Tom Andriola 00:07
Hello and welcome to Gradually, Gradually, then Suddenly, a blog and interview series with leaders to discuss current issues in how data and technology are shaping our world. My name is Tom Andriola, and I’m the Vice Chancellor for Information Technology and Data at University of California Irvine. My guest today is Ed Marx. Ed serves as Chief Digital Officer for Tech Mahindra Health and Life Sciences. As CEO, he oversees digital strategy and execution for providers, payers, pharma and biotech. Ed is active on boards, writing books and speaks globally as a partner in Marx & Marx LLC. Formerly, Ed was Chief Information Officer at Cleveland Clinic where he was responsible for digital solutions and information technology. Prior to joining Cleveland Clinic, Ed served as CIO for the advisory board of New York City’s Health and Hospitals, Texas Health Resources and University Hospitals. Ed, it’s an honor and a privilege to have you join us today. Thank you and welcome.
Ed Marx 1:06
Thanks, Tom. It’s my privilege really, thank you for having me.
Tom Andriola 1:10
Well, you know, for anyone who’s been in the healthcare IT industry, we know Ed, because he’s been so active in the health IT industry as a fellow with the College of Healthcare Information Management Executives and, and you’ve won numerous awards including CHIMES 2013 CIO of the year, you’ve been recognized by CIO and Computer World Magazine as a top 100 leader. You know, you don’t get those accomplishments without being someone not only who knows their stuff, but also someone who has contributed within their peer industry for a long, long time so you know. Really love that you’re joining us today and to share your experiences with our audience.
But there’s some things I’ve learned along the way Ed, as we were preparing for this interview. In addition to your healthcare career, you’ve served in the Army Reserves as a combat medic and an engineer officer, which I didn’t know before we talked a few days ago. And so you bring this kind of commitment to the healthcare industry that is just amazing, and I want to be able to bring that out in today’s discussion. As you’ve seen technology over the course of your career, explain to us what you see happening today, that is not just about running technology for the enterprise, but is actually about saving lives.
Ed Marx 2:27
Yeah, well, Tom, it really is a reflection of my teams that I’ve served with and you know this really well, also being a great leader is if it was up to us individually… it wouldn’t look so good. But we have been blessed to be surrounded by people, hopefully better than ourselves, and just make for a great team. And then I’ve had the honor just serving at great organizations. And so when you add the great organization and great teams. You can’t help but to achieve some level of success So I really do see the accolades as a testimony to those that I’ve served with.
In terms of, yeah, saving lives, you know, that’s really how I view healthcare technology – we’re part of the care provider team – and we do save lives. And sometimes we lose sight of our mission, and we start viewing our job just as going to work and, you know, punching the clock type thing. But I always found it helpful to sort of have this vision that what we’re doing in healthcare is really sacred, and should be treated as such. And also it provides this motivation right, every day, because we all deal with problems personally we deal with problems professionally, and it’s really helpful to always have that North Star. And it’s like even on the worst day something my team did with technology, saved people’s lives. And so, that’s been my mantra that keeps me going. And I can share some, some examples when it first happened for me, on 9/4/93 with the birth of my second child, my first daughter. And I won’t go into great detail but it was as traumatic as a birth experience, as you might have heard of, and I wish for no one. And it was is really quite, quite awful except for the great care that we had. She was born floppy, without life and they revived her, but then she had three life-threatening conditions and, you know, we didn’t know what to do we were this young couple, you know, in our 20s like ‘what do we do?’ So they were like ‘we could life flight your baby to the nearest Children’s Hospital,’ about an hour’s drive away, but then we’d be separated from her. But if we kept her at our hospital, you know, they didn’t have the appropriate level of nursery NICU for her to have good chances for survival and we’re like, ‘oh my gosh’, you know, but then it dawned on me, I’d been working with the techies, as I used to call them and I had partnered with them to sort of evangelize a new system that they had where clinicians could dial in to the electronic medical record and they could see it in real time, you know from wherever they were. And it dawned on me, wait a second – what if we sent a technician down to the Children’s Hospital, and they would just dial in to our systems and in real time talk to our neonatologist and take care of her? And that’s what they did and she ended up having this miraculous recovery, and it was at that moment I noticed, oh, man technology can save people’s lives and so I switched as soon as I could, over into IT, and that’s how my career began. I’ve got a lot more stories how the teams that I served with have leveraged technology to definitely improve patient safety and outcomes, but also literally save people’s lives.
