Designing Digital Change for Scale: Sutter Health’s Laura Wilt on AI, Leadership and the Human Side of Transformation

Speaker A: Foreign. Is Hard, A podcast for Insiders. Each episode, LRV Health's Keith Figlioli will talk to the healthcare insiders who are helping to fundamentally transform our healthcare industry.

Speaker B: Hi everyone, this is Tom Salemi of Device Talks. Welcome back to Healthcare Is Hard, a podcast for Insiders. Here I am once again with the ultimate insider, Keith Figlioli of LRV Health. Keith, another, uh, forward looking interview today. Looking at where we're headed with digital health. Speaking with Laura Wilt. She's the EVP and Digital Officer of Sutter Health. What's the theme sort of around this interview and where are we taking the series with this episode?

Speaker C: Yeah, I'm gonna try to get us focused cause we've been a little squirrely or I have for the, for the prep on this one.

Speaker B: So I don't wanna talk about the Red Sox, Keith. We're just moving on. We're moving right through that. We're not even gonna banter about them. They don't deserve any of our attention.

Speaker C: It's not even wor.

Speaker B: No.

Speaker C: So, uh, we spent a little time with Tom on the last podcast, the former CEO of Cedars about leadership. So interesting set of discussions I've been having with a lot of people over the last three or four months, which I think has influenced some of this, about how hard it is to lead right now. Uh, given everything that's going on, how fast the pace of change is. Tom talked about it from his post running and building Cedars for the last 30 plus years. I thought it'd be interesting to bring Laura on and talk about it from the digital stuff, a lot of stuff that we talk about, often in terms of technological change, pace of change, all the things we've been talking about around AI over the last couple of years. And Joe, we spent a lot of time kind of just coming back down to the human factor of change. Like, how do you do this? How do you know? You know, I quoted a bunch of numbers of how big Sutter is and the amount of employees they have and amount of clinicians they have. Like, how do you democratize a, uh, technology change that's moving faster than any of us that are in the middle of it can kind of keep pace with now. You take people that are maybe a step or two away from that. How do you think about that? How do you think about leading in that? How do you think about adopting in that? You know, we're not spending a little bit of capital on these tools, we're spending a lot of capital on these tools. And also, how do you know how you're going to get ROI from this? And so we talked, you know, a good, good amount of time about a lot of these things. And, you know, sometimes when we have folks that are chief digital officers and CIO types, you know, we talk a lot about technology, and we did talk a little bit about that, but we try to stay away from that and say, okay, what does it mean to the workforce? What does it mean to you as a leader? What does it mean to the organization? And then how do we think this will play out over the next handful of years? So it was. It was a. It was a terrific discussion. And many people who know Laura well, she's an incredible person. I joked at the end of the interview, I was like, laura, you know, you're like one of my favorite people to talk to, because every time I talk to you, you have a smile on your face and you're incredibly positive regardless of what's going on. And she's in the middle of so many different things. So it was a really, really solid

Speaker B: interview in terms of leadership. I mean, as you were talking, I think you even have to be farther ahead than them. You're sort of, uh, the scout. You're looking at the. What's next? How difficult has your job as a VC become over the last three or four years to know where to lead, where to look? There's so many different places you could, forgive me, place your bets or put your investments.

Speaker C: I think it's a great question. I think it's extremely hard. And anybody that doesn't tell you that's extremely hard, they might be fibbing. And there's two sides of it. One is like, no one's been able to predict what's been going on a couple of months ahead, uh, let alone a couple years ahead. And then if you do happen to figure out a lane or different set of lanes about what may happen and investing vectors, it's almost like a feeding frenzy in the market on certain things that are going on. And so one is like, understanding what's going on, two, picking a lane and knowing that that lane may play out. And then three, do you even have the opportunity as an investor to go do that? So it's a really easy job, actually, Tom.

Speaker B: And when you're. When you're picking that lane, you really can't look for outside affirmation, too, because you don't want to kind of create that feeding frenzy.

Speaker C: Right?

Speaker B: I mean, you're not looking for safety in numbers. You're not looking for affirmation from your competitors slash colleagues, you really need to kind of intellectually stake out territory for which you will hold and then hopefully defend.

