Bill Russell: 00:08 Welcome to this week in health it where we discuss the news information and emerging thought with leaders from across the health care industry. My name is Bill Russell. Recovering healthcare CIO and creator of this week in health it a series of podcasts and videos dedicated to training the next generation of health it leaders. Today we’re going to cover a ton of stories in a very short period of time. I’m looking forward to it. This podcast is brought to you by health lyrics want to start your health it project on the right track. Want to turn around a failing project? Let’s talk visit healthlyrics.com to schedule your free consultation. Our guest today is the original recovering healthcare CIO and uh, indie consultant Drex DeFord. Good Morning Drex and welcome to the show.
Drex DeFord: 00:46 How you doing? Thanks for having me. It’s always fun to hang out with you and kind of go through the news of the day.
Bill Russell: 00:52 Yeah, I just got it. It is can be fun and fast and furious. You’re, you’re like one of my go to people for talking about the silicon valley, Seattle based ventures. And what it means for healthcare. I mean, um, the thing I love about it is you live in that world, you live in the startup world and you have the, uh, healthcare CIO background. So you’re able to translate it for us, which is great. But, before we get there though, the softball question and which I always throw out is, uh, is there anything you’re working on that you’re excited about and you want to share or talk about?
Drex DeFord: 01:26 Um, is there something that I’m excited about it, you didn’t know.
Bill Russell: 01:31 I’m, I’m always excited about everything in the ea that you can talk about it.
Drex DeFord: 01:34 I know, and that’s, I think that’s, that’s part of the challenge for me. I’m always excited about everything that I work on and I am lucky enough, knock on wood, that I kind of continue to be in this place where I get to work on the things I went to work on and I don’t work on the things I don’t want to work on. So I like all this stuff I do. I have a lot of companies, not a lot. I had a handful of companies under retainer. I do some special project work. Right now I’m doing work with a health system that’s going through a whole process of an it review. But a lot of it is focused on governance and innovation center development and all of that. And that’s a lot of fun. It’s really interesting.
Bill Russell: 02:10 Yeah, there’s a lot of that innovation center work. I saw, um, a children’s La is doing, uh, just just kicked off their stuff around pediatrics and really gamification of healthcare. So that’s, that’s pretty exciting. Yeah, there’s, yeah,
Drex DeFord: 02:23 there’s a, you know, the thing I would probably say about innovation centers in healthcare is that my experience so far is that when you’ve seen one, you’ve seen one, they’re all done differently. They all have different goals and different intentions in what they’re trying to do. And so, um, it’s a very interesting broad design of, of innovation centers and health care.
Bill Russell: 02:46 Well, that’s, that’s what I liked about children’s La, focusing in on gamification because by doing that, they can really become the center that you go to for the gamefication of health, for, for children. And I’m sure some other children’s hospital are dabbling in it, but when you try to be too broad, a lot of times you just, you don’t attract the right resources and the right energy around it. So I like that focus. I, I dunno. Do you, do you recommend that a innovation centers try to focus in a little bit more or, or do, do you go to abroad route?
Drex DeFord: 03:20 Yeah, I think, you know, a lot of it depends on what do they want to try to get out of the innovation centers. So there were places like Cedars Sanai healthcare accelerator and that actually has a regular rotation of early stage company sort of classes that come through every 10 weeks or 12 weeks. And, um, they’re, they’re really looking for early stage companies who have really great ideas that they can use to help solve problems at Cedar Sinai. But then you have other organizations that really are just getting started and trying to get their legs and figuring out where they’re going. And I think you’re exactly right, like a startup company or like any company, if you focus too broadly, um, you definitely lose momentum. So I love that. CHLA is definitely going down this path of we’re going to focus on this and we’re going to get really good at this and that may turn into a whole bunch of different things, including a new company for them or, uh, just being, having an area of expertise that no one else has. But that’s good if you only have limited resources, focus is always important no matter what your organization is.
Bill Russell: 04:28 All right. So I had your friend West right on the show and I noticed you didn’t make fun of him on the, uh, on the linkedin post the way he made fun of you on the linkedin posts for bobbing your head. Just like that when I’m talking. So, so just be careful as we start circling back and forth here. Don’t give wes any, any ammunition to come at you. All right?
