<v Jordan Cooper>Ed Marks, CEO of Divergent, former CIO of Cleveland Clinic University Hospitals New York City health and Hospitals, a board member of Summa Health System and the former chair and of the Board of directors at the Texas Health Services Authority and the current host of Digital Voices with Ed Marks. So mouthful, Ed. Thank you for joining me.</v>

<v Ed Marx>Jordan, thanks. Thanks for having me. I'm really thrilled about having this conversation.</v>

<v Jordan Cooper>So I just want to jump right into it, have a lot of great questions for you today. I understand that you're a heart attack and cancer survivor, is that correct?</v>

<v Ed Marx>Yeah, that's correct.</v>

<v Jordan Cooper>So I'm wondering, given that unique experience, how is your patient experience affected your perspective on the American healthcare delivery system and specifically the challenges facing hospital CIOs today?</v>

<v Ed Marx>Yeah, well, it really made me realize we need to double down on the whole experience thing. So even though I was at world class institutions and had wonderful care, you know, there's still a lot of gaps. And fortunately, because I'm in the industry, right, I knew how to fill those gaps or I knew how to avoid those gaps. But you and I and others in the industry only represent what, 510% Max of the population. So that means 90% aren't able to fill those gaps on their own and don't understand it, don't have an optimal experience. And so it's really important. So it's sort of.</v>

<v Ed Marx>Double down on this passion I have about wow. How can we leverage technology in an empathetic way to make sure everyone, no matter where they're from and where they live, has a great patient experience?</v>

<v Jordan Cooper>Umm. And I know that you correct me. If I'm wrong. You're writing a book with Chris Ross of Mayo Clinic about consumers enhancing the patient experience. I'm wondering why patient experience, what's new with patient experience, what's a new insight where you going with that?</v>

<v Ed Marx>Yeah. So Chris is, you know, one of my best buddies in the world and you know, we both had cancer at the same time and he was and still as CIO at Mayo Clinic and I was CIO Cleveland Clinic at the time and we both realized these gaps that I was talking about, not necessarily against our organizations. Every organizations has opportunities for improvement. But we realize if there's gaps there, there's probably gaps everywhere. And so we got together and we're like man, we need to do something and you know we sort of as I mentioned, we sort of already understand it.</v>

<v Ed Marx>In healthcare, the need to do better with patient experience, but the average consumer doesn't. So our book is actually being written right now. We're about halfway through. It's a long, long process halfway through and it's being written for the consumer. So the publisher, Mayo Clinic press, they sort of flipped the script on us, which I think was brilliant. So this book is going to be marketed to the consumer, and it's really almost like a playbook, a handbook to say, look.</v>

<v Ed Marx>You need to be in charge of your experience because if you're thinking that you're health system is great as it might be, is gonna make for a great experience. Maybe, maybe not, but here are some things you can do, so it's super, super practical on things they can do. And then we also let them into the behind the curtains, if you will, how Healthcare is actually run and why certain decisions are made in order to sort of empower them so that they feel like they do have a choice and ensure that they have as great of an experience as they can. Because again, our premise is that.</v>

<v Ed Marx>You should have a great patient experience, no matter where you're from, what hospital you go to, what your income level is, you know what group you might represent from a diversity point of view, everyone should have an equal and equitable experience.</v>

<v Jordan Cooper>So, Ed, I think it would really help our listeners to conceptualize what you're talking about in terms of gaps of cares and the patient experience, if you could and if if you don't feel comfortable, that's fine. But I I think everyone at appreciate if you were to walk me through an anecdote, perhaps of when you were a patient, either with the heart attack or cancer and some of the pitfalls and gaps and cares that you encountered, what you think a normal person, 90% of the population would do and then how you with your knowledge as a healthcare insider, actually navigated those pitfalls? Maybe somebody listening can.</v>

<v Jordan Cooper>Make a reference to a cousin who has an issue and is in the hospital and and help them.</v>

<v Jordan Cooper>Perfect.</v>

<v Ed Marx>Yeah, I'll give you a couple good ones and I'll strip away the names of the organizations because again, it's not anything bad about those organizations because whatever happened there could happen at any organization. So I recall I went through some traumatic experience and I had a surgery and when I came out of the surgery, I wanted to be with my wife. Now my wife knew that I had been taken out of surgery, was waiting for someone to tell her and to bring her to me.</v>