Speaker C: Yeah, and I think, I mean, that's the nature of these discussions with people like Laura and others. It's like, uh, you have to understand these nuances, and you also have to separate the hype, sort of the signal from the noise. In a way, that's a core not to get into us, but for a second, it makes sense here. That's the core of our model, where we're constantly talking to the people that are in these workflows, working it, dealing with workforce challenges, dealing with technology adoption issues. And then we're dealing with these incredible entrepreneurs, uh, that are in the market, thinking about things of how those two circles kind of intersect on a simultaneous basis. That's how you can pick these lanes. But it doesn't solve the problem of could you make an investment? And I think that's the beauty and the skill of this particular game. And I think that's the same for a lot of people in operating roles right now. Are they going to pick the right technologies forever? If you look at everything that's going on, everybody is so excited about AI and now they're so excited about agents. But then the next wave of discussion came along, like, how are we going to afford this? Like, everybody's spent their budget, Like, Uber came out and said they spent their budget in the first quarter for the whole year on token consumption. So, like, there's just so much to what's going on right now. And you need smart people like Laura and others that are in the middle of all this trying to decipher and learn as much as they're also trying to point and go in the right direction.

Speaker B: Absolutely. Well, conversations like these hopefully will help, uh, you and others kind of cut through the noise and understand where the truths are. So let's begin this episode. Once again, you spoke with Laura Wilt. She's the EVP and Digital Officer of Sutter Health.

Speaker C: Welcome back to the Healthcare is Hard podcast. I have been trying to get this guest in front of me for a while. She seems to be a little busy every once in a while. But I am, um, ecstatic to have Laura Wilt, who is the EVP and Chief Digital Officer of Sutter Health. Laura, welcome. We talk so much that I'm finally excited to get it on record.

Speaker A: I'm super excited, too. Thank you for having me.

Speaker C: We were joking about prep and, and questions and, and, uh, you know, I feel like this will be a very good, fluid one for many folks. Cause you and I talk often on a lot of these topics, so. But I always start like, background. I think you have such an interesting background. How you ended up, where you ended up, how you ended up in this crazy healthcare game. Like, just love to hear a little bit of, like, the early roots to today.

Speaker A: Yeah, Well, I grew up on a farm in rural Missouri, and I started being interested in a lot of things, but never healthcare, never technology when I was doing that. But I went to Tulane for school, so sort of went to the big city also. Still not interested in healthcare or technology at that point. Finance degree, thought I would go work in banking. Started interviewing for internships my junior year and took a little bit of pause. I ended up just working in restaurants actually, all through college, which I do think teaches you so many different things that you need to learn.

Speaker C: I, uh, just told my son that I'm like, you need a job in a restaurant?

Speaker A: Yeah. Uh, you learn a lot. It's life lessons for sure. But actually I ended up. My dad was like, trying to convince me to move back to Kansas City and to apply at Cerner, and so I did and had a couple friends who worked there. But at the same time, Epic was recruiting at Tulane and ended up just deciding to go work at Epic. That was my first, like, way that I got into healthcare. And what a great experience. I just, you know, you really learn so many things so quickly. It's just like, throw you in there and figure it out. And this was a long time ago, 20 years ago. So it was different back then for sure. And really loved healthcare. Felt like I was helping make a difference, using technology to make a difference, delivering healthcare and helping physicians, nurses and patients ultimately. And so then once I started, I never looked back.

Speaker C: It's probably a different podcast, but it'd be really interesting if you chose Cerner, where your career path would have been.

Speaker A: I know it would. Like you. You could see the different things happening and you're like, would it be the same? I don't know.

Speaker C: Yeah, 100%. You've had incredible experiences at Ochsner and now at Sutter, leading large technology organizations in major change time. Like, the only way I can think about it is, like, time where, like, to be a technologist right now, you really have to be a glutton for punishment, in my opinion, because there's just so much to keep track of day in, day out. But, like, maybe starting with Ochsner, because you guys did a lot of really leading edge stuff there with you, Warner and the team, like, what was the learning like some of the learnings there. And then we can kind of switch a little bit about being in the epicenter of the Bay Area and Sacramento on the west coast with Sutter after.

Speaker A: Yeah, I think one of the things that uh, that I learned, you have to bring in the people who are closest to the work, which I think we all know. But really that was the practice and, and we did that at Ochsner and had a ton of great physician leaders, operational leaders, nursing leaders that leaned in and like it was total partnership for those projects that I think made a big difference. The other thing that I think that I learned there was some people pilot something to just have a small go live and say that you sort of got it live and that was good. I think designing pilots to learn for scale is one of the practices that we sort of eventually had. There's no reason to pilot it if you're not going to learn something that's going to help you grow it in the end. That's hard. There's not a formula that says here's how you design a pilot to make sure that it's going to scale. But I think that's why you have to have people close to the work try to really do that together. And that's the lens is like this has got to be for everybody. So if we need to do some additional work that's going to make it harder or take longer or whatever to start, it's going to be worth it because that's the purpose is to scale it.

