Bill Russell This Week in Health IT
August 18, 2020

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August 18, 2020: What are the most dangerous trends in health IT? What’s going on in the battle lines for telehealth? Technology isn’t really magic. It doesn’t change habits. It doesn’t cure isolation. We still have a lot of work to do. What’s the current status of M&A’s? Did recent activity actually go down? We look at the rise of the Executive Chief Medical Officer role and the not so sexy but essential topic of data security. And how can we finally get broadband everywhere? 

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News Day – Telehealth Mixed Messages, CMO is Hot, HIT Risks

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News Day – Telehealth Mixed Messages, CMO is Hot, HIT Risks

Episode 291: Transcript – August 18, 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: Clip notes is live. If you can’t listen to every show, but you want to know who was on and what was said, you should sign up for clip notes. One paragraph summary, key moments in bullet point format with timestamps and one to four video clips from the show stay current share insights with your team and maintain your commitment to developing them.

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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 do a quick run through the headlines like we did. We started last week. I have 26 stories. I can’t get through 26 stories. So the firstWeight or so I just hit the headline. Give you my, so what, and then we’ll go deep on a couple of others.

So that’s a new format for you. We’re going to take a look at the battle lines for telehealth and what’s going on there. [00:01:00] And the emerging role of the CMO Chief Medical Officer, they are popping up everywhere. My name is Bill Russell, healthcare, CIO, coach, and creator of This Week in Health IT a set of podcast 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 spoiled concert by Sirius Healthcare. Now we’re exiting the series and Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show’s efforts during the [00:01:30] crisis and beyond.

You know what? Clip Notes was your idea. Expanded shows was your idea. We’re committed to deliver a show that meets your needs. If you have ideas, send me a note [email protected] Do I get spam? Absolutely. But it’s worth it because I also get a few emails a week, that let me know we’re on track with some of the things we’re doing and some of the things we need to do to change course  and you guys are really helping to shape the show. Thanks for continuing to make this the most listened to health IT podcast [00:02:00] at 150,000 downloads and counting for 2020. And if you haven’t signed up for three extracts yet you’re missing out texts directs D R E X to four eight four eight four eight and receive three texts every week with the stories that will help you stay current. It helps me prepare for the show. And this is a service of Drex DeFord, a frequent contributor of the show. All right, news, this is headlines only. This is the deep dive. Headlines only. HEee we go. Comcast rolls out new [00:02:30] internet essentials partnership program for schools and its footprints, Philadelphia business journal.

I love this. I know it’s marketing. I don’t really care. The reality is we need broadband to cover every inch of this country in order to really take healthcare to the next level. And you know, without broadband, we’re always going to struggle. So anytime I see a broadband being rolled out, even if it’s in supportive schools, it just means that that broadband connection has gotten to a new home or another place.

You know, my, so what [00:03:00] on this is, you know, support CHIME in their lobbying efforts on the national level and support your state and local efforts to get broadband everywhere. The other thing I would say is this is a great growth strategy for many health system. You know, it think about it this way.

You could be doing teleconsults, telehealth to remote locations. You could partner with these rural and remote health systems. You can take, you know, you can provide teleconsults on their high acuity services. You can then transfer those services in or transfer some of those [00:03:30] patients into your health system. You can form very strong partnerships via this broadband and telehealth strategy.

if you are in front of it, get in front of it. All right. So I love that. So Comcast continued to do that and other providers hopefully just expand the national footprint for broadband. Next, US health insurance, doubled profits in the second quarter, amid pandemic. This is a, a guardian article.

Does this surprise anyone that health insurance took money in? And their [00:04:00] patients were not going anywhere. So we’ve talked about this a couple times and in fact, one, a couple of shows. I said, health insurance will be the big winners coming out of this. They’re going to have huge war chests coming out of this, and they’re going to be able to buy up anyone who is struggling.

So that can be, physician practices and others that are going to need cash moving forward. So, the other thing I would say about this is that, you know, the providers that were also insurers, it was a great hedge, being a payer was a great hedge against the [00:04:30] pandemic losses during COVID-19. So you know, that’s just something to consider. I don’t know what I’m saying there, I’m saying that your competition is probably going to, if you’re a provider is probably going to come from the insurers, starting. Yeah, while starting a year ago, 10 years ago, whatever. that’s the, that’s the direction this is going in there. Well-funded and ready to go.