Tom Andriola 5:34
That’s an amazing story, I did not know that story, thank you for sharing that today. So this is, this is personal for you, this is not just a job. This is something that connects into something that is touches your lives and multiple times, right?
Ed Marx 5:47
Yeah, you know, over and over again, the whole point of ‘we save lives’ has been reinforced. I’ve been fortunate again to be part of teams that won a couple of the Davies awards and for listeners who aren’t aware the Davies awards kind of used to be given to one organization each year by HIMSS – an organization that has really leveraged technology to improve software outcomes. A98nd in both cases it was things that the team developed that actually literally saved lives. And so that’s just been a reoccurring theme.
One thing that just keeps it front and center for me is in 2010 one of our teammates, was driving home after work and he had this tragic, automobile death on his way home during rush hour that day. And we used to always compete in this you know best places to work, type surveys, at the very end have a free text, and he’s the one that coined the phrase “we save lives”, and that was 2010 and, I’ll never forget reading it. And so I ran with that mantra.
So what happened to me more recently again that just reinforces all this so, at my last health system, I was in charge of, I was the CIO, but in terms of everything digital strategy. And so I was in this race, some duathlon, And in the last segment – I was within the last two miles, I, I felt this heavy pressure on my chest just like you read about I didn’t have any shooting arm pain or jaw pain, but I had this immense pressure but yet I was still running, you know, so I slowed down quite a bit so I knew that something was wrong. And again, I felt that thing but I was like, man, if I’m having a heart attack if I stop now. Well one, my pride and arrogance told me I can’t stop, because you know I never quit and then I won’t make the team you had to be in the top eight to make the team. And I was like, ‘what would I tell people?’ It’s like, man, that’s pretty narcissistic, but looking back at it, it may have saved my life. But I did rationalize as I’m running along. I was like ‘okay if I tell the volunteer, they don’t have any communication abilities so they’ll have to wave an official down, and by time they got the official down…’ So, I know the clock is counting down I know the hour you know, to save the heart muscle. So I was like okay by time they get someone and then if you’ve ever seen these huge races, all the streets are cordoned off and it’s hard to move around and I know the ambulance is at the finish line, where the medical tent is. So, I was like, I’m just gonna outrun this damn thing. And so I did. I know it’s crazy now. It’s a fun story to tell now, but.
Tom Andriola 8:11
Was there an element of fear that was running through your mind as you’re going through all this?
Ed Marx 8:15
Yeah, there is some denial. You know, it’s like, ‘I can’t be having a heart attack’ and I thought ‘oh, it’s just because it’s cold out.’ A lot of it was a pride though. And, and so I was like ‘okay I’m just gonna finish this’, because I can get to the finish line at that point. After I’m doing all this rationalization I was probably a mile and a half out, so I’m like, ‘Okay, it’s about 10 minutes, so I’ve already had this thing for about 5 minutes, 10 minute run, get to the tent.’ I’m thinking I need to get there. I remember sprinting back, there’s pictures of me passing someone in the finishing, shoot, and I raise my arms. And, you know, I made the team. So I could die then. I made the team. But I checked myself into the medical tent right away, and I had – because I’m in charge of all this stuff – I have this little EKG thing that we that we use. And so we hooked it up, and sure enough I was having a Widow maker the worst of the worst. They call it Widow maker, because I think the percentage like 85% is like immediate death. And I was very very lucky, very, very blessed to have made it. And so they put me in the ambulance right away. I got to the hospital within about 15 minutes, and it just so happened that they had been doing another emergency cath so the team was there. I was really lucky. But here’s where the tech came into play, and again why I’m so like passionate about this, is a one, that little EKG thing, they knew right away I had a heart attack they otherwise they were guessing because in fact, when they took my pulse, and they took my blood pressure, and they listened to my heart, they could not tell. But the EKG reading we had, we had received it, and then he sent it off to a cardiologist, and that’s when they were like, Yeah, this guy’s having an LAD, you need to get him in.
