Month: October 2019

We don’t want to improve patient experience at the expense of the clinician experience

Episode #26

Podcast with Nader Mherabi, Chief Information Officer, NYU Langone Health

“We don’t want to improve patient experience at the expense of the clinician experience”
paddy Hosted by Paddy Padmanabhan

Nader Mherabi, CIO of NYU Langone Health talks about digital transformation and its current state in the healthcare delivery space.

At NYU Langone Health, digital transformation means taking an enterprise approach to care delivery that is integrated, smart, and intelligent. Their vision is to provide a connected digital health service that is convenient for patients and their families, close to where they stay or work. The health system sees technology and digital as a great enabler and strategic asset to propel the organization forward in its mission.

Nader also believes that making the foundational technology work is critical for enabling the organization to build the digital capabilities of the future.

Welcome to the big unlock podcast where we discuss digital transformation and emerging technologies in healthcare. Here are some of the most innovative thinkers and leaders in healthcare and technology talking about how they are driving change in their organizations.

Paddy: Hello again everyone and welcome back to my podcast. This is Paddy and it is my great privilege and honor to introduce my special guest for today, Nader Mherabi, CIO of NYU Langone Health in New York City. Nader, welcome to the podcast.

Nader: Thank you for having me.

Paddy: You’re most welcome. So, let’s get started. This podcast is mostly about healthcare digital transformation and I thought I’d get started with something at a high level on the current state of digital. So, healthcare is in the early stages of digital transformation and the definition of digital varies from health system to health system. How are you defining it at NYU Langone Health and how is digital different from traditional IT?

Nader: OK. So, let’s call it a back about, we have to put a context to digital transformation into what’s happening broadly in healthcare delivery space. Clearly, how healthcare delivery space is shifting from inpatient to ambulatory, home care, and preventive care, and the evolution of that is in the various degrees worldwide and also in the United States and different markets. But in an institution like us, which is over 150 years old, how do you transform it to really meet that challenge is an interesting question. And for us, that journey started about 13 years with our new Dean and CEO, Dr. Robert Grossman taking the helm of this institution and thinking holistically across the board about how that transformation would take place. Where the delivery of care is a standardized, uniform, and of the highest quality and then clearly has digital technology embedded to deliver that service. And to that end, digital transformation means taking an enterprise approach of how we do care delivery. And then leading into that delivery, technology that is integrated, smart, intelligent, and expands all the way touching the patient and their family. And the spectrum touches everybody that works and delivers that service across the board. You want to provide all-in-one healthcare service and we are that kind of organization. We want you to be connected with us whether you need us for very small things or all the way doing your life and then the very state of your health. And we are interested in your health and your well-being throughout your life. And digital plays an important part, as well as the space plays, where if you’re coming to ambulatory locations, you want not only the technology to work but you want the facility to work, you need the care to work, you want doctors to be great, and so on. So, in that spectrum that we feel digital transformation. How’s that different from traditional IT? It’s totally different. Traditional IT is about putting systems and making certain things work for people, but it’s not thought out about how it’s been part of an integrated delivery system. And it’s really critical and pivotal to the success of that transformation.

Paddy: Yeah, I think you touched on some very interesting points there. You obviously spoke about some of the big drivers for digital transformation. One of the big ones being the shift from inpatient care to ambulatory and home-based care. There’s one other thing you mentioned there which struck me, which was taking an enterprise approach to digital. But what we see in my firm’s research is that most health systems are driving digital as a portfolio of standalone projects, but they don’t necessarily align to some kind of an enterprise strategy or roadmap. Is that what you’re seeing as well, Nader? I just wanted to get your sense of what you see as the current state when it comes to these digital transformation initiatives.

Nader: So, I think there is a mix out there. I mean some of the institutes clearly see that as strategic enablement meant for delivering care. The other institutions see it as a one-off. But, to truly deliver digital services along with the rest of your capabilities, you’ll have to be thinking enterprise. You can be where, you’re looking digital to your patient and consumers but yet inside of the institution, everything sort of goes back to the dialogue mode. That just breaks the promise of digital, the cost savings, the integration, the quality that you need to deliver. Can you imagine if Amazon took your order and then from that point on they start the paper printed and then went into another system to process that and then if it was not integrated with the delivery side of the house, how your packages would get back to you and how Amazon knows to track that. It may work to some degree, but it’s totally a broken process that will be called Digital. For example, in our market, we have competitors who put out their virtual urgent care services but it’s not digital. It looks digital to patients when they get service. But the doctors on other EMR, the doctor may be servicing you from other states, the quality may vary. So, these are the things that I call is not digital. It may look like digital, but underneath it is all sorts of stuff that may create more work and to some degree impedes quality.

Paddy: Yeah. I will come back to the Amazon comment in a little bit. I did have a question for you on that, but I wanted to just touch on this one thing related to the shift from inpatient to virtual care or home-based care. NYU Langone Health is obviously sitting in one of the highest cost real estate in the world, is in New York City. Is there a significance to this shift that is either helping you or in some way impacting your approach to digitally transforming the enterprise, the fact that you are in New York City?

Nader: Well clearly everything, when you are in New York City, you have a different mandate, one we are in a highly competitive environment. In the New York City market, there are multiple competitors and they are very close to that location to each other. So, you don’t have to go far to find another healthcare provider to get your service, which I think keeps us on our toes. The second is that, we are for example, NYU Langone we don’t own a lot of hospitals. We only have hospitals that are really in the communion and close to you. So, our vision of how we provide services, we want it to be convenient to our patients and their family and close to your work or where you live. And then having ambulatory locations that are accessible as a multi-service specialty with imaging, all the convenience that the patients are looking for. And having that connectivity to our digital offerings so that you can feel that we are one click away. But we feel that the hospitals are needed where they have complex care, but they are very expensive resources to manage and we don’t have a lot of them. A lot of our care is really in the ambulatory where we have physician offices with multi-disciplinary specialty services.