All right. Next story. HHS, Chief Officer abruptly resigns. I’m going to start here with, I’m not shocked. I have [00:05:00] no special knowledge, actually. That’s where I should start. I have no special knowledge here. I haven’t talked to anyone. Nobody’s whispered anything in my ear. I don’t know anything here.

I’m just reading the headline. HHS, Chief Information Officer abruptly resigned. I don’t think it’s a shock because we just did a major shift. Right? We moved all the, the, the reporting from the CDC database to the HHS database. That’s a major transition akin to, any HR transition for a provider. And we know that many EHR transitions lead to [00:05:30] job transition.

And again I don’t have any special knowledge. I can imagine what happened. This whole thing is predicated on better insights, better tools, better data collection, better something. It may be that they didn’t deliver. I have no idea. It may have been transitioned poorly that often leads to,  some challenges.

The CIO may not have gotten the support they expected from leadership. That could be another thing to happen again. I have no idea. My, so what on this is, is this the only reason I’m covering this story [00:06:00] is to say, don’t expect a reversal to the CDC database. I don’t think it’s going to happen. I doubt it’s going to happen.

In fact, I would go as far as to say it ain’t happening, keep moving forward, get your extracts right. Get them heading over to HHS as soon as you can. All right. Amazon launches online pharmacy in India, BBC news. we talked a bunch about this in 2019, that Amazon is uniquely positioned as a supply chain for a farmer for [00:06:30] drugs.

Right. So they are really good at moving things around with ease, with grace, the transactions they just know how to do it, and this will be a pilot at the scale of a country. So that’s pretty interesting. Just keep an eye on this and a precursor to maybe future plans in the United States.

So something to keep an eye on. Sentara Healthcare set to merge with North Carolina’s Cone Health. [00:07:00] Alright, so interesting to me, my weekend brief from healthcare it news had as its lead story M&A activity went way down in the first half of this year. And I thought that could be the most misleading headline I’ve ever seen.

Did the activity actually go down? Well, they measure the activity based on deals closed, and those kinds of things, but, you know, okay. So I agree with you. The actual announcements probably went way down. People were preoccupied, a lot of things going on, but I think the conversations went way up. The number of conversations that we’re [00:07:30] having around M&A went way up.

And here’s my proof of that. So we’ve had directed a show where he talked about, one of the first announcements and that was in the Seattle area. Excuse me, Washington state area, LA we had Cedars, last week with  Huntington. And I talked about that last week or the week before. I don’t remember, weeks are running together and now we have this one Sentara and cone health, and this is not a small one.

It’s not a massive one. [00:08:00] Actually none of these three were massive but I think it’s an indication of even well run healthy systems of a certain scale are now looking for cover. They’re now looking to partner with somebody, they’re now looking to get back to scale, and this could be a balance sheet issue.

I have no idea what it is. I would have to look closer at the numbers and if I can get access to the numbers, I will see what I can find. Here’s my, so what expect more of these. Expect a lot more of these that’s my 2 cents. I think the headline I’ll get from [00:08:30] health care IT news in January, we’ll say, the number of the amount of money, an activity in the second half of the year sets a record.

That’s what I expected. Yeah. To read, in January. Alright. Next story. Navin Haffty and Associates. If you’re not familiar with them, they’re a huge Meditech solutions provider. We use them when we did our Metatech implementations, at our hospitals and Engage. And if you’re not familiar with EEngage is essentially a part of Providence.

Providence has broken [00:09:00] out the service arms and Engage is their Meditech solution provider. They also have an Epic solution provider. They bought, a blue tree. Yes, blue tree. That’s the name of it? So they’re now essentially a, a large Epic implementation partner. They’re probably the largest, Meditech implementation partner.

They have a huge Microsoft partnership, which you read about every week on social media. Their innovation arm is constantly doing [00:09:30] posts about the companies that they’ve invested, invested in. You know, Providence wants to provide healthcare with the IT services and tools and products Yt needs to run effectively.

