News Day – Voice Wars, VA Telehealth, Amazon Echo RX Integration


Bill Russell

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It’s Tuesday News Day and today we discuss big voice announcements from Microsoft/Nuance and Amazon to alleviate the clinician burden|
#HealthIT #ThisWeekinHealthIT #CIO #Healthcare


Bill Russell: 00:05 welcome to this week in health it news where we’re looking 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 podcasts and videos dedicated to developing the next generation of health leaders. I am in a hotel room as you can see if you’re watching the video, if you’re watching, if you’re listening to the podcast, you have no idea where I’m at, but I’m in New York city, going to hang out with a couple of us CIOs and, uh, this week in New York and look forward to that conversation on innovation and maybe sharing some of that with you, uh, in the future. Uh, depending on what we talk about, looking forward to that. But there’s a lot of news stories going on this week. We have the start of the a clone wars, no, not the clone wars.

Bill Russell: 00:46 The voice Wars. We have a Amazon transcribed medical, uh, has come out. Uh, we also see that, uh, let’s see, down here at Microsoft, new ops and Microsoft have announced a partnership. So we’ll read that together. See what that’s about. Uh, the VA sees a surge in veterans using telehealth services. Uh, and we will talk about that. Amazon taps a first pharmacy for Alexa medication management. Uh, Apple has, uh, survived the backlash of tech, uh, the tech world while Amazon, Google and Facebook continue to get it. And it’s about trust. Publix commits 4 billion to food donations and many more stories to cover. So, uh, we’re going to do, uh, we’re going to do the same format we did last week. It was our first attempt at it. I got a little bit of feedback, but I think the holiday week, uh, stifled the feedback a little bit. Um, but what we’re doing is, you got tired of me just saying, Hey, I’ve got 10 stories.

Bill Russell: 01:41 And I only cover three. Uh, so what I’m going to do is I’m going to go through 10 stories real fast, uh, what the story’s about and uh, what the, so what is on the story and then come back to a couple and go a little deeper in that. And um, and that way we’ll get to all 10 of the stories. 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, go to this week, for more information. This episode is sponsored by health lyrics. When I became a CIO, I was really overwhelmed at first and one of the things I did right off the bat was to hire CIO, coach, uh, to walk with me through the journey. I, this is someone who has wisdom that can only be gained through years of experience.

Bill Russell: 02:20 And it was invaluable to my success in the role. And I now coach CIOs through health Lyric’s, if you want to learn more, visit the health Or drop me a note at [email protected] this week in health And don’t forget, we still, we’re in the last of the, a handful of chimes, CIO interviews. I think they’ll go through the, uh, through Thursday of this week. And then on Friday, we’re going to hear from SCL health, the guys in, um, uh, Craig Richardville and the, people from, uh, Colorado, Denver, Colorado. So, and, uh, also don’t forget, uh, Drex Duford’s new surface, uh, 3XDrex. You get, uh, three stories texted to you three times a week from a CIO perspective. Uh, just text Drex to 484848, and you’ll get those. And I like calling that out because, uh, again, I, I love using his service, uh, to identify some of the stories I’m going to talk about.

Bill Russell: 03:18 Okay. So go do it a little different. We’re going to go through the top 10 stories and, uh, see what we talk about. Let’s take a look at an Amazon transcribed medical. This is probably the newest of the stories. And, uh, the reason we’re talking about the reason it’s one of the newer stories is you have, uh, the Amazon reinvent conference going on this week. And, uh, with that, you will have a bunch of Amazon announcements coming out. So we’ll probably talk about them a little bit more in this episode than usual. Uh, just because this is their, their big event, uh, the AWS events. So, uh, let’s see. In 2017, Amazon launched Amazon transcribed and automated speech recognition service that, uh, makes it easy for developers to add speech to text capability to their applications. Today they are extending that to medical speech with Amazon transcribed medical, and you know, it’s, uh, let’s see.

