Newsday - Drex joins to Discuss Conferences, Price Transparency and White House IT Priorities
April 19, 2021

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April 19, 2021: It’s Newsday with Drex DeFord and Bill. We’ve got a long way to go in healthcare. We are not consumer based just yet. How do we get better? What can we adjust? The virtual CHIME conference was last week. What were the key learnings? How did big tech fit in? And what is the future of conferences? Is it too soon for in-person? Did the FBI really nuke web shells from hacked Exchange Servers without telling the owners? CMS issues new guidance to enforce price transparency rule. Moral of the story? Don’t hide your pricing from search engines. Data privacy is becoming more and more acute within healthcare. Consumers want to know, what are you doing with my data? Who’s using it? Plus Biden outline’s health IT funding priorities for 20222.

Key Points:

  • We have a long, long way to go in healthcare before we are the experience makers that we really want to be [00:09:50] 
  • Kaiser Health News study says we will end up with 60-70% of the population getting vaccinated [00:17:55] 
  • Casino Healthcare” book by Dan Munro [00:23:18] 
  • The government needs to think about cybersecurity like they do national defense [00:42:20] 
  • Mayo Clinic launches 2 new companies [00:43:47] 


Newsday – Drex joins to Discuss Conferences, Price Transparency and White House IT Priorities

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Newsday – Drex joins to Discuss Conferences, Price Transparency and White House IT Priorities

Episode 392: Transcript – April 19, 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.

[00:00:17]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 one of those goals [00:00:30] 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. We also launched Today in Health IT. A weekday daily show that is on todayinhealth [00:01:00] 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. 

[00:01:24] I ran into someone and they were asking me about my show. They are a new [00:01:30] masters in health administration student and we started having a conversation and I said you know we’ve recorded about 350 of these shows and he was shocked.  He asked me who I’d spoken with. And I said Oh you know just CEOs of Providence and of Jefferson health. And CIO’s from Cedars Sinai, Mayo Clinic, Cleveland Clinic and  just all these phenomenal organizations, all this phenomenal content. And he was just dumbfounded. He’s like I don’t know how I’m going to find time to listen to all these episodes. I have so [00:02:00] 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 we did the COVID series. We did so many great things. Talked to so many brilliant people who are actively working in healthcare and in 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 [00:02:30] really well. 

[00:02:30] All right. It’s Newsday. And we have Drex DeFord in the house. Once again Drexwelcome back to the show. 

[00:02:38] Drex DeFord: [00:02:38] Thanks. Happy to be here. Always a good time. Thanks for having me. 

[00:02:42] Bill Russell: [00:02:42] Yeah, I’m looking forward to this. We’ve got a lot of interesting topics. We’ll talk. Gosh, we’ll talk a little bit about conferences cause we just finished the CHIME conference. I actually snuck it out a little bit today. Went to the health evolution forum town hall that they had. And I think that was really interesting. I got to hear from some [00:03:00] some leaders and what they’re doing in that, in that space. And that was, that was interesting as well.

[00:03:04] We have CHIME coming up. Gosh, we got, we got Vibe. We’ve got a lot of stuff to talk about with regard to conferences. What works, what doesn’t. We’ve got some CMS stuff. You actually posted something. I think it was you. It may have been the security guy from SCL health. Whose name? I can’t remember Howard? No, I have, I have his wrong. Anyway. I [00:03:30] hate doing that on the show because now he knows that I got his name wrong. 

[00:03:32] Drex DeFord: [00:03:32] I want you to follow him on LinkedIn now we do, we have 

[00:03:36]Bill Russell: [00:03:36] Yeah talking about the the FBI security thing. How the FBI, when you got the show stuff 

[00:03:43] Drex DeFord: [00:03:43] I might’ve, I might’ve posted that too so, yeah. 

[00:03:46] Bill Russell: [00:03:46] Yeah. All right. So we’re gonna, we’re gonna talk about that. And we’ll also talk about Biden  outline’s health IT funding priorities going into next year. So I’ve outlined that, and we’ve got a lot to talk about, but let’s start with where we’re at. Let’s so let’s talk about CHIME. [00:04:00] You just finished two days of sitting in the dunking booth, waiting for people to come in.

