News Day – 2020 Consumer Survey, HIPAA mHealth Resources, Hospital at Home

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Bill Russell

This Week in Health It

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September 22, 2020: Today is News Day. We look at the 2020 Healthcare Consumer Survey, HIPAA mHealth Resources, hospital at home and HHS on their rural action plan. Is the Epic EHR falling behind? Who’s ahead in the digital race, providers or payers? Does your health IT shop need development capabilities? And how do you solve a current IT problem? Do you run after it and throw money at it? Or do you come up with a long term plan that could potentially reap rewards in the next year or two?

Key Points:

  • Are healthcare organizations just functioning off of financial incentives? [00:05:25]
  • Don’t expect a lot of money for rural broadband [00:10:20] 
  • Deloitte survey: Health Consumer Response to COVID-19 [00:16:06] 
  • We measure quality in a lot of different ways but what about the quality of the experience? [00:17:56] 
  • When customers utilize bad health apps [00:23:58]
  • Really scrutinize any investments you’re doing in facilities [00:29:12]

News Day – 2020 Consumer Survey, HIPAA mHealth Resources, Hospital at Home

Episode 306: Transcript – September 22, 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: [00:00:00] Before we get started a couple of things. First clip notes is live. It’s a great way for you to stay current and keep your team current. Sign up today with an email to clip [email protected] Also, we want your feedback. We really value your feedback for 300 episode. We actually put a form out there where you can provide your feedback on the show.

[00:00:22]What you like, what you don’t like, those kinds of things. And you can also last question is, opportunity to sign up, to receive a mole skin black [00:00:30] notebook, like this one I’m holding in my hand. You can do that by going to thisweekhealth.com/300 now onto the show.

[00:00:43] Welcome to This Week in Health IT. It’s Tuesday news day, where we look at the news, which will impact health IT today. We’ve got a lot of different stories, HHS on their rural action plan. VA talks about HIV, 2020 health care consumer survey. A couple of other things to that effect. We’re [00:01:00] also going to run through some of the stories that have been highlighting on LinkedIn and just share some of that stuff with you as well.

[00:01:06] My name is Bill Russell, healthcare, CIO, coach, and creator of This Week in Health IT. A set of podcasts and videos and collaboration events dedicated to developing the next generation of health leaders this episode. And every episode, since we started the COVID-19 series sponsored by Sirius Healthcare.

[00:01:21] And we really appreciate it. Special, thanks to Sirius for supporting the show’s efforts during the crisis and beyond. If you haven’t signed up for three extracts yet [00:01:30] you’re missing out. Drex DeFord came up with this three texts a week that he vets stories and selects the ones that are most important to people who are in health.

[00:01:38] If you want to be a part of that text Drex D R E X to four eight four eight four eight, and received three texts a week from Drex DeFord. Great way to stay current. And it helps me to prepare for the show. All right onto the news, before we get going a few stories I shared on LinkedIn and let’s start with, and I always start with a question.

[00:01:57] I just liked doing that. And some of the questions [00:02:00] is the Epic EHR falling behind, who’s ahead in digital race payers or providers. And do you need a development arm? So let’s hit a couple of these real quick, like then here’s a good one. Does your health IT shop, need development capabilities?

[00:02:17] You know what? This was interesting. I was actually sent a story from, Mark Weisman, who has been on the show a couple of times. He’s the, author of the CMIO podcast author. Is that the right word? Anyway, [00:02:30] he does the CMIO podcasts, a good friend of the show, and he sent me  Jamie S a publication from july 27th, 2020. And what they did is the study talks about how the university of Utah is using smart on FHIR to, essentially create a dashboard that sits on top of the EHR and what they, and it’s specifically around COPD. And they pulled all this data together [00:03:00] and what they were trying to do it was to address cognitive load on physicians and clinicians are having to find all the information, those kinds of things, and the results were exactly what you think they are.