Bill Russell: 04:15 Thanks to Amazon transcribe. Medical physicians will now be able to easily and quickly dictate their clinical notes and see their speech converted to accurate text in real time without any human intervention. Clinicians can use natural speech and do not have to explicitly call out punctuation like coma or full stop. This text can then be automatically fed into downstream applications such as EHR systems or the AWS language service, which Amazon comprehend medical for, uh, entity extraction. And so you have, you know, so they released the service, you record in a standard format, you send it up to transcribe medical and then takes it and turns it into text. I’m not going to say this, so what on this until I get to the next story and then I’ll come back to it. So I, nuance and Microsoft announced partnership to tackle clinical burnout and this will be around voice.

Bill Russell: 05:09 Um, ACI is built on Nuance’s dragon medical one cloud platform and speech recognition and natural language understanding technology. The partnership will combine nuances, expertise of conversational AI, clinical documentation and decision support solutions for healthcare with Microsoft strength in delivering cloud and AI solutions. Dragon medical one, a secure cloud based, uh, speech platform for where physicians and other clinicians already helps securely document so forth and so on. The ACI platform has already begun to roll out to select customers in beta form and the company’s plan to formally introduce a joint technology in early 2020 across several key specialties as well as expanding capabilities for additional specialties over the following 24 months. So what’s the, so for this, the what for this is ambient listening voice technology is, is ready. It’s not ready. It’s close. It’s really close. Close enough that it should be in your plans for 2020.

Bill Russell: 06:10 If it’s not in your plans for 2020, uh, you’re going to be probably, uh, missing the boat and falling behind a little bit. I know that we have a lot of people have nuance throughout their health systems. Uh, this, uh, represents the next step, I believe. I think you’re going to see voice, uh, we talked to Orbita your see voice platform start to emerge that allow you to automate the workflows within the health system. You’re going to see a voice and AI come together so that you’re going to see a lot of this really address the clinical burnout. And, um, you know, clinicians didn’t sign up to be, you know, uh, data entry clerks and, it leads to so many issues, so many problems. Uh, it’s much better if the technology understands what’s what’s being said and, uh, and, and makes that into a note that’s readable and then takes into account the things that need to be taken into account in order to create the proper bill, the proper regulatory environment and all those things.

Bill Russell: 07:11 So you start to take all that burden off the clinicians and make that, uh, really handled by the computer systems. And this is going to be a, we all know this is going to be a significant move forward, uh, in workflow in, uh, the, the experience for the clinicians and the experience for the patients. This is a good thing and I’m glad to see, uh, the Titans weighing in, you know, the Amazons, the Microsofts weighing in. You also have Google weighing in, as well with this. Uh, you have them bringing their AI technologies, their machine learning technologies, uh, their cloud technologies. So you’re going to see this, uh, proliferate very quickly, I believe. I think you’re going to see, uh, you may want to reevaluate your voice technologies and really look for platforms next year. So the, so what for this is, uh, next year is the year to really start to figure out what your platforms are going to be for conversational and voice technologies throughout the health system, from the patient interacting with voice in the home.

Bill Russell: 08:14 That is communicating back to the health system all the way to the operating room, to the exam room, to the clinician’s office across the board where the keyboard is not going away, but the keyboard will be minimized significantly in the, uh, interaction with the EHR. Um, so you know, and there’s going to be a lot of different plays. Look for platforms, platforms are going to be key in making this happen. So those are two of the big stories to start with. Uh, the VA, this is actually a pretty easy story to cover. So vac is a surgeon. Veterans used to tell how services more than 900,000 veterans use the agencies virtual care in 2019, uh, with their, of the VA’s video connect app up 235% in the same period. Uh, they also, uh, have noted in here that a majority of that is, uh, veterans using the, uh, mental health through telehealth platform.

Bill Russell: 09:14 So, uh, you know, so there’s two big wins here and I think bode well for, um, organizations that are looking to make a business out of a telehealth. Telehealth is a much better experience than going to an urgent care center. It’s a much better experience than, um, you know, when you need behavioral health, when you need, uh, to sit down and talk to somebody, you need that experience very quickly. And so, um, you know, we’ve talked to ginger at the health conference and I love their concept of a, and now it’s very limited. You can only do it within a, an employer program. But I love the concept of when you need help, you can get connected. Um, you know, within minutes, hit the app store, get the ginger app, be talking to a, uh, a clinician that quickly. Um, so the, so what for this is tele-health is a viable business model.

Bill Russell: 10:09 It will continue to grow. You have to figure out how to get it paid for still. That becomes still the challenge. The thing with the VA and the reason we’re seeing it surge in the VA is because there’s no payment mechanism. It’s very easy to do. So the payment mechanisms still have to marry with telehealth services. But I think what you’re seeing is people saying, Hey, I’m willing to pay for the convenience, you know, 10, 15, 20 bucks. We have to figure out what that, uh, what that equal equilibrium is on the price that people are willing to pay for that telehealth visit. Uh, and then it starts to expand it and then expand the services on top of it. So, uh, I think that is a, an important move. Let’s see. That’s the VA story. Let’s go to this one. This is a modern healthcare story.

Bill Russell: 10:53 Amazon taps first pharmacy for Alexa Rx management. So Amazon Tuesday unveiled what the company hopes to be the first step in a broader effort to let patients manage their medications using Alexa. The company’s voice assistant is the cornerstone of the tech giants push into the healthcare sector. This past spring, Seattle-based Amazon launched the invite only program for healthcare companies, including hospitals and health insurance to develop skills and transmit protected health information through the voice assistant while meeting HIPAA compliance. The new skill collaborations between Amazon and medication management company Omnicell was built as part of that program. Uh, Amazon partnered with supermarket and pharmacy chain giant Eagle for the skills initial launch customers of the chain, which has more than 250 pharmacy locations in the Midwest and mid Atlantic are now able to review their current prescriptions, set reminders, and take medications and requests for prescription refills through the new Alexa feature.

Bill Russell: 11:53 Um, the reason I highlight this story is I think it’s important for us as healthcare providers, healthcare, health it providers to realize that there is a, uh, there’s a, uh, battle for the, uh, for the home that is starting to go on. And we, we want to be in that battle. We want to be in that conversation. And right now what’s happening is you have Amazon, uh, hooking up pharmacy information, uh, pro probably through their PillPack or, or, or through this partnership, um, where people like my father in law who are 87 years old who forget to take their medications, you can set reminders on Alexa. Now he interacts with Alexa with his Amazon echo, uh, all the time. It’s a, you know, it places country music forum. It, uh, it really is kind of an amazing, um, an amazing dynamic between an 87 year old, um, uh, whatever octogenarian, whatever, whatever the term is for it.

Bill Russell: 12:53 And, uh, and technology and it’s, and it’s a very natural connection. Uh, he, he asks about the football scores, about what games are on today. Um, you know, how are the Cowboys doing? And uh, you know, it’s, it’s a very natural, they’ve, they’ve created something that’s very interesting and it connects very well into the natural workflow of the home. And I think we as health system providers need to be thinking about how we’re going to do that. So that’s the, so what on that story, and it’s why I highlight that story. Uh, let’s see. Publix commits $4 billion to fund, uh, donations to alleviate hunger. And as I said last week, you know, 70 to 80% of health is not healthcare related. It is related to social determinants. And I think we should not, uh, minimize these stories. We should continue to, uh, highlight them in our communities.

Bill Russell: 13:47 Um, and by the way, this is on the heels of them already contributing 2 billion in food donations. So this is actually doubling up on that. And, uh, the commitment to commitments over another, uh, another 10 years, I believe. So another $2 billion towards the food donations to alleviate hunger. Um, again, partner with figure out the partnerships that are gonna matter for delivering health. Uh, healthcare is about restoring health. Uh, how are we gonna deliver health, keep people healthy in our communities? And I think it’s through partnerships with companies like Publix who are, uh, making these kinds of commitments. Uh, we talked about Amazon reminding you of your pills. I did these stories out of order or nuance. Microsoft talked about that. Um, here’s one patient’s open to remote monitoring. There it is. Patients open to remote monitoring to reduce doctor visits, survey shows, and a overall interest in wearable devices such as Fitbit and Apple watch was high with more than half of those polls saying they would use such a device at home.