You know, I mean, my, so what on this is a great, you know, this is a completely different business than running, improving, adding healthcare in your markets. And so my so what is use them, don’t use them. They might be a good partner for you. You should evaluate them and you probably will, because [00:10:00] if you’re doing Meditech, you probably will because we just shrunk that, market significantly. So if you’re doing a Meditech implementation, you’re probably going to look at them but I would say evaluate them. You would any other supplier talk to their references? Are they eating their own dog food? The usual evaluation still applies just because they happen to be a health care provider.

you’re going to evaluate them the same way. I think I’m telling you what you already know. So I’ll just move on. JAMA study, 38% of older US adults ill-equipped for [00:10:30] video visits, healthcare innovation. And you know, I commented on this on social media, which by the way, just as an aside, I’m going to start doing, I’m going to start taking one story a day, Monday through Friday, I’m going to post the story, ask some questions, try to interact with you guys. And this was part of our splitting up our, our social media strategy. So if you want to follow the show, we have a show web webpage that you’ll get the clips. You’ll get a bunch of stuff. We’ll continue to come out there. But my personal, Bill [00:11:00] Russell’s CIO LinkedIn page, I’m going to start posting a story a day, some comments on it and invite you into a conversation.

This one, the JAMA study got a fair amount of back and forth. You know, my take on this is I saw some people comment on these numbers. Can’t be true. 38% of all the U S have the, are you telling me that older US adults don’t know how to use a cell phone and don’t talk to their kids via FaceTime. And the answer to that is of course they do.

[00:11:30] You know, a lot of them do and maybe even a majority of them do. And the 38% doesn’t represent all of those people. it represents a group that’s even broader than just those people. So let me, let me fine tune that a little bit. Some do not have broadband. Let’s say that’s 10%. Don’t have broadband.

So just flat out you’re you’re not gonna be able to reach them or their broadband is not adequate enough. And that does exist. My father does not have a cell phone. My, you know, [00:12:00] my father-in-law’s cell phone is a flip phone. If he didn’t live with us, he wouldn’t have access to any of the things we’re talking about here.

All right. So many and it’s not like they live in a place that doesn’t have cell phones or broadband, they choose not to. All right. So that’s at least 10%, if not 15%, if I think about it, you know, the other thing is many enjoyed, just getting out of the house. Right. So think about it. We’ve isolated, all these people, and this is probably not just older adults but it’s probably other adults as well.

We’ve isolated these people for some [00:12:30] people getting out of the house to see their doctor or see anyone is a major  event. It addresses the isolation that people are feeling right now. Right. So that’s, you know, so that’s an important factor. I think the other thing is, you know, we’ve trained people to go to a doctor.

They don’t like the telehealth vehicle. They want to know that somebody’s looking at them. Right. So there are time, we have these stories, right? That there are things that you will not see over a telehealth visit that you could potentially see if the person was sitting in front [00:13:00] of you. I would say the other, I said in that post was technology isn’t really magic. It doesn’t change habits. It doesn’t cure isolation. the, so what on this, as we still have a lot of work to do. It’s not only a technology project, it’s a change management project on a cultural level, right? So it requires marketing communication, private public partnerships for broadband access.

It’s a significant partnership probably beyond your four walls to get that, get [00:13:30] that adoption number, you know, even higher within your communities. Lots of things beyond technology on this one. Alright. So, my last story I want to cover real quick is policy implications for COVID-19 pandemic in light of most patients, spending only one night at the hospital after elective major therapeutic procedures, greater than 72% are now spending only one night at the hospital after elective major therapeutic procedures. Interesting. [00:14:00] you know, carry at a distance is now a thing it’s part of our vernacular. We educated people really well. It’s not that we don’t have rigorous processes to make sure that our, that our hospitals, you know, are, are safe and that we’re not transmitting a disease kind of things.

But what we communicated to the community was, Hey, You know, what, if all these people who are sick, converged on a single location, it increases the likelihood of transmission in that location. All right. So that’s what we communicated. And so that, that’s now a part of the, the, the [00:14:30] mindset as people are looking at it, you know?

So he’s the, so what on this, I don’t really want to go into, that aspect of hospitals, but I want to focus in, on the title, hospital and their procedures and their cause I want to focus it on the title, which is. Shorter length of stay, you know, people seeking remote locations for electric procedures.

You know, it’s, it’s interesting. I heard of another hospital this week building a large tower billion dollar tower and, you know, unless you’re an academic medical center with, really [00:15:00] focusing in on high acuity patients, I wouldn’t invest much in new towers or campuses. Asset light strategies are the most logical next step in healthcare, right.

