Newsday - Data Challenges, Telehealth Start-Ups, and Empathy Through Technology
March 1, 2021

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March 1, 2021: Anne Weiler, health tech entrepreneur and advisor to This Week in Health IT joins Bill for the news. What happens after you sell a successful health startup? What are the stages of a CEO getting back into the real world? We call it health tech CEO recovery. Retail giant Walmart might be slowing down their ambitious expansion into healthcare. With the growth of telemedicine, how many handy clinics do you actually need? How much data is healthcare generating every single day? What do we have to do to clean it up? The platform Truveta will use machine learning and AI to take billions of clinical data points provided by the health systems for searchable health insights. Microsoft announced a new portal called Viva. IBM are trying to sell off their Watson Health business and CVS Health launched a senior medical alert system called Symphony. Plus how fine is the line when technology tries to start telling you how you’re feeling?

Key Points:

  • At what point do we have a saturation of handy clinics? [00:09:20] 
  • Walmart may not be in the edgy tech space but they’re still one of those companies that does experiment, learn, experiment, learn, experiment, learn and then scale [00:10:35] 
  • An American Sickness book by Elisabeth Rosenthal [00:15:50] 
  • IBM are trying to sell off their Watson Health business [00:18:05] 
  • No matter how smart your machine learning is, if it’s not being trained on anything it’s not going to get any smarter. [00:20:26] 
  • Microsoft announced a new portal Viva [00:32:22] 
  • CMS are starting to loosen their pocket books to reimburse for things that are going on in the home [00:42:05] 
  • CVS Health launched a senior medical alert system called Symphony [00:42:15] 


Newsday – Data Challenges, Telehealth Start-Ups, and Empathy Through Technology

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Newsday – Data Challenges, Telehealth Start-Ups, and Empathy Through Technology

Episode 371: Transcript – March 1, 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]Special thanks to Sirius Healthcare, Health Lyrics and Worldwide Technology who are Newsday show sponsors for investing in our mission to develop the next generation of health IT leaders. We set a goal for our show. And [00:00:30] one of those goals for this year is to grow our YouTube followers. We have about 600 plus followers today on our YouTube channel. Why you might ask? Because not only do we produce this show in video format but we also produce four short video clips from each show that we do. If you subscribe, you’ll be notified when they go live. We produced those clips just for you the busy health IT professionals. So go ahead and check that out. 

[00:00:55] We also launched Today in Health IT. A weekday daily show that is [00:01:00] on todayinhealth We look at one story each day and try to keep it to about 10 minutes or less. So it’s really digestible. This is a great way for you to stay current. It’s a great way for your team to stay current. In fact, if I were a CIO today, I would have all my staff listening to Today in Health IT so we could discuss it. You know, agree with the content, disagree with the content it is still a great way to get the conversation started. So check that out as well. Now onto today’s show. 

[00:01:27]Welcome to this week in health IT. It’s Newsday. [00:01:30] Walmart, CVS, Microsoft and Watson Health and whatever my co-host and I decide to talk about it which could be pretty interesting. We’ll see. The co-host for  today isAnnen Weiler former CEO of a healthcare startup good afternoon Anne.

[00:01:46] Anne Weiler: [00:01:46] Yeah. I’m in Seattle. It is afternoon. 

[00:01:49] Bill Russell: [00:01:49] Great. So I just said, are you fully recovered from the healthcare CEO thing? 

[00:01:55] Anne Weiler: [00:01:55] No. No. Well, yes and no. It’s a hobby now. [00:02:00] So I think that’s not recovered, cause that might not be, digital health being your hobby maybe says you need some better hobbies.

[00:02:11] Bill Russell: [00:02:11] I don’t know. It seems to be well, it’s my job and my hobby now. I spoke to Todd Johnson and Todd Johnson was a CEO sold right around the time you did. And he went, he’s now working with Avia and we started talking about the stages of health tech CEO [00:02:30] recovery, I guess it is. And so let me see if I get some of them.

[00:02:34] There’s sort of a joy, right? I mean you sold it and there’s sort of a relief cause there’s just this constant pressure of running something but then it quickly turns to sort of a Oh God, I’d like almost a panic like, I have to take care of all the things in my life that I’ve neglected for the last number of years. And then you say, all right, I’m going to give myself a [00:03:00] rest and you start to rest.

[00:03:01] And then boredom kicks in pretty quickly because you’ve been running at such a quick pace and then extreme boredom kicks in. And then you’re like, all right, what am I going to do next? 

[00:03:10] Anne Weiler: [00:03:10] Or a global pandemic

[00:03:12] Bill Russell: [00:03:12] Or a global pandemic, which does what get you back in the game quicker? 

[00:03:18] Anne Weiler: [00:03:18] Yeah. Yes, definitely. I mean, I was doing some consulting again, you know, in the hobby I’m really interested in tools for seniors and aging in place.

[00:03:29] So I [00:03:30] was doing some consulting there and I did some consulting with Techstars. They had a longevity accelerator but when COVID hit, then suddenly at least in Washington state we were immediately told, you know stay home. And not just stay home but only go to places you can walk to. So. You know, I, I was just at the phase of like okay, you know a little consulting some time off, maybe it’s time to do a little bit of traveling as I contemplate, slowly contemplate my next [00:04:00] thing.

[00:04:00] And then it’s like, well actually why don’t you just stay home? So I’m like, well if I’m staying home, but maybe I should be working. So I went and got myself a job at Amazon which is completely unrelated to healthcare, which is why I, well, I shouldn’t say completely unrelated. We, you know, we have customers  that are in AWS that are in healthcare, but it’s not my specialization right now. It’s my hobby. 

[00:04:24] Bill Russell: [00:04:24] The you know, that’s interesting. Have you found, so you’re in Seattle? [00:04:30] I’m down here in Florida. I live in a fairly desirable area. Have you found that the real estate prices are going up? 

[00:04:36] Anne Weiler: [00:04:36] Yes. 

