[PODCAST] Digital Healthcare and the Evolving Role of the CIO

healthcare podcast Oct 01, 2018

About this Discussion:

Edward Marx has an incredible history from starting at humble beginnings to being the CIO of on the of world’s most sought after healthcare facility.

The Cleveland Clinic is on the forefront of utilizing technology to change the human experience with hospitals. From the treatment the patient receives, to their interaction with clinicians, and the continuing care far beyond leaving the hospital, technology is changing the way we stay healthy as a society.

In this episode we talk about Edward’s journey to the CIO of the Cleveland Clinic and how healthcare is being revolutionized by taking advantage of the advances in technology, from real-time patient monitoring to utilizing augmented reality for training, plus so much more.

For more information on the Cleveland Clinic, visit my.clevelandclinic.org/

About Ed Marx:

Ed Marx is the CIO for the Cleveland Clinic with an extensive history in business and IT leadership. His career spans multiple disciplines, from his time working on the clinical side of the house to leading the next transformation in technology for clinical care. Ed has been acknowledged for his commitment to innovation, most notably, the HIMSS/CHIME 2013 CIO of the Year and recognition in both CIO and Computer World, “Top 100 Leaders.” Ed strongly encourages a balanced and disciplined approach to life and has competed in over 100 triathlons, climbed Kilimanjaro, and is an active contributor on Twitter and LinkedIn.


Official Podcast Transcript:

Erin and Syya: 00:01 All right, welcome to another episode of the Innovation Calling podcast. I'm Erin Smith and I am Syya Yasotornrat, we are super excited to welcome, our super happy guest, Mr. Ed Marx to the innovative Innovation Calling podcast, Ed is a well respected thought leader and innovator with 20 plus years and I'll say nicely 20 plus years in technology and business leadership. If we can stress one thing about Ed Marx, he is a super passionate, extremely disciplined and a completely dedicated to improving our experiences within the healthcare industry. Ed is currently the CIO of the Cleveland Clinic and he joins us today to help us understand the state of digital healthcare and the evolving role of the CIO, especially in today's social media influenced society. So thank you and welcome to the Innovation Calling podcast.

Ed Marx: 00:58 Thank you. Very honored and excited to be part of this.

Erin and Syya: 01:02 So Ed, I've known you for awhile now and you know, I'm always impressed by your enthusiasm. You embrace life and you take it by the horns. So before I dive into the world of digital healthcare and the evolving role of the CIO, I have to ask you, where does your enthusiasm come from? Um, you know, what I ideally like to do as an entrepreneur is I like to put it in a bottle and market to the masses. So what do you attribute to, where do you get your passion from?

Ed Marx: 01:38 I don't know. I just love life and I'm happy to be alive and I just think we have this amazing opportunity in our lives to do amazing things. And so it's exciting that we live in a world today where almost everyone has opportunity, especially in the west to make something happen and impact the world and change the world. And so it's like, wow, I got to be part of that and I can, I don't, I'm not a victim of circumstance. And I take a lot of strength and pride from my parents. My Dad specifically a Holocaust survivor, came to United States eventually with nothing. And the United States gave them this amazing opportunity and he was a very successful person by many different accounts. So it's like, wow, what? We're so lucky to be alive and let's make something happen and do good for the world. So it's just, to me it's infectious. Love it.

Erin and Syya: 02:32 And that right there. I didn't, I completely forgot and I apologize. I did not remember that your father was a holocaust survivor that has have had make such a great impression on you. Uh, did he teach you anything else as far as that? I mean obviously he went through a lot. Was there anything else that might have struck you more? Maybe that discipline side of you? Because I get passion and you can have passion but you can't have the discipline to execute. I can see where all good ideas with no plan can fail.

Ed Marx: 03:04 What is it? Execution with, or vision without execution is a broken promise. And so you need both. You need the vision and you need the passion and then you need to be able to execute. So yeah, I learned a lot of discipline from my parents growing up again from very, very humble beginnings and they made something of themselves despite having no education and you know, having a terrible war experience. And so that was part of it and then in the military helped form shape my young Ed as a 17-year-old in basic training and learning about physical fitness and the discipline required. I did a lot of sports before that as well. So over time I just learned, wow, to accomplish certain goals you need to be disciplined and then if you get up earlier than other people you could be average but have above average outcomes.

Ed Marx: 03:46 And so that's what I did. I knew I was an average soldier, so I got up earlier and everyone else and had above average results. I was an average officer, army engineer officer, and I was afraid of flunking out of engineering school because I was a psych major at the time. So I got up earlier than everyone else graduated top 10 percent of my engineering school. Um, so I've just applied that same sort of edict throughout my life. It's like, Hey, you know, I'm pretty average person with very humble beginnings, but I can have extra ordinary results if I just put in extra work. And so that discipline. So. So it kind of reinforces itself over time. So you find out, wow, by getting up earlier and working out or like when I used to play tennis I used to, I used to literally half hour before any of my tennis mates showed up, I used to serve about a thousand balls, tennis balls, serve them, and when they came, even though it was average server, my serves were a little bit above average because I spent just knocked over a thousand. So I learned quickly I could apply that same sort of discipline to my work life, my family life and all that kind of stuff. And so it just became a part of who I was. So he says, get up earlier.

