Original article was published on Artificial Intelligence on Medium
Guy Nadivi: Welcome, everyone. My name is Guy Nadivi, and I’m the host of Intelligent Automation Radio. Our guest on today’s episode is Toby Buckalew, CIO of OneShare Health, a faith-based nationwide healthcare sharing organization. At the time of this podcast’s recording, we find ourselves in the midst of the global COVID-19 pandemic and, as such, we want to find out from a C-suite IT executive in the healthcare space how automation and AI are making a difference to IT operations during this crisis. Toby has a lot of firsthand knowledge to share with us about that topic, and we thought our audience would benefit greatly from hearing him share his insights and takeaways. Toby, welcome to Intelligent Automation Radio.
Toby Buckalew: Guy, thank you very much for having me here.
Guy Nadivi: Toby, your organization, like many others, had to transition its personnel to work remotely due to your state’s stay-at-home order, which I understand you were able to accomplish rapidly. What role did automation play in enabling that kind of agility?
Toby Buckalew: Well, Guy, automation was a key element that allowed this to happen. We implemented a cloud-first, cloud-only strategy for our technology infrastructure, which made this possible. Now we required the ability to manage and reconfigure and update several hundred workstations remotely as we redeployed people to work from home.
Toby Buckalew: Now, how do we accomplish this in less than a week without touching all that equipment? Well, cloud-based endpoint management was leveraged to make those needed updates. It’s actually really neat the way it worked out. We matched the serial number of the machine from our database with the user and created a profile for them that said what firewall settings, what software was installed, how it was configured, and what was removed. Then when that user went home and logged in, those updates took effect wherever they were. We did not have to touch all those machines.
Toby Buckalew: Security was a big consideration for us and anyone moving their staff offsite. How do you ensure the same levels of security when you take them out of the protection of that office environment? For us, we did that using AI endpoint security, in addition to the traditional anti-virus and anti-malware endpoint protection that’s out there. But it allows us to monitor the behavior of the machine, what’s happening with the CPU, the memory, the drive, and look at what’s going beyond normal and catch that, suspend that app and notify us, essentially. If we find that it’s suspicious, we can go ahead and block it, quarantine it, remove it, and share that information with the other workstations automatically. So we can have protection beyond the traditional definition file. Together all these tools and information allowed us to move 300 plus people remotely in just a few days.
Guy Nadivi: Wow, that’s impressive. Toby, you were profiled by CIO Magazine, not long ago, for a digital transformation you led at another healthcare organization, and I want to dive into that. But first, I want to ask you, how are digital transformations changing the role of the CIO?
Toby Buckalew: That’s a great question, Guy. The role of CIO is one that continues to evolve. The CIO was the technology guy. He was the enabler. He knew what was going on, what the technology was, what it could do, and how to put it in place and then build the teams to support those. But today, that CIO is not just leading technology drives in a company. That CIO is focused on the relationships in the business and the business itself. Now, as technology becomes more ingrained in all aspects of the business, the CIO’s vision has to change. The CIO themselves have to change. As technology and business is constantly evolving, that CIO has to evolve with it, and not just technology but the business itself.
Toby Buckalew: Now in the past, leading the change for technology change to improve operations was the way to go. But, well, the way to understand this is to look at how the CIO evolved in the first place. A lot of people get in technology because they’re introverts. They’re not comfortable around people. But as those people gain skills and experience and showed some aspects of leadership, they’re put in management roles. Now, that meant they had to work with people, which is often uncomfortable for an introvert. Some of these people, a lot of these people, led to the role of a CIO in some way, shape or form.
Toby Buckalew: But today they can’t just be those introverts. They have to expand and transform themselves to become a people person that understands the business, and not just technology. You used to always be asked, “Does a CIO have a role at the table?” The question was always up in the air, but today it’s almost always “yes”. The thing we need to be asking today is does the CIO understand what we do in the business? That’s a more important question.
Guy Nadivi: So let’s get back to digital transformation, which is a Herculean undertaking under the most favorable of circumstances. However, it must seem positively Sisyphean when trying to digitally transform a company like the one CIO Magazine profiled you for, and I’m going to quickly iterate through the constraints you had to deal with so the audience gets a sense of what you were facing.