[00:04:39] Bill Russell: [00:04:39] I mean, people I think people are leaving the cities in droves and finding places like your place right there with a nice view of trees.

[00:04:47] Anne Weiler: [00:04:47] Well, I am in the city. I’m in Seattle proper but Seattle proper is a strange place because we have all these lakes and freeways. And so what ends up happening is these concentrated [00:05:00] neighborhoods. And so the neighborhood feels very residential but I am actually in Seattle. I’m just not downtown, but yes, my neighborhood is, you know, houses are getting snapped up.

[00:05:11] There’s not a lot of inventory. Yeah.  

[00:05:17] Bill Russell: [00:05:17] Our subdivision. I think there’s like 600 homes in it or something to that effect. And they I was asking somebody the other day, you know, what’s the inventory looked like? They said, well, there’s only seven homes available. [00:05:30] And I said, well, is that normal?

[00:05:31] They said, no, usually it’s like, this is the prime season to be selling down here. Said usually the inventory is like 30 to 40. It’s just. And gosh you have to feel bad if you’re one of those seven homes, I guess. Anyway. 

[00:05:44] Anne Weiler: [00:05:44] Hey, I have a question for you.  I saw your blog post on going to Disney world and the COVID precautions that they took and everything. But I was wondering, like, given the timing of your trip, were you having HIMSS withdrawal? 

[00:05:59] Bill Russell: [00:05:59] Oh, [00:06:00] that’s an interesting, that’s an interesting question. No, no. I explained this on last week’s show with with Sue Schade. My wife was the primary caregiver for her father. And around Christmas time, I started saying, we need to get you away.

[00:06:16] It’s been three years of caring for him and I just, I wanted to get her away. And we had gone on our honeymoon to Disney world and I thought, and I thought, okay, this, this is good because we can go there. It’s only a couple hour drive from where we’re at. [00:06:30] So if anything happens with her father and we arranged for someone to come down and stay with her father but then her father passed  away and so I looked at her, I said, you know, you still want to go. She’s like, I absolutely want to go. And the couples that was flying into look after her father said, can we still come down? Cause we, you know, because there’s two feet of snow on the ground here and we really want to come down and I was like, yeah you can still come down.

[00:06:53] So we went up and then came back and we hung out with them. And it was, you know, as, I, [00:07:00] so it’s actually one of the most listened to podcasts on the Today in Health IT show is my trip to Disney world. 

[00:07:07] Anne Weiler: [00:07:07] Because everyone is having HIMSS withdrawal. Will trip to disney world. 

[00:07:12] Bill Russell: [00:07:12] I think everybody wants to know it’s like, what does it look like?

[00:07:15] You know what does Disney world look like post COVID? And I actually, I don’t think we know yet. I think it will continue to evolve over the next six to nine months. So we’ll see. See what happens. Hey you want to talk a little health [00:07:30] IT stories and technology. All right. Where do you want to start. There’s a lot of interesting stuff. I like to save all the all the edgy digital stuff for our conversations. 

[00:07:44] Anne Weiler: [00:07:44] Go ahead. Tell me what you’ve been reading.

[00:07:50] Bill Russell: [00:07:50] I dunno, you want to do home and home monitors. You want to do Walmart strategy. 

[00:07:55] Anne Weiler: [00:07:55] I like, I’ve been watching both of those. So. 

[00:07:58] Bill Russell: [00:07:58] All right. So the Walmart [00:08:00] strategy I personally, so I sent you the story for business insider. The I’m personally am not a huge fan of the story. They found eight current and former employees, they have a new CEO and they were sort of asking them, how’s it, how’s it going over there?

[00:08:13] They got, you know, like three people said, Oh my gosh, we’re in complete disarray. And you know, three other people said, Hey it’s full steam ahead. Clinics are going well, that kind of stuff. And the title of the article is Walmart pulls back from their clinic strategy. So [00:08:30] they have their it’s slowing down pretty significantly, according to the article.

[00:08:34] And I don’t think you can make those numbers up. There’s a, you know, there was a belief that they were going to get a couple of hundred or at least a hundred or so by the end of 2021, and it looks like they’re going to get 30, 40, some odd clinics stood up. And so, you know, that’s kind of a hard number to, to look at it and say, are they making progress on the flip side?

[00:09:00] [00:09:00] There was a, you know a global pandemic, maybe that slowed it down a little bit. I don’t know. But what, what are you, what are you hearing? What are you, what are you reading on this story? 

[00:09:11] Anne Weiler: [00:09:11] I was wondering, yes, there’s pandemic there’s oh, telemedicine, you know, perhaps we don’t need quite as big a footprint.

[00:09:20] I also wonder if, you know, at what point do we have a saturation of handy clinics, you know, I mean, not [00:09:30] sure what’s going on near every Walmart but here in the Northwest we have Zoom care, which is trying to be that everywhere clinic. And then, you know, my closest place, if I wanted to go is an urgent care that is owned by MultiCare, it’s a collaboration. Then you’ve got like, you know, the Concierge Care. So it’s the, you know, the One Medicals and everybody, because healthcare has been such an in-person thing. Even somebody building and trying to build a new virtual business is trying to have a footprint. [00:10:00] And so I just wonder is, where they looking at it and, you know, certainly the initial hey, there’s a clinic in Walmart.

[00:10:07] Like that makes perfect sense and, and convenience and all of these things but maybe there’s a question about how many clinics you actually need and did telemedicine and then pandemic actually say, Oh actually we, maybe we don’t need such a big thing. 

[00:10:21] Bill Russell: [00:10:21] Well, you know, that’s an interesting point that you look at what, how this has sort of rolled out and transpired.

[00:10:27] Maybe they are rethinking their strategy and not [00:10:30] moving as fast. I mean, that’s one aspect. The second aspect, I always remind people is you know Walmart is amongst those companies, maybe not in the the edgy tech space but they’re still one of those companies that does that experiment learn, experiment, learn, experiment, learn and then scale.

