Podcast Q&A with BJ Moore, Part 1: From “Bubble Gum and Bailing Wire” to Operationalizing

BJ Moore has quite a unique title. In fact, when people see that he is EVP of Real Estate Strategy and Operations in addition to serving as CIO at Providence, “they usually think it’s weird.” Moore, however, has become accustomed to that type of reaction. “Real estate and IT are becoming closer and closer,” he said during a recent interview. Not just because capacity became such a high priority for IT leaders during Covid, but also because he believes the workspace of the future is going to be “a melding of physical spaces and technology.”

During the discussion, Moore opened up about how his team has responded to the challenges stemming from Covid — both the original surge and the recent variants. He also gives his thoughts on how the digital divide affects care, why it’s so important to continue long-term investments (even throughout the pandemic), why going to the cloud feels like “cleaning out the garage,” and the power of storytelling.

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Key Takeaways

• The three primary factors in the decision to combine IT and real estate under one office? Capacity management, remote work, and the commitment to become carbon-negative.
• With staffing becoming a bigger challenge, Providence has evolved its model to focus on “staffing the community” rather than a specific hospital or clinic. “We’re trying to create more elasticity,” said Moore.
• As the initial Covid-19 surge abated, Providence went from the “bubble gum and bailing wire approach” to one focused on operationalizing and streamlining.”
• In keeping with the goal of being carbon-negative, Providence is partnering with Microsoft to eliminate data centers and move to the cloud, which “is like cleaning out your garage.”

Q&A with BJ Moore, CIO & EVP of Real Estate Strategy & Operations

Gamble:  Hi BJ, thanks so much for your time. The last time we spoke was in the summer of 2020. And now it’s like, here we go again.

Moore:  Right. A lot has changed, and a lot has not changed.

 

Gamble:  Definitely. So, I’d like to talk about core objectives your team is working on, and of course, how the Covid-19 variants are affecting that.

Moore:  On a light note, I saw a meme the other day that said, ‘The hardest part about the two weeks it takes to flatten the curve is the first 18 months.’

 

Gamble:  It’s so true.

Moore:  When we last spoke, it was before we combined the two roles, so I can explain that a bit. In August of 2020, I took over the real estate strategy and operations team. Basically, all the hospitals, clinics, and administrative space rolls up into me, as well as a lot of the caregivers who actually clean the hospitals, clean the rooms, and manage the real estate portfolio. When I tell people that, they usually think it’s weird that a CIO would have both hats.

Capacity management

The context for that is threefold. In March of 2020, the reason we were trying to flatten the curve is that we were worried about the ICUs being overrun. It takes 10 years to build a new hospital and add hospital beds. We needed to spread out the people who were getting Covid. What happened was instead of just relying upon our ICU beds, we really leaned on digital health. We went from 10 virtual visits to 10,000 virtual visits. We went from really not caring for anybody from home, to caring for more than 20,000 COVID patients from home. And so, it became clear that the concept of a hospital bed is actually an abstract idea; you can grow and treat your capacity either digitally or with physical assets. That’s one reason.

“The workplace of the future”

The other is remote work. We’re not just going to bring people back into their old offices and cubicles. It’s now a collaborative, hybrid work environment. People are going to work from home because it helps productivity, but they can come into the office for specific needs. Again, it’s very much a melding of physical spaces and technology to make that workplace of the future.

Smarter buildings

The third reason we combined the roles has to do with our goal of being carbon-negative by 2030. We can’t do that with facilities alone. It’s going to be, how do we get out of the data center business? How do we build smart buildings?  How do we use technology to expand or increase our capacity versus building new buildings or building new hospitals, or adding new hospital wings?

“Real estate and IT are becoming closer”

Our CEO, Rod Hochman, MD, had an epiphany. He said, ‘Real estate and IT are becoming closer and closer. Let’s combine them.’ And so, when we say we need more hospital beds, it can be an abstract idea versus ‘the real estate team wants to build buildings or the IT team wants to build IT solutions.’ That’s the context.

 

Gamble:  It makes a lot of sense.

Moore:  Now, people will ask, ‘why do you own both?’ I’d like to think that in three years, they’ll ask, ‘why weren’t these two things always together? Why did we think physical buildings were these static things that just existed?’

 

Care delivery of the future

Gamble:  So it was at least partially driven by Covid and the need to reimagine space?

Moore:  Exactly. Necessity is the mother of invention, and now we’ll never go back. When we announced the strategic partnership with Microsoft in July 2019, I made the mistake of calling it ‘the hospital of the future.’ I regret that quote; in hindsight, I should’ve said it’s care delivery of the future. Care at home, remote care delivery, and telehealth are the types of scenarios we need to double down on. The hospitals are always going to be critical, but it isn’t the primary push anymore.

 

Marching toward carbon-negative

Gamble:  Can you talk more about the goal of being carbon-negative? That’s a really interesting premise. Where are you with that now?