[00:04:04] And if people wondering what I’m talking about you, you actually manned the session as one of the Zoom people that they could talk to if they went to the CrowdStrike booths. So you were sitting there waiting for it. I mean, talk, talk about let’s talk overall. I mean, this is what their second virtual conference.

[00:04:24] We did the fall forum. Now we did the spring forum, virtual. What can we learn? What are we saying? 

[00:04:31] [00:04:30] Drex DeFord: [00:04:31] You know, so, I mean, I think there’s a part of me that is like they’re getting better and not just chime, but to sort of conferences in general. I just did the American college healthcare executives college you know, forum virtually too.

[00:04:47] They’re all a little bit different. They’re using different tools but I think they’re getting a little bit better over time and in a conversation with somebody else either they said, or I said something to the effect of hopefully by the time we have this all [00:05:00] figured out, we won’t need to actually use any of it anymore.

[00:05:02] And I know that we can talk about that too. 

[00:05:06] Bill Russell: [00:05:06] It’s okay. It is getting better. I agree with you there. They’re all getting better and it’s really interesting, but they leave you wanting don’t they? 

[00:05:15] Drex DeFord: [00:05:15] I think, I think there’s like, there’s a couple of different pieces of this. One is the tools have gotten better.

[00:05:21] And the other part of this, as we have lowered our expectations about what we’re necessarily maybe going to [00:05:30] get from the conference and we’ve gotten better at navigating the tools ourselves. And so You know, they’re not perfect. They’re not live conferences. A lot of the reason that I go to the hams annual conference or health or chime or act is for the social interaction that goes on, not necessarily for the presentations, but for the actual sit down and hear people, you know, misery loves company, you know, we’ll talk about what, what they’re working [00:06:00] on and what they’re challenged with and what we’re struggling with and trading, you know, ideas.

[00:06:04] And then sometimes you know, you just develop friendships over years and years and years. Sometimes this is about trading barbs and beers and you know, all that’s good too. And all that is missing from the, from the online format. 

[00:06:19] Bill Russell: [00:06:19] Did you get get a chance to take in some of the center stage stuff? There were keynotes, what were they? They were, they were really round tables. 

[00:06:27] Drex DeFord: [00:06:27] Yeah. I thought they were [00:06:30] you know, I thought there were good to this idea, you know, of CHIME. I think of moving from you know big, expensive commercial keynote speakers who are really entertaining and can be a lot of fun to watch and, you know, at least online making that transition to more practically oriented folks who are in the field. Folks who are in the trenches, how they’re solving problems that the things that they’re up against. [00:07:00] Good, interesting transition.

[00:07:02] And I think you know, really useful. 

[00:07:05] Bill Russell: [00:07:05] Did you all right. So a bunch of really good moderators, all former guests of the show. So Carina Edwards was there and Andrew Rosenberg from Michigan was there. Daniel Barchi and Darren Dworkin. So all former guests of the show. So we won’t say anything positive or negative about them, although they’re all phenomenal.

[00:07:25] Drex DeFord: [00:07:25] Fantastic. 

[00:07:25] Bill Russell: [00:07:25] Yeah. And they were, they did a good job of moderating. Did you [00:07:30] learn anything? So the first, the first session was the EHR providers. It was Meditech, Epic and Cerner up on stage. Learn anything, anything exciting? You walked away from there?

[00:07:44]Drex DeFord: [00:07:44] Yes it is. It’s hard, right? I mean, we’ve been doing this for so long and we keep such a close eye on those companies and what they’re doing that it’s hard to have any big reveal at a conference like this [00:08:00] unless they intentionally put something in place to try to have a big reveal.

[00:08:04] So, you know, honestly, no, I don’t think I walked away with like new or special information, but it’s interesting to hear them talk about their company’s challenges as they went through the pandemic and you know how they’ve leveraged the work that they did or how they’re leveraging the work that they did to prioritize and accelerate work that they’re going to do in the future.

[00:08:26] That’s all real good that, and know, Howard Messing needs a better light. That [00:08:30] was the other thing that I really got kinda dark and in the dark. But that would be the only other thing I woudl say. 

