Bill Russell: 00:09 Welcome to this week in health it where we discuss the news information and emerging thought leaders from across the healthcare industry. This is episode number 31. Today we take a look at the cms final rule and we discuss apple’s healthcare initiatives in more detail. This podcast is brought to you by health lyrics. Health systems are moving in the cloud to gain agility, efficiency, and new capabilities. We’ve seen health systems deliver 30 percent reduction in it operating costs, reduced server provisioning time from two weeks to five minutes, and increase uptime and customer satisfaction in the process. Work with a trusted partner that has been moving health systems to the cloud since 2010 visit health lyrics dot com to schedule your free consultation.
Bill Russell: 00:45 My name is Bill Russell, recovering healthcare cio, writer and advisor with previously mentioned health lyrics. Before I get to our guests and update on our listener drive, our sponsors have agreed, as we’ve talked about before, to give $1,000 for every additional 100 subscribers to the, uh, to the podcasts, either itunes or Google play or youtube channels. We have two more weeks to go. If we just get five more subscribers, we will have raised $3,000 for hope builders, an organization that provides disadvantage youth, the life skills and job training needed to achieve enduring personal and professional success. I’ve hired their graduates of stories are really inspiring, really amazing. Uh, if we get another 105 we’ll raise 4,000 bucks. So we’ve got two more weeks to go join us by subscribing today and be a part of giving someone a second chance. So today we are joined by a cio who’s been at the same health system for almost 14 years, which is amazing in and of itself, a leader in the industry and an advocate for health it, the CIO for intermountain healthcare. Mark probst. Good morning mark. Welcome to the show.
Marc Probst: 01:44 Morning Bill. Good to talk to you. You’ve got to.
Bill Russell: 01:47 Got a neighbor right across here doing some weed whacking. So if that gets in the way, just let me know. I’m actually broadcasting from outside today. Um, man, you’ve been, you’ve been at the same health system for 14 years. I bet you a lot of cios would like to know what I mean. What do you attribute that to? How have you been able to do that?
Marc Probst: 02:08 Uh, I think Bill it’s work in for an amazing organization that’s really been forward thinking and uh, and not trying to screw up too many of the things that were already in motion, but we have changed a lot. I mean we’ve put in a, we were a completely self developed for about 40 years and we just replaced all those with cerner and Oracle. Peoplesoft and legacy or some off the shelf products. Um, but I dunno, you know, longevity, I think it has to do with the ability to work with others, you know, not, not be a know it all and keep my head low and it needs to be low. Yeah,
Bill Russell: 02:46 relationships are the key there. And a great forward thinking organization. Uh, also. Um, and then obviously doing a great job. I realized you wouldn’t say that yourself, so I’ll just say it, you know, the making that transition, that was a transition. You guys had a homegrown Ehr for many years and then it just got too unruly towards the end. Right. It just got so big and so massive. It just didn’t make sense to try to keep maintaining that. And so you, you went out and did your, your RFP and ended up with cerner.
Marc Probst: 03:16 Yeah, I mean we really built applications to support the clinical and the financial functions but not really to automate them but to support with automation, certain aspects of the caregiving process and when meaningful use came out and as technology, you know, really got much better. Help, which is our long time electronic medical record was, you know, ask a green screen, you know, very, very fast but mainframe based and clinicians were looking for a lot more from the system and to rebuild that. What we tried, we tried with Ge for about six years and that turned out to be just too heavy of a lift. So we, uh, we did go with cerner and it’s been, it’s been good.
Bill Russell: 04:02 Well let me share a little bit of, you’re a little bit of your background, your. So you’ve been obviously there for awhile, 30 years in the industry prior to inner mountain, you were with Deloitte, so you’ve been with Deloitte and with Eny, so you’ve been with a to the large firms and you’ve been a cio for a tpa as well. Um, and we’ll talk a little bit about this. So, past board chair for Chime and the chime foundation member of the original hit policy committee, uh, in the early stages, stages of meaningful use. So we’re going to talk about both those topics. You’re walking the halls of, of, uh, of the hill and what that was like, and we’ll talk about meaningful use a little bit in our first story this morning. A resident of Utah for the past 21 years. A Salt Lake, I assume.
Bill Russell: 04:48 Yes. And, uh, and you’ve lived all over. So you’ve, um, you know, Virginia Tampa, uh, grew up, uh, and uh, we’ve talked earlier, grew up in Pennsylvania, I had some time and, uh, on the main line of Philadelphia as well. So, uh, you’re married, have five children, older children. So you’ve, you’ve actually made this transition from children to, you’ve done the college tours and whatnot. Any, any words of wisdom for me as I’m, as you can see I’m off today. I’ve got the college hat on. I’m taking my daughter to college tours. Any words of wisdom of how to make that work transition successfully?
Marc Probst: 05:28 I would say get a bunch more subscribers and watch your checkbook pretty closely. Definitely don’t get cheaper as they get older, but they get better as they get older.
