Published January 2022
From his perspective with 25 years in the healthcare technology industry, Enrique Estrada, the new senior director of healthcare industry solutions at VMware, is impressed with how CIOs pivoted during the pandemic. As a former marine, he learned how it’s key to adapt and overcome; and that’s exactly what he saw CIOs do. In this episode of healthsystemCIO’s Partner Perspective Series, Anthony Guerra, editor-in-chief and founder, Estrada says patients should be at the center of everything, because ultimately, we are all patients. Estrada fell into healthcare early in his career, but because of how important it is, he would never leave it. He also sees more hope than many who say healthcare is technologically 10 to 20 years behind, instead, predicting healthcare is only a few years away from keeping pace with other industries.
“ … there’s these virtual visit industries that have been created, these doctors are actually working in their homes, right? And so, CIOs are being challenged to be able to extend that standard of care or create a new standard of care that engages them as well.”
“The whole 21st Century Act is really, really important because I believe that the data should follow you anywhere; your personal PHI should follow you anywhere, just like a credit card transaction follows you anywhere, so should your data.”
“What we’re seeing as far as what’s next is this big orchestration of workflows, data, and devices coming together and being used across different clouds as part of one encounter.”
Guerra: Enrique, thanks for joining me.
Estrada: Thank you for having me.
Guerra: All right. Great. Looking forward to having a nice chat. Why don’t you start off by telling me a little bit about your organization, a little bit about VMware and about your role there?
Estrada: Yeah, sure. So, I just joined VMware, just about four or five weeks ago. At the end of December, and really focused on really putting together our solutions, working with our business units, working with our sales teams, as well as working with our partners to package solutions that are really focused on solving some pretty unique problems in healthcare. And the other part of that, too, is looking for gaps where we can drive some innovation. So luckily, I walked into a room of really passionate folks, really smart folks – they are all committed. And I just got here, like I said, so my background specifically has been healthcare and technology for the past 25 plus years.
Guerra: So, you’ve been there four to five weeks? I mean, how much did you know about VMware’s healthcare situation offerings, products and services before? What’s that process like, based on your level of acquaintance sort of getting a feel for what’s going on? And then going from there, one of the things they said about Steve Jobs, one of those quotes is that one of the biggest things he did when he came in was, he stopped a lot of stuff, as opposed to starting new stuff to get them to focus on certain things. Is that anything like what you’re looking at?
Estrada: Great question. Traditionally, just to go back to the top of that question, traditionally, my awareness, knowledge of VMware has always been the foundational piece in data centers, right, whether it’s in, in the cloud or on prem, at the enterprise level. But I also have been aware that VMware has also been this foundational component that’s driving and evolving their value proposition. So if you look at things like their end user computing, their modern apps, and really this focus around multi cloud, this is something that has been in the realm of healthcare for quite some time, I just didn’t know personally. I didn’t know that there was such a big piece VMware had in these roles, especially on the end user compute side, because as we look at digital health, we’re seeing this big kind of evolution and push to kind of meet the patient where they’re at. And so, the end-user computing side, the Workspace ONE side, is really starting to play a very pivotal role in helping meet those needs. And so, I continue to be surprised at all the things that they’re doing in healthcare.
Guerra: What are your thoughts on speaking to customers? Our readers are the CIOs. To what degree do you want to do that and, and use those conversations to help? Now another thing is, you’ve got different constituencies in healthcare, right? It’s not just hospitals, you’re dealing with other parts of healthcare. So how do you think about that in terms of satisfying the different buckets that you have within healthcare, and then integrating conversations with customers to see what they’re looking for? To help drive your roadmap?
Estrada: Yeah. So, one of the things I’ve been doing on day one was the first thing I said is, can someone show me where the data is at, right? Can you show me where the data is at with overall customer engagement, right? Our net promoter scores, satisfaction, can you show me the KPIs, all the operational stuff that normally goes on when you want to know what’s going on with your customer. So that’s the first thing I started to do. So, the good thing is, we track things really, really well. And you have to be careful when you say you want to see the data, because there’s a lot of data. But I’ve also started to talk to customers in my first couple of weeks here directly.
