 Live from Las Vegas, Nevada, it's the Cube at HP Discover 2014, brought to you by HP. We're back, welcome to Las Vegas everybody. This is Dave Vellante with Jeff Frickin. This is the Cube. We're here at HP Discover. This is day two. We've done a number of HP Discoverers over the years and this year there's a particular emphasis on talking to the customers, the IT practitioners and the CIOs. We had Jason Cohen on yesterday, CIO of Omnicom. Bill Laskowski is here. He's the CIO of Metro Health in Michigan. Bill, welcome to the Cube. Thanks for coming on. Thank you, my pleasure. So tell us a little bit about Metro Health. You said it's about a $350 million organization. Yeah, we're a healthcare system. However, we're only one hospital. But in terms of healthcare, we're about a $350 million organization that's small. But what's different about Metro is we have a huge emphasis on primary care. So we have multiple other sites across West Michigan. We are more ambulatory, which is outpatient, physician services and so on than we are anything else. But with that being said, we've built a brand new healthcare campus that we call the Metro Health Village. About a 200 acre campus that has a brand new hospital, multiple other buildings and it's designed for the healthcare of the future, which 10 years ago when we were designing it, truly is where we're at today with where healthcare is going. So the campus, so how many beds in the hospital? It's only a 208 bed hospital, but you got to remember healthcare is going out and not in. So it's a small sort of mainspring of innovation that you then sort of export to the distributed locations? It is, I mean, we had the, when we were designing this thing and even strategizing it before we built it, we brought in the futurists and others that were predicting where healthcare was going. And we realized, and we knew back then, but it's so prevalent today, consumers, our customers, are the ones that are going to be making more decisions with their healthcare dollars because they're going to have to be paying more of it. And we knew that healthcare was going more amuletory and more outpatient. So we needed to get ahead of this and we needed to build a new hospital. So with that in mind, we just didn't build a replacement hospital. We built a healthcare village that was all about the future of healthcare. Yeah, I mean, as a consumer, that sounds very appealing because we've all been inside or most of us been inside of a hospital, it's imposing, it's sterile, this is not a comfortable place. Well, you're saying a couple hundred acres? A couple hundred acres. When all is said and done, we're going to have about 40 buildings on the campus. We probably have 20 now and it's just continuing to expand and so on. And a lot of these are like, we have a cancer center, we have a health club, we have consumer stuff like a Starbucks and all, you know, restaurants. We have a hotel. I mean, it's a community. And it's there not just for our patients, it's for families that are there for their loved ones that are there for a purpose. It's also there for the employees and for the physicians. It's a place that thrives because we're there to really be a great experience for all the key stakeholders. Yeah, it sounds like quite an experience. So Bill, talk, you know, one of the topics we always cover is innovation, right? Everybody's trying to spend less time keeping the lights on and more time innovating. And this sounds like a pretty innovative approach. I wonder if you could take us back as to kind of who initiated this and what were the drivers of taking this kind of progressive look forward to build this, I guess campus is probably the best word. Well, I would say it begins with our CEO. He's been with Metro for 20 years. I've been there 18. He's been a key mentor of mine. I've been working with him for a number of years. But he's a visionary and he gets out in front of it. He's a vision guy. Nothing is too small for Metro. I mean, we're small, but we know that we can get it done and achieve it. But it's all about what's best for our customer. What's best for our patients. What's best for our families and what's best for the community. And the innovation comes with thinking in the future but getting ahead of it. So not only do we have a little bit of a competitive advantage, we have the opportunity to bring technologies and other things to help enable this future. And it's really helped us because indeed that's where healthcare reform is going. So this is pretty innovative from my standpoint. It seems like you can move faster than some of the larger institutions. It's one of our advantages. Small has good and bad as opportunity and challenge. The challenge is we don't have scale. So my cost, I only have 70 people in IT, although really IT is throughout the organization. So we're partnering with everyone across the organization. But it gives us that agility, we don't have a bureaucracy above us to make decisions. We move quick. We are very innovative compared to anybody let alone at 200 bed hospital. We have been in virtualization in four generations of virtualization now. We're on the cutting edge of that. But we've done it because it enabled this agility and enabled this kind of experience. And we've utilized as much of the technology as we could possibly do, even getting ahead of where technology tends to be. How has your information architecture changed as a result of this? People talk about the future of healthcare. A lot of times it comes down to information, information access, privacy, things of that nature. What has been the info impact of this change? I'll go back to a key strategy that we put together back in 2003. We stepped back and at that time we were using a lot of applications from multiple vendors. And we don't develop our own software for the most part. We use EMRs and other packages and revenue cycle stuff and so on from a lot of different vendors or we did back in 2003. We stepped back and this was aligned more with where we're going with the vision. We said integration