Bill Russell: 00:10 Welcome this week in health it where we discuss the news information emerging thought with leaders from across the healthcare industry. This is Episode 51 is a special end of the year episode actually the first of four episodes that captures the best of the first 50 episodes from 2018. A little reflection on the past year and what our awesome guests have shared with us. More on that in a minute. This podcast is brought to you by health lyrics be a market leader we help you to clarify your health I.T. plan eliminate confusion to align your work experience breakthroughs visit health lyrics dot com to schedule your free consultation. My name is Bill Russell. Recovering covering health care CIO writer and adviser with the previously mentioned health lyrics. OK here’s what we’re going to do I have four end of the year episodes for you. The CIOs of the clinicians the innovators and the top 10 episodes we’re going to end with the top 10 episode what an amazing group of guests we’ve had this year.
Bill Russell: 01:06 It is so hard to narrow down the content for the end of year shows. My production staff and I’ve been working on this for several months. I really do hope you enjoy it. A couple quick quick things a couple of things about the show that you may or may not know. We don’t make money. We’re not trying to make money. In fact quite the opposite we do have a sponsor however the sponsor is my company healthlyrics. I own the company which means I sponsor my own podcasts. We have two young and talented people working on our production team. I really could not keep up without them. Most of the videos you see on the social media are produced by Justin Russell and most of the website work on both the Healthlink site and this week in health I.T. are curated by Holly Russell. We started the show and continue the show for the next generation of health I.T. leaders.
Bill Russell: 01:56 I have a network of some of the smartest people in healthcare and really outside of healthcare as well for that matter. I get to have fantastic conversations with them about so many relevant topics. I know that most I.T. staff will not get the opportunity to interact with these leaders and I wanted them to benefit from their experience and expertise as I have. So here’s what we do we just get on Zoom call and we record our conversation to guide the conversation we’ve come up with three different formats. Our standard show is news and questions kind of. We cover some news stories and I ask them a series of questions our deep dive episode is another of the forms. This is where we go deep on a specific topic and finally we just introduce a new show last week which we are calling our case study episode a case study where we create a fictional health system and we present our guests with similar problems to the ones that our listeners face and ask them how they would solve those challenges. Dale Sanders was kind enough to come on our first case study episode and we had a blast. It went a little long over an hour’s probably long for what we’re trying to do here.
Bill Russell: 03:04 But it was such great content and the genesis for that was you know we did it emanate kind of case study with Sue shade we did first 30 days of being a CIO case study with Ed marks and that just we got such great feedback we decided hey you know we’re just going to have a episode format called the case Study. So I hope you enjoy that. Love to get some more of your feedback on it so that we can fine tune what we’re doing. Okay just a little background on the podcast. The first episode aired in January of 2018 and it was downloaded 28 times during the first week. That’s right 28 times and I think half of those were from my family members and my really close friends tried to figure out what the heck I was doing. I recorded the first episode on my iPhone using the voice memos app.
Bill Russell: 03:59 It was highly technical and high tech. It was just essentially me talking about the show and the JP Morgan conference which I just finished attending. That episode has since been downloaded over 200 times. The show now gets between about seven hundred to fifteen hundred downloads per week for the audio and many of you tell me that you haven’t even visited the podcasts that you just wait for the video clips that show up on YouTube LinkedIn and Twitter and that’s how you’ve been picking up on the content and and those get thousands of hits every week. And so you know my goals for this year are pretty modest to prove that there is value by getting about 500 consistent listeners every week. We’ve exceeded that goal. Another goal was not to miss a week of production. This was a little bit harder 52 straight weeks of the show and we produced the show through vacation’s through my kids moving through and through my day job.
Bill Russell: 05:01 Not the least of which we’ve had guest cancel at the last minute and other wonderful challenges to overcome. I had to do show without a guest and when my guest actually canceled on that Friday morning and as you know we put the show out on Friday and the guest canceled on Friday morning which is understandable given the caliber of guests that we have on the show sometimes are called into board meetings. And those kinds of things. And so. So I went it alone and I talked about four different news stories on my own not my favorite way to do it. But the show must go on as they say so 52 straight weeks of production was a goal and and we’ve exceeded that. So actually we’re close to exceeding that we have to do one more show and these end of the year episodes will take us through that. So I want you to know that your feedback has been extremely valuable to shape the content and provide encouragement to continue the work if you want to communicate just to let you know if you want to communicate with me or the show you can always email us at [email protected] is the easiest way. It’s not a huge staff as you understand and I will read each one of those emails.