Drex DeFord: 04:48 Wes they, it doesn’t matter. I mean, we’ve known, we’ve known each other since we were, uh, you know, since we were young captains in the air force. And so, yeah, he has so many ticks and quirks that I can make fun of that. I just don’t, and then he picks on me for all my, all my weird, I do get into this though sometimes when somebody is like going the right direction. I’m like, yeah,
Bill Russell: 05:09 keep going. It’s good. All right, well let’s, let’s, let’s get a, it’s a rapid fire here. So Jp Morgan, Amazon Berkshire has finally named their joint venture. Um, so they have named it haven. Uh, it’s, uh, you know, the veterans led by a doctor, Atul Gawande hired in June. Uh, let me see, here’s another, uh, you know, essentially here’s the quote, you know, we want to change the way people experience health care so that it is simpler, better and lower costs Gawande said in the statement, we’ll start small, learn from the experience of patients and continue to expand to meet their needs. And, uh, and we’ve talked to, I mean that you and I specifically, but we’ve talked on the show about this before that I believe he was a great hire for this. Uh, he is very pragmatic, will start small, he is very analytical, so he will look at all sorts of numbers before he even determines what, what path they will go down. And, uh, I think by hiring him into this role, they’ve really increased their odds of doing something that’s going to be pretty transforming. I think everybody just assumed that these three companies would come together and do some transformative, but that’s not always the case. We’ve seen large companies do goofy things in healthcare before, but I think by putting him in place, they’ve really increased their odds. So w what are your, what’s your thoughts on the name? What’s your thoughts on where this is at or where it’s going?
Drex DeFord: 06:34 Uh, so what’s the name of the original? What, what did we use to call it/ JP Morgan Amazon chase. What, I mean, what I, you know, I guess my initial reaction is thank God we don’t have to say that anyway.
Bill Russell: 06:48 I know you just say haven, but we’ll just say haven. How long will people take before we have to say, Oh, you know, haven JP Morgan, Amazon Berkshires.
Drex DeFord: 06:58 Maybe they’ve even made it more complicated in the near term. Um, but I, you know, I, I’m with you. I think Atul Gawande was a great choice to lead the organization if, uh, you know, all the things that he’s written and all the things that you see him when you see him present or see him talk in the past even before joining the company. Um, very practically oriented. Very good. I think solid stuff. And so, um, it’s been a year and all we have so far is haven now, I’m sure there’s been a lot of work that has gone on in the background and I’m sure ultimately they will wind up generating things. I think a piece at a time that ultimately we’ll figure out. They were actually building a great big jigsaw puzzle, a piece at a time. But I’m looking forward to the first pieces coming out because I think better, faster, cheaper, safer, easier access, health care for patients and families is absolutely what we’re all after. And it’s definitely what they’re after.
Bill Russell: 08:01 Sure. So, but if you’re a CEO, I’m going to put you, I’m going to promote you. So if you’re a CEO in Seattle, I mean you’re talking a lot of employees in Seattle or New York City, a lot of employees in New York City, um, and probably some other cities. Have I really thought about it, but those two cities specifically, if you’re a CEO of a health system there, what would you be doing today? I mean, are you, are you concerned that this might change the patterns of people seeking health?
Drex DeFord: 08:27 Um, I think that, you know, as an employer you’re probably so continue to be so wrapped around the axle with the current arrangements at that you have and trying to manage healthcare costs, working with whoever your third party, you know, your provider is your insurance company or um, you know, whatever arrangement you’ve created as an employer that you’re looking, I think at haven and saying, you know, I hope they come up with something, but I don’t know that as an employer of public spending a huge amount of time thinking about what’s coming from haven, I think, I think you’re probably hopeful that something great is going to come out and ultimately it’s going to impact the costs that they have to pay to provide healthcare to their employees. I just don’t know if they’ve spent a lot of time really thinking about the details of what that might be. What I’m guessing.