Guy Nadivi: The company you digitally transformed was once publicly traded, but their stock had been delisted. Then they went bankrupt and couldn’t spend any money during the bankruptcy process. When you arrived, the facilities, hardware and software were not only out-of-date, but testing a system once caused an outage that left you without power for a week. Exacerbating all of that was the fact that the new owners wanted to change business models and turn the company into a service provider. The cherry on top of all this was that the embattled staff didn’t have a customer-focused mindset commensurate with being a service provider.
Guy Nadivi: Now of all the many things I could ask you about this experience, one in particular leaves me most intrigued. Many CIOs coming into such a dysfunctional situation where they owe no allegiance to the incumbent personnel would have just said, “We’re going to clean house. We’re going to let everyone go and outsource to an MSP.” Or, “We’re going to bring in consultants on site to take over,” or something along those lines. But instead you chose to keep everyone and transform them, so to speak, along with the technology. So I think other CIOs would love to hear from you, Toby, about what factors led you to take that route, and also how confident were you at the outset that the people you started your digital transformation journey with would survive and prove capable of accompanying you over the finish line?
Toby Buckalew: In the beginning, I didn’t know I’d be successful. I didn’t start with a confidence. In fact, it was a huge project to begin with and I knew it going into it. I could have easily gone in, ripped everything out top to bottom, as many do, but much would be lost and I needed to understand what I had to work with. I started down that path. Now, who did what? What was being done today? When would things be replaced, fixed, updated according to the current plan, and where were we in that plan? More importantly, why are things being done the way they are today?
Toby Buckalew: Now, ripping & replacing the people could have happened. The problem I had with that was when I started sitting down with all these people, I realized that they’re the ones who are making all this work. They’re holding all those band-aids and bailing wire together and making the business continue. Not very well, but it continued. So I realized if you don’t focus on the people, your transformation is going to fail. What’s also overlooked is within that group of people, there’s tribal knowledge and experience the business isn’t leveraging.
Toby Buckalew: So I ended up sitting down with everybody in the crew. I asked, “What do you like about what you do? What you dislike? What do you aspire to be doing? What would you do with a magic wand to fix what you do today to make it a better place?” What I discovered was there’s a huge amount of latent talent the company didn’t know it had. They had all the resources they need to fix the problems they had, they just didn’t know it. Not only that, but these people had some tremendous ideas of how to fix what was going on because they had that tribal knowledge and experience.
Toby Buckalew: So ripping all those people out would have jettisoned all that valuable information and experience. So what I realized was we need to bring these people along as part of this transformation, and that’s what made it successful. It wasn’t the technology. Anybody can rip out a system, put something new in. It’s the people that make it happen, people that make it work. Once I understood what I had, I had the confidence and the knowledge that we would be successful.
Guy Nadivi: Fascinating journey. Digital transformations are, as I think many people know, marathons, not sprints. The most commonly cited average duration for a digital transformation project is 5 years. Despite that, they still don’t have a very high rate of success. According to Korn Ferry, a well-known management consulting firm, the average tenure of a CIO is 4.3 years, with some variation based on industry. Toby, what’s the correlation between the high failure rates of digital transformation projects and the relatively brief duration of a CIO’s tenure?
Toby Buckalew: Well, I’m going to have to say to be honest, I think 4.3 years seems a little long for a CIO these days, to be honest. But no, a full true digital transformation involves change of the company culture and use of technology and not simply replacing hardware and software. It’s not a change. That’s a key driver for transformation failures is they just replaced the equipment without looking at the big picture. Now, the expectations are never met when that’s happened and those transformations usually fail when they only focus on technology. I like to say that a transformation is a metamorphosis and not simply a change or a new system.
Toby Buckalew: Now, you combine that with the length of time it takes to implement new systems and services from end-to-end, and you find that the continued spending and time on these projects and subprojects become too much, and people forget the importance and even what they started off to do in the first place. Over time, that fading memory and that continuing increased cost and all that pain leads to a limit in which people say, “Enough is enough.”
Toby Buckalew: Now the pain experienced with that change is long lived systems around which the company culture and business was built can be real anything, let alone a massive transformation. The way around that is to really identify who can help and who’s going to hinder it, who can champion the project and make them all part of it, make them all stakeholders. Find a place for them on the team. But for the CIO, you really have to focus on the relationships inside the executive team and keep them onboard in the transformation in addition to people at all layers of the organization. Make sure you communicate and keep them excited throughout the process. Celebrate the wins.