[00:10:48] Haven’t had a massive level. So it’s, it’s not something you turn your back on. Cause if you turn your back on it too long and they might come back with something else, you might be right on the footprint though, the footprint they were [00:11:00] building. So they were going from the in-store clinics to a fairly sizable chunk of their parking lot.

[00:11:06] That they were, they were standing up and we’ve seen these facilities go up, you know, it’s, it’s comprehensive. So you can go, you can get mental health primary care. You can get x-rays images, labs, you name it. It was a great one-stop shop kind of model, but it is a lot of real estate. If you know, we have a fundamental shift in how primary care is delivered, [00:11:30] so we will have to keep an eye on this one.

[00:11:35] I, just, the, I, it makes, it still makes a lot of sense to me. You know, here’s a related story, Kaufman hall today, I’ve read a couple of them. And I think if they did their study probably over the last couple of months and I’ve said, you know, the health systems are taking a significant hit, you know, between 50, 50 and a hundred, a hundred billion dollars.

[00:11:57] And I think, and they attribute [00:12:00] that primarily to COVID, which is probably true, but I think what’s going to happen to me out of this is they’re going to say, Hey, the COVID number numbers never came back. And I think one of the reasons the COVID numbers will won’t come back to their preached COVID levels is because new entrance figured out a way to sort of sneak in here and squeeze in there, especially across the telehealth and urgent care clinics like you described.

[00:12:27] Anne Weiler: [00:12:27] Yeah. And then if you think about some of [00:12:30] the beginning of the pandemic I once sat on hold, like, you know on, hold for a telemedicine visit with the university of Washington for like five hours. Nunez. Yeah. It just like, the system was just overwhelmed. This is when they. You know, this was when there was absolutely nothing in person and you immediately had to go to virtual and I thought I had COVID and I may have had [00:13:00] COVID. Who knows?

[00:13:01] But yeah, the system kept crashing, kept booting me out, kept\ I think, prioritizing other people’s issues ahead of mine. And you know, there becomes a point where your loyalty to your, you know, your system whether you know, they have all my records and my primary care doctors, there is not, you know, I’m going to weigh the options of like do I want care or consistency?

[00:13:26] Bill Russell: [00:13:26] Yeah I had a weird, and I’m trying to figure out if I like this or [00:13:30] not. I had a weird experience this week. I had to do, I had to do an overnight visit to a hospital for observation with something that was going on. So I did that. It happened to happen at a time where I was between closing my company in California and opening my company in Florida.

[00:13:46] So I was without insurance and so yeah, so, you know, you get the $27,000 bill and

[00:13:54]Anne Weiler: [00:13:54] You never want to be an observation, you want to get admitted. That’s what Elisabeth Rosenthal says in her book.

[00:14:00] [00:14:00] Bill Russell: [00:14:00] Really? 

[00:14:01] Anne Weiler: [00:14:01] Yeah. Yeah. She’s got this whole thing of like how to avoid bills and like the observation, they can charge you a lot more money.

[00:14:10] And one of the things is like, always ask. And if you’re under observation, either say, well, either I’m well enough to go home or I’m sick enough to admit me. 

[00:14:20] Bill Russell: [00:14:20] Yeah, that’s interesting. And I did send a test and that kind of stuff, $27,000 something, and that was great. So I get the phone call. Hey, we sent this to your insurance. They turned it down. [00:14:30] I’m like, yeah. That’s cause I don’t have insurance right now. They said, Oh, okay, well let’s change this to cash bay said, okay. So they changed it to cash bay he said, all right. So the new amount is right off the bat they gave me a 65% discount. Wow. Okay. So I’m like 65%. Wow. This is, this is great.

[00:14:49] And I said, Hey, is there any additional discount if I pay it all at one fell swoop. And she said, yeah let me look. Yeah it’s another 20% discount. [00:15:00] 85% discount off the $27,000 observation bill. And so my first thought is lucky me, my second thought is, does that eat away at the credibility? And the trust that I have with my health system to know that they they’re able to charge 15% of what they originally were going to charge and still make money.

[00:15:22] Anne Weiler: [00:15:22] Yeah. Yeah. 

[00:15:24] Bill Russell: [00:15:24] It’s a, I don’t know.  It’s a weird dynamic. I clearly, I like it. [00:15:30] I’m really happy. I hope they don’t listen to this episode and think I’m ungrateful because I’m really grateful, 

[00:15:34] Anne Weiler: [00:15:34] Of course you’re grateful for the care. You want the care and the cost to align. I would say just for the listeners out there, assuming there are people listening to us talk here, not just the two of us, but the book I was talking about was an American Sickness by Elisabeth Rosenthal who’s the editor of Kaiser Health news. And if you haven’t read it, if you’re in healthcare and you haven’t read it, [00:16:00] it’s fantastic. She breaks out the, you know, how we got to here. And I think for me, what was most shocking was that everyone is complicit. Like everyone, you know, they talk about everyone taking their cut, but there really is a lot of that, but she also, at the end, says, you know I don’t have a global solution, but I have a local solution.

[00:16:24] There’s this whole checklist of like, if you’re going to the hospital, all the questions you need to ask. And also that [00:16:30] business about, you know out of network, like you need to give them a piece of paper before your surgery saying, I am not I’m not condoning any out of network physicians because that’s where some of the costs come in anyway. Not new news but a great book.

[00:16:45] Bill Russell: [00:16:45] Interesting. Well, I will have to pick that up. It’s your hobby. So these are the kinds of books you read like while sitting out by the lake, I guess. 

[00:16:52] Anne Weiler: [00:16:52] Well, and you know what? I had the great fortune of, I was speaking at Mayo Clinic transform conference [00:17:00] one year and I had actually, it was pretty incredible on the way to the conference because I was a speaker, you know, they helped me get there and everything I was with Dr. Brancusi from Jefferson. And got to talk to him about the innovation they were doing and on the way back to the airport, I was with Elizabeth and got to talk to her about her book. So if I had been, if I had been one of your guests at that point, I should have been actually interviewing these folks.