[00:08:37] Bill Russell: [00:08:37] You know, I’m actually putting a little bit more of an edge to my reporting and my posts and that kind of stuff. And I’m calling out some stuff.

[00:08:46] And one of the things I’m going to start calling out is we are a self-congratulatory lot. I understand the work we do is hard and we’ve done some great things. And I agree with all those things, but gosh, we spend an awful lot of times self [00:09:00] congratulating ourselves for what we’ve accomplished. And I’d like to see, not that I don’t think we should do that.

[00:09:04] We should absolutely do that. We should have a CIO of the year. We should applaud the most wired. We should, we should do those things. Those are our accomplishments. But I, I think we need to spend a little more time saying, hey, where, where are we not making the grade? Where are we not hitting the mark?

[00:09:19] Where are we not providing our consumers what they want? It’s interesting cause I have some people that work for me now, and This Week in Health IT. I’m not a one man shop anymore. And they [00:09:30] listene to every podcast. And there are times they listen to the podcast and they get angry and they just say, I don’t know how these people think that the consumer experience is any good.

[00:09:38] This was my experience. And they send me over this email and I’m like, no, but the reality is we’ve all had those experiences. And when we hear the self-congratulatory stuff, we’re like, you do realize we have a long, long way to go here before we are the the experience makers that we really want to be.

[00:09:58] Drex DeFord: [00:09:58] Yeah. I mean, it is, it is [00:10:00] perspective. Most of us who work in healthcare. When we go to get health care, we have special access just based on people that we know who can help us figure out how to get appointments and help us navigate. When I got this bill, can you help me figure it out? The rest of the normal population don’t have that kind of access.

[00:10:24] So we kind of unfortunately start from that position. And you know, I’m [00:10:30] with you. We have to celebrate our small wins that are incremental progress but I think we have to do it in the context of, like you said, we got a long way to go, we are not, you know, we are not a consumer based delivery healthcare systems for the most part yet.

[00:10:49] There’s a lot of work to do to get to the point that. where there people aren’t as happy with us as they are with Amazon Prime.

[00:10:57] Bill Russell: [00:10:57] Yeah. And I’m pretty happy with Amazon prime at this [00:11:00] point. I mean, they, they do a great job. So I don’t want, I don’t wanna go down this path too far cause I don’t want to sound like I’m being negative.

[00:11:07] They did a great job with the conference. I just, I would have liked to pick up more, you know, how are we going to adjust? How are we going to get better? And those kinds of things, again, I thought the questions were great. You know, Daniel really went after the, the the big tech companies which was interesting because I thought Darren didn’t go after the EHR companies at all. [00:11:30] It was such a friendly, little gathering and then big tech came out and it felt like Daniel went after it and I’m like, that’s interesting. We treated them like, you know, the grandparents came over and we love you.

[00:11:40] Thanks for coming to our stage. And then big tech game and we treated them like you know, like party crashers. 

[00:11:47] Drex DeFord: [00:11:47] Oh I was wondering, I was like, okay, where’s this going? Who’s the other grandma and grandpa and yeah party crashers.

[00:11:54] Bill Russell: [00:11:54] Party crashers. I mean, it’s like hey you know you guys, are you going to help us or you’re not going to help us? And if you’re going to help us, it [00:12:00] has to look like this or and Daniel was just right in their face. Hey, are you going to work together or you’re not going to work together? If you’re not going to work together, this isn’t going to work because I can’t work with just one of you. I need to work with all three of you because I have a Microsoft agreement.

[00:12:11] I need to put my stuff in Google’s cloud. I need to use AWS for some things. And if the three of you can’t even agree, I think the exact quote was something along the lines of if the three of you can’t even agree on a time where you can come together and do a video call, how am I going to get you to work together for my health system?

[00:12:29] That [00:12:30] wasn’t the point, which I was like, Ooh, that was pretty sharp. That was, that was my 2 cents. Hey, so conferences, we want to get back together. When is, when is too soon? So one of the articles out there, some healthcare associations moving full steam ahead with conferences starting this summer.

