 Live from Las Vegas, Nevada, it's theCUBE at IBM Edge 2014. Brought to you by IBM. Now here are your hosts, Dave Vellante and Stu Miniman. Welcome back to Las Vegas, everybody. This is theCUBE. theCUBE is our flagship program. We'll give out to events like IBM Edge because we're at today. We extract the signal from the noise. I'm very excited to have Mike Smith here as the CIO of Lee Memorial Health System. We love to talk healthcare. It's something that affects all of our lives. Stu and I, we talk about it at our work. We talk about it when we're in theCUBE. It's always a great case study, Mike. Thanks very much for coming on theCUBE. Thank you. So you're up on stage today in front of the big audience, about 5,000 people here with a colleague from Citi and Jamie Thomas. So how did that feel? I felt good. It was a great crowd, a lot of energy, good topics. And it was nice to be on the stage with Jamie and the fellow from Citi Bank. So storage is cool. I've been in this infrastructure business a long time. And that's all well and good. We were talking off camera. Storage is not something that should keep a CIO awake at night. If storage is keeping a CIO awake at night, that's not a good thing. You've got other challenges. So I wonder if you could talk a little bit about Lee Memorial, start there, sort of what your focus is and talk about your mission. Yeah. Well, we're a large healthcare provider in Southwest Florida. And we have all elements of healthcare delivery from the hospitals. We own all the hospitals in that area to long-term care and home health and the physician offices. And so really the continuum of care coverage, so whatever a patient might need, we generally have those services. And that's a pretty big deal. That's kind of unusual in this instance. How large are you guys? Well, there's several rankings. We're over a billion in net revenue, 1,500 beds across four hospitals. So pretty good size. Four hospitals, okay. And you've got IT in each of those hospitals? Yeah, it's all centralized. So we run all of the information technology out of a central location. And we have a backup data center. And we're kind of unusual in a couple of respects in that we have all of the hospitals, that's unusual. Usually it's fragmented in the market. And the way we're structured that we work hard to deliver integrated care for the community. So I talked about this morning some of the challenges with the cost of health care quality, that sort of thing. And a lot of that has to do with the way we deliver health care. It's, we're a person, when we walk in, we would like the care to be all coordinated, but that's not the way care is delivered today, generally, because care is not paid for that way. Care is paid for by in Canada. So those are some of the changes that really the, probably IBM, probably CMS, Medicare, all of those players are trying to change because that's where some of the cost and the quality is occurring, is with those different providers that aren't coordinated. So we've been tackling that with the information technology solutions and the clinical record that we put in. So you obviously, highly regulated industry, HIPAA compliance was something that was, and probably still is, top of mind. Although you've been throwing this new curve ball, which is the Affordable Care Act, AKA Obamacare, how has that changed your focus, your priorities, your investments, and your objectives? Well, I would say in some respects, what it's done is not changed them so much, but rather accelerated them in some respects. So we've been working hard to deliver integrated care to our community for many years. We've been after that goal, but what the Meaningful Use effort and Accountable Care Act did is provide some funding that helped accelerate what we're trying to do. And you know, this whole notion of Meaningful Use is kind of interesting. Folks don't necessarily think about it, but really this reflects what CMS, what Medicare is trying to do, which is move us toward evidence-based care, best practice care, move us toward coordinated care. And so if you think about that, as CMS tries to change the reimbursement model and pay us for delivering an outcome rather than physician office visits, for example, you really can't do that if you don't have everything wired together. So if you take the goals of CMS on one hand, and you take Meaningful Use on the other, you'll see that Meaningful Use and those goals with the electronic health record really are to enable that Medicare care and change it. So some folks in our audience may not understand the whole Meaningful Use thing. Maybe we could talk about that a little bit, because essentially in order for you to get paid, you've got to demonstrate that you're actually adopting technology, right? Right. In a way that is Meaningful and has outcomes. Right. So it's a real stick in a way, right? There's no upside, you don't get, or is there? Well, there is. There are, in the first several stages of Meaningful Use, there is upside. There are dollars that are made available that are considerable, and they range from, say, in total $50,000 of physician, $44,000 to be specific, to several million dollars for hospitals. So it's considerable. And then after 2015 or 2016, depending on what kind of provider you are, then there is a stick that kicks in. And if you're not Meaningful Using at that point, then you start taking payment penalties. Okay, so it's there for the taking now. So that's why you got to be fast. Yes. So that's actually a good thing for those who can move fast. Yeah, so it really has helped to accelerate the implementation of electronic health records. And if one used it wisely, not tried to rush in just to get the money, but actually tried to put in solutions that would have long-term