We people are now going to look at that hospital very differently. I would rather go to that place. We’ll look at retail and say, Oh really? I mean, the, the, you know, the smart and final is right next to the place. I’m going to go see my doctor. Do I really want to have a procedure there? but now they might look at [00:15:30] the campus and say, Oh, that’s where sick people are. I’d rather go to the place that’s that has fewer sick people in it to have my procedure done. I’m just saying that it’s something to have a conversation around. I would keep an eye on these numbers. They indicate significant spending pattern changes.

And reimbursement rate changes and a case mix index changes. I mean, there’s a lot of things that could affect the bottom line here and it’s worth keeping [00:16:00] an eye on. All right. So. Let’s go deep dive telehealth is interesting to me. Telehealth has, if I were to read  these articles in and of themselves, I would be thoroughly confused about telehealth.

All right. So the first one was a survey. American plans use telehealth after COVID-19 and this was actually sent to me by a vendor. So, full disclosure, Harmony healthcare IT, and I looked at this and I’m like, Hey, you know what? It was a well done. A group of research, [00:16:30] they gave me good insights. I’m going to share it with you guys.

It’s it’s worth taking a look at it. Their methodology is from July 8th, July 10th. We surveyed 2042 Americans on the topic of telehealth of those respondents. 51% were female. 49% were male, meaning of 36, 57% had employer based health insurance. 23% had Medicare, 10% had Medicaid. All right. So that’s your group?

And you know, so that’s a [00:17:00] decent sized group. They did the, they went through the effort to ask the questions and I liked the members. I like how they presented them. So here we go, telehealth and COVID-19, 67% have used telehealth since COVID-19 46% use telehealth prior to COVID-19 2.9 average telehealth visits since COVID-19.

71% are feel fearful of visiting a doctor’s office due to COVID-19. That number is down by the way, that number at one point, that number was approaching, [00:17:30] between 85 and 90%, which is a yeah, but still the fact that it’s at 71, I, I hope that number is still coming down. Cause that’s a, that’s going to be a challenge for us.

If people are afraid to go to the doctor’s office anyway, 63%, were apprehensive about the first telehealth visit. 72% enjoyed their tele-health experience. 72%. You know what that tells me? It tells me 28% didn’t I’m not shocked that 72% did I’m shocked that [00:18:00] 28% did. Why would they not enjoy the experience?

Okay. what’d they most, well, I’m going to come back to that in a second. What patients liked the most about telehealth convenience? Makes sense, safety. Yep. Flexibility less wait, time, comfort. Easier to schedule followup, better communication. 28%. Didn’t like it. Why is that? Tele-health wait times. Here’s the, it starts to reveal itself.

It doesn’t, it’s not pulled out specifically, but it reveals itself in this way. Right? So [00:18:30] the wait time should be shorter between telehealth and in person and a 34% experienced at delay. Due to technical difficulties in their tele-health experience. Alright, so 34%. And we said, what 28% were not happy with their visit.

Why is that? I think, I think, you know why that is most preferred platforms to use for telehealth. So this is their preferred platform. This is the consumer they’re [00:19:00] asking, right. They prefer to use Zoom. the medical at 27% prefer to use Zoom. 25%, the medical providers app or website, 19% Skype, a 14% FaceTime, 6% Microsoft teams, 5% Google Hangouts, 4% other.

Okay. I find that fascinating, but that’s also indicative of what we’ve done. Right. So we’ve stood up a lot of different platforms and it’s now time, or I’m sorry. We stood up a [00:19:30] lot of different applications to deliver telehealth services. And it’s now time to start orchestrating the experience from end to end, to make sure from scheduling, to getting the person on the line to troubleshooting.

If there is an issue talking to the doctor, to getting it documented, to getting the prescriptions filled if there is, I mean, that whole orchestrated experience needs to be thought through. This number of 28% are not happy with it is a little high for me given [00:20:00] the number of things that people are looking for from this that we are delivering on.

Anyway, a lot of, so Harmony Health Care. and they have a survey out there, you know, very interesting. It’s good. A good survey. All right. So that’s the first thing it’s like, Hey, people love telehealth. It’s going well, things are great. The next thing is probably my favorite thing. I’ve seen a long time because I’ve been asking you guys for statistics and CHIME isasking you for statistics and others are asking you for, for statistics.