Bill Russell: 05:41 Uh, yeah. Well we don’t make any money from the podcast then, you know, you’re the second person who sort of intimated that asked me about this week that there’s a, this is really more of a public service thing of, of just getting, getting you guys on the line and asking you questions and giving the benefit to as many frontline staff as can get it. So, uh, one of, one of the things we like to do is we like to open it up to our guests before we start the show and just say, you know, what are you excited about? What are you working on today? And just give you the floor. So, um, so what do you got?
Marc Probst: 06:13 I got to tell you, bill, what? I’m excited. So I’m in the latter part of my career. I do have older children and I’m older because I have older children. Um, and I am so excited. I think it is such an amazing time to be involved with technology and healthcare and having been a cio and whatever that role turns out to be in the long run, they’re still cios will be leaders in what we do in technology. I believe. And I’m excited about the confluence of so many technologies right now and the potential that that has not to just help healthcare but to absolutely change it, improve it, and probably save it for our country and you know, globally, I suppose if you want to think that way. And if you think about artificial intelligence and the potential that has as it gets coupled with the cloud and all the data that exists as it gets coupled with what we’re doing around interoperability as it goes mobile and with the power that we now have with the mobile devices.
Marc Probst: 07:15 And I see a day from a consumer perspective where Dr Google or Dr Apple or whatever we want to call it, is there, that’s where they’re going to go for their initial primary care is going to be the device and all the knowledge that that device has that’s going to help healthcare because we don’t have enough clinicians to start with. And it really helped focus what they do and it will be way more real time because we are all wearing monitoring devices. And you know, we’re learning a lot more about ourselves. You know, the human body is actually becoming its own platform for computing. So I’m excited on that side and continue to look at the confluence of capabilities. I look at what we’re doing around natural language processing and voice some nuance and some of the companies that work in that space.
Marc Probst: 08:06 Um, we have been working with Stanford around computer vision, actually teaching the computer to see. So think about the triad of being able the computer being able to see computer being able to hear and artificial intelligence. Can we create Jarvis? Can we create what was an ironman three and just have the clinicians do their job and ask the computer for support and we’ll do all the documentation and all the, you know, the dirty work behind which is what we should be automating. Because to me that today we don’t facilitate care with technology. We facilitate creating a record, we get information to clinicians that’s a little more useful to them, but we don’t facilitate what they do day to day. In fact we get in their way and we hear that all the time. But again, this confluence of so many new technologies that are at the very heel of the hockey stick, these things are going to take off. I mean, I know we all know they’re gonna take off. I’m not telling anybody anything they don’t know. But it is so exciting and I, I think I’m going to witness in the twilight of my career an absolute shift of how technology is used and what we’re doing in healthcare. So I think that’s really, really exciting and it’s a great. Like I said, it’s a great time to be a cio in healthcare
Bill Russell: 09:30 in the next decade. You’re looking at precision medicine and what it can do and that’s, that’s just amazing and nanotechnology and whatnot. But in the short term, we’re not that far away from being able to interact with the computer by just saying, I mean we’re already doing it with our phone, but just saying, uh, you know, hey, cerner, open up the medical record, a, uh, you know, tell me what my schedule is today. All right. Give me the vitals on that patient and all that information just coming back to you and potentially being spoken back to you. So you’re, you’re actually interacting with a computer more like what we envisioned all those years ago and this, this really is an exciting time. And um, I think we’re going to see just exciting things in the next couple of years and then in the next decade, I think we’re just going to see advances that are really going to make our lives a fundamentally better as we, as we move forward.
Bill Russell: 10:20 So yeah, it’s, it is definitely a fun time. Let me, uh, so let me transition. So we’re, we’re, uh, we do two things on the show we do in the news and the second is we do soundbites in the news. We each pick a story and we discuss. So, um, so I picked, I picked the obvious story for this week. I’ll be the um, you know, every week there’s sort of a story that just sort of drops out and you just have to do. And so cms proposes the final rule, uh, for the promoting interoperability program. Let me read a couple things here. So, uh, today cms finalized the rule to empower patients and advance the White House, my health edata initiative and the cms patient over paperwork initiative. This final rule and others issued earlier in the week will help improve access to hospital price information, get patients greater access to their health information, and allow clinicians to spend more time with their patients.
Bill Russell: 11:09 So if you break those three things down, you have a well The agency previously required hospitals to make publicly available list of their standard charges or their policies for allowing the public to view this list upon request. Cms has updated its guidelines to specifically require hospitals to post this information on the Internet in a machine readable format. Uh, and I suppose that’s mostly for organizations that want to start creating comparison apps and those kinds of things. You can just download that and look at it and we’ll talk about that a little bit. And then the final rule also reiterate, uh, the requirement for providers to use the 2015 edition of the certified electronic health record technology in 2019 to demonstrate meaningful use to qualify for the incentive payments and avoid reductions in Medicare payments. And then finally the final rule removes unnecessary redundant and process driven measures from several pay for reporting and pay for performance quality programs.