But the second cool thing was when I got there, they had already contacted the Cleveland Clinic, which had my records, and talking to the number one doc in the world, and they had shared via the cloud, they had shared all my images that they had taken now, So it was really technology that maybe didn’t save my life, but, but it certainly increased the quality of my life and on all the safety aspects, I actually do think it did save it. Because again they didn’t know that I was having a heart attack, but they may have kept me in that tent for a long long time until I degraded.
The, and then the cool part, too, was the technology that then enabled me to have a better recovery and a better life outcome so, so I was totally healed completely healed but I wanted to get back to racing. they were like, Oh, you’ll be lucky if you could walk you know five miles, let alone you know do your big race, so I was like no no no no I really want to do this so I saw this doc that was really great he was not a techie doc at all but he became one so I said, Hey, let’s do all this Bluetooth automation. Look at my records every day look at the stats look at things, and he did, he agreed. So just started adjusting my meds on a near daily basis for the first couple of weeks, after that we had a pretty good rhythm. he was looking at my data all the time.
Anyways, long story short, day 90 I was crossing the finish line for world championships. So, technology, I know it saves lives. I know it improves the quality of care. That’s why I like I’m so passionate about this stuff. And so adamant about, you know, evangelizing all the benefits. So anyways, that’s a long story but that’s really how it’s all come together. I’ve seen it, I can’t let go of it. And I’m just on this mission to you know, help anyone, learn more myself, so we can do more. So that’s what it’s all about for me.
Tom Andriola 11:31
Ed, that was awesome. Thank you. I don’t know that we have ever heard a better connection, as well as the personal story, right, it’s, because healthcare is about stories. So thank you, that was amazing.
I want to pivot to this – you are maybe the only the CIO, or certainly a, a very select group who has actually also published books, five as a matter of fact. I now know why it’s called Extraordinary Tales from an Ordinary Guy, because that is an extraordinary tale you shared with us. In 2020, you had a healthcare best seller called, Healthcare Digital Transformation: How Consumers, Technology and the Pandemic are Accelerating the Future. What’s been your motivation to write the books?
Ed Marx 12:14
Yeah, I never had this dream of like publishing books, you know, that’s too much of a chore. I used to speak a fair amount and I’d blog and I have these stories that happened to me you know like this one. And, and people would say you should write a book, it’s like, I am so average Tom, it’s not funny. In the book you know I talked about how I got caught by the police, a couple times before I was 18. You know, shoplifting, joyriding my parents’ car in the middle of the night. Uh. I flunked out of college. I did go back, but I got a 1.6 GPA, you know I was borderline alcoholic. I mean, I was just average. And so I’m telling people, you don’t have to do anything special you just have to do. So I have thought about, okay, if I wrote a book, it’s really not about my stories, but if somehow I could tell people what’s the foundation of each of those stories, then maybe it would help them have extraordinary tales. And so that’s what I did. So I just kind of broke it down like, there’s ah, probably like 10 things that if anyone did, you don’t have to be top of the class, I’m telling you I’m an average intelligence, average everything. But if you apply yourself – boy, that sounds like what my teachers told me in elementary school. I still have my report cards from all the way back, and that’s the common thing. If Ed would only apply himself, he could do okay. It’s like yeah okay I’ll write this book and that way people when they want to know okay, hey Ed, how do you achieve these kind of things? I could say look, it’s really easy, anyone could do it, I did. And so Tom I just learned that, you know, growing up in terms of our careers right? I switched over to IT which I mentioned. I was a director and there was like, 20 other directors, and they had better experience, they had been in healthcare longer, they were way smarter, way more technical, all that kind of stuff, but maybe they didn’t volunteer when they said ‘hey who wants to lead United Way?’ ‘Who wants to speak about what we’re doing here?’ that they would just sit quietly and not doing anything. I was like okay, you know, if I believe in United Way, let me volunteer. Oh yeah, learn to speak. Mm hmm, I don’t really like speaking, but it’s probably something I should do. So I just did these different things and then I found myself separating from the pack. Not that you’re trying to beat your peers or anything like that but what I’m trying to say is, is if you do just the basic stuff. Others aren’t doing the basic stuff and you can you can surpass them or you can achieve your career goals. Or if it’s writing a book, you just set your mind to it and you can do it. It doesn’t take any magic – I guess that’s really what I’m trying to say and I hope it’s coming across.