Speaker C: And in Ochsner, I mean, just say with that for a second then pivot over. Like I always think, and maybe I'm wrong, but you can tell me I'm wrong is like it's almost necessity for where you guys had to go given your payer mix. And I think people miss that a lot in terms of what you have to do from an automation standpoint.

Speaker B: Yeah.

Speaker A: You had to figure out every way to be as efficient as possible, use the resources, like, and really try to make things scale for everybody. Yeah.

Speaker C: And is that different now with Sutter? I mean, you know, it's a different. You know, when I talk to various folks in your group that also at Ochram, Just curious. It's a different way to think about technology use. Let's leave it in there. Versus what was happening at Ochsner. Was it very similar?

Speaker A: You know, I think maybe, uh, when I first arrived a few years ago, there was like a different mindset about technology and things like that. But I really feel like we've tried to spend all of our efforts on technology is going to make things easier for either our teams or for our patients, but ideally for both of us. So, like, how do we find that? And that's where we should focus our time, which I think is a pretty good message. Helps everybody focus their efforts. The willingness and adoption and all of those things I think are really, you know, it's almost like we can't do enough from a technology project perspective.

Speaker C: So take us in. So you got to work with Warner and Ochsner. They dragged you over to Sutter. What were the first, like, what was the mandate like? What was like, hey, Laura, come with me, let's do this. What was the marching order out of the gate?

Speaker A: Yeah, well, we're going to be the leading health system, um, in the nation for technology and AI and digital. So no mincing words there. It's like we're going to figure out how to do that. And we, when I started had some work to do to make sure that we could get there. You know, everything's a work in progress. But one of the things I did when I first started was just do an assessment of some of the systems I joined and they had gone live in mid 22 with a workday HCM and payroll implementation. And there were some challenges with that. So that was sort of tail end of working through that. But a lot of just really needed to kind of rebuild some of the trust around how we use systems. Uh, so assessment and then kind of quickly learned we had some foundational stuff that we really needed to tackle. And I had the opportunity. I get to work with a great CTO here. James Klutz is amazing. And so partnered with him and really started to go after those things and then was able to bring in a lot of application team leaders to. So we could start doing the foundational stuff to build for transformation and innovation.

Speaker C: Right. It feels like in the. And we'll get into some of this stuff next. But given everything that's going on with all this explosive technology and AI and the various other things, if you don't have that, uh, mindset at the core is almost an impossible task. To your point about, like, being very

Speaker A: purposeful with pilots, you know, I think so. I think you gotta have those fundamentals and you have to know them to be able to say, like, here's the thing that could really help us leapfrog and make a big difference. It's very hard without knowing that.

Speaker C: I found, yeah, this is like an outsider Prep question, which is, do you think people are missing? Not just the foundational stuff, but I happen to have a lunch with a very close informatics colleague yesterday and we were talking a lot about this is why it's coming to my mind, are people missing the data side of this? And I don't mean the data side of this, of what is implied. Simple AI prompting back and forth. But if we start moving to agentic, are we ready? Are the systems ready? Are the, Is the data ready to be able to do any of the things that are in the headlines? And uh, it's within the core of like thinking about your system. This. That's why I bring it up.

Speaker A: Yeah, I think the data is what the data is. To me, the big thing is the workflow. How did that get there? And is it, you know, because you can create data in a system, but it could get there for different reasons and it could look different because of those reasons and then what somebody does with it after could be different too. So I really think it's a little bit of both. It's like, do you have the workflows and do you have a deep enough understanding of those workflows? Which is where I think Agentic can be a huge game changer for us. But you have to deeply know those workflows, otherwise you're just going to like pile on layers of more, I think, confusing things than really getting to sort of the root or the source of what the opportunities are.