[00:20:30] And, my friends at the Chartis Group. Again, they’re not a sponsor. I’m just, I’m impressed with their work. Went out and created a thing called the telehealth adoption tracker. If you haven’t seen this thing, it’s worth seeing, and then there there’s a, some long URL.

I’m not going to give you, but it seems like they’re going to update it on a monthly basis, which is great. And I love this. Here’s what they did. So the Chartis Group and Kythera labs have brought together a team [00:21:00] of data science visualization experts and industry thought leaders to develop a telehealth adoption tracker thing.

I like that about this is, you know, when you have the visualization experts, they don’t try to overdo it. It’s a very simple set of graphs and graphics. It looks like it’s all built on Tablo. It’s real easy to navigate really well done. All right. So, and it’s not complex. There’s not a ton of them to interact with it’s really well done. Are the interactive tool allow you to filter by geographic market. In fact, that’s a really [00:21:30] cool, us graphic there, and you can look at, the usage of telehealth by state. Right. And so I’m going to go through some of their findings in a minute, but it’s really cool.

So I’m looking at this right now. I could look Florida’s at 21%. Missouri’s at 11% new Hampshire’s at 18%, and this is for the week ending, 7/29. Now I can move this little graph back and get the week ending, whatever, you know, 7/14, 6/3 2020. And I could [00:22:00] see that the numbers were a lot higher.

If you go back to 6/3 and they have the different weeks and the amounts and those kinds of things. So very, very well done. Let me, let me tell you some of the insights that they, they give again, cause it’s worth looking at their insights. Alright. So the first thing they say is national telehealth utilization has stabilized.

So at one point we were up around 50%. That was mid April. it’s now seems to have stabilized around 18 to 20%. And this is the sixth straight week that telehealth [00:22:30] utilization has remained between 18 and 20%, which gives them the indication that this might be the new norm. Alright. We went from 50 to 20 that’s if reimbursement stays the same, right.

Reimbursement has to stay the same and some of the other exceptions have to stay the same. But if they do say the same, we’re at about 20%. And we’re going to go into some of those things, which might be changing. Anyway. Meanwhile, telehealth adoption rates with COVID-19 hotspots, code hot tea.

COVID-19 hotspot States Rose. This is not a shock to anyone, right? [00:23:00] So Florida went up to 21%, Texas 23, Arizona 21. when you are in the midst of a surge, more people use tele-health, urban and rural telehealth divide is pronounced and show signs of widening. rates of telehealth use in urban areas has exceeded those in rural geographies.

Since the beginning of the pandemic, the telehealth adoption rate for primary care visits was 28% higher in urban geographies than rural ones. Okay. I expected a gap. I didn’t expect it to be that high. So [00:23:30] that’s, that’s so pretty interesting divide by overall telehealth adoption has stabilized recently.

The urban rural telehealth device has widened since the early weeks of the pandemic. Up from 18% differential during the peak telehealth adoption weeks in mid April. So we’ve gone from 18 to 28%. it never changed so interesting. Our telehealth usage during the pandemic and the change between urban and rural  it’s interesting. I think we are experiencing COVID-19 very differently depending on where you live. [00:24:00] Urban experience is very different than the rural experience. I think that’s somewhat to do with that gap, right. In a rural locations for the longest time we weren’t wearing masks because quite frankly we’re far away.

I, you know, I look out my window, the next house in a suburban area. It’s pretty far away. In an urban area, I get on an elevator and I’m reminded of how many he will live within feet of my front door. so very different ways of experiencing [00:24:30] COVID-19 very different ways of seeking out your healthcare, based on how you’re experiencing COVID.

Anyway, their last insight. Telehealth has predominantly functioned as a modality to manage established patients. This one’s interesting to me. So new patients represent just 5% of overall telehealth visits compared to 13% of in person visits throughout the code period, indicating that virtual care modalities to date have been primarily utilized as tools to manage care for established patients, finding [00:25:00] ways to leverage telehealth, to expand access to new patients will be a key driver and tell how it’s continued adoption and growth.

Interesting. So that’s going to lead us to the next story, but again, great graphic. You can look at this. It has a really interesting curve here that shows me that we were at 0.7%, tele-health usage in February, and that ballooned up to mid April at 51 50.8%. and that was the peak. And then it started to come down [00:25:30] gradually and, and they’re right.