Paddy: Yeah, that’s interesting. So, let me come back to the Amazon comment. We’ve been seeing the emergence of a lot of these what I call the digital front door applications if you will. Amazon is not the only one, Walgreens has launched something. In fact, they were on my podcast recently. We’ve seen Walmart launching something. We’ve also seen Best Buy making statements about getting into the whole business. So obviously they are all approaching it from their own standpoint. And then you’ve got the traditional health systems like NYU Langone and others that have a really strong connection with a community and a very strong brand image. But, at the same time, there is also a shift in terms of consumer preferences. Do you feel that there is a certain shift that means that the marketplace or the competitive environment is going to shift towards a whole different mode and means of acquiring and retaining patients? Can you comment on this trend, especially all these new non-traditional players getting in?

Nader: So, it depends on perspective. If you want to be just transactional, it’s one thing. Clearly, if I just want to see a virtual urgent doctor and just get my antibiotics or get treated and that’s it. It’s a different mandate where you want people to be connected with you, where you want them to think about you and their phone when they think about care. So, we think of much more of an integrated long-term perspective I suppose, to be totally transactional. So, we think that you feel that we are there for you when you need us and we are one click away from your phone, which most younger generation from early teens to 50s think now. So, it’s a broader spectrum and that we’re there with you in the long haul, not just a transaction.

Paddy: That’s well said.

Nader: Because we are capable of providing that full level of service. Our enterprise is capable providing that level of service. It’s a full service.

Paddy: That is true. So, switching tracks a little bit, as the CIO of NYU Langone Health, you have responsibility for maintaining your core transactional systems, but you also have a responsibility to drive the organization forward from digital initiatives and digital investment standpoint. Health systems carry a lot of technical debt and they’re generally considered to be a little bit of an under-invested in the technology landscape and a lot of the IT budgets from what I’ve seen and heard, get consumed in core platforms such as electronic health record system. They also have to invest in building for the future, even though that may or may not produce returns. Example being telehealth where I’m told no one’s really making money but you have to invest because it is the way of the future. How do you do the trade-offs in your role as a CIO?

Nader: So, couple of things, one I am very blessed that we have great leadership who really see IT, technology, and digital as a great enabler, not just an expense, but as really a foundational, enabler, and a strategic asset to propel the organization forward on its missions. The second thing is we’ve been very thoughtful about how to do this. So, for the past eight or nine years, we’ve been very focused on really fixing IT, the guts of technology and platform delivery and really curing it. As opposed to, you have a crumble building and you just want to build on that capability on top of it. So, we didn’t do that. We really were mindful of really fixing and fundamentally being platform-oriented and fixing all of that. So that when you moved to digital space, your foundation is not just totally rotten, and it will crumble. So, I will give you a concrete example, our virtual urgent care platform is really part of our EHR platform. The doctors don’t go to different systems to document the patient. They could clearly in the same chart, see their appointments whether that’s a virtual appointment or their regular appointments in one place. And the patient is engaged through the same app. So, that is an important aspect of really standardizing on platform, fixing the foundation and the data and the workflow, and really having the foundation of technology work and then that enables you to build on and create the digital capability. Now really the other thing, we’ve done is a lot of standardization of EHR across our enterprise. All our hospitals, all our ambulatory locations use one EHR, that’s okay, but use one common workflow and one common standardization, that is really what’s built on top of that. So, that you can assess the quality care we provide across the enterprise, not in one location or two locations. And the patient experience is the same whether you walk into our ambulatory location or a hospital in New York City or walk in Brooklyn or in Long Island you feel you experienced the same thing. So, these are foundational. That also allows to reduce the cost of technology services, so we’ll be able to maintain. We don’t spend all our IT dollars on EHR, to be very blunt. We don’t, Why? Because we’ve standardized so much and so we don’t have a lot of staff, an army of staff to maintain various workflows. So, we were able to use those dollars for other novel things such as improving patient or family experience through technology. I just want to make that point. If we are thoughtful about it, we actually don’t have to spend a lot of money on just EHRs. Now the implementation of EHR cost money again, I cannot deny that but that’s what we have to really not allow, standardization is the key. For example, we have one formulary, we have one supply chain item master.

Paddy: It sounds to me like you had a head start on this matter, Nader, because you mentioned that over the last several years, eight or nine years, you have been focusing on getting your IT, your core IT platforms standardized. And you’ve been investing progressively in that, so you don’t feel that you’re under-invested or unable to move forward with digital. So that’s a good place to be in. I also wanted to just ask you, so is your primary focus from a digital transformation standpoint. Is the primary focus really enhancing the patient experience or do you have other aspects? Can you talk a little bit about what may be your top two or three focus areas when it comes to digitally transforming the enterprise?

Nader: So clearly obviously, by far, most of our patients and their family , clearly because that’s who we serve. But no, it’s also how we can improve our clinician experience. So, we have another initiative that is really complementary about how we improve our physicians and nursing staff and other clinicians as part of that care. One of the things, we were very mindful when we did that and which go back to your question, it was siloed process. We didn’t want to improve the patients’ and families’ experience at the expense of the clinicians and make their life miserable. We were very thoughtful, and they are complementary. Same thing we want to improve our workforce experience. As you know a lot of work is instead mobile and people are mobile, how do we do that? Same thing for our scientists. How do we improve the researchers’ experience? We should be thinking through that. How we improve our students experience with medical students with academic and our own staff? So, when we mean digital, the focus is across the board. And I think there are all complementary. People expect a different type of service. But digital’s part again is a piece of how you move the organization forward to meet the challenge of the 21st century. So, it’s the space, it’s the quality, it’s the curriculum of medical education. So, the content matters and a lot of focus is given also to the content. For example, we have a three-year medical school track that we serve. How can you do that, because with the technology it enables you to do that. But we have to rewrite the entire curriculum, the medical education curriculum.

Paddy: Yeah, that’s well said. Now one of the big drivers and big enablers for digital initiatives is data and advanced insights. Aggregating and analyzing data and healthcare content has got some challenges. Some are historical – data quality, data silos – but also interoperability issues and so on. Can you talk to us a little bit about how you’re approaching data governance and really harnessing all the data that you have to drive some of the digital experiences that you’re building?

