Bill Russell on AWS, Cerner, Transparency, and Mayo’s Moves

Bill Russell: 00:04 Welcome to This Week in Health It news where we look at as many stories that you can in 23 minutes or less that will impact health it. My name is bill Russell healthcare CIO coach and creator of this week in health it a set of podcast and videos dedicated to developing the next generation of health leaders. It’s Tuesday news day. We have a lot to talk about, but first an explanation. This is our new studio at least for the next three months. This is our new studio. My wife and I are living out a bucket list item. We sold the last studio we sold our last home. The studio before was my home office. And uh, for three months we’re going to be living in a ocean front home. Uh, which is a great opportunity. It’s off season and we get to live in this place, uh, for the holidays.

Bill Russell: 00:46 Again, bucket list item. Looking forward to having the family home for the holidays. Uh, for those of you in the Midwest and Northeast, I just came back from New York. I know how cold it is. Don’t hate me, but we’re going to do this for three months, see how, how it goes. And then in three months we’ll move to another part of the country. So anyway, it’s to say, let’s get to this, get to the news Tuesday news day, lots of talk about, uh, two Mayo clinic stories. Halmka gets hired, uh, John Halamka, former guests of the show and future guests of the show as well. Um, and also, uh, Chris Ross went into why Mayo clinic chose Google cloud as its provider. And a couple of other items. There are, there’s four AWS stories, I apologize for that, but AWS, uh, reinvent was last week. And so you have a bunch of them.

Bill Russell: 01:28 They actually overlap a little bit. There’s really two, three ish main themes. So we’ll cover, cover them as a group and a, and take a look at the main themes from the reinvent conference, a hospital groups Sue to block price transparency rule in the wall street journal. And another one that, uh, another story on transparency that goes into a little bit more detail. Again, we’ll cover those two, uh, together. Satya Nadella CEO for Microsoft and how Microsoft is preparing for quantum and edge computing. A pretty interesting story. Actually. It’s a very short story. It’s just his answer. Uh, from a Q and a session, uh, the most remote emergency room life and death in rural America. This is the Washington post story. And uh, I covered this because, um, there’s going to be a lot of talk in the community these days about what’s going on and how healthcare is evolving, especially in an election year and Washington Post’s stories and a Newsweek stories.

Bill Russell: 02:27 They get a lot of, a lot of air time with, uh, with our constituents. And I want to cover that. So that’s interesting. It’s really about telehealth. And then a final story. Best buys healthcare strategy. Uh, somebody grabbed a slide, went into more detail and I want to cover this a little bit. Uh, and that one of the key points is they’re going to get insurance to pay. So a great story look forward to, uh, getting into those. Uh, we want to thank our founding channel sponsors who make this content possible. Health Lyrics and VMware. If you want to be a part of our mission to develop health leaders, please go to this week, health.com/sponsor for more information. This episode is sponsored by health lyrics. And uh, what, you know, when I became a CIO, I was really overwhelmed at first and one of the things I did is I went out and hired a CIO coach, uh, to walk with me through the journey.

Bill Russell: 03:13 Um, this was someone who had wisdom that can only be gained through years of experience and it was invaluable to me in my success in the role. I now coach CIO’s through health lyrics. And if you want to learn more, visit health Lyrics.com or drop me a note [email protected] we are back on our normal schedule. Just want to make you aware of that Tuesday news day and Friday interviews. Uh, I hope you have time to catch up on some of the great interviews we’ve done. Uh, in the month of November, we dropped an episode almost every day in the month of November. Um, and, uh, just want to let you know, we’re going back to our normal, a normal schedule. Thank you for supporting the show. We have over 100,000 downloads for 2019, uh, which is just amazing and I, I it’s, uh, I really appreciate it and really appreciate your feedback.

Bill Russell: 03:57 A quick shout out to Drex DuFord’s new service, 3XDrex, uh, where you get three new stories, Texted to you three days a week, Monday, Wednesday, Friday, uh, to sign up, just text Drex to 484848. I use it for my research and it is extremely helpful. All right, ready for the news. As you know, we’re going to do this a little different. Uh, I’m going to introduce 10 stories quickly, give you my take and then we’re going to circle back, uh, if there’s time and take a look at, uh, the stories in a little more detail. Okay. So where are we at? Actually, here’s, here’s where we’re at. If you like the format, please let me know [email protected] right now we’re at a hundred percent approval rating of the new format. So I’m going to continue to do it until, uh, until something else happens here.

