Dr. David Bensema joins us to discuss these stories: Does Epic hinder innovation? Depends on when you ask | Panel charged with improving nation’s health IT infrastructure set to meet.
Plus Google Glass, breaking down the wall between physician, computer and patient.
Also, should we all be considering Hamburger U?

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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. This podcast is brought to you by health lyrics. This is episode number three. My name is Bill Russell, recovering healthcare cio, writer and consultant with the previously mentioned health lyrics. Today I’m joined by David, Dr David beds, former Cio for Baptist health in Kentucky. Welcome David.

David Bensema:            00:39               Thank you very much, Bill. I appreciate the chance to be here.

Bill Russell:                   00:42               Yeah, I’m looking, looking forward to the discussion. So, but before we get started, why don’t you give us a little idea of what you’re working on these days and what you’re excited about.

David Bensema:            00:51               Alright. Well my number one job now is retirement and so a lot of travel and time with grandchildren, but it’s also offered a chance to do some more reading. And one of the things I’m very excited about is it’s given me a chance to circle back with the number of folks that I’ve mentored over the years, check in how they’re doing and be able to offer myself and, uh, my time to help them continue on their journey. The other thing that I’m excited about is the back that we are now in regards to Ehr is at that point where almost every system has a, most physician’s offices have them, even with the pain points. It’s a period of enhancement of utilization. It’s the time when we’re now finally approaching some of the hard questions like interoperability and I’m the end user interface in meaningful ways. And so that has me very excited. This is a great opportunity for, uh, folks in it to enhance and better utilize these significant investments that our systems have made.

Bill Russell:                   01:56               Wow. So, so a retirement, so grandchildren catching up on your reading. Um, yeah. You know, and I’ve heard from a lot of ceos that they wish they had more time to read and to catch up on the news, which is one of the reasons for this podcast I liked, I liked the fact that you mentioned, uh, catching up with the people that you’ve mentored over the years. Um, I mean that, that has to be really rewarding to see people move a move up and move on in their careers and, and, uh, you know, to, to still have a place to speak into their lives and, and be a support for him. I would imagine that that’s pretty rewarding for you.

David Bensema:            02:35               That’s an absolute joy. And you know, one of the things that I reflect on it, yes, the greatest joy and pride in regards to my time as Cmo, cio at Baptist health is that we had a strong succession plan in place. And when I stepped away, Trisha Julian and Dr Brett Oliver stepped in and the system never missed a beat. In fact, it’s accelerated. And that’s what I did best, um, was get out of the way and let some really good people do their job, but having prepared them in advance so they could do the job.

Bill Russell:                   03:07               Yeah. Well, that’s a great model. I, uh, I appreciate the humility in that. Getting, preparing to step out of the way. It’s a good, good thing for a cio is to take away from this. So let’s, uh, let’s get started. We’ll go into our first segment. Let’s take a look at what’s in the news. Um, so, you know, we each pick a story. I picked this story. It’s a, it’s interesting to me. I think it speaks to maybe some feelings that are maybe under the surface out there in the industry. The story is, does epic hinder innovation? Depends on when you asked. There’s a, uh, a couple of stories. The, um, there’s a story from modern healthcare, uh, monitor health care, but there’s also a story that was in one of the business journals and uh, you know, the business journal had the CEO for Minneapolis based fairview health systems saying some pretty, uh, pretty interesting things. He essentially said that the electronic health record, um, uh,

Bill Russell:                   04:13               well, let me just read it. It’ll make it a lot easier. He said, I will submit that one of the biggest impediments to innovation in healthcare is epic because of the way that epic thinks about their intellectual property. Have others that develop on that platform. Uh, he went on to say, um, he calls for a march on Madison, Wisconsin. Um, he says, epic has architected an organization that has an added his belief that all good ideas are in Madison, Wisconsin, and on, and on the off chance that one, one of us think of a good idea. It is still owned by, uh, is owned by the Madison, Wisconsin Company. However, you know, you fast forward two days and, uh, this is, this is a press following up with their health system with fairview health system. On this, it says, despite adding to the Sea of complaints about the EHR companies, fairview health system services leaders are optimistic about working with their vendor epic systems.