Erin and Syya: 04:53 I love it so easy! For a non-morning person. I can't tell you that advice is like you're asking me like for the worst thing that I can now ask me to stay up later to do it. Maybe

Ed Marx: 05:08 Yeah, for some people It's later, but the point is you give that little extra. They say it's lonely on the dirt, on the pack of the extra mile. You know, people talk about it. Just go that extra mile where you go the extra very few people on it. There is very few people out there running it for at 4:30 am, and so they may not run it all. Or they might run at six but only run half the distance. So. So even though I'm an average runner in a race, I'll beat them because I got up earlier.

Erin and Syya: 05:35 That's true. I've seen that professionally as far as you, you have always been much more awake and alert and I think getting up early, getting those, getting the exercise and blood flowing, I think it really does help with cognitive thinking.

Ed Marx: 05:49 And on the work side too, you know, to give a work analogy, it's like reading or listening to podcasts. So I, I'm always like reading this morning I was on a stairmaster for an hour. I'm reading this book called, "Measure What Matters." That's like the big book right now for us at Cleveland Clinic and I'm always listening [to] podcasts. I'm always reading. I'm always like on Twitter looking up articles that seem interesting or on Linkedin what people write. And so I'm average, but I guess I'm average above average results because a lot of my peers are just whenever they learned 10, 15, 20 years ago, that's it. But I realized, dang, I'm sort of average, so I want to perform well, beat my, my own personal expectations as well as my manager dang, I'd better do a little extra. And so that's what I do. So why not exercise and read at the same time?

Erin and Syya: 06:43 I can't read. I can't read and walk at the same time. I think walking and chewing gum is really tough. Tough for me. So maybe I should practice that a little bit more than.

Ed Marx: 06:52 It could be any combination. I'm just giving you some random examples, but it's any way to combine things when you save time and it just enriched your life, which then enriches other people's lives.

Erin and Syya: 07:02 What I think that's really great bit of advice. I don't know how I can market. Then marketing will bottle though. Trying to figure that out. We're gonna make our millions off you, Ed. Think you have a lot of stuff too. And then I will figure that out towards the end. How about that? So on that note, you know, we've been talking about healthcare and obviously if it's a hot button, you know, politically, uh, I think we're at that stage in technology where we're really looking at more of an interactive way of viewing how we as a society receive our healthcare, how we view our own lives and the way we can take care of ourselves. So could you help me understand what you define digital health care, um, for yourself and then for how your career has evolved and now currently at Cleveland Clinic?

Ed Marx: 07:49 Yeah. So everyone has a different definition of digital. So I don't know that there's a perfect one, but to me it's the natural evolution of technology combined with the user experience. So, you know, 10 years ago we talked about mobility or 15 years ago was ecommerce. No one talks about ecommerce anymore. It's just a natural thing. Who we are, what we do, you know, no one talks about mobility as much as we did a few years ago because everyone now is mobile enabled. That's just the way of life. And so digital is nothing more, and especially in healthcare, it's just a natural evolution of technology. I imagine five years from now we won't be calling a digital anymore. It's just been a natural part of how healthcare is delivered, but because it helps sort of define and catalyze and focus, you know, we adopt the same sort of thing.

Ed Marx: 08:38 So I think it's both a cultural phenomena as well as you know, a technology phenomena. So it's really redefined the whole user experience. So specifically to health care with the patient to the clinician, to clinician to clinician, patient, family to family. So the whole thing is, is a new way of looking at things and working with one another that has great potential to rapidly impact the quality of care because for a variety of reasons, again, we will get into this a little bit later I suppose, but, but for one major thing is patient engagement. So I think one thing that's been lacking in the past, we haven't had a tool to really engage patient, but now the patient becomes more and more engaged with their own health. So I've got some examples. I don't want to jump too far ahead, so I'll just stop there. That's sort of my definition. You know, it's, it's really an emerging together, of technology and the natural evolution of technology with a user experience and the whole cultural phenomenon wrapped around it and that sort of digital health and it has the potential to transform healthcare the way we know it today.

New Speaker: 09:52 No, I was going to say, well, to that point we want to get into the current state. I would love to go a little deeper into how, you know, for the example you talked about about the patient really being more enabled and taking care of their own health. Can you give some more examples of that or go even deeper into that about how it really is changing.