Bill Russell: 04:49 So, uh, let’s take a look. First story, Halamka looks to scale digital health globally for Mayo clinic. This was in the health data management, uh, piece. Uh, there was actually a bunch of pieces done on this. This is the one I took a look at. The silhouette for this story is, uh, the CEO for Mayo clinic has a great vision and uh, and they want to be a digital company by 2030. Um, they’re, they’re utilizing platform thinking. Their, uh, culture is aligned. Uh, they have strategic investments across the board and you know, this is really a health system that has all the main thing, all the main ingredients lined up to become a digital health company. And it’s going to be one that we’re going to follow very closely as you do normally in this space. Mayo is a leader, but they’re also a leader in the digital space.

Bill Russell: 05:39 And, um, you know, if you factor into that hiring great people like John Halamka and, uh, you know, this is, this is really going to be the health system to watch in the next three to five years if they’re able to make that transition to a digital company and really use their brand, uh, to launch things forward. You know, I worry about the farm and the animals and, uh, and John’s health, to be honest with you, the amount of travel and the amount of things that he does. Uh, the last time I interviewed him, he had flown from, uh, we, we met up in salt Lake city, but he had flown from Boston, but he had not crossed past Chicago yet. In other words, he had flown in the other direction around the world to get to salt Lake city. Um, you know, that’s a hard pace to continue and, uh, and uh, if anyone can do it, John can do it.

Bill Russell: 06:26 And I am looking forward to great things out of there. Um, story number two, why Mayo clinic chose Google as its cloud provider according to their technology chief, this is Chris Ross, their seat, Chris Ross their CIO. The so what for this is, it’s a simple answer. He gave superior technology and uh, I’m sure they looked at it in depth. He saying it’s superior technology. It’s something to consider. Um, you know, he also, there’s a lot of talk in this article about protecting your data and um, and how they protected their data and it can only be used at the discretion of Mayo clinic in certain ways. So, uh, I think they’re trying to get out in front of the people are now starting to say, including myself, you know, why did, why did the world come down so hard on Ascension but not Mayo, who just announced recently a deal with, with Google.

Bill Russell: 07:17 Um, and uh, and I think Mayo is getting out in front of that and telling people, here’s the kind of contract we signed and here’s how we protected our data. Something to look at, something to consider as you signed these cloud deals. A Cerner expands AWS relationship with new machine learning initiative. Um, again, lots of stories from uh, the reinvent, uh, Amazon transcribed medical and the expansion of the use of machine learning and AI to prevent readmissions primarily on the Cerner platform. And this is a result of the, uh, the Cerner announcement of them really partnering closely with Amazon and the AWS platform. Um, you know, when this first came out I said this was a story, this was sort of a pre announcement. We’re going to have to see how this evolves and as this is evolving, I’m now, uh, of the opinion that this might become one of the most important stories for 2019.

Bill Russell: 08:07 Cerner has strapped themselves onto a rocket ship and it is moving at hyperspeed and a, I think you’re going to see exactly what the CEO for Cerner said, uh, an acceleration of innovation, uh, around the Cerner platform. And it’s going to be interesting to watch and we’re going to keep an eye on it. Uh, the next story I think is fascinating cause it’s a Newsweek story so it will get um, uh, broad, uh, you know, broad distribution amongst, uh, end users amongst patients, among consumers. And it is Do you trust Jeff Bezos with your life tech giants are getting into the healthcare business? Obviously the Google announcement at Ascension when all the way up to the wall street journal and uh, propagated at that level and now people are seeing uh, some of the announcements with Cerner and Amazon others and they’re starting to piece this together and you’re going to see more pieces like this out there.