I just got off a call earlier with a large channel partner/customer. And we’re working together to look at some very unique use cases that they’re having problems solving downstream with their own customers. And so when I think of a customer, I think of customers from a couple perspectives, one is our partners. They are one of our biggest customers. They consume our services; they resell our services. They also innovate on our platform. So, I want to know what’s working well for them. I want to know what their roadmaps look like. But I also want to be able to speak directly to the payers, providers and life science customers that are ultimately invoking the services that we provide. So, workflows are very, very important at the health care level, we play a very big role in ensuring that those workflows stay efficient and consistent and accessible anywhere they go. And so, it’s good to hear firsthand what’s going on down in the trenches, so to speak. I’m a Marine, so I guess I can go back to that kind of vernacular. So, I want to know what’s going on downstream and understanding, how is it that we could look at improving or changing, or just knowing overall if things are going well. All feedback is good, whether it’s good or bad, it’s all constructive. And it all kind of hopefully leads us into a better direction for everyone’s roadmap.
Guerra: I was going to touch on the Marine part later, because I did see that in my research, so we will get to that a little more later. But I’ve read some military history. And as you mentioned, one of the things that some exceptional generals have said is they want to see for themselves, right? So you say you got lots of data, but nothing’s going to equal that one-on-one conversation with that customer, to see if it what you’re seeing in the data is really resonating with what this person is telling me. Right?
Estrada: I think you’re absolutely right, I think what you need to do is contextualize all of that, and you can look at it; you can’t find that out just by looking at the numbers sometimes. So I think data is a powerful tool that helps provide some talking points and discussions and maybe even directions, but to your point, when you sit down with the customer, and you get all the context of everything that’s going on, especially in healthcare, it’s eye opening. We’re all in healthcare for a particular reason, right? We all either trained and got educated to fall into this industry, or just by chance, like myself, starting off as an engineer, I found my way to this industry. But we’ve all been in this industry because we all believe in the impact that we can provide. And so when you have the ability to sit down with a doctor, a nurse, a patient, and I’ve had some great opportunities to sit down with patients to tell us what we’re doing good or bad. Those things really, really resonate. And they should, because when you’re in healthcare, you want to make sure you’re doing everything you can to make the process and the system better. So I agree. So thank you for the general references.
Guerra: And conversations with CIOs, right?
Estrada: Let’s just put this in context. CIOs over the past few years, they don’t get enough praise for what they’ve had to do. No one really planned for this. You couldn’t plan for it right, first of all, and then it hit you. And CIOs had to make some very tough decisions very, very quickly [when COVID hit]. And that is how do you take everything that’s been in a brick-and-mortar environment, and overnight, without batting an eye, extend that beyond the four walls to where those providers, those clinicians, those staff members, those administrative members that keep things running are working? How do you ensure that workflow continues to extend with all the right provisions and security to the home? I really take my hat off to what they had to do very quickly. And they did an amazing job in doing that. And luckily, we’ve been able to partner up with them, and helping ensure that security, that control has been able to be extended to meet those workers where they’re at.
Guerra: A lot of our CIOs come from the military; they have a military background. And that transition you’re talking about that they made when COVID hit that seems to me like a very military oriented task, like the military is very good at that: your objective changed, now go achieve it. Would you say that’s the case?
Estrada: I was I was in O351, which is an assault gunner part of an infantry battalion. And one of the things you learn in the Marine Corps very quickly, is adapt and overcome. And I think that’s exactly what we saw these leaders do. They saw something coming, they adapted, and they overcame, and they did it with swiftness, and they did it with efficiency. And so, I think, it’s brought a lot of light into how we work remotely. I think the next thing we’re probably going to start to think of is how do we facilitate the migration back into the workforce as things hopefully start to come around and get a little better for all of us, but they’ve been able to adapt, overcome very, very quickly and they’ve done it tactfully.
Guerra: One of the things that’s often said is healthcare is 10 to 20 years behind in terms of technology use. Everybody who comes in from outside of healthcare says this. I’ve heard that repeatedly, so I don’t think it’s just a myth. Are there technologies that you see underutilized in healthcare that you want to encourage our readers to consider getting on their roadmap?
