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PODCAST/TECH: Interview with the Cisco health care brain trust–Transcript

This is the transcript of my interview at HIMSS with Cisco’s health care team leaders Jeff Rideout & Frank Grant. The audio podcast is available here.

Matthew Holt:  This is Matthew Holt with The Health Care Blog. It’s another podcast from the HIMSS floor and today I have got the brains trust from Cisco’s Health Care Group, Jeff Rideout, who is the vice‑president and the medical director. He was formerly in the health plan world, and he’s been at Cisco, what, three years now?

Jeff Rideout:  Yes.

Matthew:  Ah, good guess. Jeff Rideout and Frank Grant who is the director of Healthcare Sales, who was roped into this at the last minute and didn’t know he was going to be involved, but anyway! So, we’ll pass the mike between us.For disclosure, as you guys know, I do a little bit of work for Cisco now and again. So it’s a company I like and I’m unlikely to say rude things about them. But the good news is that I don’t think there’s going to be anything rude to say about them, unlike some of the other people that I talk about on The Health Care Blog.So let’s start at the beginning. This is a question for you, Jeff. Why did Cisco decide that it wanted to get into health care, and why did they want to hire you in the first place?

Jeff:  Well, Cisco has been working with health care customers for 20 plus years. About three years ago, we were invited to join a White House council and give our thoughts on productivity and how technology could help, specifically in health care. I think that got the bug in the company. John Chambers (Cisco’s CEO) comes from a health care family. Both of his parents are physicians.So, from that point it was really, how do we make more of an impact like we have in other industries? That started the process, which eventually led to what we call a "health care vertical" that Frank and I lead. It is really a coordinated go‑to‑market effort for health care customers.

Matthew:
Frank, what’s the organization of Cisco in health care? Cisco’s been
known historically to be a horizontal sales company in which people
have territories. You might be calling on a hospital one day and a shoe
factory the next or whatever.Obviously, with Jeff around
there’s an effort to do some more both for leadership and visibility on
the policy side. But what does that mean in terms of nuts and bolts and
selling stuff?

Frank:
A great point. I think, in general, Cisco’s looked at this as: a year
and a half ago we created the health care vertical. So, your question
is, "Why are we focused on health care?" Because we created the
vertical and said we think it’s important from a sales standpoint to
have our people up to speed so they can speak health care terminology
and will have a vertical focus.So we still have reps, to be
honest, that have maybe 75 accounts and two of them are health care.
But we’re trying, moving forward, to purify those people so that they
may have only healthcare…[Laughter]Not from a mind standpoint!

Matthew:  The purification process! Sounds unpleasant! [Laughing]

Frank:
Big brother is watching you! [Laughs] But they maybe take them so they
have 15 or 20 health care accounts. We also have people that are only
pure health care and have been for years and other people who are
moving to a pure health care focus.

Jeff:
You know the way I put it is that it is largely still a horizontal
structure and we are trying to overlay a vertical subject matter
expertise on that. I think the challenge is that health care is
complex, so how do we balance the complexity in the subject matter
expertise that people need with the fact that a lot of these reps can
sell more easily, quite frankly, in other industries?The
balance here is how do we move an industry that is complex? But the
other thing about the industry is that it’s trying to do good things
for people. That’s where we catch the emotion ‑‑ if you will ‑‑ of not
only the sales reps but also the company in general. We want to see
this industry improve.

Matthew:
So let’s talk a bit about some of the more interesting technology.
People know that Cisco makes networks. Obviously you guys are a very
dominant force in that business as a whole. There are routers and
switches and all that good stuff.We also know that hospitals
have been spreading both the internal networks and WiFi networks
inside. What are some of the things that excite you the most about
what’s going on over those networks? Presumably the more that goes over
the networks, the better you guys do?