Speaker C: You know, we've got a lot of announcements happening. I'm not going to name any vendors in this. We have a lot of announcements happening, a lot of things happening to your point. And everybody's coming at it from different angles, top down, sideways, bottom up. I assume that has to be thought through when you're thinking about this level of digital transformation. And even though a vendor or a news piece is talking about something that's now going to be horizontal in nature, can it be in this environment? Or it's kind of pivoting into like the systems of record. When you start thinking about your core systems of record, like I've heard you present at JP Morgan, I've heard many other people starting to bring their, their, their technology leaders to JPM to talk about their source systems and really like their anchor platforms. Like, do you have to lock all that down? Do you have to lock down and say, look, I'm fixated with your point about workday. I'm fixated with epic, I'm fixated with some of my core vendors. And then I can figure out where other people fit into this. We write a lot about thinking about AI and agentic from an architectural view. And I'm just kind of playing off sort of how your point of how you came into Sutter and kind of said, look, we got to fix some of the core before we can go forward.

Speaker A: Yeah. The way we try to look at it is kind of both, which is a little bit hard. But I think you have to really know what some of those source system of record vendors are doing and where they're trying to go and make sure that you understand that, because you don't want to spend a lot of time recreating something that they have on their roadmap that's going to happen this year. But at the same time, you want to see what's out there and see what some of those opportunities are to really drive the biggest impact and really identify the value. So I think you kind of have to do both, which is tough. It's hard to make those calls. And I, uh, do think there will be people, you know, I. I know a lot of people are turning their products into platforms and they want to be the new healthcare platform. And I think people should try. Right. Just like I think the people who are platform players should also innovate. So I'm happy to see everybody trying. It is a tough spot to be in on, um, the health system side to just try to figure out, like, how is this all really going to work and come together.

Speaker C: And you talked about this beginning with me. We first got on, which is like, part of it. Part of what I was driving here is like, getting to that point of pace of change, uh, how do you keep up with it? I mean, every day there's a new announcement, like, so not only how you, you know, you brought this up, but it reminded me of last week in our annual meeting when I can't remember who said it, but they were saying, like, the pace of change is like a vertical line. And then adoption is like this slow curve that kind of like barely is keeping up. I'm just curious, like, in your seat, you know your thoughts on that?

Speaker A: Yeah, it's how it feels. It feels like change is exponential. Our ability to adopt is linear. So we're trying a lot of different things. You know, I think you have to be like, open and curious. It's one of our values, etc. It's like curiosity. So trying to be open and curious, but at the same time you can't get too distracted. So I think it's A work in progress. Like I was just talking with some of my team and we're like we need to have a focused time where we're spending time on like are ah, we making progress on the big important things that we need to do while bringing in new ideas and make sure we're doing that too. But almost spend like time doing each of them. Time dedicated to each of them instead of just how we're how I feel like I'm doing it right now, which is kind of whatever rises to the top of the day. So I'm going to try to be more focused on that.

Speaker C: And it's um, that not just for you, but like, you know, when you think about these organizations, you know, you, you guys, this is approximations but you have 50,000 employees, 12,000 physicians, 2,000 advanced practice clinicians. Like so that's you sitting in the epicenter of the seat now. You distribute that problem.

Speaker A: Yeah.

Speaker C: You know, does this have to become from a management standpoint and then we can dive into some more of the technical stuff. You know, really managing to your point. The vital few to use older language while the worthless, I wouldn't say worthless many, let's say worthless pilots sprinkle themselves across until they become a vital few. And then getting the entire organization to understand that seems like a really daunting challenge these days.

Speaker A: I think it sort of starts at the top. It starts with the system strategy. What are we focused on with the system strategy? I think that Warner's done a great job of this and really sharing that. So we have meetings with our leadership team, all managers and above. We have meetings with our top 500 to 600 leaders, which includes physician, nursing leaders, administrative leaders, at least quarterly. And we're focused on are we making progress on these things? What are the important ones to focus on? I try to anchor to that to make sure that we're doing things in service of that. And then we have some obviously other ones that are kind of specific for digital, which is how can we make sure we have connected care for our patients and then how do we make things easier for all of our employees and physicians that work with us? So we try to really focus on those things to make sure people know if you're, if you're doing something and it's is in a direct line to making work easier, to making care better. Then you gotta ask yourself and rethink like what am I doing? And sometimes you do that. Right. Like we're doing a ton of stuff on, on cyber right now. Everybody is. And drawing that line for how from a cyber perspective are really helping make things better for our patients and improving care because it is directly connected. If our physicians and our nurses don't have the systems they need to use, we know there are problems. So like that's how we have to really think about it. But then you can get too broad where everything can tie back to those things. So you gotta, gotta work on it.