Tom Andriola 14:42
Absolutely. All right, so let’s talk about this last 15 months, this pandemic. It’s something that we’re going to talk about for years afterwards. The healthcare industry has gone through a lot of changes over this period. Is it lasting change from your perspective? What would you say is different in this period versus the other technology periods that you’ve been a part of your career?
Ed Marx 15:06
Yeah, I think the pandemic definitely ushered in a wave of rapid transformation, it’s been an accelerator, no doubt about it. The concern I have is how far will we retreat. It’s like after someone has a heart attack, as an example, you know, they talk to you about diet and exercise, but there’s all sorts of studies that show that after about six months and a year later, people just go back to their regular lifestyle. So they did some improvements, they started walking every day, they started eating you know better, but then over time, they kind of went back, so I don’t know how far backwards we’re gonna walk this acceleration, this advancement. So, one data point I have is that we started off collectively. You know there’s less than 1% of virtual visits being done pre-pandemic. And then during the pandemic there was highs of 85%, the average I saw was about 65-70%. Now the latest data I saw It’s about 12%. So we went, 1%, to 85 or 65, and then now to 12%. Now, the pessimist says, ‘Oh my God, see, we didn’t hold our gains we came so far back’ but the optimist says you know like our mutual colleague Chris Ross at Mayo Clinic, he said, ‘Ed, but that’s 12 times more than what it was, and that I mean 12 times in 15 months. That’s pretty good advance. So I think it’s definitely gonna stick I just hope we reached the bottom and from there you know, sometimes you make an advance like when you’re climbing a mountain in order to succeed and reach the summit, you purposefully climb high, sleep low. So you’ll go 1,000, 1,500 feet higher than you actually sleep on each successive day, and that’s how you acclimate and make it. And perhaps that’s what we’re doing now in healthcare and digital transformation is, we did like 5000 feet one day, and we’re gonna come back, you know, a couple 1000 feet but at least we made significant advance. And why I believe Tom, we’re going to stick. We’re not going to go further back, and I do believe we will advance from there, is there’s other things going on besides the pandemic right? It’s consumerism. So consumers and they are already demanding this from us you can do everything online, you know, but why don’t we have more convenience or personalization, with healthcare? So, so that’s one thing is consumerism. The other is a retail. So retail’s kicking our behinds you know on the provider side. So you’ve got Walmart now, you’ve got a Amazon threat that’s slowly emerging, you have definitely CVS and Rite Aid and those sort of companies, pharmacy, the smallest town, so that’s the whole retail thing and then you’ve got payers now, so payers are now competing directly for primary care, in fact, payers now control more PCPs then do providers.
The last thing you have is digital-first companies so these are provider organizations that are purely digital so they come out digital first and take care of you in any way they can digitally and it’s very convenient and lower cost and all that kind of thing. So I think the provider traditional providers, like hospitals and such are going to be forced to take that 12% floor and start ramping it back up. So it’s definitely not going lower for all the reasons I said, and it’s going to have to go higher if they expect to compete with convenience that all these other competitors that they’ve never had before, are providing. So I think that’s some of the dynamics that’s going on that really is going to force us – if it hasn’t already – to really up our game when it comes to digital transformation and taking advantage of virtual care options.
Tom Andriola 18:36
You and I were talking about the role of the local community hospital. And you made a statement that caught my attention, you said ‘it would be really bad if the local community hospitals were to fail’ in this in this disintermediation that’s going on. Can you expand for audience what you mean by that?
Ed Marx 18:54
Maybe this is a little folksy of me I don’t know, but this is certainly my thinking in the last couple of years. So the reason why I think it’s important that they continue to have a strong existence is, they are like the town center of many cities. You know, you’ve got your libraries and your administrative buildings, and your churches and synagogues and mosques, but you also have your hospital. It’s just part of the community and when there’s community events they’re sponsoring community events, people have good paying jobs there. There’s a sense of, oh I know Joe, he’s a nurse there. I know, Betty, she’s a doctor there. You know there is a great place for career and really important for communities to have such a vibrant living organization it because it takes care of the community its people. And this is, you know juxtaposed to some corporate medicine, where they’re not part of your community, they’re really thinking a lot about revenue. Whereas the local hospital yeah of course they have to think about revenue and they should, but they’re really thinking that healthy community healthy. We don’t want to be known as the diabetes capital of the world we want healthy communities. And so they’re going to take a lot more action and care, then I think some of the other entrants might who are taking more of a profit motive than a motive of hey, this is our people, and we want to take good care of them. So, so that’s, those are some of the reasons why I just a big proponent of the local hospital really part of the reason we wrote the book, the 2020 book on healthcare digital transformation, was like a wake-up call, like do something, here’s some ideas, here’s what your competitors are doing.