Estrada: So, let me be the disrupter in the old stigma that we’re 20 years behind. And maybe I’ll be the first, I don’t know. But let me just say this, I’ve heard that for as long as I’ve been in the industry, right? I hear it all the time. And it’s funny, because that marker never moves, it just continues to move along with whoever saying it. I can tell you firsthand. I’ve been fortunate to be surrounded by some amazing folks. And here’s what I have seen. And I think maybe this statement should change to instead of being 20 years behind, maybe it should be that we’re two to three years closer to having parity with the financial industry, with the e-commerce industry, with the retail industry. And the reason I say that is because a lot of those folks, a lot of those very sharp engineers that develop these modern apps are coming from those industries into healthcare. And they’re changing the way development happens, they’re more agile. We moved away from the traditional waterfall aspect. They come in thinking API first, they’re developing micro services or platforms that are not monolithic. And really look at the consumption of services.
And I think bringing that type of talent from other industries, into where we’re at today has led us to have things like HL7 FHIR, that can quickly drive interoperability to exchange patient data. We’re looking at mobility and having patients able to access their personal health information from anywhere. So, I don’t think we’re 20 years away, I don’t think we’re 10 years away, I think we’re two to three years closer to having this amazing industry that’s changed very quickly. And a lot of it is because of the talents at the engineering level that’s come over to change that.
The other aspect is CIOs are hearing this from their clients, i.e., their doctors, staff, etc., that they want to be able to be mobile as well, they want to be able to work anywhere, and be able to access information anywhere. And that’s happening, right? It’s not your old traditional, “I have to be at the hospital to access my EHR.” There’s this whole locum tenens industry that’s been created, there’s these virtual visit industries that have been created, these doctors are actually working in their homes, right? And so, CIOs are being challenged to be able to extend that standard of care or create a new standard of care that engages them as well. So, everybody is signed up for the adoption. Now, it’s time for us to help at the VMware side, to be enabled to do that with technology and services.
Guerra: As you said, the pandemic has exponentially changed connectivity, and all these things. Technologies underlying that, like those from VMware, have been embraced. What’s next? What’s the next step? Is it around cloud? We hear a lot of questions around cloud, a lot of people are unsure of how to move forward because there are so many different ways to set it up. What are your thoughts on that?
Estrada: So let me first touch on the first part of the question of what’s next. Before I joined here, I took a nice little break in Mexico, completely decompressing, making sure I had a full charge. But here’s what I was able to do. I went to Mexico was able to go anywhere, and use my credit card and go anywhere, and that information was able to follow me. So when you say what’s next, it’s patient data interoperability. The whole 21st Century Act is really, really important because I believe that the data should follow you anywhere; your personal PHI should follow you anywhere, just like a credit card transaction follows you anywhere, so should your data. That’s a long way for me to say that I really believe that people should be focused on interoperability.
We’re seeing your modern apps be developed in very quick time to solve some very immediate problems. COVID is a perfect example where you had contact tracing and wellness apps and coaching apps coming together very, very quickly, overnight, being developed in containers; we’ve kind of developed this adoption and adherence in healthcare. All that data that’s been developed and being used to engage members, patients, people on clinical trials, etc., needs to make the few hops it must to get back to where it needs to get to. And sometimes that clinical data repository can be the EHR, sometimes it may be a data lake, sometimes there’s a lot of devices involved engaging patients and may be part of an ecosystem.
What we’re seeing as far as what’s next is this big orchestration of workflows, data, and devices coming together and being used across different clouds as part of one encounter. So, to give an example, I get discharged from the hospital; it turns out my hospital is doing value-based risk. They’ve taken the full risk of their population. And I’ve been put on a program for 90 days for chronic diseases. As part of that discharge strategy, they given me a kit to go home with, in that kit comes a lockdown iPad, a couple peripherals that are tethered to it. And every day, I’m taking a couple of health sessions, all that information is going to the ecosystem provider in this case, it could be a remote patient monitoring company, they’re collecting all that data in their cloud, but that information is being traversed over a provision cloud, maybe through a carrier.
So that’s the second cloud, then ultimately, all that data should go back into the EHR, because I want my doctor to know how I’m doing. Because maybe I am low risk, maybe I am at risk, maybe I’m having some adverse events or effects because of the medication, and I want my doctor to be able to see that.