Bill Russell: 14:51 And, uh, I, I think the important thing here is to, is to realize people are willing to trade privacy for, uh, for convenience, for cost, for benefits to them. So there is a, uh, uh, these ads now that are coming out, you have people who are driving around don’t mess with my discount, right? So they’re driving around with an app on their phone, which is monitoring their movement of their car, their speed of their car and where they’re going. And what people are essentially saying is, you know, what, for state farm or for, uh, uh, progressive or whoever it is, I think it’s, those are the two I remember. Um, you know, I’m willing to trade my privacy information if you are willing to reduce my costs or if you are willing to fill in the blank. I think that same opening exists for healthcare.

Bill Russell: 15:43 Uh, if we’re willing to walk through it, if we’re willing to come up with the solutions that add value to people’s lives, reduce the cost of care, improve their overall health, uh, and uh, and that privacy trade is going to be one that they’re willing to make. So, uh, so here’s another one. Uh, another Microsoft story and I highlight this because we don’t talk about security. We have a security episode coming up in a couple of weeks with the Cleveland clinic team, uh, where we talked about security in depth and I think it’s going to be a good episode for people to hear. Um, and uh, it’s actually the last episode, uh, where, uh, ed Marx was still the CIO of Cleveland clinic. He has now moved on and I did it with him and his, uh, chief security officer, a really good episode, appreciate, Ed putting that together.

Bill Russell: 16:31 Um, this story is from the MIT technology review, which is one of my favorite, um, uh, journals to read. And the reason is because it really goes in depth on the technology. So, uh, inside the Microsoft team tracking the world’s most dangerous hackers. And what it talks about is that, uh, the Pentagon recently awarded Microsoft $10 billion contract to transform, um, transform and host the U S military’s cloud computing system. But as part of that, what they needed to demonstrate was their ability to protect that data because, uh, if you think the health system is under attack pretty often because people want access to those records, the Pentagon is under attack literally by nation States all the time. And they go into detail here of how Microsoft has really organized itself in such a way to monitor these attacks and to start thinking like attackers. And they have a, they have set up some really cool, um, groups that are dedicated to, uh, dedicated to certain countries, a certain attack vectors, um, uh, you know, certain groups, uh, hostile groups.

Bill Russell: 17:41 And what they’re doing is they continue to, they’re taking this massive amounts of data that they receive. Um, and because they’re monitoring and processing in real time, they’re able to respond very rapidly to, to these attacks as they evolve, they’re able to evolve. Cause when you think about it, we send data to Apple and Microsoft pretty often when our system fails or when our system has an issue or those kinds of things, and they’re taking that telemetry data and they’re marrying it with other systems to identify when the attacks are hitting and how they’re spreading throughout. Um, I think there’s this, this is interesting. You know, Microsoft used to be the biggest hole within most organizations back in the, uh, windows XP days. And I think they got their act together and they continued to evolve, evolve, evolve, evolve to, to now being the point at the point where they can be trusted with the, uh, security of, uh, of the Pentagon.

Bill Russell: 18:39 Now I, I know it’s more complex than what I’m making it and what this story, uh, makes it out to be. It’s a, uh, uh, you’re talking about many factors. You’re talking about a lot of new technologies, a lot of new things. But, uh, but, uh, you know, Microsoft has stood that up. The, so what for this story and it’s worth a read the MIT technology review inside Microsoft team tracking the world’s most dangerous hackers and uh, the, so what for this is around security. It is really good to identify partners at this point. Anyone who’s trying to go to do the security thing on your own, thinking that your staff is good enough to defend against the attacks that are coming into healthcare. Uh, first of all, that’s a huge mistake and I don’t think that represents a lot of health systems, but I think some think that their chief security officer or their, uh, you know, dual factor authentication is protecting them.