Bill Russell: 09:05 Uh, the, so what for this is can Amazon uh, you know, can Amazon “?” and do you trust Amazon “?” to do to healthcare what they did to retail and that is to aggregate the supply chain create a digital experience and drive out waste and improve the user, the consumer experience. That is to design the whole thing around the consumer experience. The question is, can Amazon do it or are there enough regulatory and other roadblocks and do you trust Amazon to do it? Which is another thrust of this story. Um, you know, that’s the, so what can they and do you trust them to do it? I think there’s a lot of different opinions about that. I think with the Cerner relationship, uh, they have their, they have their foot in the door. I mean, no matter how you look at it, someone said to me, why is that a big deal?

Bill Russell: 09:54 Cause Cerner, you know, losing market share, Epic’s gonna own the whole thing. I’m like, well, except the numbers don’t say that. I mean, I know that Epic has won a lot of contracts and they are now the predominant, uh, EHR in the market. But you’re still looking at Cerner, which is, I don’t know the exact number right now, but I know it’s in the 20s, maybe even the thirties percent range in terms of the EHR. So, um, you know, Cerner, Meditech, Epic, uh, Allscripts, Athena, you know, anytime those players do something and, and Athena a little bit less, but you know, people think Meditech’s not a player, but Meditech’s a player. They have a significant amount of market share, especially in smaller health systems. So, um, just something to keep an eye on, you know, can’t Amazon do it. And uh, we’ll come back to that story, actually a summer Cerner AWS team to tackle readmissions.

Bill Russell: 10:45 Uh, the so what for this. This is just one more example of rapid innovation around the Cerner AWS platform and uh, I’ll jump off of those stories. So the next story is hospitals, hospital groups, Sue to block price transparency rule for the wall street journal, uh, from the wall street journal. The so what for this is the optics of this are horrible for healthcare going into an election year essentially. You know, it seems like what we’re saying is, you know, we’re fine with surprise bills and opaque billing. We’re really fine with it. In fact, we want to protect it by suing to protect it now. And it’s an awful place to be, especially during an election year. It seems like we’re saying patients be damned. We’re going to protect our business now. That’s not actually what this is about. But this is really about, I hope, what this is really about and what I think it’s really about is no companies should be compelled to disclose every aspect of their pricing.

Bill Russell: 11:41 There’s no other industry that you’re required to disclose all of your costs for the development of whatever services that you’re delivering. I think that’s what this should be about the article though, to be honest with you, some really lame excuses for why healthcare can’t do this. And we almost seem incompetent if you read the article because it talks about all these lines of you’d have to build this massive spreadsheet which would corrupting and you know, destroy computers. It would absolutely bring the internet to its knees. And I’m reading this thing going, you know, a lawyer wrote this, but man, they should have consulted with somebody who knew something about technology because it is the lamest piece of crap I’ve ever read. Um, you know, we can’t do our pricing because it can’t fit into a spreadsheet. Okay. We don’t use spreadsheets for heavens sake anyway.

Bill Russell: 12:30 Just the whole thing was just ridiculous. And then they said, well, you can’t do it. On a website because you know, it would be too big for a website. Well you wouldn’t, that’s anyway, it’s just, it’s anyone who’s technical who’s listening to this podcast knows that that is the most insane argument ever. But because it’s in that article, when I see it posted on LinkedIn and, uh, and Twitter, you know, people’s comments back, are you kidding? Healthcare is this lame. We’re not this lame. I just want people to know we’re not this lame. We could do this. Technically we’re choosing not to do this. And, and what I’m saying is the, so what is the optics of it are very bad. So we just have to keep an eye on that. Satya Nadella, how Microsoft is preparing for quantum and edge computing.

Bill Russell: 13:12 So the so what for this is such as answer to the question is essentially we architected for edge and quantum computing and this, so what is, uh, architecture matters? So they designed in such a way that they can do edge computing because they have so many data centers across the country and they’re able to push that even further out beyond their data centers to, uh, to remote locations. And then the quantum is designed in a, in that you can use different platforms within their cloud environment, a next story, the most remote emergency room, life and death. And by the way, when I talk about architecture, it’s amazing to me that just gets in the, when I’m talking to healthcare it, they tend to say, Oh yeah, yeah, whatever, whatever our CTO has that, no, no, no, no. Everything gets architected. Every application that gets, uh, uh, that gets purchased, that gets developed.