Moore:  We mapped out an 8-year journey with infrastructure investments and de-investments, and strategic plans. Right now, we have five data centers. We want to get out of the data center business and give that to Microsoft, which has its own green initiatives.

We have a pragmatic plan mapped out. It’s a sizeable investment, but it’s reasonable. In the United States, hospitals and healthcare represent about 10 percent of the greenhouse gases. We see it as our responsibility to lead by example. We just can’t talk about global warming and the impact on communities without doing something. So yes, we have a bold goal, but we’re marching toward that.

 

Moving to the cloud

Gamble:  Where are you with the data center piece? I’m sure that’s a big part of it.

Moore:  We’re probably about 60 percent through that journey. We liken moving to the cloud to cleaning out your garage — you find things you’ve held on to that you don’t really need. It’s the same thing with applications and servers. We’re actually retiring more applications and servers than we’re moving into the cloud. The last big workload we need to figure out is getting Epic to Azure. We’re partnering with Epic and Microsoft on that. We already have a few of our Epic instances in Azure. We’re actually one of the largest — if not the largest — Epic instances in the world. But we can’t put in Azure yet, so we’re partnering there.

The data center is just one part of it. It’s also upgrading infrastructure, moving to LED lighting, and moving to smarter buildings where lights are turned off dynamically. It’s changing the way you manage computers by putting them to sleep. It’s making investments in solar, wind or other things to provide green power to our ministries. It’s a 10-point plan we’re executing on.

 

Gamble:  I’ve heard a few whispers about this throughout the industry, but not a lot in terms of concrete plans. Sometimes it takes a large or well-known system to create a blueprint, and others will follow.

Moore:  That’s the hope. Rod is also the American Hospital Association chair, and so he, rightfully, sees it as his responsibility to lead by example. We’re proud to be doing it.

 

“This isn’t a competition”

Gamble:  And you get to help develop the blueprint.

Moore:  We also get to find out what doesn’t work, and we’re going to share that with our peers. Let’s learn together. This isn’t a competition. We want to help other health systems. And so, as we try things and they don’t work we can warn other people to not do that, or to do it differently. And obviously, we want to learn from our peers as well. We don’t have the monopoly on great ideas. We want to learn from others so that we can all get there.

 

Creating “elasticity”

Gamble:  Are you approaching things differently, particularly as we’re seeing new surges and variants?

Moore:  I don’t think we’re approaching things differently, but I do think we’re accelerating our early learnings. Things like remote care delivery, telehealth, and bots — how do we help our patients self-serve or navigate the health system more easily? We’re looking at how to leverage machine learning and AI to continue to evolve our models so that we know when surges and peaks are going to hit, and when we’ll see a decline. PPE and ventilators are no longer a sticking issue, but staffing is becoming more and more acute (no pun intended). How do we manage staffing levels to make sure we’re staffing appropriately?

We’re starting to look more at communities of staffing versus the traditional model where a nurse or caregiver was assigned to a hospital, and they remain there. We’re trying to create more elasticity by having an employee serve a community versus a specific clinic or hospital.

And so, I wouldn’t say we’re doing anything different because of Delta. I think we’re just evolving our strategies to meet needs as they arise.

 

Gamble:  Let’s talk a bit more about bots. What are you doing in that area?

Moore:  We’re continuing to evolve Azure Health, and we’re partnering with Nuance to see how we can leverage ambient artificial intelligence to enable people to navigate healthcare more naturally.

We’re looking at using ambient AI to unencumber caregivers from typing into the electronic health record by having natural speech with the patient, while AI does the magic behind the scenes to make sure the patient and caregiver information gets put in the right place. Those are some of the things we’re doing with bots and AI to improve scale, patient experience, and caregiver productivity, and to reduce burnout.

 

Operationalizing & streamlining

Gamble:  In terms of telehealth, Providence saw that huge jump along with so many other organizations. What are doing to try to maintain that and make sure it’s being used effectively?

Moore:  As you can imagine, when we went from 10 to 10,000 telehealth encounters in March of 2020, we were really proud of the scale we were able to achieve, but it was a little bit haphazard. Our focus now is on, how we can make those experiences better? How do we make them more seamless? How do we ensure security, while also ensuring a positive experience for the patient and caregiver? It’s going from the bubble gum and bailing wire approach we had in March, to really operationalizing and streamlining it. We’ve seen a small dip in telehealth usage, but it hasn’t come anywhere near to reverting back to the mean. The engagement is there. And so the question for us becomes, how do you improve the experience?

I mentioned the quote from Microsoft where I regretted calling it the hospital of the future; we’re partnering with Microsoft to identify the clinical, caregiver, and patient experiences that can now be added into telehealth. We’re looking at the next generation of that.

Video and voice capabilities are still a core part of telehealth, but it’s also about, how do we get care delivery teams to act more like a team? How do you we create more seamless patient handoffs between specialists? How do we have better notetaking and annotation and better communication between patients and docs? We’re starting to explore those scenarios with Microsoft.

Part 2 Coming Soon…