News Day – Google’s Health Record UI, Microsoft’s Strong Play

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Bill Russell

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Bill Russell: 00:04 Welcome to this Week in Health it news where we look at as many stories as we can in 20 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. We are going to, you know, look at a lot of stories. We have 10 stories to cover and we’re going to do something a little different this week on these 10 stories and I’ll get to that in a minute. This is based on feedback that you have given me on how you want me to try out a show. So I figured on this Thanksgiving week I would try something new out and see how it goes. Uh, we want to thank our founding channel sponsors who make this content possible. Health Lyrics and, VMware. Uh, if you want to be a part of our mission to develop health leaders, go to this week, health.com/sponsor for more information.

Bill Russell: 00:53 This episode is sponsored by health lyrics. When I became a CIO, I was overwhelmed at first and one of the things I did was I went out and hired a CIO coach. And a CIO coach is someone who, uh, has wisdom, which has gained through years of experience. Uh, it was invaluable to my success in the role. And I now coach people through health lyrics. If you want more information, you can learn more at, uh, healthLyrics.com or you can drop me a note at [email protected] Uh, don’t forget to come back, uh, every day. Uh, this actually not every day this week cause this is Thanksgiving week, Monday, Tuesday and Wednesday. This week we’ll have shows and everyday next week we’ll have a show until we’re done with the, uh, look back look forward series we’ve done with healthcare CIO’s a great series, asked a set of CIOs the same eight questions looking back on the year, looking forward on next year.

Bill Russell: 01:42 And great feedback from you guys on the show. I really appreciate it. So we’re going to be running shows through December 6th, uh, every day. Um, shout out again to Drex DeFord for his new launch. 3xDrex which is a tech series, which has helped me to do research for this show. And, uh, hopefully can help you as well. It’s a three stories texted to your inbox Monday, Wednesday, Friday. Um, from a CIO perspective, you could just, if you want to sign up, text D R E X to, 484848, and you’ll start receiving, uh, some of the, uh, some of the stories from Drex. I found it to be valuable. It’s only reason I’m sharing it with you cause I, uh, I, it’s helped me to do my research. Okay. We’re going to do something a little different here. We’re going to do a fast look at the top 10 stories.

Bill Russell: 02:31 And as you know, what I usually do is I do the 10 stories and I do so what, or I do the stories and I do a, so what, what I’m going to do is I’m going to start the show by doing all 10 stories and the, so what on all 10 stories and then we’re going to circle back and look at some of those stories. So thanks for your feedback, which has given me the idea for, for doing this. You got tired of me just saying I have 10 stories, but I’m only going to cover three. Now I’m going to cover 10 and then we’re going to go back and do maybe two or three in depth. All right, here it goes. Top 10 number one lyft launches, $2.50 Rides to the grocery store. The, so what here is, don’t dismiss these announcements.

Bill Russell: 03:09 Uh, 80% of health is not related to health care, uh, but to social determinants. We know this to be true. Uh, and this announcement may be more impactful than most of the things we’re doing in healthcare. Um, and I would say to health systems, explore ways that your health system can address that 80% social determinant gap. A story number two, Mayo clinic partners in Abu Dhabi. I think the, so what for this that I have two ‘so whats’ for this. And the first is brands matter in healthcare. I would rather see a Mayo doc than the doctor down the street. Brands do matter and they’re going to continue to matter. And if I have a certain disease, I absolutely am okay flying to Rochester rather than driving down the street and going to the doctor down the street. Um, because again, brands matter. Brands have a certain space in your mind and they say quality.

Bill Russell: 03:59 They say, uh, best in class. And you know, when I have a certain diagnosis, that’s what I want. So brands matter. That’s the first. So what, uh, the second, so what is more of a, just a, you know, an observation. We’re in an election cycle and it’s good to be reminded. Healthcare is going to take a beating over the next year. And it’s good to be reminded from time to time that we’re exporting our healthcare around the world. And, uh, you know, it’s not because it’s bad, it’s because it’s still the best in the world and even as broken as it is, and we know it’s broken. We know how we have issues, but, uh, we are exporting it all over. It’s, you’re seeing it, um, you’re, you’re seeing it time and again, you see it with Cleveland clinic, you see it with Mayo clinic. Uh, you’re seeing it with, uh, other health systems are doing it as well.