Nader: So, let me go back again 10 years ago when we were going through that journey and now it’s eleven years. So, I have been involved in a lot of data warehousing projects and data analysis throughout my career. And one of the things that I learned and with my team from the beginning, we knew that we are going to a journey and really standardizing a platform and getting out all the pipes and reconnecting things in a meaningful way. So, we set up some free guiding principles about the data because we knew in order to upgrade analytics you have to get the data right. As you know, in old traditional data housing projects and still people do it, how many pieces of data gets mapped and translate into the data warehouse ETL tools, which I’m sure exists in every institution. One of the guiding principles, we say that, if the data quality is not there, we will fix that at the source. We refrain from mapping the data in the data warehouse in the analytics layer. So, being the CIO of the place and having control of all the systems, this one guiding principle, we did the hard work. So, we went and said, we were going to fix the transactional system about the data, we’re not going to map it. So instead, in my organization, people don’t map the data, people fix the transactional source. It’s hard to work but when you do it then the data quality gets better. Second about data quality, you have to put in the hands of people to see it and make it visual so people could use it. So that’s how quality gets better. Right. I mean this is written about this in many places. If the data is hidden, it’s not visualized then the quality is not going to improve. Because when people see the data and say wow what’s this? Was this really the amount or is that really the length of stay number? That doesn’t quite make sense. Then people want to go fix the source. People are going to really focus and then you take it out of that equation and then what’s left is really the real thing. When you want to act, when you see what’s happening in an enterprise whether that’s clinical care or corporate. And people say now I believe in data and believe in quality, this is what’s really telling me, what do I do about it. And that’s the other part, what do you do about it? Which is also an interesting part where what kind of data and insight can you provide that’s actionable. And so, you have to be mindful of that about how do you make the data actionable. And it doesn’t do any good if I show your data that’s three months old. It may be nice to know; it gives you some perspective. But it’s hard to take action on a three-month-old data or sometimes from last 24 hours data, depends on what we’re trying to do. So, these are the foundational things people think you have to think through. And we thought about that 10 years ago and that was the big dividend for us. Now that we have 700 metrics and 83 dashboards and we continue investing in data analytics, AI, and so forth but I’ll stop there.

Paddy: Yeah. Well, let’s talk about AI since you brought it up. What is the current state of AI? There’s a lot of talk about the promise and the potential but also a lot of concern about how it might be used unintentionally, harmful or discriminatory ways. What is your take on that?

Nader: Well, clearly, we see the use of NLP, predictive analytics and AI in a way that we think that it’s helpful, depends on what you want to do with it. A lot of people focus on putting AI in the highest end of the spectrum in terms of predicting mortality, which we do some of that. We’re giving it to their highest level of work, which is in our cases, clinicians, they’re highly intelligent, they practice. So, we think that helps them in a great way. But also, we really think that AI can be implemented at the other assets and we can help others to give better insights so people can do their job better. We don’t think AI is at the point where it’s going to cure cancer but it’s clearly a capability that helps people make their decision better, for us, it is across the spectrum. We also see some utility for that across very low hanging fruit things where it really can bring to fruition some things that are very mundane and provide good insight for people to do and we can reap the benefit of that. So, we see it being applied across the board, but we don’t see that as being the panacea that it would automatically cure the patients, and everything run on their own and AI would drive everything. But it’s very helpful when you highlight where a patient could be at risk for heart failure and alert the heart failure team. So, there are other things that are clearly complementary, scanning things and bringing insight to things.

Paddy: Yes certainly it looks like AI has made a great deal of progress in certain areas specifically images, you mentioned scanning. But there are other areas like cancer, oncology where no one’s going to turn over a diagnostic or a treatment decision to AI tool anytime soon. But yeah, I get your point as well. Well said. So, we’re coming up close to the end of our time. I do something called a lightning round where I mention a few terms that relate to emerging technologies in healthcare. I’d love to get top of the mind thoughts on those terms. So, we’re ready for this?

Nader: Sure.

Paddy: Okay. Here we go, Cloud.

Nader: Okay. Well, you can’t avoid it, that’s for sure. It’s always going to rain someplace. We know that our clouds are important. You have to be very mindful of that. I can see in the healthcare industry ourselves; we will be in multi-tenant cloud there is not going to be one cloud that we will be residing. So, you have to approach it in a very programmatic way. There has to be ROI for a cloud. To do that, you have to really make sure that you orchestrate your cloud strategy. So, you can’t leave this strategy, the orchestration to others. You, the institution has to do it in a thoughtful and careful and calculated way. And you have to be very calculated about how you move yourself to the cloud. That gives your users, your patients, your institution the best value.

Paddy: Okay. Next one, voice recognition.

Nader: Well, I’m surprised you didn’t put voice recognition with AI. I mean what is voice recognition without an NLP and AI. Right. So, I think to combine, and here’s what, AI and NLP and all these tools play a great deal. We think it’s a game changer for our clinicians that could make an impact, improving their lives. If it’s done in a way that is integrated, for example, we do try our clinicians use voice recognition on top of our EHR, just great potential. I’m optimistic about this technology combined with NLP and AI on top of an EHR that is truly integrated. And hopefully, at some point, this technology would take away the keyboard and mouse. And also, with the video. So, it’s just not by itself, I think with video, with NLP, with integration with EHR to the point where the mouse and keyboard. And there are firms that already have a prototype working. Where you now talk to a patient face-to-face and the EHR is around you with a video, with a voice, with the computer screen and so forth. So, I’m very optimistic about that.

Paddy: Yeah, that’s great. Automation and RPA (robotic process automation).

Nader: I would say that, first, you should have a good enterprise strategy. This is where I think people kind of do that in small niches. And sometimes people buy multiple RPA tools, which is okay, because it’s in the technology. But given the technology that is highly regulated, there are so many steps to follow and paths to meet all sorts of regulatory requirements and billing and so forth. I think it’s a good play, especially in the backend office, even helping clinicians to work their queues about mundane things that they can move around to lighten up their day. So, there’s a good play for cost savings and reducing the burdens on those workforces.¬

Paddy: Yeah, I see this being used a lot in the RCM space. Do you think that’s a good candidate for the prime candidate today?