trumps functionality. In other words, you have to have great functionality but integration is what will enable the experience we're talking about. So we stepped back and we said, you know what? We need to find a new integrated solution that brings all of our parts and pieces which as you saw, we were expanding out together so it's seamless. We ultimately ended up with what is today the leading EMR vendor out there which was built completely for both ambulatory outpatient inpatient to be an integrated platform and that's what we use. So you're physically, you're distributing but your information assets, you're integrating. Well, and I should probably point out we also had the strategy that we had to go digital. So we had a lot of paper in pockets and so on to really get care around a patient. That means your information needs to be around a patient. That means your application's got to be tied to a core and not in these disconnects between the pockets of data that were in these other applications and in our paper charts. So we went digital. We had a strategy to invest in going digital and that's not just the EMR, that's the infrastructure to enable it. So you're there essentially. You've got a patient focused data records that people can access. That's Nirvana for many places, Jeff. So Bill, the other thing we talk about a lot with CIOs is this tug between kind of the technical side and keeping the lights on versus the business side and really being a business contributor to the organization. Talk a little bit about that in your role and how clearly you had some top level strategies that were being defined. How have you been able to execute those via the technology? Is it business-first support by the technology or it's kind of here's our technology that's stacked that we got and here's what we can do with it on the business side. We do not have a separate IT strategic plan. I have been working with, like I mentioned, our CEO for 18 years through time. He has not only appreciated but got very involved in the appreciation of what technology can do for our strategies. And so we have a small executive group, it's about six of us, and we are all about strategizing and embedded in that is the technology. So when we know that we have a strategy that's going to increase a certain service line in the hospital or we have a strategy to provide excellent primary care and integrate it all together, it's inherent that technology is embedded in that strategy. So our technology strategy is in all of our core strategies. And then talk about kind of the implementation. We have a lot of practitioners that like to watch a show, they love to hear from their peers. What are some of the just recent things you've been working on that are high priorities and what's coming up next that you're getting excited about? Well I'll tell you, it's never a dull moment and what's happening with any industry but especially healthcare is we are quickly catching up and surpassing some other industries and being electronic, being digital and so on. That means that everything we do includes information, it includes being on a note on our infrastructure, it means integration to our EMRs and all that other stuff and that includes things like all the medical devices. So monitors with patients that are integrated right with the EMR to give us real-time information. There are constant projects to improve and to bring the latest technologies let alone the IT stuff, right? The infrastructure to keep it current, the applications and so on. So we never have a dull moment. Probably the most notable thing that we're working on right now is our virtualized desktop environment. We're in our fourth generation of virtualized desktop. We use VMware's VDI, we just went with a brand new architecture with HP, we went with a complete flash three-par arrays for our, and we've improved performance multiple times. I don't know, I don't have the metrics in front of me, but we significantly improve performance reliability and it's one of those factors that our end users are saying, wow. So the issue prior to putting in, so why did you bring in the all-flash rate? Was it just sort of your VDI infrastructure, boot storms, things of that nature were problematic? Oh, it's multiple things. I mean, from a cost standpoint, it was very affordable but from performance is probably number one. We were experiencing complete growth in our VDI environment and some things that we didn't take into account three and a half, four years ago when we had our previous generation implemented was the onslaught of larger monitors and mobility and all the other things that tug because we used VDI through all those devices. It tugged on the performance to the point where we had to improve that and plus we're doing a lot of video now. So we had to have an environment that's cutting edge and can handle all that has emerged in the last couple of years. And the all-flash array, obviously, as we were talking earlier before you came on about the impact of flash and now the costs are comparable to high-speed spinning disk which is sort of an oxymoron if it's spinning at any high speed. So your VDI infrastructure sounds like it supports this concept of telemedicine if I can use that term. You got distributed docs and they can access them. I would go even broader than that. I would say that VDI invertization means that it enables anytime, anywhere for anything. And we have, every single one of our users at Metro is on a virtualized desktop. So our endpoints are multiple things but they're all running really in our data center. So your experience with the devices is comparable or equivalent to or maybe even better than my performance if I'm using my laptop. Is that right? In a lot of cases, but you get the other benefit of continuity. In other words, your desktop, your data, your applications that are still running at any time you can connect to it real time and get right to it without delay. And we're talking like six seconds or less to just connect and be right on your desktop. I was