Ed Marx: 10:09 Yeah. I'll give you one really deeply personal one. So, you know, about a month ago, I won't go into detail for sake of time podcast, but I was running this race and then the last mile and a half I suffered this massive heart attack. No one has a lad or widow maker guy right away. And uh, so I made it through obviously otherwise I wouldn't be a special guest on your podcast. And so I got these tools, that one's a remote EKG, all Bluetooth and another one is a heart monitor and pulse and I'm able on my own to take these measurements. Okay. So now I'm engaged at a level different than a patient of the past. So it's kind of ironic that those technologies that I advocated for, I'm now an evangelist of because I'm a user myself. So I'm, I'm doing these readings daily and I care. It's like, dang, I wonder if this medicine's working on.

Ed Marx: 11:04 I wonder if I exercise Rehab Program is working and I get real time feedback. Then that feedback goes directly and without me having to do anything after the initial setup, goes into my electronic health record where my clinicians are alerted and they are contacting me and making real time adjustments to my medications now in the past, so I have a followup appointment May 22nd. In the past it would have been four weeks where I'm going to come in and they're going to do vitals and based on my vitals, they're going to decide what to upper lower my meds. Okay, that's four weeks now instead of waiting four weeks, every week they're adjusting my meds already, because I'm engaged, I'm providing the feedback because I have to, you know, take the measurements and things like that. But again, it's very, very simple to do. And so I'm like really into it now.

Ed Marx: 11:57 Like more than than I would happen if I was waiting four weeks or six weeks for an appointment, but then to take action. So they've already made changes to my exercise requirements, everything in every week it's updated because I'm engaged. So that's the missing piece. And, and you know, studies have proven that the more engaged the patient, the better the outcome. So it's not like I know skip my meds or skip my-skip anything because two reasons. One, I'm engaged because I get to see it'd be part of it and I enjoy that part. But the other thing is I'm held accountable. So in the past you show up, well I'm sorry doc, you know I didn't eat right or, and you make some excuse and, but you got away with it for four weeks. Well now I have to make. I'm measuring myself every day so I can't, I'll be held accountable on a weekly basis now, not once I show up to appointments. So that's a very practical, real example of how digital health helps with this engagement and I think you get better outcomes.

Erin and Syya: 12:56 So, right. There. I didn't think about this accountability. I just think I'm seeing more of the context of real time data. Like you say, through EHR, Electronic Health Records, the doctors are able to give you real time assessment saying maybe the meds should be adjusted accordingly. I didn't even think about the other side, which is probably the frustration that most healthcare providers have is the fact that we ourselves are probably not doing ourselves any favors in our own healthcare routine. I don't even think about that at all, actually.

Ed Marx: 13:32 And then another example of less personal is the whole concept. So I think we're going to see a shift, you know, because obviously cost is still a big issue so we need to figure out, everyone's seen the studies about how, where United States ranks in costs, you know, are the most expensive, but our outcomes aren't as high as other countries that spend less. So there's definitely an issue now the some explained explanation for that variance, but there's still a various that's unexplained. So one thing we need to do is become smarter. So with digital technology, so this is what we do today and I think this is the future, so we call it "hospital at home." So we have patients that come in that used to be admitted and instead of admitting them and that's no fun for the patient, it's dangerous for the patient, right? Not necessarily the Cleveland Clinic, but we know from statistics that being, once you're admitted to the hospital you can get some hospital acquired infection, some other issue that you didn't have before you went.

Ed Marx: 14:29 So you know, in hospitals not necessarily the safest place. So it's not a fun place as much as the Cleveland Clinic, we try to make it as our very patient focused and all about the patient experience. So we do a lot to make sure that it is a great experience. But on the whole net net, right? No one wants to be in a hospital. It's dangerous as I mentioned. Some hospitals are dangerous and it's expensive. So what we're doing is identifying the set of patients that we can send home with the appropriate technology and it's easy stuff, just Bluetooth setup because everyone is so digitally enabled these days, and then they convalesce at home. And so far our early experience has shown that the quality of care is higher, the same or higher, so that outcomes are same or higher. The patient engagement and patient experience is higher.

Ed Marx: 15:17 So we measure that and the cost is about half. So as technology evolves, people become more comfortable, we have better improved processes to manage all this. I think you're going to see, I don't want to venture a percentage, but I would love to see 50 percent someday of all cases that currently go through become admited, being handled at home. So that's where you again, you save lots of costs, everyone's happier and the quality is the same or better because think about it, you're convalescing at home and when you're in the hospital. Because again, I had a recent hospital stay. I had to stay two nights, one night in ICU and one night in Telemetry. Every two hours they are coming in and poking me and it was uncoordinated. This wasn't at the Cleveland Clinic, was it some other place which I love that place. I'm not saying anything bad, I'm just trying to describe to you the patient experience.