Bill Russell: 12:05 Cms said it eliminates a number of measures. Acute care hospitals are currently required to report across four hospitals, pay for pay for reporting and value based purchasing quality programs. And a deep paid certain measures that are multiple programs. And all these changes will remove a total of 18 measures from the programs. And need to inidate another 25 cms said it’s changes in hospital quality and value measures will eliminate more than 2 million hours of work saving providers, almost 75 million annually. So, um, that’s a, that’s a high level overview of, of the final rule. So let’s just start with a pretty open ended question. So what’s, what’s your initial reaction to the final rule?
Marc Probst: 12:49 A directionally correct? Um, it does show that the current administration, cms, even the White House are listening to some of the things that are being asked of them from people like chime in and us as a voice, as a healthcare community. So I think directionally very good. Um, I’m happy that they’re making some changes, um, but it’s excruciatingly slow in getting to the actual solutions that we need is what I believe. So, uh, I again, and if you want some context with that bill, I mean, I did, I was part of the hit policy committee and our job was to define meaningful use. Um, I won’t go into the nuts and bolts of that, but it was a fairly liberal group and I’m a pretty conservative guy and uh, I think what we did, although in the, again, the intentions were correct, it really wasn’t an healthcare improvement bill.
Marc Probst: 13:45 It was really part of the stimulus package. So, you know, the intent was to get more out there, um, but in through meaningful use, we created such a rigid structure than what it ended up doing was really tamping down any kind of innovation. It didn’t help interoperability very much. Um, and what I liked today in the final rule and what you outlined is that it’s, it is minimizing some of the rigidity that was in meaningful use, but still trying to get some of the benefits of technology out there and, and incentivize people to use that technology correctly. We don’t have enough focus and you know, I’m a one trick pony. When I go to DC, I pretty much talk about same thing and that standards and I think were excruciatingly slow in getting to standards within our healthcare, uh, environment in the United States. And that’s hampering a lot of the benefit that cms and the administration are trying to get, but I am happy with the rule because again, I believe it’s directionally correct and I’m an easing some of the burden that meaningful use and some of the programs have put on us as providers and us as a healthcare community.
Bill Russell: 14:55 Yeah. And I think one of the things I’ve heard over and over again is a meaningful use got much more directive in two and three. So in the first one it was, it was directional and said, you know, here’s, here’s directionally where we want to go. And in two and three, they really expanded on that and told you exactly how they wanted it done. I think this goes back to that directional, um, uh, you know, it’s not telling cios and, and health systems in the EHR providers, this is exactly what we want you to do there. They’re being much more, much more open, but I want to touch on that. It just case in point, you know, they’re not saying, hey, this is what the ehrs has to look like. They’re saying we’re removing these measures. Okay, now go practice and, and you know, the 2015 rule is really mostly about Api and it’s saying, all right, here’s all we want you to do is to, to make that data available so that other systems can inhale it, use it, and, and, uh, make it readily available not to be a captured it in the confines of the EHR or the provider.
Bill Russell: 16:00 We want it to be accessible and interoperable so they’re, they’re getting directional again. But what do you say to those people? So this is the thing I’ve always struggled with, there are people who say, hey, cms needs to set the standard cms, you know, we’re not getting enough direction. But on the other hand, we have those same people will say, uh, you know, too much government oversight, they’re telling us too much. And then those kinds of things, uh, you know, we just, we just want to practice medicine. I mean, it is such a fine line to a, to walk, to say I’m a, do we really want the onc setting, What kind of standards? Do we want them, Um, do we want them settings, the data standards so that, that data will flow more freely. Uh, do we want them to set a EHR standards so that a one Ehr to another will be pretty standard for a physician. They can go from a cerner shop to a, an epic shop to a Meditech shop and be able to practice medicine pretty readily because it’s common. What, what kind of standards would you look for from the government versus just just let us alone eventually healthcare we will work it out.
Marc Probst: 17:08 Okay. So I come from the reddest state in the nation and I mentioned earlier, I’m pretty conservative. I have to tell you though, when I go back to DC and I talk standards, I think the government needs to define data standards so that we can get to a level where it is truly fluid data that’s moving between the systems and it means something. Even using fire and some of the API work that we’ve been talking about and frankly we’ve been using for quite a while and pushing here at inner mountain, it doesn’t get to a level of specificity where you really have this fluidity of data and where it can be used and computed. So what we’ll do is we will get more data into the hands of the consumer, which is good. There’s nothing wrong with that at all. We’ll get the ability to shift data between systems or health systems or hospitals, but it won’t be readily computable so either we’re going to have to go through some pretty challenging work to get that normalized into the system so that it can be consumed by the computer and provide insight that our clinicians are looking for or I think they’re just not going to look at a lot of it and it’s likely to be the ladder.