<v Ed Marx>And they couldn't find where I was located. Now obviously I was located in a safe place and I was getting care. But there was this big gap in terms of. Hey, where's my husband? You know, from my wife point of view, imagine that you kind of freaked out like this major surgery. And then I'm like, coming out of recovery and I'm like, hey, where's my wife? You know, I'm alive. You know, kind of stuff. And hey, we had a successful surgery or not. And let's celebrate. And so there's this gap. Now my wife, also from healthcare, she's a doctor nurse and she.</v>

<v Ed Marx>She knew what to do, and I sort of knew what to do and how to escalate things and how to get to the right people and, you know, get to the right executives. Now, the average person would not have had that, you know, sort of knowledge. But in the book, we talk about how they need and not just them because they might be incapacitated, unable to really advocate for themselves. But they have to build a team around them, which might include family and friends that advocate and know what's happening so that they can get involved. Then you can talk about another experience where.</v>

<v Ed Marx>My dad, I was taking care of my dad. So my dad went through a lot of health challenges last year, and so my whole family got involved and we kind of took turns. But here's so simple example. So again, at another great health institution where they booked my dad for an appointment, you know, for to get a scan. And so they booked it on a Tuesday and it's like a 30 minute travel time just to travel. But the preparation, you know, to get him in the van because they had to follow all these rules and put him in a wheelchair.</v>

<v Ed Marx>It was like a 3 or 4 hour thing, right? OK. So they they scheduled the scan one day and then maybe the neuro exam based on the scan two days later. So that's a lot of travel, a lot of logistics and a lot of costs. So I was like, I got involved and I said, wait a second that scans available pretty much in real time. See, I know that cuz I'm insider, so why not schedule his appointment?</v>

<v Ed Marx>An hour after the scan, so he does it. So he comes in on the same day beautiful, better patient experience, right. Much happier patient much happier family and everything is smooth. And the physicians that you can argue quality right because now the physician almost in real time taking a look at the scans. So I'll give you one more example. So back to me. So I was recovering from something else and typically that recovery you would get you would come back 30 days like after your event. So there's a Cath lab event. So this is my widow maker.</v>

<v Ed Marx>So typically after you're old given, OK, you come back 30 days later. They take one blood pressure and then based on that adjust your meds.</v>

<v Ed Marx>On one blood pressure and that blood pressure could be messed up because maybe something you ate or you walked up the stairs to get to the appointment, whatever it might be. So. And then, you know, from a patient satisfaction point of view and quality and everything, that's not really helpful to wait a month. So with technology. But I knew that. So I had the technology available to me. And so I set it up. We already had it set up, but I leveraged it so that real time this physician was getting my data in real time, right, all Bluetooth connection and I watch and I had. Yeah, my blood pressure thing was.</v>

<v Ed Marx>A Bluetooth enabled. So the physician was getting the data in real time every day. So I said please please look at it every day and to his credit he did and he adjusted my bet meds on a daily basis for the 1st 10 days.</v>

<v Jordan Cooper>Ed.</v>

<v Ed Marx>Wow, that's personalized medicine right there. And I had this amazing recovery. So not everyone would know that. And so that's what this book is really about. It's like empowering the patient and their family and their friends to really be advocates. And because, you know, they don't have this same capability because they just don't know. So the book is really letting him know.</v>

<v Jordan Cooper>Ed, I think that all of our listeners, many of them probably know you, but if they don't, they can definitely hear the enthusiasm and passion in your voice. I wanna pivot for a second away from patient experience to a different aspect of who you are as a person. I understand that you run triathlons as a member of Team USA. You've worked your way through submitting the highest peaks on each continent, and you're an avid tango and bachata dancer. Is that right?</v>

<v Ed Marx>Yeah, that's that's good research right there. Yeah.</v>

<v Jordan Cooper>So have you found that the mental and physical challenges of these endurance sports translated all into helping you meet the demands of being a high profile CIO?</v>

<v Ed Marx>Yeah, I think what it takes is energy. You have to. So what was described to me and I actually took a three day course on this. They said an executive is the equivalent of a professional athlete. So I went through this course with professional athletes and their dietitians and everything like that went through this course about having that mental and physical mindset of an athlete. And that's really what it takes. So if you're gonna lead, right, it's high stress environments and it takes you work some long hours and sometimes through the weekends or through the night, all that kind of stuff you need to be.</v>

<v Ed Marx>Really fit mentally and really fit physically. You need to, you know, do all the things that we all know that everyone's told us since we were kids, you know, you know, to eat right and avoid certain bad behaviors and be the right weight. And some of this stuff is some people might push back on me a little bit, but you really need to think of yourself as an athlete and if you wanna be a great leader, you're going to have to have a lot of energy. So you need to do whatever takes naturally to be this great leader. And so that leads to other.</v>

