Speaker 1: Hi, it's Jessica DeMassa with WTF Health. What's the future of health? I'm talking to the who's who of health tech and health care innovation here in the digital health studio. And joining me right now, I have Ian Manavelle. He is the head of health for Fujitsu. How are you, Ian?

Speaker 2: Very well, thanks, Jessica.

Speaker 1: Good. So we're going to dive into cloud and health care and hear about what's going on. Because we were chatting before, and you were telling me things are starting to change with how people are thinking about putting their data up in the cloud or maybe not thinking about putting up their data in the cloud for a very long while. So tell me what you found out.

Speaker 2: Yeah, well, Fujitsu ran a survey on cloud adoption readiness together with the Australasian Institute of Digital Health. And the findings were super interesting. So we surveyed close to 300 digital health experts. And we asked them a whole bunch of questions. And one of the key findings was that 82% of the respondents did not have a cloud adoption roadmap. So they hadn't formalized any sort of a plan of how to move the technology to cloud environments. But over 50% of them had already started on the cloud journey.

Speaker 1: Uh-oh. So we're buying things, but we're not exactly sure what we're buying and how it's going to get us from point A to point B. That's it. All right. So what's been happening as a result? Because I'm sure in your job at Fujitsu, you're trying to help people determine that roadmap for how they're going to implement cloud. What are some of the challenges that you're encountering? Because I would imagine that this is a sea change for a lot of health IT departments to think about is moving everything from servers and from having control over and then letting that go into a decentralized cloud-based environment. So tell me a little bit about what you're hearing.

Speaker 2: Yeah. So most of our customers are state departments of health. And so they provide shared services or technology for dozens or hundreds of hospitals and clinics around the state. And they're used to a model whereby they've bought their infrastructure and they own their infrastructure. And they need to maintain it, which means that every however many years, they need to replace their infrastructure. And it's very, very costly. Yeah. And also, particular infrastructure varies depending on what you want it to do. In the era of chat GPT and large language models and AI proliferating, you need different infrastructure. So the old architecture and infrastructure just doesn't work. And so I think a lot of these state and federal departments of health have tweaked to that. And they've said, well, we wanted to move to a subscription model. We want to move away from the CapEx model towards an OpEx model. OK. And we're going to have to work with our finance people to figure out a way to fund that.

Speaker 1: Oh, wow. That's always fun. So how do you help these executives, these folks who are leading that change, towards adopting cloud technology? How do you help arm them with the information they need to negotiate this stuff with finance? I'm curious to hear what your advice is for them in terms of how to win the expense over.

Speaker 2: Well, there's two main elements for us. First of all, we believe that a cloud-first digital strategy always helps. Now, not necessarily a tactic, but a strategy. So there's got to be the intention to move to cloud. And then the second thing is you need to understand how to construct a business case. So a lot of people say, well, is it going to save me money? Yeah. And they want a yes or no answer. There isn't a yes or no answer, right? So it could save you money, or it could cost you money if you don't manage it carefully.

Speaker 1: Yeah, and if you don't have a strategy, I would imagine it's even harder to build that case. So let's talk about that for a second. What are your hot tips for putting together a cloud roadmap or a cloud strategy? I mean, you're dealing with people in all different places in the process of developing that. So give us some tips. If you've done nothing, but you're already buying stuff, what should you do?

Speaker 2: What are your tips? So for starters, I'd say you definitely need to create a roadmap. And with a cloud-first strategy, the safest thing to say is whenever you're acquiring new applications or new platforms, make sure they're cloud-first. So they're typically hosted on AWS, Azure, Google Cloud Platform, or potentially a private cloud. And private clouds are sometimes owned by the State Departments of Health or sometimes provided privately to secure data. So that's definitely, for all new technologies coming in, definitely adopt cloud-first. The second thing I'd say is that there's some areas that cloud probably doesn't work that well for. Like what? Well, say for example, storage. So healthcare organizations often need to keep records for a very long period of time, like decades. And all of that data typically doesn't get access very frequently. So you can actually store that record on-premise at relatively low cost. You don't need to keep it in a cloud environment. So that's another cloud optimization tip. There you go. I like that one. The other thing that you've got to do is you've got to work with your finance colleagues so that they can understand that things that they used to pay for once every five years or once every 10 years, they now need to budget for every month. Because typically, when you have a cloud subscription, it's a monthly fee. And a lot of health systems operate at a fixed level of expenditure. If you go to them and you say, we want you to spend more per month, they're not going to understand that easily.

Speaker 1: Yes. So, I mean, talk a little bit more about that because that really does require a lot of sea change in terms of just the cost of how care is delivered, right? So, I mean, as far as, are you meeting a lot of resistance in that? Or do people kind of understand, no, we need to invest in the infrastructure for the future and it's going to require a different type of payment model?