[00:17:30] [00:17:30] Bill Russell: [00:17:30] You would have and you know, with that kind of experience, at some point I have a feeling you;re going to get the itch to get back to a health care All right. You tee up the next story. You pick one of yours and just throw it out there. 

[00:17:45] Anne Weiler: [00:17:45] Yeah. So I’ve got two stories and they’re both, the reason I picked them both is because I have some personal experience with both of the companies.

[00:17:56] So one’s IBM and one’s Microsoft. So there [00:18:00] was a, an article about an number. The first one was in the wall street journal, but a number of places about IBM trying to sell off their Watson health business. And his thought that was so interesting because, you know, they came out of the gate. They were so early in trying to apply AI to health data, to find all of the insights that we know are in that health data but just went [00:18:30] terribly wrong.

[00:18:31] And I think, I dunno if you remember this, but there was a session at HIMSS a couple of years ago that was Mayo Clinic MD Anderson and Watson and they were talking about, you know, what they were trying to do and how hard it was. And that very day MD Anderson actually announced that they were no longer working with Watson.

[00:18:53] So the, you know, wrangling the data was really hard. And in fact, they, you know, they were trying to do a [00:19:00] cancer moonshot but they ended up doing things like patient scheduling which is, you know, another problem. But and you know, at the same time, I think Mayo Clinic is doing some work now in actually themselves and working with Google because they’ve you know, they’ve chosen Google as their cloud provider and actually getting those insights from the data.

[00:19:21] So Big challenge but my personal story here is that when we were a tiny little startup we are actually an [00:19:30] IBM Watson partner. And we were like, I’m serious. It was before their partner program was even in place. And we were like, wow, this is amazing. You know? And we can, once we figured it out, we figured it out.

[00:19:43] It makes, this makes also makes perfect sense is that IBM doesn’t actually have any data. So they have to partner with anyone possible, whether that’s a health system or another vendor to get the data. And they are, [00:20:00] I want to say, like, I think they’re actually a little bit, they’re alone in this, in the industry.

[00:20:04] Like every other technology company has some place that they have some data that they can analyze and then compare things to, you know, like Google Scott. All the search data and you know, was doing the work with flu finder for awhile. But I think the biggest challenge with IBM was that they had nothing to start with.

[00:20:26] And if you don’t have data you can’t train your algorithms. And so no matter how [00:20:30] smart your machine learning is, if it’s not being trained on anything, it’s not going to get any smarter. So I it’s an interest it’s, you know, it’s great moonshot. But I think fall fell down in the execution and the key execution of like, where are we going to get data from?

[00:20:49] Bill Russell: [00:20:49] Yeah, it’s a well, and they went out and bought it right? So they went out and they bought Explorus. And Explorus had data [00:21:00] from like a fair number. I mean, Explorus was pretty big at the time they bought them a fair number of health systems. And we were one of those health systems in Southern California.

[00:21:09] We were also an investor in explorers. So we were happy to see them, you know, with an exit it’s not in the unicorn exit status, but it was it was a pretty good exit at the time. Yeah. You were talking about this, let’s see 2013. They started with the MD Anderson pilot to my [00:21:30] friends sites from health systems, vast troves of research and patient data.

[00:21:33] And develop new NLP power decision support tools by 2018, the two organizations that fallen out with MBA Anderson, pulling the plug on the project after spending more than $60 million following multiple examples of unsafe and incorrect treatment recommendations. Yeah, and I remember when that happened, because they came in, they had the big booth at HIMSS.

[00:21:55] They were talking about all the things they were going to do. I even went to a [00:22:00] session. I don’t remember if this was at HIMS or chime where the IBM people were talking about what they could do for us. And essentially what they mapped out was a normalization of our, a sort of a data governance slash normalization of our data to make it ready for AI.

[00:22:20] And I thought. That’s an interesting, and by the way, the project they mapped out for me was probably a $60 million project, just, just to clean up the data. And I was like, wow [00:22:30] that’s amazing, they yeah, they found and by the way, I still think AI and machine learning on the clinical side is is still highly risky.

[00:22:47] Yeah, very early, early, early stages. We’re seeing AI be deployed in a lot of places. And by the way scheduling is a great place for it. Administrative, cyber security there’s a whole [00:23:00] bunch of places that AR and AP and there’s a whole bunch of places to employ it within healthcare that can literally return hundreds of millions of dollars across the health systems. If not billions. 

[00:23:14] Anne Weiler: [00:23:14] And don’t risk anyone’s life.

[00:23:17] Bill Russell: [00:23:17] Right? That’s the thing. It can’t be wrong. Right? A Doctor makes a mistake and, you know, we say, you know, doctors, aren’t perfect, but if a machine makes a mistake, [00:23:30] that’s. We haven’t gone down that territory yet. And it’s gonna, you’re just not able to go down that territory yet, but so it has to be right a majority of the time. And now granted. You know, Watson was never going to, you know, do the surgery. It was never going to you know, it was never going to make the final diagnosis. It was always going to be in partnership with a physician. So there’s, I mean, there’s a lot [00:24:00] of room for this, if it gets implemented correctly.

[00:24:02]Anne Weiler: [00:24:02] They say the other piece of this though, is it’s one thing to partner on the data like them saying to you, we’ll clean up your data. It’s the other thing to actually own and understand the data, which is, I think what flat iron did was to say, we are going to be an ammar for cancer, and then they understand the data that’s coming in which results in less having to interpret and clean up the data to find the insights. So I [00:24:30] think, you know Watson was kind of like, We’re here, you know, tell us what we can do. 

[00:24:37] Bill Russell: [00:24:37] Yeah. That’s the age old mistake in healthcare right. To show up and say, we’ve got a solution when, you know, let us help you, let us know, what’s your problem. We’ll let you help. Well, you know, we’ll let you watch while we solve all of healthcare’s problems and they sort of almost did come at it that way. It was almost that kind of bravado. 