[00:03:10] The participants completed more recommended care, recommended tasks per minute, over longer sessions. The keystrokes per task were lower. and, the participants expressed a desire for. A reliable presentation of information that matches how they think and how they operate as clinicians. And a, one of the things I said towards the end of [00:03:30] this is, the organizations that master the EHR, with standard space technology frameworks will begin to differentiate themselves in the modern, in the modern era of the EHR.

[00:03:40]and the reason I say that is, and we’ve talked about this a lot on the show. There is going to be the need for speed, the need for agility to, to address problems that your EHR provider, when they put it on the roadmap and say, we’ll have it for you in a year. That’s not going to be quick enough and smart on FHIR is a great, framework, open [00:04:00] source framework for, delivering the information directly into the clinician workflow.

[00:04:06] But in order to utilize that you have to stand it up. You also have to have some development capabilities, not, heavy coders and that kind of stuff, but some development capabilities in order to tap into it. And I just asked the question, does your health IT shop, need, have any development capabilities and do they need development capabilities?

[00:04:25] So that’s where that came from. Great article, by the way, if you get a chance to take a look at that article, [00:04:30] it’s worth taking a look at, who’s ahead in using digital for the care of communities, providers, or payers. And this came from an, a story. The blue shield of California created a dashboard for advanced public health to increase the transparency around community health and, to help address health disparities. It’s a really cool dashboard. It has been used in California to give people a picture of what’s going on in the community, health outcomes, preventative healthcare [00:05:00] utilization, access, health behaviors, social risk factors, environment, economic health, the tool is free to the public.

[00:05:06]The hope is that the community and organizations, health advocates, hospitals, physicians. And others will utilize it to improve the overall health of the community. And I just, I throw out this thing, who’s really incentive to use technology for the benefit and health of the community. I know we anticipate that, there’s altruistic organizations.

[00:05:25]there are even faith based organizations, but a lot of these organizations today are just [00:05:30] functioning off of. financial incentives and it’s hard not to, especially after COVID and the, shock to the system that was from a financial standpoint. And But the reality is when the ORs and ERs are empty hospital financials, implode.

[00:05:46]however, when they are empty, the payers do just fine. That’s what we saw through code so that the payers are incented to keep people out of the hospitals to keep them healthy. And I think it’s one of the reasons that you might see more innovation around [00:06:00] the, community health from the payers than the providers at this point.

[00:06:05]I, again, I’m not overly excited about that concept. I just, thought I’d throw the question out there. Let me, Let me hit the one on is Epic falling behind. Cause this one guy got the most traction. A lot of people commented on. I made the statement that the Epic EHR is falling behind, but now give it, consider it has a huge lead and it’s losing ground gradually as I look at it.

[00:06:30] [00:06:29] And my key, my point here is that I think they need to replatform in the next 24 months. And, to date their competitors have tried to compete, head on with Epic and they’re just losing. Epic is a very customer centric organization. They listen to their, provider partners very closely and they provide them exactly what they’re looking for.

[00:06:50] So if you’re going to compete, you have to stake out new ground. You have to identify where things are going. And stick that grant ground out before they get there. The other thing is there’s a benefit as they get [00:07:00] larger, it’s harder and harder for them to make a shift to replatform. They have so many modules now they have so much going on that there are times they actually had in the other direction, that they’re trying to solidify, people’s need and really push hardware to the, to the edge that they possibly can.

[00:07:19] And so I make the case that, we need an internet based a web based EHR. That’s a, that, that’s truly replatform. That’s truly written from the ground up. [00:07:30] went to our Cerner, went to AWS and they’re running in the cloud. And at first glance, you look at that and they go, ah, Great.

