Cloud and Machine Learning have arrived, CIO as Convener, CMS Big Announcements in a Discussion with John Halamka

Use cases are real, adoption is happening in the cloud and for machine learning. What the CMS announcements mean for the consumer in healthcare and how the role of the CIO has changed to a convener. Dr. John Halamka joins us for a fun look at the big announcements at HIMSS.

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Episode 10

Bill Russell:                   00:11               Welcome to this week in health it where we discussed the news information and emerging thought leaders from across the healthcare industry. It is Friday, March 16th. This week we cover big announcements from this podcast is brought to you by health lyrics, a leader in moving health care to the cloud. This is episode number 10. My name is Bill Russel, recovering healthcare cio, writer and consultant with the previously mentioned the health lyrics. And uh, in 2011 I became a cio for a pretty large health system, $5,000,000,000 16 hospital system in southern California and southern California. I immediately realized that I needed some, some people with wisdom, some people to help me chart the course. And so I asked around and people recommended I seek out the two johns from Boston, a glass or a. and lo and behold, the two johns were teaching a course at the Harvard School of Public Health called leadership strategies for it in healthcare.

Bill Russell:                   01:06               And it, it would’ve been a great course. It was just the two of them, but they also introduced us to some, some great people, Stephanie Real from Johns Hopkins, a Blackford Middleton. Uh, Dr t dot, he gave a phenomenal presentation on the value of the Emr on that week I was introduced to Ken Mandel as well, who, who helped me help shape my thinking around Ehr interoperability. Uh, it really was a wonderful, a wonderful experience. Today I’m joined by one of the professors for that course and one of the John’s a cio, Beth Israel deaconess. Dr John. Good morning, John. Welcome to the show.

John Halamka:              01:41               Good morning. What an honor it is, you know, as a 55 year old person, my next 30 years have devoted to mentoring those who will replace me. So it’s all about the students or are you still doing that course? That was a, that was a phenomenal course. Yeah. And so although it has been shaped and shifted a bit because remember that course came out of the meaningful use era and now we’re in the kind of post meaningful use era. So, you know, professors and topics are slightly different, but I’m absolutely in it every year.

Bill Russell:                   02:10               Well, that’s great. Uh, so you’re, I’m going to give a brief, uh, your bio is way too long to read on a 30 minute show. So, uh, two times cio of the year, the Harvard website lists like, uh, like about 65 publications that you’ve been a part of. It’s larger than that. It actually looks from that website, like you either retired in 2011 where they stopped updating it after 2011. Um, but I, I love when that site that it lists your 1980 national merit scholarship. So they, they really captured all the things that you’ve, you’ve, you’ve accomplished. Um, and clearly you’re a prolific blogger under the deep docker on blogspot life has healthcare cio. You also have a book by the same title and uh, art. So I’m wondering the blog, are you gonna you gonna change the blog to uh, you know, uh, don’t know, Geek farmer or what, what, what’s your, what’s the, any, any changes in store for that? The blog.

John Halamka:              03:07               Well, so fascinating question. Have you noticed that in 2018 the attention span of most folks seems to be reduced a bit, so that’s why it’s a 30 minute podcast. In fact, I’ve written thousands of blog posts and articles, but what I figured out is that people these days want tweets. They want facebook, they want snapchat, they want instagram. So what you’ll see is that although I’m still writing for the academic literature and writing books and articles and opinion pieces and that sort of thing, my social media presence has actually been reduced to, you know, sort of daily. Here’s a pithy thing you should learn about today. A little different.

Bill Russell:                   03:48               Yeah. This is a little different. Well, one of the things we like to do before we get into the meat of the show is just ask our guests, you know, what’s, what’s one thing you’re working on now? Or what are you excited that you’re working on right now?

