Should we grade healthcare on the curve? What is the real reason that Allscripts on Azure is a big deal? Why are healthcare startup investors in New York getting antsy? and Stephen Klasko from Jefferson Health welcomes us to a brave new world of digital transformation.
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Bill Russell: 00:12 Welcome to this week in health it where we discussed the news information and emerging thought with leaders from across the healthcare industry. It’s Friday, February 16th this week, and cheers, bipartisan Budget Act allscripts on Azure and implementing a cloud first strategy. This podcast is brought to you by health lyrics, a leader in digital transformation in healthcare. This is episode six. My name is Bill Russell, recovering healthcare cio, writer and consultant with the previously mentioned health lyrics as it’s going to happen from time to time. My cohost for today, uh, was called into an urgent meeting that makes the show a second priority, I guess. Go figure. So, David Chow, we’ll be back with us in a month, but the show must go on as they say. So I’m going to switch up the format a little bit and, uh, I’m going to take a look at four stories and skip the second segment where we talked about leadership or the tech talk.
Bill Russell: 01:08 And, uh, we’ll, we’ll close out like we’d normally do with a, I guess my favorite social media posts for the week, or at least one I, I believe, uh, we should, uh, should take a look at. So here goes a wish me luck. Okay. So in the news this week, I’m going to cheat a little bit. I’m going to start with a, uh, with an email I received from China. Instead of a story received this email, it was on the bipartisan budget act that this is sort of an abridged version of what the, what the letter says. And there’s, there’s two things I disagree with this. And one thing that, um, that I agree strongly agree with. So I want to talk about those things. There’s an email from a cletus earl chair of the board of trustees, cio of a Kaleida health. Uh, we were pleased to share good news about the bipartisan Budget Act of 2018 that passed today.
Bill Russell: 02:07 It includes provisions to lessen the burdens of meaningful use programs and help expand access to telehealth services. So let’s take a look this last July as chime then. Board chair lack, I testified on a bill, uh, that removes the claws and the original hightech statute that stipulates the meaningful use program must be more stringent over time. This language has been used as a justification for this for cms to move to new stages and tougher measures in response chime has often had to advocate for reasonable list to be applied to these proposed measures and objectives to avoid significant portions of our membership being penalized. So I’m going to stop there. There’s, there’s three main points here. It’s this, it’s telehealth and it’s the opiod, uh, money that was set aside. So on this alone, I’m not sure how I feel actually think I, I don’t like this. And primarily the reason I don’t like this is it essentially chime is advocating to grade on the curve.
Bill Russell: 03:08 And while I understand how difficult it can be for some systems to meet the requirements for meaningful use and some of the, some of the requirements have been crazy over the years and chime has helped to really ratchet those back to something that was a little bit more sensible and actually had an impact on the community health. Uh, I don’t like grading on the curve because at some point it’s going to be me in that hospital, it’s going to be my children and it’s going to be my grandchildren in that hospital. And, and I don’t feel good about the fact that it’s being graded on the curve. If the health system can’t deliver on these things, I’m not sure they can deliver on security. I’m not sure they can protect my health record. I’m not sure they can ensure that the systems are gonna stay up while I’m on the operating room floor.
Bill Russell: 03:56 So I don’t like grading on the curve in healthcare. I think it’s, I think it’s a bad precedent. I understand smaller health systems don’t have as big a budgets, but uh, this is sort of what drives consolidation. If you cannot keep your records secure, if you can’t meet meaningful use, you should be looking for a larger partner to, to fold into, um, you know, and there’s a lot out there that are looking to expand their footprint. They have very sound, uh, it strategies, they can make this thing work. The, uh, I guess the other argument is, well, it must be easy if you have a really large health system and you have money to meet these things. And I can tell you as someone that had 16 hospitals and had to run this, it wasn’t any easier for 16 hospitals than it is for, for one or two.
Bill Russell: 04:41 It is a, it is very complex. You’re across multiple time zones, you’re across the multiple health systems, multiple a governance structures. It’s, it’s hard. It’s hard to matter if you’re a one hospital system or a 20 hospital system, uh, and, and, but I just still don’t advocate grading on the curve. So a, additionally, the bill included language that will allow increased reimbursement for provisions of telestroke Tele Dialysis services, chimes to support legislation that will enable expand access and improved reimbursement for telehealth services. This is a phenomenal a stance for China. They should be pushing this in every aspect. I think it’s a, it’s crazy that you could have a health system in Pennsylvania and the border is literally, you can see the border from their hospital, but they cannot practice telehealth across that border. I think this is one of the things would really drive down the cost of healthcare, open up access and, and create all sorts of new competitive models that would benefit the benefit the patient.
Bill Russell: 05:45 And I think that’s, I think that’s what we’re after. I think that’s what’s important. I think the, uh, the regulations, the state regulations predominantly have held back telehealth and I, for one can tell you that when we went to rollout telehealth in Texas, the, uh, the legislation there was, was archaic and we really could roll out the same telehealth program we’re rolling out in California. We could not roll out in Texas. They have since changed that and we applaud that. I think this is one of the areas where if the government could just level the playing field, we would see all sorts of new models. So I think that’s a good thing for China to be pushing forward. And finally, uh, they’re pleased with the $6,000,000 to help combat the opiod crisis. And don’t get me wrong, I, I, I believe this is a crisis.
Bill Russell: 06:31 I believe we should be combating this. I saw at the JP Morgan conference this year, a lot of health systems are doing great programs and really making an impact on the opiate opioid epidemic, but I don’t think we should celebrate when money gets spent. I think we should celebrate what the money does. I think there’s $6,000,000,000 that the government is going to spend a, would be better off in the hands of a thousand other entities other than the federal government, and we shouldn’t measure them on when they spend the money. That’s great. It’ll get somebody elected, it’ll feel good that they’re spending the money, but at the end of the day, let’s measure results. Let’s not measure the fact that they’re spending money, so maybe we’ll applaud it. Maybe not. I’m not as passionate about that as I am grading on the curve, but again, that’s a, that’s what shame is doing for health systems and I really do applaud them getting involved at the national level and starting to have those conversations.
Bill Russell: 07:27 I think that’s very important. Let me turn off my email here so that we don’t get those things along the way. Here we go. Healthcare startups are flushed with cash. There’s our second story and I think this speaks to an interesting dynamic within the startup world within healthcare. So healthcare startups are flush with cash, but investors are starting to worry. This was in modern healthcare and I think it’s actually a reprint from a crane story out of New York. And uh, let me just read a couple of things here for it. A New York healthcare companies continue to attract hundreds of millions in venture capital funding last year, but some private investors said they are growing more concerned that investments are resulting in either mergers are not, not resulting in mergers and acquisitions or Ipos. Investors are particularly concerned about the lack of exits in the digital health sector, although there were dozens of a life sciences, Ipos, no digital health companies debuted on public markets and they quote, wow, can’t read that name.
Bill Russell: 08:29 There was a gentleman from a Nafa Med capital city expects to see investments in health tech sector companies decrease next year, worrying that the current model is overheated. I hope for the state of the ecosystem, it does decrease. That’s an interesting, uh, point of view because we know it has been just, it has that hockey stick curve that’s going on right now. One of the issues is that health tech startups often lose money initially, which makes it more difficult to find a buyer or declare an IPO, said the vice president of Manhattan based, uh, this is, uh, this is an interesting story and I, I think it’s starting to touch on something these, uh, you know, the venture capital gets in because they want a return on their investment. And at the end of the day doing a digital health startup takes time. I was a part of several, uh, we incubated a couple.
Bill Russell: 09:21 One of them did go out of business, another one, the, uh, uh, is still going strong in, but it was a, it’s a very rocky road. Those first couple years are very difficult. It’s a very long sales cycle within healthcare. There are a lot of competing firms. There’s a lot of not invented here. Uh, you know, there’s a lot of health systems with innovation programs and even if you take the best thing since sliced bread to them, they will look at it and say, no, no, we’re, we have something better. Even if their thing is, is crap is trash. So, um, so there’s a lot of things against healthcare startups in the space and uh, I think it might be overheated right now. I think there might be too many things and there needs to be shakeout and we’ll probably see that just naturally, we’ll see that we’ll see some, uh, some businesses go out, uh, we’ll see some not get to their true valuations and be rolled up into other organizations.
