"Healthcare must embrace the cloud. That is where all the technology innovations are happening."

Q: You’re the CIO of one of the largest and most complex health systems in the country. What are the top two or three things that occupy your mind these days?

Moore: One is obviously the pandemic and the things that come with that — how do we keep our communities safe and our caregivers productive? Then, the tools that come with that –remote care delivery, big data, modernizing. We’ve got a lot of technical debt here at Providence and so, we’re unable to be agile and innovate as we’d like. Those are probably the top three things on my mind now.

Q: Your colleague Aaron Martin was also my guest a while back. How does your role complement his, specifically with regard to digital transformation at Providence?

Moore: Aaron and his team create the marketing brand, so, anything that’s kind of external patient community-facing, they own. And they own the front door for that patient experience. So, things like online scheduling, for instance, and anything that has a broad marketing brand front-door as it relates to Providence, is really Aaron’s team.

The handshake that happens when that front door is open is with my team. So, the actual infrastructure and digital assets – EPIC and its scheduling — happens in my space. All the caregiver tools that nurses and doctors use to deliver care is also on my team. All the other stuff, such as network and cyber are on my side along with the administrative tools and systems that support Providence. Once the front door’s cracked open and the handshake happens with my team, it’s a good partnership.

Q: For large organizations — Providence or Mayo Clinic — what I see is that from an old model standpoint, digital is really driven by a handful of senior executives working in collaboration. Is that almost the default model to move a big ship like Providence?

Moore: The strategic intent comes from this handful. But digital transformation includes basically everybody at Providence and within the Digital Innovation Group — everybody along with our caregivers. As far as setting the strategy, tone, direction, phases and approach goes, it’s Aaron and I that define that strategic intent. It is a huge effort.

Q: Can you share examples of innovative use of technology that you’re using in your world to drive the organization forward in this transformation journey?

Moore: There are two partnerships that we have. The technology we’re using entails to deliver better caregiver productivity. We’ve been partnering with Nuance and their DAX tool to work with ambient Artificial Intelligence (AI). It’s common knowledge that the biggest burden for many caregivers is really annotating, adding to the EHR, so, anything we can do to improve that experience for them especially during a pandemic and labor shortage, has been critical. Leveraging very nascent, ambient AI has been crucial. But how do you listen to a conversation and really have AI pluck out the necessary components and add that to the EHR while ignoring the rest of the chitchat in the room? That’s one of the pieces of innovative technology we’re using.

Second, we’re really aggressively moving to the cloud. All of the technology innovations are happening in the cloud now and our deep partnership with Microsoft enables us to move all of our data centers, assets to Microsoft Azure. That’s where it’s really paid off. During the pandemic, we built our big data model there. Once that’s in the cloud, we’re able to do machine learning and AI to predict the use of ventilators, PPE surges as COVID progresses etc. It’s a strong model which, within two weeks’ advance notice, can help tell us when a community will surge or pull back. These emergent technologies have been invaluable for us to navigate COVID and have helped us really deliver on that vision.

Q: The cloud is right there at the forefront of innovation in healthcare. Nuance is now part of Microsoft, and you too had a partnership with Microsoft. So, did all this make Nuance an easy choice?

Moore: We’ve been a Nuance strategic partner for a decade. Before the acquisition, we were already in a three-way partnership with Microsoft and Nuance to really look at AI. That made it easier as did my 27 years at Microsoft, my last role there was as part of the Azure team. So, my network is strong there and maybe I do have a bit of an advantage over the other CIOs. Many CEOs have been at Microsoft for 27 years and worked on Azure. So, I’d say all of those facets made the partnership easier.

Q: With 27 years at Microsoft, you must have seen a number of different industries. You’ve recently come to healthcare so tell us about your first impression and how that has changed over the past one and a half years you’ve been here.

Moore: I joined Providence about two and a half years ago, and initially, healthcare was really far behind. My observation of healthcare was the industry was 15 to 20 years behind other industries as far as using technology. Providence was further behind or further ahead than everybody else. And my assumption was based on the fact that they were change-averse; maybe just slow to adopt change and that’s been my biggest epiphany through the pandemic.

In the last 18 months, we’ve adopted more change at Providence and accelerated things more than we ever did at Microsoft. We always think of tech companies as agile and quick but we’ve moved quicker than I ever moved at Microsoft. We’ve accepted more change than ever.

