News Day – Iowa Caucus, Epic Scrutiny, Next in AI and More

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Bill Russell

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February 11, 2020: It’s News Day. We look at 10 predictions on health AI from a friend of the show Dr. Anthony Chang. I have a feeling regulatory policies regarding AI technology in medicine and healthcare will start to reflect the exponential rise of AI capabilities. We also talk about Epic scrutiny, the Iowa Caucus from a health standpoint and privacy and security. 

Key Points:

  • Epic ONC battle update [00:03:00]
  • You need to think outside of the EHR, there’s a lot of other source systems [00:07:30] 
  • Privacy and security and regulatory policies regarding AI technology  [00:13:00]
  • At Davos the tech leaders called for AI regulation [00:22:00] 

Iowa Caucus, Epic Scrutiny, Next in AI and More on This Week in Health IT

Episode 182: Transcript – February 11, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[00:00:00] Bill Russell: Welcome to This Week In Health IT news where we look at as many sources as we can in 23 minutes or less, that will impact health. IT. My name is Bill Russell, healthcare, CIO, coach creator of This Week in Health IT a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

It’s Tuesday news day. And here are just some of the stories we’re going to talk about, 10 predictions on health AI from a friend of the show Dr. Anthony Chang. We’re going to go back to Epic. Talk a little bit [00:00:30] about that. We’re going to talk about, let’s see, what else are we going to talk about?

We’ll talk about some of the challenges that are going on right now. practice fusion and other things that are going on. We’ll talk about that a little bit in what health its response might be for that. And we’ll go from there. This episode is sponsored by health lyrics. I coach health leaders and all things, health it coaching was instrumental in my success and it was the focus of my work at health Eric’s I’ve coached CEOs.

For health systems, startups, CIO, CTOs. If you want to [00:01:00] elevate your game in 2020, visit  dot com and schedule a free consultation. All right, let’s get to it. this is going to come fast and raw. My son is getting married this weekend and I didn’t have much time as it really as much time as I usually do to prepare.

So I’m, this is going to be unfiltered and fast on these stories. So let’s open the fire hose and see where we go. Oh, actually, can we talk about the Iowa caucuses for just one minute? And we’ll talk about it from a health it [00:01:30] standpoint. We try not to be political on the show. So, you know, I am one of those people who talked loudly at my TV when I hear silly things and we actually have tons of family in town and we’re watching the caucus results.

And then I hear. That the results are going to be delayed because of an app. And I’m like, are you serious? how this is so cliche, I can’t even believe it. you know, the, the first thing they do is they blame the technology. They blame health, it not health ID, but they blame the it department, you know, the app’s not working.

and [00:02:00] I started to think, you know, you know, how complex can this app be? Really? I mean, dual form authentication submit your results. And that’s it. I mean, you know, anyway, the night goes on. I started to think, you know, I wish some people from my EHR go live team where we’re there on the ground in Iowa, they would have had this solved probably within minutes, but definitely within, within an hour.  then I hear they can’t get the results back. Cause the phone lines are flooded with Trump supporters. And again, I’m like, [00:02:30] seriously, do the phones not work in both directions in Iowa? I just didn’t get it. you know, The, The easy way to solve that problem is I think phones and I was still working both directions.

So if they knew the precinct captains phone numbers, they could call them and, you know, get the results. you know, I was, I was really appalled at it taking the fall. for this and really the overall lack of troubleshooting skills from everyone involved. So anyway, just wanted to get that off my chest.

And I told you this was going to be unfiltered and raw. So I [00:03:00] apologize. here let’s, let’s go to the Epic stuff for, so here’s your, Epic ONC battle update for the week, Christina far from CNBC follow through on our promise to publish the hospitals, which signed the Epic letter. And, which goes to what I said on the show, which is a, this is not going to be one of those battle or one of those things that gets done in secret behind the curtain.

This is going to be something that gets brought, to your communities. let’s see, a couple of quotes from this, one doctor who signed says he shared ethics, privacy concerns as a number of [00:03:30] proposed medical app skyrockets. there are tens of thousands of healthcare apps said, Neil, Coleman and the chairman of the family medicine at Mount Sinai in New York and president of the Institute for family health and an interview, getting these big computer systems to communicate in a predictable and secure way, took a decade.

