The Power of Global Collaboration in Digital Health (ft. Michael Nusbaum)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation, challenges, and opportunities across healthcare and life sciences. And now, your host, Ed Marx.

Hey everyone, welcome to another edition of Digital Voices. Thank you for listening. I know you have a lot of different choices. I listen to a lot of other podcasts as well. And you've taken the time to be with us, so thank you for that. And as always, no commercials, no sponsors, just pure content. And I get to have another friend on today, so I'm super excited. I want to welcome Michael Nussbaum to Digital Voices. Michael, welcome.

Thanks, Ed. It's great to be here, and it's, uh, really great to see you again. It's been a long time.

Yeah, we were just reminiscing before we hit the record button And we served together on the HIMSS Membership Services Committee. And I want to say, because I know I wasn't a CIO yet when I started that, so it was early 2000s, so like 2002 or so. So we've known each other well over 20 years. We haven't aged at all. We're still super handsome.

You got that right. I knew I liked you from the start.

And then we got to connect again. There's no time to tell the story, but I remember it vividly. But we connected again in the Middle East. We were in Riyadh and then we had a sudden opportunity to meet some government official. And again, no time for that story, but I still remember that day quite well. But anyways, and I followed you, Michael, you just fantastic success. So we're going to get into all that. But the most important part of our entire podcast is this question, and that is, what is on your playlist? What kind of music do you like to listen to?

Well, I have a pretty wide range of musical tastes. My very favorite all-time band was Crosby, Stills, Nash, and Young. I'm a Canadian. Young is a Canadian. But even better, I play bass guitar in a couple of bands and we play all that stuff. So whatever music I love to listen to, I actually find a way to play it.

I love that. I wish— that's a talent. I've tried and I wish I had it and I don't. I wish I could play an instrument well. And so I'm sort of jealous. That's really cool. Um, in terms of the bass, how long have you been playing the bass?

Uh, since high school, I played the standup bass in grade 7.

Dang, a standup bass. That is even—

No, no, but I play, I play bass guitar, electric guitar now. It's the same thing actually. It's just a little, the guitar now is a little smaller. Yeah.

No, that, that, that's awesome. That makes it even more fun. I can definitely visualize that. What about your life mantra or message? Is there like a purpose statement or anything that sort of helps guide your life?

Boy, there's so much, but in terms of life, I'm a big advocate of work-life balance. I talk about that to students all the time, and I've managed to design my career so that I really have maximized that balance. I live in a great place. I live in Victoria, British Columbia on the west coast of Canada. It's a beautiful place. And I've got all the work I could ever want since I started my career. You know, that balance to me has given me a really peaceful and happy life.

Yeah, that's cool. And I want to jump into that so you can tell everyone a little bit about yourself. We'll start on the personal side, but then on the professional side, because one of the things that makes you unique in the industry is you've been independent for a long time. A lot of times people have sort of an established career like I have, and then they become independent, but you've been doing this for some time and obviously for great benefit as you alluded to. So before we get there, yeah, tell us a little bit about yourself. We know you're Canadian, we know you play bass and we know you live in beautiful, yeah, up in Canada, Victoria.

Yeah, so, well, in terms of my, I come from Toronto, grew up in the big city and then moved to Victoria, which is a small city, but still on the map. A lot of people come here. And it's great. I love to, I have a sailboat. I've had, we've had 4 sailboats and I go sailing in the summer and I still, even though I'm becoming rapidly an old man, I still ski. So skiing in the winter, sailing in the summer and everything in between. Dang.

And Victoria, for those who have not been, you have to go. It's one of the most beautiful parts of North America. And don't know that I knew about the sailing part, but now I'm inviting myself over.

Of course you are. And you're perfectly welcome.

That sounds pretty amazing.

Yeah.

So tell us on the professional side, like what happened? You grad— you played bass in high school, but then you went to healthcare. So tell us about that journey.

