Newsday – Cybersecurity Strategies, Vaccine Distribution and Biden Administration Predictions for Healthcare
January 25, 2021

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January 25, 2021: Today Drex and Bill talk cybersecurity strategies, vaccine distribution and Biden administration predictions for healthcare. The new final rules to Stark Law and AKS regulations include the addition of a new “cybersecurity exception”. What does this mean if you’re breached? Will the government cut you some slack? What’s the possibility of building your own cybersecurity program? Should you be using a partner to help? If so, which partner? What are Amazon’s plans post exiting the Haven joint venture? Bill and Drex also break down The Healthcare Innovation 2021 State of the Industry Survey. 

Key Points:

  • New cybersecurity donation safe harbor rule [00:08:25] 
  • Micky Tripathi tapped as Biden’s National Coordinator for Health IT [00:06:20] 
  • Johnson and Johnson are coming out with a vaccine that may be a one-shot that could last for a year [00:20:30] 
  • Bundled payments is how you figure out how to get to value based care [00:30:31] 
  • We keep talking about bringing in more and more data sets. This is going to be a key area for us. How do we push this forward? [00:43:26] 

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Newsday – Cybersecurity Strategies, Vaccine Distribution and Biden Administration Predictions for Healthcare

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Newsday – Cybersecurity Strategies, Vaccine Distribution and Biden Administration Predictions for Healthcare

Episode 356: Transcript – January 25, 2021

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] Welcome to This Week in Health IT. It’s Newsday. My name is Bill Russell, former healthcare CIO for 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged. 

[00:00:18]Drex Intro: [00:00:18] Today Drex DeFord is in the house and we talk about everything. It feels like we talk about everything. In this episode we actually disagree on something. It’s a lot of fun going back and forth. Hope you enjoy.

[00:00:29][00:00:30] Bill Russell: [00:00:29] Special thanks to Health Lyrics, who is our Newsday show sponsor, for investing in our mission to develop the next generation of health IT leaders. 

[00:00:37]You know, I ran into someone and they were asking me about my show. They are a new masters in health administration student, and they, we started having a conversation and I said, you know, we’ve recorded about 350 of the shows and he was shocked. And I said, well who he asked me, who I’d talked, spoken with.

[00:00:56] And I said, Oh, you know, just CEOs of Providence and of Jefferson health. And [00:01:00] CEO’s from, you know, Cedar, Sinai, Mayo. Clinic Cleveland clinic and you know, just all these phenomenal organizations, all this phenomenal content. And he was, he was just dumbfounded. He’s like, I don’t know how I’m going to find time to listen to all these, all these episodes.

[00:01:14] I have so much to learn. And that was such an exciting moment for me to have that conversation with somebody to realize. We have built up such a great amount of content that you can learn from and your team can learn from. And the, we did the COVID series. [00:01:30] We did so many great things. Talk to so many just brilliant people who are actively working in healthcare and health. It addressing the biggest challenges that we have to face. We have all of those out on our website, obviously, and we’ve we put a search in there and makes it very easy to find things. All the stuff is curated really well.

[00:01:49] You can go out on a YouTube as well. Almost every episode we’ve done since episode six. Has been recorded as a video podcast. So you can watch the video as well. You can actually pick out some [00:02:00] episodes, share it with your team, have a conversation around those things. We don’t expect that everybody’s going to listen to every episode we record.

[00:02:07] And that’s why we cover different topics. And we are starting to organize our website around topics and collections as well to make it easier for you and your team to find those things which are going to help you. To really stay current and to really advance the the knowledge of the team. So we hope you’ll take advantage of our website, take advantage of our YouTube [00:02:30] channel as well.

[00:02:31]Newsday, we have co-host Drex DeFord in. Former CIO and founder of Drexio Digital Health. Hey Drex, how’s it going? 

[00:02:39] Drex DeFord: [00:02:39] Hey good. How are you? What’s happening? 

[00:02:41] Bill Russell: [00:02:41] Good. We decided to do a hat episode. You have your oh, yours is cooler than mine. Mine’s Baylor. This is where I send money to. And yours is your Dexio Consulting, which actually makes money. 

[00:02:53] Drex DeFord: [00:02:53] It’s where people send me money. Yeah. 

[00:02:55] Bill Russell: [00:02:55] Yeah. Clearly you’ve read Rich Dad, Poor Dad and understand the right side of the equation as [00:03:00] opposed to my side of the equation.

[00:03:02] Although I am a proud Baylor dad, really excited for My daughter go in there. It’s a great school and we’ll see what happens. It should be you know, they had 2 basketball, the men’s and women’s basketball team last year, probably both could have won the national championship, but they got up, they seasoned got up ended and we’ll, you know, we’ll see, we’ll see what this year brings.

[00:03:28] Drex DeFord: [00:03:28] Yeah. 

[00:03:28] Bill Russell: [00:03:28] Hey Drex there’s a lot of [00:03:30] stuff going on. Like we could, we could probably do news for like three hours if we really want to do today. 

[00:03:34] Drex DeFord: [00:03:34] For sure. There’s a lot happening. The inauguration yesterday.

[00:03:39] Bill Russell: [00:03:39] I’ve heard there was an inauguration yesterday. 

[00:03:41] Drex DeFord: [00:03:41] Yeah. Yesterday. I’m not sure. When are you going to show this Monday?

[00:03:45] Bill Russell: [00:03:45] Yeah, it doesn’t matter you, you blew the illusion. You went through that. 

[00:03:49] Drex DeFord: [00:03:49] Sorry, sorry. 

[00:03:51] Bill Russell: [00:03:51] Yeah, no we record this on a Thursday, the week before it goes live on Monday, but yeah, the inauguration was yesterday [00:04:00] and went down without a hitch. I don’t, I think they, they took down the barricades and stuff like you know, a couple hours after it was all done. There was just nothing going on. So. 

[00:04:10] Drex DeFord: [00:04:10] And how about Amanda gorman? Did you see her? The poet Laureate who 

[00:04:15] Bill Russell: [00:04:15] I did, I don’t know. I don’t understand people who had time to watch the inauguration. I, there are certain things like it’s like, did you watch all the, remember when they had hearings and stuff? Did you watch all the hearings? I’m like. I have a job I can [00:04:30] work during the day. I don’t know how people do that. So I don’t know, I’m not at all. I’m just wondering how people have time to do that. 

[00:04:37] Drex DeFord: [00:04:37] I’m such a political nerd. You know, I have a degree in public administration, so I spent you know, this is also part of something that’s really interesting to me, but I also work late nights and overnight sometimes depending on you know how my mood is striking me so I can take time during the day to watch stuff that other people can’t. 

[00:04:58] Bill Russell: [00:04:58] Yeah. And it’s [00:05:00] you know, I’ll pick it up on podcasts. I’ll pick it up on and on, but I don’t watch TV either. So people are like, Oh, what news station tune into? I’m like, I don’t, I don’t watch TV. We have TV because it’s part of our subdivision. We have to have it sort of thing. But I think the only thing I watch on TV now is golf. 

[00:05:19] Drex DeFord: [00:05:19] Super productive then. And all that wasted TV time and do work 

[00:05:24] Bill Russell: [00:05:24] Well. It’s not wasted teaching TV time. It’s it’s podcasts. It’s audio [00:05:30] books. It’s it’s that kind of stuff. And I don’t want to sound smarter than I am because I’m not, you know, clearly I’m not, I’m not listening to books on you know, epidemiology, I’m listening to books on how to run a business and those kinds of things. So so we’ll, we’ll see what happens. All right. So we’ve got, we’ve got a lot of topics we’ve got We got some security stuff.

[00:05:51] We can start there. We’ve got some, you know, we’re going to hit the vaccine stuff. We could talk about maybe predictions for what we think is going to happen in this administration. [00:06:00] There was an interesting UFCVI came out version two. There was a story about Amazon. I, you know, I didn’t find the story, all that interesting, but I wouldn’t mind going back and forth with you of where Amazon is going to go post Haven.

[00:06:13] But to start the show, I think we should just note that Mickey Tripathi was tapped. To be the Biden’s natural coordinator for health it and excited about that. He was on the show last year. We did a past present and future of interoperability that he’s he’s [00:06:30] been there since the beginning. He’s a great contributor, a wonderful gentlemen, and just wish him all the best in that role. And we will keep a close eye on keep tabs and check in with him from time to time. So. 

[00:06:43] Drex DeFord: [00:06:43] For sure. Mickey and I worked together quite a bit when I was the CIO at Steward. And he was, you know, like running all of the interoperability stuff for Massachusetts and it’s good to see him. [00:07:00] Well deserved and it’s the right person at the right at the right time to do this. 

[00:07:05] Bill Russell: [00:07:05] Yeah. He is a he is a great candidate. I mean, he really he’s so immersed in it, so it’s not like there’s no learning curve whatsoever. I mean, he steps in picks up exactly where they left off and now, I mean, they’ll direct it wherever the administration is going to direct it. But he is he’s also very adept at moving in and out of different groups [00:07:30] of people. So if you do one, a person who’s going to be apolitical on this topic. And I think Mickey’s a great candidate for that as well. 

[00:07:39] Drex DeFord: [00:07:39] I agree. I agree. Glad he’s there. 

[00:07:42] Bill Russell: [00:07:42] All right. So I will let you decide where you want to start. I gave, threw out just about all the topics I want to talk to, but where do you want to start? 

[00:07:50] Drex DeFord: [00:07:50] Well, so there’s, there’s this weird thing that I think is going on, but I’m not really sure it’s going on that. I kind of want to talk about it. It’s tied to cyber security. So if we [00:08:00] start there. Okay. So I will send you these three articles.

[00:08:04] I don’t know that you’ve seen them or read them necessarily, but, but I will send them to you so that you can add them to the post game playlist for the listeners. The first one has to do with back in December. There was a new cybersecurity donation safe Harbor rule that was created that created the capability [00:08:30] of bigger organizations, bigger healthcare organizations.

[00:08:34] It allows them now to donate cybersecurity services and technology to smaller organizations and not run a foul of the stark laws. I find that to be very interesting. And the last time that something like this in my head happened was in 2006, when we were, when there was a new rule that was a stark safe Harbor rule that said that you could donate it stuff.

[00:08:59] If you were a big [00:09:00] organization to smaller organizations, smaller healthcare organizations and not run a foul of the Stark Laws. So this, this is a weird sort of pattern, right? Okay. I know it’s been a long time ago, but I feel like I’ve started to see this TV show before. The second article has to do with The new law, a new HIPAA cybersecurity law that promises to lower fines and give you audit relief.

[00:09:30] [00:09:30] If you’re using one of the frameworks that the government has approved. So again, this has to do with kind of like making sure if you’re, if you’re doing the right things and you wind up being breached. The government will cut you some slack. If you’re using the right framework. I find that to be kind of interesting.

[00:09:49] And then the newest thing is that Biden has included over $10 billion and you know, part of the COVID relief proposal, but it’s, you know the program [00:10:00] to try to get money into the hands of people who are trying to create. Better cybersecurity programs. And I know that this is going to send people off on a little bit of a rocket ship, because I’m going to say a couple of words that can be inflammatory, but it makes me wonder if there isn’t, probably without calling it, this, does this start to feel a little bit like maybe a meaningful use? There’s the trigger words a meaningful use [00:10:30] program for cyber security. And I don’t know what it’s going to look like. 

[00:10:33] I don’t know how they’re going to structure that money that’s being spent, but just with the setup, you know, here’s the donation Stark safe Harbor. Here’s the framework. Here’s the stuff you have to comply with for us to cut you some Slack. If you get breached and now here’s money. I feel like I’ve seen this TV show before. 

[00:10:52] Bill Russell: [00:10:52] Ha ha meaningful use for cybersecurity, OB actually, I sort of crunched there a little bit when you said that. And [00:11:00] hopefully we learn from meaningful use. Almost everybody who was there early on. We’ll say you know, there was, there’s some things we just didn’t take into account. Let me break all three of these down real quick. So the first one is essentially I’m able to go into my integrated delivery network. Oh no, not my integrated delivery network. I was always able to do that, but my clinically integrated delivery network, which is right. The people that aren’t necessarily a part of our system, [00:11:30] but are a part of our contracting and a part of our delivery mechanism. Those kinds of things. 

[00:11:35] Drex DeFord: [00:11:35] They may not even have a formal relationship with you. This could be a group practice that refers patients to, to your hospital. They just, you know, when patient needs inpatient services, they refer them to your hospital. Now in the past, if the big system gave that small group practice something maybe an exchange. Now you still can’t do it in exchange for admitting patients to your hospital but in [00:12:00] the past, doing anything like that could cause you to run a foul of these Stark Safe Harbor rules.

[00:12:06] Bill Russell: [00:12:06] Yeah. So the reason, the reason we have to love this is you know the network is vulnerable at its weakest point. And if you’re connecting in to all these these, you know, privately owned hospitals are privately owned clinics, privately owned physician practices and those kinds of things.

[00:12:27] Generally speaking, there are [00:12:30] cybersecurity practices and tools, and those kinds of things are going to be a lot weaker than the 6, $7 billion can also some, even $3 billion on system. Therefore if you’re the cybersecurity head of the $3 billion health system you’ve been looking at this for literally a decade trying to figure out how do I make that point in my network, more secure. But you weren’t able to give them anything. 

[00:12:56] Drex DeFord: [00:12:56] Right. Right. And so now, you know, sort of in this construct of [00:13:00] services and technology, you can, There’s a, there’s a lot of capabilities that you could  provide. And s  it’s an interesting scenario. I actually, I’m writing something with David Schoolcraft at OMW law here in Seattle on this specific situation and those articles will release sometime soon.

[00:13:25] Bill Russell: [00:13:25] All right. So the second one is if I follow, I don’t know, [00:13:30] the NIST framework for whatever. My finals will be less than one. I’m not a huge fan of that. I mean, I understand the positive nature of it. It gets more people to adopt the frameworks and the frameworks are good, but here’s the thing it’s like saying, Bill, if you follow this recipe, everyone’s going to eat this food.

[00:13:47] Well, you shouldn’t eat anything that I bake. I mean, I can cook, but I can’t bake. You shouldn’t eat anything. I baked it doesn’t matter what recipe and you shouldn’t give me any leniency if I’ve followed the recipe, but it still tastes horrible. [00:14:00] You know, I breaches a breach is a breach, so I won’t add et cetera either.

[00:14:05] But a breach is a serious event, whether you’ve followed the recipe poorly or, you know, or you had nothing in place. So I’m not jumping up and down about that one. Are you, did you like that one? 

[00:14:19] Drex DeFord: [00:14:19] Well, so I think this is where the concern comes in with the meaningful use kind of cross conversation, right? Part of meaningful use was you have to do these things and if [00:14:30] you do them, you will have meaningful use of an electronic health record. It was very compliance oriented. Check these boxes, and we will give you money, but that didn’t really help us, you know, as a CIO at a health system doing meaningful use.

[00:14:45] In many ways, the things that we had to check the box on weren’t the things that were helping us build a good clinical program. They were things that we had to check the box on to get the money. And so we did. And so I wonder if this isn’t going to be a similar challenge, right. [00:15:00] I guess it moves people, it moves people further to the left or the right, whichever way you look at it. Moves them further down the maturity models. So at least they’re using a framework. If they use it in a very compliance way. Know, declaring that you’re using a framework and using in a compliance way is very different from having a really good solid cybersecurity program.

[00:15:24] But it’s better than somebody who hasn’t declared any framework and has no cybersecurity program. [00:15:30] So maybe it’s, you know, it’s better than nothing, but I think it’s also, it can be a challenge if it’s a check the box drill and that’s always been a problem in cybersecurity. 

[00:15:40] Bill Russell: [00:15:40] You know, and then what’d you say 10 billion is 10 billion.

[00:15:46] Yeah. And actually I think that is underfunded and my guess is that’s just one, one swath of it. I, my guess is there’s also military money that’s being spent on cyber security. There’s probably a bunch of different agencies that are spending money on [00:16:00] cybersecurity. I took that budget needs to be a lot higher than, I mean, did you see the one of the banks of country, maybe it’s New Zealand or something like that got hacked.

[00:16:10] I mean, you know, there’s, there’s an awful lot of warfare. And I think I used that term specifically. There’s lot, a lot of warfare going on right now between countries. You know, it’s almost like the drive by shootings of Chicago back in Al Capone days. That’s happening with these [00:16:30] with these, you know, crime organizations, crime syndicates, those kinds of things.

[00:16:35] And there it’s just, it’s happening all over the place and you almost need an Eliot ness kind of programs to weave this out. 

[00:16:44] Drex DeFord: [00:16:44] Yeah, I, you know, and this is the part where I, you know, I say things and then I realized you have to be careful what you wish for, but there’s a part of me that you know this is not a political [00:17:00] statement, but like forget space force, let’s take that money and that initiative and put it into a cyber defense force for the United States.

[00:17:09] Because I think creating the situations where you leave a lot of small organizations and small hospitals, especially in healthcare, small hospitals, independent practices, alternative sites of care, other things to fend for themselves when it comes to cyber security, just isn’t good for the. Ecosystem.

[00:17:28] It’s not good for the economy [00:17:30] at large, right. People keep getting dragged off and beaten up and alleys. They keep getting hit by drive by shootings to use your analogy. And maybe it would be better if somebody sort of centrally stepped in and said, you know, here’s how we’re going to do this. Now there’s a lot of possible downside to that too.

[00:17:46] You know, don’t get me wrong. But there are just some things about this that make me wonder, do we need more? I don’t know, oversight guy guidance, definitely funding and [00:18:00] support and insight. And you know, the challenge that we have right now with somebody being breached by ransomware or something else.

[00:18:09] And then the whole drill is to kind of keep it as quiet as we can and not tell anybody and to have press releases that say really innocuous things so that all the other people in the neighborhood, all the other people in the ecosystem, can’t find out the information to figure out how to protect themselves. That. In and of itself is a big challenge too. 

[00:18:28] Bill Russell: [00:18:28] Yeah. So [00:18:30] I want to say this as a transition to our next topic, which is whenever somebody says, Hey, you know, let’s fund the government, the federal government, not the state, but the federal government to put a program together, they’re going to make it better and those kinds of things. I always look at it through a sort of a an eye of, you know, will it make it better? Or are we going to end up with the world’s best iron lung kind of. And then and so in cybersecurity, I am a thousand percent [00:19:00] behind a federal program. I don’t care if it’s military funded. I don’t care if it’s. I don’t care where the money comes from and clearly needs to be done well. But it is the federal government’s job to protect us from foreign actors. Period. And so, yeah, funded, get it started. Let’s get going. The reason I say that is because we’re going to, we’re going to shift gears and talk about vaccine distribution and I see more and more people calling for, Hey, Biden’s gonna do a national blah, blah, blah.

[00:19:29] I hope, [00:19:30] I hope, hope, hope he does not do a national program. We are pretty close at this point. I know I’m talking to my neighbors. I’m talking to my parents. People are in line. People are getting the vaccine, they, the distribution mechanism, we’ve gone through the worst part of the project to like, sort of stand it up.

[00:19:49] The, the, the goofy stage where information isn’t really readily available. People don’t know what they’re supposed to do. Where am I supposed to go for this? Well, we [00:20:00] we’ve gotten through that. And I’m a little concerned that we’re going to step back now and say, no, we need to fix this well, there’s things we need to fix, but not, I mean, it’s not a reboot of the program. That would be really scary to me. 

[00:20:15] Drex DeFord: [00:20:15] I think there are things in place today that are definitely usable and we should continue to expand on, but the logistics to deliver now, you know, this is sort of, for me in the context of, and we know that Johnson and Johnson is [00:20:30] coming with a vaccine that may be as a one-shot vaccination that could last for a year. But as it stands right now, two shot vaccine that lasts for about six months and there’s 300 million people. And let’s say we’re just going to vaccinate 70% of them. You know, a hundred million shots in a hundred days, I’ve done, I’ve done some math. And I actually posted something out on Twitter the other day of begging someone to tell me that my math is wrong, but it [00:21:00] turns out there’s something approximating 3 million shots per day that you have to give forever in that model, just to keep COVID away from 70% of the population. The current system logistically is completely incapable of handling that.

[00:21:22] And so there needs to be an orchestra conductor and that’s helps us figure out how we take a bunch of PAs and put them in [00:21:30] Uber or something, or MAs and put them in Uber’s or something to go out and gives you, I don’t know what the logistics are, but we are way. Way under what we need to be to actually get the economy moving again, get people back to work and life back to normal.

[00:21:45] Bill Russell: [00:21:45] You know what Drex, this is what I love about having you on the show. And I love about this back and forth is because we’re finally disagreeing. People are like, Oh, you guys always agree. So we’ll disagree on this and we’ll disagree from a couple different perspectives. A. The [00:22:00] reason the distribution is the way it is, is because we had a limited supply of the vaccine.

[00:22:05] So as we start to ramp up, which no one expected it to be ramped up by January 20th of 2020. So in fact if you ask the experts, they wouldn’t even expect them to have a vaccine until late this year, let alone distributing it until next year. So, you know, it’s one thing, again, I’m really apolitical on this.

[00:22:26] I want to get shots in arms as much as anybody else. We’re trying to solve the [00:22:30] wrong problem, because look, if you ramp up the production, I can get it in arms. Here’s how you get it in arms. You give it to CVS, you give it to Walgreens, you give it to Walmart. Okay. They are within 10 miles of 95 to almost a hundred percent of the population.

[00:22:48] So now people know, Oh, I have to go, just go to Walgreens. I’ll have to do is go to CVS. They know where those places are. We can ramp that up. If the productions there, we can ramp that up very quickly. And you know what those [00:23:00] organizations understand the consumer, understand how to do scheduling, understand how to do outreach.

[00:23:06] You know, the way we’re doing it now through hospitals, hospitals. Don’t understand how to do scheduling in this manner, or they not understand how to use scheduling for surgeries and those kind of things, but not this kind of stuff. They don’t understand outreach in this manner, in this way. It’s a muscle that they’re developing, but they’re not there yet.

[00:23:24] And so, you know, I sort of stepped back and I go, okay, we can ramp this up as quickly [00:23:30] as you want, but that’s not the problem. Everyone’s worried about that problem. That’s not the problem. The problem is. That if I see all these different numbers, but roughly 30 to 40% of the people don’t want to get a vaccine.

[00:23:46] That’s the problem. That’s problem number one, problem. Number two is there is the disenfranchise, the people in our society, we need to go out to them who aren’t readily. 

[00:23:57] Drex DeFord: [00:23:57] It has to be a whole education program, right? 

[00:24:00] [00:23:59] Bill Russell: [00:23:59] Yeah. I mean, that’s, the education is always a silver bullet. So, I mean, I read these posts of these anti-vaxxers and it’s close enough to the truth that you’re like, gosh it’s, you know, it feels right, but it’s not right. And it’s and it reminds me of what my friend used to say. He said, when half-truth has presented as whole truth, that becomes untruth. And when they say, well, it’s not a vaccine, it’s a genetic.

[00:24:26] Okay. Yeah. I mean, technically that’s true, but it’s also a [00:24:30] vaccine. You know, it’s a different type of vaccine than we’ve ever had before. It’s new, it’s different, but it’s still a vaccine. I’m sorry, I’ve rambled there for a little bit. 

[00:24:39] Drex DeFord: [00:24:39] Oh no. I mean, it’s, it’s fine. I think, you know, the, one of the articles that I know that you’re going to include in the in the post-game feed here is an article by as reclined that you know is it’s called Biden’s COVID-19 plan is maddeningly obvious.

[00:24:58] And it is a little  [00:25:00] Trump slamming. There’s no doubt about it, but realistically, all the things that you’ve just said are exactly right. Like there’s lots of distribution channels that we could and should be going through. And. There is a lot of vaccine supply right now that is still, you know, being held back and isn’t being put in arms for a lot of different reasons and all of that, you know, the, I think operation warp speed was great getting us to the point of [00:25:30] having a vaccine, but the distribution part of the plan isn’t warp speed. And that’s where we’ve got to make these shifts. And it includes all this stuff. Education, helping people understand what it is, how it’s good for them, what, how it changes the economy and then putting them in places where they’re easy to access.

[00:25:48] Let’s put some grease on this, let’s make it slippery so people can get these shots as quickly and easily as possible. And I know we’ve got phases and I know some States are now starting to sort of like slip back on phases [00:26:00] and say, okay, now everybody under 65, I mean, I’m. I’m the last person in the line.

[00:26:06] I have, you know, I’m lucky I have no co-morbidities I don’t have any of the issues or challenges and I’m not 65. So I’m going to probably be one of the last people to get it, which is why I want it to hurry up. I want to get my shot too. 

[00:26:20] Bill Russell: [00:26:20] All right. Well, let’s let’s move on. I’d love to hear what you were or you think the Biden administration, and by the way, I need to give you kudos. It’s sad that I had to give you kudos on this, but [00:26:30] I mean, you called this and you said, Hey, we need to keep closer tabs on Trump between the election and the inauguration, because he’s going to do something really stupid. And lo and behold, he did something really stupid. And I said, Oh, come on there’s a lot of checks and balances and whatnot. And sure enough you know that event at the Capitol, there’s just no there’s just no excuse for, so. You called it, I just want to, I wanted to give you, you [00:27:00] know, the shout out that there are times when you’re writing I’m wrong. So 

[00:27:04] Drex DeFord: [00:27:04] it’s rare though. It’s nice to hear you say that. 

[00:27:07] Bill Russell: [00:27:07] So what’s the, what can we expect from the Biden administration? Do you think? Well actually, let me help it. Where, where, where are we going to? What can we expect? 

[00:27:22] Drex DeFord: [00:27:22] You know, so I think, you know, as kind of the foundation of the program, being a believer in [00:27:30] science and the science behind it, I hope what will happen is that Yeah, the office of the national coordinator can continue to stay in place.

[00:27:39] It returns to a role maybe of more prominence than it’s had for the last four years. And that it’s data-driven to help us figure out how to create better delivery systems. And kind of that’s it in a nutshell, when, when it comes to, how are we going to spend money? What are we going to spend money on? That it’s not driven by, [00:28:00] I mean, it’s always driven by politics, you know, to a significant degree. Right. But hopefully it’s largely driven by really smart people like Micky Tripathi who tell the Biden administration, senators and congressmen, here’s where we need to spend money and they listen. And I mean, that’s kind of, that’s kinda my hope that the culture and the environment that is created as one that supports that kind of you know, smart people, making smart [00:28:30] suggestions. 

[00:28:31] Bill Russell: [00:28:31] Yeah. I think we will. All you have to do is really rewind to look through the Obama administration and figure out where this thing’s going to go. And to be honest with you, I don’t think ONC CMS, I don’t think there should be much change there from, from the perspective of health IT. I don’t think you know, it’s still, interoperability is key. We’re still going to be seeing fire. We’re still going to be seeing the USCDI. A different emphasis, right? That the current or the departing administration [00:29:00] was really the emphasis was on building a market. How can we make healthcare into a true market?

[00:29:05] And I think we’ll, we’ll, you know, come off that a little bit, but again, it’ll look very similar because the underlying infrastructure for either a market-based or even a single payer base and that kind of stuff where even Medicare advantage for all still looks the same. You’re still trying to share the information across a large swath of the mechanism are still trying to enable The the innovation community [00:29:30] to innovate on top of the data.

[00:29:31] And this is one thing I like about Biden that we talked about this last time the Biden cancer initiative. He traveled around. He understood the limitations of interoperability. And I think when someone says to him interoperability, he’s not going to have to look at somebody else. Who’s going to go.

[00:29:45] Drex DeFord: [00:29:45] What do you mean by that? Oh, I know what the problem is. 

[00:29:47] Bill Russell: [00:29:47] I know what the problem is. We’ve got to get in front of that. So I think that’s positive and we will probably go back to, you know, again, the Obama administration, we’ll probably get back to those to those bundles in the bundled [00:30:00] payments. And those things are hard to do.