[00:07:37] They’re running in the cloud, but the reality is you can run an Epic in the cloud. You can run Metatech in the cloud. You can run a thing in the cloud. It’s not hard to run these systems in the cloud. The question is which one is actually going to replatform and become an on internet architecture. So accessible APIs, scalable, ubiquitous access, those kinds of things that are the nature of what [00:08:00] applications  Some of you are just going to say, look, my EHR runs just fine. I don’t need anything else. but, I make. Make the case that, your operational, your operational data store, your analytics data store, your document data store, they’re all growing and they’re growing rapidly.

[00:08:14]I’ve been keeping an eye on that and, poor architecture runs out of headroom eventually and then the other thing I make the case of, these, these monolithic platforms were not designed for innovation. They actually stifle and slow down innovation. not by design, but they, by design, they end [00:08:30] up slowing down innovation.

[00:08:31] So until they replatform, they are going to continue to move slower and slower. They have more clients, they have more baggage if you will, as they move. some of these other players are going to be more nimble and able to. To move now, again, I think the clock is ticking. I think you could see a significant advantages to, whoever does replatform first in this space.

[00:08:53] So those are just a couple of the stories that I share. If you are following me on LinkedIn, I’m going to drop a single story every [00:09:00] morning, every weekday. And just open it up with a question and let’s see if we can get the dialogue going out there. All right. Some stories for today. HHS focuses on let’s open this up, focuses on tele-health and tech innovations in the rural action plan.

[00:09:19] Okay. The plan lays out a four point strategy intended to address the hurdles, provide a. To providing rural healthcare, including building a substantial health model for rural [00:09:30] communities, preventing disease and mortality, increasing rural access to care and leveraging technology and innovation.

[00:09:35] The ladder initiative includes broader support for telehealth and funding for the development of technological. Solutions to chronic conditions. It also acknowledges broadband access as a continuing concern, making the use of health. it’s interesting. Don’t expect big dollars coming out of HHS to fund a rural broadband.

[00:09:55] It’s just not going to happen. plus I think it would probably be, it would be a mistake at this point. We are [00:10:00] so close to a, to a terrestrial kind of, internet. you have a Starlink. You have, space X Exelon launching Starlink, you have other providers out there, starting to create that constellation of, of access points for lack of a better term, satellites, but their access points, to the internet for these rural locations.

[00:10:20] So it’ll be interesting to see at what speeds those, those satellite communications, come down at. And if they’re able to keep up with the, with the [00:10:30] demand for the rural. so anyway, I’m just, so what on this is, don’t expect a lot of money for rural broadband, but expect them to focus in on that the first part of that strategy, which is.

[00:10:43]building a sustainable health model for rural communities. This is one of those things that we have not really spent enough time on. I feel like Mayo is starting to head in this direction with their care, the care in the home, kind of thing. If you do care at the home, you could eventually do rural [00:11:00] communities extremely well.

[00:11:02]by just taking that technology and leveraging it across a different, different set of modalities and, and, care delivery, networks. there’s an awful lot of stuff that can be done here. I, I highlight this story, mostly because I think people think this is a technology story and it’s, I, I don’t think it is, to be honest with you.

[00:11:21] I think once a health system with, the reach, academic medical center that really starts to understand their [00:11:30] ability to leverage rural communities and to bring those rural communities, into their care plans and into their, into their insurance products and into their hospitals, quite frankly, because rural communities, they need that higher level of care that is only offered in the cities.

[00:11:47] And if you’re tied into them delivering care at the, out of their home or out of remote facilities, through technology and through other means, you’re going to have access to those communities. So [00:12:00] anyway, HHS, right thing to look at that, and I think the care models is the most important thing of that story.

[00:12:05] That’s the, so what the care models matter in that, VA report identifies HIE barriers to improving care coordination. This is one of those that you just scratch your head and go. Ah. Okay. and I was reading this story. Let’s see the org noted that facility’s challenges for sharing information include the need for additional training and increase in community partners and an understanding of how to use the program.