Speaker C: And I, and I've heard you said it in a few different settings like it's another, another way to think about this before we move on is principle based. I've heard you talk a lot about, you know, does it make it easier, you know, does it improve care? Is it people first? I assume that's some of the advice for some of the technical leaders and information leaders out there as well, which is you have a set of tasks that are really important, but then you also have to set of principles that kind of guide all that.

Speaker A: Yeah, that was definitely. I wouldn't say that I was like really thinking about this a lot, a lot of the time as this has happened over my career. But looking back I think I was influenced a lot by Epic. They have 10 commandments and guiding principles and like these things. Then I had some different rules over time where it was very much like here are the rules. This is like a, you know, a visio diagram of rules. If this, then you do this. If you do this. And I was just like this is kind of impossible for us to be able to know and make decisions based on this because you're not going to account for every scenario. So I really tried to get to a more principle based decision making sort of framework to say like what's important to us? How do we think about decisions? Write those down and share them. And had the opportunity to do that with the team at Ochsner and we've done that here at Sutter as well. So I think it doesn't fix everything. And you obviously still have to have uh, rules for a lot of things but at least for decision making, having that framework, framework of knowing, like okay, well if you bring this forward to me, what questions am I going to ask? And I'm going to ask how did you think about this for what's it make easier? How does this make something different for care?

Speaker C: So one more mechanical question. I'll ask the stuff what's working because you guys have a lot of stuff I think is working. I've heard you talk a lot about your stats which I want to bring bring out, but capital planning in this Environment. How do you think about that?

Speaker A: Well, I think we, uh, have a capital committee and everyone's like, can we. Should we be dedicating more capital to digital? And I continue to say, like, thank you, and what I really need is your operating, the operating dollars, because so many things are showing up that way. And we, like everybody, are really feeling that pressure, the margin pressure and everything, with expenses rising and reimbursement not at the same pace. So, you know, that's a big focus for us. We are trying to make sure that we're thinking through it and really doing it in collaboration. So we're, you know, we've announced several new building projects that we're working on, and it's been great to partner with those teams because we're trying to bring really these same concepts forward. Like, how are we going to make sure this is an easy, streamlined experience for people? We do that with our Chief Consumer and Brand officer, with our facilities team, with our nursing leaders, and we're talking about, like, you know, one of the things right now in a lot of places when you walk into somewhere, there's, uh, some sort of security screening and making that not feel like you're in line at tsa, because that's not a great experience. So we're, like, trying to find technologies that will help us do some of those kinds of things right now.

Speaker C: Interesting. And let's talk about what's working. So, like, things like Sutteriq, things like some of the portal efforts that you guys have done and the wraparound on that. Like, I've been impressed every time you have stood up and, like, shown me some of those slides or you've been on stage and seen them. What's m. Really been working and what's different? Because I think some of your stats are also a little bit a deviation or two farther than I see others. Yes.

Speaker A: For that, we probably owe some thanks to Warner for pushing us on making sure that we're measuring the right things. We've, maybe I'll start patient perspective first, really been laser focused on how do we work on access here in our area. It has. Historically, access has been a challenge, so that's been the focus areas, like, we need to make it easy for people to see us. We know people want to schedule online, so a ton of work, again, in partnership with the entire organization, our physicians, um, our medical groups, on how do we open this up so people can come and see you? We know they want to. The demand is there. Like, how do we do that? So that's what a Lot of the focus has been. And then I would say the second thing from a patient perspective is this concept that we have. It's part of our overall strategy, which is how do we connect with our patients, no matter where they are and where they are in their health journey. So not just because, you know, you have to come to see a physician or because you're in the hospital, you're connected with us, really. How do we make that available to you wherever you are, whenever you need it? And we call that our connected use strategy. It's like, how do we connect with people and make it easy to connect with us for the first time, too?

Speaker C: When you think about that connected strategy, is that also where you think health systems have to lean in? Obviously digitally, but I'll, uh, make it more mechanical, you know, if there's five apps that I'm using all the time.

Speaker A: Yeah.

Speaker C: Does the Sutter app have to become part of my lifestyle in time, which then also becomes part of the loyalty side of this for you all in a competitive market where you guys play today, let alone what you may do with a line of that gets through. I'm just curious, sort of like how you're thinking about that, what you have to enable, which then may touch the consumer and the brand officer may touch what Warner's doing, et cetera.