Bill Russell: 14:04 Every workflow, every, uh, data element, every architecture matters. And when people don’t keep an eye on architecture, eventually the, uh, the infrastructure will get frail and fragile and it will eventually, uh, it’ll eventually show up in failures or the inability to, uh, to create new workflows or to handle new business models or to, uh, support the clinically integrated network architecture matters. And it’s not just the job of CTO, although that is a key component of it. Uh, next story. The most remote emergency room, life and death in rural America. This is the Washington post story. Again, I’m covering these stories because, uh, for the next year anyway, uh, there’s going to be a lot of stories out in mainstream media about healthcare and you need to know what they’re saying. Washington post post did this story and they’re talking about how these rural health care systems are struggling.

Bill Russell: 15:02 They are, uh, really have an inability to keep these emergency rooms open and they’re now starting to lean on telehealth as an enabling platform for rural medicine. It’s actually, you know, they could have done a different, uh, title, but it wouldn’t have got as many clicks. But, uh, really what the story is about is tele-health as an enabling platform, which means that there’s a business opportunity to support rural healthcare for those in urban centers with a significant number of physicians and that don’t have a physician hiring situation. Um, and there’s probably some other business models that I’m not thinking about that are going to present themselves. And the final story is best buys healthcare strategy, get insurance to pay. Um, and uh, I’m going to go to this story actually. This is, so what is best buy is one of the most relevant healthcare companies for seniors in the country right now.

Bill Russell: 15:53 And let’s go ahead and start there. Let me see if I could find that story real quick. Here it is. And there’s a great slide here. Coordinating care across every everyday needs of seniors is vital and we have begun to address this imperative. This is a best buy slide. Okay. Coordinated care across everyday needs for seniors is vital and we have begun to address this imperative. Uh, here’s some of the key bullet points. By the way, they have a really cool diagram. It has, uh, most of the things that, uh, seniors are, uh, being, are trying to address isolation, anxiety, medication management, chronic disease, physician follow up. Um, gosh, access to care, transportation needs. It’s really small print, sorry. Uh, and they have three main bolt boards. Coordinated care across these social determinants of health is growing needs that CST supports an Anthem. Santina Molina already offer one of these services as a plan benefit and we charge insurers a per senior monthly recurring fee to provide these services.

Bill Russell: 16:55 In the past year, best buy has spent $1 billion on acquisitions to expand its healthcare services. According to Forbes, a senior cares is best buy as niche in healthcare services market. 1 million seniors are using the company’s health offerings and best buys goal is to expand the services to 5 million seniors, seniors by fiscal year 2025. According to MarketWatch, I’ve, I’ve covered some of these things before today. Most of the seniors that we serve are utilizing easy to use mobile phone products and connected devices that are tailored for seniors and come with a range of relevant services. I think that is going to transition in the next probably three years to voice enabled and conversational technologies. But again, relevant. My, uh, you know, 87 year old father-in-law who is now almost famous on this show, uh, is interacting with Alexa pretty regularly at this point. Um, Ms. Berry, uh, CEO, uh, shed light on how best plans to expand its healthcare business.

Bill Russell: 17:55 She said the company plans to scale its five star service that connects seniors with caregivers, dispatchers, emergency personnel, and more. We also expect to advance our commercial business where the services we provide for seniors are paid for by insurance providers. This includes services such as remote monitoring based solutions that provide meaningful insights to improve timely care and reduce the costs to frail seniors. Um, you know, I go deeper into that story because it continues to fascinate me. Best buy is having a relatively weak Christmas holiday season, but their stock continues to rise and I think their stock continues to rise because people now see them as a healthcare company and, uh, it’s just something to keep an eye on something, a potential partnership in your marketplace, a potential competitor in your marketplace, don’t know which it’s going to be. Um, the emergency room remote care, I’m not going to go into that Washington post story worth taking a look at Satya Nadella.