And now people are writing these apps in all different languages. There’s no possible way. A system that has been developed for decades now could all interface with all these apps and keep [00:04:00] information secure. This needs a lot more thought and more structure and regulation. He’s just wrong, but we’ll see.

We’ll come back to that later. clearly does not have a health it background seems to have more of a medical background. We’ll explain why this is, this is not rocket science. We can do this. And, and that’s really the essence of what I’m going to talk about in, in my take on this. some health ID experts note that the letter has not been signed by some of the largest health systems in the Epic ecosystem.

And they say that’s significant. And it is their absence [00:04:30] represents a thundering silence at David Brailer. The first national health information technology coordinator appointed by George W. Bush. Many health systems are quietly discussing how the data access and data fluidity actually benefit them in the long run.

Here’s the full list of health systems and it lists all the health systems and, you know, there are some notable. Epic clients that are missing from this list and some very large health systems that are missing from this list. In fact, there’s very few large health systems represented on this list. so here’s, [00:05:00] here’s, you know, here’s my take.

We’re not going to go into this in depth. Well, actually we might a little bit, you know, I sit on the show, I wouldn’t sign this letter and I’m going to stand by that. I wouldn’t have signed this letter. I spoke with people who chose to sign the letter and their, and their, their reasons. they gave me their reasons to sign the letter.

And I respect that and I respect the leaders who signed the letter. even though I really disagree with them signing letter, for those who didn’t sign it for fear of Epic, which is a comment that I heard. I hope this isn’t a real fear. I understand. Wanting to stand in [00:05:30] solidarity with a vendor that you trust and stand in support of an issue that you see as problematic that has to be solved. I, you know, but I don’t understand fear that that doesn’t really resonate with me. I may be naive, but I don’t think that’s a valid reason. I don’t think Epic operates in this way. At least I hope they don’t retaliate against their customers. It’s just silly. And I think unfounded.

But I just want to re reiterate my advice on this, which is to stay out of the fight. and really, to be honest with you, the fight is over the rule is going to go through. So let’s, let’s talk about how [00:06:00] to handle this moving forward. you know, this, the show really is, is, Partially about staying up to date on what the news is, and partially to give me an opportunity to talk about how I would respond to this if I were the CIO of a health system.

And so that’s what I’m going to do here. How we would handle this moving forward, you know, the rule calls for a development ecosystem, you can wait on Epic, Cerner or your EHR provider of choice to solve the problem for you. Or you can try to get ahead of the curve. there are platforms that have been in existence for [00:06:30] well over five years that bring all of your healthcare data together and, You know, and, and, and they’re already out there.

They’re already out there. They already work with your EHR. They already provide a security layer and a bunch of other things. they’re out there. I’ll talk about those in a minute. but here’s what I’m going to do. I’m going to share a simple diagram that talks about serve the service oriented, designed for healthcare data.

It will be on the episode page for this on this week, health.com. Just go to this episode’s page. It’s not going to be hard to find a, this is a [00:07:00] simple diagram. There are more sophisticated ones out there. I saw one by Dale Sanders from health catalyst, very sophisticated, a lot of detail. That’s not what this is.

This is, you know, this is, this is the purpose of this document is for communication. This is not about detail. I’ve given this, the non tactical, this presentation, this deck to nontechnical exacts to help them understand, what needs to happen to share data effectively in healthcare. And they got it.

And you know, I’m gonna, I’m going to give it to you real quick in, in two minutes or less, [00:07:30] you know, you have the. That source data layer, that’s all your source systems. And you need to think outside of the EHR, it’s not just the EHR, there’s a lot of other source systems. You have your ERP solution, you have your, your HR solution.

There’s you have solutions across the board, your PAC systems, you name it. and, you know, as you move up, you have an integration layer, which, you know, every one of those systems will have distinct integration, mechanisms for sharing that data. Then you’re going to have an aggregation later layer.

This is where you bring the data together. And in some cases you normalize [00:08:00] it, but you, a lot of times you just bring that raw data up there and make it available. Then you have an API layer. This is where you create the standard set of APIs that your developers, any developer that graduates from college next week.