Marc Probst: 18:17 They’re not going to look at a lot of it. It’s funny and you can stop me whenever bill, but you know, probably five years ago I went out and I did 23 and me, you know, I was going to go out and get to some of this precision medicine and I was gonna understand more about my dna and I went and I did it and it wasn’t all that insightful took took it to my physicain. He didn’t even want to look at it, you know, he didn’t even care. Um, and it’s because it’s not relevant to what they’re trying to accomplish. We’re giving physicians what, eight minutes on average to deal with a patient. They don’t have time to consume this stuff. It has to be brought to them in a meaningful way. And so I’m a big proponent of the government being much more aggressive in defining standards and putting them out there for us.
Marc Probst: 19:07 Now. There’s a lot of things around that and how we use the data. How Our systems look like, how we present it and how we do ai and those kinds of things that would actually be facilitated if the government would get to that basic standard. It’s, it’s like the government tells us how to build a road speed limits and those kinds of things, but the cars that are on it, you know there’s regulation, but they are able to consume that. They’re able to use those things because the government took care of the basics. I don’t think the government is taking care of the basics and I’ll readily admit it’s really, really hard, but it’s not a simple solution, but it’s the right solution and I will continue to proport that in my discussion.
Bill Russell: 19:48 The thing I always say to CIOs is you can start this work today, I like to start with transparency for two reasons. The first reason I like starting with transparency is a it, it’s such a great foundation to sit in front of the physicians and they go, why can’t we get to this? And then you give them transparency into the data and they go, oh my gosh, this is crap. And you go, okay, you know why it’s crap. It’s because we need to start internally with data governance across our medical group and our acute care facilities in our large customer care. We need to get our house in order so that CBC is a CBC CBC across across the entire system. And they get, as soon as they see it, they get it and they go, yeah, yeah, we need to do that. On the, on the flip side, one of the most underused people in, in data governance is the patient.
Bill Russell: 20:36 And it’s interesting when you start putting that data out there and the patient can consume it, they can easily look at it and go, I don’t live at that address anymore. Or I never had that test done or that’s not me. I’m now. All those things are a little. Some of those things are a little scary. It’s like a, you know, you’re giving the wrong information, to the wrong person. But um, if that’s what’s reflected, if what you’re giving the patient is what’s reflected in your system, you’re going to uncover a problem that could potentially lead to a medical error later. So that’s why I liked, I liked the interoperability that they’re doing. I like the transparency to it because I always think that transparency is the beginning of transformation usually. Um, alright. So, so we’ll transition, let’s, let’s go to a, what’s your story for this week?
Marc Probst: 21:24 Well, I know last week you talked about apple and the hiring that they’re doing and that is actually what, when we communicated earlier, what really came to my mind as something that I think is really interesting in the press right now, now they’re hiring physicians They’re aligning with providers on a, on the provision of care for taking care of their own employee base. And I do think it’s interesting what they’re doing and in opening up their system for healthcare and we’re actually involved in that. I don’t know if it’s trial pilot, whatever, and we’re doing some work in that space. Not a ton yet, but we’re involved in it, but I’m really interested in the changing dynamics of health care that, um, people are taking, you know, think of the, the um, uh, the buffet and jp Morgan and I’m going to miss one Amazon and what they’ve put together around, they’re going to go after healthcare and they just hired Atul Gawande one day, right? to lead that effort. All of the. So the apple article in and of itself that you’ve already talked about is interesting and what I was interested in, but it’s really more the broadening of how healthcare is being provided across the industry and how it impacts us as the provider organization.
Bill Russell: 22:41 Well let talk about one that’s probably hitting your area. So you have cvs in, in Salt Lake and your, your area.
Marc Probst: 22:46 We don’t have cvs. We have Walmart and
Bill Russell: 22:50 wow. Interesting. So you don’t have to, you don’t have to deal with this one, uh, CVS announced this past week that they’re expanding their telehealth initiative and I think some of the other players are probably going to come into your market and do the same kind of thing. Right? So they’re gonna. Uh, you’re gonna have the blurring of lines between, uh, you know, who, who’s the, who’s the first point of contact, you go to your employer clinic, you go to your pharmacy lead telehealth initiative. How are you guys preparing for potentially new partners and new, um, new directions that people are going to come into your, your health system?
Marc Probst: 23:34 Um, I wouldn’t say we have it solved. Um, we are in a fairly unique situation in Utah, we’re by far the largest provider of healthcare in the state, a little over half of it’s provided by intermountain healthcare and that’s an insurance product we’re the largest insurance product for healthcare in the state. So we have some unique, you know, that you’re not going to find in New York, right? That kind of situation, you have a lot more competition. And so people, like, it wasn’t cvs, but one of the, the, uh, grocery store chains really wanted to get into the retail clinic health care. They came to us to work through it and ultimately they didn’t implement it. But I think right now we’re okay because of our size and stature that we have. But if the united wants to come in here and make applied or a cvs who’s a huge player, wants to come in and make a play, we’re going to have to figure out exactly.