[00:24:54]Last week I keyed you in on something that’s unfolding here at This Week in Health IT. We started off with our [00:25:00] influencer podcast a little over three years ago, but since then we’ve been able to introduce Newsday and Solution Showcases and last year, We expanded even further with our daily COVID-19 series.

[00:25:10] And now we have a daily show Today in Health IT and I’m happy to say that we’re not done growing yet. We have something really exciting happening here at This Week in Health IT. Our goal, as you know is to help inform, educate and train health leaders. And we understand lots of people take information in in different ways.

[00:25:29] That’s [00:25:30] why we’re introducing written content to our site for the first time. You’ll be able to find news write-ups covering each of our shows in detail as well as feature stories. And I’m really excited about the feature stories. We’ve hired two great feature story writers and they’re going to take topics that are highly relevant to you and relevant to our industry.

[00:25:49] And they’re going to turn them into feature stories on our website. I’m so thankful for all of our listeners and the conversations that we’ve had our sponsors and the dialogue that we’ve had in the [00:26:00] back and forth has really convinced me that this is the best next step. I want to thank all of you for listening and joining with us on our journey of raising up the next generation of health leaders by amplifying great thinking to propel healthcare forward. 

[00:26:13] Truveta. is it in the market. We talked to, I talked with Ed Marks about this a little bit, a couple of weeks ago. Truveta is an interesting place. So this is essentially a massive data store about out of the 10 or so [00:26:30] health systems coming together.

[00:26:31] And they’re not small health systems either. I mean it’s Providence. It’s Trinity it’s it’s, it’s just, it’s it’s some very large health systems coming together. Big data stores. And they’re essentially going to anonymize the data and monetize it, anonymize and monetize marketing. Wow. That’s hard to say, but that’s, that’s, that’s what they’re, that’s what they’re going to do and obviously the whole thing’s couched under for the good of humanity and for the good of mankind. But [00:27:00] the the reality is that’s in this, this same vein of we are, we’re going to take all this data, but let me ask you this with regard to this. Yeah, the what do we have to do to clean up the data?

[00:27:14] You’ve had to clean up some of the data. What do we have to do to clean it up, to be ready for AI? I mean, is there a path for this? 

[00:27:23] Anne Weiler: [00:27:23] No I don’t think there is. I don’t think there is honestly. I mean, I actually wrote, I’m happy to, I think [00:27:30] it’s still up on the web Wellpepper website that I wrote a number of blog posts on this one in particular called garbage in garbage out.

[00:27:36] And it’s not so much that. You know, I’m not, I don’t want to insult people and say that everything in the EMR is garbage, but I have, we know that it’s not consistent. We know that it hasn’t been consistent over time. And a lot of the information is in the notes. And you know, I just anecdotally read a pretty interesting [00:28:00] Twitter thread of a doctor who was like talking about the terrible notes that the previous physician had put in and she couldn’t follow them and they were too wordy and they weren’t getting to the point.

[00:28:09] And then she read it. She realized it was her. That’s a lot of the challenge. I’m actually a big fan of small data instead of big data, because the smaller, the data, the easier it is to actually interpret what’s going on. And that’s, you know, at Wellpepper we had care [00:28:30] plans, patient care plans that we had defined. And so when the data came back from those care plans we knew what the patient was doing and we knew what we had asked them to do. And it made it much easier to, to actually, you know, apply machine learning to see, for example, is somebody at risk of dropping off their care plan. So I would like to see less, like here’s all of our data and more like. Focused and perhaps even more thought about, you know, [00:29:00] how much health, how much data is healthcare generating every single day?

[00:29:04] Are there ways that we can just make the ingest of that better than rather than going back and trying to, you know, just look at absolutely everything that’s been created. And then also like, what’s the hypothesis? What are you trying to find out? Cause there’s, there’s different ways to do it.

[00:29:21] Right? You can do a cluster analysis and say, You know, here’s a bunch of data machine learning. Please tell me things that are the same. And then you [00:29:30] can go and say, okay, well, what’s the same about these. That’s it’s really interesting, but it’s very academic and gonna take you a long time. 

[00:29:37] Bill Russell: [00:29:37] Yeah, I was, I was always trying to quantify the value of the data and the data with the highest value to AI machine learning. And really a lot of our analytics was stuff that didn’t pass through human hands. Right. Right. So all the telemetry data was beautiful. It just passed right in and it was very clean. Exactly. [00:30:00] So then the question became, all right if that’s our best data to work with, how do we get more of the data like that, that doesn’t pass through human hands anymore?

[00:30:10] And I think that’s the next step. I mean, clearly there’s going to be stuff we have to get through notes and that kind of stuff, but yeah. And we can think through how we’re actually collecting that and how we’re getting it in. But at the end of the day more streaming data directly from the body is going to be a lot better for us. [00:30:30] 

[00:30:30] Anne Weiler: [00:30:30] As a patient engagement advocate I think the other thing is that what happened in the hospital is only a very tiny thing. You know, like the rest of my life has lived outside the hospital. And so that kind of goes back to again, like looking at specific problems that happen within the hospital that you can fix, you know, you started off on the administrative side.

[00:30:56] I think that’s great. You know, I know there’s been work done with sepsis. [00:31:00] So you know, like 90% of the patient experience and data is actually outside of the hospital. And so think about what, what are you trying to solve? 

[00:31:10] Bill Russell: [00:31:10] Well, here’s what I wanted, I wanted a four point dataset to start to apply all my data practices too. And it was essentially the EHR data. Okay, great. We got, we have that data set. I then want your browser history. And I want to be able to mine that. I want to be able to your your [00:31:30] shopping history. And in your grocery store, I mean, I wanted to take those, essentially those four datasets, and I think we can make a pretty comprehensive whole person profile and almost predict where you’re going to struggle with regard to health.

[00:31:47] And maybe clearly education’s important there, but that’s like two or three data points in a way you go. Yep. So, wow. Anyway let’s see, where can we go? So that’s IBM [00:32:00] Watson. You talked about Microsoft what’s going on in Microsoft? 