I’m afraid. So I’m like, Come on, we’ll help you. I’m trying to shake things up so that they realize they got to do something they just can’t sit still, so that’s why I believe in that.
Tom Andriola 20:40
I’ve heard you use the phrase, and the postmodern CIO and it captured my attention. Tell me about the postmodern CIO.
Ed Marx 20:50
Yeah, so, you know, we, we all know, for all of us have been CIOs, we all know that okay the old school CIO, so pre-modern CIO was the data processing manager, was the IT geek. And that we had to evolve to the modern CIO who, had a CIO title now, so got out of the basement at least, had a lot more visibility, and they came up through the technical ranks, but they learned a little bit on the business side. And I feel like we think as a community that that’s where we need to be. And I’m arguing, no, that’s the modern CIO, but we need to postmodern CIO. But we see evidence now of a lot of healthcare systems hiring externally. And I’m a big proponent of hiring externally, I think you learn a lot of best practices from other industries. But there’s no reason we cannot develop ourselves as a profession, you know, to become CTOs and CIOs. We are not training ourselves what it is to be a postmodern CIO. So there’s really like five things, one is that business leader that truly knows the business, you know like, especially like you, Tom, and you’ve got a little bit harder than average you’ve got two major industries that you’re responsible for. So, it’s really understanding those components like, what does it really mean to be a clinician? what does a clinician really go through? You know, that translator of listening to some of the issues and challenges and then not talking tech to them, but just understanding and then working with them, brainstorming solutions. And my litmus test to this, is that if a guest comes into your C-suite, they don’t know that you’re the CIO. So, when they’re listening to conversations going around, they cannot decipher that whether I’m the CFO or CIO. And none of these things are magic, kind of like the extraordinary tales thing.
Ed Marx 22:45
One other thing is being a change agent, right. So you’re bringing so much change to the organization, that you have to be very adept at bringing change I always used to say to be innovative, you have to be innovative or to be digital, you have to be digital. So, if you yourself are not changing with the times, then it’s going to be hard for you to bring change to your organization. So that’s why I always challenge myself like okay I’m going to learn something new. I’m going to do something new. I’m going to learn some new technology, I’m going to learn more about nursingone day a week I started working in the O.R. So I did have this experience as a combat medic, and so I was able to kind of like Undercover Boss. So I wasn’t these people’s bosses but I was an executive of the Cleveland Clinic, but I worked in the O.R. one shift, a week and no one knew except for my boss, my OR manager anesthesia manager, and the chair of anesthesia and of course my CEO, but no one else knew so they were like oh, this is just someone who comes in one day a week. And, and I learned so much in about change right and so I could change myself.
Ed Marx 23:41
So anyways – change agent, second one, the third is a talent scout. So as I said early on, my success is predicated upon the people around me and I tell you, it was just me, now we’d be in big trouble. We’d be pretty average. So I always look for people better than me. whether it’s sports, or spouse, you know, it’s like I need someone better than me, whether in sports or spouse, you know, I need someone better than me otherwise we’re gonna have a really average marriage, so talent scout.
Culture warrior, so again it’s a lot about change management and it’s a lot about leading cultural change. Really technology is sort of last, but reimagining how technology might work, reimagining new things – automation, thinking about some of that new, new stuff, you know, keep your eye on the horizon to start bringing in, you know like what sort of vogue right now, you know, AI, machine learning, those sort of things. Being on the forefront of that hanging out with these really smart people that have these great ideas and just learning from them. And I used to do that. I used to support, there’s this club it’s still exist today it was all these doctors, it was, it was the funniest thing though, Tom because they were all like, 30 years old, they probably had an undergraduate degree in engineering and stuff, they became doctors, and they’re super smart and then we meet once a month, and it’s now a global organization, but it started right upstairs from where my office was and, and they would present to each other these different ideas and then they’d always turn to me and say, Mr. Marx, what do you think? I’m like, I have no frickin idea what you guys just said. It was way beyond me, but I just told him outright said it sounds good, I like it. Let’s figure out how to fund it, you know that that was sort of my role, but I was like I have no idea but anyways it’s stretched me.
