A (2:13)

You look, we must have crossed paths like. It is remarkably small world.

B (2:17)

It really is. Yeah. And he's actually worked out in San Francisco area as well, but he's an east Coaster, so he's from Boston. Yeah. All right, so let's talk more about the cmio. Role. Because that's really interesting that you make that transition. What was that like?

A (2:34)

You know, it's actually interesting how much of an overlap there is. When I was younger, I actually felt a little bit of discouragement from others, and I don't think that's the way it is now, from talking to my students and talking to colleagues. But there was this thought of, you can't do both, you can't be in both worlds. Clinicians speak one way, it speaks another. There's no overlap, there's no liaisoning. Don't even bother. But the truth is, a lot of the lessons learned in medical school apply, and vice versa, to some extent. I mean, there is a certain amount of algorithmic thinking in medicine, although we won't say that, we won't call it that, but there is certainly not yet, anyway. Not yet. There we go. And what's nice is I work with a fantastic team of nurses and the sort of teamwork and interactions you have on the floors do kind of mimic on the administrative side. And like I said, most of us has a background either or is still currently clinical. And then with the analysts. Right. I have the background in programming, and so we do speak the same language. And it's the same way. Like, I have really, really good analysts who I work with, and they make tremendous output.

B (3:35)

How does the shared mission of healthcare affect that, enable you to straddle both sides?

A (3:42)

I think the core of everything is still the patient. I mean, even if it's cybersecurity or data innovation, you're doing it predominantly for the patient. And then to some extent, you're also. You're wanting to deliver better care. So, again, it's still that focal point of the patient. And we all try to remind ourselves that in meetings when things might get tougher, there might be some things that seem insurmountable, that this is still, at the end of the day, for better patient care.

B (4:06)

I love that. I love that. Yeah. And it simplifies everything if you put in perspective. Right. We're all here for the patient. We're all here for better outcomes and a better patient experience, regardless of the technology that we choose.

A (4:17)

Exactly.

B (4:18)

So, you know, as you look out over the next 12 months, 24 months, what are your key initiatives? What are the things that are sort of keeping you up at night?

A (4:26)

For initiatives, at least I want to build our team in a direction where they feel pretty empowered to keep doing the work they're doing is in recent. Well, now it's months, but I was gonna say in recent years, there's been certainly a change in technology and it's boomed across the healthcare space. And one of the things I've tried to do is get the team more center around innovation, feel more comfortable with some of the pilots we're doing when it comes to AI and to other healthcare related tech. But also I guess as it pertains to cyber, to be more comfortable with doing forensics. As time, as more and more data gets fed into the healthcare space, there's also a need to be able to make sure it's being accessed appropriately. And sort of like we were talking about with that overlap and that dual background, I think my team and I are the most poised to be able look at a case and say, was there appropriate access to the chart? Was there not appropriate access to the chart, what's been done and almost be able to create an audit trail so that my good friend the CIO and the CSO are able to kind of combine that all together and see what's happened and make a good report for the organization. The other thing also kind of has to do with this explosion of data and we've already seen we're able to leverage population level health or across a cohort of patients to make better outcomes, whether that's access to care, whether that's better recovery, earlier discharge. And I think that's untapped. I mean, I think there's so much more coming into that space and so I want the whole team, myself included, to be prepared for that, you know.

B (5:43)

Yeah. And as you think about AI and AI enabling a lot of those use cases. Have you set up a governance committee yet or are you in the process of doing that? Oh, you have? Great.

A (5:54)