Marc Probst: 24:30 And we’re talking about exactly the problem you’re talking about, Bill. Um, what’s, what’s going to happen? A lot of this primary care, a lot of this urgent care work is simply not going to be controlled by us any longer. When you have people with $6,000 out of pocket limits that they’re going to have to hit and they can go to cvs for $39.95 and have an interaction or then go to their iphone and do it for next to nothing. That’s what they’re going to choose to do. What we need to become then are the specialists that they can’t do over the phone. You know, you pretty tough to do a, a prostate surgery, you know, over your iphone. I suppose we could figure that out some day, but I’m not going to try it. You know, pretty hard to have your annual physical where you have to be touched over the iphone.
Marc Probst: 25:16 So we’re going to have to become better at what we do. We’re working a lot on access, so where the hours used to be eight to five, you know, the hours now start at 6:30 and go till nine because that’s what our consumers want and we’re no longer going to be able to direct them as well as we were able to in the past. Um, because of all these options, I think it’s great for the consumer by the way, a little harder on our clinicians, but great for the consumer. So we’re just going to have to change our access methodologies. I think we’re going to have to become more specialist focused because that’s what they’re going to need to come to us for. If they can get the answer to their otitis media for their three year old, um, either over a telehealth visit or through their iphone, then they’re going to do that. But there are things that we’re going to, we’ll be able to do that you can’t yet and probably never will be able to do over those, those technologies.
Bill Russell: 26:10 So I do want to talk to you about the, uh, the apple health app, iphone APP and in the work there. But the last thing on this, before I go there, I’m so telehealth can be we talked about is sort of defensively, like who are you going to partner with, how do you keep other players coming in, but it can also be an offensive strategy and I think we’ve noted on the show before that you guys, you guys have launched a
Bill Russell: 26:36 I think the terminology is digital hospital where it’s essentially virtual hospital. Um, and so you have mean you’re, you’re overseeing, um, intensive care units and those kinds of things across the market, but you could also launch a telehealth program across states that you’re looking to get into or looking into the future of getting into a out of that as well. Are you guys. Well, I mean not to reveal strategy, but do you think health systems. Let’s talk this way. Do you think health systems will start to enter markets that way that they will enter first through these convenience plays? Are these convenience options and then start to stand up clinics and the and the physical infrastructure will follow after they’ve established a base?
Marc Probst: 27:21 Yeah, absolutely. That’s happening and will happen. We’re doing it not, we haven’t built any built any clinics out of state, but we currently provide a lot of telehealth, again, kind of specialty things that they may not have in some of these rural areas or in one pan or Wyoming and some areas that we serve. Interesting. We use telehealth to provide some care in Alaska and um, and it was incredibly successful. There was an Alaska law and don’t take this as Gospel, but I’m pretty sure this is correct what I’m going to tell you. There was an Alaska law that said if it couldn’t, if the care couldn’t be provided in Alaska, it had to be provided in the next closest US state, well that would be Washington, right. And um, through the work we’ve been doing from telehealth because our costs are so competitive for, for actual care and our care quality is high.
Marc Probst: 28:21 Um, this is primary children. So our children’s hospital, we actually were able that we didn’t, but Alaska changed the law so that the patients could come to Salt Lake City and go to our children’s hospital. So I think, I think that’s an absolute strategy or really good one and we will continue to deploy that. Our CEO has said a number of times, Mark Harrison, that, you know, we really don’t want to build a lot more capital asset buildings out there, but if we can do this virtually and really be helpful to the communities we serve and the communities outside of where we serve, we want to be able to do that. I think we’ll be doing it not just in neighboring states, but internationally as well.
Bill Russell: 29:01 Yeah. So, uh, so today was the final day of onc is interoperability forum and one of the, one of the big headliners was a ricky bloomfield, apple health. It, a physician who works for apple and he demoed their, their apple health app. And uh, let me just read a little bit. So Bloomfield took the audience through all the cool nooks and crannies of the iphone APP, mainly its ability to vacuum up medical data, uh, to an appreciative audience with their oohs and Aahs. Uh, it’s a real fire APP, not a pretend watered down app bloomfield. Said another entry into the ongoing conversation over fire that’s been moving past simple boosterism. I’m tremendously optimistic about health it ecosystem today. He continued crediting the work of Tech Pioneers and some of the regulatory and legislative efforts that have been opening up the data. So you guys are a part of this Beta program. There’s 80 some odd systems now that are, are participating in the Beta program which moves data out of the EHR through fires. Obviously a limited dataset but through fire and into the apple health app. Can you give us a little bit of an update or you know, just anything on how that’s going or what your thoughts are?
