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This is Laura Dierda with the Becker's Health
Care podcast.
I'm thrilled today to be joined by Chuck
Podesta, chief information officer at Renown Health. Chuck,
it's a pleasure to have you on the
podcast today.
Thank you. Thank you very much. I'm, happy
to be here.
Now I know we've got a lot to
talk about. There's so much happening in health
care and technology right now and really, you
know, cool things you're doing at Renown as
well. But before we dive into our discussion,
can you tell us a little bit more
about yourself and your background?
Sure. Yeah. So I've been here at Renown
Health for about 3 years now. Started actually,
I just had my anniversary 3 years in
July.
But I've been a CIO now for almost
30 years
and,
and almost 40 a little over 40 years
in health care, IT,
in my career, and I used to introduce
myself and say that just makes me old,
but somebody stopped me one day and said,
no. That makes you wise.
So I'm gonna go with wisdom over age,
in my introduction from now on. So,
but the last, I would say, 15 years
have been in academic medicine, and now at
Renown Health, for 3 years. We're an integrated
delivery system
in, Northern Nevada. Also have a, we have
2 acute care centers along with, children's hospital,
all the ambulatory
clinics that you would imagine that would be
part of an integrated delivery
network. We also have a very tight affiliation
with University of Nevada Reno,
School of Medicine. So,
we are rapidly, you know, moving
academic affiliation,
you know, with,
residency programs and and,
certainly,
focused on research activities, clinical trials, and things
like that. So I'm excited about that since
I I do have a background
in academic medicine. And, you know, we are
this is good timing for this because we
actually are embarked on a a multiyear strategic
planning effort, and we're actually getting towards the
end of that, coming down to the actual
initiatives that will start in 2025.
So
happy to talk about those.
That's fantastic. Well, we can dive right in.
What are some of the big opportunities and
headwinds that you have your eye on right
now? What's top of mind for you, especially
as you mentioned, some of that strategic planning
for the future?
Yeah. I think it you know, it's a
it definitely is a growth strategy,
that that we're embarked on in serving our
our community here in Northern Nevada. And if
you know anything about, the Reno area, it
is from a a population
perspective.
We have an influx of people from,
a lot of different states, but, particularly
California right now.
So,
every time I drive around, I see new
housing units going up,
and, it's really,
the population is expanding. So we have to
expand with that and make sure that we're
we have facilities available in in the various
areas of Northern Nevada that serve our patients,
and community. We also have a a large
rural population as you can imagine,
with a lot of critical access hospitals,
that we,
work closely with as well. So that needs
to be part of the strategy. I think
in in just to name a few areas
we're focused on, I think this will mirror
a lot of what's happening with health care,
you know, across the
United States
right now is,
so in areas of virtual care,
you know, which a lot of that started
with COVID
and kind of petered out a little bit,
post post COVID. Although, I don't know if
I can say post COVID because,
COVID's here to stay.
But things like, you know, telehealth, telemedicine,
hospital home,
virtual nursing, all those things come under kind
of a virtual care
umbrella.
And as organizations,
move
more towards a a value based care
model versus
fee for service. These types of
technologies and initiatives come into play, and that's,
no different here. But now we also I
I should have mentioned, we also have,
an insurance company, Hometown Health.
So we are in the
payer space as well, and we do have
value based care models for some of our
patients. So we have to look at these
type of virtual care strategies to help in
that area. But also from a rural care
perspective, when you think of telehealth and telemedicine
expanding out into those areas, it certainly makes
a lot of sense. So
I know that's something that's being discussed, you
know, across the country. A lot of,
organization already moved in that direction. We're going
there as well. And I would say the
next thing is data analytics.
We hear that
across all of health care.
That will be the engine, I think, that
drives everything. You've gotta have quality data
to do a lot of different things, you
know, when it comes to
looking at personalized medicine,
certainly disease outbreaks. We learned that from our
COVID experience.
Operational efficiencies within the organization
itself, patient experience,
and safety.
You know, data analytics plays a huge role,
in all of those areas. And, of course,
with
the buzzwords now with AI and ML,
without
a solid data analytics program,
you can't really venture into the AI ML
space without it.