Ed Marx: 16:09 They woke me up at least every two hours to poke me and then they also came in to do vitals. They they should as they do in any hospitals, in Cleveland Clinic, do those at the same time, but they don't. So as a result, about every hour I'm getting woken up. So it's not a fun experience. So anyways, if you could convalesce at home that the experience is much better and you're with your family, it's less invasive on your family. So that's really the future is hospital at home and you know, you see that already at early start of that as the whole telemedicine, right. Everyone's familiar with that by now. There are some laws that need to be updated and approved and there needs to be better reimbursement mechanisms and those things are starting to hit depending on what state you're in. We do a lot of that at the Cleveland Clinic today. And have for many years, but that's, that's the only way that I engage in healthcare today other than my heart attack episode, is I just pick up my phone and I engage with my caregiver via the phone. So that's the other wave of the future. So you'll see, I think already there's probably like five to 10 percent adoption, but I think you'll see that go up to 80 or 90 percent.

Erin and Syya: 17:13 Wow. I can absolutely see that. I hear your point. I can't tell you. Unfortunately now with our own personal family experiences, if I can avoid the hospital, I would much rather, I think people in general are much more comfortable with their own homes and if I could simply call a doctor and say, Hey, here are my symptoms and I'm feeling is it something to be worried about? Should I come in or should I not? I could see where again, resources minimizing the wait time in emergency rooms, right? For cases that are really urgent versus someone that, you know, let's be honest, might be on the other extreme, that might be a hypochondriac. I mean I could see so much from, from a hospital perspective as well. You mentioned something here. I guess this all sounds great. I think like we discussed earlier, our societies now more inclined to accept this type of interaction. What is it do you think that is inhibiting us from being able to make this from five percent to an 80 percent adaption rate? What are the obstacles right now that you're seeing? Um, for hospitals in general and/or for patients?

Ed Marx: 18:21 Yeah. I don't see too many obstacles for patients because again, where the patients are demanding these sort of things and that's unfortunately no health system. Hospitals are usually slow to adopt technology because it's there. We're very conservative by nature and for good reason. There's good historical reason. You know, we do a lot of research to make sure that any medications for instance, that you receive are safe and there's a ton of research that's done. It takes awhile. We call it "bench to bedside." It used to be like, oh, I don't want to get my years right. It used to be 15 years bench to bedside. I think it's been cut in half and I think we're going to see that increase and just talking in general research to actual, to benefiting the patients. So we're conservative by nature so it's definitely not the patient side.

Ed Marx: 19:11 So the patients are pushing us. And then I think the next thing is, is the payment mechanism, because you know, we are paid to provide services and the way that most payment mechanisms are set up today, there's no incentive to adopt digital now again, that is slowly changing and I think it's going to accelerate as consumers demand more and we try to focus more on cost. So for instance, value based care. So we have a great product called "Oscar," so Oscar is a digitally native payer that we've partnered with and so all of our Oscar patients interact almost exclusively via the phone. You set appointments, those sorts of things and that. But the arrangement with that payer is that everyone's incentivized to leverage digital as opposed with traditional fee for service. So in traditional fee for service mechanism, there's no incentive for digital.

Ed Marx: 20:14 So that's an issue. So that's why I think, you know, the really the two main issues, you know, the secondary ones are ones we just talked about. One is okay, maybe some of the population's not ready, but I think that's a small amount and getting smaller. We're conservative by nature and for good historical reasons, but the really big ones are one is payment mechanisms so that the payment system of 30, 40 years ago hasn't caught up yet. It's starting to. Oscar is a great example, but other sort of ACO or accountable care organizations are good examples but it's slow to adopt and then the second one is policy, so policy hasn't caught up on the state and federal level. Some states are better than others, but it's hard sometimes like across state lines to provide care because they require you to have state licensure in that particular state and I just think those are false borders. And so I would love to see us take a more federal approach and remove borders from healthcare because they're arbitrary really, and really start changing our payment systems and policy to enable further leveraging of digital health.

Erin and Syya: 21:26 You just made us put it on mouthful stuff here, which I did not realize. I think I didn't think about the policy side of it. Of course I shouldn't. I shouldn't have thought of that because healthcare is highly regulated. You have a lot of experience with policy. Um, and I didn't know this and I apologize for all the years I've talked to you. Could you help me understand you've had a very strong relationship with THSA, the Texas legislators, I'm sorry, Texas Health Services Authority. In your experience working with them and talking to and working with, was it Governor Perry and Abbott?

Ed Marx: 22:07 Yeah.

Erin and Syya: 22:09 You said that you would like to see it in a more federal level. Is this something, where is Texas taking the lead here and trying to make this much more of a federal, discussion or is it still, are you saying that right now with policy, it's still stuck in the state to state.