[00:12:47] Interesting, different, different approaches here. The Federalists Federation of American hospitals is going to get together in Nashville. It’s going to be a smaller group. The HIMSS [00:13:00] obviously is trying to go full steam ahead. HFMA has decided to push back even further. So they’re not doing their event, I think until either late this year or early next year.

[00:13:12] But you know, the HIMSS event is right around the corner, I think it’s August. Yeah. It’s August. So, I mean, that is that it feels like it’s just right around the corner. So do you feel like, I mean, they will probably be the first large event that tries to come [00:13:30] back. Do you think they’re pushing it? Think they’re going a little too early or think that’s the right timeframe?

[00:13:35] Drex DeFord: [00:13:35] You know, there’s so many, indicators that I watch all the time about this. I have my first Pfizer vaccine in, I get my next one on the 29th and give that another 30 days I’m in June. I’m you know, I’m vaccinated and I have all the antibodies built up but I realize that’s not most of the country.

[00:13:56] And so as we continue to sort of watch the, okay [00:14:00] 30% of the countries vaccinated and we’re vaccinating, I dunno some, you know, some percent every week the math says we ought to be at the point where we probably have everybody vaccinated who wants to be vaccinated maybe by July, something like that, unless we have some kind of a problem with a vaccine, which we see right now with Johnson and Johnson. And so now we’re holding up the show. Now how many of those doses would be in arms if they weren’t [00:14:30] held up? So it’s a very tenuous thing, right? And I, it concerns me a little bit about trying to walk the tight rope of okay let’s do it in August when maybe July is the time when everybody has maybe finally vaccinated better. But only takes one, oops. To make that, you know, two months later, a month later. So I’m skeptical. I’m kind of like a, it would be better if maybe we waited a little bit longer, but you know, I’m sure there’s a lot of other [00:15:00] ressures around all of this that, you know, that make August a reasonable date. 

[00:15:06] Bill Russell: [00:15:06] You know my question is who else is going because you know, the mortality rate in my age group is less than 4% since the beginning of the pandemic to now. And I’m an, I’m in an older. group actually it’s a closer to 2% actually in my, in my age group.

[00:15:25] And so you know, that doesn’t concern me. I have my first dose of the [00:15:30] vaccine. I’m going to get another one. I’ve seen the stories where people have gotten the vaccine, also get COVID but the numbers are so minuscule that it’s within the range that they tell you is the risk that it could, that you could get the vaccine and still get it.

[00:15:46] And so I think the risk is low enough that I feel safe going. The risk, even if I get it is not, you know, it’s an acceptable risk. I mean, I have more risk driving to the airport and driving in, you [00:16:00] know, Vegas traffic than I am really am I going to get to after I’m vaccinated and I’m wearing a mask, actually getting COVID and then being one of the 2% that actually has a is a fatality from it. So I’ll feel safe. 

[00:16:16]Why go, if you’re not going to go and why go with, you know, the people I want to see aren’t going to go? 

[00:16:22] Drex DeFord: [00:16:22] Yeah. I think my concern is probably more of the larger public health concern. I’m not a public health guy but [00:16:30] I do worry about the variants. And I do realize, I mean, it sounds like right now that as variants continue to proliferate.

[00:16:38] They’re for the most part handled by the vaccines that we have today, but it probably takes, you know, one or two weird variants that aren’t handled by the vaccines that we have today. And we’re back at the beginning of this whole cycle again. And the way we get more variances that people aren’t vaccinated and they’re out trading around the virus and the virus continues to adapt and generate these variants.

[00:16:57] So in the larger [00:17:00] sense, you know, the reason not to go might be you know, just hold, you know, keep your powder dry for another few months and we are able to sort of wipe out all the variants too. It may be about personal safety for a lot of people. I think it is. I certainly think that by August, given my vaccine status, I’ll probably feel much more safe about traveling.

[00:17:25] But I may not travel because I worry about this larger public health [00:17:30] potential challenge that’s out there. 

[00:17:33] Bill Russell: [00:17:33] Yeah, I was, I was trying to pull up the site. I covered this on Today in health IT on Friday, of course, we’re doing this on Thursday, so the show will go live tomorrow morning, but it’s the most recent HHS statistics and those kinds of things.