[00:12:28] In addition, facilities reported [00:12:30] technology challenges to viewing community health information through VA exchange, including the dual sign on requirements for VHA providers to sign into the electronic health record and then sign. Into the joint legacy viewer JLV to access community partner, patient information, the JLV data quality was not ideal information.

[00:12:51] Naming an access was not user-friendly and facilities reported a cumbersome process. one of the reasons I pointed this out is because I believe this is, a case, [00:13:00] a good case study of, we know that they’re rolling out a millennium and PowerChart millennium PowerChart cross, the entire VA.

[00:13:09] And as they do that, some of these things, some of these challenges are going to just, that they’re going to dissipate. Because if they get onto a single EHR and that EHR is sharing the information effectively, so some of those problems are going to dissipate. Then you have the sharing the information with the community.

[00:13:27]that’s just, that’s a matter of getting [00:13:30] the, ontology, right? Getting the datasets correct. And getting them, shared it into the appropriate HIE. in those communities, but to be honest with you, if you’re in a Cerner environment and, he gets Cerner, Epic, Allscripts and Meditech to talk you’ve, you’ve covered, I don’t know, 80% of the market.

[00:13:50] And so to a certain extent, yes. I love the HIV work. I think it had its day. And I think it’s going to diminish. And I know that, I know that there [00:14:00] are programs that are heading in this direction and really bolstering the age. But to be honest with you, I’m not seeing it. I’m not understanding the need for it.

[00:14:09]at the community level, I think they are underfunded. I think their technology is sporadic. I think some of it is phenomenal and you go to Massachusetts, go to New York, go to other places there. the HIE are we’re well funded and well thought out and well implemented, in other areas.

[00:14:26] And some of the areas that I was responsible for, the  [00:14:30] were fragile. They were, severely underfunded, funded by the health systems and not really by the state. And, represented a significant challenge to the sharing of data. The sharing of data is not a problem of, standing up the technology in between these things and getting the information to move back and forth.

[00:14:50] It’s a competition challenge. Not for the VA, but for others putting their information in there and, accessing those HAES, [00:15:00] is a body of work that a bunch of people haven’t really, stood up as a priority to get to that data and to share that data. Now, if you have a large VA facility by you, I’m sure you would prioritize that work and do that work.

[00:15:13] But if you don’t, you’re probably not prioritizing that work anyway. the reason I highlight this story, the, so what of this is, sometimes you spend the money, focus on it and run after the problem. But when you can see the finish line [00:15:30] for addressing 70 or 80% of the problem head on with, with a large project, like the implementation of an EHR system wide across the VA, That has a good data structure that you’re defining as you go, that you can share that data.

[00:15:45] Sometimes it feels like you’re spinning your wheels a little bit to, to run around on this. Now people are going to disagree. I disagree with me on this. I get it. I understand. but I use it as a case. In point, we had several of these things where you just had to [00:16:00] grin and bear what you had. Because you knew that something good was going to come in the next year or two.

[00:16:06] And it’s just, it’s just the challenge of dealing with legacy and getting through legacy. All right. Deloitte did a health consumer response to COVID-19 survey and here’s what their findings showed. This is from September 14th, 2020. You can get it on the Deloitte website. the findings show that, many consumers show agency and engagement consumers are increasingly [00:16:30] willing to tell their doctors when they disagree with them are using tools to get information on cost and health issues are tracking their health conditions and using that data to make decisions and accessing and using their medical record data.

[00:16:43] That’s interesting. and probably the first time I’ve really heard that the patients are that actively engaged. I’d want to dive into this study a little bit more and understand who they surveyed. What pipe actually has the populations down here. Let’s just go down. Wow. [00:17:00] And it looks like interesting.

[00:17:02]sewers are comfortable telling their doctors when they disagree with them. And that looks like it’s pretty standard across the board with seniors being a little higher than gen Z. Although they’re all pretty close to 50% or higher. Let’s see somewhat likely. you get the picture. extremely likely is a 50% or higher, which means somewhat likely is, 30 to 25% and a slightly or not at all.