Marc Probst: 30:17 It’s going well. Um, we also would share in Rickys approach and beliefs that having that data. I won’t say we have any appreciable apps built right now or uses by our consumers, but directionally again, we liked strategy. We’re able to use the technology so we’ve proven we can take fire and we can move data to those apps. So I think we’ll start to see development and improvement in that area really soon. But I, and I don’t have an end point to and say, Hey, do this great thing we’re doing
Bill Russell: 30:50 and I think part of that is just the, uh, you know, this is still early on in the process fire still early on in the process, so we need to expand it to other data sets and uh, an apple still new in obviously it’s still a Beta program, so, but I agree with you directionally, if you get that data into that central repository, open it up to the APP development store and all those developers can start to access that data and utilize it obviously it creates a whole bunch of questions for physicians. And then the back of my mind, as I’m even saying it, it creates some questions, but I’m sure that there’s a, you know, I like the fact that you have a physician who’s, who’s at the helm there, who’s a aware of some of the issues of people misinterpreting data or putting the wrong data out there. So, um, all right, so let’s transition to soundbites. So sound bites. I have five questions, one to three minute answers. Um, you know, don’t feel the need to, to, you know, go into a volume on it. Just a, you know, what’s just what’s at the top of your head on these things. So the first question I have for you is, uh, you’ve been an advocate for easing the burden on physicians and patients. Uh, how have you seen technology be used to reduce that burden?
Marc Probst: 32:05 Yeah, and I think I started that when you asked me what I’m excited about. Um, you know, what’s happening in technology. I really believe our ability to capture information, not through traditional keyboards or poking on a, on a screen, but through voice, through image, through all these other capabilities that we have that’s going to be the biggest burden, easier for our clinicians that’s out there. Um, and then what we do with that data, once we’ve got it into computable data, we’ve got all kinds of options, but getting it from getting the computer of the way of the clinicians or the consumer and making it just a facilitator of what they’re trying to do. That’s the win here. And honestly, I never, I never thought we could teach a computer to see not, not when, early in my career we can and it’s amazing what you can do when you have some of these new capabilities.
Bill Russell: 33:00 So it’s two directions, right? It’s getting data in, so you see advances in helping us, helping us to get the physicians to get the data in a lot easier and then getting the data out. So one of the things I’ve heard from physicians over and over again, it’s, look, I’ve got to go to six different screens to get the picture and that’s where we’re going to see a lot of advances in the next, uh, the next couple of years is really consolidating that overall snapshot so that they can get that information very quickly. And also just getting the information in, it’s going to be a lot easier.
Marc Probst: 33:33 Yeah. Technology is, it’s really interesting where we’re at, um, you know, we think of the Emr, the Emr are fairly old technology. I mean, they’ve done a good job, epic and cerner and all, all the providers in refreshing some of the things that they’re doing in modernizing some of the look and feel, but the baseline is they’re pretty, they’re older technology, right? I mean they’re, they’re like me, they’re older, doesn’t make us irrelevant or bad. It just makes us older. But some of the new technologies that are coming out today and our ability to be able to feather that into these core processing systems. Pretty exciting. And, and, and I’m like I told you, I’m really excited about the future.
Bill Russell: 34:15 Yeah, absolutely. Your CEO is actually one of the Ceos I love to listen to at the JP Morgan conference and he shared that intermountain has partnered with Medicaid on a specific zip code that is sort of a, a, an underserved or a, um, a market with, you know, just generally poor health for various reasons. Uh, but you guys have partnered with Medicaid has assumed risk and regardless of if those reasons are, uh, you know, it’s a food desert or, or other issues, you guys have partnered with them. Can you give us a little bit of maybe background on that or you know, how it is playing a role in that, uh, in that initiative?
Marc Probst: 34:56 Sure. So, you know, our, our main office building is in downtown Salt Lake and if you go up to the 22nd floor, which is our top floor, it’s not the top floor of the building, we don’t own it, but you go to the 22nd floor and if you look out to the east, so you look out the windows face east, we’ve got the wasatch mountains and they’re beautiful, great skiing up there. And um, and then if you walk to the other side and you look at the neighborhoods that are going to the west, there’s a massive differential even in our estimate, you know, the mortality rate between those two vistas out to the east. Very wealthy population, very educated at the University of Utah’s up there. A lot of, you know, it’s just a really good demographic. You go out and look to the west, you have a different demographic and I believe it’s like 10 years is the difference in mortality rate between those two areas. So that’s really, I don’t know that that’s exactly what got mark Harrison thinking about it because he’s pretty wise anyway, but it is a stark reality that there are things we can do to improve the health care across our community and that we have a responsibility to do so. So, uh, we, we, uh, we brought in a Gal, she actually already worked for us, but we made her an, a senior vice president
Marc Probst: 36:16 over our community care and names Mikelle Moore and she’s done an excellent job in aligning us with Medicare, aligning our own insurance products, aligning the delivery of care and all of this requires technologies you might understand, you know, underlying it, the data requirements to even understand those demographics and the difference, the hot spotting that existed in there. So we had a lot of analytics involved in it. Yeah, there’s a lot of technology supporting it, but really it’s a moral issue that, you know, just because you live to the east of our building shouldn’t make healthcare better than, uh, than any other area of our, of our state. So we’ll learn a lot. We’re learning a lot. We are
Marc Probst: 36:54 immensely committed to value based care as an organization. I think we may be one of the leaders in the country and actually taking on risk, not in sheer numbers, but certainly on a percentage basis for the population. We have a much smaller population than a lot of states, um, but from a percentage basis of the work that we do, we have really moved a lot into value and that’s caused us to build new tools, new data warehouses or data lakes and, and the analytics and support it. So it’s been very good for us to take the challenge that Mark Harrison laid out at the JP Morgan Conference
Bill Russell: 37:33 And I think health systems that assume risk in any way, shape or form. I know in southern California we had about 250,000 lives at risk and we had sharp on. They have a lot of lives at risk and you have a insurance product, a upmcs, an insurance product. When you take that risk, it really does sort of help to fund and helped to get you the investment You need to put the technology around that, uh, because the, the numbers tell the story. And, um, it’s, uh, it’s, it’s pretty, pretty apparent. Intermountain is considered pretty a pretty forward thinking health system. Exceptional results. Talk about how you get ahead of the curve, uh, specifically, uh, how do you set technology and whne does technology lead because I know that gets kind of iffy when does technology lead and when does technology really just sit back and support the strategy? You tell me what we’re trying to do and we’ll find the technology versus, hey, you know what, this is a technology that’s, that’s probably something we need to start playing with immediately because it’s going to change things
Marc Probst: 38:41 early in my career. We were the guys that did that, right? We surfaced and look at these cool new things called keypads, crts and, you know, bring those into your into your system. We looked at, um, some of the early eMrs and said how to bring them in. And it was all driven by us as Geeks, as technology guys that, you know, that’s what interested us and most of the providers and most of our business partners, they’ve been, they didn’t think that way. They were still using selectrix. And you know, a lot of manual process and that’s not a negative, that’s they were doing a really good job with the tools that they had, but we were interested in it. Well that’s completely turned around from my perspective, Bill, where they actually know more about technology at least in their specific areas than I’ll ever hope to know.
Marc Probst: 39:30 Um, I’ll stay interested, I’ll stand, try and stay on top of it. I will go learn things and go to conferences and look podcasts and, and, and learn things. But, but they are really the ones that are, they understand everything about technology. I don’t have to teach them how to use a mouse. I don’t have to teach them how to use an ipad. They’ve got that because it’s embedded in their everyday lives. So I think to answer your question in an innovation perspective in maybe you know, I’m really interested in ai and I am, so I’m going out and doing a lot of research I can lead to bring those ideas to management and what we might be able to do and then try and secure funding to go do more with it. Or another area I’m really focused on is virtual reality. I can lead those because I have an interest and their different than what our typical consumer would be, but I got to believe 90 percent of this is business lead and as it professionals we need to figure out how to facilitate what they want to do with that technology. And it’s not easy with all the integration requirements and security requirements and you know, frankly all the overhead we have to put on it to make sure it’s safe and usable. Um, but most of the time I would say it’s business driven at this point and I’m happy with that. I think it’s great. That shows we’ve been successful, right? We brought technology from abacuses and Selectrix to uh, the men, they’re really, they’re using leveraging it big time. They’re pressing us,
Bill Russell: 41:03 CMS just announced getting rid of fax machines. So if you have any Seletrix around there, I’m pretty sure that they’re going to want you to get rid of the, the selectrix as well.
Marc Probst: 41:12 Well the Smithsonian, my like, them,
Bill Russell: 41:16 so this is a little tougher topics. So you read recently outsourced 80 plus jobs. I’m talking about the decision. Why, why did you decide to outsource and how did you make the transition really work for everybody involved?
Marc Probst: 41:29 We’re still trying to make it work, Bill, so we haven’t succeeded. Um, why did we do it? The employment rate for technologists in the State of Utah is pretty much a negative number right now. So it’s a very, very competitive environment. A lot of what’s happening in Silicon Valley. We now will have what we call silicon slopes. So a lot of it’s moving into Utah because it’s a favorable business state. Um, there’s good talent here, but it really did put a press on us to say, wow, we’ve got to figure this out. I mean, short term it’s going to be hard, but longterm we got to be in a situation where we can support intermountain healthcare. And so that was part of the decision making. The main reason we did it is we believed we needed to get to the cloud more quickly. So we got a partner that, you know, they’re, they are outsourcing jobs, but that wasn’t the primary reason.
Marc Probst: 42:24 The primary reason was we needed to get to the cloud and there was a certain set of people that work for us today that wouldn’t, we wouldn’t need, right? I don’t need a lot of data center people I don’t need a lot of DBA is, and a lot of SAs if I’ve got everything in the cloud. And so it was a better transition from our perspective to get us to the cloud quickly and actually take care of those people that work for us because at scale these cloud vendors do need DBAs and SAs and some of the people that we’re working with. So that was the thinking in it and really, really hard hardest thing I’ve done in my career. Um, and I know some of the people that listen to this are gonna say what it wuss. I mean, it’s only 80 people. We did, we did 2000.
Marc Probst: 43:06 Um, but for me, it, it’s, it’s been a challenge to maintain the culture of the organization, to maintain the trust of my employee base. And so we’re still working through that. And, um, uh, you, you used the term transparent earlier, um, that, that’s been my goal is just to be completely transparent, being completely honest with my people. Lots of them are coming back around, some of them are probably never going to come around and, you know, they’re not going to think I’m a anything but, uh, you know, nasty cio that did something bad, but a tough transition for sure.