[00:32:05] Anne Weiler: [00:32:05] Well, so this is a little bit, not like not entirely related to health IT but it is because IT cares about, you know, employee productivity and, you know, like we have all in hospitals, we have all these people who are not who, you know, administrative running, running the hospital, all these places.

[00:32:22] So Microsoft announced a new portal, a portal sounds like such an old word. So is it, can you have a new [00:32:30] portal, a new way of having employee experiences? It’s called Veeva. And you know, I said my personal connection to this, I did actually used to work at Microsoft and on SharePoint, but it has some components of SharePoint.

[00:32:46] But it’s and I dunno, like, you know, obviously Microsoft must’ve been working on this for a while, but it does seem a little bit COVID related in that it came out as we’re all working at home. [00:33:00] And it’s this, you know, it’s like supposed to be your digital front door, I guess, to your employer and your productivity.

[00:33:07] So what are you working on and what’s going on in your organization? But what I thought was interesting is that if you look at some of the articles, there’s a tiny snippet of wellness. Employee wellness as part of this. So it’s not just, Hey, what’s the news going on in my company? Or what documents was I working on or who do I need to collaborate?

[00:33:27] There’s a little bit of like, check-in of like, how are [00:33:30] you feeling today? And I thought it was interesting because you know, there’s a whole. Industry around employee wellness and, you know, companies like live a life aid life lie made. And you know, that Microsoft’s trying to step, you know, put a toe in the water here, but also like there was some backlash around you know, it’s tracking your productivity and telling your employer potentially when you’re working and when you’re not [00:34:00] working. So that’s, you know, that’s a question of that’s, that’s definitely something that is not helped with wellness, but I was also thinking, so I was thinking about it from a couple of standpoints, the portal or the internal intranet as a wellness activity, which is kind of interesting. I was also thinking about the, you know, the doctors and nurses and healthcare workers who are really, you know, talking about burnout. And then they’re given these like wellness modules to do. And they’re like, this is not, you know, that’s not the problem. [00:34:30] Solve the core problem, which is, you know, not enough resources and all of these things, so that that’s another component of it.

[00:34:37] And then just how how fine the line is when technology starts to try and tell you how you’re feeling. And I go back to this, you know, I did a talk at HIMSS one year on how to deliver empathy through technology. And I fully believe that it works, you know, that you can. And one of the examples I gave [00:35:00] was when I first got my first iPhone I was looking at it and it said you have a busy day tomorrow.

[00:35:07] Your first meeting is at eight. And I was like yeah, I do. I do have a busy day. Thank you for noticing iPhone. And it felt, you know, like, okay, my phone is looking out for me. Let’s compare this to something that Microsoft did which is, you know, outlook gives you your productivity stats and they do it in their rears.

[00:35:27] So they have been you know, [00:35:30] monitoring you. So in January they sent me a thing that said, You have been working outside of business hours every day for the last month, except for two, one of those days was a Sunday and the other day was Christmas. Well I was selling my company. You don’t think I know that I was wroking alot!?

[00:35:54] Bill Russell: [00:35:54] Now you want to get in an argument with it and say do you not understand what I’m going [00:36:00] through? 

[00:36:02] Anne Weiler: [00:36:02] So that those are some of the things that this brought to mind and I thought about like the, you know, rather than telling you what happened. Maybe come up with something that can help you. Like hey, I automatically put a block on your calendar because you’ve got these two meetings and you there’s, you know, I know you’re going to need a space between them to think because one of them’s with your vice president.

[00:36:27] So those are all the, I mean, it’s a little bit [00:36:30] squishy of thoughts but those are all the things that came up. And I was particularly like, do you want your portal every day to ask, like, are you happy today? Like, 

[00:36:40] Bill Russell: [00:36:40] I do want to talk about this specifically. This is interesting. And by the way that you sent me aat the woman sitting behind the desk and the top picture of that literally could be like your picture from 20 years ago sitting at a desk at Microsoft.

[00:36:57] Anne Weiler: [00:36:57] Well you know, here’s a [00:37:00] funny thing that Microsoft has that you can sign up as an employee to have your name used in documentation and advertising. And I did it because as a former technical writer and as a, you know sometimes marketer I know how hard it is to get fake names. And if you do poor fake names, it’s troublesome. So I signed up and I have advertised many many things. Windows phone [00:37:30] in particular was when Vollmer was on the Today Show the demo, had my name on it. 

[00:37:36] Bill Russell: [00:37:36] Oh, wow. That was your, that was your 10 seconds of fame right there.

[00:37:43] Anne Weiler: [00:37:43] I have a friend of mine was in a store, picked up a Windows phone, like the sample phone and, you know, the, it started doing its little demo thing and it’s like, you have a new message from Anne Weiler. And my friend was like.

[00:38:00] [00:37:59] Bill Russell: [00:37:59] That’s funny. But you know, you bring up an interesting point on technology and we’ve never, we’ve have not been good at this over the years. And it wasn’t until I would say about seven, eight years ago that, you know, I started looking at the psychology of rolling out technology and the impact that has on people and how they receive it and and how they interact with it.

[00:38:23] And I think this is a growing area. I’ve talked to several people now of development teams that our brain, that those [00:38:30] kinds of psychological and sociological just research and, and things to bear on. How are people going to receive this technology? How are they going to utilize this technology? How do they want it to talk to them?

[00:38:45] You know what, what verbiage do they want to hear and not hear from their technology? What, when they say one thing, it might sound like big brother. And when they say it another way, it might sound like grandmother. You know, it’s like, Oh thank you for putting your arm around [00:39:00] me. And so it’s, it’s you know, it’s just one of those things.

[00:39:04] All right. Let’s talk about it. This is essentially an evolution of the intranet. SharePoint was always a lackluster intranet and a security nightmare for me, but that’s a whole other thing.  Anyway. So, they split this up. They have four modules, they have connections, insights, topics, and learning.