Bill Russell:                   05:15               Uh, that take on the relationship came a few days after he blasted epic for hindering technology development. The Not for profit 11 hospital, uh, 11 hospital health system then took a different tack saying Ehr vendor does in fact help innovate. So what happened? Um, you know, James overstepped here and he’s trying to walk it back and I think we should let them walk it back. We’ve all made these kinds of mistakes in our careers where we got out over our skis, maybe said something that, um, that we shouldn’t have. You know, if your hospital runs on epic, there is no need to have an adversarial relationship with that vendor. You just, you don’t want to have to overcome the complexities of innovating in health care while trying to handle strain relationship with the vendor. Uh, with that being said, um, uh, know it’s an interesting conversation, David, to talk about the, that was the place that Ehr vendors sorta reside in this innovation play. Uh, you know, are, do they hold all the cards? Are they, uh, you know, are they just a piece of the puzzle and you know, what, what was your experience working with your Ehr vendor? You don’t have to mention them by name, but what was your experience working with your Ehr vendor? I mean, did you feel it was a little of both that they hindered in some areas and move to Ford or, or. I’m just curious what, what your experience was?

David Bensema:            06:39               Yeah, I think it is a two edge sword. I think it hinders innovation and that you’re trying to stay with a foundation system. You’re trying to minimize some of the unnecessary variability out in the markets. And in our system we were really more of a constellation of hospitals when we started our journey to an integrated Ehr back in 2014 and it was a big part of us becoming a system. So we wanted to eliminate some of the variability product helps that in that it was going to be integrated across our entire system. But then there was this feeling by a lot of our users both in nursing finance positions. Yeah. They were getting hemmed in by the foundation system. Uh, what they now see is that in having a, the products across the system having standardized, um, so much they now know the product well enough that they can in fact innovate off the platform with confidence because they know how it responds.

David Bensema:            07:48               They know what the guardrails are and they’re moving fairly quickly through their enhancement. Other people call it optimization. I don’t believe you optimized because that’s in first there’s an end point of perfection that you reach, you don’t, you, you continue to enhance. And that enhancement is actually facilitated by the structure of the Ehr and by the fact that it was put in as a foundation product across the system and got us to a common platform and a common starting point. Now we’re watching them, uh, have enhancements and in fact had put in a very wrong change control process. Who makes sure that we didn’t respond to the opportunities too quickly. And to your point, get out over your skis, you know, get, get ahead of ourselves and overrun the change capacity of our clinicians and end users. You have to balance it. So at this point in time, I don’t see Baptist health being impaired in its capabilities, but I can see where somebody would feel that from draining yourself. Foundation system, um, is a blocked innovation because you say if my product can do it, we’re going to use it and you don’t look at some of the third party softwares out there. You don’t look at some of the alternatives, but later you have the opportunity to create those alternatives within the platform.

Bill Russell:                   09:22               Yeah. It’s interesting because, uh, you know, one of our future guests and marks and I had a conversation I think about two years ago and we were just just getting ready to go into our EHR, a consolidation. We had nine different EHR platforms across the 16 hospitals and I asked them, you know, about. We were talking about the, the fact that his organization does internal surveys and they had a very high approval rating for the it organization. I some, how is that possible? And he said, well, you have to understand where we’re six years past our EHR consolidations. He goes in and when you baseline on the day of going live, it’s going to be that the lowest point within the organizations, uh, satisfaction with it, but if you stick with it and you continue to iterate on top of it, um, that, uh, you know, you’re going to be able to build a pretty good system around the workflows that, uh, you know, the clinicians really need.