[00:17:26] So we’re becoming more, according to this where you are, we are [00:17:30] facing and we are becoming. Consumers of healthcare were starting to demand certain things. interesting. We have to get our finger on the pulse of what the consumers are saying, and that we’ve talked about this before. One of the, so what’s on, this is going to be, do you have a mechanism to collect the, users or the consumers viewpoint on the tools that you’re providing and the services you’re providing and the quality that you’re providing?

[00:17:56] I know we measure quality in a lot of different ways, but what about the quality of the [00:18:00] experience? and then consider also that your populations experience healthcare very differently. There are chronic conditions. There are, the young invincibles, they all have little, a little different picture of what health care should be and how they access it.

[00:18:13] So as you’re starting to, define these, you’re going to have to create those personas. around that. And I know some of you have said, I’m getting tired of doing these, these personas, I’m getting tired of doing experience maps, until you get them right, it’s like your architecture diagram for your network until you get [00:18:30] them right.

[00:18:30] You gotta do them. As, don’t just sit back and go, I don’t like him. experience maps are there for a reason. Personas are there for a reason, it’s hard to design a set of tools without understanding the consumers that you’re working with are their second point.

[00:18:43] Consumers are using virtual visits more than ever before and plan to continue using them. it really depends. Yeah. they were doing this essentially during COVID. yes. I would agree with this people. I got experience with it. People liked it. I would like to use it more. And, when it comes time for me to see a doctor, I [00:19:00] will pursue, a virtual visit first.

[00:19:03]so that makes sense to me. I think we have changed behavior somewhat, more consumers. there are third point where consumers are using technology for health monitoring and are willing to share their data. I would say almost everyone’s willing to share the data. Once you strap something on like an Apple watch or a, I guess the new, Amazon.

[00:19:20] A device or whatever, once you strap one of those on you have to know that you’re being monitored and followed. the whole idea of privacy goes out the window. when you strap it on, you know [00:19:30] that yeah. they are tracking via GPS so that they can give you a really cool map when you’re done your job or your bike ride or whatever you’re doing.

[00:19:37]I think people are less concerned about privacy, especially that group. That are using health monitoring tools. so that’s, just something to consider and then their final point, a trusted clinician relationship. Remains paramount. The top factors for an ideal health care experience in the Deloitte 2020 survey of us health care consumers, mirrored the findings.

[00:19:57] I have a similar study in 26 [00:20:00] doctors who listen to care about them. Doctors who don’t rush and clear communication as health systems, technology companies, and others rollout virtual services narrative to provide the same. Personal experience as during an in person visit, this is particularly true for organizations that are developing tools or services for those with chronic conditions, as they are most likely value a sustained relationship.

[00:20:26]the, so what on this is know your consumer, and [00:20:30] you know what the Jen, if you see these national things, They’re great. They give you a perspective, but know your consumer because the consumer in Lubbock, Texas is different than the consumer in Southern California is different than the consumer in Northern California.

[00:20:45] And those were three markets that I operated in when I was the CIO. And so you have to really. No, those entities and you just can’t take the generic. everybody wants a digital experience while everybody may or may [00:21:00] not want a digital experience based on their relationship with their existing doctor and in the community that they live in and how they function.

[00:21:07] All right. Next story. OCR updates, the HIPAA resources for health apps and cloud computing. And for this one, I, I’m going to give you the links too long. So the link I gave you is this week health.com/m health apps, APS, M health apps. So if you go there, it’ll take you to the OCR, update [00:21:30] website. And it has a bunch of the things that the OCR is doing.

[00:21:33] So the department of health and human services, office of civil rights, updated and renamed it’s formerly former health app developer portal as HIPAA resources page for mobile health apps, APIs and cloud computing designed to support covered entities and mobile health developers. There’s a couple of things in this story.