Speaker A: Totally well. And I think it comes back to some of those, like, guiding principles, like, how do we make it easy for people? How do we do things that might be harder for us on the front end, but we know we're going to scale. We know if we ask you to download a second app or a fifth app or a tenth app, the likelihood of doing that drops off. Remembering your passwords for all those. You know, it's just like some of those mechanic basics, but trying to have one app we call ours My Health Online, that really has everything that you need when you interact with us, including. We just launched Ask Emmy, which is the sort of chat inside of my chart, which has. We haven't even shared some of this. So preview. We have, like, we just opened it up for patients. We've had over 22,000 people use it so far, and it's like 7,000 weekly active users right now. And this is like, we haven't even told anyone about it. We just sort of turned it on. So I think that's so important is, like, we know people are asking these kinds of questions. They're doing it maybe in not as private, not in your health record sort of environment. So, like, how can we enable that for you and then make it easy for you to use. So very excited about that. Same concept really applies for our employees and our staff and our physicians that Sutter IQ is like our internal chat and ability to use AI and ask questions and have that on our internal environment as well as be able to go use the web version.

Speaker C: So one side question before we jump into our favorite topic, which is where you were going, some of the agent proliferation stuff, but like with your hat on. I think a lot of health systems are also and even payers for this point. They're trying to realize that there's one thing to do for your clinicians, your patients. But your point you just made about your employees, uh, and the level of, we'll call it automation but AI sort of footprint and then actually taking all of what you have in the back end of uh, it might be sitting on SharePoint, might be sitting somewhere else and trying to get that in. Is that a huge effort too? And do you have a huge internal team that's like hey gang, like how do we take Sutter IQ and make it like the place, the first place that everybody goes to or whether it's copilot or whatever with your Microsoft license. I'm just curious, I'm always curious about this because there's like these two different circles that are going on right now.

Speaker A: Yeah, we're trying to pay attention to both. I would say we have been more focused on a singular patient experience than a singular employee experience. As an employee, you still go to a bunch of different platforms that we use that I think same thing is happening on that side though. Like, I know we're not supposed to name vendors, but you can think of them as the big ones that you know that are software as a service vendors that are platforms inside of all of our systems right now. And they're all trying to be the single source of truth engagement platform for our employee experience. So we're watching that and trying to again do the same thing. Be curious what they have figure out where we want to play. But trying to take a inventory of all that today.

Speaker C: Yeah, I uh, think that's talked about less, I know it's publicized less, but the amount of work to actually build an intelligence layer at the corporate level now it doesn't have to be healthcare anywhere. To build an intelligence layer to make sure that every one of your employees is activated at any one point in time through a single kind of way, I think is a massive opportunity for a lot of people. And a lot of people are in that area. But it's something that I think a lot of our health leaders should be thinking about some more. So switching back to where you were going with me and the core vendors and just curious, like we've had a lot of separate discussions on this, which is our view is if you really step back on a lot of these core systems of record, where everybody. We've had the SaaS apocalypse we've had, they're all going away. Like, uh, everything that could happen, the stock market goes down, like everybody's excited. Our view is a little bit of a flip on that, which is like we feel like as everybody catches up at the systems of record and they want to be, you know, systems of action as well, that agent proliferation, true agent proliferation, back to the infrastructure, back to the right tools, back to the right data, back to the right workflow, to your point, back to the tools that your organization already uses. A lot of that could come out of those vendors and have to be managed as the next wave of what we keep calling agent proliferation. We should come up with a cooler name. But just curious like how you guys are starting to think about that. It's very early days. We're probably not even in the batter's box yet fully in it even to use one vendor use epic, like, you know, their agent studio is very nascent. And so I'm just curious like how you're thinking about preparing the organization for that, let alone how you end up managing, monitoring, governing that level of potential automation.

Speaker A: I think that we are very early stages on this and this is going to be an area for all of us to pay a lot of attention to. Sometimes I've heard people say, you know, you think of agents like you could have just as many agents as you do employees or more. Right. You've heard of software engineers or developers managing 10 coding agents as part of what they're doing. So I think that it's going to proliferate. I think it's a good word even if it's not as how health systems and how everybody. I think any business is going to try to manage these is going to be difficult. I know there's a lot of people that, that say like, well, we want you to put all of our agents into our platform, even if they're running another system. I just, I don't. For me it's early to say, doesn't make sense totally yet, uh, for me to do that because I do think that those systems of record are going to. They have advantages when the agents are built into their Systems for ability to monitor it, uh, share what they're doing just like they do for, for other types of activities that happen. So I think there's an opportunity there. But I agree with you about the systems of record will have agents and they will I think assuming that they all continue to mature, I think they're positioned to really work well.