So that's big. Interoperability,
again, again, the government's got involved in that
as well and and requiring a lot of
interoperability
between systems.
Lots of challenges there.
But from a coordination of care aspect, you
you really need to be able to move
information
in and out of your electronic health records
in a seamless fashion
to a variety of other systems,
both within your organization, but outside of your
organization as well.
I mentioned briefly AI machine learning. That's,
without question,
probably the biggest thing that's going to impact
health care in the next 5 years
around.
Right now, it's you know, a lot of
it's focused on administrative processes, which is great,
saving people time, productivity, things like that.
But we're also getting into diagnostics and treatment
plans and things like that, going forward.
Research will also be big in the space.
Wearable tech, which,
has been around for for quite a while,
but it's getting,
I think a little more play post COVID
as well as part of the tide of
virtual care, hospital or home. Also, the technology,
I think, has caught up a bit.
Better technology, better wearables.
I think the focus,
for us and and and others from what
I'm hearing is is that continuous monitoring of
chronic diseases will be big. If you think
about, you know, chronic diseases like,
like diabetes,
COPD,
congestive heart failure,
things like that, those are the highest cost
diseases that states that are out there.
And so continuous monitoring of those, I think,
gives us a
window into what's happening to those patients, but
also allows us to intervene
in lower cost settings,
for them and hopefully drive the cost down.
So that will be,
I think you'll see wearable tech kick off
more than it has.
And then certainly cybersecurity,
you know, that's we every time we turn
around, we just had a,
the issue with Change Healthcare. That was the
biggest thing,
I would think in the past year, but
also variety of other ransomware
attacks that have taken place. I think one
of the technologies that you're gonna hear more
about is blockchain.
It's been around for quite a while,
and used in, like, claims processing
and some other types of applications. But I
think, securing patient data, it's it's gonna have
a role just
based on the way it's architected. And I
know a lot of companies are starting to
look at that, and I think that that
will play a role for us. And in
cloud computing, you've gotta have a strategy around
that
as well,
just to be able to be scalable in
your technology as you're implementing,
the different applications.
But, you know, there's risks associated with that,
as well as we all know,
with the, you know, the various cloud type
systems that have gone down,
and, you know, with the change health care
issue and,
merger and acquisitions
in in the industry,
it's very difficult to have
backup plans. And so,
you need to have,
you know, some sort of business continuity
tied to, that cloud computing. So,
lots of challenges,
I can touch on,
you know, the data security
and and privacy's,
on everybody's mind.
Right now,
I talked about interoperability
and just, there's just so many diverse systems
out there and moving data around. Again, that's
a data security issue as well.
Regulatory compliance, I think that just will increase
and become more complex,
as we go forward, especially with AI and
ML.
That that will add cost certainly to an
organization,
especially to IT.
The implementation costs as well, I think are
gonna be a challenge to a lot of
these new technologies.
When you think about cybersecurity,
I'm seeing some statistics around, you know, the
average
budget for cyber is 4 to 6 percent
of the total IT spend in an organization.
That's going up to a 7 7 to
10% spend.
So,
you know, does your IT budget go up
to account for that, or do you have
to make cuts in other areas?
So that's gonna be interesting.
And also the impact on smaller providers,
they can't afford
a lot of these technologies. So, you know,
what are we gonna do in in those
spaces as well, and how can we help?
Training challenges, you know, the user adoption of
these new technologies, I think, are is gonna
be
interesting. And how do we train,
especially our clinician clinicians to use these technologies
in in a patient care settings.
Data management and the quality of that data,
that's key. As I said, that's gonna drive,
especially the AI and ML
aspects of of what we do.
Just AI if we just touch on AI
and ML just a bit too. You know,
you're hearing a lot about
security around that as well, but also
the ethical use of of that technology
and things like algorithm bias. And and, so
those are the things we're gonna have to
be really
careful and watch over,
as you implement those types of technologies as
well.
And then we've got a bunch of legacy
systems sitting out there.
We gotta figure out what to do with
those. A lot of them fit. A lot
of them don't.