Is going to know how to hit that API later, understand how to make a request, how to get the response from that request. And then you have the security layer on top of that to ensure that the rules are being followed, that you want, to be followed again. Not the most complex, there are nuances to that, and [00:08:30] there’s a lot of different details.

But, from there you have a path to an internal developer or an external developer. I personally don’t think you need both those. I think you have the same development platform for both internal and external, but. I know that clients like to have both for, for, for reasons. and then there’s presentation layer.

So there’s the app layer and things that go on now that might even sound complex to you. I’ll share the diagram. It’s not complex at all. A lot of systems have been designed with this. you know, the, You can wait for the HR providers, they’re going to [00:09:00] have to do this per the 21st century cures act.

And they will do it. It’s not as complex as what, people have made it sound. and quite frankly, if one of the EHR providers wants to buy a company, they probably could, as I said, there are vendors who’ve been doing this for about five years, heart health, catalyst, MPH, RX, bad name, good product, redox, MuleSoft among others.

you know, This rule is going through, you can do it securely and adhere to the specifications. This isn’t rocket science. I would say, get moving on this, [00:09:30] get ahead of this. This is something we can do. We’ve done much more complex things than this, for sure. Okay. Let’s, let’s move on from there. you know, hit the website, hit that page.

I’ll put the document out there. It’ll be a PDF. easily easy to, I think easy to understand if you have a question, just shoot me an email bill it this week in health it.com. I got an email this week from AI med and has some predictions for this year where AI is going to go in medicine for 2020.

And these are so spot on. This is from dr. [00:10:00] Anthony Chang, who was a former guest on the show. And I I’m just gonna, I’m gonna run through them real quick. Got about 13 minutes left. So we’ll just, hit these. And here they are top 10 from Anthony Chang, the era of cognition, neuroscience and AI will begin this year.

So he’s saying, Hey, this is, this is really going to, this is really going to take a step forward. This year. Number two data from wearables devices will demand an AI strategy. This is absolutely true. [00:10:30] When I hear people say, Hey, we have too much data coming in. We need to make sense of it. We can’t give it all to the doctors.

That is absolutely true. You cannot, you can’t throw all this data in front of the doctors. You have to make sense of it before you put it in front of the doctors. They don’t want data. They want, insight and. There’s a whole bunch of data that they are willing to allow you to put through filters through AI filters and bring that forward.

And so the data from wearables is going to require an AI strategy, a generative methodology, such as a generative [00:11:00] adversarial adversarial network scans will help. Neutralize the problem of inadequate healthcare data, a major issue is lack of healthcare data, including access for AI projects, but the deficiency can partly be neutralized by generative AI methods that will create synthetic data.

Although heterogeneity of the data may be an issue. That’s interesting. And that’s, I, I’m going to reach out to dr. Chang, talked to him about that. Essentially, what he’s saying is we don’t have enough data. We’re going to, [00:11:30] we’re going to generate some synthetic data. There could be issues in doing that. But he sees that as a, a next movement.

the next one we’ve talked about on the show and I firmly believe AI in the form of robotic process, automation will become more appreciated and useful as a tool in healthcare administration. I think this is already happening and will continue to happen. This was one of my predictions for the year.

number, the next one, conversational AI will be increasingly more common and sophisticated in the healthcare. Absolutely. We’re seeing that. And we’ve talked about that a bunch on the [00:12:00] show. there will be less hype about deep learning and its ability to predict with superior results. The more and more focus on patient outcome and behavior.

I think that’s true too. You’re going to see this, really applied to the patient and impacting their behavior. Cause when you think about it, If you can’t keep somebody from eating McDonald’s every day, it’s gonna be hard to keep them healthy. And so there’s whole bunch of places that AI can be applied that is not as, intrusive and, have as many barriers to it.

Next one, there will be more application of [00:12:30] AI in altered reality, virtual reality, augmented reality, and mixed reality. I’d love to talk to him about that some more and understand that a certain circuit surgical and procedure based subspecialties will incorporate. Image interpretation and deep learning more during procedures also fascinating, important issues in AI, in medicine, such as bias and inequity and particularly data privacy will be even more in the forefront.

Absolutely. We’re going to end up talking about privacy and security a bunch. This year. I have a feeling and regulatory [00:13:00] policies regarding AI technology in medicine and healthcare will start to reflect the exponential rise of AI capabilities. All right. So here’s my take. If you’re a leader in health, it get in front of this, get your people trained.

