News Day May 2020 This Week in Health IT
May 5, 2020

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May 5, 2020: Welcome back to another Tuesday Newsday! After all of the COVID episodes we have published recently, we would love to hear from you, email us with the biggest challenges that have been present in your work. We will go through those on next week's show so send in them in as soon as you can! In today’s business we look at a few important stories that touch on the current state of the pandemic but more so on what comes next. The first topic is the future of
enterprise software and what it might look like in the coming months. Bill reads through a few thoughts on this, talking about automation, expenses and more. With so much changing in such a short period of time there is sure to be a whole of movement with the tech sector as some companies will disappear, some will step up and some will shift. This will impact the health world in many ways and we look at a few examples. Cerner and AWS' well-publicized partnership has taken on new meaning with them announcing their joint effort to useable data for researches on the COVID-19 pandemic and Bill looks at the story that explains this. The rest of the episode is used to look at declines in outpatient visits, perceptions of safety at hospitals, struggling hospitals and how health centers can try to prioritize new and existing projects in a post-COVID scenario.

Key Points From This Episode:

  • What is the biggest challenge that you or your health system is facing right now? We want to
    know!
  • The looming changes in enterprise software; perspectives on what is next.
  • More automation suits the customer and should be embraced.
  • Reshuffling and acquisition in the tech market and how this will be felt in healthcare.
  • The work that AWS and Cerner are doing to make COVID-19 data available for researchers.
  • Declines in outpatient visits since the advent of the pandemic.
  • The need to make hospitals places people feel safe visiting after the crisis.
  • How the coronavirus has affected financially struggling hospitals.
  • The list of hospitals who have been forced to furlough staff as a result of the crisis.
  • Healthcare projects that will continue through and after the crisis.
  • A simple framework for prioritizing projects for the short term future.

News Day: Post COVID IT Projects, At Risk Hospitals and Digital Transformation

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News Day: Post COVID IT Projects, At Risk Hospitals and Digital Transformation

Episode 241: Transcript – May 5, 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.

[0:00:04.8] BR: 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’re going to take a look at a lot of stories. Let’s see. We’re going to take a look at enterprise software, what’s going on with enterprise software. We’ll take a look at Cerner, AWS, their partnership and how it’s paying dividends for researchers. We’re going to dig into the financials a little bit. There’s way too many stories on the financials and what’s going on to ignore it. 

Then finally, we are going to take a look at COVID-19 proof IT projects, 13 hHealth System Execs on Tech moving forward in what projects they’re going to focus in on. Those are just some of the stories. My name is Bill Russell, healthcare, CIO, coach and creator of This Week in Health IT, a set of podcasts, 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 has been sponsored by Sirius Healthcare. They reached out to me to see how we might partner during this time and that is how we’ve been able to do as many shows as we have, on a daily basis. Special thanks to Sirius for supporting the show’s efforts during the crisis.

I would like everyone who’s listening to this show to stop right now and send me an e-mail. That is of course, unless you’re driving or something to that effect. If you’re not, flip over to your e-mail client and send an e-mail to [email protected] We’ve done 40-plus COVID series podcasts, one every day for the last seven weeks. One of the things I want to hear from you is what is the biggest challenge you or your health system is facing right now today, May the 5th? What’s going on?

If you want to go a little further than that, it would be great if you can just – what is the one question we can try to field on the show next week, or to try to address over the next couple of weeks? That’s it. Just two questions; what’s the biggest challenge and what’s one thing we could do or think we can address, topic we could address that would really help you out? That’s it. I’m going to share some of these starting next Tuesday and I would love your feedback and your input. Again, stop right now. Just stop, go over to your e-mail client, [email protected], send me an e-mail.

All right, it’s Tuesday news day. Let’s get to the news.

Why Enterprise Software Will Be Forever Changed. Why will enterprise software be forever changed? On an earnings call this week for ServiceNow, CEO Bill McDermott said, “Around the world, we see that customers who are farthest along in their digital transformation are better equipped to manage this crisis. Companies lagging behind are realizing that they now have a burning platform. Accelerating digital transformation has become a business imperative.”

He pointed out that during the next three years, about 7 trillion dollars will be spent on digital transformation and yes, this process is likely to accelerate. 