John Halamka:              03:59               So you may know that I serve Bush for four years, Obama for six years, and the current president not so much. And so I’m spending much of my time internationally and so the bill and Melinda Gates Foundation asked if I would help unify the data of Africa and how do you deal with HIV, malaria, and TB, how do you deal with challenges of a mobile workforce? People whose names, genders, dates of births are probably not sufficient, are accurate for matching. So my current work, which is really interesting is deploying biometrics and Africa in a cloud based blockchain backed mechanism to exchange healthcare data for HIV care. So that’s live in South Africa today. Next step will be expanding to Senegal and Mozambique.

Bill Russell:                   04:44               Yeah, that was a, you sure that in the um, in the patient id section and it’s actually a, it’s amazing because generally speaking, I mean it’s better than what we have in the US. I think. I mean, I mean you’re really, you’re matching the patient data, you’re bringing that stuff together and, and, and bringing that data to the point of care, which is, uh, something that we still politically and for other reasons still struggle with in the US. It’s pretty amazing.

John Halamka:              05:13               But remembering us, we have extraordinary technology in medicine, but we have what I’ll call psychology problems, right. That is, there isn’t an incentive to share data or maybe a cio and see, you know, you had no gray hair before he became the cio were also stressed that we have to be so focused on, oh, I dunno, email reliability as opposed to interoperability. It just hasn’t floated to the top of our priority at the moment. Yeah, that makes sense.

Bill Russell:                   05:43               Here’s what we’re going to use as our framework for the discussion this week. We have a, I just pulled the modern healthcare story. It has it listed. Seven announcements. I’ll read off the seven, but you know, if you have another one or you want to highlight, that’s fine. Here’s the seven that they sort of highlighted. Big announcements from Google Announces Google’s out healthcare API. Cms. Seema Verma announced trump administration’s may healthy data initiative, which includes mud changes. And we’ll definitely talk somewhat about that. A certain role at salesforce, uh, their health cloud and marketing cloud. The healthy intense of lytic launched of political impact. United Healthcare is bringing Apple Watch, twitch motion wellness programs, cms to push blue button, two point. Oh, API for $53 million Medicare patients and epic has immigrated nuances, ai powered virtual assistants a into an Ehr. And these were just the top seven as you know, everyone’s sort of stores up there, big announcements for that week and there’s probably 100 others.

Bill Russell:                   06:47               So here’s what I’d like to do. What we’re gonna do is I’ll pick two. You pick two and uh, I’ll, I’ll kick us off here and I’m going to cheat as I usually do this. Why do a show so I can cheat? Um, I’m not really gonna. Focus it for our, my first thing. I’m not going to focus in on one specific item. I’m going to focus in on a trend that I’m seeing a that’s going on, which is this move to the cloud. Because if you look at the epic nuance, that’s a AI powered. That’s a move to the cloud. You have the, the salesforce health cloud, that’s a move to the cloud. You have Google’s Api and you did a session on cloud at the, uh, at the time event. And so I think it’s kind of timely, kind of interesting to talk about and I’ll just sort of sum it up this way.

Bill Russell:                   07:34               Eric Schmidt did the, uh, the, uh, opening keynote, and here’s a quote that I pulled out of there. So he said, get to the cloud, run to the cloud immediately. I can assure you that our data centers are more hipaa compliant, more secure, more efficient and better than your data center. Only after you get there will you have access to a host of new capabilities and then went on to talk about access that you’re not going to build out these ai and machine learning capabilities, uh, in your data center that you’re going to want to tap into the things that scale that the cloud brings. I’m also, Jonathan Bush didn’t interview Jonathan Bush from Athena, uh, went on to talk about, you know, another trend which is people want to, they want to develop directly into these applications and we need new architecture in order to do that.

Bill Russell:                   08:28               And he said, uh, I went from, we have a lot of other tech companies connect to Athena net to the base where we are now to, you’ve got to actually let other people build in Athena. So, uh, you know, the basic premise that I have is we class started off as an infrastructure play. So let’s, let’s get out of our data centers and let’s do Dr in the cloud. Let’s, you know, let’s go to Amazon web services, those kinds of things that have moved to more of an application deployment. Some of us did work day, some of us did box, some of us did salesforce and the myriad of other and Ehr are now trying to do a deployment models through the cloud. And uh, now it’s really changing to an architecture play the platforms or are allowing us to create new types of applications. And in healthcare there’s thousands of applications that, uh, still don’t, don’t live on top of these new models. And therefore they’re not open. It’s harder to share data. It’s harder to do some things. So, you know, let’s just start with my question for you is, are we, have we finally moved beyond the fat stage of the cloud? Are we moving to, you know, this is now something that healthcare ceos should definitely have a strategy for and be moving forward and I don’t know, a little bit more of an intentional way.

John Halamka:              09:49               So I think if summarize the transit hams extraordinarily well, which is, you know, move to the cloud, embraced open API and have a suite of apps that surround your transactional systems and truly engaged patients and providers in novel ways at why while all along, while adopting machine learning ai, these newer technologies while keeping everything reliable and secure. But so let’s ask, where’s the cloud? Great, where’s it not? As a cio, I oversee 145 mission critical applications just deployed to 40,000 to users access 12,000 times a second at 450 locations of care. You know, I’ve lived in the dream like you did. Now ask yourself, how exciting is it to wake up in the morning and wonder whether your vm ware slices are booting or not flat? It’s not in 2018. Interesting. I need to focus my day on how do I improve the doctor usability experience, how do I make that sort of patient stickiness to our healthcare system as opposed to the competitors healthcare system better?

John Halamka:              10:55               And if you look at traditional architectures, let’s take us. You and I are probably similar age. It’s 1995. It’s Foxpro or box. So you know it’s two to three tier client server. Like you can’t move that to the cloud, right? You need to have an architecture that says your web and mobile native, you’ve got Api and you’ve got this transactional system running in a place that’s very easy to connect to. So for me, I’ve moved seven petabytes of patient identified data to aws. I’ve moved my production clinical systems where I can write that Fox pro thing still can’t move where I can to the cloud and sure I’ve kept some on prem because you know, the Internet might disappear. I mean, it’s not a joke, right? I mean you’re going to North Korea or God only knows what state sponsored cyber terrorist activity to take out, I dunno.

John Halamka:              11:48               DNS routing or something. Right. So, so you to have some things local, but I really, really try to move things out of my data centers because I want to procure rather than provision services. And what your thought hymns 2018 is exactly what you mentioned, which it seems like, oh actually this is not a risk. It’s a risk mitigation because Amazon has 50,000 employees instead of your five. You know, looking at security when badness happens at the Internet, you think Amazon is going to route first, are you? It’s going to be Amazon that figures out a route around the problem we’re doing it. The Bas are sufficient, the reliability sufficient, but there’s one area that’s not sufficient and that is indemnification. So for fun, go call Jeff Bezos. Jeff, no. Let’s imagine a bunch of Amazon engineers go rogue and suddenly, you know, I don’t know, the HIV status of government officials is on facebook. Are you going to indemnify us against that? His answer will be no, Aaa, that’s great and you’ve got highly reliable, highly secure infrastructure, but I’ll tell you, it’s still early. Google, Amazon, NTT Data, all of them aren’t quite yet to what I’m going to call a single standard for paying. You should badness happened to your data.

Bill Russell:                   13:23               Right, and that’s A. I’m not sure that’s going to change. We had, we did have workday, we didn’t have a box. We did have salesforce, a Microsoft as well, and we have bas with all of them and when it came down to the Indian indemnification clauses, there’s not a single one of them would that would, would sign up for it and I don’t foresee that chain changing anytime soon. Do you?

John Halamka:              13:47               Well, I imagine this or two models to explore, which is I have a $25 million dollar cyber liability policy from Lloyd’s of London. So I say Amazon, Google, NTT Data, my, here’s my data. Oh, and by the way, I will protect around that with a cyber liability policy. But Michael Dell back when Dell was doing hosting, actually thought said, you know, I can’t make it an infinite indemnification, right? That would bankrupt the company. How about this? I’ll agree to pay you three times triple damages, you know, over what your contract value is. So you, you invest a million with me. I have a $3,000,000 check headed your way. If anything bad happens. Now, obviously that’s not exactly efficient. If I have 2 million patients in that cloud and the say average cost, what do you consider litigation media management, credit reporting, forensics. All the rest is 300 bucks per patient, you know, 3 million doesn’t go very far.

Bill Russell:                   14:48               Know one of the things the, you talked about Foxpro and, and uh, we’re both programmers probably at a different level. I mean, you programmed an Emr and I used to make applications within, within foxborough. The thing we loved about it is highly. I mean, you could customize the heck out of it. You can make it through exactly what you want it to. I think this is one of the drivers to the cloud though. Um, even though they are very, uh, you know, when you get salesforce, you get salesforce out of the box, but then you have this force platform on top of it and now all of a sudden you can build applications that you can really customize the solution. You can bring in Iot data, you can do a whole bunch of things to it. I think this is one of the, the new drivers to the cloud that, that, that we’re seeing is this, you know, and I guess Jonathan Bush also talked about this, that people want to be able to plug in new applications, new thoughts, new things into it, and the cloud is giving us a new way to do that that we haven’t really had since Foxpro to be honest.

Bill Russell:                   15:46               I mean people give you the Emr and they’re like, here it is, you know, if you want something, put in a, a request and maybe the vendor will do it, maybe they won’t do it. So what are your thoughts on that?

John Halamka:              15:58               Totally correct. So we call this at a bid EMC, the EHR plus strategy. And what does that mean? So it turns out I have five clouds of EHR, right? It’s, I got an Athena cloud, get any clinical works cloud, a Meditech cloud and epic clouds and self built clouds and they’re all fire enabled. So what we say to this 26 year old in the garage, you know, you have this beautiful function that doesn’t exist in the EHR. And what if we get input data from the transactional system using a javascript object notation from the cloud. Can you plum that? And the usual answer is in a weekend, right? You know, it’s like, oh, here’s a new, Oh, our productivity application is Monday, good enough for you. And that’s literally what we’re saying. As long as you cloud enable your data and your transactional applications with standard based specifications on fire, that ecosystem of APP developers can just rapidly deploy what you need.

Bill Russell:                   17:04               Well, we spent a lot of time on cloud. I’d love to love to hear what your, your first big announcement you want to talk about

John Halamka:              17:11               miss you. I know this is going to sound like the Gartner hype curve, right? But I thought the theme of fear of him in 2018 was machine learning. Right? And you had to be careful. What is machine learning? It’s not, you know, Watson is going to replace doctors. I mean, that’s not what we’re talking about. We’re talking about boring, prosaic stuff. And let me give you an example of what I went live with yesterday. Now I hope you’ve never had to have surgery, but if you’ve ever had surgery, you know the doctor can’t put a knife in you without a consent. Have you? I mean you were a cio, you know what a nightmare it is to track down thousands of pieces of paper coming from doctor’s offices all over humanity with a handwritten wet signature on consent. And so fine, you digitize this or that and you have econsent.

John Halamka:              18:01               She’s still a nightmare. What do we do? We ask Amazon to monitor our fax machines. Now. What’s that all about? We trained Amazon machine learning services to recognize consent forms. And so what happens, this is literally the application. Amazon is a listener on our facts traffic. And when it sees a consent form, it knows how to identify the patient on the consent form and then writes me a fire Api, a check box into the EHR that says Ken sent received. They’ll does so wow. Suddenly no armies of humans searching stacks of paper and Amazon just does it for us with 99 point nine percent sensitivity and positive predictive value.

Bill Russell:                   18:52               Wow. Did that require you to move your data out or is this just. I mean, you could have done that without moving your petabytes of data out to aws.

John Halamka:              19:01               And the answer is it just turned out to be a little easier to plum because I have my ehr in aws, so. Right. Connecting and Amazon machine learning service to an APP that’s running an aws. It was like minutes, right? You don’t need to worry about, there’s no firewalls or vpns or any of that other crazy stuff, but you’re correct as long as you move to this sort of Api approach, uh, it could have been possible for Amazon’s APP to call an Api even at a distant site.

Bill Russell:                   19:32               That’s interesting. So, you know, last week I said that some of the overhyped themes were a ai machine learning were, were some of the things you walked into a booth and they said, you know, we have, you know, we’re using ai, we’re using machine learning of course, if you ask them to distinguish between machine learning and ai, that they really couldn’t do it. It’s just, you know, well, it also is indicative of WHO’s working the booth floor versus whatever. But, um, but these technologies are real. We saw, I count like about 15 to 20 real world example. The three m booth was interesting. They have real world examples where they have applied these things because of the new, uh, the ability to move things through the API, the ability to free this data. Um, and uh, and now the computing power that’s available, it really is only limited by our creativity to start thinking about what things that are very manual today that we could, we could then automate by plugging these things in or, or other tools that are out there. And there. The great thing about the cloud as you could, you literally could fire it up this afternoon with a credit card

John Halamka:              20:41               and you’re totally right. So when I talk about the machine learning applications we’ve deployed, they’re literally written in a weekend and so here’s another example. I built an API into our, our scheduling system and I now have access to millions of previous our cases, doctors and patients. I don’t use the names, that’s not important, but the patient say, what is the procedure or what is the comorbidity? So what if you say, Hey, Amazon, I’m bill needs an appendectomy. How much time should we allocate? Well, oh, bill is a 53 year old person with no comorbidities and the surgeon is Dr. famous who’s done a million appendectomies, the answer is 25 minutes. So we just did that. And what did it do? It freed up 30 percent of our, our schedule.

Bill Russell:                   21:33               So here’s the, here’s the question. So with Cio’s from across the board, so you’ll have a cio from a rural health system. You have a cio from a multibillion dollar large health system with $100,000,000 budget. Note, this used to be something that only the $100,000,000 budget cio could really talk about if, if, if you were, if you were the cio of a small rural health system, are there things you could start thinking about and tapping into that you couldn’t do before because this stuff is available,

John Halamka:              22:02               right? And so we’re an open source shop so to speak, and that is everything we do. We open source to the world so you can assume, you know, fine, we might prototype something for you, but then it’s going to be available at Google or Amazon or other provider you just lift off the shelf with your credit card for 49, 95. So I guess the one advice would be make sure your ehr vendor provides these fire Api, you know, move to cloud hosting if you can, and then you can just take advantage of this library of all this other stuff. And it is one final example for you, Beth Israel deaconess going through a merger right now, $5,000,000,000 merger has health care gets better by getting bigger. You remember that?

Speaker 3:                    22:47               Okay.

John Halamka:              22:48               Our philosophy is even though you’re going to be running epic here or Meditech there, these apps as so just lift them off the shelf. Plug ’em in Don.

Bill Russell:                   23:05               Alright, sorry. Had a technical glitch there for a second. You know what? Let’s let’s jump to your favorite topic. I know, I know you. You’ve worked in a lot of different administrations and this is not really a left right issue on the political spectrum. This is really about interoperability. We want better care through interoperability and I’m just pulling up the article from the magazine, so I’m going to cover is some of the announcements from cms and the administration. I think the thing we can agree on that, the closing sentence here is we can effectively transition. We cannot affect the transition to value based care system unless we transfer all of the clinical and payment data to the point of care. Uh, I know we can get their care of doctors have all the information. I’m not sure if that statement specifically, but common ground would be the more information you have at the point of care that the better care you’re going to receive.

Bill Russell:                   24:00               And that’s, that’s the promise of interoperability. So here’s, here’s some of the announcements. I’m curious. I’ll just read some of them and I’d love to get your feedback. So, uh, so for data to flow freely, this is a quote from Seema Verma, uh, the uh, cms, uh, administrator for data to flow freely. She said there would be, there’d have to be an overhaul of meaningful use. And the full ballroom at hims 18 broke into applause. So that surprise you that they broke into applause at all. So meaningful use built a really important foundation. Absolutely. I how I, I firmly believe healthcare still would, would not be digitized if we didn’t do mud.

John Halamka:              24:46               Stage one was great. I mean Dave Blumenthal, John Glasser and the team put together a good floor. It started to unwind and unravel at about stage two. Where then what ended up happening, unfortunately, is that every federal government department decided to make meaningful use. It’s policy lever. Oh, I think we should have implantable devices using universal device identifiers. We should record social determinants of health. We should stamp out at Bola. And every one of those was layered on top of Smu. And so what ended up happening is it co-opted the agenda of every healthcare vendor and every provider in America. What should have happened is we should have had but I don’t know, stage one and stage one plus and then stopped. And so what we’re dealing with now when you’re talking about stage three is it’s just not relevant, right? We’re living in a world of machine learning and Ai Apis and clouds and it’s still with what are the 17 quality measures for diabetics you’re going to. And it’s like, oh, stop.

Bill Russell:                   25:52               Instead of. So what they say is a, you’re going to see a series of the proposed rule changes by the end of the year. Uh, should we just, should we just say it’s had its day and, and end it, or should we, should we try to modify it?

John Halamka:              26:07               So here was my complaint with both stage two and stage three. If that said, you must drive a prius. Wait a minute, I have a volt. No, I have a tesla. No, no, no, no. It has to be a prius. Well is the outcome that you should be able to drive a vehicle with low pollution? Well then let me buy what I want to buy. If I want to use a skateboard, that’s okay too, you know, getting some exercise and that’s why we need to scrap the current meaningful use construct and what we need to say the outcome is that patients and families are going to better engagement because we’re building tools, but don’t tell me what tools or how to build those tools because in my case, believe it or not, I mean I’ve built 30 Alexa skills and so it’s like you got to have Alexa on your desk and say, you know, make me an appointment with my cardiologist. I mean, as opposed to what an EMU made say is build a portal and have a check box will know. So I love this idea. Energy. Say it’s a political. It’s not right, it’s not left. I would say let’s have an outcome we want to achieve and then let the market figure out how we might solve that best with emerging technologies.

Bill Russell:                   27:18               Yeah, I agree. I’m going to read a couple more things here. So, uh, continue to quote, we’re changing to a new era of empowered consumers. I love the fact that we’re finally using that consumer, uh, the term, uh, we, you know, we can talk about that. So we’re changing to a new era of empowered consumers. We are putting patients first and making sure patients have access to their healthcare data. You’re hearing that from the White House as well. We’re very clear that patients should have their data and access to it in a timely manner because that will increase the. Actually this quote is silly at the end, but that will increase quality duplication and testing. Well, we don’t want to increase duplication so I’m sure it was whatever, but, but generally the thought is if we give it to the consumer that is going to help to change healthcare.

Bill Russell:                   28:06               And, you know, one of the, one of the articles I wrote a while back is I have this theory that if you did give the patient a data to the, to the patient, if the patient had all of their data, and I, I love e-patient Dave and I, I’ve, I’ve had him speak at our health system. Um, you know, I think it would, it would really change some things if I had all my data and every American, uh, had all of their data. I think you’d see a couple of ecosystems arise. You would have, you have cloud providers come in and say, hey, give us your data and, and will add value to it. You’d have researchers come in and say, hey, give us your data and feel good about yourself. You’re going to help us to cure cancer. And you, you may even have Pharma come in and say, hey, give us your data and we’ll give you money.

Bill Russell:                   28:49               I mean, it’s, your data has value to us and we want to compensate you for the value. Um, are we at a point now where there’s enough momentum behind this or are we still caught up in your doctor as well? So are we still cut up and they, we don’t want to give data to their patients because they don’t know what to do with it, which is, you know, judy quote, I think she got caught on. But um, but that is a sentiment that I found talking to a lot of physicians. I don’t want to. I’m trying to protect the patients. If they had this medical record, they might make the wrong decision. Where are we at on this?