Speaker 2: I think it varies, but the good news is, certainly in Australia, most health systems have realised that this is the direction of travel and they're bringing the rest of the non-technical executives and decision makers along with them. I think that some of the health system funders and finance people still need a little bit of support in terms of understanding how to convert those capital costs into operating costs and smooth them out over the time period of the subscription. But then the other issue for us is, once you've decided to, say, for example, you want to move your applications or your data to that cloud-hosted environment, it's not like one fixed price, right? So different parts of the cloud are charged at different rates. Okay. Okay? So that's another-

Speaker 1: Another little complication here that we need to work through. Yeah, another gotcha. All right, but no, you've got to, I guess, keep all of this in mind so it helps to have the perspective of somebody who's got an expertise in this like yourself. And then how are folks handling the idea that, like you said, you could store still with the technology that's in place on site, but then move other things to the cloud, like the dual system here? I mean, is that going over well as an idea? Because I could see where there might be some, you know, wait a minute, now we don't just need this one thing, we need two things. So are you coming across that as well?

Speaker 2: Definitely. So, you know, at Fujitsu, we apply a hybrid model where we think some things need to stay in the data center or on-premise and other things need to move to the cloud. But some organizations have said, no, we want to move everything to the cloud. Just take it all. So, you know, you've got to listen to the needs and wants of different organizations. And some organizations run very effectively with totally cloud-hosted solutions. And now the, you know, platforms like, you know, Microsoft and Dynamics 365, and, you know, many of the commonly used applications in healthcare are cloud-hosted. It's easier to move a lot of that estate over to the cloud. What I would say is things that are stable can typically be operated out of reserved environments in that cloud that are lower cost, but you do need some extra capacity because you never know how much demand you're going to need from your virtual machines. So you do need some additional capacity and that might be a little bit more expensive. So that's what you want to keep an eye on.

Speaker 1: Got it. Now, I'm curious to know from you, like, you know, what's the ultimate benefit of cloud? Like, I mean, for those who might be early in the days of starting to buy this technology and implement it, and it might be, you know, it sounds good in theory, but like, what's the ultimate benefit? I mean, you have clients who've been using Fujitsu technology in this way for a long time. So what are some of the things that you've seen in those healthcare organizations that have either transitioned to a hybrid model or have transitioned into a full cloud model?

Speaker 2: Yeah, look, it is complicated to explain and, you know, there's not a simple, easy answer, but the way I put it to people is just say, for example, you've got a laptop in your workplace and then you're at home and maybe you've got your own personal laptop and your laptop at work has the application that you need to work on. And so you can't gain access to that laptop because it's in your workplace. And even though you've got an internet connection or a mobile signal at home, you can't work from home. So you're kind of stuck. That's the non-cloud environment. Yeah, when your applications and data are cloud hosted, you can access them from anywhere that you have an internet connection. So if you've got a broadband or an NBN or a mobile signal, you can get on the internet and you can use appropriate security, which I'll come to in a minute, and access that application so you can work anywhere. You can work from home. During the pandemic, it was a really accelerated cloud adoption because people realized that they couldn't come into the office or into the hospital, so they needed to work remotely. And so that caused a lot of organizations to accelerate their cloud adoption. I mentioned security.

Speaker 1: I do want to, I was going to say, if you're not going there, I'm ready, because that's the thing that, I mean, might bestill the hearts of a lot of people who are concerned, like, well, do I want access to certain numbers of our systems outside of the hospital? I mean, if there are patient privacy and security concerns and things like that. So talk about security. I mean, how do you tackle that?

Speaker 2: Well, look, I used to work in hospitals here in Australia and overseas, and I could stroll into the hospital and I could walk up to a trolley and pick up some case notes.

Speaker 1: Yeah, that's true, you could.

Speaker 2: Yeah, so there's a lot of malicious actors out there, and the threat is going to get worse. I hate to say it. I'm not trying to scare people. Just look at the past.

Speaker 1: No, and actually, currently, there's a lot of- It gets worse all the time, right? Yeah, there's a lot of-

Speaker 2: It doesn't get better.

Speaker 1: It gets worse. Yeah, there's a lot of data stealing happening in the US.

Speaker 2: Exactly. So the way I put it is, particularly with public cloud, with these large platforms, they have very large sums of money invested in them. They're like banks, right? They invest a lot in the cybersecurity. Now, if you have to do that for every hospital, that's going to be very expensive. Whereas if you can keep your applications and data in that secure environment, then you're benefiting from only paying a portion of that cybersecurity, but getting the whole benefit of the whole security posture of that cloud environment.

Speaker 1: So you're saying it's actually more secure and that you're sharing the expense of that top-notch security with everybody else who's kind of participating in that system.

Speaker 2: That is my view. Absolutely. I like that. Absolutely. You're getting all of the benefit and just having to pay for a sliver.