Well, what's interesting about digital health, I came at it from a completely different perspective. And back in the, in the late '70s, there was no such thing as digital health or healthcare IT. And so I, after high school, I went to the University of Toronto and studied industrial engineering. I thought I wanted to be an engineer. And I started in electrical engineering and flunked electricity in my first year. So I went to industrial engineering, which doesn't exist very much anymore. And then I worked as an engineer in a hospital and I thought, you know, I really don't want to be an engineer. And the hospital administrator, who's a well-renowned guy, said to me, well, why don't you try hospital administration? So that's what I did my master's in. I took a master's in health services administration. Out in Alberta, which was one of the primary schools at the time. And and so I'm trained as a hospital administrator, but I married that with my engineering background, which was quite technical, and started working, I guess, from the early days. And we're talking now late '70s, 1978, '79, in what has become health informatics or healthcare IT and now digital health. So I was kind of a I guess you consider me a pioneer in the field. Yeah, the discipline came around. You know, later, sometime later into the '80s, mid-'80s, I guess. And so I hooked up with universities. I was teaching courses in health informatics because I guess I was playing around in the sandbox from a pretty early day. So yeah, so, and then I worked for 2 governments. I worked for the Alberta government when I graduated in the health administration role. And I worked for the British Columbia government when I moved out to Victoria. And, but I hit the wall. I found that it was, although it was great, you know, opportunity working for government, they run on a political agenda, not on a, on a business agenda. And so I thought I could do better on my own. And I had an opportunity to, to establish a consulting firm, which I did in 1983. So I've been doing independent consulting. I am not in transition. I am an absolute career centered. And then been a consultant since '83. So I've done a ton of different kinds of projects. It's been a very rewarding career and not too many days have I, have I not had a full slate of work in front of me in all those years.

Yeah, you're, you're clearly a pioneer and also pioneer in, in creating your own world, creating your own business. And it's quite a lot of kudos to you for doing that. And that's definitely one of the things we're trying to unpack. with you here today, because I know there's a lot of people listening who are like, hmm, you know, I wonder what that's like, what that world is like, and, you know, how I can enter that world. So we talked a little bit already about how it's sort of evolved since its inception. Can you give like one or two examples of customers that you've are either helping now or helped in the past?

Sure. Well, I started off most of my work fairly localized in British Columbia. And I, you know, Labana was a hospital-centric industry. You know, most of the work was in hospitals. So I worked in every single hospital. In the province of British Columbia, before I started branching out across Canada and then across across the world. I'm very much international now. I've done different roles. I did a lot of strategic planning. My contacts were primarily the CEO, not the CIO. And so the CEOs would have that relationship with me because I come from their world, the health administration world. I participated and eventually led the. The Health Administration Association for British Columbia. So I got to know all these guys and many of them were having trouble with their, with their IT departments and with their leadership in their IT department. So they would bring me in to do interim CIO work. I did lots and lots of that. And this was all during a time when there was a big transition from the big iron mainframes, those that worked, you know, that lived in the basement of large teaching hospitals and cost millions of dollars to, to the PC environment where you had your, your, your desktop was at all the smarts you needed at the time. So there was a huge transformation going on at that time. And that launched me into all kinds of opportunities in the early years.

That's really cool. You mentioned some of the international work. So I know that you're doing some things with International Patient Summary. Can you share a little bit about that? That's pretty exciting.

Sure. Well, digital health has become very globalized. And so I've been working with a lot of standards development organizations, SDOs, over the years. I'm on the IHE International board currently, and do a bunch of things with ISO, the ISO, the Technical Committee on Health Informatics, and other things. And one of the initiatives that has come about in the last 4 years is the development of the International Patient Summary, which is done as basically a very unique collaboration amongst SDOs. Many of the development organizations that are building standards have been competitive. This one was collaborative, and they built the infrastructure for A patient summary that was trans— that could be transportable across borders. That border could be international, but could also be domestic across provincial borders or state borders. And it could also be organizational where it's across the street, for example, between 2 different health systems. This thing has really taken off. It's being adopted in countries all around the world. And it's been a tremendous journey. And that's been occupying a lot of my time in recent years. It's something that's going to bring the world together in terms of digital health. It'll be the very first thing.

Yeah, I love it, and we'll definitely drop a link to that in the show notes for those who are interested. And you have mentioned a few times already sort of this global perspective, and I want to, I want to go down that route just a little bit. But before we get there, tell us also, because this is part of that global reach that you have, you got super involved with HIMSS, like at the board level. So after we were on this membership services committee, you got even more involved with HIMSS. And talk to us a little bit about About your HIMSS involvement, the sort of things you've been doing, and, and sort of the global level as well.

Yeah. Yeah. Well, this has also been a very rewarding experience for me. I, I joined HIMSS basically as soon as I graduated, and HIMSS was just new at the time. And I found myself, I did volunteer for committee work, as you know. And, um, and then I applied to join the board. I was the first Canadian on the HIMSS board at that time. It was global. the HIMSS board and, um, I joined it and then HIMSS changed it the way it was organized and it became HIMSS North America and HIMSS Global and it was segmented a little bit. But when I left my stint on the board, which was 4 years, I was vice chair. And, uh, my chairman was one of your very good friends, Ed, Chris Ross. And we all used to get together, old friends from the day. But, uh, uh, it was, it was a tremendous opportunity and experience. Boy, did it. Did I learn a lot. And the smartest people I've ever met in digital health were on that board or around that board, people like yourself, of course. So it was great. And HIMSS is a wonderful organization, and it really does bring together the world in this industry. And it's really important to stay connected to the expertise around the world when you operate in digital health.