Okay then, what are other people in the industry saying about this? Because that could be a little self-serving, if you think about the ServiceNow CEO saying, “Hey, our stuff is in high demand. No kidding.” Soma Somasundaram, the CTO for Infor. Sorry, I’m still working on names. He has this to say, “As the demand for automation continues to grow, software architecture must adapt to support the vast amounts of data needed to power automated work streams. In particular, there will be a large focus on leveraging cloud technology to enable AI in automated processes.”

I think that is really true. I think we’re going to see automation come to the fore. I think we’re going to see the combination. It’s not just digital, it’s not just engaging the consumer, but it’s creating these workflows that are automated. You have to bring in tons of data and you have to start to eliminate work and to make it easier for the people who are in that work stream, that information comes to them, that’s packaged up, that they can review, that they can move it on. Good thoughts from Infor.

Ayman Sayed, CEO of BMC, “Both the technology buying centers and gravity in companies will shift to allow for technology buying across the company.” If that doesn’t scare you, I don’t know what. I don’t know what’s going to scare you. This is one of the things we have been trying to reign in for years. That is departments going out and buying things. I think what we’re getting to is a point where people are saying, “Look, define the architecture, define the framework and we’ll go out and find the best solution for what we’re doing.”

When you define that architecture, you have to define the workflow, you have to define the data elements, you have to define the things that it brings in. You can’t just throw that out when they find a good solution. What you are designing is the enterprise architecture and then they can plug things in. As long as they play well within that enterprise architecture, the data should flow, the automation should be allowed across multiple systems, across multiple elements. Again, that’s what BMC is saying. That purchasing essentially, purchasing of technology decisions it’s going to is going to go out into the field.

Eric Clark, CDO, Chief Digital Officer for NTT DATA says, “Clients need to reduce dependency on human interaction, so they’re looking at solutions that offer contact list operations, self-help, self-heal tools and automated workflow.” I think that’s going to hit healthcare as well. I think one of the things you’re seeing through this pandemic as people are getting used to interacting with machines as mediaries for physicians and for office staff and those things.

Look, there’s nothing really special about the office staff within the – within the physician practice. If it can be automated, If the experience can be improved, that’s what the consumer wants. Now, I understand that they add different value to the practicing physician and that’s a whole another conversation to have, but people are going to be looking for tools that move the process along at any given point in time. I recently redid our insurance for our company and I went to a completely automated solution. It was really beautiful. I’m not going to give them a free advertisement here, but it was really beautiful. I mean, signing up for it.

I had a broker working for me and they said, it’s going to take at least five weeks to get you onto the new insurance. I went out, I signed up. By the way, it was like a day before the month end. I went out. I signed up. They approved my insurance. They’re going to send me the cards in the next week. They integrated it with QuickBooks. It was slick. That’s what we expect. We expect things that can be done by us ourselves that move things along at a faster pace to be done that way. The broker lost my business. It’s not that I didn’t go to another broker. I just went to a broker who’s processes are completely automated.

Anyway, Yvonne Wassenaar, the CEO of Puppet, which is a very important company. If you haven’t looked at Puppet, it’s an organization that we used five or six years ago, phenomenal technology stack. As we head into this, what will likely be a recessionary environment globally, that’s a recurring theme by the way, this is not the first person that talk about this recessionary environment. There will be an increased focus on investments that deliver efficiency and optimize the business.

I’ve heard from fellow business leaders repeatedly how they are reassessing their priorities for the year ahead, introducing new steps into procurement processes and many of them are instituting blanket cuts. The next CIO, as a next CIO who has lived through several economic downturns, the bar for software purchases has just been significantly raised. The winning software companies enable cost containment, drive efficiency and ensure business continuity today without turning their back on innovation. The others most likely will go out of business, or be bought.

Again, we’re not looking specifically at healthcare. We’re looking at what’s happening to the enterprise software stack. You have to consider these things as you move forward. Adam Mansfield, the practice leader for UpperEdge, “I envision a world where there’s significant consolidation coming out of COVID-19, leaving a much smaller pool of truly viable enterprise software vendors through a consolidation enterprises will be further locked into particular vendors and functionality. For example, I can see an end-state where Microsoft, AWS and Google Cloud are essentially left as the last survivors, because Google has bought ServiceNow and Workday. Microsoft has acquired SEP and Salesforce. AWS has acquired Oracle.”

Yeah, I don’t know about those predictions per se, but you can see that happening. There are significant financial pressures on these organizations. They’re missing complete business cycles. I’ve talked to and heard from sales organizations that are really struggling. It’s impossible to call on sales organizations on healthcare organizations right now, or any organization that is not almost completely focusing on COVID and the impacts of COVID.