Ed Marx: 22:26 It was very exciting to work on behalf of the governor in Texas for eight years and it was very interesting and eye opening because I got to work with a lot of state legislatures and help develop policy and give testimony and things like that. So it was great. It was a very eye opening experience and I've been exposed to some other things since then on, on the federal level that had been very eye opening. I'm glad to be a part of it. And certainly the Cleveland Clinic has a lot of effective relationships as well. Yeah. So I think that I wouldn't categorize myself on an expert on this particular policy issues, but there are still a state to state borders and it's highly regulated at the interest. And I just want to be careful here because I don't want to get into a political discussion, but you know, the various medical associations working with the state, you know, it can be, it can be very regulated and so some states are more progressive than others.

Ed Marx: 23:29 Uh, but I think in order to spur this on what I'm saying is, although I'm, I'm definitely a states' rights sort of person, I'm on a personal level. I think getting a federal engagement will help here to say, look, when it comes to healthcare, we have a mandate across the country to increase the quality of our care with our citizens. And do it at a price point that's less expensive than it is today. And one way is to do digital health and therefore we should have maybe one licensure for all clinicians that can cross state boundaries and allow providers to see patients from other states if that's what they want. You know, a lot of people come to certain providers for very specific care, for sure at the Cleveland Clinic from around the world. And so when they go back to their states, you know, it should be simple and easy to continue to provide follow up care and things like that. So I think there's more that can be done, you know, at the state and federal level to really help spur digital growth.

Erin and Syya: 24:38 So I'm not as familiar with the specifics of HIPAA, for example, but this is kind of moving on where my head is with digital health care it's going to require a lot of data, right? We're going to be amassing a huge amount of data, if we're going to have these types of interactions, I can see where you're going down that path to say, okay, if I am here in Texas, and you're in Cleveland, right or Dallas area, if I want to talk to you, can I do to be available, made available for you so that you can give me the proper health care you need so you have the proper information to help whatever issue I might have. Do you see data being more prominent, from a healthcare perspective, from the hospitals to have that accessibility of information and how would the office of the CIO being able to support that? I mean, that's a lot of data. So I guess my question would be what kind of investments are we looking at if we move and we will move to digital healthcare provider solution, how much investments are our hospitals willing to make because this is going to be a huge investment?

Ed Marx: 25:53 Yeah. And I think on the telemed side, it won't be so much investment specific to the telehealth because we do have, the capabilities with secure communications or sort of handled a HIPAA related PHI type of things, but where the data gets really interesting data in a digital health, and we didn't know, we're just talking about one aspect, but there's so many different aspects is really precision medicine. So that's something else that we've been pioneers of and this is the concept of getting so a lot of data and artificial intelligence and machine learning, genomics data with your electronic medical record data that you're capturing. And ideally with payer information that you might have and being able to do these predictive algorithms and predictive analytics that then lead to precision medicine. So an example would be, you know, we do these sort of things today, you know, we can predict with high accuracy who might be candidate for readmission, right?

Ed Marx: 26:51 We don't want anyone to be readmitted because it's, not, it's not right. Number one, it's not good for patient, for the patient and their family. It's not good for quality of care. So we have the ability to predict who might come back and so when we know that there's someone who is at high risk for coming back, we can take appropriate action and be proactive and reduce that likelihood of ever coming back. Or we can risk stratify our patients and realize who's at high risk for diabetes and then take very proactive approaches to ensure they never get diabetes or we manage the diabetes really carefully. So that's, that's easy and not many people are doing, but that's not as hard as the next step stage, which is this precision medicine and this is the ability. Now that I know all this stuff, I've been able to do predictive analytics. I've got all your genomics data, I know your history of, you know, what you respond to well in terms of drugs and things like that. It is then saying, okay, now you have this particular issue, this medical challenge. How do we craft a treatment plan that's specific for Ed Marx?

Ed Marx: 27:57 And so, you know, today, like if you have a fever, you might be given a standard medication, but that medication is only going to work for 50 to 60 percent of the population. So it's like trial and error, right? We gave you that medicine. Oh, it didn't work for Syya. So we're gonna, we're gonna get her some, some other drug and so it's like a experiment almost. But if we have all this other information and we know based on family history and again, genomics that this specific aspirin, just make it up a silly example, is going to be perfect for you. Then so we deliver that and you get, well your fever goes down and that's precision medicine. So I made a very simple example, but think if you had, you know, God forbid you had a cancer or something and you, you don't want just, you know, to a therapy that might work for 50 percent of the population, you want to therapy, it's going to work 95 percent for you.

Ed Marx: 28:54 And so that's where we're headed as an industry and certainly here at the Cleveland Clinic. So that's where data becomes this massive, massive amounts of data. So we do tons of genomics, we're leaders in the world in areas of genomics and so we're amassing tons of data and yeah, we have to be very smart with how we store that data, protect that data and that, you know, there's data integrity and those sorts of things. So it is a, it is a rising challenge for a lot of healthcare systems, but we certainly have a lot of good experience doing it already.