Bill Russell: 18:49 I won’t go back into that story. It’s really about architecture. Let’s go back into this hospital Sue’s story. I covered a bunch of it, but let’s see. The burden of compliance with the rule is enormous and so this is hospital group sues to block price transparency rule wall street journal. The burden of compliance with the rule is enormous and the way out in way out of line with any projected benefits associated to the rule according to the suit. Which by the way, I don’t think it’s true either. I think price transparency would go a long way into restoring the confidence of patients. Yeah, think about it. Patients walk into an emergency room, they get care or they get care in some way and an operating room or whatever. Um, they are essentially, it’s like they’re walking into best buy. We’ll just keep using them. They’ll walk into best buy, they buy a TV, they walk out with the TV, and then they receive a bill three months later.

Bill Russell: 19:43 First they receive an explanation of the TV that they bought and the potential cost is $10,000 and you’re like horrified. You call best buy. Am I going to pay $10,000 for this TV? And they say, no, no, it’s not TV. Don’t worry. Somebody else is going to pay a portion to that. You don’t have to worry about it. And then three months later you received the actual bill and it’s $7,000 and you’re like, I didn’t want a $7,000 TV. I wanted a $500 TV. What just happened? I don’t know. You understand how ludicrous that is that we cannot tell people what it’s going to cost for their services. I understand it’s complex, but we’re smart people. We can figure this out. I was just at a conference and I asked people what their innovations were and to be honest, we went around the room. The one I was most, uh, I was really most excited about was one health system said we are going to get to a single transparent bill for our clients.

Bill Russell: 20:31 And I was like, that’s innovation. That’s what we should be doing as health it anyway. Um, and that’s what, that’s what people want us to do that is innovation. By the way, does it require huge amounts of technology? Just requires us to bring all the pieces together. Uh, the groups say that disclosure under the rule would be a compelled speech in violation of the first amendment. They’re asking for an expedited decision saying hospitals could otherwise spend needless time and resources preparing for a rule that may be invalidated by the court. Um, by the way, that is true. I believe that is true. I think it’s, uh, interesting that we’re trying to compel them to disclose their costs. I just really compelled us to disclose, disclose our costs. It’s just not normal. Um, we should be trying to do it just to, uh, just cause it’s the right thing to do in some ways.

Bill Russell: 21:23 Um, so anyway, uh, let’s see. I want to go more into, so hospital group says that the true costs is far higher. The rule requires hospitals to publicize the rates. They negotiate with individual insurers for all services, including drugs, uh, supplies, facility fees, and care. If doctors who work in the facility, it’s scheduled to take effect in January, 2021 with hospitals facing fines up to $300 a day if they don’t disclose the negotiated rates. I, I dunno, I mean, I don’t think that that fee makes any sense whatsoever. And I think what people are going to choose to do if this goes through, they’re just going to choose to pay the fee. I don’t think we’re going to see price transparency. I would like to see those fees a lot higher. If you’re going to do it, do it right, you know, make it so that people have to get there.

Bill Russell: 22:09 Um, and then anyway, some of the silly things I talked about before, you know, spreadsheets, websites crashing and those kinds of things, uh, just want to share those things with you. Um, you might get stopped at a holiday party where somebody says to you, you know, I can’t believe you guys want to keep your pricing a secret and don’t want to tell the patients. Um, and you should just be, uh, ready to talk about those things. So I have to go back to the Cerner stuff real quick. Um, Cerner and AWS is a rocket ship. There’s two main things they’ve done. Machine learning around readmissions is, uh, is one of the things they’ve done. They have a use case and it drove down readmissions significantly. If I can find it real quick, I will try to, uh, um, I will try to get to the number.

Bill Russell: 22:56 But it was a, it was a really compelling use case. Uh, a large Cerner client. There it is a large Cerner client asked for help predicting patients at risk for being readmitted, uh, from a rerehabilitation center back to the hospital by applying machine learning technology to historical data migrated from AWS cloud. Cerner built a model that helped the delivery system reach its lowest readmission rate in over a decade and sent more patients directly from re rehabilitation to their homes. Um, and that just gives you an idea and that’s the tip of the iceberg. I mean, and we know that readmissions is not something new. We have, we have, uh, other algorithms around this already, but I think it’s the tip of the iceberg. They’ve latched themselves onto a, uh, a technology stack that is just loaded with opportunity. And the other one we talked about was Amazon transcribe medical, uh, and a Cerner as soon as it came out, said that’s going to be a part of Cerner.