Nader: I think so but there are other spaces as well. I said that just like a physician work queue. There are a lot of mundane things that comes on and a physician work queue. They complain to me about staying after hours to clean a list. Then maybe an RPA tool can prioritize and move things around and channel those tasks to others. So, there’s a good play in other spaces as well. So, I’m open minded about it. I’m open-minded about that. It could be applied in many places. I think if you talk in terms of Wall Street, I’m bullish on it.

Paddy: Yeah. I agree with you. Yeah. Any anything that reduces ‘pajama time’ as they say. It’s great. All right. The last one on the list is AR/ VR, extended reality.

Nader: Again, you mentioned the AR/VR but you’re not mentioning 5G. So that’s another fastening space, I think is a much longer-term to be very honest. As you know right now, AR/VR, people are using as teaching tools, as things that we can simulate. For example, in healthcare and education, you can teach medical students or a resident about surgery techniques. So, I think right off the bat, today, it’s a great teaching tool. But also, a good patient education tool but the devices are still heavy, they weigh a lot and cost a lot. Think about how you can teach a patient or their family about a procedure that he can see it. Again. Good teaching, it’s there, cost has to get cheaper. But you can imagine that someone with 5G actually visualizes and do robotic surgery from a remote corner of the world. That’s kind of interesting when you combine these with a reliable remote network and be able to feel and touch things in a different way.

Paddy: So, are you piloting 5G at NYU Langone health?

Nader: Not yet. We have, some of our wireless access points are turned on for 5G. We are experimenting a little bit here, but I like to scale things once we expect to be across the board because that’s where you realize the benefits right. When you all are or are connected in different ways. So, to realize, you have to have it enterprise-wide. Otherwise, it’s just, when it’s isolated that you don’t reap the benefit in a meaningful way.

Paddy: Yeah well, one thing I did want to mention for the benefit of all listeners. You have a very interesting Medium page where you talk about some of these initiatives. And I’ve read some of those blogs, they are very interesting, you share with the public at large. Some of the initiatives that you’re working on, so people can look at and understand how you’re thinking about some of these emerging technologies as well. I just wanted to give a shout out because I haven’t seen many others do this and I think it’s great that you’re sharing some of this information in a public forum.

Nader: That’s great. And I appreciate the comment, I think my team has done a great job of really putting that together. So, I’m sort of acting as chief editor. Really the articles, most articles are written by my team. They write and our faculty by large. So, one of the guiding principles we had for our medium. What I wanted to put there are things that are useful, that are highest quality, that give people perspective but not bombard people with all sorts of stuff. So, we are being very thoughtful about what we put there and we share as much as we can but with quality. I think quality is important because there’s so much out there and I think public and our colleagues really need something that they trust in and this with quality.

Paddy: I certainly see that and I have read through several of the blogs. So, anyway, we’re almost at the end of our time here and I just had one last question for you. You’re in New York City. You worked in your past in the banking securities industry and so on. How is healthcare different from other sectors when it comes to digital transformation, technology wise? What advice do you have for tech firms and digital health innovators who are looking to serve the needs of NYU Langone or others like you?

Nader: Well clearly, there some technologies, there is a lot of commonality in terms of how you organize technology. For institution, how do you create governance? But on the other hand, healthcare in is its uniqueness. One of the advices I have which I’ve learned, also the hard way that, transaction in healthcare is very complex. Think about, by the time you think of seeing a clinician and how many transactional interactions you would have by the time you actually in the exam room or buy the medication. Think about a banking transaction whereby, you want to buy securities or replace an option. It’s a very simple, binary transaction compared to the amount of data is being collected just for you to make an appointment to see a doctor. So, in healthcare one of the advices I have is, be very mindful about because healthcare transactional is multi-touch, complex, not that cannot be solved through visual means and optimize. But there’s complexity that you have to be aware, it’s not as black and white as banking transactions for example.

Paddy: Very well said. Well Nader, thank you so much for your time. It’s been a pleasure speaking with you. And thank you be sharing all those insights.

Paddy: We look forward to staying in touch.

Nader: Thank you. My pleasure.

We hope you enjoyed this podcast subscribe to our podcast series at and write to us at

About our guest

Nader Mherabi, Senior Vice President and Vice Dean, Chief Information Officer, is responsible for all information technology (IT) activities for NYU Langone Health and for information technology’s development as a strategic organizational asset. He previously was Vice President for IT product solutions and Chief Technology Officer for NYU Langone, responsible for technology strategy, infrastructure engineering, networks, data centers, application architecture, systems deployment, and support across the institution. Mr. Mherabi currently leads NYU Langone Health’s digital transformation initiative, driving the integration of the institution’s workflows, revolutionizing the digital patient experience and clinical environment, and empowering the institution with big data and advanced analytics to improve care delivery and efficiency.

Mr. Mherabi has designed and implemented many large-scale, diverse systems for NYU Langone and has extensive experience in hospital clinical systems integration, research information technology, and education systems. He has developed an operational architecture for in-house application development and integration, as well as an electronic data repository, warehouse and dashboards center, research-specific infrastructure for computation and collaboration, and scores of mid-size applications for research, education, and clinical care environments.

During his more than 30 years in the information technology field, Mr. Mherabi has implemented large-scale systems for top Fortune 500 companies worldwide, such as Credit Suisse and CitiGroup, and held several prominent IT management positions including Senior Director at Mount Sinai–NYU Health, Vice President at Credit Suisse First Boston, Vice President at Citibank, and Senior Application Developer at AT&T and Aurora Consulting.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.