Bill Russell: 06:12 Okay enough reflection on the show today we’re going to start with the innovators. So this is the innovators show you remember we’re goin to do innovators clinicians CIOs and then we’re going to do that top 10 episode and that will be the last episode we do for the year. Now you know innovator’s all of our guests really are innovators there is no doubt about that. But these are the people that have either started their own company or are instrumental in developing solutions for health care that are new or based on some new technology that is presenting itself. So here we go. First one Charles Boise is the chief innovation officer for clear sense an AI in machine learning company.
Bill Russell: 06:58 Charles has a clinical background and he is a data genius you know in my interactions with Charles. The one thing that strikes me about him is I can’t believe he is as humble as he is given all that he has accomplished and how smart he is. So the first two clips are really about gaining AI adoption in health care being artificial intelligence and how to introduce AI to your clinicians so here goes the first one is about using AI as a cognitive trigger and not a club. And the second one is on how we gain adoption within health care.
Charles Boise: 07:35 So back in the late 80s early 90s at L.A. County USC I’m you know I’m also a trauma nurse and what not, we did a lot of predictive models and so I worked with a doctor Willie Shoemaker who started the Society of Critical Care Medicine. We actually built predictive models for patients in trauma that would predict. Depending on the therapy what the outcome would be. We made a really big mistake back then we called prescriptive analytics. The clinicians went nuts.
Charles Boise: 08:03 They didn’t want the machine telling them what to do. And this is really what this article is all about and this is you know this is almost oh my gosh it’s almost 30 years later right. So again with AI we can build out you know beautiful models that I would like to say can assist I can call it intelligence assist. To be honest with you. I don’t like the idea of using this technology to tell somebody what to do. I’d rather produce a cognitive trigger. This is what is described in the in the article. If I can give you a heads up that something’s going on that you may not have been aware aware of. That’s fantastic. Then you can you know make a clinical decision and move forward.
Bill Russell: 08:49 And now gaining artificial intelligence adoption with the clinicians
Charles Boise: 08:53 how do you how do you get that adoption.
Charles Boise: 08:56 And this article points out that there needs to be an adoption is really the way to do it. You don’t blackbox any of this stuff, many folks out there how you know their models are proprietary models and you know this thing you’ve got to show how you got to know how you got to where you got. What did data elements you used. What weight you attributed to them. You know what was a neural network that was in play was it random force. What did you go all the way through the process to get to the point that you’re at now in and how accurate is asking how accurate is it. You know you have an R.O.C. curve to show. You know reverse matrices and so forth. What’s the precision what’s the recall you have to be able to demonstrate that and you have to be able to demonstrate with their data. And you really can’t make statements like you know you know this model will work everywhere because they are very geo specific what works in Southern California isn’t going to work as well in Sarasota Florida. It’s gonna needs some tweaking because the demographic nature and even some of the external factors so.
Bill Russell: 10:01 It’s interesting to watch these clips to see how our production has changed.
Bill Russell: 10:04 We like just cut things off at the end. Yeah. Great insights from Charles OK we’re going to continue in the next couple of videos I want to share with you is interesting from this perspective it’s from Dr. John Halamka CIO for Beth Israel Deaconess Medical Center and so many other titles that go along with John and most of our listeners know John. He is a frequent speaker guest blogger. He’s out in the community and really a leader in one of the interesting characteristics of John is he shows up in all four episodes so he will show up in the innovators episode the clinician’s episode the CIO’s episode as well as one of his clips got into the top 10. So we’re going to share that. If you’re wondering none of these clips that you’re here today are in the top ten. And I I pulled out the top ten clips to be to stand alone on their own.
Bill Russell: 11:03 John came on the show twice with us this year. It was phenomenal to have him and we really appreciate his time. He in the first clip here he’s going to share his work with the Gates Foundation which I find just fascinating what they are able to do with technology in and in Africa on you know your standard flip phones using block chain moving the technology around. So I’ll let him explain that a little too. And then the second is really just a wildly innovative solution when John and I got into a back and forth on cloud computing and how it can be applied to healthcare. He gave me an example of how using Amazon and you know essentially a credit card they were able to gain a significant amount of efficiency in their OR. Here the next two clips on the show John Halamka last time you were on we talked you shared about the Gates Foundation the work you’re doing in Africa. Can you give us an update on what’s going on there.
