied to get the information and initiate it quicker and then be more targeted for our nurses and nursing assistants be able to serve that customer population more effectively. Hopefully some lean techniques can be brought into place for this.

Paddy: Right. Interesting. So, let’s talk a little bit about innovation at Geisinger and innovation again is one of those words that’s thrown out a lot in you know in the market. There seems to be a lot of innovation that’s happening just through day to day you know work in healthcare enterprises but there’s also an innovation ecosystem that’s developing or the digital health startups and even within health systems/ innovation arms. I think Geisinger has its own innovation group. How do you integrate the innovations into clinical care and what are the such as factors? And what are some of the challenges you’ve seen?

John: So innovation to us is really important. We don’t innovate just to publish, or research just publish. We want to innovate so we can make a difference in the care and lives of our patients. So, you know we’ve done a lot of stuff over the years and we have some things call like proven care where we’ve identified ways to treat a patient more effectively for a particular condition. And if they came in for like cabbage, coronary artery bypass graph. You know we had a specific set of order sets that we built where we administered antibiotics before the patient ever undergo for surgery getting ahead of it ahead of infection things like that. And these protocols have worked successfully. We’ve done another thing called proven health navigator where we actually navigate through a care manager process with our patients through the care delivery system through our care manager type approach. And we now we alert when a patient is under that care management protocol if they visit an emergency department because their medications are in need of being adjusted and as soon as they register at the emergency department it flags out and notifies their primary care doc as well as a care manager simultaneously. And in most cases can avoid the ED admission for that patient or ED registration process and get their meds corrected and they can get back in the home setting more effectively and they’re happy not to spend four hours or six hours in an emergency department. There’s something called proven recovery where we know by building a patient up before surgery that we need to we need to have a patient stronger. It’s always been stated that you don’t eat anything before a surgical procedure because you can have a you know of a poor reaction to your anesthesia but that’s been proven not to be the case. And small amounts of food you’ve built up the strength of the person they recover faster from surgery. There are no those issues but those all came out of innovation and evaluating new ways of doing things and learning from others. We learn a lot from Europe. Europe or the Middle East or even the Far East on their techniques. And we tried to leverage those for the work that we do.

Paddy: Interesting. Well John we are coming up pretty much to the end of our time here and I just have a couple of last questions. So, tell me what your advice for technology firms big and small who want to be a part of Geisinger journey.

John: So I do get quite a few inquiries from a number of different companies. I think the most important thing is to understand. I obviously don’t have time to stop and answer every one but it would be beneficial if they research before they hit me on a sales call because I think the benefit for these companies could be understand the direction that we are going as an organization how they may be able to support the work and the initiatives that we have underway right.

Paddy: Right. My last question for you John. What occupies your mind the most in a typical workweek as CIO of Geisinger.

John: Well we do have a lot of work transpiring and as I mentioned earlier Paddy in this process, we’re doing six enterprise applications which are under way simultaneously. They won’t all go live at the same time but a number of different diverse initiatives from joint ventures with other health systems where we’re going to outsource all their work to our systems and then support them going forward to this whole host of enterprise applications that we’re implementing at this time. So, there is a lot of that going on. Cybersecurity as every other CIO it’s in the forefront of your mind. You’re thinking about that all the time. You’re always looking to improve your cybersecurity stance, surveillance. All of those initiatives as part of cyber it’s really important to stay ahead of it as much as possible and to have people thinking in terms of what they do can impact cyber security. So, I would say cyber is a big factor looking at ways that I can you know establish our IT infrastructure our applications support teams at a lower cost providing a higher quality service. We’ve studied IT service management all of my entire team of about 900 people have become IT SM certified wants out we had them Lean-certified as well because we want to continue to look at new fresh approaches to how we do our work, how can we turn things around faster to meet the business needs of the organization and to do it in a very cost effective manner. I think that healthcare is changing dramatically as other industries have gone through this transformation. The difference is health care is very complex and there is a number of different outcomes that can happen. So to say that you’re going to just outsource the whole thing may work or it may not work and you’ve got to be very careful and involve providers you know throughout this process to make sure that you’re in alignment with meeting the needs of the providers to meet the needs of the patient. And in my mind, that’s the most important thing.

Paddy: That’s so well said John. John thank you so much for taking aside the time from your busy day to talk to me and for being a guest on the podcast. Really appreciate your time and I look forward to staying in touch with you.

John: Thank you Paddy. It was a pleasure. I really appreciate the opportunity.

Paddy: Thank you John. Take care.

John: All right. Bye.

We hope you enjoyed this podcast subscribe to our podcast series at www.thebigunlock.com and write to us at info@thebigunlock.com