Yeah, it came our way. About a year ago, one of the chairs had wanted to implement a scribe. Seeing that all of healthcare was seeming to use it and that was our first, like it's not just scribes, but that was our first example of hey, we've got to be careful about this, right. There is a lot of considerations when it comes to retention, use of data. How long are you keeping the recording? Is it discoverable? How are you handling hipaa? How are you handling privacy and security? And we all got into a room together, the executive team, some of the clinical representatives, and really just discussed, saw a couple of demos, saw what it was like and then from each of their very impressive backgrounds, whether it's full time medical practice, whether it's risk, whether it's medical records, wherever they were from, they were able to contribute some component to both the governing Structure, how are we going to do this in the future? And also a policy that we passed out to all of medical staff and were able to approve very quickly. I think that's actually helped along the way because there's always going to be either concerns, hiccups, technology issues and having something in place to understand how to approach that made us able to go, like I said, not just with scribes, but some other rollouts like computer assisted coding, patient outreach, things like that. And I've heard from other colleagues across organizations that that seems to be what works best. The other thing that was was really key is I've practiced here for a while, so I know a lot of the clinical leaders and they trust them both clinically. And several of them are either have engineering backgrounds, really like going to these tech conferences. And so we've made it an to go at least once a year to one of the tech conferences or health tech conferences. Sorry. And just see what's out there and meet with vendors together so that I understand I'm an ER background, I don't quite necessarily know inpatient or internal medicine or urology or vascular surgery background. And having a sense of what they need in their workflows, hearing their feedback has also made us make sure we're not just going down a fruitless avenue for a product. And I think that's really important. Like effectively having physicians in the conversation.

B (7:46)

Yeah, that's great. In many ways you're facilitating those conversations with the other teams, the tech teams, obviously the governance teams. Have you set up a sandbox? Are you? Some people will set up a sandbox where physicians can go off and test new tools or the application of AI. Have you considered that? Are you thinking about doing that at some point?

A (8:06)

A little rudimentary. We certainly have like a non prod environment. But even that is a little bit close. One thing I've done for we get residents and students and not just here, but across other facilities. I've used some of the open source tools to spin up a sandbox for them so that they can learn AI. I'm about to test it on a new resident rotating in July. But effectively it's synthetic data, synthetic patients got an API. But if something happens, it doesn't sit on our network. It's purely academic and that's where we're going with that. I've gotten some feedback too from the attendings who wanted to take part. Just because it gives you the space to maybe explore methodology rather hey, am I doing something with a black box technology? And that affects Real patients. The answer is I can't allow that.

B (8:51)

Yeah, no, no. I love that approach too. I think more people should look at investing in sandboxes and allowing that discovery process and exploration process. Are you finding that those residents are bringing in their own AI because of the.

A (9:06)

I've heard rumors from wherever I've done clinical work.

B (9:11)

Yeah.

A (9:12)

It's far more accessible. Like if I. Some of the scribe companies, just using them as an example, will offer a low cost subscription model, even free. And if you look deep and it really relates to the topic of your podcast. Right. If you look deep into the language and no one reads, it's your fault if anything happens. Like it's a big responsibility to be using these tools and the vendors are very smart in making sure that they distribute onus, you know.

B (9:35)

Yeah. Which is. Makes it difficult really to adopt in a responsible way, if you will.

A (9:41)

Exactly. And I think to your question, that's why we were like the time is now for governance because we want tools, we just want them in a way that we feel safe.

B (9:49)

Yeah. And I think you were, you and Amy, did you go to that conference or you presented?

A (9:53)

I think, yeah, I gave a talk very similar on what it's like to consider AI at a more community based setting.

B (9:59)

Yeah. Oh, cool, cool. That was at Stanford. Yeah. Nice, nice.

A (10:03)

That was, that was very inspiring. Like the work that everyone.

B (10:07)

Incredible organization. Yeah. You mentioned other tech conferences. Do you go to Vive or hims or you do?

A (10:13)

Oh, okay. Yeah. Although I think I might over attend. But according to, you know, health and Vibe and. But Becker's as well. Becker's is.

B (10:22)

Yeah, Becker's is good too. Yeah. Cool. So, you know, as you think about your journey, if you could go back in time and see your 20 year old self, what would you tell him?

A (10:32)

You know, it's funny and I said it's probably changed now, but I would remind you that even though people are saying you can't do this work, there is actually a lot of niches in medicine where if you have interests, there's room for you there. And that it may seem unorthodox and not necessarily a path that's possible, but that's how many specialties became cemented, you know what I mean? Like it's true for things like occupational, environmental, addiction medicine. Those areas traditionally only had a practice pathway and they become cemented, just like clinical informatics as a formal pathway for a physician. And so I think I would just emphasize, and I say this to students a lot and residences, if this is your interest as we were talking about kind of at the central theme, you're still doing something that affects positively patient care and maybe even more so if it's at the system level.

B (11:18)

I love that. Yeah. So if you're interested in mental health or you're interested in other sub segments of that area, go for it because there's a lot of opportunity to contribute. Yeah, that's a great way to think about it. I always love that question because I always get unique answers and this is a new answer. So I appreciate that.