John Halamka: 12:07 Sure. So the challenge in South Africa 65 million people 16 percent of the population is HIV positive. And the challenge of coordinating care across what is a very heterogeneous country right. There’s urban there’s rural there are issues with infrastructure network bandwidth is expensive and slow and identity management who are you is actually a challenging question because names are misspelled. Workers move around. So the Gates Foundation we took the process of care delivery and brok it down into several what I’ll call APIs or core functions. So core function 1, Who are you. So we’ll do identity management and we’ll do it based on biometrics is named date of birth. Math doesn’t work so well. Issue somebody’s identity cards hard to know. Biometrics. If I say I’m there take your fingerprints I scanned your retinal Iris palmgrain geometry or whatever is the bio metric of the future that build a system by which I can link your data by biometrics.
John Halamka: 13:14 That’s an interesting infrastructure. So are API number one is a general biometric infrastructure. We deploy that in the right care clinics and now can tag your HIV laboratory data to you. So you just walk into a right care clinic and it says Ah here are the last five viral loads that you had showing your medication is working very well or not. From one problem two is how I share the data with a patient right. We’ll talk about I’m sure there this increasing trend in the U.S. of patients getting access to their own data their notes etc.. Well hey Bill do you have an iPhone 10. Well imagine that in South Africa my lowest common denominator is the Nokia flip phone you had in 1997 running on a GSM network maybe and so we’ve had to create a medical wallet for the patients that runs on a feature phone over very low bandwidth and that’s something we’ve deployed. We did a lot of usability testing and keeping a good number of folks in South Africa on the team really help this what the needs assessment was. Final question is how do I deal with population health data aggregation and look at variations in care quality and understand trends. So what we’re working on currently as is how do you expand what our early work in biometrics and this medical wallet to something that is going to help for country wide population health analytics and that of course could be machine learning and it could start South Africa and scale to other countries. So what’s the platform. So we’re starting to think through that.
Bill Russell: 15:02 The great thing about the cloud is you literally could fire it up this afternoon with a credit card
John Halamka: 15:08 and you’re totally right. So when I talk about a machine learning applications we’ve deployed they’re literally like written in a weekend. And so here is another example I built an API into our OR scheduling system and I now have access to millions of previous OR cases doctors and patients. I don’t use the names that’s not important but the patients say what is the procedure or what does the comorbidity. So what if you say hey Amazon Bill needs an appendectomy. How much time should we allocate. Well Bill is a 53 year old person with NoCo morbidity and the surgeon is Dr famous who’s done a million appendectomies. The answer is twenty five minutes. So we just did that. And what did it do. It freed up 30 percent of our OR schedule
Bill Russell: 16:01 30 percent. That is just amazing. OK.
Bill Russell: 16:05 I’ll be honest with you guys there are times where I send out invites to people that I didn’t really have a relationship to with prior to doing the show. And one of those people was Daniel Kraft. Now I had met Daniel before and we had some mutual friends. I met Daniel at the exponential medicine conference down in San Diego which is a phenomenal conference if you get the opportunity to go. You should do that. And we have some mutual friends. And I put out the invitation for Daniel to come on the show and he agreed. And I was really excited to let me see. His title is physician scientist and chair of medicine at Singularity University and exponential medicine. He is a fascinating individual a physician who just is on the cutting edge talking to all sorts of people around the world on what they are doing in the area of exponential so the first clip here is to explain what exponential are and I’ll let him do that and then the second is a I thought an interesting conversation I had with him on augmented reality just one of the many exponential technologies that he is following that he talked about on the on the episode when he came on.
Bill Russell: 17:18 So here’s Dana Kraft talking about exponential in Augmented Reality.
Bill Russell: 17:22 Give us an idea of how exponential is are going to address some of the biggest challenges we have in health care we have you know cost access fragmented care care variation even within our communities in the U.S. but you care variation around the world. How how does how does exponential start to change that paradigm.