Q: I wanted to touch on recent partnerships — Truveta, for instance — where you’ve you talked about AI. This one’s really the big head call for driving those kinds of initiatives. What’s the reason behind it?

Moore: Truveta was really a white paper, an idea that Providence had over three years ago, internally. But we realized the power of something like collecting patient information, voluntarily and being part of this kind of a study and anonymizing that data. But realizing the power of it was really about getting other health systems involved as well. So, we created Truveta. We were the founding members and now there’s over 17 other health systems involved and owing to that, the value is getting large with diverse datasets. We have complete coverage across the United States and having that breadth of data and the diversity of individuals really allows for better insights.

If you know anything about big data, the bigger the data, the better the insights of AI and ML. We’re just at the early stages but we’ve got some really good early insights on things like vaccine efficacy that wouldn’t have been possible before Truvada.

So, we’re really proud of what Providence did to help form that and I’m just amazed to see the progress that Truvada has made. You know, they’ve really hired a great leadership team and a great set of technologists to do some good work.

Q: Truveta also helps drive your own destiny with data and you can get your EHR system to pull it with other data. But when you bring your own data science capabilities and drive your own insights for your own outcomes, was that a move to go in your own direction, at your own pace?

Moore: There are a couple of things — Truveta being owned “by other health systems” being one. So, health systems owning the patient data and being stewards of that data was certainly a big part of it. We took a different approach with Truveta — instead of partnering with a tech company to do this, we basically created Truveta, who hired tech executives to drive it. We got access to that tech talent which was really aligned to the mission work we were doing at Providence and the mission work with other health system. So, it’s been a win-win.

I’ve got great engineers, attracted great talent, but frankly, the talent that Truvada’s been able to attract, you know, is at par with any tech company. We’re stewards of our patient data but we’ve got access to engineers that we would just not be able to touch within healthcare.

Q: Exciting! Providence has also incubated tech companies, partnered, invested in others, been deeply involved in the innovation ecosystem as investors and deployers of technology. How do these innovative new technologies – mature or not as well built-out as you’d like them to be — work? How do you sift through to the ones that have a shot at making an impact on Providence and then, stay for the long haul?

Moore: The first thing is to identify the patient or the caregiver’s experience that we’re trying to fix, where the existing ecosystem isn’t filling that niche. Then, once the area to innovate has been identified, the Digital Innovation Group starts to incubate that work. My team becomes Customer Zero. How do we jointly develop those solutions with Digital Innovation Group to ensure it can meet the needs of a health system? It’s always done in a way knowing that’s going to be spun out and the value would be Providence being just one of 30 or 40 customers. It’s an opportunity to innovate and to fill a niche that isn’t being served by others in the industry. It’s a really unique opportunity to spin these companies out and have them be standalone entities. So, it’s definitely a journey.

Like any incubation process, there’s some things that work amazingly and one hears about them. If they’re disasters, we don’t let anyone know about them. We just quietly — fail fast and move on to the next innovation opportunity.

Q: What are some of the challenges that inevitably startups are going to face? What do you look for them to cross before you can feel reasonably confident? Is it integration, interoperability, workflow?

Moore: My experience, especially coming from tech is that tech individuals seem to feel like they have all the answers. So, it’s one thing to be competent, capable and confident. You know what you want. I guess what I look for early on is a partner that’s willing to listen and learn, know what they don’t know and willing to partner and really use us as a subject matter expert. It’s like we think this is a problem to solve and we think we have a solution, but it’s got to be give and take. It can’t be that they have all the answers and we just accept it.

So frankly, a lot of it has more to do with the partnership aspect versus the tech. Is it really a give and take? Does it have access to our clinicians or expertise? What works or doesn’t work in the real world? Its important to have a partner that’s willing to listen to that and flex; really introduce a design-thinking approach and then, it depends on the solution. Do we integrate three API to something like EPIC? Do we build new interfaces? While those things are more technical in nature, frankly, technical things are pretty easy to solve. It’s more of whether it solves a business problem or not or if it’s a great patient or caregiver experience and whether it meets the needs of Providence or another customer that’s critical. So, I’d say it’s the software things versus the technical things.

Q: What about the other end of the spectrum — the big tech firms?