Bill Russell: 04:48 Um, so, uh, what we’re doing is good and it is still a world-class, uh, Microsoft, Microsoft, uh, four big ways Microsoft wants to change healthcare. Uh, this is a story that came to us from the advisory board. The, so what for? This is everyone’s signing on for AI and ML players. Uh, the four main ones are Amazon, Google, uh, Apple and Microsoft. But one of these players is not like the other. And that story will probably go to a little bit more. Uh, the next story doctor will monitor your health wirelessly. This is from the MIT technology review and, uh, the, so what from this story, I mean from the title you can tell doctor will monitor your health wirelessly. Home health and home monitoring will become the norm. Once the payment mechanisms catch up, uh, health systems want to start thinking about how they’re going to deliver this care outside of current models.

Bill Russell: 05:40 The reality is you’re not gonna be able to take these doctors that are already seeing five, 10, 15, 20 patients a day, maybe 30, and say, all right, you’re going to see two more digitally. Uh, what really is gonna make more sense as this side of the business grows is standing up this side of the business and having a dedicated arm for delivery, uh, Intermountain has already done this, mercy health system in st Louis has already done this and it’s going to continue to grow. Every health system is going to want a digital delivery component, uh, within their organization. If you haven’t already stood that up. That’s the, so what, uh, number six, how AI in the exam room could reduce physician burnout. Physician burnout is real thing. The ‘so what’ for this is ambient listening and AI. Um, which AI AI in this context is just a fancy word for, uh, taking voice commands, making sense of them, and uh, doing the right things with them, either putting them into the medical record or, uh, or recording them, uh, for future playback or those kinds of things.

Bill Russell: 06:38 But just figuring out what to do and how to appropriately use that voice. So ambient listening, AI, these are going to be two huge buzzwords for 2020. There are already buzzwords now. Uh, and they will continue to be at the forefront of how we think about reducing the burden on clinicians. Now, it’s important to note that technology isn’t the only thing that’s burdening clinicians. There’s a legal, there’s regulatory and I, a lot of it is regulatory, to be honest with you. They’re documenting things that they don’t see the value of. Um, there is, uh, you know, reduced rates and the, uh, increased competition. And, uh, you know, the burnout is not a one dimensional factor. You can’t just say the EHR caused this. There are a half dozen reasons why there’s physician burnout, but this is one of the areas around technology and around the EHR that, uh, is being spearheaded to address this, uh, number seven, Mount Sinai awarded $2 million to build a supercomputer for medical research. Uh, I think the, so what for this is $2 million to build a supercomputer is a low amount of money. So that is a cool thing. That we’re standing up 3,800 Intel cores to do genomics researchers for only a $2 million. I think the other, so what for this is every academic research center is going to want to have these kinds of capabilities and going to need some sort of super computing capability, either at least, uh, in the cloud or a built out on prem.

Bill Russell: 08:07 You’re just going to have to keep up. If you build it on prem, You’re just gonna have to keep upgrading it. So that’s the, that’s the downside of that. So anyway, a side note, a number eight, eight major changes for 2020 from CMS. And a, I will probably circle back on this story and go through the eight things real quick. But here’s the ‘so what’, CMS, ONC, HHS, presidential edicts are going to continue. Uh, they’re going to continue to no matter who is elected, this is just the pace at which things are moving right now. Uh, I would say create a team or uh, if you’re not that large, at least a person who’s dedicated to these, to these changes, uh, because almost all of them have some form of it implications to them. And we’re going to want to stay ahead of the curve. And if you can, if you could stand up a whole team, these, there’s going to be projects every year.

Bill Russell: 08:53 There’s going to be a half dozen to a dozen projects every year that you’re going to have to be, uh, addressing. So just something to keep in mind, a story number nine, Apple research app solicits volunteers. The, so what for? This is, we have Apple health records now, which is LinkedIn to a lot of EHRs. And pulling down that data and gives people the ability to pull that data. And some have said, you know, if we don’t allow health systems to share the data with research that the, we’re going to have a, all of a sudden we’re not going to have enough data for research. And I think it’s the exact opposite. I think if you put all this data in the hands of individuals and you solicited individuals to participate in a sleep studies, cancer research studies, uh, cardiovascular studies, you name it, I think they would line up in droves to share their medical data and to share their record.

Bill Russell: 09:39 In fact, I think you would have an abundance, uh, of, of opportunities to have data for your research. So Apple research app solicits volunteers and, and it was a success. And I think it’s, I think it’s the new model. I think it’s the model that we should be driving towards. And number 10. Um, it’s just a continuation from last week, which is, uh, uh, you know, in, in looking at the Nightingale project, the, uh, the agreement between Ascension and Google a lot has come out since then, but I’ve really liked the stuff that Google has come out with. If you look at Google’s blog, they have shared some stuff. You have a dr Feinberg coming out and talking about it. You have some other of the data scientists, they’ve produced some videos. They produced a video of what the interface looks like to the health data that they’re creating.