Erin and Syya: 29:30 That's great. So I appreciate that. I am really thrilled to hear that we do hear about the evolution of leveraging more AI. Again, precision medicine. You've mentioned this before it is, I guess my question on this is, okay, so you're about and you hear about artificial intelligence, virtual reality. Is this something where there's some fear of all those terms, right? Because there's a certain amount of ignorance that Hollywood has, you know, made those words more evil sounding than liquid. It actually is. Right. Can you help clarify, just to make sure we're clear on this, we're not looking at having some kind of robot, you know, talking to us when we're looking to get our healthcare, right? I mean, could you clarify exactly like in virtual reality for example, how would this be applied in a way that's realistic and not, you know, Hollywood, you know, I don't know what's that thing called the terminator kind of robot talking to me?

Ed Marx: 30:32 Yeah, so we've changed the name so we use AI, but to us it means it doesn't mean artificial intelligence. It means augmented intelligence, so we'd never have plans to take away the human empathy, so we'd never have plans to replace a clinician who might hold your hand when you receive a terrible diagnosis or hug you when you celebrate being cancer free.

Ed Marx: 30:59 We will never replace that. That's, that's just fundamental to who we are as an organization about patients first and patient experience. So we call it augmented, so we want to give our clinicians have tools to make them more efficient and accurate when seeing their patients, for instance. So if they have a tool while they're seeing you, that helps them sort of prioritize faster than they could on their own mind based on the inputs that they're receiving, sort of what questions to ask? That's what we consider augmented intelligence so that I'm asking the question, but they might be prompted based on your answers and the machine learning behind the scenes based on your answers,to focus in and hone in on something. Because, you know, the medical information available today is, you know, and the amount that that is produced on a daily basis, is more than any human could possibly take.

Ed Marx: 31:53 So if we have systems that can augment the clinician and the augmentation, understand all the new research, all the new studies and the clinician is also up to date. But obviously it doesn't, can't memorize, you know, libraries full of information. But they know they know enough to ask the right questions and when they ask the right questions, you have augmented intelligence helping them along saying, "Oh, based on everything, I just heard Ed say, think about x. You know, it's maybe only one in a million. But ask the question because what else?" And uh, so we see that as how we will use it or are you using it?

Erin and Syya: 32:31 So, so if I'm understanding correctly in this context, is it something where, based on our recording here, like you're, you and I are doing a video chat, is it something where like a chatbot is like listening on the side and then kind of scrolling as clinicians are talking to the patient?

Ed Marx: 32:46 Right. Correct. That's cool. And so it's just augmenting the interaction because you want realtime feedback, you don't want to get a report 24 hours later and then there's another question that's asked and then based on that question, that might lead to other permutation of questions you want to know right then and there. Right. So this is just augmented the experience. The other thing we're doing is we're completely, you know, remember the Cleveland Clinic, we have a three part mission which is sacred to who we are. So we've been focused all on the, on the provider side, but we're also a research organization and education organization. So we have this new med school, beautiful Med school. That's about to open and in it we're revolutionizing, along with Case Western, our academic partner, the way that we train our future clinicians and one way is augmented reality and so I've participated in this where you wear goggles and someday it'll just be like glasses, but right now it's still kind of awkward goggles, but you do all your human anatomy through augmented reality and it's quite fascinating and we found that the retention rate for the students is higher than when they had a real cadaver.

Ed Marx: 33:54 And real cadavers are an issue because they're expensive to maintain, you know, they're not easy to work with, and so by doing augmented reality, you get the same experience but better because now you're actually walking inside the heart chambers and you're looking around and seeing the aortic wall and you can touch things and so, the learning environment is much richer. And so that's an example of how we're doing real today, doing augmented reality to assist with our training of the next generation of clinicians.

Erin and Syya: 34:30 Wow, I mean, I can see that absolutely being a cost savings. I mean, and you said consistency. Unfortunately us as humans, we're not, we're not the same, so I didn't imagine for a future doctors how different their experiences with each cadaver.

Ed Marx: 34:46 Yeah. And it's easier to get dates is what I'm told. You don't smell like formaldehyde.

Erin and Syya: 34:55 I was just going to say there's, there's all those chemicals you have to touch. That's crazy. So. Well, let's shift a little bit because I think this is a great conversation. I know you and I could talk about this all day long, but you know, as a leader and you're seeing all of this technology being leveraged today, you know, it's not simply just a matter of keeping the lights running anymore or keeping, you know, the computers, you know, keeping help desk, running, etc. I mean, you know, you gave a great speech at the HIT summit earlier this year and I kind of want to go over it real quick here, is you gave a message saying that leaders, you know, in technology you need to take risks and lead proactively. And it really took to heart for me because I feel at times technology though we are at the forefront of helping move business forward with making them more efficient, et cetera. I do sense at times that technology leaders tend to be pushed back as an overhead versus a source of innovation for whatever industry and business. So could you help me understand what you were trying to tell the audience and how can that be applied to, to really make innovation move along faster than it currently is?