Speaker C: And is that the next wave? You brought up cybersecurity but like broaden that cybersecurity and risk is that the next wave at, you know, most health systems or other health organizations have to get prepared for. So it's not just hey, the model might be fully released and it's going to go amok but then there's these other aspects that you all need to be prepared for.

Speaker A: Yeah, I think for sure from a governance perspective, understanding the risk. And I think our team's done a really nice, our chief AI officer in partnership with our chief Privacy officer, uh, they've done a really nice job of building a governance framework that's flexible but is taking a look and all of, all of the risks and making sure that we're making decisions on those and not just sort of waiting for them to happen. The cyber acceleration of identifying vulnerabilities in software though, that's like back to fundamentals. Like you got to patch your systems and you probably have to yes, do monthly patching for some things but monthly patching is not going to be the end state of where we are with this. So we're going to have to get better at doing things. And that's like really sort of fundamentals. Which servers are ah, which applications that impact which users at which location. You know it's basics but you got

Speaker C: to know it totally. And when you think about that, do you think that let's uh, say with health systems, do you think health systems are prepared or more importantly have the right guidance right now either at the federal or state level because there's not much there on some of these things. So is it more back to principles and more about the way we want to operate in some of this? As much as it's about hey, here's the federal or state mandates, you know

Speaker A: I would say I think the federal guidance around specifically like cyber and vulnerability patching is pretty uh, I was, I

Speaker C: was referring more to AI but oh

Speaker A: yeah, on the AI I think there's a lot of people, groups, organizations trying to come together to put some of that together. But it is very, it's not just governance for the sort of machine learning based models. It's really different with generative AI. And how do you understand it's really how people are using it. And what do you need to put in place to understand that?

Speaker C: And one question on that, consumer lift. So if you think about what we often call the implied or the informed consumer doing, to your point, doing a bunch of stuff outside of your systems, but then coming to your ambulatory sites or your doctors and the inpatient saying, say, here you go. Like, this is. Like, this is what I think. I don't know how much discussion you've had with your clinicians on that or how much that's actually happening, but I'd be curious perspective on that. And then how does the health system even deal with that? How do the clinicians deal with that?

Speaker A: Uh, yeah, I think it's an important conversation to have with your physicians. I think we have. Our informatics team is trying to have those conversations with our physician leaders. I have personal examples of doing that activity and bringing that to my pediatrician, to my kid's pediatrician and talking to her about that. And she was super gracious, really. But what we talked about was how can we make this easier and part of the workflow? Because honestly, in that scenario, if I could have sent her all that information before my visit, she could have done that reading that she did after the visit to help prepare for the visit and had a more totally effective visit and make it a little bit easier for her. So that's where I think some of these things are going to have to come together. Like, we have to use technology and not say we don't want it. So don't bring us your chatgpt, like diagnosis. We are going to have to say like, how do we make this in a way that we can share and really have that collaboration between patients and our physicians? And to do that, we're gonna have to lean in and work on it together.

Speaker C: And we heard it last week at our annual meeting when you were there. It was like, it's not like they're gonna slow down.

Speaker A: Yeah.

Speaker C: It's not like the consumer platforms are not gonna lean into what is a heavy usage pattern. So it feels like at some point to your point, the workflow almost has to be stitched out or the acceptance of that has to be stitched all the way out to the home front where people are using this. But then when they get into whatever episode they get into, that has to be transitioned into the enterprise workflow.

Speaker B: Yeah.

Speaker A: And we are hoping and envisioning a world where you can have some of that done when you're not necessarily coming in for a physician visit, but have that sort of connection and feel connected, like, oh, if I have a health question, I'm not going to go over there. I want to go to Sutter and help me, and then they'll help get me to the right place. I need to be seen, too.

Speaker C: Yeah. And back to your point about, like, that portal extension and the My Health, what you called it, uh, the Sutter Health extension. Does that then become more robust? Has to become more robust to be able to do that. Is that, uh, your feeling?

Speaker A: Yes, absolutely. We're developing our chronic disease management programs and they are part of that. So Sutter Sync is our hypertension, we have diabetes program. Those are like all part of that same experience for patients. And we did debate that quite a bit when we were working on developing that product and those programs is do we want it to be separate? And we ultimately landed on. We think that it will scale and be easier to use for everybody. Have it be more connected, honestly, for our physicians too. If it's part of that.