So, there’s now three clouds involved in that transaction. So, as we think about what’s next, we’re going to see this continued explosion of digital health apps evolving, different ways that people are going to be engaged through digital therapeutics. I always like to think of market transitions. And, looking at what’s around the corner, decentralized clinical trials is really, really big – I got some time to invest in that and see how that’s going to really change how clinical research is now going to be part of the care option. So, all this is going back and forth across different clouds. And I think from a CIO perspective, they’re really thinking about how do I lock this down? How do I secure it? Do I need to have a multi-cloud strategy? Do I need to think about how I contain these apps? These are things that are front and center. So, I believe that’s what’s coming for the next five years.
Guerra: Very good. You mentioned one of your foundations is that the data’s going to follow you, right? So I would think that, as a leader, when you’re going to be a leader, you need to have those foundational ideas of what are the things I believe, what are the things I believe need to happen, should happen, or are going to happen? So, I’m going to have those; that helps me then fill in everything. Everything trickles down from there, in terms of operationalizing it. So that’s one of your beliefs, that the data has to follow you. And let’s go from there. Do any other ones come to mind that define the roadmap?
Estrada: I think everything we do in this industry, whether you’re the CIO, chief medical officer, or you’re someone else in that whole value chain of providing services. I think one of the things – and this is probably my biggest belief — is we’re dealing with a patient-centric model. We can’t forget about the patient and everything that experience needs to be for that patient. So it’s kind of safe to assume you’re a patient, I’m a patient, our loved ones are all patients. And so we have to look at this at a very human level and think about, what is right for that patient? Not everything that works for maybe a certain cohort will work for someone else, right? So we have to think about how do we engage the patient? What do they want from their experience in this journey that they’re going to be on? And how we can support them? So that’s probably my biggest focus is doing what’s right for the patient.
Guerra: Do you think focusing on the patient has any limitations? Does that ever hit a wall? I mean, there’s providers, right? They’re a huge part of this. So, do you ever hit any problems when you go with a 100% patient-focused approach? Or is that always going to land you in the right place?
Estrada: I would say, let me go back five years ago, because I was very tech focused, I approached every conversation as: technology’s here to save the day. Right? Build it, they will come; that was very arrogant. But I was very tech focused. One of the things that I’ve learned is that the conversation should switch, it should shift to: let me understand what your outcomes are focused on. And it’s now leading in with: what are your business imperatives? Where do you want to be in the next five years? From a business model perspective, are you making this shift to value-based care? And how are you going to be measured right in healthcare?
Providers today are being measured very critically through CMS, right? Some are dealing with a capitated model, and they take this full population at risk. So I approach these conversations with, let’s talk about where you want to be; what outcomes you want to achieve. And if you’re trying to drive your HEDIS scores, or maybe drive towards this new kind of CPT and reimbursement for telehealth and RPM, let’s first have that conversation, understand what those pieces are that you want to achieve at that business level. And then we can figure out the technology piece later.
That’s not the hard part, the hard part is figuring out your business model and how we can help you get there. And then we can backfill in with what pieces make sense along this five-year journey that you have in your business roadmap. And so that’s where I’ve been focused. So, to your point, yeah, not every conversation I come into is going to be all patient-centric. But that’s my mantra. That’s my belief. Somehow, I think about that patient journey, regardless, in these conversations, however they may go, I still think about that patient journey. But I am very much approaching almost all these conversations with what outcomes are we trying to achieve? And then figure out the technology later.
Guerra: Being new to VMware, I think it would be nice for your customers and potential customers to get to know you a little bit more. So two questions. One is what made you go into the Marines? And number two is what made you go into healthcare and maybe more importantly, stick with it?
Estrada: Yeah, so I grew up in San Francisco area, went to high school in San Francisco, nice private archdiocese school taught by a bunch of very disciplined brothers. That kept me straight. And so, I made it through high school. And honestly, I didn’t know what I wanted to do. Actually, I thought I wanted to be a DJ. Because you’re 16, 17. And it’s the 80s. And, and so I didn’t really know what I wanted to do. I will say that marketing works, because ever since I was five, I remember seeing the commercials with the Marines in their blues. And I thought, man, I want to wear that uniform. So I found myself in this interesting situation where I started to wake up every morning at my parents’ house, look at ceiling in my room going, “What am I doing?” So I joined the Marines.