Ed Marx: 36:18 Yeah. I always try to encourage my peer group to take a more active role. A lot of people just, I don't know, I think it's just the way we were raised perhaps, you know, in technology as young leaders, that it was all about bits and bites and just to be reactive. And I'm like, no, no, no, no, we are. Especially today, we have to be sitting at the executive table and we have to be. And if we earn that right to be there, we need to earn the right to stay there. And sometimes we earned the right, progressive organizations will get earned. You earn that right, they'll have the position there, but then you have to earn the right to stay. I'm always challenging myself and my team. It's like how are we contributing to the objectives of our organization? How are we helping with research?

Ed Marx: 36:59 How are we helping with education? How are we helping with providing care and quality and patient safety? So you have to be really active and, and don't put yourself in this typecast box that says you can only talk with technology, spoken about. Well, for one, technology underlies just about everything now. Whether it's stated implicitly or not, and two, you're a leader first, not a technologist. So once you reached the C-suite, you're a leader first, not a techie. So, and I have the benefit, not that this is helpful but not a requirement, I have the benefit that I didn't grow up through the technical ranks. So I actually have clinical experience as well as business experience. But you can, you can learn. You can make some substitutes no matter where you are in your career to learn those aspects. So anyways, to be proactive, so I hear all the time I'm in the executive team and we meet Monday mornings at 7:00 AM and we talk about a lot of things.

Ed Marx: 37:52 We talk about our mission, our objectives and I know all the pain points that we're trying to improve for patient safety and quality of care and different areas or growth or revenue. It's like I'm an active member and I provide input and I can talk about how we can do certain things and sometimes it's technology enabled, sometimes it isn't. So I jump in and contribute and that's what's needed a lot of times again because of poor teaching of the past or just old tradition, you know, we're taught to keep quiet unless you're talking about technology or just to be reactive. Or the other one is like, "There is no such thing as a technology project," or I think that's how the people say it. And so I'm not going to lead anything. I always look for opportunities to lead whether or not it's technical or not.

Ed Marx: 38:41 And so it's like, no, contribute it doesn't matter. So if no one wants to lead it, but it's really important for the organization. Yep. We're going to lead it. And it's okay that we're leading it from technology point of view because we understand the business. So we do a lot of things which, back to my point earlier, I was fortunate to be a combat medic and than later in anesthesia aid, anesthesia tech. Not everyone has a clinical experience and that I worked on the business side so I understand the business side of healthcare. But you can do things to substitute that, so you can learn. So like we have all of our weekly meetings for my team at our institute, which is like, you know, the specialty parts of our organization. Like yesterday, we met in the cancer hospital, Tausig Cancer Center and we met with institute chair and his assistant and we learn and we hang out. And then we do that every week at a hospital or at another institute we have like 27 institutes.

Ed Marx: 39:40 So we just rotate around every year we fly. I mean every. Yeah. Once a year for all of them. And we just learn directly from them and then we shadow. So we have a program where you have to shadow a clinician one day a year. It doesn't seem like a lot, but it's a lot. Especially when you do multiple years. For my leaders myself, I try to do that once a month. Spend a whole day. I also volunteer so as another thing you could do, so I volunteer. My mom died 11 years ago, ovarian cancer, so I volunteer weekly at the Tausig Cancer Center and it's only in a couple of hours a week, but I see the caregivers, I see the nurses, I see. I talk with patients and so I'm always learning, understanding what they tell me, the patients tell me about things and I just listen.

Ed Marx: 40:22 I learn and so there's a lot of things you could do to really get to know the business. So that's what doesn't happen. That they might be strong techies, but they don't know the business and the higher you get the less techie you have to be because you hire people who are techie and understand this stuff. You really need you to focus on the business. So and then focus on leadership. Try and learn it. I, whatever book my CEO is reading, I'm reading the same book. Whenever he talks about going to conference or following someone, I follow the same person. I know what his Twitter account is. I could see who he follows. I follow the same people. So I do the same with other C suite executives. So I, I know I'm trying to know them. So I don't want to ramble, but those are just four or five things right at the top of my head that it can help differentiate you and help you add value to your organization.

Erin and Syya: 41:07 Yeah, you nailed it on the head right there. Research. Educate yourself on the business, educate yourself with the people that are around you in the same C level, suite, uh, embrace a lot of the business goals and objectives. These are such critical things that you think that's intuitive, Ed. I mean what you're saying is that I get it, but I'm sure that everyone can use more of it, right? Embrace it, really understand the books that they're reading. They are not just reading, you know, just because the CEO reads it. You're actually embracing the message within those books. It's, this is, I think, um, it's not rocket science, but it's discipline commitment.