John Halamka:              29:23               Sure. So I think you’re absolutely right that the era of consumer empowerment is here and any restrictions on data flows are gone. Where Judy got in trouble and where I’ve gotten in trouble, I’ll just tell you, it’s because the intent of what we’re meaning is just telling a patient their serum sodium is 1:39 isn’t very exciting. I have no idea what you just said as opposed to saying, ah, I’m going to fluidly give you all your data, but I’m also going to help you navigate the healthcare system, which is, here’s how you make an appointment and here’s how you get a referral to a specialist at, Oh, here’s a machine learning plugin that’s going to compare you to 10,000 people like you. I mean, those things have value is, that’s really what we want to have, not just a portal where you can read your serum sodium. And so, so absolutely. Beth is ridiculous. Been sharing notes with patients five years. Everything about you includes you and we just started an initiative where you are writing the note that goes back to the medical record and so the doctor could say, oh, I think you’re depressed. And you can say no, you know, I’m just, uh, you know, not energetic and uh, it’s rainy or whatever, you know, you put in what you say, what you think as part of the medical record. So that’s where we are.

Bill Russell:                   30:44               Wow. So that is where we are. So let’s see. They also announced my healthy data and um, I don’t know, you know what, let’s just for a second and I’ll, I’ll, I’ll let you choose the last story. Whatever you want to talk about. Everyone’s throwing our apis around like it’s the shore to everything that ever existed within healthcare, but we started this data challenge, right? So, uh, my data, my house system is different than your data and your data from one physician to another could be, could be a challenge. Uh, how much is our API is actually going to solve and how much do we still have a huge heavy lift with, with our data to, to clean it up and get it ready to, to be meaningful when we actually move it.

John Halamka:              31:28               So you’ll highlight a really important point. So if you read that trusted electronic framework and common agreement, it says, oh, we’re going to put apis everywhere for everything. We’ll know, right? Ap Eyes are fine. If the use case is query response, you know, I want to get my data from a doctor’s office. Our API is useful for saying for the last 10 million patients like this, you know, what was the morbidity and mortality? No. So what we need going forward is apis for certain architectures and use cases, CCDA, payload transmission for others, bulk extracts and Etl for others. Right. So pick your technology based on the use case and application and then you’ll be fine. Apis are very important because it does allow this ecosystem of apps to evolve, but it’s only one part of the puzzle.

Bill Russell:                   32:20               Right? Well do you have another story you want to or or theme from him? So you want to highlight?

John Halamka:              32:26               Sure. And that is that the role of the CIO has changed. Totally right. So back again, since you and I are of similar age, we were software developers and architects and we can tell you what ram do use based on its transactional speed. Do you think any of that matters anymore? The answer is what you need as a cio in 2018 to be is a convener. You understand business requirements and strategy and then you take that and procure services from multiple cloud providers. I’m plummet together and so it’s just so funny. I have an mit engineering degree, you know, I had to be a doctor, engineer, politician, economist to survive the 19 nineties, but today unbelievably, you’d probably best be associate ologist. It’s all about people.

Bill Russell:                   33:21               Yeah. The role has changed to how can you help the organization to navigate change and that is helping people to understand the vision for hey, here’s what’s possible and then bringing them together to have a conversation of, okay, if these are all the things that are possible, what should we be doing? What should we be doing? Something different in the Boston market then than they are doing in southern California probably. I mean our, our environments are very different in our communities are different and there are things that are probably a priority here then in art therapy, but we’re people that lead those conversations. It’s really fascinating to me. The other thing that’s fascinating is I had a fair number of conversations at the time for him and a whole bunch of the ceos that have been pushed into this operational role and then you’ve seen these other roles sort of elevate chief digital officer, chief innovation officer and uh, and, and I’m not sure the cio, the chief information officer knows what to do now other than, okay, well my job now is to keep the emr running to make sure that the data center runs to have Dr Capabilities and even security somewhat.