Toby Buckalew: Now, for the CIO, this is where it can get really draining. If you’re not the people person, you’re the introvert, you’re really stretching yourself to be a people person, that is emotionally draining. You can only go so far before you just had enough, you need a break. That’s where a lot cut the cord.
Toby Buckalew: Others simply move past the technology management elements, other routes, and they failed to embrace the business aspects of today’s CIO, and that creates friction with the rest of the management team. Eventually, there comes a point where it can’t be tolerated anymore. Now, others have narrowed skill sets and they simply implement past what they know and they don’t know where to go next, and so they leave before anything else happens. But it simply highlights the fact that today’s CIO really needs to evolve beyond technology.
Guy Nadivi: Let’s switch gears for a moment. At our company, we have a number of customers in financial services. Two months ago, if you had asked me whether they would be open to having their IT staff work from home on sensitive systems while letting automation do a lot of critical tasks on premise in their absence, I would have told you that a marshmallow probably has a better chance of surviving a campfire. Now, today, however, that taboo has been largely vanquished because of the worldwide COVID-19 pandemic, which has kind of forced the issue for a lot of companies. Your industry, healthcare, is just like financial services in that it’s subject to a very strict regulatory regime. So Toby, I’m curious, has the pandemic changed things enough in healthcare that more IT operations work is being deferred to automation, artificial intelligence, et cetera, so IT workers can remain at home, and if so, will that new norm remain after the pandemic ends?
Toby Buckalew: Well, I think the short answer is yes there, but in my opinion there’s three main elements involved with the pushback against people working from home, in the first place. The first is culture. If you think about it, most of today’s managers are raised in an environment in which workers and their work was always visible, and that’s how you knew how work was being done. In order to do that, they had to be right in front of you. Working from home changes that mindset. You can’t see their work directly. You can’t see the workers directly.
Toby Buckalew: The second part of that is fear and the fear of loss over control of data, sensitive data more specifically. In financial services and healthcare, these are areas in which we have federal regulation that controls what we do with that data.
Toby Buckalew: Now, technology is a third element here. For the most part, today’s workers and the managers’ lives, technology to safely and securely allow and manage remote workforces simply didn’t exist as it does today, but they still hold on to that fear and that culture of the past and the memory of technology of the past. Today’s technology workers still have access to all that same information services they did years ago, but now today it’s much easier to safely and securely store that data, manage that data, and access that data thanks to cloud services and connectors.
Toby Buckalew: The next step in that is simply we have artificial intelligence services that can help monitor and control the movement of that data and dramatically improve our ability to secure it and maintain a PCI, PII, HIPAA security needs. Now these tools help address some of the fear and cultural concerns many companies have or many managers have, but the cloud-based technologies today provide those platforms to let us do it. Today, many of those systems are superior in security when compared to your legacy systems and Co-Los and server closets and data centers of even people today.
Toby Buckalew: Now, what we did is our entire team is now working remote, and we have managers with some of those same mindsets because they’re people, and that’s a thing of all people. Our entire team is now remote, but they’re doing the same things as they did before at the same or better service levels that we previously offered. There’s some social engineering there. It’s going to be interesting to study. But we also leveraged those AI tools to help our service desk platform give our users submitting tickets remotely a chance themselves. If it’s an issue that the AI found a solution for or closely matching a solution for, that allowed us to take care of those issues quickly and focus on those that it couldn’t help. We also leveraged data management AI tools for content identification and blocking, especially related to healthcare information. I already mentioned earlier, AI tools for our endpoint protection. But together these tools in security gave our management team enough confidence that this is working well. This can happen.
Toby Buckalew: As for the future, for everybody else, as they say, the cat’s out of the bag, Pandora’s box has been opened. It’s going to be difficult to reverse these trends that have these new norms that have emerged from the pandemic, but not only are companies seeing improved productivity in many cases with their workers and teams, they’re finding that there are savings to be had in operational costs and facilities costs by not having to house all these people in a single location. It also plays well with the changing lifestyles and expectations of Gen Y and Gen Z today. But when all of this is over, there’ll be some semblance of familiarity, there’ll still be a need for people in an office, but there’s going to be a larger percentage of a work from home force just because this whole pandemic has forced us to embrace it and see that it really can work if done properly.