A (11:34)

Oh, no, of course.

B (11:36)

This is a Risk Never Sleeps podcast. I gotta ask you this question at some point. I was asking this now, what's the riskiest thing you've ever done?

A (11:42)

Sure. So you mentioned we're fellow East Coasters. Spent almost my entire life on the east coast. I met my wife when we were both in college and both of us were New Jersey, New York, New Jersey, D.C. and then effectively on a whim, decided California. Our whole roots were on the east coast. That was a Toyota with a U Haul, by the way. Corollas can actually a fair amount with that transmission. I'm surprised.

B (12:09)

That's a great car.

A (12:10)

Yeah. And that somehow made it to California with less than a week before my first attending shift, which as you can imagine is quite daunting. And in that week got our driver's license, established move in and got went to San Joaquin where I've stayed. But that was very risky and pretty.

B (12:27)

Yeah. Did you put one of these on your car? Did you have one of these stickers on your car?

A (12:33)

No, no. But there was an exit sign or whatever. You can exit backward.

B (12:38)

That's so great. What do you miss most about Jersey?

A (12:41)

Okay. Things are much closer in New Jersey, you know. So if I wanted to get to New York, Philadelphia, that was easy. California is very expansive. I missed some of the food. I certainly miss. I think we're going to talk about some of the hot dogs.

B (12:53)

Yeah. We talked about Ruts Hot. Shout out to Ruts Hot the Frog hot dogs.

A (12:58)

I have yet to find an equival pizza.

B (13:02)

Yeah.

A (13:02)

Best I've got, it was something out in Central Valley where I asked, the owner happened to be there and I said, how on earth does this taste? Just like New York. He's like, what are you talking about? I'm from Jersey City. Ah, there we go. Okay. One of mine, one of mine. Got it.

B (13:12)

That's great. My daughter went to Stevens, so we spent a lot of time in that area.

A (13:17)

Yeah.

B (13:17)

Hoboken in Jersey City. That's interesting. So Did Portnoy cover. Do you know Dave Portnoy from Barstool Sports? No.

A (13:25)

No.

B (13:25)

He does a first bite or. I forget what it's called. It's a podcast. He has an app where he rates pizza places. Yeah, I wonder if he's ever covered that place.

A (13:34)

He should. It was like being home and.

B (13:36)

Oh, that's other places in the bay.

A (13:38)

But most of it's like California style or Neapolitan.

B (13:41)

Yeah, it's not the same. I grew up in Connecticut. I grew up on New Haven Pizza represent which is probably the best pizza in the world.

A (13:49)

I'll say.

B (13:50)

I mean, you know, Jersey pizza.

A (13:52)

Oh, I've had it once and I miss it. I. I fully understand.

B (13:56)

Oh, the Sally's and Pepes and. Yeah, modern.

A (13:58)

Yeah.

B (13:59)

It's like in that block of just goodness. So no other states really have gotten it right. New York pizza is good too. I mean there's some great places and it was a John's pizza and. Yeah. Which is fantastic.

A (14:10)

Everyone has to do Ray's ones for sure. And then bagel. Like bagels.

B (14:18)

Oh yeah. New York bagels are just.

A (14:19)

Yeah, yeah.

B (14:21)

And then again, anything after 2 o' clock is awesome too. In the morning. Right?

A (14:26)

So I forgot that cities go to bed.

B (14:29)

It doesn't sleep. Yeah. Isn't that weird? Like you go to other cities and they're like Boston in particular. Boston shuts down. I think it's open till like one maybe, but mostly everything just shuts down.

A (14:41)

No, DC was the same way when we were there. Like except for certain days or the weekends that metro is closed by midnight and you almost stuck in it.

B (14:49)

Or if you weren't doing this job and I know you're doing a couple different jobs, what would you be doing? What are you most passionate about? Like, you have any hobbies or.

A (14:57)

Yeah, you know what I miss actually is in undergrad, in medical school, I actually played stringed instruments. Oh yeah.

B (15:03)

All right, here we go.

A (15:05)

Really good mentor in undergrad who taught baroque style music and said, you seem to me like a person who plays bass. Viola de gambo. I was like, okay. And taught me like for someone who is not. I'm not very good, but good enough to do in like some troops and some sort of performance along the way. It was nice. Shut up. Like there's no screens, there's no curiosions. You just kind of like you and the music and I had a band in medical school, but unfortunately we all went our different ways.