<v Ed Marx>Cool things that you get to do. You know, it's not just all about work, but it is about. Hey, I love to go dancing with my wife. That's her passion. So I need to be there for in that and I love mountains and climbing and all the other multi sports that you talked about. So it all works together. I can't imagine having the roles that I've had and not being physically fit. I just don't think I would have performed near where I've been.</v>

<v Jordan Cooper>So I wanna talk about silos, right? Just as we don't wanna view you in a silo. You're not just a former CIO or CEO of a healthcare consulting firm. You're a multifaceted person. You run marathons, you dance with your wife, right. We don't wanna view you as a person in little silent areas. Wanna see a holistic vision of who you are also in health care? We wanna see a holistic vision of data. We don't wanna see data siloed at one place or another. Can you talk to me about where you see data interoperability going?</v>

<v Jordan Cooper>What challenges you see in healthcare, which traditionally has been a very siloed industry and how you see industry trends moving forward in the data interoperability space?</v>

<v Ed Marx>Yeah. So the let me start at the macro, then I'll bring it right down to where you're talking about at the macro level, we're seeing it already. So it's not like this is like a incredible insight, but we're seeing massive mergers and acquisitions take place not just on provider side, the payer side, pharma, the different areas of healthcare, massive consolidations, right. And a lot of vertical consolidations like vertical integration consolidation. So a retailer or a big interns company buying a retailer, buying a pharma.</v>

<v Ed Marx>PBM or something, so you're seeing all this massive?</v>

<v Ed Marx>You know, coming together of these different systems at once, we're siloed and I would be so bold as to say on the provider side that we'll have 10 systems in 10 years. So we're gonna see massive consolidation. Now, the only way this works because the reason it hasn't worked well. So it's been happening, but it doesn't work well is because it data, everyone sort of ignores the data they get really concerned about the people side, which they should and they get concerned about the press side, which they should and marketing and branding all kind of stuff. But the missing piece to make all of this work is to have an enterprise.</v>

<v Ed Marx>Strategy on data management and that includes, you know the interoperability and clean data, data governance, everything and is often ignored or it's it's kept at a very tactical level, but it's actually a strategic issue, a strategic challenge, a strategic imperative that you have quality data management so that you can interoperate all of these different silos that you're bringing together to become one. And if you don't tackle it, you never fulfill the promise.</v>

<v Ed Marx>Of M&A and that's what's happened today, right? That's why even though M&A's happening, when you look at the studies that have been done like on M&A, most of them have not been successful in terms of reaching what they're ROI was or KPIs. And it comes down to data because they were, they didn't have a plan or strategy or capability to bring the data together and to cleanse it. And the govern it to keep it clean going forward. So I think you're gonna see a lot more focus on that in the future because that's the only way to make these.</v>

<v Ed Marx>M&A's work.</v>

<v Jordan Cooper>So Speaking of M&A's and data governance, it makes me think about governance and regulation in general. So you've served as a former chair of the Board of directors of the Texas Health Services Authority. Is there anything concerning regulatory bodies that might not be on the radar of most hospital CIOs that you were surprised to learn in Texas?</v>

<v Ed Marx>Yeah, there, there is a lot more people better qualified than me to answer this question, but it was an interesting eight years of service that's for sure. And I really got to learn a lot about politics. Thankfully, for the most part that at the state level anyways, politics was kind of, I mean not politics. But healthcare was sort of a bipartisan.</v>

<v Ed Marx>A challenge and and but they looked at it, you know, as one which was great. I think The thing is that we've made some rules and regulations that have made interoperability and data management more challenging perhaps than they than it should be. So we've been Uber concerned over the years about privacy, and rightfully so. So I'm not saying everything should be open. However, we've made it so hard.</v>

<v Ed Marx>For.</v>

<v Ed Marx>Organizations to share data, so there's this balance between, you know, the public and private, like how much of it needs to be protected under what rules versus the public good. And so there's always that sort of friction. And so that's one thing. So now you see government getting back involved, right with new laws and regulations to make sure we have data sharing. So it's kind of interesting. One hand we come up with a HIPAA laws and again, I'm not saying anything bad about them. I know what the intent was, but then we put our boxed ourselves in a little bit.</v>

<v Ed Marx>And now we're doing data sharing rules and regulations, so you really to get to the answer to your question, you really have to look at at the rules and regulations that exist today and how that's gonna impact your ability to do these M&A. And then what might happen in the future. But I think you know, with data blocking things like that that recently come out, I think that's gonna help sort of push us the right way because that has been one barrier to us achieving sort of that data management, that enterprise view that we've been talking about.</v>