Bill Russell: 10:34 And um, you know, transparency is a good thing. The, so what here is transparency is a good thing. I mean Google is trying to be transparent. Um, and I’m going to come back to this probably a little bit more because I think there is a powerful, so what in this, and uh, it is a, if we allow it to be, this can be one of the most powerful HIE’s in the country. And I’m going to come back to that in a minute after looking at their tools. So which one did I say? I was going to come back to first lyft. No, Microsoft, let’s go to the Microsoft story. Four big ways. Microsoft wants to change healthcare. So this is a story from the advisory board and this is, so the advisory board has a, um, daily briefing that goes out and it’s the four big ways Microsoft wants to change healthcare.

Bill Russell: 11:20 Let’s just go through them not to, uh, you should download this. This is worth reading. But number one, Microsoft wants to dethrone Amazon as healthcare’s cloud provider of choice. So a lot of healthcare organizations for infrastructure and, uh, AI tools and data tools have started to go to AWS. And Microsoft has stood up with Azure and some of the other tools that they have stood up. They now see themselves as a competing factor for that. And I agree that they probably are a strong competitor, uh, maybe not toe to toe, uh, in terms of scale and some other things, but they will be toe-to-toe. Um, but the next, the next reason they gave is probably the bigger reason. And by the way, and this is mostly infrastructure and the reality is Microsoft is almost easier to purchase than a Amazon because all they have to do is check a box.

Bill Russell: 12:08 So a checkbox in their current Microsoft agreement and now all of a sudden you can start moving things to the cloud. The problem is they don’t have a lot of health systems, don’t have the skills to move this quickly enough to the cloud. And uh, so that is going to be the thing that slows it down. Um, a little bit. And so a lot of, a lot of health systems are already heading down this path. Mount Sinai, Providence, Providence signed the big deal, city of hope. Um, and then they have a couple of others. None of these are health systems. Oh no. Cincinnati children’s and then they have some others. But here’s the big one. Microsoft wants to be seen as the providers partner, not a competitive threat. When I say one of the thing, things is not like the other, when you think of Amazon and Google specifically, maybe not Apple as much, but definitely Amazon and Google.

Bill Russell: 12:53 You think of potential competitive threat to healthcare, not that they’re going to start hiring doctors, but that they could direct healthcare in certain ways with the data that they have and start to pick the winners and losers in the market. And because they can do that, you can almost see Microsoft as the arms dealer for the health systems so that they can combat that threat so that they can have those same data capabilities and those same, uh, computing capabilities with machine learning and AI. Now the question becomes, are they going to have the wherewithal to, to wield the, you know, the, the tools in the same, um, in the same fashion so that that becomes one of the big, uh, one of the big pushbacks. So, uh, but yes, so Microsoft, and I think this is a big one. Microsoft wants to be seen as a providers partner.

Bill Russell: 13:40 Uh, there’s no talk that Microsoft is, you know, gonna use your data in a certain way. There’s no talk that Microsoft is a, is a competitor to healthcare in any way. They are really trying to position themselves as a partner. Number three, Microsoft wants to use AI to make healthcare better, don’t we all? And number four, Microsoft wants to help healthcare professionals talk to each other and their patients. So they’re, uh, they’re creating team platforms to enable a communication. To be honest with you, I have not found Microsoft’s, uh, communication tools to be that good. I have found third parties to be a lot better, so this doesn’t jazz me as much. It is an integrated platform and hopefully they can improve. Uh, for instance, we use, we use zoom all the time. Uh, and I just conducted a multi-city, a significant number of people, uh, collaboration between four health systems around security on zoom and, uh, systems.

Bill Russell: 14:35 I had never used zoom before, brought it right up and they said, wow, this is a lot better than fill in the blank that we use or whatever. Uh, one of the big health systems they point to is a friend of ours, st Luke’s university health network. Uh, Chad Brisendine. The CIO has been on the show a couple of times, doing a lot of really cool stuff with Microsoft. Uh, something to take a look at and probably something we’ll have him on the show, uh, here in the future to, uh, to chat about. I think that’d be, that’d be a good conversation. All right. Whichever the ones that I say I would get back to a doctor will monitor your health, uh, wirelessly. That is a home-health MIT review. Uh, again, um, it’s all things, you know, we, we have a lot more monitors, a lot more IOT devices, so I’m not going to go back to that one.