Daniel Kraft: 17:41 I think in a sense you know there’s lots of challenges in health care is kind of like politics it’s a bit local so you know so many different healthcare systems as you know or may have different challenges need so much are overlapping. I think where it provides the biggest opportunity is to move from you know again some buzzword we want personalized precision medicine when in reality today we’re still practicing kinda one size fits all medicine often the same dose of statim we start with you manage your patient with hypertension or diabetes with the same drugs. Trial and error broken feedback loops. Still communicate by fax machine. In many cases and so the opportunity is now to take the increasingly exponential the more available accessible data. Whether it’s our digital exhaust that can be picked up by our wearables or our smartphones or connected mattresses and start to connect that into our health care system and as you discussed the pressure is kind of meld that information to understand what it means.
Daniel Kraft: 18:34 What does it mean if my Fitbit or my mattress sensor tells me that my resting heart rate’s normally fifty five, but the last couple months it’s creeped up to 75. So what might be happening. How do we take that baseline of data like barely is doing with a baseline trial or now the all of us trial at NIH and start to understand what some of these new biomarkers digital OMX social metrics start to mean and be much more proactive and start to shift our sick care system to more of a healthcare one. Where we can utilize this overwhelming amount of data and turn it into a proactive useful information that fits into the workload of a horrible worked clinician with some great solutions are already here today but they’re not being utilised for reimbursement issues or or it’s someone moving someones cheese you know turf battles. There’s a lot of other elements beyond the technology itself the incentives the user interfaces that need to be put together as well
Bill Russell: 19:27 and now augmented reality augmented virtual reality. You know we’re seeing just some really neat use cases At Cedar Sinai I know they’re using it in other health systems they’re really using it to sort of almost reprogram the brain as you know just you talk a little bit about that.
Daniel Kraft: 19:49 Well sitting acress the room from me I already have my antique Oculus device from Facebook and I barely ever use that one it’s connected to you know a 600 dollars which I think is now 200 dollars but I had to get the you know 2000 dollar fast computer and then just two months ago I got the Oculus go it’s the same basic form factor for that, but now I can take it on an air plane, it’s really fun doing demos and put people on the first rollercoaster ride but work that’s been done at Cedar Sinai led by Brian Spiegel and others is really catalyzing use of VR and AR and XR exten reality across many different areas.
Daniel Kraft: 20:23 As people google up I give a keynote at the augmented the virtual medicine conference that was heald at Cedar Sania last spring. And you know some great examples and now taking these, often gaming platforms initially catalyzed by the gaming world and the reality engines in there to now enabling you to create an environment for someone in pain for example to be in a cold environment throw snowballs at penguins and that has been shown to reduce the need for opiates for chronic for acute and chronic pain patients. There is obviously the use of VR and AR now in surgical training and very exciting startups from also VR for example can take a orthopaedic surgeon put them in the virtual operating room give them the actual kit from Stryker or another orthopedic company let them practice with the actual instruments on the patient or the fracture type that they’re about to do a procedure on.
Daniel Kraft: 21:15 So we I was trained on the see one do one teaching world and it’s going to be a future of see one SIM one, SIM one, SIM one until you get it right now. And simulate that exactly on the anatomy of the patient you’re about operate on. And then there’s obviously augmented reality which can be used in a variety of ways of several interesting companies and academic groups planning that so a surgeon can see through the body or blend that with robotic surgery all the way to patients to improve their game application recovery from physical therapy can make it much more empowering. And so I think that’s a great example I feel that you know five years ago you couldnt have bought an oculus type thing for five billion dollars. Now it’s essentially 200 dollars available to Amazon.com and these systems are being democratized where folks around the world. You don’t even need to be in an academic center or you can be in Timbuktu to be programming for these and selling them online and even doing virtual trials that could accelerate the use of the VR and AR and XR in a variety of ways.
Bill Russell: 22:10 Exciting stuff okay.
Bill Russell: 22:13 You know sometimes I have people on the show that I have interacted with you know many times and I just enjoy their company actually a lot of people fall into that category. Anne Weiler one of those people she is the let’s make sure I get her. Is the CEO and co-founder for Wellpepper. In fact if you haven’t heard her story it’s really kind of compelling how she started at Microsoft through an incident that her mom had. Really trying to coordinate her care plan and got motivated to solve that problem started. Well peper and it’s really going well they have a lot of really great announcements this year some work with mayo and some some new client work in and just really enjoyed my conversation with her. Couple of things I’m going to highlight here. One is she sort of encapsulated what some of the big tech companies were doing in this space this year.