Speaker C: That makes sense. Let's step in the last couple questions and we've talked a lot about what it's like right now to try to manage in this. And, um, what do you think is the single most important characteristic for various digital roles right now across health systems?

Speaker A: Maybe m. Humility. I was going to say curiosity. But really, I think it's hard role to be in your organization is generally looking at you to know the answers to things that I think we have to say we don't know the answers to. So being transparent about that too, I think is really important. And then working hard to learn so that you have enough of a perspective to be able to say, here's what I know now, here's what, what I'm thinking. And then I think communication, human communication is going to continue to be so important. It's something all of us can work on. It's something I work on all the time.

Speaker C: I'm always impressed. I've never told you this, but I'll tell you this on record, like, every time we get on a call, every time we see each other, whatever, you always have this very positive. You're very, like, happy. I'm like, how like you're dealing with. I'm always amazed that you've. You've always got this smile and you've always got a very positive outlook on this. So I'm very impressed.

Speaker A: Oh, uh, well, thank you. Something I tell my kids, actually overheard it when we were on A hike at Yosemite, not this past trip, but one historically. And we were trudging down the mountain and tired and all of those things. And I overheard someone say, attitude, gratitude, like, we're lucky to be here. And I think about that all the time. Like, we are lucky to be here. We're lucky to be in the positions where are and be able to have a voice in this conversation of, uh, where. Where healthcare is going.

Speaker C: I totally agree. I used to ask this question a lot. I haven't lately, but I'm gonna. I'm gonna do it here because I can't think of a better person to ask it. Like, what does this look like in 10 years? If you can even predict that. We can't even predict, like, a week, but, like, just for fun, let's predict, like, what does this look like in 10 years? Does this look wildly different or. I read something this morning, it was really fascinating about all the people that were developing autonomous driving early days. Like, everything is gonna change and it's gonna change fast, and, like, we're gonna get into this world and, like, nothing has changed fast with driving now. It's starting to pick up now, but it's still, like, has been very slow. They were correlating that to sort of where we are with AI and agentic, and everybody's saying, you know. And it was off of Dario's great letter this week, and it was like, yeah, that may happen. It might be great to be prepared, but it's going to take a lot longer than I think a lot of people. And maybe that might be wrong, by the way. So I was just curious, like, in the seat that you sit in, what could this look like in 10 years? And how different is it going to really be? And then the other side of that is, what doesn't change?

Speaker A: Yeah. Oh, man. That's a hard question for me to end on. But to the driverless cars thing, I think the technology has been there for a while, right? It's like we have to figure out how to adopt it. So back to our earlier exponential change versus linear ability to adopt. I do think there's something to learn from that for all of us. I think the technology is changing so quickly, like, it's hard to get your head around. For me, things that the technology could do now from even last year, are so different and so much more advanced. I think our ability to. How we adopt that and bring it forward will be the difference for the next 10 years. But I also think this would be my call to action for Everyone, like, we have to be involved. We have to know and have a perspective and try really hard to make sure that. That exponential technology advancement doesn't just happen to us.

Speaker C: Yeah. And that, uh. And you may recall from last week, like, it was the one thing that I really wanted to say, and I was glad I didn't forget it when I was on stage in front of everybody at our annual meeting, which is. We're accountable.

Speaker A: Yes.

Speaker C: Like, we are accountable. The people that are in this room, the people that I get on this podcast, like, we're accountable for it. To your point about being lucky to be able to do that, I think, you know, pressures of privileges, they always say so I think it's a great way to end. And, Laura, uh, you know, I can't appreciate your friendship and the partnership more, and it's been a lot of fun, and I was very serious. I always. I'm always excited to talk to you because you do always have a smile on your face, so it's great.

Speaker A: Oh, well, thank you, Keith. I would say all of the same things back to you and the team. You guys are wonderful partners, and I really appreciate you.

Speaker B: All right, well, that's a wrap. Thanks for joining us on this episode of Healthcare is Hard, a, uh, podcast for insiders. You can find Keith Figlioli on Twitter and on LinkedIn. You can find me there as well. I'm Tom Salemi, editorial director of Device Talks. Join us next time. We'll have another great episode of Healthcare is Hard, a podcast for insiders waiting for you.