Moore: I won’t pick on one of them because they’re all partners. I’ll keep it generic. In general, they tend to follow what Matt Campos started with — “We know it all. We’ve solved this problem already. We’re going to come into health care. We’re going to change the world.” Sometimes that kind of fresh thinking is really helpful. That’s how technology innovation happens. But a lot of times, these problems haven’t been solved. If they were easy, they would have been solved a long time ago. So, it’s maybe a little too much hubris on the part of these companies. Those tech partnerships where they’re more in the listening and learning modes — those tend to be more effective, and some tech companies do it better than others.

Q: With regard to the startups, the digital health ecosystem is awash in new companies and there’s billions pouring into it. What’s your take on this digital landscape? Is it too much fluff or are you seeing some really interesting ones that will transform care as we know it?

Moore: Let me give you a context before I answer that. What I describe when I’m recruiting other tech executives is to imagine it’s 1995. The internet is coming along. We’re talking about how amazing it’s going to be with AOL and MSN, and the browser wars that will get kicked-off. That’s where I feel we are in health tech. It’s a bit crowded right now, it’s not crystal clear who the winners are going to be but when we look back five years from now, it’ll be similar to 2000.

We’re just in the really early phases. There’re a lot of players and frankly, there should be more players in this space. I think the opportunity for technology innovation and impact are huge and it’s a numbers game. For every hundred people that dabble in the space maybe five succeed and those five to succeed will transform the way we deliver healthcare. I guess that’s a non-answer, but maybe having a context for where we are, gives people an idea of the level of maturity and the opportunity that lies ahead.

Q: That’s a great analogy! With regard to these startups, they all want to work for Providence but Providence can only work with so many. So, when they approach you, what’s your advice to them?

Moore: Healthcare has not undergone their own kind of consumerization of the experience. So, my advice to these startups is, if you are at the forefront of that consumerization, you think about what travel was like before Expedia, or what taxi-ing was before Uber. It’s a similar kind of metaphor for healthcare. If you’re playing in a space that makes patient engagement, access to healthcare easier or smooths navigation of this complex system, enables our health systems to manage patients and ensure better patient outcomes and solve real business problems, that’s fine. But through that lens of consumerization, what we don’t need is more complexity in health care. If you’re adding complexity, even if it’s solving a problem, I’d say that’s not a good match to be in.

Q: What kind of technologies are your betting on except voice and AI. What else are you keeping an eye on as a technology trend to watch?

Moore: AI is still in its formative years. Most people all over use AI, including in this conversation. We’re still at machine learning, not at true artificial intelligence. So, if it’s a 30 year journey, we’re on year two –still early on. And as far as technology trends we’re looking at is concerned, what became evident during COVID is this remote patient delivery tech like telehealth, remote patient care etc. What I see really emerging and transforming is the Internet of Things, especially medical devices.

We served over 20,000 COVID patients from home. If you could send somebody home with a smart pulse oximeter, a smart temperature gauge that was uploading that telemetry real-time to the cloud, really building real-time big data models for each patient, that’s where ML and AI can really shine, real-time monitor patient’s changes in behavior, start comparing large patient populations, start seeing trends that we, as human beings can’t. These are COVID patients that had good outcomes early on and that’s what they look like while patients of bad outcomes look different – such differentiation can be undertaken. These are things that are uncommon.

Those building blocks start with Internet of Things, streaming real-time data to a big data model and then, unleashing the power of ML and AI to change the way we treat both, individuals and communities. To me, that’s really where the innovation needs to happen, in day-to-day care. We’re going to always make innovation-progress there, but we’ve been working on that problem for under 200 years or a millennia depending on when you start counting. They’re really using big data and managing individuals or communities with big data and ML and that’s three years old. So, there’s an opportunity to have an impact — much more opportunity for innovation on that front.

Q: What’s your advice to other CIOs who are listening to this podcast, who are not from a Providence type organization or from mid-tier healthcare organizations?

Moore: My advice is to embrace the cloud. All the technology innovations for tech companies happen in the cloud. If you’re staying on-prem with on-prem software, you’re stuck. You don’t have the scale, the performance, and you’re not getting any of the innovation that you could get by moving to the cloud. So, embrace it; it’s real. That’s where the power is going to be. That’s where the technology innovation is happening.

I talked to a lot of CIOs that are still debating if the cloud is the right place to be or the right place to put patient data. And unfortunately, every day they pause on that decision, and those are the days they’re not innovating.

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

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity