News Day – Nightingale, Transparency, and Nike Health Worker Shoes


Bill Russell

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It’s Tuesday News Day and we dive deep on nightingale and talk Transparency, Nike Shoes, and Amazon Care Experience.  Hope you enjoy


Bill Russell: 00:04 welcome to this weekend and health it news where we look at as many stories as we can in 20 minutes or less. That’s going to impact health it. My name is bill Russell healthcare CIO coach and creator of this week in health it a set of podcasts and videos dedicated to developing the next generation of health leaders. We have a bunch of stories. There’s one really big one which we’re going to dive deep into. And then there’s a not so small so we’re going to look at project Nightingale and the essential Google arrangement. A white house rolls out sweeping transparency rules. Big story as well. Uh, I look at Amazon care as a model and if, gosh, if we can get to it, we’ll take a look a another prediction story from healthcare execs and Nike has a new pair of shoes for healthcare workers, which I think is fascinating.

Bill Russell: 00:47 It’ll be interesting, interesting to see, I think it’s some big name doctor and put like a, you know, a doctor performing surgery, uh, embroidered on the side. Uh, we’ll have to see, uh, you know, who they get as the sponsor for the Nike shoes. 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, of our mission to develop health leaders, go to this week, for more information. This episode is sponsored by health lyrics. Uh, when I became a CIO, I was really overwhelmed at first and one of the things I did is went out and hired a CIO coach, uh, to walk with me through the process. Uh, it was invaluable to my success in the role. And I now coach CIO’s through health lyrics. If you want to learn more, visit or drop me a note at [email protected]

Bill Russell: 01:33 Don’t forget, uh, every day this month we are dropping a show. Uh, look back, look forward episode series with healthcare CIOs that we interviewed at the chime conference. We asked, uh, these CIOs, the eight same questions, they all answered them. So you get a wide range of the perspective of different healthcare organizations. So check back every day for those. Uh, and I also wanted to make you aware of a great new service that’s out there from a friend of the show, uh, Drex Deford launched three extracts, uh, which will text you the top three stories from a healthcare CIO perspective three times a week. I just signed up and I’m, I’m already using it for some of my research for the show. Uh, just text, uh, Drex D R E X two, 484848. Uh, and by the way, this is not a paid advertisement or a quid pro quo as has now become part of the vernacular.

Bill Russell: 02:24 Uh, I just think it’s a great service to the industry. Uh, okay. So now onto the news project, Nightingale, big deal. Uh, I’m going to be hitting two, uh, two sources, healthcare it, news and healthcare innovation group. Um, story. When we get to the, uh, HIPAA parts, I probably gonna stop, uh, intermittently on this because there’s so much to digest. So project Nightingale seems to square with HIPAA, but next steps matter. Yes, they do. A while Google, Google apparently signed a business associate agreement with Ascension and the scope of the data sharing appears to be in line with the HIPAA allowences. There’s still many questions as to how patient information is being put to use. Okay. So here’s what, here’s what I think transpired. I am not in the know, in any way, shape or form. So don’t take this as gospel, but you have Ascension. Ascension is a, a wide ranging health system, a lot of different markets, a lot of different EMRs.

Bill Russell: 03:19 And uh, you know, the CIO and the leadership team sit around and go, Hey, we need to bring all this data together. We need to bring this data together for, um, to do quality measures to do, uh, you know, accounting measures. I mean, you, you name it, uh, measures. It’s very hard to do measures when you have a lot of disparate data and a lot of disparate systems. So what a lot of health systems do is they go out and they go, Hey, we’re going to do a single EMR across all these things. Well, when you’re talking a hundred some odd locations, like Ascension is, you’re talking billions, not a billion, multiple billions of dollars in multiple years. Yeah. Potentially seven years to get this done from one end of Ascension to the other. And so as they look at it and say $3 billion to, uh, consolidate all of our stuff and get onto a single operating platform so that we can do this, uh, is there another way?