Bill Russell:                   10:22               And over time, the, uh, the organization will, um, will start to appreciate the platform. I’m not sure that everybody has sort of experienced it that way, but there’s a, there’s obviously good implementations and bad implementations in California. We did not have necessarily the same environment that you did in that, um, there are, there’s not an employed physician model, so there’s a foundation model, but it means that there’s a lot of independent physicians in the state of California. So for our clinically integrated network, we literally, there’s not an exaggeration, literally had a spreadsheet with 100 different Emr is on it that we had to figure out a way to build a clinically integrated network across which requires a data sharing. Um, uh, analytics. And some, some form of a digital channel to try to engage the patient. Um, and that’s really where my thoughts on this are sorta live.

Bill Russell:                   11:16               I know a lot of people think, hey, we’ll get to a single EHR provider and then we’ll be able to do everything we’re going to do. Well, that’s almost impossible in the state of California and really what I was looking for from the ETF provider for innovation. Which two things, um, access to the data by directional where possible and access to present the data back into the workflow. So if I could embed something into the tab into epic or a tab into cerner where I can present some data back that has gone through maybe machine learning or ai. Um, I think we complicate this sometimes and if the EHR providers could provide those two things, access to the data that we could start doing some things creatively outside of it. Um, maybe move some of the data elements back in and a, in a way to present it back into the workflow. I think we can see an awful lot of, uh, innovation, uh, come our way. Um, all right, so why don’t you, why don’t you set up your, uh, your story and, and, uh, and we’ll go from there.

David Bensema:            12:17               Yeah. And so the story that comes out of modern healthcare and multiple other sites that I was looking at the modern health care article regarding the health information technology advisory committee, this committee was of course setup by last year’s legislation and the cures act and as with so many things set up by legislation is taking nearly a year to have the, the group sit down for their first meeting, which they actually did a week and a half ago. Um, but my reason for wanting to put this article in a couple of the quotes, uh, which feel a little bit like, um, me standing on the first tee of the golf course in saying that I just bagged 26 bags of leaves yesterday. I’m making my excuses in case I play poorly. Well, no, we’ve all done that. And so the one quote was given the lead time prior to the committee’s person meeting, now more than a year after the signing of cures, it may be challenging for the committee, the ONC, and the secretary of hhs to meet all of our lead, all of the legislative requirements.

David Bensema:            13:29               This was Dr Steven Lane, a member of the committee. Um, yeah, and he’s a terrific guy from sutter health and then it goes onto, but he’s optimistic that the group will successfully and positively side federal health it policy and regulations. So I take some hope there. And then the other quote was, as it’s currently written, I worry the trusted exchange framework and common agreement is overly prescriptive. This came out in the onc is overly prescriptive in ways that might jeopardize sustainability and usability. And this quote was from Sasha [inaudible], uh, the director at epic systems. So I’m always concerned when we have this new opportunity, those of us in the industry who heard about this opportunity, he got very excited that, hey there, they’re going to take some information. They’re going to take input from folks who are boots on the ground. And then the first thing that comes out is really a little hedging of the bet.

Bill Russell:                   14:33               Yes. So let’s go back and forth a little bit on the 21st century cures act is, is actually a really good piece of bipartisan legislation that sets up, you know, policies, procedures, standards to that will facilitate the exchange of patient records in a secure way, um, between, uh, between all entities. It’s setting up a network of networks, if you will. It has at its core. I mean, that’s not all of what the 21st century cures act, but this is how it’s really impacting health it systems. Um, right now this is sort of a, you know, they have some voluntary stuff out there, but if this, it proves to be the same as other things, you’ll start to see it move into an incentive based and probably a carrot stick kind of thing. Um, so you know, the, the, the 21st century cures act, it really does have a lot of potential. I mean, I think we would agree with that.

David Bensema:            15:31               Yep.