Bill Russell: 23:12 So we talked about Google Amazon other things topics that continue to come up on the show because it’s so prevalent in the news and I thought she encapsulated a lot of that really well. And then the other thing I asked her was around the second clip I asked her about what makes a good health care partner. I know a lot of these innovators in tech startups struggle to really be successful within the healthcare environment the cultures are so dramatically different and sometimes plugging them in together is really hard. So I wanted to hear from the innovators what really makes a great partner for them and makes their projects go go well and gets their technology implemented well within the health system. So here’s Anne Weiler sharing two. Two things one what the big tech companies are doing and second what makes a great healthcare partner.
Bill Russell: 24:04 It’s the age old problem I’m gonna throw out a bonus question here just because I’m curious your thoughts. You know big tech players coming in doing things Amazon obviously they have not only their acquisitions but the JPM Berkshire’s thing you have Microsoft reengaging in health care a couple years ago and still moving. Google what not. Of the big tech health moves that are going on. Who’s going to have the biggest impact.
Anne Weiler: 24:30 I don’t honestly I don’t know who is going to have the biggest impact. Google’s taking a lot of bets. They’ve got deep mine they’ve got barely they’ve got Onduo probably a whole lot of other things I’m not thinking about the baseline study so if even one of those pays off they’ll have a big impact. I think everyone wants to Amazon to have a big impact so that we’ll get better customer service in healthcare.
Anne Weiler: 24:53 But thinking back to the beginning I don’t know that I would rule out China. I think that we don’t know. I don’t I’m not paying a lot of attention but there’s they can do things that a lot less regulatory and they’re very incented because of the population and the fact that the government is now needing to provide care for this population. So I think you know it’s exciting. I love seeing big tech and consumer focused organizations taking a swing at this. I don’t know who’s going to win and. Hopefully we’ll all win.
Bill Russell: 25:25 Second question so what. What makes a great health system partner for for digital health startups.
Anne Weiler: 25:31 Well you actually said it. It’s that understanding the bigger picture vision and knowing where to plug things in. Because we’re not coming in saying we have to be the only system. And in fact you know we’re not a system of record but we have a very important part to play in helping patients. So wherever we come in and they see the vision of where they need to get to even if it’s not to get there today and they can see that you know today we may deploy like this specifically for these scenarios. But in the future we’re going to be part of a larger ecosystem a larger overall digital patient experience that that’s a great partner. So anyone who comes in says yes we’re going this way. This is it’s inevitable that we’re going to interact do all of our patient interactions digitally not all of them but that there will be a consistent patient digital experience right. Those are the easiest ones to work with because they can also look at us and know that they’re not going to get backed into a corner because we have an API. We have micro services you know you can deploy a white label that you can deploy us part of a larger system and budget. Budgets always really helpful.
Bill Russell: 26:47 Yeah. Yeah. People people with a budget and a problem to solve tend to be in a sense of urgency tend to be great partners. Okay if you’re in healthcare long enough you’re going to run into some phenomenal people. And one of my favorite people. I know I’m going to say this about a bunch of these guests but one of my favorite people a Aneesh Chopra who is the president for care journey. He actually worked in the Obama White House and has been instrumental in a lot of things that are going on behind the scenes in health care. He’s he’s an influencer within the industry does a lot of speaking especially on the area of data interoperability. And so here he came on the episode one of the early episodes and we talked about a handful of things and he’s so articulate that he is going to get three clips on the show. The first is around health inoperability and what we’re doing in that area. The second was this this whole concept of the rise of the digital experience officer so there’s just new roles that keep popping up as healthcare starts to realize that I.T. and digital are completely different not completely different but different served by the same technologies with just different focuses and different outcomes and so Aneesh and I talked about the rise of the digital experience officer.
Bill Russell: 28:14 And then finally we talk about something that we’re all looking forward to which is applying Internet economics to to health care and healthcare innovation. And we believe that things like fire and advances in interoperability and APIs and the work that Apple is doing and the work that Amazon’s doing and Microsoft and others is really going to lead to this Internet economy this digital economy really exploding on top of healthcare and and and we’re looking forward to that and so here are these three clips from Aneesh interoperability rise of the digital experience officer and Internet economics on top of healthcare.