You’re looking at about six weeks at about 18 to 19%. And that seems to be where it’s, seems to be where it’s come down to. All right. So a percentage of tele-health by physician specialty is the last thing I’ll hit on here. Psychiatry is the big winner psychiatry, telehealth visits, 64.2% phenomenal.

And I think that’s, I think that’s here to stay. you know, psychiatry is one of those things we struggled with at our health system. You know, we needed [00:26:00] psychiatry in our EDS really 7/24, 365. You never knew who was going to come in, who needed a psychiatric consult. but it wasn’t, it wasn’t perpetual, we didn’t need psychiatric services in all of our EDS all the time.

And, so we actually did use telehealth and that was one of the use cases for us on neurology neurology’s number two at 30% and then internal medicine, 23, and then a bunch of them at, at 20%. Right? So internal medicine, [00:26:30] gastroenterology, pulmonology, pediatrics, family medicine. So there that rounds out your 20% list.

Again, great work from, Chartis Group, highly recommend that site. Very interesting. Alright, where should I go next here. CMS may eliminate most emergency codes for COVID-19. Alright. This is where it gets a little confusing. Cause it’s a government thing. CMS is planning to eliminate 74 of the 83 codes created to [00:27:00] cover telehealth services during the coronavirus pandemic though, it’s adding 13 new codes and could be swayed by public comments to add more coverage.

All right. So this is what they’re doing. They are the same as always. They’re putting out there, Hey, here’s our, here’s what we’re looking at. Here’s the data we’re looking at. And here’s what, has really impacted, care and actually moved care forward. And here’s stuff that we don’t see. Any evidence that care has, really substantially been [00:27:30] changed, from one modality to another.

And therefore we’re proposing not to, not to reimburse these moving forward, and then we’re moving some of those to a new category. I guess they’re calling it category 3 and they’re adding some new codes to that category three, which is we’re going to temporarily, reimburse these, probably to get some more data and those kinds of things.

So this was a M health intelligence story, but I popped over to this, [00:28:00] Foley and Lardner, LLP. Insights, which is a law firm. Healthcare law. and they did a breakdown of this. So COVID-19, here’s what CMS will do with the temporary telehealth codes. And the P H E as the center of the CMS recently issued a proposed 2021 physician fee schedule rule enumerating the services CMS proposes to add and remove from the list of telehealth services covered under Medicare.

[00:28:30] This year’s list is usually robust because CMS took into consideration. All the telehealth services, Medicare currently covers on a temporary basis due to COVID-19 public health emergency. Right? So CMS group, the Telehouse services into three less, nine codes that will become permanent 74 codes that will be removed when the PHP expires and 13 codes to add to the list, but only on a temporary basis, CMS dub these category three codes.

All right. So I’m [00:29:00] going to hit these real quick. This might be more detail than you would like, but it’s probably more detailed than you would find elsewhere. So I thought I would give it to you telehealth services that will become permanent group psychotherapy, domiciliary, rest, home, and custodials care services for established patients.

That’s an important distinction, home visits for established patients, cognitive assessment and care planning services, physic complexity inherent to certain office [00:29:30] outpatient, prolonged services, psychological and neurological neuro psycho, psychological testing. All right. So those are the ones that are become, become permanent.

Then there’s another list, 75 codes that are going to be coming off of it. Initial nursing visits. Right for low, moderate, or high, a complexity, psychological or neuropsychological testing therapy services. So physical and occupational therapy at all levels. In fact represents. A [00:30:00] lot of the codes that are coming off.

Well, that’s a lot of codes, initial hospital care and hospital discharge day management, inpatient neonatal, and pediatric critical care initial and subsequent, initial and continuing neonatal intensive care services, critical care services, end stage renal disease, monthly capitation payment codes, radiation treatment management services, emergency department visits, level four, four through five.

A demo celery, rest, home, and custodial care surfaces, new [00:30:30] home visits, new patients, all levels initial and subsequent observation, observation, discharge. And then they have the category, three codes, home visits, established patient. Anyway, you get the idea that there’s a, there’s a lot of stuff in here, but this is proposed for 2021.

It’s open for comment. So this is where I was. I was saying we need to start collecting our information. Not without, we should have been collecting this information. We should have a pretty robust set of reports right now on how we are doing with telehealth [00:31:00] in what areas are we doing well with telehealth and what areas do we, we feel like it is actually moving the needle in terms of care that we are delivering to our community and to our patients.