Bill Russell:                   15:32               Yeah. So we’re so has a lot of potential, but it took a year to set up this committee, which is kind of amazing and may show the pace at which this things moving. I guess my question to you is, we all agree I have yet to talk to somebody who said, you know, interoperability is important and it’s not, uh, something we were all striving for. So we all agree that it is, is the government going to be able to move this as fast as the industries currently? Do you think the industry is going to move faster, uh, or, or the innovators are going to move faster than, than maybe the government can get this thing in place?

David Bensema:            16:10               I think the industries, some continue to find business case that requires interoperability to function well, whether it’s for your cin that work or it’s for, um, some other care management. I don’t think population health is possible. I’m in a really meaningful way without interoperability. So I think the industry is going to push really hard. I do take heart that there are some very good people. When you read the entire list, you look at some of the lake appointees to some of the folks who were announced in November, like Robert Bob Farmer, a president of the American Medical Association. I’m the global chief medical officer for DXC technology who has been a voice for a very long time and it from medicine. Um, and then you look at Steve Radiate out of global, who was Mitch Mcconnell’s, um, appointment. And Steve led a very successful epic implementation in Norton Healthcare and has done a lot of great things with his team to move their use forward. Um, there are some folks who have a real can do attitude. And so I hold hope that this group, we’ll find themselves invigorated by each other’s presence. Go through the storming and norming process of any group, but hopefully have their meeting cadence be fast enough to be frequent enough

David Bensema:            17:34               that they can catch up

Bill Russell:                   17:36               with,

David Bensema:            17:38               you know, where we thought they should be.

Bill Russell:                   17:40               But

David Bensema:            17:41               they are not because of the delay in putting the group together. Now that the groups together, I hope they themselves start to call for more frequent interaction

Bill Russell:                   17:50               so they can get to the next stage quickly because there’s a lot of can do people here and you know, Bill, you, I lived can do with our implementations and we had to

David Bensema:            18:01               focus on teams who attitude not on focusing on the negatives or on the impediments. So I think this group has great potential. Um, I would have liked to have seen a slightly more positive initial article, but I bet we’re going to see some good stuff coming out of them.

Bill Russell:                   18:18               Yeah. As well. I know people on, on that, in that group and that I would love to be at that table. So an exciting group of people and I think are really, you know, well positioned to do something. Yeah, I’ll close this out with it. Know genevieve Morris is the principal deputy national coordinator for health information technology at the ONC. I don’t know how she fits that on a business card, but um, it’s a great quote. She says, uh, and again, we’ve all been saying this, we have to shift the market from competing on holding data itself to providing services on that data and, uh, you know, that goes, it goes all the way back to, uh, I think we’ve all been sort of thinking that and saying that, uh, but even, you know, Todd Park back when he was cto, RC IRC, cto for the federal government, I came up with a blue button and some other things in his whole mantra was that whole idea of stop competing on the data and make it available.

Bill Russell:                   19:16               Um, all right, so let’s move to our second segment. We talked about either a leadership topic or emerging technology, you know, if you agree to come back on here, I will. We’ll talk about mentoring I think in one of our next, uh, get togethers. But today we want to take a look at, uh, at Google glass. So I’m gonna let you, uh, Google glass, you know, is something that we thought Google had sort of killed off, but it has new life within healthcare. Why don’t you give us a little idea of how it’s being used in healthcare and, and, uh, maybe how it’s addressing some of the challenges that, that a health systems might face.

David Bensema:            19:54               Yeah. So several years ago a lot of us were excited about Google glass. We had a couple of our physicians who were wanting to use it and we tried to do some, uh, internal piloting and use voice command to move the cursor around, um, and allow them to use it. There were some glitches and some difficulties and I think other industries found similar issues and we thought it was holding, but there’s folks like augmetics who have partnered with, um, in this case a sutter health is one of the groups kind of leading the charge in looking at how could this be used in healthcare? How could this help two enhance the physicians utilization of the Ehr, get the EHR somewhat more out of their way by using google glass with, um, offsite, realtime, uh, scribing and reduce the paperwork or the input time at the end of the day for the physicians. And this company is trying to look at what this can look like. There’s a lot of potential in the technology, uh, but we can talk about some of the concerns that or not

David Bensema:            21:13               I mentioned in the, at least the article that I had pulled up, um, concerns about what are the difficulties of adoption, um, what needs to be overcome and, you know, what are the next steps? Uh, but I think Google glass is the technology that it staff ought to be aware of and you know, it’s the first thing that I would know about is what it’s going to be needed for support and your more on the tech end than I ever was as a physician who came in to the cio role. Uh, but you can probably speak to some of the things that it teams ought to know.

Bill Russell:                   21:52               Yeah. So this is, you know, it’s an interesting technology and we were uh, we were piloting this in our, um, in our medical group when a torch torch my departure with the health system. And, you know, it’s, it’s really kind of a basic technology. It’s, um, you know, for all of its, all of its cutting edge aspects of it and I think the guys that augmetics are doing a phenomenal job really getting the word out there, a, you mentioned sutter obviously dignity and just a ton of others. I mean the, there really getting the word out there and using it, but at the end of the day, and maybe it’s changed since I’ve looked at it a year and a half, two years ago, but, um, it was a glorified a dictation system. But let’s, let’s be clear, the value is in and breaking down that barrier between the physician and patient because instead of staring at a screen now, they’re actually looking at the patient and even though they might have these glasses on, they, uh, you know, it’s being recorded.

Bill Russell:                   22:54               It’s being a, uh, it’s being transcribed by somebody. So you, you don’t have to hire scribes. You, uh, you know, you typically you have a recording of the session and you have the ability to, uh, to go back. And I think there’s also some creative things where you can actually take that recording between the doctor and the patient and actually give that to the patient for those patients who may forget what goes on in that, in that environment. It’s actually very basic technology, but with a powerful, um, a powerful outcome in terms of know this whole physician burnout in physicians having to sit in front of the computer and the breaking down the wall between the physician and patient. I think those are probably the most exciting things. And because it’s so simple, it’s not overly difficult to, uh, to implement or maintain its. But it is, uh, there are a bunch of little compliance things, but the best thing about that are, uh, other health systems have gotten through it. And you just have to. No, you have to ask the right questions, make sure your compliance people are at the table and, and work it through. And then, um, and then also understand, I think it’s not for every doctor. Not every physician or clinician is going to put these glasses on and, and use them. There are some that just won’t do it. So I mean that’s, that was my experience with it.

Bill Russell:                   24:19               Where do you think it, if you were going to bring in a technology like this into your health system, how would you go about doing it? What? I mean? Would there be a, you know, what process would you follow to bring it in?

David Bensema:            24:33               First? I’d have to do a gauging of interest among the physicians, can make sure that I could find some physician champions, some early adopters and I think we’d have to do a pilot or proof of concept and then generate the buzz internally. Um, I used to joke that I like to function on the green principle. I wanted somebody to get jealous with what I was doing or what I had because nothing causes people to be more avid for adoption than jealousness and you know, so it’s worked in a lot of areas and so I would pilot it with a couple of early adopters and get the buzz. Um, the harder part is getting the commitment of financing at this time when everyone’s still recovering from their initial implementations of technology and they’re looking at their physician employment group as I’m a significant financial impact, uh, in a negative way if you look strictly at what salaries are and what the reimbursements are within the group that most groups are losing some money in the system and we all know how people have cost shifted.