If you’re a traditional CIO with a traditional mindset, you’re going to be disrupted

Episode #25

Podcast with Edward W. Marx, Chief Information Officer, Cleveland Clinic

"If you’re a traditional CIO with a traditional mindset, you’re going to be disrupted"

paddy Hosted by Paddy Padmanabhan

In this special 25th episode, Ed Marx discusses his personal experience with two major health events over the past twelve months, and how information technology played an important role in both events.
At Cleveland Clinic, where Ed is leading an enterprise digital transformation strategy, ‘digital’ means leveraging technology to produce seamless experiences. Recognizing the need to support legacy environments while advancing the enterprise digitally, he suggests that CIOs and digital leaders must be “bimodal” and be able to show progress and success despite constraints.

Digital transformation is not a solo trip; Ed stresses the importance of global partnerships, and aligning with the right partners can help achieve wonderful things.

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

Paddy: Hello again everyone and welcome back to my podcast. This is Paddy. It’s a very special occasion for us today. It’s our 25th episode and it’s my great privilege and honor to introduce my guest for today Ed Marx, CIO of Cleveland Clinic. Ed, I want to start by mentioning you were our very first guest on this podcast. I greatly appreciate your support. Welcome back.

Ed Marx: Thank you and I’m honored to be back and to have been your first. I’ve enjoyed, I think I’ve listened to most of those twenty-five and I think it’s an excellent resource for other leaders.

Paddy: Thank you very much. Very kind of you. Ed, I wanted to start with this. You’ve had two major health events in the past twelve months or so. You’ve blogged about both events in an extraordinarily candid way. Would you care to tell our listeners a little bit about what you went through?

Ed Marx: Yeah. It was very strange. Both were surprises. If people know much about me, I’m a pretty healthy individual and undergo a lot of routine testing just because I want to stay at the top of my game. My coaches make me do so and my wife certainly makes me do so. And in May, let’s say March of 2018, I underwent an executive physical and for those who’ve ever had one, it’s pretty much an all-day affair where it’s very intensive physical as opposed to a 30-minute physical you might have with a provider. Typically, this is all day long with multiple providers doing multiple tests. And out of that they said, Ed, you’re in the top 1 percent in your age group in terms of health. And it’s surprising that, next month I’m in a race. I race for a pretty distinguished team and I was in the national championships and I had this pressure on my chest, just as I’d always read about or heard about signifying a heart attack. And I was like, there’s no way I could have a heart attack. I’m too healthy and I was able to keep running and just for the sake of time I won’t go into all the details. I kept running and which was somewhat foolish but somewhat saved my life and I reached the finish line, made the team and checked myself into the medical ten. Where using technology, they figured out pretty quickly I was having a LAD or what’s called the widow-maker heart attack, pretty much instant death. And thankfully I was still able to breathe, and my heart was still partially functioning. So, I got taken to a hospital where they put in a stent, cleared the blockage from my heart and immediately felt better. And through digital means, which I will talk about it in a minute, I was back 90 days later, racing in the world championships. So, it was really weird though, because there were no lifestyle reasons for it. It’s completely unexplainable. And so, you never know in life things can happen. So, you always have to be prepared both personally and professionally and so forth. And then, after a year I had my year checkup of April 2019. The physician took me off my drugs. I was completely changed my diagnosis from the heart attack because they said this was just a once in a billion event, there’s no heart disease or nothing. And I was pretty happy and he says but I’m really concerned about your PSA score and I said I’m not concerned about it because I’ve watched it over the years, my physicians have watched it and said there’s nothing to be concerned with, just to keep watching it. He says, now I would go see someone. So thankfully you know working in a health system, I have easy access and talked to the Chair of our Urology Institute and he invented this new test a year ago, which is much better than a typical PSA test, has predictive analytic capabilities. And I took it and the next morning he was sitting in my office at 6:30. I thought that’s not a good sign. And he said, Ed, you know based on this test you have 85 percent chance of prostate cancer. I was like what. And so, he said what do you do now. Basically, and I said whatever you want me to do and I had a biopsy done and got the results back quickly and sure enough, I had level seven prostate cancer. They don’t do stages like a typical cancer but it’s a level between zero and 10, seven is not good. If you have below seven, you know you can do other treatments but seven, if you want to be sure and get rid of the cancer, you have a prostatectomy, and that’s what I ended up doing. And thankfully a couple of days later, we were notified I was completely cancer-free. Often times you still have to go undergo radiation chemo but because of the radical prostatectomy and the lab work around that, I was completely healed. So, it took a little while, few weeks to get back into the normal swing of things but I’m back running and racing, have had three races this month already and I’m ready to compete. So, it’s been weird. But I learned a lot through this.

Paddy: Wow that is some story. And firstly, I want to thank you for sharing that, with that, it’s so personal. And for our listeners, I also want to mention that you’ve blogged about this extensively in a series that you titled ‘You have cancer.’ And you went into a lot of things, it’s not just about yourself but you talked about the whole system and how it works. You expressed a lot of gratitude for the caregivers. I was astounded at how you managed to track every single individual who was involved in your care. And you mentioned them all by name. So, kudos to you Ed. And again, extraordinary story. Firstly, I’m glad that you’re fine and glad that you’re back on our podcast.

Ed Marx: Yes, it definitely beats the alternative. I appreciate the fact that Paddy you were one of very few friends who came to visit me just to say hello and show your support. And you traveled a great distance to do that and I appreciate it.

Paddy: Thank you. Thank you. OK. So, you now have a unique perspective of the health care experience by which you’ve been a patient in one of the leading health systems in the country, where you are also the CIO. So, tell us about how you saw the two worlds converging. The world of the CIO and the world of the patient. How did you see that converging during your recent experience?