Bill Russell: 04:11 I think it’s the common question that someone would ask, you want me to spend $3 billion? Are there any alternatives? So somebody said, Hey, there’s a really good data company, probably one of the best data companies on the planet. Maybe they have some answers for us. Maybe they have some solutions. Maybe they have some ways that they can normalize this data and move this data into a reporting format so that without doing a massive EMR upgrade across all of our health systems, we’re going to be able to create these operational dashboards and predictive models. And not only that, we’re going to be able to tap into some really cool, uh, AI models and machine learning. Again, I don’t know anything specifically, but as a former CIO, I could easily see that conversation happening. So that conversation happens and somebody goes, let’s go talk to Google. And they do a is my guess as to what happened.

Bill Russell: 05:04 So here’s what we have. Um, you sit down with Google, you start doing the deal, and they sign a business associate’s agreement. Now. So part of the challenge becomes people don’t understand what a business associate agreement does and doesn’t do. And then they also don’t understand how many business associate agreements are in place and how much of this data is being used. So as you listen to this story, we’re going to jump over in a minute to what HIPAA actually is and what the business associate’s agreement actually, uh, covers, uh, in, in a minute. But also think about this. You have business associate agreements with all sorts of companies that have access to that data. You can have it with call center companies, you could have it with billing companies, you can have it with collection companies, you can have it with quality companies. You can have it with I, the list is so long I can’t even keep going.

Bill Russell: 05:51 It’s, uh, there’s a significant number of companies that have partnered with health systems to provide value on top of that data and it’s covered by a business associate agreement. Okay. Um, so the health data sharing collaboration between Google and session has raised some big concerns nationwide, starting with some employees at Ascension about what the initiative could mean for patient privacy. So I, you know, I find it also interesting. Um, you know, there’s a process for escalating this, uh, for the employees. If they see this concern, they could raise it within the it department. Hey, we see and they say if there’s a concern with a specific tool and we’ll get to that in a minute, but Hey, there’s a problem with this tool and the it department can look at it. And if the it, if they don’t like the it department’s response, you can escalate it to compliance.

Bill Russell: 06:42 And then there’s an anonymous hotline, then you can also go to, so there’s, there’s multiple levels within the healthcare organization to go to, but it actually, and then you can go to the federal government and there’s a compliance outlines there. Uh, but they like jumped from here to the wall street journal. It’s, that’s a significant jump to make. It was almost like, um, you know, we know best and we want to make sure that everyone in the country knows about this. Now the good thing that’s coming about as with any whistleblower kind of thing is we’re going to have a great conversation and discussion around HIPAA, around, um, business associate agreements around, uh, data privacy and sharing and around who should really control, uh, the movement of that data. So, um, another thing I want to get into, there’s so many misconceptions on this.

Bill Russell: 07:35 Another thing I want to get into is legally the medical record is not owned by the patient except in the state of Vermont. There’s only one state in our country where the medical record is owned, keyword owned by the patient. The medical record is owned by whoever creates the medical record. And the reason for that makes perfect sense when you think about it. Um, if my hospital system makes the record, we own the record because if you change that, which is very possible that it might change, you end up with a challenge. And the challenge is there are records made about me in just about every other industry, right? So if I buy a book from Amazon, they have a record. Now, is that record mine? Do I own that record? And if I go and you know, fill in the blank, if there are records of about me, uh, all over the place, do I own all those records and do I get to aggregate all those records a good conversation to have?

Bill Russell: 08:28 And we will, uh, we’ll broach that a little bit at the end of the show. So, uh, let’s see, the so called project Nightingale, it’s a, I’m sorry, I’m going to go back to this one more time. So the record is not owned by the patient access to the record is, uh, is legally mandated by the rules are, it’s legally mandated. So I can have access to my medical record if I go to my health system and I request it. Now what’s interesting there is there was another story, I, I, I’m not sure I covered it on the show where I’m close to 50% of health systems are still struggling to meet the federal requirement for providing the medical record to the person in the allotted amount of time. So a significant problem that still needs to be overcome. All right. Back to the story.