[00:30:02] And, you know, again, we talked about it. We’ll talk about it on the tomorrow show, which will be last Friday, shadow bundled payments, and return to that with with Rob DeMichiei, former CFO for UPMC, because that was one of the themes that we talked about at the JP Morgan conference. So, all right. So those are some of the things we can think about and look at. Let’s 

[00:30:27] Drex DeFord: [00:30:27] bundle payments, bundled payments are really kind [00:30:30] of the, this is how you figure out how to get to value based care. Right? I was at Stewart, we were a pioneer ACO, and a lot of that was around, you know, how do you figure out how to get to value based care and set sort of the, here’s, how it works for everybody else to be able to sort of come along for the ride.

[00:30:46] And that has sort of intermittently fell apart and then come back together in different places. I’m hoping that there’s a. You know, there’s a better stream of good examples for everyone to follow. 

[00:31:00] [00:31:00] Bill Russell: [00:31:00] Yeah. The bundles, the bundles for people who don’t know, you know, it’s like hips and knees. What they will do is they’ll go into a market and they’ll say, you know, on average and cost this, so CMS is going to pay this.

[00:31:11] And by the way, they’ll also structure it to say that’s from diagnosis to complete recovery. And so the challenge for an integrated for back when I was doing this integrated delivery network was that you know, we from diagnosis, we were typically in the room, [00:31:30] right? So our network was in the room, but you, you come in, you have the surgery and then you go into rehab and, and, and some some posts.

[00:31:41] Post-surgery areas that we didn’t own or control in any way, shape or form. And you were still managed first of all, the cost was for the whole thing. And second of all, you were still managed to the quality that you could deliver, not only within your four walls, but also in potentially several [00:32:00] other.

[00:32:00] And so we had to as the network, we had to figure out how to manage these entities and it was. It was not as easy as you were thinking. 

[00:32:09] Drex DeFord: [00:32:09] Yeah, that’s too sure. Real challenge. 

[00:32:13] Bill Russell: [00:32:13] So let’s you know, let’s end this with some some forward-leaning well, actually, you know, there’s, there’s another story.

[00:32:23] Drex DeFord: [00:32:23] Yeah, do another one, do another one.

[00:32:24] Bill Russell: [00:32:24] Let’s, let’s get this. So healthcare innovation group Mark [00:32:30] Haglin. They do an annual state of the industry survey. I’m going to give you a couple of, a couple of their findings. So one of their findings is it budgets are seen increasing to meet needs.

[00:32:43] And they said among the survey respondents 31% said that zero to 5% of the organizational revenues are expended on it. 34% said five to 10% of their revenues are going to it fully 35% said that more than 10% of their revenue are being spent on [00:33:00] it. So as for transplant, 67% of respondents said that their budget has increased over the past two years.

[00:33:07] While 26 said it stayed the same only 7.5 reported that it decreased in that time. I’d be surprised. I’d be surprised if many decreased last year there was an awful lot of extra costs. In dealing with pandemic. Does it surprise you those numbers in terms of you know, 31%, zero to 5%, five to 10%, 34%. [00:33:30] And over 10%, 35% of the revenue number being spent on IT. 

[00:33:37] Drex DeFord: [00:33:37] I’m really surprised. I’m really surprised. And I think some of this also might have to do with the way that the math is done. Realistically back in the day, I talk way, way back in the day where you had an it budget and you were counting, you know, that was your entire that’s.

[00:33:54] What, when people ask that question, you thought about it budget as the spend, but [00:34:00] because we’ve evolved to this world where it. Is the enabler for everything that we’re doing very often, it costs wind up being buried in other departments budgets. And that could be an informatics person. It could be the cost of a you know, a cloud-based application that is only used by the finance team or the marketing team. And so it’s in the marketing budget. There’s a bunch of ways that this, I mean, it, you know, [00:34:30] everything’s connected to everything now. And so it is a part of everything. And so I think when you start thinking about how do you do the math, there’s maybe some health systems now that have indicators that this is an it thing, but it’s not in the IT budget. And that may be why the numbers go up.

[00:34:45] Bill Russell: [00:34:45] Well, there’s a couple of organizations, Scottsdale Institute Gardner and others that do comparisons of different health systems and their spend and that kind of stuff. And I talked to the person who had to put it together and they said, this is really hard because you know, some IT [00:35:00] budgets have clinical informatics.

[00:35:02] Some don’t have clinical informatics, some count the full costs of you know, analytics is all the analysts that are out in the field. Some only counte it the central organization. And so it was a huge normalization effort. Before they could produce something that would allow you to compare yourselves to similar health systems. And so 

[00:35:24] Drex DeFord: [00:35:24] Anytime I’ve done this, it’s been you know, children’s hospitals comparing each other [00:35:30] integrated delivery networks, comparing each other. I mean, like you said, you can kind of go through the list. Sometimes him is included sometimes HIM as an included some kind sometimes biomed clinical engineering is included.

[00:35:42] Sometimes it’s not included you know, And every place is different. Sometimes you’re running for EHR and sometimes you’re running one, sometimes you’re running two ERP systems and sometimes you’re running none. And so there’s a, there’s a lot of, you know, [00:36:00] benchmarks are great. Don’t get me wrong. I, I think it’s a good place for us to start with, you know, in an I S department or any department and look at those benchmarks and say, why are we different from the benchmark?

[00:36:13] Not. We’re higher than the benchmark. So we must cut spending. 

[00:36:18] Bill Russell: [00:36:18] I hate that. 