You could see because of those downturns over the end of Q1, Q2 and maybe even into Q3 if there is a resurge in the fall as people are talking about, that some of these companies just lose their bearing and end up getting purchased. Anyway, I’m not going to speak specifically — enterprise software in healthcare. Maybe I should. Enterprise software in healthcare, we’ve been slow to adapt. There’s a ton of ServiceNow clients within healthcare. A bunch of us are using ServiceNow. A bunch of us are using Microsoft Office 365. We call that essentially our move into the cloud.

The biggest enterprise software we all run is primarily our EHR, our clinical documentation system and billing system, as well as our financials that we have to run as well. Those are the enterprise solutions. I mean, the same thing they’re talking about in the broader market, we could see within healthcare. We could see a lot of companies fold into each other, so we can see consolidation. We can see a renewed emphasis on driving those companies to help us solve the problem that we have, which is to drive cost containment, drive efficiency and ensure business continuity. Business continuity is going to be a much bigger conversation coming out of this obviously.

All right, next news story. Cerner, AWS Partner to Make COVID-19 Data Available to Researchers. I’m only highlighting this, because it was a – I think it’s an interesting aspect of the partnership with Cerner and AWS. They’re joining to offer access to de-identified patient data to researchers fighting COVID-19. Epic is doing this as well, as are others through various things, various platforms that are out there. Let me give you a little detail.

Stored on Cerner’s health data lab platform, which is hosted by AWS, the de-identified patient data will offer healthcare researchers a slew of COVID-19 related demographics to help track the spread and surge. This the healthcare IT news story, by the way. The data sets are also include lab results, underlying illness and chronic conditions in clinical complications among other statistics.

An advisory committee will choose recipients of the free offer by combining and utilizing different types of clinical patient, social determinants and other open source data, researchers can build intelligent models, which could, in theory, anticipate patient outcomes and help improve predictive analytics. Again, towards the end of last year, I talked about the fact that I believed that this partnership between Cerner and AWS has some legs to it. Of course then, everything got thrown into a whirlwind with COVID-19. I still think it has promise. I still think it will from a data and analytics side, as well as interoperability side, I think it will level the playing field in a lot of ways. It’ll be interesting to see where this goes.

Next story and we’re going to delve into the financials a little bit here. Outpatient Visits Down 60%, Because of COVID-19 Study Finds. This is Becker’s article. From mid-March through mid-April, outpatient visits have declined nearly 60% due to COVID-19 according to research from Cambridge Massachusetts-based, Harvard University and healthcare technology company Phreesia. The decline is largely due to the cancellation and deferment of elective procedures and preventative visits for their analysis researchers from Harvard. Phreesia analyzed visit volume data from – they’re from the company’s more than 50,000 provider clients, researchers found the New England and mid-Atlantic states saw the largest declines in the number of outpatient visits.

As the number of inpatient visits dropped, researchers saw the number of telehealth visits increased. However, the increase only partially offset the drop of in-person visits. Okay. I’ve been consulting a fair amount recently with different companies via Zoom, which has been interesting, talking to various people. One of the things we’ve been talking about is we’ve done a phenomenal job, a phenomenal job of telling people, “Stay away from the hospital. It’s not a safe place.” Essentially, that’s what we did.

We said, stay away from here, go through the drive-through clinic, get your testing done there, don’t come in to the ER. We did a really good job. Well, we better get together with marketing and figure out how we’re going to undo that job, because our livelihoods, our revenue really depends on it. We’ve got to turn this thing around and we have to make those hospitals a safe place.

Last week on the show, I talked about Atrium’s movement in that direction and what Atrium did essentially was they’re utilizing their digital capabilities, they’re utilizing telehealth, digital hospital, a bunch of marketing to be honest with you and their testing capabilities. They’ve packaged all those things together to create a safe space for people to go and continue to get care that they need. I’ve also been hearing some just horrific stories of people – heart attacks didn’t end. Strokes didn’t end as a result of COVID. We’re hearing some stories of people actually having strokes at home and not going into the hospital, because they’re afraid of COVID.

To a certain extent, we have some work to do here to undo what we’ve done in terms of cementing in people’s minds to stay away from the hospital, which is now we’ve got to just completely undo that and get them to understand that a hospital is a safe place and we have to make the hospital a safe place to bring people back in.