David Bensema:            25:45               Um, but convincing the suite would be, I think the hardest part. I think getting a couple of position pilots, easy getting through the security and permissions aspect. Some of the compliance you talked about complicated but not complex. It’s just followed the dots, you know, just do things in the proper step sequence, but then getting the buy in from the senior leadership and getting them to not micromanage it because if the adoption is slow or if it’s a hockey stick type curve, you know, you have to just let them stay out of the way and let it evolved naturally. Um, I think you’re right, it’s not for every physician. I think patients will actually have more comfort with it, maybe because they don’t fully understand it all, but mostly because they get their doctor back. I think patients would be more favorably inclined towards it. Then the general physician population initially. Um, I think the other area that you have to think about is who are you working with and are you working with them everyday? And then what happens when your scribed to remote scribe is out ill no different than when my medical assistant without ill when I was in practice. You don’t function as well. And how prepared are the physicians go back in and actually utilize the Ehr if necessary. That’s the thing I think is going to create some bumps in the road. They’re not insurmountable. You just have to be aware of them.

Bill Russell:                   27:23               Yeah, absolutely. Often keep an eye on it. Um, I, I agree with you that uh, you know, if you don’t have hard dollar savings. I, I, I loved my cfo. She was, she was wonderful. We had a great relationship, but she, uh, she was a stickler for hard dollar numbers and the challenge with some of those projects that you’ve noted is if they’re calling for her dollar numbers, that means you have to force adoption and when you have to force adoption, it creates a, a different dynamic than if it just gets pulled through nationally the organization. But um, yeah, so look for the hard dollar savings that’s going to get it through funding, but the, the, the softer aspects of this I think are the more exciting things. Physician burnout, uh, and breaking down that barrier. So you just have to make the case, have to get in front of leadership and say this is worth doing and a proven out with pilot. So exciting stuff. So let’s, uh, let’s go to our final segment, a favorite social media posts for the week. I’ll let you, as our guests give you a nomination for, uh, for your favorite social media posts for this week.

David Bensema:            28:31               Attempt to see one from when it’s sunny on linkedin and he’s been with a google before, Motorola, et cetera. But his comment was a lot of social media as a platform for discussions, bereft of the kind of empathy and nuance that an in person conversation has. So he first get trolled for something you didn’t mean then have no way of explaining yourself without finding yourself shouting into ether. And finally you wonder why you spoke in the first place. A lot of my posts get a lot of love and affection, but I personally find them without strong opinions, land almost colorless, good enough to provide a window to live, but not a complete expression of what I really feel. Uh, maybe that is because I don’t write well enough to articulate with nuance or maybe social posts are not the best medium are you? So as I read that, I thought, you know, I’ve, I’ve done some of those posts, but I’ve also done somewhere I’m stronger worded and I think people have to have the courage of their convictions. But I think it’s also a little bit of a reminder of the rule that we had in our. I sent two emails. If you’ve sent two emails, you need to get on the phone. Yeah, because emails don’t carry the nuance, neither the social platform, their starting points. I think we need to remind ourselves, these are simply starting points. Getting on the phone is necessary for the health of your organization.

Bill Russell:                   30:01               Thanks for sharing that. That’s a, that’s a great post. And uh, I think we’ve all been there. I’ve a couple of people that troll my post and you know, constantly or

Bill Russell:                   30:09               commenting how it has ruined, has ruined healthcare and uh, you know, I understand where they’re, they’re coming from. But uh, yeah, social media platforms probably not the best place to, uh, definitely not the best place to pick a fight and definitely not a good place to try to have that discussion in an open dialogue. So I appreciate you sharing that. I’ll take us home with something a little, a little a not as, not as philosophical as yours. It’s a Justin Eisenberg, who’s an executive recruiter, posted a story on KTV u dot come in and out Burger reveals managers make a $160,000 on average, to which he says, I should’ve gone to hamburger university and know I’m not even going to comment on that as it stands on its own. It’s amazing to me that managers make that much and um, you know, and when I was going to school it was a big thing. I Dunno, maybe maybe now that college degrees are starting to focus on, on running franchises or being managers and franchises. We will see that’s all for this week. Thank you David for joining us. And please join us next week when sue shade from sturbridge advisors will be here. Remember to follow us on twitter at [inaudible] this weekend. Hit check out our new [email protected] and subscribe to the podcast on apple podcast or Google play. Thanks for joining us. That’s all for now.

 

 

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