Bill Russell: 28:54 Sema Burmah came to HIMSS she did my healthy data initiative. She did the blue button 2.0 initiative. Do you want to give us a little little background on the two of those and wher you think they are going to go
Aneesh Chopra: 29:09 well let me begin by saying the announcement that she made that couldn’t have been more bipartisan or maybe we would call it nonpartisan if you removed the the voice of CMA or the voice of Jarrett and simply read that presentation without knowledge or context as to who might have delivered it. You could have imagined anyone from the Obama administration carrying that message forward. So this is really building on progress and really pushing it further and faster in the direction that it desperately needs to go. So that’s why you saw me applaud a great deal of the work that was done. The big message I would say is that the healthcare delivery interoperability strategy that I mentioned before the B2B model was built on the foundation of hippa authorizations.
Aneesh Chopra: 29:54 Where you you may share. You’re allowed to share but that doesn’t compel you to share. So you could put a request in as a physician. Hey I’ve got that patient could just send me the records and if they chose not to respond then you wouldn’t get the data but they were legally allowed to respond and so we had this framework. You might be able to share it and you didn’t have to. What CMA saying is that the other half of Hippa the individual right of access it doesn’t mean you own your medical record Bill it means you’re entitled to an electronic copy. And in a readily producible format these are words that are going to come into play in the API discussion so Siever basically said I’m going to pivot and embrace Information Exchange tied to that consumer’s right and that I think is the kind of sea change that naturally is a progression of where we learned as we went. And that’s the model. I think that’s going to carry lowest cost highest data liquidity because it’s a legal right to request a copy in a readily producible form. And she built on that.
Bill Russell: 30:56 Well let’s talk about this show originally through the show for CIOs to share with their staffs so they could stay current let’s get in it a little bit more of the technical aspect so you have Tefco, you have fire. What is it.
Bill Russell: 31:07 What does a CIO tell his organization or what does what does the the the front line staff do with Tefco and fire and where where should they start and where are we at
Aneesh Chopra: 31:20 so this is a conundrum which is you can either be a supply sider which is your job is to envision the infrastructure that you’re responsible for modernize it and prepare for the future. The other is a listener and responsiveness to the clinical leadership and generally on the side of listen first which is to say there’s a signal out there that you’re hearing from frontline clinicians from physicians that are involved in these new value based models. And they’re complaining about something about the difficulty to do their job. And of course there’s general complaint but then there’s more specific complaint I would like to know this at this time in this way so I can make a decision without weakening my productivity.
Aneesh Chopra: 32:06 So my sense is that if you start to listen if you’re the CIO and you start listening to the customers needs in a manner that perhaps we don’t quite do today cause we make a single decision I’ve got to make a big EHR decision and I’ve got to maintain it uptime security. That’s its own job. Now I’m listening and saying well wait a minute I’m no longer deciding what EHR to buy now I’m thinking what application might write on top of the EHR that might delight my individual care teams or clinicians and patients to have a better experience. So think of it like a digital experience officer. That role that listening function I think is the missing link today because what their job is to figure out what it is that people need or want and then map it back to what are the underlying data assets that we have available. And if you kind of do your job right you serve up the data in a format that allows a random app developer on the street who can do the day to day app development for that doctor and not crash your secure systems or require you to allocate limited resources.
Bill Russell: 33:09 So are we finally at a point where the I mean that’s an interesting distinction. I don’t own my medical record but I have access to it electronically. Is that does that create a new ecosystem where the apples and the Googles and the Amazons and the others of the world can now say hey the the patient is the center of medical record not necessarily the health system. So now we can create. We talked about these ecosystems and I think all will arise were the cloud providers will saying hey if you as a patient want to give us your data we can now add value to it or we can now add other data to it and make it inhance it make it better. Are we at a point where the patient is finally that the locus of this the medical record or we’re not there yet.
Aneesh Chopra: 33:56 We are closer. But what is missing right now Bill is that delightful application that helps my mom and my dad on Medicare make the best use of that information. So we’ve got a plumbing technical standards right. We’ve got a legal and regulatory framework that encourages it. We’ve got the cloud providers and others helping to facilitate adoption in use. But that last step. Who’s going to help read my mom’s Medicare blue button file and remind her when she should get care or where if she needs care she can choose the right provider that meets the needs that she has to have addressed. And my personal opinion Bill is that this is going to look a lot like the transition from pension plans to 401ks, where we used to have these employer fiduciaries that would take our money and make big judgments even if we might have wanted to do something else or someone else could have given us advice to have a better more reliable retirement.