Bill Russell: 09:15 The so called project Nightingale. Overall, it does appear to meet HIPAA compliance standard based on Google and Ascension’s own statement of what has been reported so far by the wall street journal and others. A CNBC reported that while Acension and Google did sign a business associate agreement as required by the HIPAA, some Ascension employees were concerned. Okay. So we’re going to come back to that through the concern. I want to go over to HIPAA real quick and again, we’re, we’re just trying to educate people on this specific topic cause there’s a lot of confusion. So, um, why was HIPAA probably not violated? This is straight from the healthcare innovation group. A story, the answer lies and understanding at least in some degree, the scope of personal uses under HIPAA. It is true that two or more commonly discussed components they have a are the privacy rule and security rule in the context of use and disclosure of the privacy rule is the applicable rule in governing the use and disclosure of protected health information.

Bill Russell: 10:09 HIPAA allows covered entities to use and disclose protected health information without consent or notice for treatment, payment and healthcare operations purposes. The use and disclosures include providing protected health information to business associates to assist with permissible categories. Would you like to hear the permissible categories? Sure. Here we go. Number one, conducting quality assessment and an improvement activities including outcome evaluation and development of clinical guidelines. And it goes on and on. It’s as long paragraph number two, reviewing the competence of qualifications of healthcare professionals, evaluating practitioner and provider performance, health plan performance, so forth and so on. Again, long paragraph number three, exhibited except that’s prohibited under some long uh, guideline 164.502A5 subsection I underwriting enrollment premium rating and other activities related to the creation, renewal and replacement of contract of health insurance or health benefits and seeding, securing.

Bill Russell: 11:10 And you get the idea, you can do a whole bunch of stuff around, um, insurance capabilities. Number four, conducting an arranging for medical review, legal services and auditing functions. Number five, business planning and development, such as conducting cost management and planning related analysis related to and managing the operating entity. Uh, and it goes on number six, business management in general, administrative activities and entity including but not limited to hear how broad this is. Business management and general administrative activities of entity, including but not limited to, which means there’s no way that they signed an agreement that is not covered under HIPAA by the way. So a number one management activities relating to the implementation and or compliance with requirements of this sub chapter. So this is a subsection under number six business management and general administrative activities. One was management activities relating to the implementation of compliance and requirements, um, of the subject or a subsection two customer service subsection three, resolution of internal grievances.

Bill Russell: 12:12 Number four, the sale, a transfer merger and consolidation. All are part of the covered entity. And number five, consistent and applicable requirements, uh, creating the identified health information or limited dataset in fundraising, so forth and so on. Uh, so as this demonstrates it’s a very broad reading. Um, and hopefully with the escalation of this we will revisit it and we’ll take a look at it. So, uh, let me go, continue to go on here cause we’ve already used a bunch of the time. So Ray D’Onofrio a principal data analyst at technology consultants, SPR explains development tools such as Google data studio can be problematic for HIPAA compliance because it doesn’t have logging of data changes, access controls, data viewing and screen locks. That could be true in my use of a Google data studio. I don’t recall those things being in place, but they could be in place.

Bill Russell: 13:02 I’m not entirely sure, uh, if nothing else as a result of this Google, within the next three months, we’ll put those things in place. Um, how and which is good. It’s good that we’re having this conversation. It’s good that they are going to be required to put that in place. However, Tactica HIPAA compliance is a bit of a red herring. He said it is the spirit of HIPAA that should be in question, uh, is data acquired and used for specifically providing value to the patients? Um, yeah. I mean, sure. By the way, I, again, I’m going to totally agree with this at the end of the show. So I’m not going to be a hypocrite here and poke holes in this, but that’s, that’s not, they’re adhering to the law as it is written. So we can talk about the spirit of the law all we want, but, um, it doesn’t seem to be relevant at this point, uh, but it should be relevant.