Bill Russell: 19:35 Uh, the reality is, you know, I’ll just share from my experience. Um, you know, the, the, the biggest breach comes through. Your people are giving away their passwords. They just absolutely will give away their passwords and they’ll give them away. Not maliciously. They’ll give them away in, in ways that are, uh, you know, it’s, it’s crafted for them to do it. And they give it away by using their same password that they’re using on their clinical systems, uh, on their banking system and on other systems that may not be as secure. You know, the average person isn’t remembering a hundred passwords. And when you think about a hundred passwords, you think, Oh, well that’s crazy, but you know, I’m using one of those, uh, you know, password things. And I thought, I wonder, you know, let me check how many passwords this thing is holding for me.

Bill Russell: 20:22 It’s holding 125 passwords. Well, no individual is holding 125 passwords. And so what they do is they end up, um, if they’re sophisticated, they end up with a pattern that they’re using. Uh, the passwords are different, but the pattern is the same so that they, all they have to do is remember the pattern and they can figure out what their password is for these various systems. Um, or they can, anyway, there’s, there’s a lot of reasons they give them away. Uh, the is, you know, phishing and spear phishing and, and targeted attacks caused them to give it away. And, you know, I used to think that, uh, you know, these attacks were for unsophisticated users and they’re not for a sophisticated users. I was just with a, a CIO who said, you know, for the first time, uh, he fell victim to one of the, the, they do a, um, they do the, uh, internal, uh, spear fishing and fishing attack software to test their group and to educate their group.

Bill Russell: 21:17 And he, and it’s gotten more, much more sophisticated as it’s gone along. And he fell victim to, uh, to one of the emails here recently. And I think that’s true. I think the, the attacks are getting more sophisticated and it’s getting harder to protect. You need a partner that has a very sophisticated way of, uh, monitoring, exfiltration, monitoring, uh, anomalies of patterns across your wire, uh, monitoring, um, you know, your perimeter. Um, but also the, the new, uh, devices that are going to be moving stuff in and out. Right. So are you using TLS too? Are you, how are you, how are you encrypting that data? Is that, is that data really, um, safe from one end to the other? I, I just think it’s security has gotten so sophisticated that it requires an outsource partner relationship, not outsource it completely, but to bring in that expertise to help you out.

Bill Russell: 22:12 And, uh, the final story, and I’m still getting used to this format, it’s a little different for me. Uh, we’re going to go into is why Google’s move into patient information. That’s a big deal. This is David Blumenthal. Um, and this goes into this story that we’ve been covering for the last three weeks and I’m just gonna hit a hit on it at the end here. So a recent agreement between Google and Ascension, you should national health system, which we’ve talked about if you had another sign of how digital revolution is transforming healthcare, we’re at the Dawn of a new era where clinicians will be able to apply in real time the collective human experience in treating any particular problem to the care of every patient with that condition. And that is the promise of all this data. We’ve been collecting. People have said, you know, this is her healthcare.

Bill Russell: 22:58 The promise though is once we get those data points where we get, uh, all those data points around each individual visit or at each individual person together, we can now start to apply that data in ways that we’ve seen in other industries really changed the industry. So, um, but the critical reactions to the agreement under which Ascension will send a Google cloud, the clinical data it collects on it’s 50 million patients and Google will process that data to help Ascension better manage its patients and its finances. Make it clear that changes of this magnitude are never smooth. The announcement generated concerns about privacy, patient privacy and the miss use of information for the private gain of third parties. It triggered an investigation by the us department of health and human services and calls from members of Congress, Congress for further inquiries. Uh, we are obviously at the beginning of what will likely be a long contentious and vital debate over the manage, uh, how to manage personal health information in the digital age.

Bill Russell: 23:58 Uh, patients have the undeniable right to privacy. And control over their personal health data. Doctors and hospitals need leeway to use patient information in their care. Patients, health professionals and larger society have an interest in learning from our collective experience how to care to, uh, how I’m sorry. And the larger society have an interest in learning from our collective experience with care to better prevent and treat disease. And tech entrepreneurs want a return on their capital when they add value to that management of healthcare data. The coming debate will be about how to manage these sometimes conflicting interests as health information technology revolutionizes the healthcare system. Um, this is an important article. This is Harvard business review, uh, David Blumenthal. It’s recent. It’s a November 25th. Uh, it is definitely worth the worth the read. Um, you know, setting the legalities aside for a moment. Here are the fundamentals underlying the Ascension.