And so in the final piece related to that, and it goes back to the culture change, change management is, you need to change IT. So first, the change begins with you. So, okay, if to be digital, I got to be digital, okay I got to rewire myself now. The second thing is for us to lead digital or be part of the digital transformation, it has got to be digital. So for me what that meant, We’re going completely agile, so not just development, but I mean, everything we restructure we called ourselves, communities and we used agile capabilities and format everyone went through agile training. The other thing we did is adopt best practices of it, which is ITIL or ITSM and so everyone as a condition of employment, had to take three-day course and pass a test – they had three chances to pass it. Any new hire had six months to take the course and pass the test, and then we went to zero defects. And so as it started, like we built up our credibility.
So that’s what a postmodern CIO does is those five different things I just went through, because a modern or definitely a pre-modern CIO, doesn’t do that. Another litmus test is where do you spend your time. If you spend your time in IT, then you’re probably not a postmodern CIO. I know I’m saying some things that are heretical and probably offending people, Tom, sorry, but it’s really meant only to try to accelerate all of us, you know, to becoming better, better leaders in our organization.
Tom Andriola 26:41
That’s fantastic. Alright Ed, last question. And this is a question that all of our guests get. we always leave everyone with the last question. I’m a big believer, much like you, in terms of that change happens much more by many people make small, incremental changes, moreso than one charismatic leader putting out a vision. Right, when I was leading University of California , the IT function, 8,500 IT people. If I could get 1% more out of 8,500 people that was much more than I could ever possibly try to do as a leader. So, we target an audience of up and comers, whether they’re in healthcare education or IT, these are people, you know, our listeners are people who are trying to make their mark, trying to grow in their careers. And so I love to ask our guests who are so accomplished in their careers, what are the two or three actionable pieces of advice that you’d give to an early career person to say this is what worked for me, and made the biggest difference in growing a career and my impact on my space.
Ed Marx 27:47
Yeah. The first one is to hang out with life givers. So Tom, That’s why I actually started like I was like pinging you when I first met you. I was like, Dang, this, this guy knows his stuff I’m really impressed, it’s like wow that’s insightful, and I just want to be around those type of people. So you are, they say you’re just like the three or five people you hang out with the most, so hang out with, with life givers, be with people that you know – iron sharpens iron, and they, you learn from them, they inspire you and hopefully you’ve got something that gets back to them as well. Hang out with other leaders that you admire, and then give back to them and so that’s that would be the first thing.
Sort of related, but different because it’s more formalized, is have a mentor. So, I’ve always been on this, one year have a mentor, the other year mentor someone, because you always want to be in the cycle of pouring yourself back out to others what people have poured into you. So, find a mentor and then for me mentoring is a one-year contract with someone you meet is actually written down on one sheet of paper, like what two or three objectives, and it’s like one hour, one and a half hours per month, so it’s not a huge time commitment. And I’ve had, you know, probably 20 people now that I can call that have been my mentors every other year, and then again, I’ve mentored someone else on the off years. So that’s, that’s the second thing I would do.
And then the next thing is change hobbies every three to five years. So you should always have hobbies, outside of work, that give you rest, give you pleasure you know whatever it might be, but change them, because it’s through a variety of experiences that you learn more and get more creative. So I think great leaders are very creative. And so how do you get creative? Well you open up your mind to a lot of different things, so maybe you mountain climb for a few years, and then you switch to ballroom dancing for a few years, and then you do I don’t know racecar drive or I don’t know – I haven’t done that one. But, do something different, just to challenge your mind, meet new people.
So those are three things that I think could move you 1%
Tom Andriola 29:45
That’s awesome, Ed, thank you very much.
Ed Marx 29:49
Tom, thank you for having me. And I can’t wait to hang out more and learn from you.