Bill Russell: 13:52 And then we have some other people talking about, um, uh, the back and forth between actually how Google and Acension handled the, uh, notification of people around. Uh, this project doesn’t seem that anyone knew it was going on. Uh, I’m going to go down here. There’s a good one from a lawyer to see us. So similar point was raised by healthcare attorney and the point that’s being raised is that, uh, BAS happened all the time, but this one’s between Google, which is, makes it a big deal because Google is in the data business. Similar point was raised by healthcare attorney Matthew Fisher, a partner of Westboro, a huge law firm in Massachusetts who echoed, uh, McGraw’s assessment that product Nightingale is not fundamentally that different from all sorts of interactions that occur between healthcare organizations such as Ascension and vendors such as Google on a daily basis as long as Google fulfills its privacy and security obligations under HIPAA.

Bill Russell: 14:49 With regard to the protected information provided by Ascension, there’s no HIPAA issue to um, on the face of things you said Fisher a big unknown and this is a huge unknown, um, about the relationship, though is whether Google will be permitted to de-identify the Ascension patient information and uh, this is a problem for two reasons. One, the, uh, Google can then use that data in all sorts of different areas that they are pursuing within healthcare to fine tune search results and which will, uh, increase their value to health systems in order to get positioned well in order to grab some of the dollars. As you know, most health, um, encounters began with a search of Google. I have this condition and Google is now working very hard on its search results to uh, position, um, you know, the right information for me. When I say strep throat or I have a sore throat.

Bill Russell: 15:47 It positions the right, uh, data as well as recommendations and the ability to do advertisement, which, which is their core business. So they could de-identify this information, they could get much more specific potentially and know that it is bill Russell who is searching bill lives in California, bill fill in the blank and that, um, that ad could be very specific to me. So, uh, even to the extent of knowing my insurance so that they can, uh, I mean these, some of these things are actually huge convenience things. I mean, I search it says, well, I know this is bill Russell Bill you have a sore throat Bill Here’s the three doctors you can see that are covered under your plan. Fill in the blank. With that being said, it’s still a huge violation of my privacy and we’re going to get to that in a minute. Uh, the other thing is, uh, an argument can be made and it is being made.

Bill Russell: 16:38 Um, Google is doing work of the university of Chicago and a plaintiff is making the argument that no data is De-identifiable in the hands of Google because of their data prowess. And there’s a certain case to be made that that is true. Um, then they go on to talk about, um, let’s see. We have to remember that the average person is not a security expert and can easily be overwhelmed by technical jargon from suppliers professing how secure and trustworthy they are. He said, um, so you know, Google is saying they’re trustworthy. Google is saying they’re going to, uh, protect the data and all those other things. So let me, so here’s, here’s my, so what, um, the move by Ascension was, was a good move. It is innovative. It is forward thinking. It is, um, not accepting the status quo and is looking for a way to not increase their debt load by $3 billion, which ends up getting passed on to patients and increases the cost of healthcare.

Bill Russell: 17:39 Uh, it is a way of providing a new set of services that aren’t available today. Uh, I’m not arguing that this, uh, move in innovation was a bad move in any way, shape or form. I think it was a good move and a strong move. Um, I think what was missing was one step and that was, uh, at what point do you engage the user community? Not that you’re required to, uh, but is there an ethical obligation to tell people, Hey, we’re giving your data to um, to Google and beyond an ethical, is there a new, um, is there a new playing field that we operate on where it’s important to notify the users so that we don’t take this kind of PR black eye and slow the project down by a couple of months while we’re trying to fend off all the things that are going to be coming at us?

Bill Russell: 18:30 What is there like an open comment period that could have been used? Um, so that’s one thing. And then I would be remiss if I didn’t bring up one of my favorite topics, which is, um, I believe that we need a patient bill of rights or whatever around the data, specifically around the data that the medical, that let’s assume, I’m going to say the healthcare system can continue to operate exactly how they operate. I don’t care. I do care, but let’s assume I don’t care for this case. I want to have every data element that the health system has on me delivered to me electronically and in some sort of format that can be parsed and that can be fire. It can be, well it could be XML can be, um, I dunno, it can be any number of formats and we could determine what the format is and I get the data and then I can determine what I can do with the data because I believe that if you gave blue button 2.0 kind of esqu kind of thing, you give every patient their medical data that there will be a data ecosystem that emerges.