Be the most knowledgeable person in the room on this topic. Get in front of the ethics issues, set up governance. If you are large enough with enough adoption, this is, this is a, you know, a top of mind conversation. This is the, this is probably one of the top conversations over the next five [00:13:30] years. Top of agenda.

it’s this. Is going to be one of the forefront conversations for the foreseeable future. And so my comment on this is get ahead of the curve as much as you possibly can get ahead of the curve. I’m going to bring three stories together. Here is this so electronic health records vendor to pay 145 million to resolve criminal and civil investigations.

This is, details around the practice fusion, $145 million DOJ settlement, and, [00:14:00] And, electronic health records create a new era of healthcare fraud, this Kaiser health care news. one of them, I think I’m pulling from his talk and another I’m pulling from. Dunno. alright. So let me give you some of the details.

Department of justice announced details about the previously announced $145 million settlement by Allscripts own practice, fusion, practice fusion admits in the settlement that it solicited and received a million dollar kickback from an opioid manufacturer in return for a line of drug makers, marketing department to design EHR clinical decision support [00:14:30] alerts that encouraged opioid prescribing outside of the acceptable medical standards.

Which is like, wow, in and of itself 145 million is not enough for doing that, but a solicitor to 13 other agreements in which drug companies paid the company to influence CVS alerts, to increase their prescription drug sales obtained, ONC EHR certification fraudulently by falsely claiming to the certification body that its software met 2014 edition portability requirements after which it [00:15:00] disabled the feature and advise users to contact the company.

If they needed. Patient data export it. Oh my gosh. 145 million is not enough now. Unfortunately, they’ve already been sold to Allscripts. So I don’t think Allscripts should take the brunt of a hammered for this, but this is egregious allowed providers to falsely claim Medicare and Medicaid. The HR incentive payments when its product did not incorporate standardized vocabularies as HHS required a deferred prosecution [00:15:30] agreement requires practice fusion to make compliance changes, obtain independent oversight report, any evidence of kickback violations by other EHR vendors and to make details of the company’s unlawful conduct available to the public on.

A website, the oversight organization must also approve any sponsored CDs rules before they are implemented. the Northern California U S attorney said in announcement, prescription decisions should be based on accurate data regarding a patient’s medical needs, untainted by corrupt schemes, any illegal [00:16:00] kickbacks and deciding what is best for patients.

Electronic health record software is an important tool for care providers. It is critically important that technology companies do not cheat. When certifying the software, the $145 million settlement was announced by Allscripts as a tentative agreement in August, but a specific details were not provided Allscripts said in its Q2 earnings calls.

So a lot of this is from the HIStalk article. so a couple of things, my take on this. we had practice fusion at the health system where I was at. [00:16:30] Actually, we did not, if I, I need to say this correctly, we were a Meditech shop. We had Allscripts, touch works as our, within our foundation. Now within our clinically integrated network, we had all sorts cause we, we didn’t control those DHRs we had.

And not exaggeration. We had close to a hundred different HRS practice. Fusion was one of those and they were very challenging to, to deal with. So, you know, here’s my take on this. This is really a black guy in the industry and it impacts all of our [00:17:00] credibility. don’t don’t mistake the fact that your system didn’t use practice fusion as you go unscathed by this.

consider yourself scape. you’re in a bucket of behind the curtain practices that the public doesn’t understand. And when they get a chance to look behind the curtain, they, they see these unseemly things pop out. So let me think about that. So here’s how I can be constructive on this topic and it is this okay.

Tell your story to the patients. If you don’t tell your [00:17:30] story, they’re going to make one up and they’re going to take these stories, knit them together and come up with their own stories. we need to be intentional to tell our story both internally and externally. This is one of the things I talked to my clients about health.

IT Leaders about all the time is how are you telling your story constructively internally? Have you developed a story? What is your story? What is your point of view? What is your, what is your health it organization doing for the organization? If you can’t tell that in a, in a way. That is, that is encouraging.

[00:18:00] That is, hopeful. That is exciting. then don’t expect people to be excited about the things that you’re doing. You have to tell the story, not just the health system story, but the health it story. What is the health it story doing for the community? And it’s doing a lot of great things. It’s, it’s, you know, it is it’s fulfilling the triple aim.