Bill Russell: 09:27 Yeah. So if I’m, if I’m a CEO in New York or if I’m, uh, I guess providence in Seattle or Uw in Seattle, I’m putting a team together, I’m calling them up. I’m saying, doctor Gawande, I’d love to work with you putting a team together. I’m saying, look, they’re dedicated to you and we’re going to, we’re going to come up with a model that works specifically for your program that helps your people live healthier lives, that keeps them healthy and vibrant and at work, I guess is what we’re looking for. Um, and not to be too cynical about it, but um, but essentially it is an employer program and really if you do, if you’re able to do that, what you cut out is the insurance carrier, you don’t cut out the health system, you don’t change the health system, but whoever’s able to partner with them, you know, that’s, that’s an awful lot of of people. There’s a lot of lives there. So I’d, I’d be trying to figure out how to sort of hone in is what I’d be doing.
Drex DeFord: 10:25 I think you’re right. I sort of took it from the, your question from the perspective of a large employer in Seattle and not necessarily the health systems, but you’re right, if I was a health systems I would definitely be trying to figure out how do I get in that game early and make sure that I’m a part of that and not somebody who gets left out. Now if you’re a children’s hospital for example, you’re Switzerland and all situations and so, um, you’ve got unique, interesting specialty care that can only be provided by that organization. Still you need to get involved in the game early. I think that makes a, makes a big difference and proves that you really want to save dollars and, and make, uh, make health care more cost effective for patients and families and employers.
Bill Russell: 11:05 This, this is going to be the hard thing about going rapid fire. I want to follow up on that, but if I follow up then you’re going to follow up. Uh, so, so next story, uh, assessing EHR use during hospital morning around, so there was a study, I actually pulled this from your feed. So there was a study that was done and they, a mixed method of collecting information. And what they determined was that, uh, across the analysis was that there’s as people are rounding that these are, these are the three things they found, high degree of variance and the ways teams use Ehr is during morning rounds. Number two was pervasive use of work arounds at critical points of care. Third thing was Ehr hrs are not used for information sharing and frequently impede intercare team communication. I’m sorry, in a fourth one, system design and hospital rooms settings do not adequately support care team workflow. Um, so interesting findings. I to be honest with you that none of those findings really surprise me. Um, so you know, what, what can we be doing? What are we doing? What can we be doing to, uh, to address this specifically? Do you think?
Drex DeFord: 12:16 Uh, I, you know, I thought the same thing when I read the article. I don’t know that any of those things surprise me. I think the real sort of takeaway and that is our inability in healthcare to yet create clinical standard work around the use of the electronic health record. So we’ve, you know, to sort of turn a phrase and kind of paved the cow path instead of sort of sort of saying we’re going to do everything in a different way. So now that we’re using EHRs, and that means we’re going to change the way we do morning rounds so that we can integrate the Ehr more effectively and not do work arounds. That creates a whole group of risk in and of itself for patients and families. And, uh, none of us really want that. But I think we’ve still sort of got this word situation where we have, um, uh, we have clinicians and others who are unwilling to change and unlearn the habits that they already have about how they do morning rounds and other clinical provision of care to.
Drex DeFord: 13:22 But in this instance, particularly around morning rounds, they’re unwilling to sort of change their ways of doing it to integrate the Ehr more effectively. And then I think the other part of that is sometimes the Ehr doesn’t work very well to be able to facilitate the work that they’re trying to do too. So it’s really sort of two different pieces of this. One is a management engineering effort to make sure that we’re using the Ehr as much as we can in the workflow and the workflow has been modified to adopt to the EHR and the other one is changing the Ehr and doing the informatics stuff that we needed to do to make sure that the right date is available when it needs to be used in morning rounds.
Bill Russell: 13:58 Yeah. This is one of those things that really showcases the leadership of the health system because this is not just that it’s a team sport. Like you said, it’s not just it, it’s uh, you know, standardizing clinical workflows is standardizing clinical terminologies, uh, practices, uh, data sharing. It’s, it’s all those things. It’s embedding it into those rounds. Um, you know, in a couple of CIOS have talked about embedding analytics in those rounds, but also embedding workflow people in those rounds so that they’re constantly adapting. The EHR and identifying those work rounds that could lead to a care gaps because they are, they are potential care gaps. And uh, and you know, these are the kinds of things we’re trying to eliminate. So it is, it’s a, it’s, it’s complex. You could always tell the really well run health care organizations because you really have to fire. It’s if you’re firing on to those four cylinders, it, it shows. Yeah.