USA Today went even further, Coronavirus Strains Cash-Strapped, Hospitals Could Cause up to a 100 to Close Within a Year and they have some quick hits on this. Network analysis of financial report submitted to the Centers for Medicare and Medicaid Services, CMS found that almost half of the counties with coronavirus cases are served by a hospital that reported a net loss in 2017. Communities served by 640 of these struggling medical centers, there is no other hospital in town. Mainly all of those in jeopardy are in rural counties. As the virus spreads into rural America, sometimes weeks after the urban hot spots, many small hospitals must wrestle with the choice of laying off longtime staff members.

Okay, so rural healthcare is going to struggle. It’s going to create a challenge to say the least, for those rural health systems. You know what? It’s also going to create an opportunity, because there’s going to be a gap there that needs to be filled. There are large health systems at some point, wherever the large city is that’s not too far off, should figure out a way, not necessarily to save that hospital, because I’m not sure that if it hasn’t been making money for years, that it is savable per se.

To provide the level of care that’s required in those communities, or the best level of care that they can in those communities, it’s going to end up being a significant amount of work that we’re going to be doing over the next couple of years, I believe. One more and then we’ll get to IT projects. 227 Hospitals Furloughing Workers in Response to COVID-19. They just have a list. It’s a Becker’s healthcare story. It’s pretty sobering when you read it. Children’s in Minnesota, a 181 nurses, Providence, Rhode Island, doesn’t have the numbers, a portion of its staff. Indiana, MU Health and Columbia, Missouri traveling nurses.

It’s primarily people that aren’t directly related with COVID care. The question you have to ask is are we going to be able to bring these people back? It’s 227 hospitals. Almost everybody is feeling a pinch that is going on. They are now looking at the financials very closely. This is primarily, let’s see. I think it’s primarily larger systems, or primarily smaller systems. You have some here. Hey, here’s one. University of Virginia Health System citing revenue loss of 85 million per month due to COVID-19 pandemic.

Those are the numbers I’m hearing. Losses of 10, 20, 30, 50, 100 million dollars a month-ish. That creates a situation that is not sustainable for any length of time. Hard decisions have to be made. Hard decisions on furloughing staff, on letting staff go. We’re going to have to establish new normals. No one knows what the new revenue normal is going to be. If you came into this thing as a billion dollar health system, you might leave as a 800 million dollar health system. It remains to be seen. There will be some revenue destruction as a result of this. I’m not sure we’re going to capture all that revenue. I’ve heard people talk about the fact that these cases haven’t gone away. Well, some will have gone away. There just is destruction, revenue destruction as a result of this.

All right, final story. Let’s see, IT Projects That are Going to Continue. Health systems around the US are reporting significant revenue decline due to COVID-19 pandemic, but many, also CIT projects as crucial to providing patient care. I will tell you in my informal conversations, I’ll cite this story in a minute, but in my informal conversations, the projects that people are saying are going to continue are all over the board. It really depends on how you experienced COVID-19.

If you experienced COVID-19 and said we couldn’t gather all the data we wanted to, there’s probably a big data project after this. If you said, “We couldn’t track PPE,” there’s probably a PPE project after this. There’s probably dashboard projects, there’s probably business continuity projects. Some are saying, “Look, we’re doubling down on our EHR strategy. We’re going to make sure that the next time this happens that our EHR – we’re on a single EHR from one end to the other.” 

Some are saying digital front door, digital, digital, digital, consumer. It is all over the board. Here’s what the story cites. UW Medicine Seattle, University of Washington, medicine has been an ambulatory and revenue cycle Epic customer for a long time and we are in the middle of a project to expand our Epic footprint into inpatient and ancillary departments across our hospitals. We are not going to stop this project. Our experience with COVID-19 has further cemented our commitment to give our providers a single EHR and standardized and improved workflows.

Interesting that they would say a single EHR and they say, we’re Epic from one end to the other. Clearly, they’re not epic from one end to the other, or they would already have a single EHR, which is interesting improved workflow. That is the case probably in most health systems. It’s not that they haven’t committed to Epic, it’s that they haven’t finished. It’s not across the board, or they’ve done acquisitions, or they’ve done M&A and they haven’t brought everything inside. 