[00:17:47]The numbers are actually pretty encouraging except for the, you know, kind of, I think it was Kaiser Health news. There it is. There’s a report. So Kaiser health news came out with a study [00:18:00] that essentially is looking at this and saying, look, we’re probably going to end up at roughly 60 to 70% of the population getting vaccinated.

[00:18:10] It looks like about 20% are just not going to get in line. And then there’s a portion that are just not going to get vaccinated either from an access standpoint or some other reasons that are there. So we’re and they’re talking about, you know, herd immunity somewhere in the upper [00:18:30] eighties is what they’re looking at.

[00:18:31] So we are going to go into next year and sort of sustainable future where some portion of the population is not going to be vaccinated. And then we’re going to run into this thing of, you know, if this is an every year thing and we’d look at the flu vaccination rates. We we’ve got some challenges in front of us in terms of feeling a hundred percent safe.

[00:18:56] And this is part of my concern and [00:19:00] is, I don’t think we’re ever going to feel a hundred percent safe. How are we going to get back to, you know, how are we gonna get back to functioning? This isn’t really where I wanted to go with the show, but I, you know, when we talked about these conferences, And I’m looking at a picture of all these people milling through the HIMS floor and we all know what that’s like.

[00:19:19] Yeah. You’re not going to feel safe. There’s no way you’re going to feel safe in that environment. So they’re going to have to redo the, the showroom floor differently. They can’t possibly have, you know, 40, 50, [00:19:30] 60,000 people in that room. So, you know, what does it look like? They’ve got to rethink. And I think one of the things this article talks about is they haven’t published what their safety protocols are going to be. And I think that’s going to be a limiting factor. HIMSS could be in trouble if they don’t get ahead of this safety aspect, just from the conversation you and I just had. 

[00:19:50] Yeah, no, 

[00:19:51] Drex DeFord: [00:19:51] I mean, I think the look, but even after everybody’s vaccinated is 70, 70%, let’s just say 70% of the people that decided to get their [00:20:00] vaccination.

[00:20:00] There’s some other percentage beyond 70% that already had COVID and have some sort of natural immunity. So maybe we can get to 80%. But when it comes to conferences like this you know the, the new normal to overuse the term might be that we’re still gonna, you know, wear masks and situations where we can social distance.

[00:20:23] And, you know, we’re going to spend a lot more time thinking about washing our hands and what we touch and what we don’t touch and [00:20:30] shaking hands or bumping elbows instead of shaking hands, all the kinds of things that. We’ve learned to do in the last year, that probably are pretty good for public health in general anyway. Like, you know, if you’re not washing your hands and sort of keeping your social distance from people that you don’t know or aren’t in your core group, you probably should be doing that anyway. I mean, it just, you’re probably just generally going to stay healthier because of that. So maybe we’ve developed some habits now that are gonna go on and they’re gonna be good [00:21:00] for us. And I do, I do worry about it HIMSS yeah. 

[00:21:03] Bill Russell: [00:21:03] So if anybody’s listening from HIMSS here’s the, the reality is if you have s50,000 people there, these 10,000 are not going to be vaccinated. And if 10,000 people aren’t vaccinated, I doubt you’re going to have 50,000 people there. So 

[00:21:18] Drex DeFord: [00:21:18] You got to tell us, so you’re going to tell us the protocols. You gotta tell us what you’re doing, how you’re changing, what we have in our head as the vendor floor and the conference rooms. How are you doing that differently? [00:21:30] Feel comfortable telling our company we should go and they should. 

[00:21:35] Bill Russell: [00:21:35] And there, there are still companies that have travel bans on and I’m like, okay, so there’s whole health systems that aren’t going to be sending their team to this event. They can’t afford to send their team to this event from a, from a risk standpoint. And so, anyway, we’ll move on from there and hopefully  somebody from HISMS is listening. They’re gonna come out with their safety protocols and we’ll figure it out. To be honest with you I have not decided whether I’m going yet. So I’m going to continue to have conversations. [00:22:00] Find out who’s going. If enough people are going, then I will probably end up going. CMS. So CMS issues new guidance to enforce price transparency. Did you see this one? 