Drex DeFord: 15:00 And then mistakes happen and other challenges occur. I mean I think one of the best things I ever did as a CIO, what is the least technology thing I ever did as a CIO? And that is, you know, we had a group of really amazing workflow specialists that were part of our team and really spent all their time in the field figuring out how to help clinicians learn how to change their workflow to use the tool more effectively. But at the same time they brought back the information that they needed to tell the technologist about how to adjust the tool to take better advantage of the workflow. And you know, it’s a people process technology thing. As we’ve said a million times, if they all work together, it’s a beautiful thing. And if you just try to pull on one handle really, really hard, it just, it just doesn’t work. Right.
Bill Russell: 15:48 Yeah. And I’ll take the last word on this, which is I tell CIO is all the time on this one. If you’re not doing this well, your clinicians are going to be cynical. And then when you start talking about digital and transformation, they’re just going to look at you like, are you kidding me? You didn’t do the last one. Well, right. This is like, this is like we say, the data center has to always be on every time they turn on the computer. I mean, that’s what this is now. Your, your work flow to work for people. You have to be constantly improving it and making them more efficient. Uh, this is a story I do want to get your, your take on. I mean, we, right in their backyard and I guess we’re visiting Amazon again. Aws, uh, and Beth Israel deaconess have done a, uh, uh, I guess Amazon has given Beth Israel a $2 million investment slash grant, uh, to work with them on artificial intelligence and where it can be used in the hospital to provide more efficiency. Um, this is, this is really interesting. I’m not even sure what question I want to ask here other than, uh, is this the new norm? Are we going to see these kinds of plays as these players, they have these great tools, they’re trying to figure out what to do with them. Are we going to see more of this?
Drex DeFord: 17:00 I, you know, I think companies like Amazon have a lot there. There’s a lot of profit there, right? And there’s the potential for more profit and they’re really in a great situation to be able to sit down with an organization that they consider cutting edge. Um, like Beth Israel Lahey and sort of create this kind of program for them. And really this kind of runs the gauntlet of innovation or the, the not the gauntlet, but, uh, I guess spectrum of innovation from one end. You probably have a Beth Israel Lahey He’s saying stuff like, you know, these are my requirements for, these are chronic problems that I have that I think AI or other AWS capabilities might be able to help me with. Can you help me figure out how to solve that problem? And on the other end really is Amazon saying we have some super cool tools that do really interesting things, but we’re trying to figure out how they might actually help you in health care.
Drex DeFord: 17:58 And, and then there is a spectrum in between there where there’s lots of overlap. So if they work really well together, I think they spend the energy and the resources effectively and they may be able to come out of this with some pretty good products. So from the Amazon perspective do we develop something that other healthcare systems can use and then we can sell that. And on the Beth Israel Lahey side, they get to solve problems earlier than other people are able to solve them in a market that is super competitive and has already sort of in many ways gone across the bridge from fee for service to value based care that Massachusetts market is really one of the leaders in the country in this. So they’re ahead of the game already.
Bill Russell: 18:44 Yup. And I think this is one of the benefits of, of John Halamka going into the innovation role, leaving the, uh, uh, information role, uh, to the side. It gives him more time to focus and his data’s already out on AWS. So they were an obvious partner, uh, with, uh, with these guys. I do, since we’re talking about Ai, I want to touch on one of your former colleagues. So Eric Topol is coming out with a new book, deep medicine, how artificial intelligence can make healthcare human again. And you know, people keep talking about, uh, you know, AI is the buzzword. Well, you know, I was on a panel once and it was just, Aaron Levie asked me, he goes, you know what, what’s a buzz word that, that you, you know, you, you hate that I said, there isn’t a single buzzword I hate cause they are buzzword for a reason.