Over time. Now we clearly have a long way to go, but you should be talking about those, those steps every year that you make in that direction. We need to be intentional about telling the story. How is it strategy [00:18:30] is, is health system strategy these days. And, you know, from the user perspective, you know, I had a firm.

That helped me create videos and presentations. From the first day I became a CIO. You are public figures, CIO CTO. If you have C in front of your name, you’re a public figure. You’re either a public figure within the health system. representing health it and the technology within the health system, or in some cases you might be, a public figure outside of the health system, talking about [00:19:00] what you are doing for the community.

You’re an ambassador for health it and the health system, most health system marketing teams, quite frankly, are understaffed. And, they may not be experienced in this level of communication. That’s why I brought a firm in almost on the first day. You don’t have to, you don’t have to have more retainer and you don’t have to have one contract.

You just have to have somebody that really understands how to get the message out. You need to use social media. I promote your house houses, some of the content that they put out there, tell your story. I’ve heard someone talk about [00:19:30] CEO’s before and they said there’s two types of CEOs. There’s the ones that actually get work done.

And the ones that are, you know, socially out there in the, in the media. And what I would say is the role has changed. it really, you can’t say that there’s two CEOs. There is a role. Part of the role of the CIO is to be visible, to be visible within the health system. And one way you do that is through social media.

Because there are going to be people you don’t get to talk to that. You’re going to be able to reach through social media, maybe not [00:20:00] Twitter, LinkedIn, whatever, but some aspect you’re figuring out what the best mechanism is to communicate with your internal staff. And they communicate with the community.

If you have something exciting you’re doing through, through a portal or, or to, to make. going into your clinics, easier or telehealth or whatnot. you know, Mark out some marketing teams do a great job. I was in New York city. I saw things plastered on the side of a bus. I saw things on billboards and that’s that’s exciting work, but part of that gets [00:20:30] augmented and supported by, the words that you take out into the community.

So, so I think it’s important to recognize that role within the organization and to embrace that role and to get out there. And, you know, one of the ways you can do that, if you, if you have a C in front of your title is to shoot me an email and tell me what we could talk about that you’re excited about within your health system.

What’s the best practices. What’s what are things you’ve done for the community? I’m more than happy to do that. And I’m not doing that from me. I’m not saying this whole thing from a self-serving standpoint. [00:21:00] I firmly believe this. I set this up within my organization. We actually had a team of, that was sort of a spin off of marketing.

We had a three person team that, was the front end for all of our projects that we did within the health system, because they helped us to communicate better, throughout the entire organization. And, in uniformly across the projects. Right. If you rely on each project team to put together their communication strategy, they’re all gonna be different.

And then it’s going to appear that health. It is [00:21:30] disjointed the organization. So we had a filter that, that went through and it really helped the project managers to focus on other things they needed to focus in on, and to have a team with expertise, to create the training materials and the documents and any kind of communication and interaction with the field.

They, they, they handled anyway. Couple more stories while I’m out of time. Well, I, you know, next week I’m going to talk, I’m going to get back to my top 10 format if I can. That would be great. at Davos, the tech leaders [00:22:00] called for AI regulation. I thought that was interesting. tech giants do appeal to, governments.

Please regulate us a wall street journal article, I think is fascinating as well. why successful digital officers don’t always have digital in their title. This is a Heidrick and struggles. White paper. I think it’s safe to say it’s a white paper, a interesting read and worth looking at well, we’ll get to that story next week.

Actually, we’ll get to all of these stories, next week, and, And we’ll dive into them in some detail. So that’s all for this week. Special, thanks to our sponsors, VMware, StarBridge [00:22:30] Advisors, Galen Healthcare, Health Lyric’s, and Pro Talent Advisors for choosing to invest in developing the next generation of health leaders.

This show is a production of This Week in Health IT for more great content. You check out our website this week out.com or the YouTube channel. If you want to support the show best way to do it, share it with peer, send an email, let them know that you get value from the show. And, You know, just keep expanding the, expanding the conversation.

We’ll be back again on Friday with another interview with an industry influencer [00:23:00] and Tuesday news day next week. Thanks for listening. That’s all for now.