[00:36:19] Drex DeFord: [00:36:19] I have to look at those benchmarks and you have to say, why are we different from the benchmark? And if you have a legitimate reason that you’re different from the benchmark, because you have a much more complicated system, or [00:36:30] because you’ve really spent a lot of time working hard to consolidate applications and simplify the infrastructure, maybe you’re below the benchmark, you know, CFOs don’t like it when you make the argument that we need more money because we’re below the benchmark. You usually get, you know, beaten in the head with a frying pan because you’re above the benchmark. And it’s really just a question. Why are we different from the benchmark? Can you legitimately explain why you’re different from the benchmark?

[00:36:59] And if you [00:37:00] can, then you’re right sized for your mission that is being asked for by your leadership team and board. That’s where you should be. If you’re not then. That’s maybe where you should get smashed with a frying pan. 

[00:37:14] Bill Russell: [00:37:14] Yeah. And I’ll tell ya the rarely was it that I ever presented that number because I felt like and  we had it. We always had it because every now and then somebody would ask to have it. They would ask me, you know, how do we perform against others? That’d be like, all right, this is [00:37:30] how we perform. And we were always in the. you know from a spend standpoint, one of the lower percentages, and one of the reasons for that was we were not an Epic or Cerner shop.

[00:37:38] We were a Meditech shop and we were running a six and a half to $7 billion health system on Meditech. Well, the thing about Meditech is quite frankly, it’s, you know, it’s flat out 50% less for. To run Metatech from an operation standpoint than it is to run Epic and I’ll challenge

[00:37:56] Drex DeFord: [00:37:56] Not just the EHR, it has all kinds of stuff embedded in it. Right. I mean, [00:38:00] you’ve got ERP and supply chain and you know, so these are all other systems that you don’t have to buy. 

[00:38:06] Bill Russell: [00:38:06] Yep. The other thing, so yeah, so we were always in that right. Percentile. But my case was always, this, what’s the right thing to do. Where are we going from a strategic standpoint? What are we trying to do as a health system? Are we trying to be a consumer facing health system? I mean, I don’t care what the strategy is. It could be that strategy or some other strategy. If we’re trying to be those things, let’s identify the technology components, put the right [00:38:30] technology components in place in order to deliver that, determine what the most cost-effective way to do that is and do that and not sit back and say, Oh my gosh, we spent 7% this year, or 6% or 10% of revenues.

[00:38:44] You spend the appropriate amount of revenues to execute on the strategy. That’s what I always felt. 

[00:38:51] Drex DeFord: [00:38:51] Exactly. 

[00:38:53] Bill Russell: [00:38:53] You know, we, we talked about bundles and, and value-based payments and those kinds of things. And they have a little thing in [00:39:00] here that, you know, risk contracts and those kinds of things are going to go up. And I agree with that. And one of the things, one of the points they make in this articel is if risk based contracts go up and value based care goes up. Then we need to get really good at analytics and you know, it’s, it’s, it’s interesting because when they say a majority, it’s crazy the numbers in here. The Majority [00:39:30] feel like they are top of the line when it comes to analytics.

[00:39:37] And I just don’t let’s see. Yes, we’re advancing our analytics development. 37%. We are early on in our analytics journey. 38%. We have not used data analytics until now 12%. We have no plans to use data analytics. On any level or scale 12%. So maybe that was overstated. 

[00:39:58] Drex DeFord: [00:39:58] 12%? So those are the, those are [00:40:00] the organizations that will be bought soon.

[00:40:02] Bill Russell: [00:40:02] Yeah, 

[00:40:03] Drex DeFord: [00:40:03] They’re on the they’re on the pressure acquisition list.

[00:40:06]Bill Russell: [00:40:06] Well, 24% are on that list. We have not used data analytics until now, and we have no plans to use data analytics. Now that 24% is clearly some sort of asset play to be purchased. I don’t even understand that answer. 38%. How can 38% say they’re early on in their analytics journey? 

[00:40:29] Drex DeFord: [00:40:29] You [00:40:30] know, so this is another one of those things where I think there’s maybe some benchmark thinking going on that we’re doing better than most places that we know of with analytics, right? So we must be in the higher category of analytic use, but I look at this.

[00:40:51] The places that I think are doing really good really well with analytics. It’s not a thing that is [00:41:00] only coming out of an, of an analytics or a knowledge management shop at that organization. And it’s not just dashboards. It’s actually the creation of a culture where frontline managers and directors, our citizen data scientists, and there they have access to, and the ability to understand data in a way that helps them run their part of the business in the most efficient way possible. And that can be clinicians [00:41:30] that can be clinic managers that can be, you know, kind of across the house. When you get that, where everybody’s got access and everybody can actually use the data to make better decisions sometimes on their own.

[00:41:43] You know, now you’re doing, you’re really doing something with analytics, but you know, having a bunch of dashboards and, you know, posting dashboards and S sometimes just retrospective stuff. That’s nice, but that’s not, I don’t consider that to be advanced analytics. 

[00:41:57] Bill Russell: [00:41:57] Yeah, no, it’s it’s. Yeah, that, that [00:42:00] was sort of my experience that we, we had a lot of data Wranglers people that would take all this crazy data and make.

[00:42:08] Sense of it, or actually not even make sense of it. They would get it into a form where we can actually run reports on it. And that was a significant number of people on the staff that I had. And what we were trying to do is we were trying to change the mindset of, all right. We need to, we need to produce insights and nothing brings that [00:42:30] home more than you know, a to use social determinants is one or actually a pandemic brings that home.

[00:42:36] Right. If I were a leader of a health system, I would go in right now and say, alright, I need a detailed information on the population that lives in our markets. I need to know you know, Who lives here. You’re around. What’s the age categories. There’s I mean, that would have been when we’re getting ready. 

[00:42:57] Drex DeFord: [00:42:57] and that’s the whole outreach program. Right. And [00:43:00] then you start pounding that list. Hey, come in, you got to get a shot. How can we get you scheduled? You know, you’re in the one B window. Yeah, let’s go. 