Bill Russell: 10:18 So just want to make you aware of that. That’s a very interesting trend. This is a short one, allscripts to showed you a Microsoft azure powered Ehr at Hims 18, and let’s do a public ssa built from the ground up natively within the Microsoft azure cloud. It functions like an APP, not a traditional EHR and gets technology out of the way of patient care. This is a bold, imaginative, new EHR, not simply a series of incremental advances on existing software. If that’s not a marketing statement, I don’t know what it is. I’m going to talk about why this is. This is actually a good tread, but, uh, you just got to call the marketing statements out when they’re made by focusing on a user centered design. The new cloud based EHR addresses usability and efficiency issues. Black said and in turn improves consumer experience because by making it more a realistic for patients and care teams to interact.
Bill Russell: 11:11 Uh, okay. I, I mean, that’s a marketing statement. I think it misses the point almost completely of why it’s a good thing that, uh, allscripts is going to Azure in the cloud. The, uh, the primary reason is there’s two primary reasons. This is a good thing. A three actually if I thought about it, the first is that, uh, the allscripts infrastructure is awful in its current iteration. It just going to say it like it is. We were, we were in allscripts shop and we had a, their enterprise in our ambulatory environment. And to be honest with you, it was a, it was hard to keep the thing running. Uh, I, there was a lot of things I liked about it. It was a very open platform, good set of Apis. We can do some very interesting things on top of it, but let’s not kid ourselves.
Bill Russell: 11:57 The Microsoft platform that was built on is circa, I don’t know, 2002, 2005. And it was really, they just hadn’t invested in bringing it forward like they should. And so I think this move will give them a new modern stack and I think that’s an important. I think the second reason this is important is if they allow allow the health systems to tap into Azure, right? So as you’re actually is a, is a great ecosystem. If you can move that data in there. There’s a lot of powerful things, you’re, you’re gonna start to see some ai and some other things layer on top of the azure platform. If, if allscripts as an EHR can be built on top of that, open up that data and make it accessible to those platforms. Now you can see some health systems start to play around with a play around with a machine learning play around with artificial intelligence.
Bill Russell: 12:50 And I think that is huge. And then finally, uh, the, uh, the Microsoft cloud platform is more stable and secure than most other, most health systems out there. So I think this move is a very strong move from a technical standpoint. I understand why, why Paul black is not talking about those things, those things don’t sell. What sells is we’re going to make the, the, uh, life of the clinicians better and it’s going to be a better user experience. And it, it may be those things. I’m not putting those down, but I don’t think that that’s the main reason. This is a big story, that this is a big story because it’s going on the azure on the azure platform. I wouldn’t be surprised to see a more ehr make this move. I’ll be interested to see the first one that makes the moves and puts it on the, puts it on the Amazon aws platform. That will be interesting to me. Okay. Take a little drink of water here. Give me a second.
Bill Russell: 13:49 Sorry for that. Dead Air. Let’s see. So our final story is uh, uh, you know, one of my favorite people in healthcare, I haven’t met him yet and I look forward to, uh, uh, to the opportunity to getting to meet him. He’s from Philadelphia, home of the, uh, of the superbowl champion Philadelphia Eagles and the CEO of Thomas Jefferson University and Jefferson Health in Philadelphia. So he, uh, he wrote an article in modern healthcare in response to the, uh, Amazon Berkshire, jp Morgan, really focusing on what the impact could be. Oh, this is great. It’s a short read. It’s a great short read. I’ll give you a little bit of what’s in it and then I want to talk about the implications for, uh, for it. So, uh, let’s see. Are we, we, are we ready for one click healthcare? There’s a title, are we ready for one click healthcare?