Speaker 1: All right, so what's hot at Fujitsu right now? Like, I mean, we've been talking a lot of changes in technology since COVID. I mean, there's such exciting things happening in the whole generative AI space, which is going to obviously need a lot more space for storage and things. So I mean, what are you guys excited about? Like when you think about coming down the pike, the technologies that are going to change healthcare in the next three to five years, what has you really excited in?

Speaker 2: Well, look, we're very focused on the quadruple aims of healthcare, okay? So that's patient experience, workforce satisfaction, population health, and value for money. And out of all of those, the area that's getting most attention at the moment is workforce satisfaction.

Speaker 1: Ah, okay.

Speaker 2: Yeah, so a lot of people are leaving, leaving the profession. They're burnt out, they're tired. And a lot of the reason why they're leaving isn't to do with patient care. People in healthcare like dealing with patients. It's all the burdensome administration, all the boring stuff that they have to do, which is often more than 50% of their job. So what I get excited about is using things like large language models and voice-to-text transcription and AI to automate some of those process flows and make the working life of clinicians easier.

Speaker 1: I think that that is the promise, right? If this is done well, is that all that administrative tasks are gonna be taken out of the system and that all we'll have left is the ability for doctors and clinicians to go back to delivering care, right?

Speaker 2: Let me give you a simple example, right? Rostering. Okay. Rostering, like we all wanna make sure that we get rostered so we can go on holidays or we can go to the dentist or just live our lives sensibly and interact with work. But when it comes to rostering in a healthcare environment, it can get very, very complicated. And I often talk about operating theater rostering, right? So you've got the patients on the waiting lists, you've got the surgeons, you've got the nurses, the technicians, the managers, and then you've got all the operating theaters and then you've got all the inventory and the drugs and all of it's gotta be managed in a high cost environment. So it's incredibly difficult to manage that. So one of the things that Fujitsu's been working on is a combinatorial optimization tool.

Speaker 1: Okay, wait. Combinatorial optimization tool. That just rolls right off the tongue. I mean, what a great name.

Speaker 2: Mathematicians love this, right?

Speaker 1: Oh, I bet they do.

Speaker 2: All right, what is this, Ian? It's mathematics that gives you a headache. But luckily, Fujitsu makes some high performance computers that are sort of quantum inspired and they can make these calculations very quickly and they can run the application to make sure that by taking in all these inputs of people and medicines and operating theaters and so forth, we can put all of that into the computer and quickly calculate which theater should have which operating list with which surgeons and which patients in the most optimal way. So it comes back to the other quadriplane which is value for money, right?

Speaker 1: Right, absolutely.

Speaker 2: So when you've got an expensive space in the hospital, you wanna make sure it's busy, it's being optimized.

Speaker 1: Yeah, absolutely. Now, what kind of success are you having with Uptake in terms of that product right there

Speaker 2: that you just talked about? It's a good question. It's completely new. It hasn't been released in Australia yet.

Speaker 1: Ooh, coming soon, I love it.

Speaker 2: So it's been trialed in Florida, in Vancouver and in Exeter in England.

Speaker 1: All right.

Speaker 2: So it's-

Speaker 1: Can you gossip at all about how things are going yet or no? It's going very well. All right.

Speaker 2: So typically it works in larger hospitals, so like big teaching hospitals with lots of operating theaters where there's a lot of inefficiency. Yeah, absolutely. Because let's face it, humans are not very good at rostering.

Speaker 1: No, I mean, not to that degree, not as good as a computer. All right, Ian. So we're here at a digital health conference and there's been obviously an uptick in digital health around the world thanks to the pandemic. In that space, is there anything in particular that you're excited about? Whether it be telehealth or more different types of ways to engage patients. You talked about the quadruple aim and that customer experience. Give us a sense of what's happening in that space for you.

Speaker 2: Yeah, look, one of the things that we see, which once again relates to workforce satisfaction and efficiency, is using large language models for transcription and generation of templatized documents which clinicians need to generate. So it could be, you've got an outpatient clinic and you've got a dozen patients who are coming in to see you and so instead of waiting weeks and weeks before you've transcribed those letters, you can create those on the fly. It could be when you're discharging a patient from hospital, you've got to capture the presenting complaint, the diagnosis, the procedure, the medications, et cetera. All of these are really good candidates for generative AI. So I think this is something that's taken the world by storm in the last few months and it's still at a slightly experimental stage. Absolutely. Healthcare's a cautious business, right? We don't want to experiment with our patients. We want to keep them safe, but I think this is a technology that's going to work really well. It's going to turn a lot of those boring forms and templates that have to be filled out. It's going to accelerate that and then free up clinicians to be more productive and get better patient outcomes.

Speaker 1: Fantastic. Well, Ian, thank you so much for letting us pick your brain, find out what's going on at Fujitsu. I really appreciate it. Thank you. All right, I'm Jessica DeMasa talking to the who's who of health tech and healthcare innovation. You can find more interviews on my YouTube channel. It's youtube.com slash WTF health. Thanks so much for joining us. Bye.