Bill Russell: 19:39 And then it’s my choice to give the data to Google or not giving the data to Google. And you know what, I may choose to give it to Amazon or Google or Microsoft or fill in the blank if it adds value to my life, if it, if it lowers my cost of care, if it think of it, I mean it’s the triple aim. If it lowers my cost of care, if it, uh, improves the, uh, clinician experience in my experience in that setting, it’s a quadruple aim actually. Um, if it, uh, increases out, improves outcomes in any way, shape or form, if it can help me to identify the doctor that I should see that has a, a higher propensity for successful operations and those kinds of things, um, anyway, uh, you get to get the picture. I want all my data and I almost don’t care how bad it is, uh, because I think that there’s companies out there that can make sense of it and once they make sense of it, they can create value for me as the patient.

Bill Russell: 20:35 We are 20 minutes in. I’m going to cover, you’re going to give me another five minutes. I’m going to cover these things real quick. White house a rolls out sweeping transparency rules for hospital insurers, Trump administration on Friday now sweeping your new rules. Uh, the first set of rules is, let’s see, insurers would, uh, have to tell patients in real time through online tool what the, a out-of-pocket for all covered healthcare services. The requirement could also make it easier for people to compare costs. By the way, this is a Politico article. Um, story continues. So under a separate policy, the administration finalized Friday, hospitals would have to disclose currently confidential rates they’ve negotiated with insurers and other costs, information like what hospitals are willing to accept in cash from a patient. The measures was the first pro’s in July and scheduled to take effect in 2021 January, 2021, the pricing transparency has emerged as an increasingly prominent part of Trump’s healthcare agenda as he tries to chip away at the Democrats pulling advantage, whatever.

Bill Russell: 21:39 Um, I, I don’t want to get into the politics of the whole thing. It’s, uh, I don’t, I don’t know if that’s why he’s doing it or is, is, is not why he’s doing it. What we’re going to take a look at is the rule itself. So the rule itself requires, um, uh, insurance companies to give information on what is going to be owed earlier in the process. They already do this. I think actually she talks about it. Our goal, uh, will be to give patients the knowledge of what they need about the real price of health care services. There’ll be able to check them, compare them, and go to different locations. Uh, this is secretary Azar. Uh, he also said a new measures, uh, maybe more significant change to American healthcare markets than any other single thing that we’ve done. But just hours after the announcement, uh, for large groups, including the American hospital association, um, said that they have a legal right and they’re gonna try to file a lawsuit to block the rules.

Bill Russell: 22:39 Um, and they go on to talk about why it may or may not go. CMS, administrator Verma said the health information insurers must disclose, is already available to patients in their explanation of benefit statements, but patients would now be able to access that information, uh, sooner. We’re just requiring that it be available before care and not after said Verma hospitals will have to post that information online for 300 common services such as x-rays and lab tests. In an easy, understandable format, CMS will specify 70 of these services and hospitals can choose the rest. Hospitals that don’t comply could face fines of up to $300 a day, $300 a day. That doesn’t seem like much of a fine anyway. Um, this is going to be a political hot potato as you can imagine. And there’s going to be opposition to this. Transparency in markets is required.

Bill Russell: 23:29 Well, transparency and markets is required. Anyone who has economics, economics 101 that, um, you know, the more, uh, access to information you have, uh, creates a better, more well more well-functioning market and hospitals and healthcare is not a well-functioning market and we do not have transparency in that market. So the administration is trying to make it, you heard that when we interviewed Don Rucker about this, that uh, they truly believe that they can, um, tweak this enough to make healthcare a truly functioning market. And then on the other side, you have people essentially saying it’ll never happen. Therefore the government should take it all over or some facsimile thereof with a Medicare for all with Medicare advantage for some, I guess is the model that’s being proposed out there. Uh, all right. Nike shoes or now let’s hit the, let’s hit the Amazon story.