[00:22:10] Drex DeFord: [00:22:10] Yeah. Yeah. That’s interesting. Don’t hide your pricing from search engines.

[00:22:17] Bill Russell: [00:22:17] Yes. So they’ve hidden it from us, right? I I’ve heard this from people. It’s like, you know, you go out to the site and you’re supposed to be able to find this and it’s impossible to find. But, you know, regardless if they hide it from us or not, [00:22:30] they can hide it from big tech. They can’t hide it from the, from, you know, Bing, from Google, from all the search engines that are out there, which means that they’re going to pull it up.

[00:22:40] And if you know anything about Google, their strategy is that if you ask a question on the front page in the box that it gives you, it tries to give answers. And so there could come a time where you just go to Google type in hey where’s the lowest price for a colonoscopy. And it pulls it up because [00:23:00] CMS is going to go after health systems that put the no search function on there.

[00:23:05] You think this is good thing? 

[00:23:08]Drex DeFord: [00:23:08] So I don’t, yeah, I know if you I don’t know if you follow Dan Monroe on Twitter and I don’t want, have you ever done had Dan Monroe on as a guest? 

[00:23:17] Bill Russell: [00:23:17] I have not. 

[00:23:18] Drex DeFord: [00:23:18] He’s a great, you know writer for Forbes and others, and he’s written a book called casino healthcare and it’s [00:23:30] you know, if you talk to Dan about this, he would probably say, I don’t know that it really matters.

[00:23:36] You know, do you care what the prices of the colonoscopy that you’re going to get? If your insurance company is paying for it and telling you that you can only go to one of these four places anyway, would you look at pricing? 

[00:23:52] Bill Russell: [00:23:52] Yes. Do you know why I care? Why? Because I’m an employer. That’s why I care.

[00:23:57] Cause I’m paying for that insurance. I [00:24:00] pay a hundred percent of the insurance cost for my employees. I am paying for that. So next year, when my fees go, when my costs go up because, you know, people aren’t being just, you know, discretionary in terms of their healthcare spending yes, I do care. I think it is a problem that there’s a $20,000 colonoscopy when the average is like, 3,500 bucks.

[00:24:23] Drex DeFord: [00:24:23] Yeah, no, I look, I totally get it but I think Dan would be able to point you to a lot of, a [00:24:30] lot of sources that say that for the most part if they knew the prices, most consumers would not change what they’re doing as far as their behavior. And so this may be some kind of an okay, start to trying to figure out how to influence consumer behavior, but this may not be the thing that influences consumer behavior. We’re burning a lot of we’re creatin`g a lot of heat and smoke around this issue, but I [00:25:00] don’t know if we’re, you know, too many analogies, but is the juice worth the squeeze? Is it really going to have the effect that we want?

[00:25:06] So we’ll, you know, we’ll see. But you know, mostly out of curiosity, I might look around and see where the lowest price colonoscopy is, but I’m probably going to the colonoscopy shop that is covered by my insurance. 

[00:25:20] Bill Russell: [00:25:20] Well, here, let me point out your inconsistency, which is okay you believe transparency is good in government?

[00:25:27] Drex DeFord: [00:25:27] Yeah. Yeah. 

[00:25:28] Bill Russell: [00:25:28] Absolutely. Do you believe [00:25:30] transparency is good when you go to buy anything? Buy a lawnmower? 

[00:25:36] Drex DeFord: [00:25:36] Yeah. If I have a, if I have a broad range of choices, then price is definitely one of the things that influences where I go to buy 

[00:25:44] Bill Russell: [00:25:44] Because yeah, because transparency communicates trust. I trust you to make the right decision.

[00:25:51] And the problem with healthcare is we are arrogant and we believe that the consumer doesn’t know enough about health to make the right [00:26:00] decision. And instead of informing them, we care for them. We care for them by keeping information from them. We care for them by not informing them. That’s one of the challenges we have. We need to change the mindset. And the mindset needs to be, you know, what we trust them to make the right decisions. And if they make the wrong decisions, there are safeguards we’re going to inform them. We’re going to say, are you sure you want to do this. There you know, there might be a better procedure here and you may want to stay in your own community.