<v Jordan Cooper>So if you had the national coordinator for the office or National Coordinator at HHS in front of you today, maybe the head of CMS, maybe even President Biden, head of Congress, U.S. Senate Majority Leader, Speaker of the House, Pelosi, if you had all those individuals in front of you today and you're like, you know what, Ed, we just think you're the best. You really understand everything in healthcare. There is, what would you recommend that we do from a regulatory perspective at the federal level in order to ensure that there is the right kind of interoperability because boy, we'd love to see these M&A.</v>

<v Jordan Cooper>Go through. We wanna see data interoperability. We don't wanna have these gaps in cares. We just don't know the right path. Ed, what would you tell them?</v>

<v Ed Marx>So there's there's two things. Well, one, they wouldn't ask me, but hypothetically, if they did so the first thing, and I know this is sort of provocative, is having a national identifier. So that's so difficult today. And again, going back to sort of enterprise data and data sharing is that we don't have one way to identify a patient. So I show up in at least 10 databases right now because I've been all over and sometimes I had these episodes, you know, where like when I had my widow maker, I was in South Carolina. So I'm in that system and I'm in Cleveland Clinic. I'm in Texas Health, I'm in New York City.</v>

<v Ed Marx>I'm all over the place, but they don't see me as one because, you know, there's not a single identifier. So a single identifier I think would really take the industry on and put it on steroids a little bit and we'd really get to the results that we're looking for a lot quicker. The second thing has to do with data sharing, data blocking. So I am appreciative of recent rules, regulations that are sort of forcing it, I think a little bit more needs to be done. I'm not a big government person at all, but for some reason we've not been able to self regulate.</v>

<v Ed Marx>And there's it's still happens. I can't go into detail, but I think you know, I think everyone listening knows watching knows that it's still happening today and even when the there's a particular vendor sort of coalesced, they charge big fees, right? And so it's another blocker. It's like, all right, I'll guess I'll do this because I'm being forced to, but I'm gonna charge you so much money that you might not want to be able to do it or can't afford to do it. So I think more needs to be done to make it open. I think if we had that single identifier and sort of open systems that.</v>

<v Ed Marx>Could easily talk to each other. I think healthcare we wouldn't be that statistic. You know, you can argue it a little bit, you know where we cost the most per capita for healthcare around developed countries in the world. But we have the lowest outcomes. You can argue some of that here and there. But the fact is that generally is true that we spend a lot of money and our outcomes aren't as great. So I think we did those two things. We would spend less money and our outcomes would improve.</v>

<v Jordan Cooper>Well, thank you. I appreciate you articulating a national patient identifiers, kind of like a Social Security number. I think they have these potentially in the European Union, but it's I know based on American political theory and thought that with our Federated national system, it's more difficult to adopt. I would like to pivot to divurgent. You're the CEO of Divergent and you said that you've been making strategic shifts and divergences portfolios and go to market strategy.</v>

<v Jordan Cooper>Recently, you've even offered on demand staffing. You focused on mergers and acquisitions. You focused on driving epic adoption. Now I know many CIO's listening to this episode right now, they running large healthcare delivery systems in the United States and they wanna know what is around the corner. What are the best and brightest and healthcare consulting in America focusing on today. And you may, it may be surprising to some CIO that you have chosen to focus on these areas. Would you mind speaking about your rationale for these strategic shifts?</v>

<v Ed Marx>Yeah. So we realized that in order to really help and partner with organizations, we needed to kind of shift a little bit and pivot ourselves. So we have a huge strength which has been historically, implementation, staffing and advisory around that, and that's good people. Organizations still need it and they're all looking for a high quality people and we're really good at that. We're really good at implementing systems and also coming back and making sure they're tuned, that sort of thing. But what the other needs.</v>

<v Ed Marx>Perhaps greater needs that I'm hearing from my former peers I meet with the whole time I'm traveling around the country all the time, talking one-on-one to CIO's and what what they really need is a couple other things. One is they need a true partner and so so we recreated a divergent to be how a CIO might want to work with a vendor. So because that's what I did when I was CIO of vendors coming. I'm like, whoa, don't they know? I mean, don't they understand? And they show me hundreds of slides and bring hundreds of people and.</v>