Or to be honest with you, there could be two or three different variations of Epic within a health system. Like when the health system says, “Yeah, we’re Epic from end to end.” Then when you actually talk to some of the people that are running the system they’ll say, “Well, really we have multiple instances of Epic.” It’s a problem for them, because it’s different builds, different cycles and they have to bring all that stuff together. A lot of health systems are talking about that. Still a focus.

Jesus Delgado, Vice President and CIO of Community Health System in Munster, Indiana. I want to read most of this, because it’s pretty good. “We are fast tracking our out-implementation of telemedicine. During the next couple of months, we are going to be onboarding hundreds of physicians. We are also enhancing our telemedicine by incorporating remote patient monitoring with full integration to our EMR.” I’d love more details on that. If Jesus Delgado would like to come on the show, I’d like to hear what you’re going to do in that area. It’s pretty interesting.

We are realigning and reprioritizing our data analytics projects. There is already anticipation that we will have a COVID-19 back in the fall. We will have COVID-19 back in the fall. We want to have better data insight into our patient population specific to COVID-19 symptoms, which is again, people are saying analytics is big. We are also going to focus on IT projects that can present opportunities for cost savings, or operational enhancements that can lead to better cost management. I think that’s going to be a renewed emphasis is getting those projects.

Scott Kelly, the President and CEO of Asante says, “In point of fact, all of our enterprise ITS initiatives have clinical operational or financial consequences if they were cancelled.” I really want to highlight that comment. It’s not like we went into the year and said, let’s do a bunch of frivolous projects. We have projects that were tied to reimbursement to revenue to better address physician burnout, to address clinical workflow, to drive out the costs of within healthcare. It’s not like we should have a whole new set of projects, because quite frankly, unless we just completely missed the mark last year and we’re planning projects that were frivolous.

With that being said, no one’s doing that. To a certain extent, we’re going to have to continue the projects we’re doing and augment them with a set of projects that come about as a result of this. He goes on to say that they’re categorizing each of their projects into three categories. Fixed timeline, COVID-irrelevant, can be pushed out three to six months in projects which are more discretionary. I like the way they’re thinking. They’re categorizing their projects. They’re looking at what can we do now and what can we delay and what things are just in cement?

If you’re building a building and you can look outside your window and see girders up, you’re going to finish that project. You’re not going to leave a tower half-finished, right? There’s a bunch of fixed timeline projects. Plus, there’s a whole bunch of operational projects. We still to patch and fix everything that’s out there.

I have pretty much run out of time. There’s a bunch of really good stuff in here. At the end of the day, I’m going to say, it really depends on how you experience COVID-19, what you’re going to prioritize coming out of this. I will also say, just re-emphasize, I think there should be an exercise going on right now around a handful of things. What are those projects? This frameworks is as good as any, that we got from Asante. Fixed timeline, projects that can be pushed and projects which are more discretionary. Probably, that’s a good high-level place to start.

Then you start to move down from there and start to determine which ones have a financial impact, either reimbursement, or otherwise. Which ones have the assumptions completely changed? By the way, we did this with every project every six months. We would start projects, they’d be multi-year projects. We get to the end of the project and realize the assumptions have completely changed, because we weren’t agile in how we looked at these things.

I would revisit all the assumptions of just about every project you have going on within your health system and determine when this project launched, are we in the same world that we are going to exit? Do the same assumptions hold? If telehealth reimbursements go up significantly, are we in a situation where it doesn’t make sense to, I don’t know, launch this thing over here when we really should be standing up a significant telehealth capability and really integrating that into the larger health system processes?

I’ve actually gone over. I’m just going to end right there and there’s a ton more to talk about. That’s all for this week. Don’t forget to send me an e-mail, [email protected] What’s your biggest challenge and what can we address in the show over the next couple weeks that might help you? Let’s see. Special thanks to our sponsors, VMware, StarBridge Advisors, Galen Healthcare, Health Lyrics, Pro Talent Advisors and Sirius Healthcare 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 can check out our website, thisweekhealthit.com, or the YouTube channel.

If you want to support this show, the best way to do is share with a peer. But the second best way to support the show is to subscribe to our YouTube channel. Go over there and subscribe. Once we get above a 1,000 users, we can start to do some really fun things. A lot of you already have. I think we’ve done over 300 hours of listens on the YouTube channel over the last – since we started the COVID series.

We’re going to be back again every day through the end of the week as we navigate this together. Thanks for listening, that’s all for now.

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