So Michael, would there be one thing that you've learned from outside of North America that might be beneficial for North America? Because sometimes, as you know, some countries or some regions of the world may be more advanced, maybe doing something a little different that we can learn from. And so in addition to the International Patient Summary, which again is a global initiative, bring everyone across borders, is there anything else that we might learn?

Well, there's so many things. And of course, you know, Canada has been an innovator as well over the years. But currently it's like a horse race. Different countries are doing different things. And we're now seeing some regional initiatives. And my favorite is the European Union, where you have a large number of countries that are working together to establish interoperability of health information across borders. And they're working together. They've got a lot of tremendous initiatives. And I think most of us around the world can look at what they're doing and think, well, why can't we do something like that here? Why can't Canada and the US, for example, have complete transportability of having your digital health record follow you wherever you are? And so, there's There's a lot of innovation coming in that region, but not to single out that region, there's initiatives all around the world now. And, you know, there's all kinds of collaboration that we've never seen. People are reaching out to share experiences and work together, and it's been great. I've been very much part of that and very proud to have helped contribute to some of that collaboration and globalization.

Yeah, that's cool. I want to dive into leadership, but before we get there, Also want to ask one last question, you know, based on all this experience and global and, but the answer may be more regional. What's like one of the coolest things you've ever been part of? Maybe it was a specific situation or maybe it was more sort of high level, but like, what's with all this experience, like what was like one cool transformation or something that you were involved in?

Well, I worked on an initiative that's very close to your heart and you might remember that I worked on something called OHIE, which is the Olympics Health Information Environment, which was to try and build An environment and infrastructure to support athletes and visitors to Olympic Games that come from all around the world, who obviously are going to have some health issues. So I worked, I had some funding from HIMSS and from others to develop a perspective, which, which we did. I put that in front of the International Olympic Committee for their consideration and still waiting for some good response there. But I know, Ed, you were an Olympic athlete and And, you know, there's initiatives like that. Another one is the Hajj, which is bringing together people from around the world along with their health records. That's something very recent. So we're now seeing a lot of these large global gatherings that can take advantage of some of the innovations in technology and in understanding the data, which is the biggest issue now is getting good data to be able to bring that together to We support a common purpose. So Ojai was really cool.

I really liked that. Yeah, I really liked that too because, and I did spend a fair amount of time in Paris this year with Team USA, the triathlon cohort. And they were raving about the healthcare at the Olympics because for access, right? And it applies to many different countries, but they had great access to healthcare. And so a lot of athletes, They use that opportunity to get all their annual checks, different things like that. And it's great that if that we could make that a reality in the Fabric and that way their record could be there, you know, as opposed to starting from scratch, stuff like that.

So I think that's great. I think we're going to see a lot more of that over the years. You know, there's all kinds of opportunities that are going to come up. So stay tuned.

So as we talk about leadership, there's a lot of listeners Michael, that are in generations below us, up and coming. What's one thing that you would advise someone just in preparation to become a more senior executive?

Sure. And I talk about this a lot to students all the time in some of my teachings. But first of all, there are certain skills of leadership that you can't overlook. Don't become a technical expert without understanding leadership skills. You have to know how to write, to write down something that makes sense to your listener. You need to be able to stand up in front of an audience and give a coherent presentation that works true to your audience. And the audience can be at many, many different levels. And the broader your perspective is, the more successful you'll be. If you want to talk to a technical audience, talk tech. If you want to talk to a leadership audience, go to the things that matter to them. Leadership also is about how to work with others. Collaboration is something that is now, you know, instilled in most of us now. We're trying to get rid of the competition and increase the collaboration. We have to know how to delegate and empower at the same time. So to all of you people that want to get into this field, you need to be empowered to see how, to test your chops, to see how well you would do. And my leadership style is not very top-down. It is very collaborative in nature. It's very flat. And so what I see is I think there's a big need for people to start to develop those kinds of skills. And so I encourage that kind of learning.

Yeah, no, that's really good. Is there anything in your childhood that you remember that sort of prepared you for leadership?

You know, I kind of backed into it. I didn't ever see myself as a leader in my childhood. When I got into my, actually, when I got into my master's program in health administration, that's when I kind of thought to myself, well, I guess there, I guess there's some opportunity here that I had never even considered. I didn't, I had started, I aspired to be a technologist when I first started my work as an engineer. I thought I would stand in front of a series of dials and levers and, and, you know, push buttons. And be a really smart guy, maybe launch a rocket ship to the moon. I don't know. But over time, I, you know, became more important for me to start to look at becoming a leader. And so I really started that journey in my late 20s.