Frank:
Well, I think that it’s a fundamental issue. Under Jeff’s thoughtful
leadership we’ve said, "Where are we headed and where do we think the
market needs to head?" Then we try to develop products and solutions
that map into that.For example, unified communications is a big
issue right now in hospitals. How do I as a physician get the
information when I want it, where I want it and exactly what I’m
looking for?So we’ve started to develop some new products. Say
a physician, for example, will carry a wireless cell phone or a
wireless IP phone or a phone or a PC. The interface all looks the same.
So, I’m a busy physician and I walk in the hospital. I say I need to
consult with Dr. Jones. It’s so nice that I have a list on my phone
that has Dr. Jones, just like on an instant message list. I click on
his name and all of a sudden I see his presence, I see he’s available
and he likes to be contacted by phone. So I ring him up on the phone.All
of the sudden we realize we need to bring a specialist in for a
consult. I drag and drop another person on my friends list and they are
immediately put into the call.So anything we can do to help me
change patient safety and save lives by making communication more
effective and more efficient is what we’re really all about trying to
do.

Matthew:
How much of that is Cisco and how much of that is you working with a
lot of partners? Tell me a bit about how that happens and some of the
products and technologies you are more excited about.

Frank:
I think we’re always working with partners because we’re not a
healthcare company ‑‑ as Jeff said ‑‑ even though John’s parents are
physicians. We are only a part. We have created an ecosystem of
partners from nurse call vendors to CIS vendors to try to work as one
cohesive view.If I’m giving a true solution and our view of
"solution" is that’s such a tired word. In our view, it has to solve a
business problem. It has to help an end user and it has to involve
third‑party hardware and third‑party software.

Matthew:
So let’s go on to the dreaded word and I was teasing Jeff about
earlier. Cisco has a new announcement and I’m going to let Jeff
describe it. It does involve the word "connection," which virtually
everybody else in health care has known. Between Kaiser, the U.K.
government and who knows, even Partners Healthcare has got a new
telemedicine center, they call it connected health. So I’m saying,
"Couldn’t you have thought of another name?"But given that you haven’t thought of another name, Jeff, tell me a bit about the new venture.

Jeff:  Well that’s kind of the point. Don’t you feel Cisco’s influence working through that?[Laughter]

Matthew:  Oh, sorry, it was your fault!

Jeff:
Exactly. Wouldn’t you rather be connected? I think what it really
represents is our goal of trying to be part of a bigger ecosystem. I
think, most importantly, it’s not about being digital as much as it is
about people and what enables them to share information, in this case
at the point of care.So, the word actually has some very
significant meaning to us and we’re trying to get away from "It’s all
about the bits and bytes and the infrastructure". It’s really about the
information and people that are going to be affected by either having
it or not having it when they need it.The fact that "Connected
Health" has become a phrase ‑‑ as you mentioned ‑‑ for the National
Health Service now, their IT program; Partner’s Telemedicine renamed
their group Connected Health. We saw an announcement from Microsoft
about a connected health architecture. I guess at one point, we
certainly didn’t coin the term, but we adopted it almost three years
ago now in Europe. I think there is a
little bit of flattery in that in the sense that at least we’ve glommed
onto the right phrase, if nothing else.

Matthew:  Early adoption and imitation is the sincerest form of flattery! That’s great.

Jeff:  Medical grade: there’s another phrase we could talk about, huh?

Matthew:
Yeah, well "medical grade" is interesting because that’s showed up in
the speech yesterday and somebody ‑ I was out late last night so I’m
struggling to remember who it was ‑ but somebody did say to me that
"medical grade network" was the best marketing tag they’d ever heard of
in health care, which I think is pretty good. OK, Jeff, what is a
medical grade network?

Jeff:
Well, the notion is that there are service‑oriented network
architectures that are appropriate for different industries. The one
that’s appropriate for health care is the medical grade network. It
focuses on the needs of the health care environment, which include
mobility, reliability, security and flexibility.The issue there
is, think about something like reliability. What does it mean if a
banking network goes down? Well, people lose money and that’s a big
problem. What does it mean if a health care network goes down? You may
have an ICU that can’t function.So what we’re trying to do is
imply that there are design principles that we can bring to bear for
the network that come from other industries where we’ve had lots of
experience. But at the end of the day it needs to be customized to
health care because health care has unique needs. People don’t work in
cubicles and people don’t have fixed stations.So back to your
original thought, what’s Cisco trying to do in healthcare and how does
it fit with our historic model? It’s a great example. How do we take
what we do well and customize it for the healthcare industry? Medical
grade is an attempt to do that.