Aneesh Chopra: 34:57 The move to 401k gave rise to companies that didn’t exist or if they did they were modest Vanguard and Fidelity and others. So I think there’s going to be a new rise of what we’ll call in health information fiduciary who will work on the cloud platforms to do the plumbing of getting the data. But it’s going to be their last mile application that will help make sense of that information. So I can shop smarter for supplemental plan so I can navigate the delivery system more effectively and I can access and use preventive services to keep me healthier and whole range of other things that will will see happen.
Bill Russell: 35:32 Aneesh Chopra always leaving you energized and informed.
Bill Russell: 35:36 My most recent guest is Dale Sanders Dale Sanders is the president of technology let me look it up just to be correct here. President of technology for health catalyst. And Dale is a new friend. In fact he’s one of those people that I ask people who should I have on the show and the most common answer to that question was Dale Sanders. And so I reached out to Dale and he offered to come on the show and he has since been on twice this year and I loved Dale because he is so technically adept. He has such empathy for the clinicians and he has done such great work in the data space and his experiences is phenomenal. He’s been a CIO. So he has a lot of different perspectives he brings to the table. He is so easy to talk to and again very humble for the amount of experience and knowledge that he has in fact all of my guests I can say the same thing for. And in this clip Dale and I talk about a modern platform for health care. We’re really geeking out at this point. But I think it’s it’s it’s a really good idea of what health care can do if the EHR was this modern health platform what it could do. But we think we both believe that it can be outside of the EHR. So here’s Dale talking about that.
Bill Russell: 36:58 What kinds of things would we look for in a modern EH.R. from the. That would define a technology platform but that you think would work
Dale Sanders: 37:08 well. I would say let’s give the attributes to the platform and then you can spin off whatever you want to including an EHR from the platform right. Once you have the data then you’ve got the platform. There is like unlimited use cases with it literally. Right. And so you have to have sort of the abstract layer and the reusable content and logic the curated data that’s facilitated with API that’s fundamental in health care so that the application doesn’t have to constantly do that. So registry’s you know core things like registry’s metrics value sets embedded machine learning so that it’s not something that you do as an afterthought but you can call an API and you can bind your data to a machine learning AI model without doing it externally to the application. It’s a natural part of the of the data first application. It certainly has to support real time.
Dale Sanders: 38:06 It has to support batch analytics. Right now it has to be micro services based. And there’s a lot of debate about what does micro services really mean. We can talk about that. But what it means is continuous delivery right. No more. I mean remember back to the days when you had to upgrade an E.H.R.. It was a it was up thousands of hours initiative that took months and months to plan and execute and even then it was ppainful right as opposed to the Micro services continuous release cycle that we see now. So let me comment on that by the way so the data operating system we have right now is Micro services based and we’re able to push out updates to our apps and the platform now faster than the cultural ability of health systems is to adapt to it because the culture you know our I.T. shops are accustomed to very rigorous configuration control and release schedules at best it’s like once a month generally speaking and certainly not daily. So that’s that’s an interesting thing that’s evolving back to the attributes of the platform. The platform has to support the integration of text discrete and image data. You have to be able to support that and make that a natural part of the data ecosystem. I think I mentioned real time streaming, it has to do that batching analytics by the way that if folks want to study this a little more it’s an easy steady Cappa and LAMDA architectures in Silicon Valley are the role model that we should all be following those design patterns are what is what we should all be following.
Bill Russell: 39:45 OK so we’re coming to the end of our first of four end of the year episodes. This is the innovators episode the last two clips come to us from Charlie Lougheed. So Charlie was has done a ton of work with Cleveland Clinic and actually a lot of health systems across the country. He was the co-founder of Explorys and explorys did a lot of really interesting big data work early on and they sold to IBM a little while later and since that he’s technically not in health care right now but he’s on the periphery. He’s co-founder of the unified project and you can look that up online and Charlie is always looking for what the next thing is in health care. He’s having conversations. And so I like to I like to tap him for just his ideas on startups and on new technologies. Charlie gave me one of the most articulate answers on block chain this year and I realize that block chain was overhyped and so people don’t want to talk about it so much but I think we’re going to see over the next 12 to 18 months some solutions.