[00:21:50] And I got the story from health. It security that I thought were interesting. So here are some of those as noted by OCR in 2019, HIPAA is limited in its [00:22:00] regulations. For third party health apps chosen by patients and not connected to, or developed by their primary care physician. All right. So if I’m a patient and I select the app that I want to connect in at 21st century, cures requires you to provide me access via FHIR and whatnot.

[00:22:17]then that app may not be covered under HIPAA because they’re not, they may not be a covered entity. And you may not be, so I’ll just keep going here. Once protected health information has been shared with the [00:22:30] third party app as directed by the individual. So me, the consumer directed the app to get my information.

[00:22:36] The HIPAA covered entity will not be liable. Under HIPAA for subsequent use or disclosure of electronic protected health information provided the app developer L developer is not itself a business associate of a covered entity or other business associate officials explained at the time further HIPAA liability is directed directly determined by the covered entity and their [00:23:00] relationship to the health app.

[00:23:01] If the patient decides to send their health information to a provider using an app that doesn’t fall under HIPAA, the patient health data is not subject to HIPAA regulations. As the U S continues to push, to adopt contact tracing gaps that may fall outside of hip. But industry stakeholders have stressed.

[00:23:18] Patient privacy obviously may be at risk. I thought all those things were interesting. I didn’t realize that it was that clear. To be honest with you. and that is actually a great thing for providers, I [00:23:30] know that there was a lot of concern about if the patient accesses their data via this app.

[00:23:35] Am I responsible for it? but the reality is if the patient uses a third party app and they request the data, that you are not going to be a liable for fines, that doesn’t necessarily mean that we don’t, worry about the privacy of our patient data. If, we should be to a certain extent, educating our patients, providing them a set of apps that work.

[00:23:58]we shouldn’t complain too much [00:24:00] when people utilize third party apps that aren’t, good or aren’t certified or aren’t authorized, or those kinds of things we should be running after this. Pretty hard to make sure we fill the gaps with apps that are trusted. And maybe that’s one of the things we provide.

[00:24:13] Maybe we provide a directory of trusted applications for our, for our patients so that they can go to a website, see the trusted apps that we recommend. Not necessarily the only ones that will support, but the ones that we recommend that we can ensure their security and their [00:24:30] privacy on. So that’s my, so what on that, there’s something to get ahead of there.

[00:24:34]there’s a new, there’s some new resources for you at the, OCR website. And again, if you wanted to get to that through us, the easiest way this week, health.com/m health app, all one word, easiest way to get there. Alright, interesting story. Let’s see how far we’re 27 minutes at, Forbes. Can platforms help reduce the $935 billion in [00:25:00] wasteful healthcare spend.

[00:25:01] We’ve talked about platforms a lot. I just call your attention to this story. September 14th, 2020. and, so they asked that question. They go into some of the opportunities that, platform creates. It creates efficiency and reduce the search times. it brings parody to asymmetrical relationships, facilitates rapid information and knowledge sharing, introduces transparency, and reduces information asymmetry, eliminate the many to many integration problem.

[00:25:26]it brings down the cost of spreading them over continually increased [00:25:30] number of users and unleashed the virtuous cycle of further innovation. So this is, that is the promise of platforms. It’s actually a pretty decently written article. we talk about platforms, a fair amount and platforms to me are really about creating that marketplace.

[00:25:45] You’re going to have consumers, you’re going to have, producers and, and that can be producers of data that get used by researchers. that can be producers of, health services that get consumed. you want to turn your health system into a platform. We talked about this last [00:26:00] week about Ohio state and how they’re talking about their healthcare system as a platform, a healthcare platform.

[00:26:06] But in addition to that, we should be thinking about the resources and a platform will provide, the ability to aggregate data, to, provide advanced analytics, machine learning and AI on top of it. the ability to build applications, the ability to, facilitate transactions. maybe financial transactions, but definitely data transactions, moving that data around, I think more and more, we’re going to be looking [00:26:30] at platforms and the EHR is a platform.