Matthew:
Let’s talk about a couple things. There was a video conference that
you guys were both involved in a couple weeks ago. Jeff started out
with a bunch of depressing statistics about the use of IT. That was a
downer for the whole show about the use of IT by physicians in the

U.S.

Jeff:  I had to rely on you a lot, if you remember.

Matthew:
Frank had to explain a bit more. What’s your sense of the change rate?
I think we’re all agreed that the problem with IT is that the bigger
groups are kind of getting it now; the bigger hospitals and AMCs. They
have issues but they’re kind of getting it. We have these mass of
community hospitals and mass of community physicians who are really not
there. You guys can’t really change this on your own. You’re obviously
working with others to do that. What do you think the answer is in how
we’re going to change that and what is Cisco’s part going to be in that?

Jeff:
I’ll quote David Brailler, from his recent interview in health
affairs. He sees a ten‑year window of adoption and then another
ten‑year window of optimization. I think as old as I’m getting that,
unfortunately, feels about right. I don’t mean to be a downer or
pessimistic, but clearly the bigger systems get it. Scale allows people
to experiment or implement and fail and succeed.Countries that
have been at it longer are doing things that we are only talking about.
That was the point I was making. I think there is a point where it
becomes entrenched in how people think they want to do business with
unified communications and secure messaging. Then, how do we optimize
it the way we thought we would ten years ago? I’d say it’s still a
ten‑year horizon.

Matthew:
Frank, what does that mean in terms of the customer base for Cisco? I
suspect to this point it’s been part of the bigger AMCs and the bigger
players. What does that mean in terms of the small 100‑ or 200‑bed
community hospital getting a hold of these applications? Are you going
to the partners? How are you going to those people?

Frank:
Great question. I think actually success in the last six months has
been in the 200 or less bed hospitals. I think we’ve had the IDN’s, the
big people, for a long time. We continue to upgrade and do new things
with them but I think people realize they have older infrastructures
and they have to keep up because they are in the community with the big
hospital chains. They’re not going to get the patients referred if they
say, "This is the technology hospital and you’re the laggard."We’re
starting to see more and more the competitive pressure really help
because there are not too many leaders in healthcare. When they do lead
and the people see that they have to compete, they respond.

Matthew:  You’re being an optimist.

Jeff:
Well, the other thing you’ve got is non‑traditional competitors too.
Retail chains providing care. While they stay fairly niche, I think the
lines between banking, retail and health care will increasingly blur
and then you will have a lot of people nipping at everybody’s heels to
provide services that, by rights, maybe physicians should have been
providing a long time ago.You also have aggregators too now.
For instance, we interviewed a hospital that put in a medical grade
network during that webcast, and one of the things I found most
interesting was that they were using their IT infrastructure that they
had built for their hospital as a service extension to their community
physicians. They became the IT department for those community
physicians that wouldn’t otherwise have adopted it.

Matthew:
Yes, I think the ASP model is going to be it. As I talk to the guys at
Sutter and elsewhere, that are putting in the Epic systems, they
intended to sell it. For example, the group that uses Allscripts in

Utah

is also selling it or renting it out to local physicians and that’s
clearly going to be a model because why would you want to set up your
own server and do it yourself?

Jeff:
But you’re also seeing it in the Medicaid world, too. We’re seeing a
lot of community clinics aggregate around third‑party ASP providers.
Some of them are technology vendors. Some are just communities that
have come together, not as a RHIO  necessarily, but it’s better if we do this together on a common platform.

Matthew:
Let’s quickly touch on a couple things. One of the things you’ve been
showcasing a lot is RFID tracking. That’s one being showcased in the
booth. Another one is Interpreter Network. With Interpreter Network
getting beyond the pilot stage now, how are those technologies starting
to roll out and how do you see them in the market?