You already talked about this from a different perspective, and I want to bring it back as we sort of come to a close. And that is because it's so important. And you talked about it without me even asking, and that's the whole Work-life balance or integration. And you talked about how you ski and you sail. Talk to us a little bit about why that's important and what you can do. And to confuse the question, you know, I'll maybe ask it again based on your answer.

Sure.

But what would you say to someone who says, well, yeah, I get that, but right now I just need to Do a lot of work, and I'll get to the work-life balance later. So talk to us a little bit about your philosophy there and how you came to it.

It's really funny. One of my kids has been through this journey where you know it was they they basically worked to live, and I tried to to counsel her to live to work. Yeah, and and and you know it it's it's and that's one of the reasons I moved to the beautiful West Coast because if I was in the downtown infrastructure, I was getting caught up even in my consulting work. I'd consult in the downtown. you know, metropolitan centers for various places and the stress levels were huge. And I'd step away from that and I go, you know, this is what, you know, I forgot I'm really working to live. So I think there's a balance there. I think good hard work is really important. And don't get me wrong, I work very hard when I am working, I work very hard, but when I'm off in my sailboat and I want to just unwind, I can do that. But then I can, then I can pull up at an anchorage and I can turn on my satellite system and I can be involved in a, in a podcast from wherever I am. So what I've done is I've leveraged technology and I've leveraged my leisure life to be able to accommodate the necessary things to be able to work. And, and so I would counsel people to really work to live. That, that is the key mantra there.

Yeah, that's, that's good counsel. I, it's so easy as you talked about. to get caught up into the work thing and lose perspective and think, oh, someday I'll get to it. But you may never get to that someday. So definitely incorporate it like you suggest. Hey, what's your favorite bass line that someone would know, like from a popular song? Because you might have a favorite bass line. Like, I'm curious, like, because I'm going to go and listen to whatever you tell me. So like, what's a bass riff?

Well, to follow the The gist of our conversation, I want to give a baseline that, uh, that isn't necessarily my favorite, but it's one of the great ones. And that is The Beat Goes On. The Beat Goes On. It was a song by Sonny and Cher way back in the day, and it's got a great baseline. And, uh, so go listen to that and think about how we're on a journey. We're not at a destination. We've got a lot of work yet to be done. The beat goes on. And we get better at it as we move forward and, uh, pass on the skills to the next generation.

Was Geddy Lee a bass— did he play bass? What did he— in the band Rush?

Yeah, Rush, Canadian band from Toronto. Geddy Lee, he was a bass player, is a bass player, and a very, very falsetto voice too. Yeah, go listen to Rush. He's pretty amazing too. But that's a little heavy rock and roll for me. I like a little bit of R&B. And the blues, um, that's kind of more my style. So, uh, go, go, go drop into Buddy Guy's bar in Chicago next time you're there and you can hear some incredible blues riffs.

Yeah, I'm gonna, I'm gonna do that. Yeah, I, it just came to mind as you were answering about Geddy Lee, because Rush also has some good, some of their songs, they have some good, good bass lines. So we covered a lot, uh, Michael, we talked a lot about base in music and then just how you got into healthcare. And again, one of the pioneers, not just because of longevity, but because of the impact. And also that you were independent almost from the beginning. So, that's sort of unheard of. And so, a lot of great wisdom there and obviously a testimony to the work that you do globally. So, we talked a lot about global perspective. We talked a lot about life balance. We talked a lot about leadership and some of the lessons there for people like Know how to communicate. It was brilliant what you were saying. Know how to write, know how to present, because you could be the smartest person, as you know, if you cannot communicate your smarts, it's not going to go very far. And then collaboration and delegation and things like that. Michael, what did we miss? Or is there anything that we talked about that you want to double down on? I'll give you the last word.

Well, thanks. And again, one thing we kind of touched on, but let me just state it directly. Lifelong learning. There is just no end of job here. You are always going to have an opportunity to learn more. I surround myself with very smart people by design, people like yourself, Ed, and others who I know I can learn a lot from. And that's very much a part of the fabric of my career has been and continues to be. People ask me for my advice because they want to learn more and I'm happy to share it, but Surround yourself by people that you can learn from and recognize that you're never at the end. There's always more to be learned. Yeah.

Beautiful. Lifelong learning and surround yourself. You are basically who you, you know, the 4 or 5 people they say that you surround yourself with. And you dropped a couple names with us of people that people would be familiar with. And you're right, without them in your life and influencing, you know, we don't get the— we don't get to maximize ourselves or maximize our impact. Michael, this has been awesome. I, I love catching up with you. I love what you're doing. I love your spirit. I love how you're helping and the global perspective. Thank you for being my guest on Digital Voices.

Been an absolute pleasure. Thanks for having me, Ed.

Hey, that wraps up another edition. Again, thanks for listening.

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