Bill Russell: 19:33 And the reason is because everyone’s talking about them. So why is everyone talking about our official intelligence? And this Eric Topol says these things, artificial intelligence is a single most important opportunity to address all the major things wrong with healthcare. Today, according to Eric Topol at world renowned cardiologists, geneticists, digital medicine researcher and author, he’s not the only one who said that this week. Um, you had, uh, ed marks did a interview of Toby Cosgrove and he said the exact same thing and Ed said, hey, you know, what’s the number one thing you think is going to really impact health care? And he said, artificial intelligence, hands down is going to change the industry. And so you have it. He’s not, I mean, Eric might be, you could point at him and say, you know, he looks at a lot of forward thinking things, but Toby Cosgrove is a pretty pragmatic guy who’s saying, hey, I’m spending some time in Silicon Valley. I’m seeing these things. This is the real deal. This is really going to transform things. So, um, you know, what’s been, what’s been your take so far? What are you, what are you seeing or, or what’s your feeling on this? Uh, you know, I’m a big fan of it. I have,
Drex DeFord: 20:38 I’m on a big fan of topols and, uh, the more that I look at early stage companies and, uh, and look at the artificial intelligence work they’re doing, which, you know, there’s sort of a whole spectrum of conversations around artificial intelligence. That’s another whole part of this is that, you know, what they’re really doing at this point is, um, machine learning and deep learning. So sort of a subset of what we think of as the larger AI concept or idea,
Bill Russell: 21:06 which has been around for a while.
Drex DeFord: 21:08 Absolutely so unfortunately, or maybe fortunately I think it’s being AI is being talked about sort of in this big, um, AI will solve world hunger kind of perspective, but I think it’s more the concepts of NLP and deep learning and machine learning that there are lots of individually examples that I’m sure we’re going to be in. Doctor Topols book, uh, where AI can make a difference or the components of AI can make a difference, can sort of change the game. Uh, create an augmented, um, support for, uh, clinicians and business operators and others that help them work on the really, really hard things and help them move faster on the things that are more routine. Uh, all the way through offloading complete pieces of work to an AI or a support system that is a component of AI. And, and I think we’re going to get there.
Drex DeFord: 22:07 I mean, I think this is just a little bit of progress at a time. And, um, you know, I read something the other day that says, every time we get to something that has artificial intelligence, we don’t call it artificial intelligence anymore. We call it Siri or we call it, you know, something else. We never actually get to Ai. And I think I’m probably okay with that. I think there’s a lot of, a lot of interesting stuff that can happen and little practical pockets that can make us better in healthcare. What do you think about it?
Bill Russell: 22:40 Well, there’s a, there’s a couple things he said in this, uh, there’s a Forbes article, actually it’s a promo piece for the Nvidia Conference, which he’s speaking at, but, uh, he does talk about the book. He said, um, uh, first thing he said, I think, which we’ve, we’ve, I think we all agree on at this point is, uh, that the data needs to be owned by the individual. And, and actually he makes an interesting point, which I hadn’t really articulated before, which was it’s better for the individual to own the data from a security standpoint. Because if you have, if you have 5 million patients with data, it’s a lot harder to get at it. Then if you have a single repository with 5 million patients in it, you know, I mean a hacker gets in and they’re their 5 million patients. And so he’s talking about the attack factors`, which was an interesting way of looking that.
Bill Russell: 23:27 Um, the second thing he goes is the same thing you’re saying, which is he shares the concerns, uh, you know about AI because a lot of it has been long on promise and short on implementation and validation. Uh, which is true. But he, he also follows that up by saying this is a great opportunity for people to together to get that validation and implementation. And the last point he makes, which is more of a policy thing. You said, you know, the UK is way ahead of the u s and the reason is because, uh, not only have they engaged in planning but also because they are already starting implementation on those ideas into, in the real world. And he said, the US has no AI healthcare strategy and there hasn’t been any national planning at this point. And it really shows then. It’s interesting because you know, when we think AI, we think Amazon, Google, uh, Microsoft, we think those big players and Nvidia and others, uh, of IBM, but we don’t think, We don’t think US policy, we don’t think people coming together and helping us to put together a, a track. But that’s happening in China. It’s happening in the UK. It’s happening in these other countries. They’re laying the foundation to really leap frog the US if we don’t get that foundation in place.
Drex DeFord: 24:45 Yeah. Yeah. I mean if you look at, if you do look at it as sort of like a national policy, where do we want to put the time and the effort and the energy, research dollars, all those kinds of things. Into a program and to an AI program, I think, you know, our tendency here seems to be more, leave it to the free market. Let the free market sorted out as opposed to China or other countries who are much more focused on these are the things we want to solve today. This is the place that we want to go. And kind of back to our earlier conversation about when you have limited resources you need to focus. Uh, I think that’s something that we’re, you know, we, we have a problem with focus and a lot of it has just built around the way the economics of our country work.