Bill Russell: 15:19 AI in the exam room. A thing I liked about this AI in the exam room here it is an exam room. Let me pull up. So this is a Harvard business review and a thing I like about this article is again, if you are not paying attention to ambient listening and AI and how the two could merge in the exam room, you really should, uh, pull up this article. How AI in the exam room could reduce physician burnout. Has two people that have been on the show. Uh, Joe Petro, who is the executive vice president and chief technology officer for nuance communications. I did a interview with him at HIMSS, you’re going to want to listen to that episode. It’s a, it covers a lot of this. And then Shafiq Rob, who is the, uh, senior vice president and CIO for rush, a system, uh, for health and rush university medical center.

Bill Russell: 16:09 Uh, it was on the show just a couple of weeks ago. We talked about this a little bit. Uh, also contributing was uh, Michael Ash, EDP chief transformation officer for Nebraska medicine device vice chancellor, uh, worth reading. It is exactly what you think it is. It talks about ambient listening and, uh, the ability to get the physician turned around and facing the patient instead of, uh, with their hands on a keyboard. So, uh, an important movement, uh, to, to say the least. Uh, let’s get these CMS changes real quick. So eight major changes, bunch of these are medical and so I’m going to hit them quickly. Number one, uh, included a site neutral payment policy and added total knee arthroplasty to the ASE payable lists for 2020 Medicare hops and ASE payment system. Final rule number two, remove six spinal procedures from the inpatient only list in the CYA 2020 Medicare hops and ASE payment number three decided to pay for certain angioplasty and stenting.

Bill Russell: 17:11 Number four, we worked the merit-based, uh, MIPS, reworked MIPS to simplify reporting requirements for providers in the 2020 physician fee schedule, quality payment program. Final rule number five, finalized price transparency policy and it’s outpatient perspective payment system. The mandate would apply to all hospitals in the U S requiring them to publicly post standard charge information starting in January, 2020. We’re just getting a lot of pushback from hospital association. So stay tuned on that. Number six finalize changes to the Medicare physician fee schedule that will expand payments to certified registered nurses. Um, nurse as Vanessa says and others. Um, number seven updated EM coding requirements in the Medicare physician fee schedule to align with changes adopted by the AMA. And number eight, included coverage for opioid use disorder treatment under 2020 Medicare physician fee schedule. So I again, I gave you the so what before and the, so what just is these, these changes from the government are just going to keep coming at about this pace, if not faster.

Bill Russell: 18:17 So it’s just the, uh, it’s going to be the new norm and not much we can do about it. Um, you know, let’s go to the Google thing. So Google on their blog, blog.google.com tools for healthcare providers to deliver better care. First you have a video from Dr. David Feinberg, used to be the CEO at, uh, Geisinger health is now the head of Google health. And, uh, I think one of the true visionaries from healthcare. And it was a shame to lose him from a health system provider. He was doing some really cool things. He was one of the, uh, original thought leaders in, uh, eliminating the waiting room and everything and represents, I think is the quote that I’ve used from him often. And I think it is a, it’s that kind of thinking that led him to Google to say, where’s the seat that I can really impact healthcare around the world?

Bill Russell: 19:11 And, uh, so a lot of questions around how they’re using this data within this Ascension data. And so they, they’re erring on the side of transparency and they say, okay, here’s, here’s how we are using the data. So we develop our test system on synthetic fake data, uh, with openly available data sets. Then they test, configure and tune to maintain the service in a clinical setting. In limited number of screened and qualified Google staff may be exposed to real data. These staff undergo HIPAA and medical ethics training and are individually and explicitly approved by Ascension for a limited time. So number three, we have technical controls to further enhance data privacy. Data is accessible in a strictly controlled environment with audit trails. These controls are designed to prevent the data from leaving the environment and access to patient data is monitored and auditable. Next one, we will further prioritize the development of technology that reduces the number of engineers that are needed to access the patient data.

Bill Russell: 20:09 It’s similarly to our external redaction technology. And the last one, we also participate in external certifications like ISO 2701 where independent third party auditors come and check our processes, including information security controls for these tools. And he goes on to say, I graduated from medical school in 1989 I’ve seen a tremendous progress in healthcare over the ensuing decades, but the progress has brought with it challenges of information overload that has taken doctors and nurses attention away from patients they are called to serve. I believe technology has a major role in reversing this trend while also improving how is delivered in ways that it can save lives. Um, and you know, my, I have a bunch of, so whats on this and the first is, uh, I, I am not worried about Google having the data. I am more worried about, I could rattle off to you 10, you know, uh, business associates that I would be worried about their data, that they’re not investing enough in security, that they don’t have the wherewithal, uh, to train their people adequately or they’re employing people that I’m worried about them potentially being bribed to exfiltrate data.