<v Ed Marx>And all and never talked like, let me talk. So we flipped the script. So we have no slides and then we when someone does want some slides with two slides and we listen and then we provide the services that many of them are looking for. So help with M&A. So being that partner that sort of someone called us a CIO whisperer. So someone that they could partner with. So all of our people that we're hiring are very successful individuals that have experienced and operations and experience on the vendor side consulting side. So they understand that all the dynamics.</v>

<v Ed Marx>And they can help with M&A and and truly partner with with everyone and digital transformation, that's another big one. It's like strategy like digital strategy, we did surveys and only about 15% of organizations have digital strategies. So how do we help them to develop those digital strategies. So we've done that. We do that. And again the thought is that we partner with them, we become a trusted partner advisor. And so that's sort of how we flip things and it's resonating really well as I mentioned. So all these visits.</v>

<v Ed Marx>Getting time with CIO that that's what they're looking for. That's what they want. And thankfully, we have the right people in our organization to provide that service.</v>

<v Jordan Cooper>So you're interacting with CIO's on a routine basis. I'm wondering what different pressures you see facing CIO's now compared to when you were at the Cleveland Clinic, University Hospitals, Parkview Medical Center.</v>

<v Ed Marx>Yeah. So that's one of the benefits of being on board. So as you mentioned, I assume health board, I'm also on Mary Crowley Cancer Research Board and I get to see it, I get to talk to the CEOs and I see it at a board level as well. So one area that we always had to deal with, but not ever as acute as today has to do with bending the cost curve. And we always had financial pressure like it costs so much money and then we always did a little things here and there to try to reduce the cost. But at the same time as always growing cuz, you know, more reliance on technology, but the pressures are acute, the margins.</v>

<v Ed Marx>Are rays are thin today, 0% negative margins that we're seeing out there. Very few have have over 2% margin right now. And the payers are getting bigger and the providers are just getting smaller. And so they're asking for help. So that's the other area. So we created a whole center of excellence around bending the cost curve. So we have the capability today and this is gonna sound so salesy I'm always guilty. That's always preface this because I always feel like so it's gonna pick up a salesperson. I really not, but literally to reduce 10 to 30%.</v>

<v Ed Marx>Of their IT spend non labor it spend immediately and that's because we have this very deep capability. You know again using an error quotes AI, but it's true to look at the detail level, the invoice level, the skew level of entire budget and immediately find 10 to 30% takeout. We've seen this with 30 health systems. It's just amazing the technology here. So that's the area that's becoming more acute for CIOs since the time that I left and.</v>

<v Ed Marx>But we came up with a solution in partnership to help them.</v>

<v Jordan Cooper>Got it. Well, Ed, we're coming up on the end of the episode. We have only two minutes left. So I'd like to invite you to close wrapping up the conversation. We've covered a lot of ground here today. We've talked about you being in surgery, navigating gaps of care. We've talked about large mergers and acquisitions. We've talked about bending the cost curve for CIOs and healthcare. And generally, we spoke about needing a patient identifier and how that may be a regulatory solution that could help facilitate private sector solutions across the United States. I'd like to ask you.</v>

<v Jordan Cooper>If you had one message you wanna share with CIO who are listening today, what is it you'd like to tell them?</v>

<v Ed Marx>Well, Jordan, first of all, thank you for having me. It's quite an honor to be with you all and everything that intersystems does. Long time fan, long time user. So it's great to be with you. I would just say that never lose focus of the passion that got you here into your roles today because it's hard being a CIO is hard. There's tons of pressure.</v>

<v Ed Marx>And there's tons of things that can go wrong and never very few people recognize when everything's working. They just recognize what things are going wrong and so many moving parts, and you can get beat up and you could like, feel lonely. And so it's really important that you get back in touch with that passion that first drew you into the industry and to remember that what you do in the teams that you lead ultimately are bringing health and Wellness and even comfort in death to many, many people and their families and helping the communities so.</v>

<v Ed Marx>Always remember, always go back to that and make sure you take your mental health breaks and then do the all the physical things you know we talked about earlier so that you could be a really well-rounded leader and lead by example because everyone else is watching you. So continue the great work and make sure that passion remains with you.</v>

<v Jordan Cooper>Well, thanks, Ed. This has been Ed marks, the CEO of Divergent, the former CIO of Cleveland Clinic, University Hospitals, New York City Health and Hospitals Board, member of Summa Health System, former chair of Texas Board of Directors of Texas Health Services Authority and the host of Digital Voices and Marks and the Excellent podcast. I also recommend that you listen too. So, Ed, thank you so much for joining us today.</v>

<v Ed Marx>Thank you, Jordan.</v>