Bill Russell: 14:43 That’s one of the promises of the partnership announced recently by Amazon Berkshire in JP Morgan. It is difficult to say if Amazon, if this partnership is going to disrupt the American health system, but one thing’s for certain, we’re going to learn a lot from the experience, their announcement, he goes on there. Their announcement is significant for reasons that go far beyond the combined one point 2 million employees. There’s medical costs they hoped to bring under control. This is a landmark event because it means the world’s most innovative employers are no longer content with healthcare to remain stuck in the ninety’s is something we said a couple of weeks ago on the, on the, uh, on the show. It means they’re tired of the lack of transparency, the massive inequities in care across the country, and the utter lack of focus on what consumers need. The qualities that define our current health system.
Bill Russell: 15:33 I, you have to love Dr Klasko for just saying it like it is. So healthcare is the only consumer product or service that doesn’t focus on the needs of the consumer. This has to change. Health focused corporations need to become consumer healthcare entities where the patient is the boss and he goes on to say further, the major healthcare industries have taken a slow and steady approach to changing dynamic because of preserving the status quo, but we don’t have the time for slow and steady. Only are one can imagine. Bezos buffet, Jamie diamond screaming, we’re mad as hell and we’re not going to take it anymore. They’re taking matters into their own hands and we should all join them. And that’s great for a health system CEO to be saying that. Here’s a list of things that he says that this partnership says about the future of healthcare.
Bill Russell: 16:23 He says, employers are watching their health benefit contracts ratchet up without an apparent end. Uh, that is one of the things that’s driving this. The second health systems need to get ready for a world where consumers can pick a with a click. If you’ve ever been in one of these benefits meetings, you know that the employees have different expectations of what a health system should be. And you just sit there and they’re like, where? Where’s my app, how can I do these things? And that’s one of the things is driving this is the, the, you know, Jamie diamond probably doesn’t want to go to another meeting of employees or he just gets hammered because of the healthcare experience and he’s sitting there going, I don’t understand how I can be spending one point 2 billion or whatever the number is on healthcare and the experience is this bad and there’s nothing I can do about it.
Bill Russell: 17:10 So you have to applaud that they’re getting out there and obviously the, the rising out of pocket burdens and a political grid grid lock are scaring people in companies into action. He went on to say in that section that it’s a, it’s time for us to stop sitting back and waiting for, for, uh, these things to come out of the government. We should be initiating. And uh, it’s a great read. Great. A great story. If you get a chance to, to hit that, hit modern healthcare, read this story. It’s really worth a really worth, worth the read. So, you know, so what is our response? What should our, from an it perspective be around this, and I think it comes back to a conversation we’ve had a couple times on the show around digital transformation and there is this, this a concept within healthcare that the consumer is finally starting to take center stage, so there should be a.
Bill Russell: 18:10 We should be cultivating a customer obsession. It should be a a significant priority of the chief digital officer, chief information officer, chief technology officer. What are we, what are we doing to foster that customer obsession and you know, it just some of the things to think about is identifying one or two service lines or specific a specific conditions and creating a a customer centered journey that really focuses on the experience of the consumer over that of the physician. Not that we don’t think about the physician experience or the clinician experience, but that we focus it on the consumer experience and say, how can we make this the best possible? You’re not going to do it across the entire health system. Pick one or two parts of the organization that is a that’s receptive, that’s open, that might already have a bent towards a consumer focused partner with them and educate them on what’s possible.
Bill Russell: 19:09 See if you can start to do some small experiments, move the needle forward. The, uh, the second thing I think we’ll talk about this somewhat next week when we have Charles Boicey on the line is a look at artificial intelligence. You should be doing pilots on artificial intelligence. It’s not something that we should be all in on just yet, but we should be doing pilots. We should be learning what does this technology have for us because it has, it will enable an awful lot of new models and new workflows that we haven’t even considered yet. So get your hands dirty, even if it’s a small pilot, even if it’s taking your favorite, a nerdy tech and saying, I want you to dig into these a to these platforms. And by the way, there’s, there’s, there’s a, there’s open platforms out there that they can tap into, uh, that are free that they could start to play around with.