Bill Russell: 25:30 Yeah. And I’m not sure, I’m not sure what it looks like. Um, but at this point we can look at those other countries to see what they’re putting in place. The last time we’re going to go over time and I apologize for last. Okay. The last story. I just want to point it out because there’s been a lot of talk about transparency and a, there’s a story about Saint Luke’s revenue cycle and how they’ve, how they’ve gone about the whole transparency thing because they got ahead of it in October of 2015 they put out a pricing tool and with that pricing tool you get these bundles and with these bundles, they actually give you the ability to prepay and if you prepay there’s a discount off the the services. And um, you know, you and I were talking earlier of the chargemaster. I mean putting the chargemaster out on the website. It’s the silliest thing. I mean I’ve, I was in healthcare, I had to, I had to reconcile a whole bunch of charge masters, um, as part of a team. And I can honestly tell you it really does take a team of experts to figure out the charge master. How, how is putting the chargemaster out on a website transparency in terms of pricing,
Drex DeFord: 26:37 uh, that, that is a great question.
Bill Russell: 26:43 do you, do you think there’s more health systems going to get to take this? I mean I love the fact that Saint Luke’s digitize this whole process and their patients now have the ability to get transparency on their APP, on their mobile APP. Do you think that’s going to be more the norm? They you think we’ll see that?
Drex DeFord: 27:01 Uh, I think it’s, I think it’s great and I hope it does become more of more of the norm. It would be nice to know what things cost before you went in for them. They’re taking the things that are probably the easiest to understand. Easiest math to do. I know you need to have these kinds of x rays and I know you need this kind of surgery and it usually takes about this long and we use this is uses this many instruments and whatever. I think they talk about rotator cuff in there as being one of the surgeries. But if you can do the math and kind of figure that out and kind of be able to stick to that because you’ve got good standard clinical work and all your surgeons do this work in exactly the same way and you really know how much it’s gonna cost, then I mean those are great and those are definitely the places to start. A lot of this is just about getting started, you know, do something. You don’t have to solve all the problems with the move to value based care, just do something, just start somewhere and that’s what they’ve done. And I think that when you put enough of these things together, you’re going to wind up with some really great relationships with um, maybe haven or others, right to, to take advantage of work that, that you’re doing ahead of everybody else.
Bill Russell: 28:12 Somebody, a CIO asked me, he said, you tell me who’s the player in the market? Who is, who’s doing the best in terms of digital? I struggled. I mean, I could, I really struggled to come up with it, but when I, when I had some time to sit back and think about it, it’s like, you know, everybody has done something right. They’ve identified some experience, they want to fine tune, they’ve identified one thing. And so this is a great example. I wouldn’t necessarily point at Saint Luke’s and say they are the digital front runner, but they’ve taken this one thing and they’re potentially leading the industry in terms of how they’re addressing it. And I think we’re seeing that all over the place. You have, like somebody has figured out, you know, expecting mothers and somebody has figured out how to do a check in process. Just everybody’s doing something a little bit and it’s almost the health system that’s able to aggregate all those things to reduce the friction is probably the one you’re going to look at and say they got it. They, yeah, they figured it out. I mean it’s, it’s focused. So
Drex DeFord: 29:12 deciding what you need to work on and working on that. And then a second part of it really is, um, I guess ego or organizations that have a lack of ego that are willing to say, I don’t have to invent all this crap here. I actually can learn from other people. And so the third part of that really is plagiarism, right? Which is the most sincere form of flattery. So being able to go to all those other places where all this other work has been done and saying, how do I integrate that into a single digital strategy that supports where I want my organization to go and what creates better, faster, cheaper, safer, easier access care for patients and families. And that’s um, that’ll be the winner. And those will be the guys who will be acquiring everybody else.
Bill Russell: 29:53 You know what Drex I had 15 more stories we’re going to talk about, but we’re out of time. So I do want to thank you for coming on the show. Always appreciate it. I assume people can follow you on Linkedin. They can follow you on Twitter as well.
Drex DeFord: 30:05 Absolutely. @Drexdeford
Bill Russell: 30:08 @Drexdeford great. This show’s production of this week in health it for more great content. You could check out the website and thisweekinhealthit.com or the youtube channel at thisweekinhealthit.com/video thanks for listening. That’s all for now.
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