Guy Nadivi: Now, since you’re the CIO of a healthcare organization, Toby, I’m very curious, what role do you envision automation, artificial intelligence, and other digitally transformative technology is playing in the future of healthcare IT?
Toby Buckalew: Well, AI and digital transformation are key to the future of healthcare in this country. The always increasing costs, the over-testing out of the fear of liability, not understanding disease correlations, the high tech fraud that takes place, they’re all common elements in our healthcare environment today. They’re driving up costs and making it more difficult. I believe much of that can be addressed through digital transformation, automation and AI. We amass a tremendous amount of data as part of anyone’s healthcare journey, and the dream of all that data was to leverage it to improve the outcome of that person’s healthcare journey.
Toby Buckalew: Now that dream was never fully realized simply because of the limitations of technology. We are dreaming before the technology was there. But today, if we can go ahead and successfully transform healthcare to control where our data resides, how it’s stored, how it’s secured, how it can be leveraged in a safe and compliant manner, we can address all those problems of the past, and even those that linger here today. Once we have a handle on that data, we can then leverage AI to find possible correlations and indicators resulting in specific healthcare events so we can address them proactively and help someone before they get sick and lower the cost of their treatment.
Toby Buckalew: These tools can even find issues with billing resulting from fraudulent charges, overcharges, and misuse to better control costs on the fraud side. Thinking beyond that, these tools can evolve to help find cures for diseases, and by pointing researchers to potential solutions in those data sets. So the future of transformation and AI in healthcare is really exciting.
Guy Nadivi: Can you tell us about some use cases you’re implementing to incorporate automation and AI into further improving OneShare Health’s operations?
Toby Buckalew: Oh, yeah, sure. Now, our whole existence is about servicing our members and taking care of them. Today, we leverage data automation analytics tools to evaluate our population’s health as a whole, and see those specific events in the population so we can decide what we can do to change our programs to better meet their needs. It doesn’t make sense to offer them something they’re not using. It’s a waste of energy. It’s a waste of money. That money can be used to better help them in other ways. We’re also using those data automation tools to help filter billing information to find, like I mentioned, duplicate bills, overbilling, and other indicators that might show some potential fraud.
Toby Buckalew: Additionally, we’re leveraging AI platforms to help assist our members in finding medical services and identifying quality providers for those services at reasonable prices, which helps improve the quality of their healthcare while controlling costs, which means for us that’s more sharing fund that can go back to help our member population. We bring all this back together. As we build our data warehouse in the backend, we’re going to continue these efforts while leveraging predictive analytics and those AI tools to help identify individual members that are at risk to help guide them to better solutions and, hopefully, prevent them from experiencing a serious illness or other event or better manage their existing condition. So we’re trying to live the future today.
Guy Nadivi: Toby, for the CIOs, CTOs, and other IT executives listening in, especially in healthcare, what is the one big, must-have piece of advice you’d like them to take away from our discussion with regards to leading successful digital transformation projects at their organizations?
Toby Buckalew: One word: people. No matter how large or small the transformation, gaining and retaining the support of others in the organization is paramount to success. For those that say it’s not important, get rid of your customers, get rid of your staff, and see what’s left of the business. There is no business without people. So the people really are your most valuable asset. It’s not that computer; it’s not that software; it’s not that system. It’s the people that make it all work. No matter how much you automate, you’re still going to need them.
Toby Buckalew: Finally, always be willing and able to pivot. Technology is going to continue to evolve at an exponential rate, meaning your transformation will look differently at the end than where you envision it at the beginning. Transformation’s original plans should be more of a roadmap to help guide you along the journey of that transformation and not a step by step detailed plan over four to five years. So always evaluate technology along the way for where it will take you on that journey and not just what it can do for you today, and never forget that people make it all happen. Respect them, take care of them, train them, support them, and get out of their way and let them do their jobs.
Guy Nadivi: Great insight. All right, looks like that’s all the time we have for on this episode of Intelligent Automation Radio. Toby, thanks for coming on to our show during these extraordinary times and sharing your successes with our audience, which I think will be especially encouraging for healthcare IT executives to hear.
Toby Buckalew: Well, Guy, thank you for having me. It was great being here with you today.
Guy Nadivi: Toby Buckalew, CIO at OneShare Health, a faith-based nationwide healthcare sharing organization based out of Irving, Texas. Thank you for listening everyone, and remember, don’t hesitate, automate.