Jeff:
Well, the Healthcare Interpreter Network is, in essence, a virtual
video call center that is now serving nine hospitals. They’re all
safety net hospitals in

California

,
so they’re essentially using the technology to share live translator
services so that the patient that comes in that doesn’t speak English
can actually talk via videolink to somebody that does, with the
caregiver present. I think it’s a fabulous idea. It requires an IP
infrastructure. It requires IP telephony.Everywhere I go, every
hospital large or small, sophisticated, academic, community; they have
a need for this because it’s based on a triaging software called Call
Manager that could triage on any number of criteria. It doesn’t have to
be language. It could be specialty. It could be whatever else you want
to do, physician specialty, for instance. It’s a great system and it’s
live and it’s working. Now we’re in the phase of how do you scale it?
How do you make it something that you can offer everywhere?

Matthew:
So, is there a cost pressure on that, that you think you’re going to
have to come up with a lower cost version? What’s the issue around
that? They don’t like the concept of lower cost at Cisco.

Jeff:  It’s pretty cheap to begin with.

Matthew:  So it was already very cheap.

Frank:  We’re going to raise the price!

Matthew:  You heard it. Buy it now, quickly before it goes up next week. It’s like housing in the bay area.Tell
a bit about RFID tracking, Frank. How do you think that’s going? This
is the thing that I thought when I saw it; someone explained it to me
two years ago. I saw it and said, "Every hospital needs this because
it’s going to save them a fortune." It doesn’t seem to be taking off as
quickly as that, or am I wrong there?

Frank:
I think it has started to take off, but you make a fair point. It’s
been a little slower than we thought in some spaces. A lot of that is
because of the tags. People said, "I don’t have a long battery life
with the tag. I put it in. It’s too bulky, too expensive and I can’t
use it." Now the prices of the third generation tags are out. They
dropped dramatically in price with a very long battery life. Now I can
afford it.I’ll give you an example. My dad was in the hospital
just a little bit ago. He had knee surgery two weeks prior and he had
to go in for the flu. He’s in the hospital bed and they call for the
wheelchair to get him out. He waits 45 minutes and the wheelchair
doesn’t come. My dad ‑‑ two weeks off of knee surgery ‑‑ gets out of
the bed and starts walking down the hall. Of course nurses and
wheelchairs appear out of nowhere and grab him because they didn’t want
the liability.I think in general, for quick things like asset
management it pays for itself. But, that’s like Jeff said with the
20‑year adoption we’re talking about: that’s an optimizing thing.
That’s just sheer ROI, let’s get it done; let’s make it happen.Now,
if I can say things like, if I have RFID and I have that with that
Cisco unified person communicator, and I am a doctor and I walk into
the OR, it automatically senses I’m in the OR and says that you are no
longer available. We can use a lot more things with workflow and how we
optimize workflow in a hospital if we really can track movements
through a hospital.

Jeff:
The other thing I’d say about the tags: up to now the applications
can’t tell you whether a wheelchair is occupied or not, so there might
be one in the room next to you but somebody might be sitting in it.
Those kinds of things have to be thought out, but if you saw the
announcement from Intel in Motion on their new pad, it’s a tablet that
has an RFID reader built into the pad. That’s a perfect example of
where an ecosystem set up partners.We love that because it
basically requires the wireless that supports it, but if you’re a
physician or a nurse and you’ve got a pad with an RFID reader or
barcode reader, that’s actually useful and connected to your EMR,
that’s the kind of solution that really makes a lot of sense and
provides the adoption a lot faster.

Matthew:
That’s great. I have to get you guys out of here in a minute or so, so
I want to say thanks very much. We’ve been talking to Jeff Rideout and
Frank Grant from Cisco and they’ve been giving me a rundown on what
Cisco is up to in health care. This is Matthew signing off from The
Health Care Blog. Thanks a lot guys.

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John Sebastian

Interesting that Cisco claims a medical grade network when their own release notes specifically state that it takes 3 minutes per AP (but they can do 4 at a time!) for the upgrade. So, say I have a 750 AP network – I’d need to schedule >9 hour maintenance window (750 / 4 * 3 = 562 minutes = 9.375 hours) to upgrade my wireless network. That doesn’t sound medical grade to me – unless we are lowering our standards for networks vs. health care.