Bill Russell: 43:43 Yeah, that is some of the hard decisions. We want to bring down the cost of healthcare. There’s a couple ways to do that. That’s one of them is by reducing the labor component, which is always going to be a reality. And then the second reality, uh, I had the same challenge in southern California. We were competing for
Bill Russell: 44:07 competing for talent with literally with Google and, and a silicon beach and um, and even silicon valley. I mean, literally people were, were, were short plane ride up to there and um, and we had to take and it was selective outsourcing, right? We didn’t, we didn’t go and outsource all 700 jobs. We just looked at specific areas where we’re struggling. Uh, like instance, our citrix environment, uh, we were struggling to hire new talent and we finally just threw up our arms and said, you know what, there are, there are several really good vendors, we should just start talking to them. They have scale, they have talent, um, because they have multiple clients, they were able to service us better. But I agree with you that the challenge with culture and the challenge with walking the organization through that as a, it’s one of the reasons that it’s a leadership position. It’s a tough, tough spot to be in.
Marc Probst: 45:01 I got a lot of gray hair for a 40 year old. Don’t you think?
Bill Russell: 45:07 I’m wondering how early you started having these kids. Anyway, so the last bit I do want to touch base. I was down in DC today, looked at George Washington University with my daughter, uh, where you went, got your Mba from, uh, and just being in DC, it is such an amazing city. Uh, and you’ve had the opportunity to walk the halls of Capitol Hill, work with lawmakers. What would you tell us about that experience? And, um, uh, what can we do, a cio is, are our representatives really informed? Can we help in the process? How would we be involved?
Marc Probst: 45:42 Yeah, sure. Um, so a plug for chime chime does as good a job at advocacy on a federal level as anyone for what we do, right? Healthcare and it, they are incredibly, um, they, they have a small team, but they’re incredibly well integrated into that environment. I enjoy it a lot. I mean, the thing I’ve learned the most is that the company is run by 24 year olds and that our representatives listened to those 24 year old. So, you know, we spent a lot. I’m talking to those, to their, to their staff, but they’re really smart and they’re really good people. And if we want to make a difference, we’re going to have to do these. These are the people that have federal level that are making decisions, whether it’s meaningful use or the use of fire or standards or any of those things. They can do it at a scale that we just can’t do as an industry. And so I, I encourage everyone to get involved that’s interested in doing it and um, you know, there’s certain vehicles, we have our own staff within DC that supports us, but we leveraged Chime a tremendous amount as well. So I don’t know if that answers the question or not.
Bill Russell: 46:54 Yeah, no, I agree. I think the thing that fascinated me about, about a couple of congressmen and senators I’ve chatted with is, um, that they almost start to break down in terms of their specialization as you would think, you know, you have, you have 100 senators and some of them are from our physicians and they become sort of the healthcare experts that are informing the rest of their delegation of, hey, here’s, here’s what this means and here’s how the EHR plays. So not every, every congressman or senator you sit across from is going to be an expert in health it. But some of them really are. Some of them really have a very firm foundation for it. And uh, and I think when those other, those other representatives have questions, that’s what they direct them over. And I loved your comment that 24 year olds are running the world. That’s the other thing that struck me is how many young energetic kids are running around Capitol Hill. It’s unbelievable.
Marc Probst: 47:53 Well, contrary to what we might’ve seen with obamacare and the aca where it did seem like a really divisive issue when you get and work with the Congressmen and the senators, they all want to do the right things around health they don’t have the right answers. And you know. And I don’t mean they have the wrong answers either. They don’t know the exact right answer, but they do want to get to the right solution. And I’ve had the privilege of working with our senator hatch quite a bit and we’re going to lose him, but you know, he was just one of these across the aisle kind of guys, let’s solve the problems. And I see that over and over in DC. And so it’s pretty refreshing from that perspective as well.
Bill Russell: 48:29 Yeah. What I say is modernizing healthcare is a bipartisan issue. I mean, you’re not going to find anybody on either side of the aisle says let’s not modernized healthcare. And so that’s, that’s what we’re doing a. hey mark. Thanks. Thanks again for coming on the show. Is there, I mean, is there a way for people to follow you? I’m assuming you’re, you’re on social media or you’re not using the selectric to.
Marc Probst: 48:52 No, I’m on twitter. I think it’s at @probst_marc with a “C”. And um, you know, you can be one of the other 10 followers.
Bill Russell: 49:02 Awesome. And while you can follow me @thepatientscio, um, my writing on the Health Lyric’s website, you can follow the show @thisweekinhit, uh, you can check out the website thisweekinhealthit.com and a youtube channel. The easiest way to get to the you tube channel is thisweekinhealthit.com/video. And it’ll redirect you over to the youtube channel. Please come back every Friday for more news, information and commentary from industry influencers. That’s all for now.