[00:26:30] [00:26:30] You know, whatever it is, but at the end of the day, it’s their decision and we trust them, therefore, we’re going to give them the pricing. We’re going to give them the quality scores down to the doctor level so that they know that the doctor they’re seeing is, you know, it is not as good as the doctor who’s down the street and around the corner that they could just as easily have gone too.

[00:26:55] Drex DeFord: [00:26:55] Sure. You said something really important there and that’s trust. [00:27:00] You know, I definitely trust the advice of a friend of mine who had their hip replaced that told me that this, you know, these guys at this organization were, you know, probably they were, they were really good. They had a really good experience there and they thought they did a good job.

[00:27:17] And then I looked up the doctor scores, the quality scores. And I was like, okay, this is pretty good. I like this particular surgeon let’s see if they’re in my group of people that I can be referred [00:27:30] to. And I found out that they were, and that’s who I went to, but I never looked at pricing. That had nothing to do with trust for me.

[00:27:39] I knew I was probably going to have a co-pay. I mean, I’m lucky, right? I have insurance. I knew I was, I was going to have some kind of a co-pay, but the co-pay didn’t change. If I went to Dr. A or Dr. B or Dr. C or Dr. D. It really didn’t. Now what the insurance company had to pay, maybe wildly different pricing.

[00:27:58] And that may be the [00:28:00] information that’s exposed and I may get aggravated by looking at that pricing and saying, how can it be $20,000 there and $5,000 there. But I don’t know that it would have changed my mind once I’d sort of figured out that this doctor is the doctor that has the quality that’s been recommended by a friend and so I trust that that’s probably the best place for me to go. I wonder if it’s more of a wall of shame issue than it is a you know, influencing patients to go to a [00:28:30] particular Is there a particular doctor based on based on price? 

[00:28:35] Bill Russell: [00:28:35] Yeah, it’s it. I, you know, I keep coming back to trust. There’s part of it that’s like, what are you hiding? What are you hiding? I don’t know what it’s going to cost me every time I go to the doctor. What do you hope. 

[00:28:46] Drex DeFord: [00:28:46] For sure? Yeah. I’ll tell you, I think from a transparency perspective, absolutely pricing should be transparent. I just don’t know if it’s going to have the influence that we’re expecting it to have. But generally speaking shining a light into the [00:29:00] darkness on any of these issues is a good thing.

[00:29:03] It’s a good thing because it makes healthcare systems also do things that they’re not comfortable with, like cost accounting and really figuring out what things actually cost instead of just saying. We have a facility charge and we just put it on top of all the things that you know, that we, every time we treat a patient, we just chunk on this, you know, a facility charge.

[00:29:24] And it’s just a big number because we aren’t good at cost accounting. Well, maybe we [00:29:30] have to get better at that. And if we do and where we’re able to figure out pricing, then I think that, yeah. 

[00:29:37] Bill Russell: [00:29:37] Cause one of the problems in healthcare is we learned this in economics. It’s called elasticity of demand. And this what happens  is when yo increase pricing. The demand goes down and when you decrease pricing, the demand goes up. And the reality is in healthcare, there is no elasticity. You can raise the price forever then we’re still going to go to that hospital. You can lower the price and it’s not going to increase. [00:30:00] So it doesn’t respond to the 

[00:30:02] Drex DeFord: [00:30:02] normal market demands

[00:30:03] Bill Russell: [00:30:03] Yeah the market dynamics. And so, you know, to a certain extent, it’s not going to change behavior all that much, but it does become a a source of trust, a source of I dunno, communication then those kinds of things. Let’s gosh, which one do we want to talk about next?

[00:30:22] Let’s talk about your security one. I think that’s an interesting thing because that’s a trust question. 

[00:30:26] Drex DeFord: [00:30:26] It is interesting. 

[00:30:28] Bill Russell: [00:30:28] Yeah. So  [00:30:30] what was that about? So the FBI. The FBI was responding to a threat, I guess. Right. Do you have the story in front of you? I don’t. Okay. So this is dangerous territory for us?