Bill Russell:                   34:28               I mean not the implementation, but the oversight of, of security has been taken away from them as well. And they’re saying, okay, my job, they really have become more of a director of infrastructure and technology than, than a traditional cio. I mean, what do you say to someone who’s saying, I want to get out of that trap, how do I get out of that trap and how do I differentiate myself in, in that space?

John Halamka:              34:54               Right. So I became a cio in 1996 and as a cio I was the chief digital officer, chief innovation officer, chief medical information officer and the CSO. Right. And so what have I done over the last 22 years? I’ve actually, I’m the air traffic controller, right? But I have carved up the office of the cio into five different components. I mean the ones that you just enumerated because that’s the nature of how the work has to be done these days. So fine. Tell us cio, you’re a sociologist, it’s a change management activity and you’re a convener and you have these experts working for you at these individual domains. You can’t do it all yourself. It takes a village. It does take a

Bill Russell:                   35:38               village and it is. It is a larger job than any and people should not be concerned that, hey, they just hired a chief innovation officer and they just. Because they’re very different roles of chief innovation officers working with VC and private equity and and looking at deal flow and a couple of other things and as the cio that also actually overlook security and whatnot, you just cannot do it all. There’s just no way anymore.

John Halamka:              36:01               So absolutely true. And so these days I spend a lot of time, as I mentioned internationally, so I’m working with entrepreneurs in Israel. I’m working with entrepreneurs in China and so imagine the Cio who’s worried about whether the Emr is fast or slow and Oh, I’ve got this great new project in Wu Han is like, uh, I can’t pay attention to that. So that’s why the innovation role has the freedom to explore these new things that are a little bit tangential to operations.

Bill Russell:                   36:29               Yeah. Alright. Well here’s. Were we usually close out with your favorite social media posts for the week? Do you happen to have one or, or am I surprising you now?

John Halamka:              36:38               Oh, well, you know what? Harvard faculty say, the favorite posts a week written by me. Sure. What do you got? Right. And so you’ll see a twitter post and the next two minutes or so where I thought a very novel means of communication. I’m just going to sound so silly to you, but the northeast has had a torrential winter. It’s been horrible. I have to buy a new chain saw. And so the guy at the chainsaw store emailed me a photo of a message on his apple watch saying when my chainsaw would arrive, that’s, we are now reduced emailing pictures of apple watches to each other. Who would have thought,

Bill Russell:                   37:17               oh man, that is a, that is a sign of the times. My, you know, my post is a little more traditional. I guess I’ll have to quit my own going for. I think that was a possibility. Um, I thought it was interesting. There was a hymns had a very lively twitter feed during the event they had a couple of polls. This one was what will the biggest impact of newcomers like Amazon, Google, salesforce, and apple and other traditional technology players entering healthcare, you know, what will the impact be? And it had four options. Spur innovation, increased confusion, grow vendor consolidation and improves user experience and looks like we’re split. I mean, it’s a pretty, you know, spur innovation. Sure. Thirty percent increased confusion. Sure. Or 20 some odd percent improved user experience. Sure. 30 some odd percent. The answer is we don’t know. There’s been so many missteps and we’re just gonna we’re gonna. See is everybody else sees. So John, thanks for being on the show. That’s, that’s really all for now. Uh, please follow John at [inaudible] on twitter at Jay Halamka and his a geek Dr at our [inaudible] dot Why you stayed with blogspot a long time. It’s been a pretty good platform for it.

John Halamka:              38:29               So far so good.

Bill Russell:                   38:30               Yeah, that’s, that’s great. So if you can follow me at twitter, at the patient’s Cio, uh, my writing on the health website and health system cio, uh, every other week I get an article out there and don’t forget to follow show on this week and hit and check out our new website this week in health And if you like the show, please take a few seconds and give us a review on itunes or Google play. And if you don’t like the show, please send me an email. Tell me what you’d like to see us do. So please go back every Friday for more news commentary from industry influencers. That’s all for now.

Speaker 4:                    39:04               Thanks so much.


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