[00:26:32] It’s a specific kind of platform. but it is, I wouldn’t necessarily call it an open platform and it’s definitely not based on internet technologies. so the, so what for that is there is an opportunity to use platforms. You’re gonna hear that word more and more from this side of the fence. but you’re also going to hear it more and more from the industry.

[00:26:51]and I think the EHR is, are trying to become those platforms, but I think they’re hampered by, as we talked about earlier, the, legacy [00:27:00] architecture, that they’ve, that they’ve used and adopted. All right, let’s see a little time, two more stories, a trillion dollar quest to bring hospital care to the home.

[00:27:11] And this is an interesting article, fast company.com September 14th, 2020. Yeah. worth a read. And, the thing I like about this is it has a bunch of good stories, right? So they, they talk about one person’s, story of losing their father in the hospital and they looked at. w what [00:27:30] broke in the process.

[00:27:31] And, one of the things they note is that so much money goes to the facilities that not enough money is going to care and too much, it’s going to paying rent and paying for, these massive facilities. And he called it’s. What do you call it? An edifice complex? yeah, I can’t find it right now.

[00:27:49] It’s, A lot of hospitals have what I call an edifice complex left says all they want to do is build buildings and we should be moving past that today. We’ve made that, low [00:28:00] asset entry into new markets is the way to go. That is usually led by digital initiatives and then followed up by, again, smaller footprints, strategically located.

[00:28:13]parking lots that you can get in and out of without massive signs and those kinds of things. I made a note of this in one of the shows way back that, in my hometown in Bethlehem, Pennsylvania, st. Luke’s. Wow. I have a building on all four corners of a major intersection. And you look at that and you [00:28:30] scratch your head and you’re like, why would st Louis have a building on all four?

[00:28:32]that one’s for OB and that one’s for radiology and that one’s for, fill in the blank, but they each have their own parking lot. When you park there, you know exactly what you’re going in for, and you don’t have to navigate, this, Massive system. Anyway, this goes on to talk about how, not nearly enough money is going towards, the actual care.

[00:28:52] And if we really did focus in on that, one of the things we would realize is that, a lot of the buildings and the campus and the setup that we [00:29:00] have is really obsolete. And if we can drive care into the home, There’s an opportunity for a, at a trillion dollar, benefit in care in the delivery of care and the quality of care.

[00:29:12]and quite frankly, in the experience, cause people want to age in place, they want to, be in their home. They want to be able to, see their family and those kinds of things. Huge opportunity there at that story is worth taking a look at my, so what on that is just has to [00:29:30] be, really strongly consider any investments you’re doing in facilities, from this day forward and really look at scrutinize them, is that required for your community?

[00:29:41]is there a reason that you’re adding on to that tower or building a new tower? A lot of those are going to be. obsolete the day that they are, built. we need to be thinking agile and nimble and a low asset, as we go forward and, utilize the space we already have. There’s an awful [00:30:00] lot of commercial real estate in the market that is available.

[00:30:03] There’s an awful lot of. other ways to go about this. But again, digital is the platform for a lot of the capabilities that are needed. We don’t have to be within the four walls of the facility to, to have a secure network, to have, data sharing and all the things that we need. All right. Last story, chime advises, ONC to help lift national patient an identifier.

[00:30:24]I’m not a fan of this. I’m not a fan of this for a bunch of reasons. one, I think it’s the wrong [00:30:30] approach. I think there is a. I think there’s a commercial, path to this. The other reason is, I think there’s security issue with it. The third reason is it just doesn’t cover everybody in Southern California.

[00:30:42]15% of the people who came through one of our ERs didn’t have social security numbers, go figure somebody. What is this going to do? Where are we going to assign an MPI to these people? They don’t want to be tracked. they create IDs every time they come in. now we were able to use advanced algorithms spring them, [00:31:00] together with a certain amount of certainty.