Bill Russell: 24:55 Google relationship Ascension sits on a trove of data accumulated in the course of caring for millions of patients who pass through its facilities. That data used to be locked away in paper records that had to be physically transported and laboriously abstracted to serve any purpose other than the care of an individual patient at a particular place in time. As a result, the near universal adoption of electronic health records over the last decade, all that information is now stored in electrons that can flow instantly to wherever it’s needed, useful and useful to provide patients privacy. And it’s protected. It’s, it’s interesting because as you read this article, you’d be Hartford. If I didn’t tell you it was David Blumenthal who served with the Obama administration and is now the president of the Commonwealth fund. You would not know what administration this was from. Cause I could, I could easily have just, I could say this was a, an article with a secretary Azar or Seema Veerma.

Bill Russell: 25:53 The, the reality of this argument is that both, um, the, both the, the dominant parties in our two party system believe that health data is going to transform healthcare. And so we have to have this debate. The, so what of this story is we have to have this debate and we have to be thinking about how we’re going to use this data and we have to be open about how we’re going to use this data. Uh, you know, the, uh, the, one of the things we talked about, our talks about, uh, recently about the Ascension deal was Ascension was under no obligation to inform the patients that they were sharing the data with Google, uh, to, you know, to generate value from that data. They, there was no laws in place. Um, and there was a lot of people who were really angry about it in a voicing their concern about it, but the reality was there was no laws that said they had to, uh, under the, uh, under HIPAA.

Bill Russell: 26:53 They’re a business associate who’s adding value to the health system and unlocking that data. The reality is if we don’t unlock that data and it just sits there, that is the biggest waste of, of data. It’s like a, it’s like an oil field that we’re not drilling in, uh, for whatever reason. But we’re just saying, uh, you know, that we’re going to leave that data alone and because we’re worried about the ramifications, we’re just not going to tap into it. The reality is we need to tap into it in order to, uh, provide better care now and into the future. And, but we also need to think about, um, how we’re, how we’re letting the patients in on the work that we’re doing. I think there’s a step that Ascension could have done, and again, hindsight is 2020, and it’s easy to armchair quarterback this thing, but, uh, I think there was a step that could have been done to include the patients, um, and give them a little heads up of, Hey, here’s, here’s the value we expect to derive from this and here’s how we expect to drive down the cost of healthcare, improve outcomes, improve convenience for you, improve the physicians experience, give the physicians more time.

Bill Russell: 28:06 Uh, all those things are the promise of this data and this data coming together. And, uh, and I believe that everybody’s intentions on, on all sides of this are good patients, providers, uh, Ascension and other providers as well as Google. I think all the intentions are good. Um, but I think there is a conversation that is going to need to happen in order for us to do this, right. Uh, moving forward, and I can’t believe I’m already up at 28 minutes, but I am already up at 28 minutes, which means it’s time to end already hard to believe. Um, I’m going to have to start saying, uh, as many sources as we can in 25 minutes or less, cause that seems to be the, uh, uh, the going timeframe. Uh, so this week, remember to check back. We have a new episodes every day this week, uh, following that, come back for our normal, uh, uh, series.

Bill Russell: 28:58 Every Tuesday we’ll have the news every Friday we’ll have an interview with a health system, uh, or uh, some industry influencer. Uh, if you want to support the fastest growing podcast in the health it space, we just cracked 100,000 downloads for this year, which uh, you know, is, is fantastic. And uh, I appreciate you guys and your support of the show. Uh, you can share it with a peer. Continue to share with peers, sign up for insights and staff meeting. Uh, these are services designed to help your career on our website. Um, uh, interact with our social media content, uh, Twitter and LinkedIn posts and repost that content. And please send me feedback [email protected] Uh, your insights continue to shape the channel and I really appreciate them. This shows the production of this week health and this week in health it for more great content. You check out our website this week, or the YouTube channel. Special thanks to our sponsors, VMware and health lyrics for choosing to invest in developing the next generation of health leaders. Thanks for listening. That’s all for now.