Ed Marx: Well, it was pretty amazing and I’m so thankful to be part of the Cleveland Clinic. I know there are amazing health care organizations around the world. I’m glad that in the two areas where I had an issue. We are number one in the world, in cardiovascular, neurology, and kidney. So, I was very fortunate in that regard. So, in the first one, it really doubled down on my passion for digital technologies and how we can impact people’s lives in a positive way. The quality of life as well as saving people’s lives through digital. And so, I became, the things that I was an evangelist of, I became a patient of and that’s digital. So, in the heart attack example, we had a little cardiac device attached to the iPhone, and immediately had an EKG reading. That EKG reading was sent to the hospital_____[unclear] and they knew immediately what to do, what we needed to do. They then took that image just as in South Carolina they knew as part of a Cleveland clinic they sent that image to the Cleveland Clinic. By the time, by 5:10 am the ambulance ride was finished, and I was about to enter the cardiovascular, the Cath lab, the images had been read by Cleveland Clinic, head of cardiology and as well as the local very fine interventionists. And then afterward, through Bluetooth technologies for anything from pulse, through heart rate, to blood pressure, to weight, everything was transferred electronically or digitally directly into my record. And as a result, my clinicians were adjusting meds in real-time. Normally you might have a four week or eight weeks follow up appointment, they take one blood pressure and then say, maybe, we should adjust your drugs. But because this is all real-time, they would get alerts all the time and then they would make adjustments accordingly. And that’s what enabled me to get back on my feet so quickly and like I said, 90 days later, I was competing in the world championships. So, it really makes a difference. And it’s the same learning, how innovative we are as a culture. This physician, the Chair of what we call GUKI, Glickman Urology and Kidney Institute. He invented this new blood test to give predictive capability as to the presence of cancer. And so, I was just thankful that I had access to that, and I saw it at work. And then going through the whole OR experience and watching all the safety, all the huddles. I paid a lot of keen attention because I’m exposed to this every day. I participated in huddles every day. And I was very keen and listening in and observing just how we practice, what we preach. And then it just doubled down again on my commitment to evangelism of digital because it saves people’s lives, including my own.

Paddy: You mentioned all the ingredients of the ideal experience where data flows freely from one part of the country to another. Or I should say one provider in one part of the country to another provider. It flows seamlessly and they’re able to pull it up and make real-time decisions or interventions at the point of care, uses an ideal experience. Of course, the healthcare as an industry is still maturing to reach that same level of consistent experience across the entire healthcare ecosystem. And we’ll talk about that in a minute. But you know Cleveland Clinic has embarked on an ambitious digital transformation program which started last year, and I was fortunate enough to be a part of that when I worked with you. Can you tell us how you are defining digital today and where you are in the journey?

Ed Marx: Yeah. So, I can’t say that we have an official definition. But the one that I’m putting out there right now and testing the waters with is, ‘leveraging technology to produce seamless experiences.’ So, we like to be very short and succinct with what we do. That’s six words to me, that pretty much explains digital and it is a major emphasis. I believe in our next board meeting our emphasis will be sort of on our digital transformation, where we are, where we’re headed and having some sort of definition that is very helpful. And then we give some additional definition around that, but that’s sort of the high-level definition and then the rest of definition. There’s sort of four main adjectives if you will and these are all surrounded by or supported by or let me say this way, the adjectives support our four corners of who we are and that is about the caregiver, about the patient, about the community, and about the organization. So, it’s all strategically aligned with the organization strategy and digital transformation is key to making our organizational strategy a reality.

Paddy: My firm’s research seems to suggest that most healthcare enterprises are in early stages of digital transformation. In fact, most health systems are pursuing digital as maybe a set of standalone initiatives as part of either a digital innovation program or as a telehealth program. And in some cases, they simply default into whatever the electronic health record system provides as an out of the box functionality. Very few are taking an enterprise view of the digital strategy and roadmap as you are doing today at the Cleveland Clinic. So firstly, do you agree with the general assessment of the marketplace and how do you see that change in the next twelve months?

Ed Marx: Yeah, I think we’re early stages, healthcare typically behind other industries. So, what you’re seeing is pockets of brilliance as opposed to sort of an enterprise strategy. That’s just how things develop and innovate. You know you think of some new ideas or just sort of pop up. And then eventually, get to a level where you start wanting to tie those things together. And then you mature to a point that, rather than taking that approach and having these pop-ups that you try to act, all you do is adding complexity by doing that. Then you’re like, let’s take a step back. And I think that’s definitely where we are. So we have had pockets of brilliance for years doing some pretty nifty things, really important things and I’m glad we did them and now we’ve matured to the point of we’re taking sort of this enterprise approach to digital transformation making sure that it’s in complete alignment with our overall organization strategy. In fact, if you look at our organization strategy, it cannot happen without digital transformation. It’s one and the same. So that’s been our approach. But it’s a maturing process. I think it’s hard to get there right out of the box. It’s almost as if in order to push the culture a little bit, for most organizations, you’re going to have to have these pop-ups, these pockets of brilliance that sort of set the standard. And say, hey, look it’s OK, it’s safe, let’s go ahead and move this direction. So, I think it’s just part of an evolution, it’s definitely not a negative reflection on any particular organization.

Paddy: Right. And it’s just the current state as it is. You mentioned a little earlier that, your one-line simple definition of digital transformation is using technology for seamless experiences. As technology obviously has a very big role to play in digital transformation. However, there is no such thing as an enterprise digital platform which means that enterprises and digital leaders have to be thinking about building their own digital platforms. What would you advise digital leaders?

Ed Marx: Yeah, now we went through the same thing. It’s like OK we have these pockets of brilliance, but this new strategy of the organization, how do we support that. And I’m a very visual person, I think many people are. And so, it took us a few iterations, but actually, on one slide, we created our digital platform. So, we basically again took those things that are most near and dear to our organization right out of our strategy. And then we said what is the underlying technology that enables these things. And so, we identified those things and then we even added some of our, I call them vendor/partners, to them that are providing some of those support areas for us. And then we could say, look we actually have a platform and then people get more engaged because they can look at the platform and that makes it more real and then they can help make it better. We always talk about how we iterate on things and so we went through a process of iteration and making it better. And so, we have a pretty robust platform now. So, when someone asks what is your digital platform? I can actually show them a digital platform and it’s aligned with our organization. And it helps my peers, because oftentimes they’ll be tempted to go run off after a specific technology. I’m like, wait, let’s look at our digital platform and see how that fits in. How does that fit into virtual health? How does that experience an engagement? And, these are the different objectives for each of those and here are the primary vendor partners that we’re working with. And so, it’s a very helpful tool.