And can we prove that. When we, when we, comment on these versus it’s one thing to jump up and down and say, look, the world wants this and we should pay for it. but at the end of the day, the money is not, an endless supply. So there has to be decisions that are made based on [00:31:30] facts. And we have to have those facts.

So anyway, that’s, that’s about as much detail as I can give you on that. The next story expanding access to telehealth is a hundreds of billion dollar question, healthcareit news. I’m not because of time. I’m not going to go too much into that story other than to say, you know, to get broadband everywhere assumes that, for telehealth to be everywhere.

You know, that’s a significant cost. We have the, the cost to, to [00:32:00] Medicare for delivering these services. And what they’re saying is if there is not a measurable distinction between delivering, from a cost, from a, care and a progress of care standpoint, then we’re not willing to fund it. It’s actually.

It’s actually really responsible of them to do that analysis. We should be doing that analysis. We should have our own analysis. We should know what’s going on. So that’s my big, so what on [00:32:30] that? here’s the thing, these reimbursements, as I’ve said before, we are safe through the end of the year, but at the end of the year, this is going to change and we need to keep an eye on this and determine what areas we can utilize.

Telehealth effectively as a health system. As health care providers. And you know, again, we’ve talked about earlier, I was talking about strategy. How do you expand the number of patients that you’re interacting with and maybe it’s teleconsults. We did, we did stroke [00:33:00] teleconsults for remote locations through our one hospital.

and that was an effective way to, to provide those services to remote and rural locations. It was also a way to, to, to really work with those. again, it changed our case mix index on a bunch of things. There there’s a lot of ways to use telehealth. We need to be thinking through those things.

We need to be collected in the data enough. Okay. It’s hard for me to stop. Sometimes I get started. All right. Chief Medical Officer. So COVID-19 is [00:33:30] elevating a new type of Executive Chief Medical Officer. The reason I highlight this, and I think it might be interesting to use. You might be losing some of your doctors and the reason you might be losing some of your doctors is because companies like Tyson Foods who had the problem in their, in their, their plants where they’re they’re processing food, hired a Chief Medical Officer, Royal Caribbean cruises hired a chief medical officer.

Right. And, and I don’t think that, I think that’s the tip of the iceberg. I think we’re going to see Chief Medical Officers, amusement [00:34:00] you name it. I think every year, the company, because of this is going to have a chief medical officer moving forward. And, so that is going to be a hot role. You might be losing some of your doctors.

It might be partnership opportunity. I haven’t really thought through, but it’s, I just found that interesting and fascinating something we should  we should definitely keep an eye on. All right. A little long, I do want to cover this one story. So, ONC to offer new funding for state and local HIE innovation, [00:34:30] using 2.5 million of the Cares Act.

the agency will give money to as many as five new projects that boost health information exchanges through the new star HIE program. so, you know, This is a healthcare it news article, and I love their format. You know, why does it matter, through its new strengthening, technical advancement and readiness star HIE program, ONC aims to leverage work done by the industry to advance HIE services for the benefit of public health.

The goal of the program [00:35:00] is to both bolster existing state and local HIE infrastructure. So public health agencies are able to better access share and use health data during and after. The COVID-19 pandemic ONC will disperse 2.5 million, which quite frankly is not that much. but you know, again, it’s, it’s better than nothing.

The problem we had with RHI is they, they, they couldn’t operate profitably and they went out of business. that happened in, in one of our Texas markets. [00:35:30] quite frankly, it was, we were in danger of that happening in our Southern California market. So if you think, well, well, maybe that was a rural location.

Now. We struggle to, they struggled operationally to keep these things running and to keep the technology current. So any, any kind of money going in this direction is good. If you are working with an HIE partner, make sure they’re aware of this potential money. And, how to go about getting, access to this money.

So that’s an important [00:36:00] development on the health it space. Let me think. Is there, gosh, there’s a bunch of things I wanted to talk about. I’m going to talk, I’m not going to talk about the little Vango, Teladoc merger. I don’t think it’s. Okay. I don’t think it’s going to impact any of you in the next week.

If I talk about it later, I think we’ll be fine. There was an interesting article. That’s not the article I want. The article I want is

There was an article of a bunch of [00:36:30] CEOs talking about the most dangerous health IT trends. I thought this was worth looking at most  dangerous health IT trends. This is a Becker’s Health IT article from eight execs. So BJ Moore, EVP CIO at Providence. Get a guest on the show. A couple of times he said a healthy trend that causes me pause right now is the rate at which healthcare companies embrace new technology.