Here’s what I where I learned very quickly. One is: you’re not an individual. You’re part of a team. In there, there isn’t any one lesson, by the way, it’s hard to explain. But you walk out with a couple things. By the time I was done, I went in as a reservist. But we got activated for the first Gulf War. So I got to go overseas. The Brotherhood is amazing. The motivation and discipline that I learned from it has stuck with me all my life. And I’ve tried to share some of those things with folks that haven’t been in the service. I talked to my kids all the time. By the way, when my son graduated from high school, I said, I got your four-year plan ready to go, just in case you don’t know what you want to do. So, he had a good plan, he had a good alternative. He went to a four-year state college down in Southern California.
But it really helped create this motivation and inspiration for me to go to school once I got out of the Marines. And you stick with things even when things get tough, right? There are a lot of times, like there’s been a couple times. You know, one time in particular, when it’s two in the morning, you’re digging your foxhole six feet into the cold earth, and it’s raining. And by the way, it happens to be your birthday. So, you learn to embrace misery very quickly. But there is some fortitude that builds mentally for you.
And so it helped me want to finish four years of school. I wanted to get a degree, I wanted to be an engineer. And then, as I made it past those milestones, I got into a few startups. I was at E-trade right when they were starting off; very, very small. I got into Cisco, which became probably the most formative experience I’ve had in my entire career because it allowed me to grow. And the leadership there was amazing. But it was at Cisco that I was able to evolve from an engineer to a product manager to being the person trying to help drive innovation for healthcare.
And in the moment, I saw that the first solution that we rolled out was called Cisco health presence. It was the very first telemedicine solution that was high def, integrated with telemetry, that we packetized; and we built that originally with a five-man team. So it reminded me very much of this fire team I had in the Marine Corps. It was just like four or five of us off in the dungeon and one of the buildings at Cisco. And that team started to grow and then eventually that process – because it was more for demo purposes – became a solution. Luckily, I was able to become the product manager in the moment we first deployed that. And I saw and heard from the patients that were using it and the experience they had, and the fact that they didn’t have to drive 80 miles take a day off work and find someone for childcare just to see their specialist; they were able to do it. And do it from this virtual encounter. That’s when I knew I wasn’t turning back. And I’ve been in healthcare ever since. And so I love this industry. And I think, like I said earlier, you either trained to get here, or you fell into it by chance, and I fell into it by chance, and I couldn’t be more fortunate to be part of it.
Guerra: Excellent. All right. Final question. As you said, two months in. VMware is a big company. So when you’re a customer of VMware, it is a large one of your vendors. It’s a big part of what you’re doing. It’s not a small thing. What do you want our CIO readers and listeners to know about Mr. Enrique Estrada? 10 months in, but fantastic guy served our country, and can dig a foxhole even on his birthday? Yeah, what do we want them to know?
Estrada: Well, first of all, thank you for giving me this opportunity to have this conversation. It’s been fun. And second, obviously, a big thanks to CIOs and all leaders that have had to make some very quick changes in the past few years. Like I said earlier, no one knows how hard they’ve had it. And they’ve been able to do an amazing job.
I really believe that innovation continues to be what will change our industry. So as I think about where they should be spending their time and what they should be thinking about, they should ask themselves what else they can do around innovation. I know there are constraints with funding, but leverage your partners. Folks like VMware, leverage us, right? We have a whole ecosystem of partners that can help you think through what we can do to digitize maybe this workflow or optimize these efficiencies. So, drive forward with innovation, leverage VMware, where you can, where we’d love to be your partner in what you do. And again, to simply thank you for all for the hard work that everyone’s had to do up and down from the nurse to the staff they’re supporting, to everyone clinically, to the top line executives that made some tough decisions.
Guerra: All right, excellent. Well, I think your patient-centric focus will resonate with a lot of people. I don’t think anybody has a problem with that. So, wonderful conversation. I enjoyed it very much, Enrique.
Estrada: Thank you. Appreciate it.
Guerra: All right. Have a great day.
Estrada: You too.