[00:43:09] Bill Russell: [00:43:09] Absolutely. I mean, actually, I mean, So it’s insights, but think about, I mean, there’s a lot of other areas like social determinants areas where you can actually gain insights from the data that we have within the EHR that would allow us to do things.

[00:43:23] Now we keep talking about getting more and more data sets and bringing more and more data sets in. This is going to be [00:43:30] one of those key areas for us is how do we push this forward? Is it a build your own? Is it a BI capabilities? Are we going you know, are we going to a health catalyst? Are we going to our EHR provider?

[00:43:45] You know, where are we going to get these capabilities? Are we going to build it ourselves? Are we going to do our own data store? Are we going to go to Google? Mayo has gone to Google for some things, and Ascension has, for some things you know, what’s [00:44:00] the right strategy at this point. 

[00:44:02] Drex DeFord: [00:44:02] Yeah. I, you know, I look at this a little bit from the cybersecurity perspective, right? Analytics people, you know, the core analytics people are. Really smart. They’re not widely available. You have to figure out how you’re gonna hire them, attract them and retain them at your health system. And if you’re not in one of those really great places, you may or may have a really hard time [00:44:30] hiring and retaining those people.

[00:44:31] So I think, you know, there’s a lot of thinking that healthcare executives have to do around. What’s the possibility of building my own cybersecurity program or my own analytics program. And should I be using a partner to help me with that? And if I do then, you know, who are the partners? I think you have to think through this, you know, do I really have the capability of building my own analytics program kind of soup to nuts, or do I need help?

[00:44:59] And if you need help, [00:45:00] you should get help. You should go out and look for that. I think there are, you know, products and capabilities that They may not be perfect, but they’re going to get you a long way down that maturity model. 

[00:45:14] Bill Russell: [00:45:14] Yep. It’s interesting. Drex as always. It was a lot of fun. 

[00:45:22] Drex DeFord: [00:45:22] Me too.

[00:45:23] Bill Russell: [00:45:23] We’ll do it again in in six weeks and look forward to seeing how much we never did a prediction [00:45:30] like you and I should do like a full on predictions. Like this is what’s going to happen. I read some of these predictions and I’m like Yeah. I don’t know. Some of them just sorta leave me flat. Like, of course that’s going to happen. You know, Amazon’s going to improve in healthcare. It’s like, they’re going to make strides in healthcare. I’m like, of course that’s going to happen. All right. 

[00:45:51] Drex DeFord: [00:45:51] That’s definitely the hard part of predictions, you can make the big, broad predictions, but hitting,figuring out the ones that are actually going to [00:46:00] hit and stick that’s where you know, that’s where you’re only going to have about a 5% hit rate.

[00:46:05] Bill Russell: [00:46:05] Yeah. If you were to tell me Amazon pharmacy, it’s going to make a big hit two years ago. That was a prediction, but saying it this year, it’s like, well, no kidding. I mean, they have PillPack. They’ve announced it. They’re going to market, right? Yeah. I know where they’re. I know where they’re going.

[00:46:19] Now, if you tell me their Amazon health employee program gets launched at a new employer. That’s news. That’s. You know, that’ll be interesting. And actually, [00:46:30] I don’t think that will happen this year. Amazon is one of those companies that moves really slow until they’re not moving slow. And then they’re moving at like hyper speed.

[00:46:38] Drex DeFord: [00:46:38] Yeah. It’s like an earthquake, you know, there’s, there’s pressure between the tectonic plates and it builds and it builds. And then once they think they really know something, there’s a giant slip, there’s an earthquake and there could be an earthquake. It can healthcare this year. I think, 

[00:46:55] Bill Russell: [00:46:55] Yeah, well, we will see what happens.

[00:46:57] Drex DeFord: [00:46:57] I see some of my friends has been hired by Amazon [00:47:00] and I’m kind of blown away that some of those people are working over there now. And when I talked to them, what they tell me is I can’t really tell you what we’re working that says to me, there’s a big tectonic plate about ready to slip.

[00:47:14] Bill Russell: [00:47:14] Well, it’s not one thing, right? So it’s, it’s you know, it’s the Alexis stuff and we’re going to put one of these in every hospital room and we’re going to put something in the, in the OR and whatever. So we’re going to do a bunch of stuff in voice. We’re going to do partnerships [00:47:30] and .. 

[00:47:30] Drex DeFord: [00:47:30] Supply chain. 

[00:47:32] Bill Russell: [00:47:32] Everyone’s always looked at supply chains and durable goods. They sort of play in that space, but. And now it’s drugs. You know, you have, you have pharmacy and whatnot. Yeah. I think that’s only going to increase. I mean they’re world-class in that space. 

[00:47:48] Drex DeFord: [00:47:48] Okay. Predictions. So we need to do predictions some time in the future.

[00:47:53] Bill Russell: [00:47:53] Sometime in the future, I predict that in the future, we will do predictions. It is, but we are coming up on the end of the [00:48:00] show. So, Hey again. Thanks. Thanks for your time. Really appreciate it. 

[00:48:03] Drex DeFord: [00:48:03] Thank you.

[00:48:03]Bill Russell: [00:48:03] What a great discussion. If you know someone that might benefit from our channel from these kinds of discussions, please forward them a note. They can subscribe on our website thisweekhealth.com or you can go to wherever you listen to podcasts, Apple, Google, Overcast, that’s what I use. Spotify, Stitcher. We’re out there. You can find us. Go ahead, subscribe today or send a note to someone and have them subscribe. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT [00:48:30] leaders. Those are VMware, Hill-Rom and Starbridge Advisors. Thanks for listening. That’s all for now.

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