[00:39:28] And it’s interesting. So connections think of [00:39:30] connections like social media for your, for your organization. So it’s ways to connect, not only I think, within your organization, probably externally. So they’re probably hoping that it becomes like a Slack kind of thing. Topics is like what Wikipedia you can essentially look up.

[00:39:48] Things like what does that product within our company and for larger organizations, like our health system that would have been helpful for onboarding and bringing people up to speed insights is what you talked about. You know, it’s looking at [00:40:00] it. And some retrospective and whatnot is asking you questions you know, and they give you the smiley faces.

[00:40:06] How do you feel today? And they can track that and put all that stuff in. And that gives you some things they got in trouble with the productivity score, basically because managers, managers were able to drill down into it and say, Anne’s only working three hours a week. I mean, literally that’s the level of detail they allow people to drill into.

[00:40:24] So that’s why, that’s why I got a fair amount of pushback on that. I think they’ve updated that since [00:40:30] that, since that time. And actually I haven’t gotten a chance to look at this. I’m just reading the article of what they have and then learning. I’m not sure what learning itself is, but you know, that could be a, an LMS, it could be a learning management system for us.

[00:40:43] So if you think about it from a portal standpoint, they’ve got, the Microsoft is good at this. They covered the categories. Now the question is how well did they cover the categories? Right? Conceptually, it’s an interesting concept. And Teams is everywhere in healthcare. [00:41:00] Zoom call, zoom call, zoom call. And if I’m talking to a health system, I have to go over and jump onto Teams. 

[00:41:06] Anne Weiler: [00:41:06] Is that, is there a security related reasons for that? 

[00:41:12] Bill Russell: [00:41:12] No, it’s exactly what it is. It’s the easiest agreement to sign and to extend and given what was going on during COVID you didn’t really want to renegotiate another contract.

[00:41:24] You just fired up Teams. And a lot of more, they were already heading in the office 365 [00:41:30] direction anyway. So it wasn’t hard to to stand this up. And it was the most integrated with everything that they were doing. So that’s this’ll be interesting. I suspect we will see a lot of these sites sort of take off and we will start, I’ll have to start hitting up some of the health systems to determine what their plans are with this. Cause. Yes. 

[00:41:51] Anne Weiler: [00:41:51] Yeah. That’s that was my thought too. 

[00:41:54] Bill Russell: [00:41:54] Should be interesting. Can we talk about the home a little bit? [00:42:00] So the home has always fascinated me. I think we’re seeing CMS start to loosen their pocket books and start to reimburse for things that are going out, going on in the home. CVS Health launched senior medical alert system. And it’s a much more sophisticated than the you know, I’ve fallen and I can’t get up. It has which I forget. What, what was the name of that company? 

[00:42:27] Anne Weiler: [00:42:27] Lifeline. 

[00:42:27] Bill Russell: [00:42:27] Yes, it’s a more sophisticated version of [00:42:30] Lifeline. It has a suite of sensors that can monitor falls, motion, room temperature also providing 24 seven personal emergency response platforms for use. So, you know, CVS has partnering with them. They see this as a, a deployment model. Clearly, if they’re partnering, they’re going to have somewhere where they can monitor this. They’re going to have a command center of some kind of where they can monitor this. And deploy resources against it.

[00:42:56] And it was interesting because I found this because [00:43:00] Aaron Martin posted something on LinkedIn and he said, you know, we’ve seen a lot of these over the years, will this one succeed? Yes. Sort of looked at it. And I’m like, you know, it really could. And it could for a couple of reasons, it can, because it never forget that CVS is one of the largest payers in the country.

[00:43:22] And so they get paid to keep you keep people healthy, right? And this is, this is a healthy play or a health place. [00:43:30] So so that’s good. It’s keeping people in the home instead of getting care at more expensive locations. So financially it makes sense. The other thing is CVS has reach is national and you know, the, the, the sensors and the technology, quite frankly, at this point are.

[00:43:49] Getting to be fairly inexpensive, easy to deploy. And so when he said, you know, we’ve seen a lot of these women succeed in my first wash it. That was, [00:44:00] yeah, it really could. 

[00:44:02] Anne Weiler: [00:44:02] Yeah. I think that, you know, the technology was never a bad idea. I think there, you need a whole bunch of factors in play for people to accept it. And I think most most people. I think I saw a study on  this for the, you know, it’s like 80% of people are some research scientists. I think 80% of people or more want to age in place at home. [00:44:30] The COVID certainly, you know, with all of the challenges with nursing homes to begin with, you know, being the first, the site of the infections and death, you know, really reinforced to people. Yes. I want to stay home. And so that may kind of removed some of the stigma of the home monitoring and the late night, you know, the late night TV help I’ve fallen and I can’t [00:45:00] get up. Sensors being smaller I think health as well, you know, like where, and families being remote also helps.

[00:45:14] So it’s, you know, you know that you need some of these things to, to stay in touch. And you know, I interviewed a whole bunch of seniors for as part of some of the research that I was doing. And one of the seniors I [00:45:30] interviewed had she’d lost her husband about six months ago and she had, was wearing you know the necklace thing.

[00:45:37] And she’s like, no, of course I’m like I’m alone. Somebody needs to know if I fallen. So I think it was, you know, people really start to understand the implications more. And then I think the issue is, do you trust who’s doing the monitoring, but I certainly liked the idea of sensors better than trying to build these smarts into all these devices.

[00:45:56] Like the one that I find ncompletely ridiculous [00:46:00] as the refrigerator. No. Cause like seniors are not going to replace the refrigerator with some new smart refrigerator. So by the time everybody has a smart refrigerator, it’s going to be for me potentially. But even, you know, I just got rid of a 40 year old refrigerator.

[00:46:14] I’m not kidding. So I think, I think there’s this, it could be a you know, there’s a trust issue. There’s an acceptance of the potential invasion of privacy because it is and then there’s a timing issue. And certainly I think COVID [00:46:30] has highlighted why people may not want to be in a senior living facility.