Bill Russell: 23:53 Um, and you’re looking at 2 cents a minute in transcription, uh, fees and a accuracy rate that is through the roof, but not through the roof. It’s a equivalent, if not better than a nuance. And as you know, nuance partnered with Microsoft. Um, so I, I’m going to try to get up to, uh, to uh, Amazon and talk to some people up there, uh, early next year about the things they’re doing. And I’m also going to try to reach out to Cerner and have some conversations around that. I think it’s something to take it, keep an eye on. It was interesting. I was at again, I was at a meeting and somebody asked me, you know, do you think these people who switch over to Epic will switch over to Cerner in three years or five years? I think the answer to that is no. Um, I think the best EHR is the one that you’re on.

Bill Russell: 24:41 Um, identify the limitations of the EHR. You’re on. Fill those gaps and live with them for heaven sake. Don’t spend another billion dollars going from one to the other or one to the other. If you have a planned migration from Cerner to Epic right now, I would halt it. I wouldn’t spend the billion dollars to be honest with you. Um, my recommendation, my, my coaching to every health system is if you have a majority of one system and you want to get onto a single system, by all means do that. But if you have a, if you’re on a certain system right now and you’re like, I want to be on the one that everybody else is on, I think that’s a huge mistake. We have seen in technology stacks and other industries over the years that all of a sudden somebody takes a lead, everyone migrates to them, and then all of a sudden their innovation cycles get slower.

Bill Russell: 25:29 They start to fall out of favor, they start to move a little slower, and then somebody else takes over. Well, you just can’t keep popping back and fix your EHR. You’re not going to keep popping back and forth. Uh, so at some point you’re gonna have to live with the limitations of what you have. Uh, don’t migrate off of what you have and, uh, you know, and, and, you know, get to as, uh, you know, as, uh, you know, homogenous an environment as you possibly can. But, uh, again, the best EHR is the one that you’re on a Mayo clinic. Uh, Mayo is doing things right. Uh, Chris Ross in his article talks about the spirit of technology, but he also talks about the importance of the contract. Uh, the importance of the contract. And I would say the importance of communication. You see Chris who doesn’t normally get out there and do interviews is getting out there and doing interviews because communicating to the community, here’s the, here’s your data, here’s how we’re going to use it.

Bill Russell: 26:24 Here’s how it’s going to benefit you is I think an important step. Not required to do it by HIPPA, but it’s an important step. And they are doing that. And then contractually, how are they able to use your data? Where can your data be used? People are worried that their data is going to show up in search results. It’s not, we know it’s not. We know that you’re not going to sign an agreement that does that. But we’re in the health care industry. People outside of the healthcare industry here at Google and they think search. They don’t think, you know, Google, you know, artificial intelligence and you know, they don’t think Google health. Same thing with Amazon. They think Amazon, they think packages at my door. They don’t think Amazon in terms of, you know, uh, comprehend and transcribe medical and those kinds of things.

Bill Russell: 27:09 So we have to do a better job of getting out there and explaining to the community our communities, we are doing these agreements, we are doing these agreements to your benefit and here’s how we’re going to use them. This is actually a much harder way to do this show if you’re wondering. Uh, so I think I am at the end. I did not clock this but I’m pretty sure I’m over over. So that’s all for this week. Remember where, uh, back to our normal schedule, Tuesday a Tuesday for news Fridays for interviews with influencers. If you want to support the fast growing podcast in the health it space, uh, here are a few ways you can do that. Share with the peer sign up, uh, for insights and staff meeting on the website. These are designed to help you in your career, interact with our social media contacts on Twitter and YouTube and LinkedIn post or repost our content and send me feedback.

Bill Russell: 27:57 [email protected] this week in health it.com. Uh, your insights continue to help. I’m going to be doing a survey at the end of this year like we did last year and I want as much feedback as you could possibly give me. Uh, I will probably publish that in the next week or so. And don’t forget, we do the best of shows towards the end of this year and I love going back over what we learned this year and who we talked to. This show is a production of This Week in Health It for more great content. Check out our website this week health.com or the YouTube channel special thanks to our sponsors, VMware and health lyrics for choosing to invest and developing the next generation of health leaders. Thanks for listening. That’s all for now.