B (15:32)

Okay, what did you play? What did the band play?

A (15:34)

Same thing. Bass and cover of a lot of, you know, rock. Like Red Hot Chili Peppers, Green Day, that kind of thing.

B (15:39)

Green Day. Nice, nice. All right, so let's go into that question. You're on a desert island. You can bring five records or albums or CDs with you. What would they be? No greatest hits either.

A (15:48)

Am I alone?

B (15:49)

Well, maybe. Okay, it's your island. You can be alone or you can be with one other person.

A (15:55)

Sure, sure. I'll go with. I get Guilty Pleasures, then. So I mentioned Green Day. I mean, I would certainly do American Idiot and Dookie. I had just seen 30th in San Francisco back in.

B (16:06)

Oh, you did? Oh, nice.

A (16:08)

Beyond a doubt, like, the best show I've ever been to.

B (16:10)

Oh, yeah.

A (16:11)

And you feel the passion because they're from the Bay Area, so.

B (16:13)

He's incredible. Yeah. On stage, he's so much energy and.

A (16:17)

Like, you feel like every part of that stage, like, he's commandeering and that no matter where you are in the audience, you know, that's towards you.

B (16:24)

Yeah.

A (16:25)

Almost like he's clinging to your section, and he knows how to do that. Well, okay. Guilty pleasure. I'll pick, like, a Taylor Swift album, one of the recent ones, or Orchard Poets.

B (16:34)

Yes. Good.

A (16:36)

And it's long enough, right?

B (16:37)

It's good. It's all good. You don't have to apologize for that.

A (16:40)

That's good stuff. And then, you know, it gets lonely. Or during the dark of the night, maybe, like, soundtracks. Something like Star Wars.

B (16:50)

Star wars soundtrack. That's so nice. You still doing music, still playing it all, or.

A (16:56)

Mostly just, like, by myself in the garage. That sort of thing.

B (16:58)

Yeah, Yeah. I started a band at Improvada. No.

A (17:02)

No way.

B (17:02)

With a couple of other colleagues. Yeah, we were a house band for a couple years. We played corporate events, and it was a blast. I mean, it's nothing like a band. I mean.

A (17:10)

What did you play?

B (17:11)

I sang. Well, I, I. I stood in front with a mic. Let's just put it that way.

A (17:18)

No count.

B (17:21)

Yeah. So I've been known to hit the karaoke bars as well, so. But I. Yeah, I love music. I've been a big fan of music all my life, and poetry and writing and things of that nature, culture and literature and paintings and, you know, all the like. So. All right, cool. You get back to Jersey at all?

A (17:38)

Yeah, pretty often. Family's still there, friends. So I try to do it maybe once every two to three months and. Okay, San Francisco to New Jersey is not a bad trip in general.

B (17:49)

Yeah. And where do you, like when you vacation, you stay in San Francisco, you go, you hike or.

A (17:55)

Yeah, that was one thing about California that was. Help mitigate that rapid transition from east to west. There's a lot of open space.

B (18:02)

So much open space.

A (18:03)

Right. Like.

B (18:04)

Yeah.

A (18:05)

Within I think a 30 minute distance is probably 10 to 12 places where you can fully immerse yourself. We have two dogs, so they really like that area.

B (18:14)

What kind of dogs?

A (18:15)

So both are mostly hound mixes. Interesting story is we adopted them from Hawaii. They were both shelter dogs and they are siblings, so they. It's nice to reunite them. Yeah.

B (18:24)

Oh, that's cool. How old are they?

A (18:27)

So the boy is four and the girl is three. According to the.

B (18:32)

They're younger, so that's good. You got a lot of time with them and you've been down to Big Sur or.

A (18:37)

No, it's on the list. I, I will say there's a few places like Mendocino, I guess. Redwood.

B (18:42)

Yeah, yeah.

A (18:43)

Or. Sorry, Reading. Excuse me? Reading. Where? Like it's on our list and outside that sphere of influence. So we just. There, you know, bring the dogs north four hours, south four hours. We do some trips down to La Ojai, Joshua Tree and that's, that's.

B (18:57)

Oh, Joshua Tree, I love that. Yeah. I went to a concert back in 16 in Indio. Coachella.