[00:46:38] And oh and then it can then sort of like, I wanna say convenience, but there are, there are more services now that you can get at home. So it’s not just the, the monitoring it’s, you know, if some people like to go into assisted living because they don’t feel like cooking anymore and they don’t feel like care caring for their home, like there are ways that there are so many more, you know, gig economy or other [00:47:00] types of services that it is, it is definitely more possible.

[00:47:04] I think that my challenge is that devices are not like, yes, that can tell you if something happened, but I’m really interested in the preventative side and the community side. And, you know, it’s like a loneliness, that’s the problem. And the, are you being active? And you know, the monitoring can tell you what happened, but it can’t actually change the behavior that we need to change for people [00:47:30] to live longer and more independently.

[00:47:33] Bill Russell: [00:47:33] You know, it’s, it’s interesting to talk about all this stuff. Well, let me give you the perspective from a healthcare CIO perspective. So we did try to do some of this stuff in our home health program. We actually, we actually went into people’s homes. We had a small team, went into people’s homes. We set these things up.

[00:47:51] Usually it was for a specific cases or like monitoring for 30, 60 days, something to that effect. [00:48:00] And then we would go in and take the equipment and move it somewhere else. We did have a call line and there, you know, and they would tell me stories of, you know, there’s, there’s this one guy that calls every day and he calls every day, but mostly because he wanted to talk to somebody.

[00:48:15] Yeah. And, but that was, you know, again, that ended up being part of the service that we ended up providing. Let me tell you some of the things that were hard about this one is sending that team into people’s homes. That’s no small deal that there’s, there’s [00:48:30] a special Well, first, first of all, there’s a legal framework for doing that.

[00:48:35] There’s a there’s a training aspect for doing that. So that, that was not easy in and of itself. The second thing is the, we, we based it on an iPad that was completely wiped. The only thing you do with it was monitor a handful of your devices and make a call into this line. And. They, they broke them. I, you know, I have no idea how they pick them up.

[00:48:59] They’d take them, they’d [00:49:00] move them. They’d become disconnected. And so we had to continually think through, okay, how do we make this thing? Like completely proof of no one can break it. And so we’re constantly engineering around it and that kind of stuff. And then second of all, and then the final thing I would say is that call center is really important.

[00:49:20] It is a cost and you need money to sort of fund it on the other side. So we were never able to scale this up because it never made money. [00:49:30] But if we were a payer, that would be a different equation. That’s why I think this might work on this side or for health systems that have a significant managed care population or an at risk population.

[00:49:43] Anne Weiler: [00:49:43] Yeah. Your, your point about the, you know, who’s the team going into the home is it’s definitely a key one. And then also how durable are these sensors? Are they going to fall off and give a false [00:50:00] alarm? You know, there’s just, there’s so much complexity. And I mean, CVS probably has the pockets and the patience to do this, but it’s really complicated.

[00:50:14] Bill Russell: [00:50:14] Yeah. Well that’s all for this week. Wow we’ve talked a long time. I appreciate it. Appreciate you coming around. 

[00:50:23] Anne Weiler: [00:50:23] I said that you just joined clubhouse. 

[00:50:26] Bill Russell: [00:50:26] I did just join clubhouse. I have no idea what it is. 

[00:50:30] [00:50:30] Anne Weiler: [00:50:30] Yeah. We could be having this conversation on clubhouse. We could set up a room on clubhouse this week in health IT and people can come and listen to us live and ask questions. To see our beautiful faces because it’s audio only. But you know, there are lots of healthcare  folks having conversations there. Doctors, nurses you know, talking about patient care, there’s venture folks talking about [00:51:00] digital health all of you, all of your healthcare friends are there. You’ll see. So it’s like, you know, someone described it as like a live call-in show. It’s a little bit like that. 

[00:51:11] Bill Russell: [00:51:11] Wow, can we actually do our recording? Yeah, well, 

[00:51:16] Anne Weiler: [00:51:16] No actually that, so the one difference is they ask that you not record it. It should be a live event. So it would be a, a lot. So but what we can do is, you know, we can have a room and have people come and we can [00:51:30] actually, you know, people can ask us questions and things.

[00:51:33] Bill Russell: [00:51:33] Wow. Well, I’m looking forward to delving into it. Somebody told me this morning that I needed to be on clubhouse and I thought. 

[00:51:42] Anne Weiler: [00:51:42] I will say as a, you know, heads up though, is they have been criticized for their privacy. And I think the other really interesting thing is that, you know, there’s so many people in there having conversations and their employers can’t hear the [00:52:00] conversations unless they’re on Clubhouse. You know, it’s a private network right now. So it’s got, that’s kind of interesting. 

[00:52:09] Bill Russell: [00:52:09] It’s really private. I went to sign up and it said it said we’re not ready for you unless somebody lets you in. And one of my friends inside. I guess  vouched for me.

[00:52:19] Anne Weiler: [00:52:19] They didn’t ask me to to let you in. I would have let you in. 

[00:52:23] Bill Russell: [00:52:23] Yeah, I was, anyway, I’m excited. We’ll have to as [00:52:30] I venture around there, I’ll see if I can find you and what we can do in there. 

[00:52:34] Anne Weiler: [00:52:34] Lots of folks are there. I know Christina Farr was looking at setting up a digital health conversation too, so 

[00:52:41] Bill Russell: [00:52:41] Cool. Anne thanks for your time. Always a great conversation. 

[00:52:46] Anne Weiler: [00:52:46] Good to see you.

[00:52:48]Bill Russell: [00:52:48] All right. That’s all for this week. If you know someone that might benefit from our channel, please forward them a note. They can subscribe on our website this or wherever you listen to podcasts. Apple, Google, Overcast, Spotify, Stitcher, probably some [00:53:00] other places that I’m not even familiar with. We want to thank our channel sponsors who are investing in our vision to develop the next generation of health IT leaders VMware, Hill-Rom, Starbridge Advisors, Aruba Networks and McAfee. Thanks for listening. That’s all for now.

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