Bill Russell: 24:21 Should we hit the Amazon story? So, um, Amazon care and employee perspective. So Amazon care, this is from a CNBC and I think it’s interesting. I just wanted to cover it cause I just think it’s interesting. So, uh, it’s exactly what you think it is. They, they download an app, they get a bunch of disclosures. They let them know, Hey, you’re using a medical group. You’re not being, this is not, um, you know, there’s, there’s a medical group that’s using it and has disclosure statements and those kinds of things. Uh, and then it starts to guide them through the process. So, um, according to the screenshots, uh, Amazon employees trying, try the service out, get a welcome kit, a mobile phone holder and a digital thermometer. If those are interesting. From there they’re asked whether they could, would prefer a free chat via nurse, via messenger care chat or a video chat video care with a medical provider and employee might share that they’re feeling unwell and the provider would follow up within minutes and ask for a set of questions to figure out whether the patient needs to be seen in person.

Bill Russell: 25:26 If so, a practitioner will then be dispatched and a map and the app shows their location an estimated time of arrival. Amazon employees can also set up a profile with their payment methods, care history, uh, and their dependence. So far the company has received dozens of positive ratings and reviews and playing. The employees are happy with the quality of the care. Um, despite its focus on employees, Amazon cares viewed by analysts and other health experts as a threat to establish telemedicine companies that offer similar services to consumers. Many of these companies have struggled to market themselves and stand out in a hotly competitive space. If Amazon care succeeds among employees, the company could someday sell it to millions of people who already rely on Amazon for their groceries, entertainment, and more. Wow, that’s a stretch. I mean, I’d love to see that, but that’s, that’s a stretch to scale that, that’s, uh, a little ways away.

Bill Russell: 26:22 Um, but I think what’s, what’s more likely to happen is you’re gonna see this, um, end up in the, uh, in the, uh, Amazon Berkshire, JP Morgan, uh, model, uh, the Haven model. And then you’re gonna see it marketed to other large employers. And that is a very real possibility. Uh, but I just wanted to give you an idea of what that model looks like. It’s a, uh, it’s a really well, sounds like a really well designed digital, uh, experience model. And then finally, uh, just cause I have to talk about it. Uh, Nike has new shoes specifically for healthcare workers. And uh, Oh, here’s this from a Fox business. So this showed up in my feed and, um, my healthcare feed, Nike has made a new shoe designed specifically for healthcare workers who spend upwards of 11 hours per day on their feet. The air zoom, pulse pulse, interesting air zoom pulse is fashion and black and white soles and Nike logo and, and bedded in the blue five point pointed star.

Bill Russell: 27:31 Anyway, you get the idea. It’s a really cool, um, six upcoming design variations featuring everything from LGBTQ pride. Rainbow to cartoon sketches of medical instruments are set to go on sale next month. So interesting that they’re coming out with shoes designed specifically for healthcare workers. And I, you know, this shoe brought to you by, I don’t know, dr Topo. I don’t know. We’ll see. We’ll see what direction they go in. I think it’s a, I think it’s fascinating and interesting, a lot of news to cover. Um, love your feedback. Did I hit the Mark? Did I miss the Mark? Uh, I definitely went a little longer than I would like. Um, just shoot your notes to [email protected] I would love to get your feedback. Uh, remember, check back every, check back off and we’re dropping an episode every day this month.

Bill Russell: 28:25 Um, please come back every Friday for more interviews following that in December. We will start back with our Friday, uh, interviews. Uh, and if you want to support the fastesr growing show, um, share it with a peer. Sign up for our insights and staff meetings on our homepage, uh, interact with our social media content on Twitter and LinkedIn post or repost that content and again, send me feedback. I, the feedback is so helpful. I can’t even begin to tell you. I love getting the emails. I will respond to each one [email protected], uh, the show’s production with this week in health it for more great content. Check out the website this week, or the YouTube channel special. Thanks again to our sponsors VM-ware and health lyrics for choosing to invest in developing the next generation of health leaders. Thanks for listening That’s all for now.