Ed Marx: 41:51 It just get involved. So I take a lot of calls from peers who are trying to, they see something that they want to improve on and I'm always happy to help them and this person's trying to get sort of that big cio position. And so I talked about a lot of these things and then I said, you know, I don't ever see you present. I don't see you write. I don't see you tweet, I don't see you on Linkedin. And I was like, you have to network. It is part of it too because you're exposed to other people and you learn new ideas and you talk to people and that broadens you. If I, if I'm limited to my knowledge of today, two years from now, oh my gosh, the world is passing me up so and I can't do that. I made a pledge, an implicit promise to my employer when I took this role, so for the Cleveland Clinic that I'm going to be the very best CIO they've ever had and we're going to have the best patient experiences that we've ever had and caregiver experiences and so I owe it to my organization to continuously learn and improve myself and reach out and by interacting with others and networking like examples I gave you.

Ed Marx: 42:56 It does so many things. One is the network is you learn from others and you listen, but the other thing is when you prepare to make a talk, you have to study. You have to research and so, that's why I'm sort of up to date on different things. It's not because I graduated with a degree in there. It's because I'm continuously investing myself because the more I invest in myself, the more I can give away. You have to give yourself so you can give away what you received. So, it's just basic.

Erin and Syya: 43:22 It's the teams that I've seen you work with, I can absolutely see it trickling down because again, with true leadership, right, you're setting the example, you're in essence setting the pace for the rest of the organization and the tone for how you going to set the culture. I mean, is there anything specific you are looking at for your own team members at the Cleveland Clinic, is there any personality traits or anything that you do that uh, you'd like to impart and share with the audience today?

Ed Marx: 43:55 Well people have heard this before, but I, live by it. It's like I try to hire people that are better than me because I told you a couple of times already. I'm pretty average. So if I can hire people that are better than me, then we're going to be this rock star team. So I've made a couple of key hires recently. I'm very, very excited about. They're definitely better than me. I've, known, I knew these people before and I admired them. So now we get to work together on a team and that's really the secret. And so to the extent that you can build your team with people you could trust and just better get, have a similar philosophies and are passionate about service and about taking care of patients. So I looked for, you know.

Ed Marx: 44:37 So in summary is hire people better yourself, but look for people of passion, you mentioned that very beginning of the podcast. Passion. That's key because you know, it's hard work, right? It's, it's a very beautiful work, but there's no denying there's a lot of long hours and hard work. But if you're surrounded by people, that have passion that's just really helps carry you through the hard times. Like, wow, okay, yeah, our mission and we're here for one another. We carry one another when one has fallen. So, um, so that's really important is that passion piece and that's something you can't teach. So I just started hire for it.

Erin and Syya: 45:13 Excellent. And it's true, you cannot teach passion, that's for sure. I call it fire in the belly. If you've got fire in the belly, whatever it might be. You know Ed, we're kind of like, get on the. We're wrapping up here and I just want to say thank you. First off for the time, is there anything that you'd like to announce or anything you'd like to promote or advocate or just leave a message with for us?

Ed Marx: 45:38 I have nothing to promote or advocate. Just I just encourage my peers and anyone listening to, you know, find that passion. If you don't have it, you know, whatever it might be is, explore yourself. Try to find your authentic self and get excited about something and then, you know, change the world. We have very limited time. You know, that was known to me on April 7th. So you got to do while, you're here to make something happen.

Erin and Syya: 46:14 Erin, is there anything that you'd like to know?

New Speaker: 46:18 Great words of wisdom. I didn't expect it to twist like that from a digital health care perspective, but I think it's, it's true. It's that advice just goes through all aspects of life. all industries, I'll everything, put yourself out there, continually improve and I love the passion side. So now I think that that's a great note to leave it on.

Erin and Syya: 46:39 Cool. Great. And so just to, in summary real quick here from our conversation. Ed, I mean you have done so much. I mean I kind of touched the surface of the depth of your life experiences, professionally and personally. Um, but my takeaways here is again, obviously with passion, it seems to me with any level of innovation, if you want to make a difference, it really comes down to you want to do it. Okay. I guess we can go use that passion where again. You have to have the discipline to maintain it and a plan to execute on it. And any real true innovation, it's gonna evolve. Anything that's going to change our current state of life is going to have to take work and you know, we're seeing it now as I'm watching, you know, all the postings coming out of Cleveland Clinic.

Erin and Syya: 47:34 It's already the most innovative hospital here in the United States. You guys are doing amazing things and you know Ed, I'm really excited to see, I know every announcement that Cleveland Clinic comes out with, I know you're going to be the underpinning to execute and make it happen. So, you know, on behalf of us regular patIents out there, thank you very much for all your hard work because we're just going to get the fruits of your labor for that. So again, thank you very much for your time and, I definitely look forward to seeing and hearing from you again, Ed.

Ed Marx: 48:08 Thank you so much. It's been an honor to be part of your podcast.

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