A: What keep me up at night are still security-related issues. It's not likely we'll have a lot of them. It's like that saying: 'the devil you know and the devil you don't know.' That to me is always my big concern. We have very, very little downtime here. But I am administrator on call. When I get a call in the middle of the night, my first concern is that, if we're down, we're the victims of a service attack or something like that. At the application level, we have such a strong team here. With all the security stuff that's out there, it's those characters we don't know, and we don't what they're up to.

Q: What do you envision for healthcare IT 10 years from now?

A: We're just wrestling with exactly that issue here. We've just gone through our capital budget again this year. Our capital budget for IT, for the first time, has actually started to go down. The reason for that is we've basically installed a very rich revenue cycle management, we have a decision support environment in place, a great data warehouse. The baseline is all in place now. I think what we're going to be moving to is mHealth  -  that's where it's going to go. 

We'll get through that last mile into the patient's home. We'll be doing a lot of remote monitoring, particularly for chronic conditions and for patients that are sort of early post-discharge from the hospital. It will be a different situation. It won't be them calling us to tell us that they think they need to come in. It'll be us calling them to tell them they better come in, that they've got some issues that they may not be aware of. I think that's where the game is going to change. 

As a tertiary care hospital, we're going to be doing a lot more monitoring of patients outside the institution. I think telemedicine is about ready to just explode. Not traditional telemedicine where we think of a doctor or a patient doing a consult with a doctor in a remote location, but telemedicine with the patient themselves within their home settings. That's so inexpensive. It's very inexpensive on the technology side. You really need to change your care delivery model and resources that you have here at the hospital that are supporting that delivery system. I think it's going to be so different 10 years from now. n