From my perspective, healthcare systems across the [00:37:00] nation are about 15 to 20 years behind other industries. We need to be more quickly embracing cloud computing, machine learning, artificial intelligence, big data, internet of things, consumerization of health experiences, and other emerging technologies to accelerate health insights, improve caregiver productivity, and to improve access to health outcomes for our patients. Yeah, I, again, who I dunno if it’s 15 to 20 years who can argue that we should adopt [00:37:30] some of these technologies a little faster, there’s a difference between adopting them in the clinical setting and adopting them in the operation setting , you can adopt some of these things as quickly as you want in the clinical setting. There’s all sorts of, I mean, the thing that slows the status of the regulatory environment, I’m not putting that out there as an excuse. I agree with BJ more. I think we have adopted things way too slowly and that there’s things we could adopt that would really move, move, move things forward pretty rapidly.

John [00:38:00] Boscos SVP and CIO for Northwell out of New York. To me the most dangerous trend would be for CEO’s to assume it’s back to work as normal before the pandemic hit us as with most major events like this, the hardest work. Doesn’t happen during the event itself, but rather with the recovery from it, this was the case with the Superstorm Sandy that hit the East coast as well as others.

Other emergencies we have experienced, even though the pandemic is still going. We have learned many lessons, not only about how to respond even [00:38:30] better the next time, but also pointed out inefficiencies in areas in our organization where improvement is needed. Absolutely. Amen. You are preaching to the choir.

Yeah. Coming out of there’s a lot of work coming out of this. We should not assume that we’re coming out with the same set of assumptions that we went into it with. The world has changed. Expectations have changed. Financials have changed. Markets have changed. How we interact with our patients will change.

I think the emphasis on home care or care at a distance is going to [00:39:00] dramatically impact us. Michael Stansbury is Vice President of  IT innovation at Houston Methodist has health organizations continue to innovate to provide better consumer patient experience, create efficiencies for clinicians and utilize data to improve the health of our population organizations could easily overlook the importance of data security. Absolutely. Even one security breach is one too many. Sure. Now, with that being said, I would love to see a lot more innovation around [00:39:30] data security. We don’t seem to spend enough money and time there. We’re focused on a lot of really cool things, and that is not one of the more sexy things of data security  in that space. So we, I would like to see innovation groups, you know, offer some challenges in that area and see if we can’t, can’t really, we should be one of the industries that’s pushing this forward. Somehow we, we, we looked at banking and other industries and we go, Oh, you know, they’re protecting money.

We’re dealing [00:40:00] with people’s lives. You should have really good security and we should be funding it, at a certain level. So, let me see if there’s any others. Let’s see, isn’t Lee Carmen Associate Vice President of information systems, University of Iowa, hospitals and clinics. I think one of the most dangerous trends in health it right now is the increasing demand to integrate clinical data across different sources and from different organizations without a national patient ID.

I talked about this last week. I’m not going to go into it. yeah, he’s right. You know, if you, if we’re [00:40:30] not matching the patients. I don’t know if patient ID is the right way to go, but if we’re not matching the patients effectively. Yeah, that’s a, that’s a significant risk, Zephyr. And we had him on the show.

I believe the most dangerous trend in health IT today is medical device vulnerabilities. Amen, brother, my gosh. I feel like I’m at a revival. That is absolutely true. I’ll tell you our biomed devices. We had some that were on the windows now that this was eight years ago. I hope that’s not the case. Any, any more today, a part of that was the, the pro the [00:41:00] FDA process was slow and cumbersome.

Anytime they changed it. Yeah. We wanted to upgrade those things and it would not have been that hard to upgrade them, but then they, they don’t become compliant anymore. Right. So that whole process needs to be looked at. And, that’s, that’s a little, a little disconcerting. Let’s see what, any others that I want to touch on there, there’s a lot here.

A good article. If you get a chance to read it, Becker’s hospital review five, the most dangerous health IT trends insights from eight executives, and I’m sure you guys have your own [00:41:30] lists. If I thought about it, I could probably add to that list as well, but that’s all for this week. Don’t forget to sign up for clip notes, get your staff to sign up for clip notes.

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