Paddy: So would you say you’re pretty much complete in the process or are you still putting some pieces in as part of their digital platform today?

Ed Marx: Yeah. You know one is too small a number for greatness, you can’t go on this alone. This is not a solo trip. I think in about half you could do things by yourself but not today. And it depends on your organization, we’re a global organization. So, we need a global partner to help us. And so, we’ve identified a small handful of potential global partners. And so, when you look at our digital platform, there’s probably, out of I want to say 30 sub-components of our digital platform, 20 of them will probably be filled by a single partner. And I think that’s important because everything’s so integrated and I don’t want to make things more complex they need to be. I believe in simplicity and not only does it increase overall value but drive down costs. And it’s easy to understand. So, it’s easy for other members of our organization to understand why we do the things that we do how they’re all interconnected. And then we can leverage because of the scale of these sort of relationships. You get a lot of benefits; you get a lot of backward investment into your organization. And your views align with the right partner, you can really do wondrous things for your community or as I mentioned for us, it’s more on a global scale, but you can do wonderful things. It’s almost an ethical imperative that if you have this great product or service and we believe we do and specifically in healthcare, then we want to share it with as many people that we can in easy to understand format and by having a partner sometimes you can do those things a lot quicker.

Paddy: And I think you provided a good thumb rule if you will. If you have about 30 components or so that need to go into what you would describe as a digital platform. Well, two-thirds of those components are going to come from a very small handful of strategic global partnerships and the rest, of course, you’re going to go for best in class technologies or very specific technologies as the case may be. That’s great thumb rule, at least, something that people can relate to. Switching topics here. Let’s talk about the organizational structure for digital transformation. You mentioned earlier on too, that it’s about collaboration, no one can do this alone. It requires teamwork, stakeholders within and outside the organization. Again, our research indicates that when it comes to the digital leadership role there’s quite a lot of variation within the industry. For the most part, digital leadership seems to fall on the CIO today. However, a number of leading systems have also appointed leaders who are dedicated to just that role and in some cases, they are even coming from outside the industry. So, can you comment on this trend? Can you comment on what the emerging trend as far as their org structure is concerned for a digital transformation to be successfully executed by health care enterprise?

Ed Marx: My perspective, for me, I’m less concerned about organizational structure as I am the person filling a particular role. I think if you have the right CIO, you don’t necessarily need to also have a CDO. Now it really depends on that person. I always say, disrupt or be disruptive. If you’re a CIO and you have a traditional mindset, traditional skills, you’re going to be disrupted. And your organization probably going to have a CDO or if not a CDO, other people sort of leading the digital transformation. But there’s no reason as a CIO that you can’t be both CIO and help lead digital transformation. Again, it’s a skill set, it’s a mindset and it’s really about collaborating with your peers. That’s why I don’t really care where it sits. It’s really about being a collaborative leader that you collaborate with nurses and physicians and other clinicians and strategy and business development and finance. You know the whole thing. The second thing I would say is I am very much supportive of individuals coming from outside of health care. I think one of the reasons our growth has been retarded is that we’ve become very insular over the years. And if you just look at some of the policies that you see, when it comes to hiring and it says must have 20 years healthcare experience. Why? If healthcare fine. Why do you want 20 years healthcare experience? I’d rather bring in people and have a healthy mix from outside and inside. Maybe get someone from manufacturing or someone from finance or entertainment, some more progressive field and then have them as part of your team. And that diversity makes for innovation which makes for digital transformation. I’m a big believer in pulling people from outside IT, not outside IT but outside healthcare. Again though, it’s not one or the other, you can be all those things, you can be that CIO that has a fresh mind, fresh skillset, collaborates. And at the same time brings in people from outside of health care into your organization to make it stronger. You can do all those things.

Paddy: Yeah that’s very well said. Coming to the question of the investments that are required. Obviously digital transformation is a multi-year effort. There are significant investments that enterprises have to make, and they are making across the board. A significant amount of IT budgets or technology budgets in healthcare are consumed in maintaining legacy environments. And you hear of some of these big numbers and somebody has to upgrade an EHR system for instance or somebody has to upgrade their infrastructure, for instance. A lot of that goes into just upgrading your existing environment and part of it is necessary because without the state-of-the-art environment, a lot of the digital functionalities can’t even be turned on, they just won’t work. How do you kind of trade-off between the need for your legacy environment to be refreshed versus the need to invest in futuristic technologies as well?

Ed Marx: Yeah, I think there’s two things. One is you definitely have to be bimodal. I’m sure all of us you know 90 percent of CEOs deal with this where you do have a lot of legacy things that you have to take care of and continue to pay attention to. It’s a common problem. But you can’t use that as an excuse. You also have to be looking forward, and I think about that from strategy and operations you know I need to make sure that I’ve got the right people making sure things operating well. And then looking towards the future and then trying to spread investments the best I can depending on my situation. You got to operate both. It’s not like one or the other. That’s definitely a key component. The other thing is to become more and more data driven. I believe in data over emotions. And if I can really quantify the need, if I can benchmark myself, if I can really quantify all that we do. So, another example, I mentioned a couple already just now. But another one would be, what time is spent, do you do time tracking and then do you look at the analytics behind that. What time is spent on legacy? What is spent on, we talk about run, growth, and sort of transform as our three buckets. And we have our OKR and objective key results on each year that attempts to move 5 percent of the run into both transform and grow. And we can show that. And then when we talk with finance or strategy or others about investment and improving IT, we use data now to show look in the last two years we’ve increased our spend into areas of transformation and growth. We’ve been good stewards. Give us more and we’ll continue to make that transformation. But if we didn’t have data and just did it based on philosophy or our ability to argument in the moment we’d be in big trouble. So, both being bi-modal and then being data-driven helps to overcome that.

Paddy: Right. Right. One question that has come up and I’m sure you’ve had this come up to you as well. Cleveland Clinic is a big organization, you have a lot of budgets you’re able to make a lot of investment. You have the luxury of taking a longer-term view. But if you’re the CIO or a leader of a regional, the smaller regional system or community hospitals somewhere, it’s a matter of survival on a day to day basis because of the nature of the marketplace today. What’s your advice for them? What would you say to them, if they say look, this would work for the Cleveland Clinic doesn’t necessarily have to work for us because we’re in a very different place?