Bill Russell: 40:54 You know we’re going through that trough and we’re going to start to see some solutions actually come out that are based on block chain. It will be interesting to see how health care adopts them well Charlie gave us a really great answer on some of the use cases for block chain, the second second clip here is a healthcare startup economics. And Charlie just shares some great. If you are thinking of doing a startup if you’re thinking of or even evaluating startups. He talks about the economics and how people should be approaching it and how they should be thinking about the value that they add to healthcare. So here are these two block chain health care startup economics.
Bill Russell: 41:34 So that’s a great setup so you don’t distribute it so the nature of block chains distributed immutable record Smart contracts. So I wouldn’t give you five health care use use cases and let’s just go through you know you know likelihood of happening and impact on health care. So the 5 used cases provider licensing credentials. Do you think block chain has application there. And then what would the impact be
Charlie Loughee: 42:02 I think it has incredible potential there. It would have a big impact on the process credentialing is slow it’s cumbersome it’s redundant it’s expensive. If you’re going to get to a good economy and health care it’s absolutely critical.
Bill Russell: 42:15 Block Chain based HIE based between actually between anyone payors providers well whatever but block chain based HIE.
Charlie Loughee: 42:23 What do you think could be the next generation of HIE and HIE technology as it has struggled. Right. For a lot of business reasons but some technical reasons so I think it’s got a pretty good chance they’re not as high as credentialling but a decent chance
Bill Russell: 42:38 medication supply chain. Lot of talk about that. What are your thoughts on that.
Charlie Loughee: 42:43 Well the question is to what degree do the consumers really care. Yeah I’ve heard a lot about this in the food industry. I think has applicability. I think it’s really more regulation will drive that.
Bill Russell: 42:54 OK. How about revenue revenue cycle or more specifically fraud prevention and auto adjudication of medical claims processing.
Charlie Loughee: 43:02 That’s another one I think will be a big opportunity. You know that we all know that process today is fairly broken. It’s extremely expensive it’s a big part of the cost to health care. So I’m bullish on that as well.
Bill Russell: 43:14 Efficient prior authorizations and referral through Smart contracts.
Charlie Loughee: 43:19 I know we’ll see. I think we’ve got some pretty good systems in place to do that today. Maybe later that one doesn’t come to the forefront for me. Right now.
Bill Russell: 43:28 you’ve had a successful entrepreneurial venture in health I.T.. So I really have two questions around this. What was the one thing that surprised you as you got into health care and what’s the one thing you would tell someone going into this space today.
Charlie Loughee: 43:42 I think the one thing that surprised me getting into healthcare not knowing anything about health care was how gracious and helpful the health care community was particularly to me and Steve and others that didn’t have experience with it about getting up to speed. They knew that we had something to offer from data. So you had to bring something to the party. We understood Big Data we understood different industries but it is a good market to be in. A lot of really smart people people that liked to teach and if if if you give them the respect and be patient they’ll do that. They’ll coach they’ll tell you what they need. So that is something I really do love about the market and still do yeah.
Bill Russell: 44:26 So what would you tell somebody who’s just starting off their health tech firm and they’re going into the space. Yes maybe something you’ve learned as they get started on this on this path
Charlie Loughee: 44:38 I think not understand the economics.
Charlie Loughee: 44:41 That’s absolutely critical. Yeah you had to follow the money. You have to understand how how these models work because you can have a great idea great technology but if it doesn’t improve the situation for the provider for the payer for the patient or at least two of those three. All in all it’s it’s it’s going to be a tough sledding.
Bill Russell: 45:04 Well I hope you enjoyed the innovator’s episode if you know one of the things I’m going to really encourage people if you’re listening to this podcast. Share it with somebody. We I believe that this content is really valuable I believe it’s valuable to healthcare I.T. staff to digital staff to strategy staff. I think it’s valuable to startups to consulting firms. Anyone who’s working in healthcare I believe this is valuable for. So please share it with somebody and that we could get the word out and continue to just have this great content available to build the next generation of health I.T. leaders.
Bill Russell: 45:42 So the best way to follow the show is the Web site thisweekinhealthIT.com. You can also follow us on Twitter.
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