sustainability, it's really been a good deal. So how do you spend your time? I mean, obviously, you know, you're here at a storage conference, so the infrastructure matters. We had Tom, Ross, and Milian, and we all agree. Yeah. Infrastructure matters. Especially when it breaks. Yeah. But frankly, we don't want to think about it. We don't. So how do you spend your time? Well, so let me start out with some basics. One of the things that I tell our informatics and IT organization is we really have three priorities. One is to keep the lights on, right? You heard this morning that if we do not deliver good care, if we do not deliver good services with our information systems, then everything else we put in place is gonna fail. And in matter of fact, if you think about it, we would actually be better off leaving everybody on paper than putting in automation that moves them to paperless and have the automation be flaky, right? Because they're gonna be dependent on one of them. So keep the lights on. Quality, quality data, all that kind of thing, all falls in that category. The second is those projects, those activities, those new systems that we plan during the capital budgeting process and the health system that we elect as an organization we're gonna fund and do. And the third thing is everybody else, the organization, everything else the organization dreams up during the year, which is a lot. Oh, there's always the biggest candidate. There's always everything else, right? And that's a challenge. Because there's way more to do than we can get done and every day we put more in, which creates more demand, which is more we can't necessarily get done. And the whole industry's dealing with that problem. So, Mike, most of the businesses we talk to now are often in the data business. Of course, in healthcare, it's a big challenge because you've got all the security issues, Steve talked, HIPAA compliance and everything, but how is the role of data and business intelligence and analytics changing your job? Well, a variety of ways. It's a fun conversation to think about though, so let's begin by talking about what does a physician do? So one would say, well, a physician to give care, ask for information about you, maybe your family history. Maybe order's a test. Does not actually get you better. What gets you better is a pill, a shot, surgery, that sort of thing. So if you think about what I said, the physicians themselves are deeply in the information. That's what they do. And so we're about providing information to them as well as information to run the business. So I spent a lot of my time working with physicians, working with clinicians, working with the business leaders to set strategies to make those needs. Are docs embracing technology more than they have the stigma attached to them that they're not the tech set to reject tech? Is mobile changing that? Mobile's changing that and the specification and usability of the electronic health records are changing that. There are stereotypes about what an electronic medical record does or an electronic health record does. And those stereotypes about how usable they are often are stereotyped. It doesn't apply to... And so one has to look at what we're really talking about. We're talking about how well or how well they are and how well physicians adopt to those EMRs. Like we were talking off camera about informatics. We talk about healthcare informatics, the data, what you're doing with that data, your data sources. And everybody talks about being data-driven. We all go to these conferences and get our heads filled with really exciting ideas about the potential of data. How is that seeping into your business? Yeah, so if you think about informatics, a couple of things. First off, the term informatics is really the application of those clinicians, business people to the information technology and discipline and really advancing that through leadership and through training and input that affects the design of those tools. So informatics as opposed to the neighborhood of, I would say 35 nurses on the informatics staff, the IT staff, several physicians work on the staff, pharmacists work on the staff, and that's their role in the IT department is be the informatics staff. When we think about data and analytics, often that manifests itself in application of alerts and rules so that if a provider, a physician, or an extender places a medication order, the system has rules that are smart enough to say, hey, by the way, did you know that patient is on a similar medication? Excellent. We got a break? Yeah, we have to break? All right, sorry, Tom, we have to leave it there. I got one quick question. Got time for one quick question? So we talked off camera, you don't have a chief data officer? No. Right, okay. Are you the chief data officer? It's a combination of individuals. We have clinical disciplines around the data, financial disciplines around the data, so we really have several domains that are handled by different individuals and the data officer role is really shared. Right, and then EDGE, IBM EDGE, we kind of threw storage under the bus at the top of the hour here but still, at the end of the day, infrastructure matters, so maybe a word on what you're doing with storage. Infrastructure matters, and as I said before, whether it's the data storage, whether it's the power and processing, the redundancy, the tape backups, all those kinds of things matter deeply because that's the integrity behind what we do. Mike, thanks very much for coming on theCUBE. Appreciate your insights and your time and always a pleasure speaking to someone of your experience and about a very important topic. So keep it right there, buddy. We'll be back, this is IBM EDGE, this is theCUBE, right, back after this.