Ed Marx: Well two things: One is I would challenge that assumption now. I have worked in community hospitals previously. It has been a few years, so, I admit that fully. But I think it’s just scale. While, I may have more resources today than I did 20 years ago working in a small community hospital. By percentage, I bet it’s the same. So, by numbers of FTE, for instance, it’s much more. But in terms of number of FTE compared to overall number of FTE for that organization I bet the percentage is pretty close. And I always thought innovate where you are, scrappy innovation, and you do what you can, you can carve out, you’ll figure out ways to carve out some dollars to do some transformational things and then you have to prove yourself. And I recall being in a small hospital back in rural Colorado and we had very limited dollars, but we took a risk. We spent some dollars in a couple progressive digital areas, if you will and we helped turnaround the revenue, the number of patients we were seeing, the amount of revenue of the organization. And we proved ourselves and then we got more money. So, I sort of challenged the assumption a little bit although I have deep respect for those who are in that situation and are trying to make a go of it with very limited resources. So, there’s no doubt that is another challenge. I think that what we’re seeing though, Paddy, is a lot of M&A and I think people are realizing the days of a one-off hospitals in today’s environment, given government reimbursement and where health care is headed is a very difficult task. And you’re seeing a lot of hospitals and we’ve purchased a few of those that are more rural that by themselves there’s no way they could compete. And by becoming part of a larger, more robust health system, it’s not only great for the community and the caregivers that work there but also the patients.

Paddy: Yeah yeah. Now I think that is true. And also, I think the good news is that there is a recognition that some of these capabilities that you have to invest in for a digital future are really critical for the survival of the organization. And it’s not just M&A but even in terms of the strategic priorities for the highest levels in the organization, I think there is some recognition that we have to make the investments for the future. It just can’t be business as usual. It’s not sustainable, especially as we shift from fee-for-service to a _______[unclear] model or a value-based care. So, switching topics again I want to go back to the question you mentioned about leadership in the pool, the people who come from the outside or whether they are from the inside. The kind capabilities, the kind of mindset and attitude they need to have to be successful in a collaborative environment. Now obviously digital transformation is not going to mean the same thing for everyone in your organization and many of your current talent pool will have to reskill themselves maybe with assistance from the organization. How are you looking at this maybe three, five years out? You know the technology landscape is going to look very different from what it is today. The business landscape and the modes of engagement with a patient, the modes of engagement between caregivers is also very different. What do you see as the strategic imperatives for your team and your talent pool in order to be prepared to transition seamlessly into the future?

Ed Marx: Yeah. The first one and I know this isn’t going to surprise you, but it might surprise others. My focus is really on passion and does an individual have passion of any sort and service passion in particular and then are they empathetic. It’s really about culture. If you have these things that are very difficult to teach. If you are passionate about what you do, and you want to be the very best database administrative for instance, or network engineer, that’s what you need or if you’re service like your heart is all about serving others. Those are things that are caught not taught, that are so important to success. Because you could have the 10 best database administrators that maybe are clock watchers and not all that interested in what they’re doing. What it means they have you know 10 let’s say average and who are passionate about they what they want to do, are service oriented, have deep care for our patients and providers they will outperform every time the others. So, we really look a lot to that. But the other things that we do is we have provided enormous amount of training. We train our people to make sure they understand the latest and greatest in training. What’s out there in terms of technology. We expose people, we have our own internal academy for business technology leadership where they’re exposed to more technology. We have rounding, everyone has to spend a day with a clinician where they’re exposed to. This helps both on the soft side that I spoke about but also the tech side they’re exposed to the technology where we are. And sometimes that helps create new ideas for technology what else we can do to make patients’ lives better, our caregivers lives better, outcomes better those sorts of things. And then hiring, as we talked about, hiring some team from the outside from other industries has proven effective. I recall you know we were trying to stand up enterprise analytics before it was as common as it is today. We knew payors were well ahead of providers at the time, so we hired that analytic leadership from a payer, and they set us on our proper direction very quickly. So, reaching out to other industries that have more strengths is really key. I think one final idea Paddy that I would have is that, we do these exchanges once a year, well literally two exchanges. One is with health care institution that we respect, the other is with a non-care healthcare institution that we respect. And we spend a whole day with our IT leadership team together and we compare notes. What technologies are you using? What are you seeing down the road? And then try to learn from them and how do they get training on that. How did they learn about what to do with it? So, there’s all sorts of methodologies. I don’t think there’s one specific one. But it’s really a matter of a healthy mix of all those things.

Paddy: Thank you. Ed, it’s been a real pleasure speaking with you again and you always have a fresh perspective on everything. I appreciate your coming back on the show and I look forward to catching up again soon. Thank you again.

Ed Marx: Thank you Paddy.

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About our guest

Edward Marx is Chief Information Officer at Cleveland Clinic, a $10 billion medical system that includes a main campus, 10 regional hospitals, 18 family health centers, and facilities in Florida, Nevada, Toronto, Abu Dhabi, and London. He is responsible for the development and execution of strategic planning and governance, driving optimal resource utilization, and team development and organizational support. Ultimately, he will develop leaders and leverage digital healthcare technologies to enable superior business and clinical outcomes.

Prior to joining Cleveland Clinic, Edward served as Senior Vice President/ CIO of Texas Health. In 2015, he spent over two years as Executive Vice President of the Advisory Board, providing IT leadership and strategy for New York City Health & Hospital.

Edward began his healthcare service as a janitor while in high school where his commitment to patient care began. He later served as an anesthesia technician before transitioning to the information technology field. Concurrent with his healthcare career, Edward served as an Army combat medic before becoming a combat engineer officer.

Edward is married to Simran and they have five children and three grandchildren. A member of TeamUSA Triathlon, he attempts to stay health through competitive cycling and running.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.


The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.