Again, costs associated with doing that. So,
I would say that, you know, from my
standpoint, when we look at the initiatives here,
right now, and I think across the country
that,
probably gives you a pretty good summary of
where we're heading, but also, you know, some
of the challenges involved in it. So I'll
stop there for a minute.
Yeah. Yeah. No. That was a fascinating overview.
Think especially you mentioning just so many different
areas, whether
it's virtual care and looking at how, you
know, that strategy will continue to evolve as,
value based care becomes more prominent and then
talking through artificial intelligence, machine learning, and data
analytics infrastructure that health systems need. I know
a lot of organizations across the country are
in various stages of trying to figure out
what makes the most sense for them, what
investments are are gonna be primary. And,
the most important is they're evolving their organizations,
to really incorporate those tools in a meaningful
way. And then the security piece of it
too. Yeah. I think it's just so fascinating,
to try to pin down, you know, how
you can
continue to build out and create these systems,
that are also then secure and the partnerships
that are going to be most beneficial while
also
understanding the risks,
that are are clearly out there no matter
who your partner is or,
how, you know,
secure it seems at the moment. So I
think it's just been fascinating to hear you
talk about some of those different areas,
in really highlighting
what's top of mind for you.
So that's been really interesting to hear. When
you think about just, you know, that continued
growth, talking about wanting to grow both in
the urban as well as rural setting,
and then obviously add value to Renown overall,
How do you think about that? What's really,
how do those things play together? And then
I I know every helped your dollar is
precious. So how do you,
make sure that as you're growing and making
the right IT investments, you can really show
that return?
Yeah. So I it's a great question. I
mean, you have to be careful because, you
know, you depending on the size of the
organization, you know, you
you can only do so much. Right?
You from a financing standpoint, depending on what
your, you know, your bottom line is, what
you look like s and p, if you're
gonna do debt financing, and what your capital
spends can be. And and, of course, you
have your, you know, your keep the lights
on types of spend.
Every year, you've got to keep your medical
equipment up, new medical equipment coming in certainly
in the IT space around networks and infrastructure.
So you've got all these other costs that
you have to make sure that you account
for before you can do the growth strategies.
So you really gotta focus in on,
you know, what what can you what, you
know, what do you wanna be when you
grow up, but also what what can you
be and what you can't be, right, you
know, based on
where you are from a financial perspective. So
you gotta take that all that into account,
and and we're doing that that here as
well. But you can there's some medication
strategies around some of this that
can help you make the right investments,
going forward
and not try to be all things to
everybody.
And and one of them is is around
if you think about the IT, some of
these,
technologies I talked about is is to really
have a pilot mentality
on everything that you do. So, you know,
don't go all in and
and and really look at the size of
your organization. You know? Most of health care
is not Mayo and Cleveland Clinic and and
Stanford's of the world. Right? Most of health
care is is renowned and smaller. And so
you have to be very careful. You know,
you hear the term chasing, you know, shiny
bright objects all the time. And I I
think CIOs,
a lot of ways, fall into that trap,
especially younger CIOs trying to build up their
their careers and resumes and and
and
and and going for that, you know, kind
of bleeding edge next best thing.
And you gotta be very careful about that
because you can make a break, an organization,
by making the wrong decision on some of
these newer technologies. So I I urge a
lot of CIOs. I do a lot of
mentoring,
that, you know, be very careful about chasing
those shiny bright objects to build your resume
on the backs of the of the organization
that you work for
and really focus on doing the right thing
for the organization. And that will build your
career, not the shiny bright objects. So
the piloting,
and the and the strategy we have here
at Renown is really to see what the
mayos of the world are doing in the
Stanford. I want them to be chasing those
objects.
I want them to be innovative and doing
all that work, And then I wanna stay
close to what they're doing and and
see and and see what works
and what and more importantly, what doesn't work
so I don't fall into that trap. And
then pilot the things that that do work,
or look like they work. And and that's
what we're doing here. We're not afraid of,
some of the newer technologies. We're doing some
things in ambient
listening with our providers that's,
that has a lot of promise rolling that
out right now on,
around clinical content and and productivity for our
our providers and and also,
some virtual nursing,
piloting that we have. But, again, these are
not,
companies
that
are,
just on the market. They've been working with
other organizations,
so we're following that lead. That's okay,
to do.