Bill Russell: 20:02 We did that at, uh, at my previous house system and uh, and did some interesting things and not things that you would roll out, but we were, we were learning as we were as we were going. And uh, I think that the last thing I would say on this thing is a, we’ve got to start focusing on speed or a speed agility move faster. So don’t worry about perfect. Uh, I had a conversation with one of my former employees this week and he was frustrated on how many things they’ve started and had to trash because it just, you know, they get down the path and they’re, they find that something’s not gonna work in the data. The data’s not clean enough. The, uh, the, the, the tech stack doesn’t, it doesn’t work and they can’t scale it, whatever it is. And I would say, you’ve got to kill this mindset.
Bill Russell: 20:50 You got to kill this big project rollout mindset. You’ve got to do these little pilot projects, little projects incrementally focused in little steps. Building on top of it, obviously choose the right underlying stack, the right underlying infrastructure that’s going to be able to scale. You could look at, you can look at Amazon direction, the Google Direction, uh, the Microsoft direction. That’s if you are not a big budget organization that’s going to build it out from scratch with, with a bunch of open source things. That’s where I would, I would have, if you have the money in the talent, you could look in that open source direction and build it out, which is, which is what we did, but we had a little bit more budget than, than most do, but you could do it on those, on those open platforms and stop thinking about, we’ve got to build the perfect portal, rollout a portal with one feature.
Bill Russell: 21:40 Roll out a portal with it. Just get it out there, iterate to perfection. Don’t strive for perfection before you get it out there. We’ve got to start focusing on agility, speed, getting it out there. That’s the only way we’re going to be able to respond to this, this consumer obsession in the, in this move towards the consumer. So that’s probably enough, a new stories for this week. Uh, I’m going to close on a serious note and a highlight a, a, a post from our cohost from last week. So shade, she wrote a short but thoughtful piece on the, uh, the shooting in Florida and her blog post, she talks about the shooting in, her title is this can’t be the new normal and we’ve got to do something about this and I think we can all agree on this that this really cannot be the new normal and despite what people are saying about thoughts and prayers, I believe empathy and, and prayer have great impact and it’s the right place to start.
Bill Russell: 22:46 So my thoughts and prayers to go out for the people affected, uh, but now we have to have to work. And I think that’s the point of sue’s story. It’s, it’s not enough to end there. Uh, it does have great impact, but if it requires more, we have to look at the underlying causes. Now I’m really going to talk about this from a mental health perspective. I think this is a mental health issue and I just want to highlight and applaud the systems that have made huge investments in mental health and I know there’s a ton of them. I’ll just, I’ll just mentioned to andy and I apologize if you have a, a great mental health story, please send it to me. I’d be more than happy to highlight it. A, you know, providence back when I was with providence St Joe’s just before the merger.
Bill Russell: 23:30 A pledge of $100 million towards mental health in 2016 and I think it’s those kinds of commitments that are going to make a difference. Innermountain mountain integrated mental health screening with primary care and specialty practices and I think those are the kinds of things that are going, going to identify issues before they become, before they asked collate and uh, and, and we do. It is a hard issue. I was talking to my daughter about this last night and she’s like, you know, you can’t solve this from a mental only a mental health approach. And I agree with that. It is a very multifaceted, a problem that we are facing and it’s not gonna be easy, but I would encourage us not to take the easy solution, the, the quick, you know, we, we banned this clip or this assault rifle or whatever. There’s still thousands of guns out there and if this person wanted to kill, they could have done it with a car, a or, or with a drone or any number of things that are going to be around, uh, around the house that, that they could have done it.
Bill Russell: 24:29 I, you know, it’s. And so we have to address this from a lot of different angles, uh, from a, from a guns perspective, but also from a mental health perspective. I’m just going to close with the words from a Tony Tersigni CEO of ascension who after the last Florida shooting the nightclub shooting, uh, had these words to say, and I think it’s fitting a let us together as one nation turn our words and raw emotions into action with positive public policy that more effectively addresses the growing challenge of mental and behavioral illness. I can’t say it any better than that. So that’s a so that’s all for now. Please follow me at the patient’s Cio it. Don’t forget to follow the show on twitter this week in health it. And check out our website at this week in health it. Please come back every Friday for more news, commentary and, uh, information from industry influencers. That’s all for now.