A (19:04)

I was going to ask.

B (19:05)

Yeah, I mean, yeah, but it was. They called it Old Chella because it was older bands. It was three days, six concerts. It was Stones, Dylan, Paul McCartney, Neil Young, the who and Roger Waters. Yeah, it was incredible. It was incredible. It's funny, like, not many people knew. I don't even know how. I can't remember how I even found out about it. But I ended up going out there with a childhood friend. I've known him since I was two and a half years old. And we traveled out there and we were heading up to Joshua Tree on Indian Chiefs and turned back because it was so windy on Route 10 there. So we ended up going back. But. Yeah, that's a wonderful place, isn't it? Joshua Tree.

A (19:42)

And at night. It initially seemed daunting, but we did that trip inland. Oh, it's just gorgeous. Like, I don't know if you're supposed to, but you can stop along the road and just take it all in, you know?

B (19:51)

Oh, it's amazing. Yeah, you feel like you feel small. You feel like there's something else out there that's just so much bigger than you.

A (19:59)

And yeah, again, no screens, no pollution from light. So, yeah, as far as you want.

B (20:06)

It's so, yeah, I know it's so, yeah, you want to go back. So you're obviously spending time with residents. If you were to address a class of non clinicians that want to break into healthcare and cybersecurity, what advice would you give them?

A (20:23)

Sure. I mean, I think what worked for me was, I guess there's many ways. It's similar to the question asked before. There's many ways to decide if it's right for you. Like a traditional path that everyone might shunt you towards. It may be less true nowadays, but volunteering, shadowing, going through this checklist and then you get into medicine. And I would say that that's not necessarily true. Like, I have a lot of students who have gone many non traditional ways. Some also did programming. Some come from backgrounds with writing, music, legal, some are nurses. There's many ways to get to that finish line, if you call it that or that's how you perspective on it. And I would say, like we said before, just don't lose that niche interest that you have because it probably will make you at the end of the day a better clinician or conversely a better administrator, if that's the path you choose, is ultimately medicine, you know?

B (21:10)

Yeah, I love that. It's like, you know, life's a journey. We hear that. Right. But it truly is. I mean, be open to the journey. Let it take you where it's going to take you. I certainly didn't plan to do what I'm doing today. And it revealed itself. And I love that about life and the opportunity to really live it. Right. You get to get introduced to interesting things and you get to end up in Central Valley, California, from Jersey.

A (21:34)

So you went writing to cyber and like.

B (21:37)

No, I went out of school into a startup as a technical writer of all things. I'm a writer by trade, actually. I've been in JAMA as a poet. My poetry is published in jama.

A (21:48)

Yeah, I may have seen it. That's awesome.

B (21:50)

Yeah. Yeah. So if you read jama, I'm sure you do the October last year issue. There's a poem in there that I wrote.

A (21:57)

I read that. I just didn't know it was you. That's amazing.

B (21:59)

Really.

A (21:59)

Oh, they send you a lot of issues once you become a member. And I'm not complaining because. And so it's a great publication.

B (22:06)

Yeah, yeah. And then realized I was. I had sort of an idiot savannah as it relates to trends and market trends and technology. Got into products and been into products ever since. Products, marketing, sales, done all those functional areas. But I love to build products that take a process that might be manual or otherwise and automate it and to get some really interesting results and outcomes that you couldn't do otherwise.

A (22:32)

I think that's what was an area of informatics that was really appealing, was seeing very much like you said, where there's a lot of repetitive tasks, even if it's just pulling data, where the two approaches could be keeping binders with medical record stickers and vital signs, or you could pull that very quickly and that is that population change that we were talking about. So I love where we can safely automate. I love that.

B (22:54)

Safely automate. That's a great point and that's a great way to end the podcast. Dr. Izzo, thank you so much, Joe. It really is a pleasure meeting you. Like thank you for hearing your journey. This is Ed Gaudette from the Risk Never Sleeps podcast. And if you're on the front lines delivering patient care or protecting patient safety, remember to stay vigilant because risk never sleeps. Thanks for listening to Risk Never Sleeps. For the show notes, resources and more information and how to transform the protection of patient safety, Visit us@SenseInet.com that's C E N S I N E T. I'm your host, Ed Gaudet. And until next time, stay vigilant because Risk never sleeps.