like firing up my laptop these days with the flash drive that's in it. How about the role of the CIO? Obviously people are talking about CIO becoming more business oriented. Sounds like you were heavily involved in this transformation. Yeah. How's the role of the CIO changing? I've been fortunate enough to be involved not only in the conversations where we're going strategically but to take an active role in that. And the other thing that I've been very blessed with is a great group of IT folks, which includes some very excellent leaders who take on the day to day, the operations, much of what I used to do, say seven to 10 years ago, I no longer have to worry about them. And so I can stay on the business side. I can stay on the front edge. I'm much involved. In fact, we have physicians that are in our IT staff because the physicians and the nurses and the clinicians are integral to make all this happen. I want to ask you about your philosophy on vendor management. You're a mid-sized organization. What's your philosophy? Would you rather have sort of multiple vendors to keep each of them honest? Would you rather have one throat to choke? Talk about that a little bit. Well, I wouldn't say that we want one throat to choke but what we want are a couple partner vendors and we use that word very carefully. A partner vendor is somebody that's not just looking at the next sale, but they are with us all along the way to help us in any way we need, both in future and in current. And we find that with HP. We find that with just a couple other vendors and we do not have, and we're not able to with our size to handle all of the multiple vendors there for all the multiple things. So we do want more within one but we go a level above that. We want a true partner. Who's good at it? I mean, you can name names, it's okay. Unless you don't want to. Well, I'll tell you, Epic is one and Epic is our EMR. That's the EMR. They're number one in the industry and they're excellent. They really put us first when we're in any conversation about our needs in our future. We have a couple others that are a little less important to us but I would say from a technology standpoint, HP and VMware is a very key partner to ours because we're engaged with their engineers and with their product futures because we're very cutting edge. And the one thing I do want to say that's extremely important for vendors to invest in is the verticals. And for healthcare, to understand us a little bit better to understand that what we're talking about is life critical in everything we do because we're reliant on our applications and our information. Real time, our providers do not have a paper record to go to. We could be in surgery. We could be in a very important point in ED and we need real time real quick. It's life critical that this stuff not only works but it works continually with high availability. So Bill, you sound pretty progressive. You talk a lot about your customers. The one population that you haven't mentioned directly or maybe I just missed it was the doctors. Talk a little about the role of the physician communities and I presume that you've got maybe some that are in your system, some outside your system. You say you focus primarily on a primary care. So those are the guys out in the field giving checkups, dealing with wellness and some of these other more progressive things. How have they taken this technology kicking and screaming? You know, we like to tease them all the time that they're not the most savvy and clearly they're right on kind of the pointy edge of the spear and the delivery of this stuff. We're very partnered with our physicians. In fact, they are part of our strategy. They're part of our leadership. They're part of our IT leadership. I have a chief medical information officer. He's a physician. He works with me side by side in our strategy. We have a clinical informatics team that has physicians and nurses that are really an extension of IT and it's that glue between IT and the physicians. Everything we do has the physicians involved. If anything, our docs are very progressive and they're challenging us to keep up with where we need to go and that's the only way this is going to be successful because they're the ones that are taking care of our patients. How about, we haven't talked much about regulation, Affordable Care Act, things of that nature. How much of your time is that budget, is that sucking up? You know, people talk about the 70% keep the lights on, 30% innovation. Is that initiative, meaningful use, et cetera, pulling you in the wrong direction or is it the right thing for the industry, do you think? I don't think that we're doing anything that is specific just for compliance and regulation. We have to meet that. But we find that our strategy that we put together for us, really the byproducts of doing what we're supposed to be doing anyways are meeting meaningful use. So we meet meaningful use because we're already doing the right things. There may be a couple things we've tweaked just to make sure that we comply with the exact requirements, but it's all about doing the things that meaningful use was really about. The whole healthcare reform is really not, even if we didn't have healthcare reform, we would have healthcare reform because the folks that are flipping the bill for healthcare are still, for the most part, the employers, they want it. They need it. They have to bring their cost structure down for healthcare. It's a business imperative. It's a business. So we have to be very cost efficient. We have to be very effective. We have to do great outcomes and quality for our patients and all that are byproducts for meeting the Affordable Care Act and for meaningful use. Bill Likowski, awesome segment. Really appreciate you coming on and sharing the vision of your organization, really paving new ground in the healthcare world. Quite innovative and extremely impressive. So thank you. All right, keep it right there. Everybody, Jeff Frick and I will be right back with our next guest right after this.