As a CIO, you don't need to be
on that that leading edge,
unless you do work for,
Aimeo or a Cleveland Clinic or those types
of organizations.
So
so, again, following others,
focus on data quality and security in everything
that you do. Right? So whatever these pilots
are, whether this new technology is, you've gotta
have a data quality program around that,
and you've gotta have a security program around
that as well.
You also have to be able to train.
Right? You've got all these, for example, using
a you've got physicians using,
ambient
listening technology with their patients. How do you
train for that? How do you train IT
to support it? What kind of staff do
you need? So your workforce evaluation
involved in that is super important. And then
the continuous monitoring and evaluation, you know, auditing
your programs,
monitoring your programs,
things that are working continue, things that are
not stop
before they do get too expensive, and just
the evaluation, the constant evaluation of that going
forward. So I think if you put those
kind of mitigation
strategies together around all the you know, whether
it's virtual care, whether data analytics, whether it's
interoperability,
AI, you know, wearable tech. We talked about
all these things, cyber.
If you add in, you know, the piloting,
focus on data quality and security, train, train,
train, train,
continuous monitoring evaluation of every single one of
those,
then you have a, you know, a high
likelihood of success,
in those areas.
If you don't put those mitigation strategies in
place,
then there's a lot of risk involved with
a lot of these newer technologies that are
coming out, and you could end up in
a situation of, you know, spending
money that, you know, you don't have in
an organization on things
that don't actually work.
So so that's that's super important.
That makes a lot of sense. You know,
it's great advice. I think with our last
minute or 2 here, I was wondering if
you could talk about where you see some
of the best opportunities to grow in the
future. What's,
do you see as being really the space
where,
leaders, CIOs, and other health care executives should
lean in?
Mhmm. I I think the biggest the biggest
thing, and we we've already talked about it,
is AI,
AIML
and everything that goes with it, whether you're
talking about
ambient technologies and the things that are kind
of offshoots from that,
along with the, you know, certainly the data
analytics play that goes with that. Because if
you think about it in the next 5
years,
you know, you think about 5 years ago,
what we were doing with AIML even maybe
3 years ago,
and and where what we've done just in
the past couple of years and and where
that whole technology is going. And I know
there's there's certainly a lot of challenges with
it. We talked about the the ethical aspects
of it, safety,
algorithm bias, and things like that that all
need to be worked out. And there's a
lot of organizations, you know, IEEE and some
others that are and even government organizations that
are focusing on that. So
I'm hopeful,
that we, you know, put
a fence around this thing so that we
we're using it in the right way.
But when you think about it, gosh, it
it has the biggest,
impact, I think. You know, when you think
about personalized medicine, right,
and AI and ML impact on personalized medicine,
predictive analytics
and helping clinicians do the right thing for
for their patients,
a huge impact in that area as well.
And you can't forget about research.
AI and ML will play in accelerating research
and getting, you know, pharmaceuticals,
you know, to the market faster,
getting different types of procedures and care
to the market faster back into health care
in a translational way that can be used
a lot faster than,
you know, when you think about the timelines
for research from
beginning basic research to be able to use
whatever comes out of that is like 13
to 15 years same with drugs
and imagine shortening that down to 3 or
4 or 5 years what the impact of
that is gonna be to health care,
you know, across
the across the United States. So to me
that that is where
the focus,
needs to be. And, again, all these other
things I've talked about
aren't of less importance, but
need to, you know, be shored up so
that we can focus on,
some of these other, you know, bigger technologies.
And, again,
again, when we think about AIML too, it's
around cybersecurity.
I think it'll have a big impact in
that area, both good and bad because the
bad actors will use it as well.
And then,
you know, we'll have to respond using these
tools as well.
And so that that'll be interesting to see
how that plays out, but yeah, but that's
why I think it's going.
That's fascinating to hear. Chuck, thank you so
much for joining us on the podcast today.
This has been a really interesting discussion, and
I look forward to connecting with you again
soon.
Absolutely. Thank you. And, I I appreciate it.