[00:31:02] We were able to link records and do that kind of stuff. But at the end of the day, if people don’t want to be tracked, they don’t want to be tracked. And, the national identifier while I applaud what they’re trying to do. And they are trying to, create a record, a single long shooting record that, gives you all the information you need at the point of care.

[00:31:22] But the reality is. They don’t review all the information at the point of care. there’s so many holes in this. I understand that for research, but again for [00:31:30] research, anyway, there’s a lot of different ways to do this, but anyway, chime has taken and by the way, a lot of you.

[00:31:36] A lot of CEO’s and other, individuals have said, this is a good thing, and we are encouraging China to pursue it. In fact, I’ve yet to run into too many people that agree with me on this, to be honest with you. so a lot of you are saying, Hey, push this forward. And they are, and this is exactly how I would push it forward.

[00:31:53] If I were them. they not only got the, champion the legislation through and. really educated the, [00:32:00] congressional leaders on this and got that, that, moratorium pulled off. gosh, what was the foster Kelly amendment? There it is. And, they removed the bill that prohibits the federal funds for the adoption of NPI, which is exactly what we asked them to do.

[00:32:13] And now what they’re doing is they are making recommendations to CMS on how this can be done and how it can be done effectively. they. they say that there’s already mechanisms out there that they can utilize. they could utilize. things like the [00:32:30] post office, our USP USBs. Yeah. Post office, data standards.

[00:32:34]so they can set up data standards to pull these records together. multiple address standards, new birth bursts standards. and again, they know not all these, not all these are perfect, but they will get us heading in the right direction. Above all chime continues to assert that the first policy obstacle that must be removed is section five, 10 of the labor HHS appropriations bill that has been in place for two decades, [00:33:00] concluded the organization.

[00:33:00] We continue to advocate strongly for Congress to remove this ban and open the pathway for a nationwide strategy to address patient identification. While our members vary in their opinions on whether a unique number should be assigned to every patient. What they can agree on is that a ban is an enormous barrier to safe and interoperable care for patients.

[00:33:21]maybe, clearly I fall on a different side of this, but, at the end of the day, I think that, Google’s already figured out how to do this. I [00:33:30] think they’re doing it for Ascension. I think, the essential deal that everybody was up in arms up, but I guarantee you, they brought all that data and they matched those patients just fine.

[00:33:39] Quite frankly. I think that Apple can do this very easily and probably already has done this, pretty easily. And, I think a lot of this is a technology problem. Not a lot of it. two thirds of this is a technology thing that you could really address 90 some odd percent of the duplicates.

[00:33:59]the other [00:34:00] is quite frankly, there’s a bunch of people without IDs, nor do they want to be tracked. So there’s that aspect of it. That my percentages are gonna go out of whack here real quick. and then there’s, there’s training. Quite frankly, there’s training. And again, but a lot of this is technology.

[00:34:14] We can nudge people. So when people are checking in, you get that nudge that says, Hey, this person might already be in the system. They find that person that’s already in the system, or even pop up potential people that this might be. So when I say my name’s bill Russell, it might show up as there’s 15 bill [00:34:30] Russell’s in this health system, it might match based on birthday, might match based on, my cell phone number or whatever the other things are. but there’s a lot of different things that, that can really address the spring this together. And then we still haven’t figured out the structure of sharing this data across the board with researchers in an effective way, I guess we’re starting to see that with cosmos. We see that with, some of the stuff that Cerner’s doing as well, and there are others, health catalyst is doing this and I’m sure they [00:35:00] are matching the patient records, pretty effectively.

[00:35:02]Anyway, just wanted to make you aware of the fact that CHIME is, is advocating for this and pushing it forward. Like we have asked them to do that’s all for this week. don’t forget to sign up for clip notes, clip [email protected] Get that email out and you will get an email back to get you signed up..

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