Bill Russell: 21:22 You know, Google is paying their people top dollar, they’re not going to lose their job at Google because someone comes along and says, I’ll give you, you know, $10 per medical record that you give me. Um, they’re using controls, they have controls, they’re investing in security. They understand the ramifications of that data getting out. Now what people are worried about is the, the um, the, the, I dunno what the, the wall, the perceived wall that there is between Google health and Google advertising and other Google ventures that are out there. They think that all that data just went to Google and it’s now available to their search team and it’s now available to their, their advertisement team. I can guarantee you without ever seeing a contract, I can guarantee you that that is not the case. That there is no way that Ascension signed a deal that said, Hey Google, here’s the data, have at it, make money with it.

Bill Russell: 22:16 Do what you want with it. There’s not a chance that they did that. First of all would violate HIPAA. Um, and we know that this, this deal doesn’t violate HIPAA. So, um, there is a wall between those organizations. Now here’s the thing I think Google should be careful of and it is, if they continue down this path, this is one of the areas where the federal government could come in and say, look, we want you to separate this off. If perceived or not perceived, uh, are perceived or real. Um, there’s this concern in general public that this data is going to be used in this way and we want to make sure that there’s not only a logical wall between the two organizations, but there’s a complete separation between the two organizations so that there’s no perceived and you might as well just change the name from Google health to fill in the blank.

Bill Russell: 23:01 Whatever really cool name your marketing group comes up with. I think this is where this is going to lead. Uh, and I’m not even sure it matters who gets elected, but I, you know, if Elizabeth Warren gets elected, I can guarantee you that you’re going to see a lot of pressure for Google to split this off. Um, because she has stated that I’m a no political affiliation here, just stating what I’ve heard. So, um, here’s the other interesting thing and the last thing, because I’m already going to go over on this, this week’s episode again. Um, so I ran, they have a video, they have a, uh, a YouTube video on the, uh, EHR interface or the interface that they put on top of the data. And I had a physician look at it and you know, here’s some of the things we went back and forth.

Bill Russell: 23:45 You know, it’s really easy on the eyes. You could search scan documents, which is a really nice feature. So you have that unstructured data that comes in, in a fax and it actually takes all that NLP data and makes it available via search, which is really powerful. A predictive narratives are available, which is really nice. And it’s displays labs in a traditional medical display, which was really nice as well. Um, the doctors, well specifically this one doctor I was talking to said, you know, it’s, there are improvements here, but it’s not revolutionary. And I think that’s what we put on Google. We expect Google to do revolutionary things. Here’s the thing I found revolutionary. So again, not a physician, I’m a technologist. Um, I think, so this doctor was comparing it to an Epic interface. What I was comparing it to was they just took data from 50 disparate EMR.

Bill Russell: 24:37 They’ve put all that data together and they made meaning out of it with a, with a, uh, with a user experience on top of it that made sense of that data. This could be the most powerful HIE in the country because Google has a way of bringing that data together and normalizing that data and making it available, making it searchable, making it, you know, think about from an Epic standpoint, Epic says, here’s our data model. Put everything in that data model. Cerner does the same thing. So does Athena. So does so does a Meditech, all of them start with a data model and say, put it into our data model. Google starts with the, you know, send us your, your tired, your weak, your poor, your, you know, send us your wretched data and we will create value from it. And I think that is a, again, I think it’s one of those powerful HIE’s in the country from that perspective, uh, that, you know, that’s really all for this week.

Bill Russell: 25:31 Um, thanks. Oh, let me know if you’d like the new format [email protected] Uh, I’m going to continue to doing it in this way for a little while. See, see if I get better at it and see if you guys like it. Uh, remember to check back every day, Monday, Tuesday, Wednesday this week for a show and everyday next week for a show and then we’ll fall back to our a Tuesday, Friday schedule. Following that, uh, if you want to support the fast growing podcasts in the health it space, uh, you know, continue to send me feedback. It is really helpful and, uh, you know, let me know. Are there other stories you want me to cover, people you want me to talk to? Um, you know, just keep sending the feedback. It’s really appreciated. The shows production of this Week in Health it for more great content. You check out our website this week, health.com or the YouTube channel. Special thanks to our sponsors, VM ware and health lyrics for choosing to invest in developing the next generation of health leaders. Thanks for listening.