[00:30:44] Drex DeFord: [00:30:44] Definitely. Well, the FBI apparently went out and without getting into the kind of nitty gritty technical details, the FBI got a warrant to be able to go out and go [00:31:00] into organizations and do some partial cleanup of breaches that had happened. You know take particular actions and a network to to,

[00:31:12] to at least partially resolved some of the issues that were in these networks.

[00:31:18] And so part of this was the, you know, sort of uncomfortable feeling  ylike, You know, I’ve been breached and then the government actually used the information about how I’ve been breached to [00:31:30] come in and do a partial cleanup. But they didn’t fix everything. They just remove this particular piece of malware and it’s I I don’t know, it feels it doesn’t, I’m not sure it feels right.

[00:31:42] I’m from the government. I’m here to help. And just a little bit.

[00:31:46] Bill Russell: [00:31:46] That’s what you said. Just, I just pulled it up. It is Howard. It’s Howard Haile who’s the CISO for SCL health. And he put this FBI nuked web shells from hacked exchange servers without telling [00:32:00] owners, which is interesting and of itself. And I think that’s the, that’s sort of the gist of it.

[00:32:04] It’s not you know, the FBI looked at it and said, lo these organizations didn’t have the skills and which was probably accurate. They probably didn’t. 

[00:32:12] Drex DeFord: [00:32:12] But how do they know that? I mean, you know, how do they know that? And then the other thing I wonder about is if you go in and you remove that, you know, those web shells, if you go in and do that work have you has somehow that organization now lost evidence that they would like to know as part of their investigation [00:32:30] around the hack themselves.

[00:32:32] This is a really interesting to me like how, how did this happen? I would be upset if my organization were one of those organizations because, you know, I don’t know how I’ll tell you, how do they know? I wouldn’t have taken care of it from a transparency perspective, I would at least have appreciated a phone call saying that we’re going to do this. Are you okay with it? 

[00:32:55] Bill Russell: [00:32:55] I agree with you. I like something doesn’t feel right about me about this. So, and [00:33:00] it’s department of justice press release published today. The FBI states they used the search warrant to access the still compromised exchange servers, copy the web shell as evidence, and then remove the web shell from the server.

[00:33:12] The FBI requested this warrant because they believed that the owners of the still compromised web servers did not have the technical ability to remove them on their own. And that the shells pose significant risks to the victim. Based on my training and experience, most of these victims are unlikely to remove the remaining left shells, so [00:33:30] forth.

[00:33:30] It goes on to say but I think a little later on it says, Hey, the reason they didn’t tell him was because they thought they might essentially interfere with this work. And it was too critical. In other words, They didn’t want to risk being told, no, you just did it. And we need, we need policy and ethics people to be working like triple time these days.

[00:33:54] There’s so many new things coming at us. 

[00:33:56] Drex DeFord: [00:33:56] Yeah. I think that in this story, [00:34:00] there’s some top secret,there’s some piece of this story that we don’t know, and we don’t understand that might make us also now, I mean, as I sit her and sort of think about it again, there might be some piece of this that makes us, if we knew that part of the story, we might go, Oh man. Okay. That totally makes sense. So I wonder if there’s some piece of intel that we don’t have that makes this [00:34:30] feel not right. But if we knew the other piece of intel, we might say, I’m glad they did it. I just don’t know. It feels uncomfortable knowing what I know. 

[00:34:40] Bill Russell: [00:34:40] Yeah. Well, I wouldn’t want to, I wouldn’t want to come home after a week gone and have a little note on my door that says, hey FBI was in your house for a couple of days. We just thought we’d take care of some things. I, don’t know it’s just part of me that wasn’t, I don’t know. I don’t know. I don’t even know what I’m saying. I just, I guess there’s [00:35:00] policy and there’s ethics. And I really, I want them weighing in on this stuff.

[00:35:06] I want them, if the cybersecurity stuff is going to create some interesting things. Data privacy is becoming more and more acute within healthcare, what are you doing with my data? Where are you using it? Who’s using it? There’s an awful lot of things that we could use people coming out of our colleges and universities who are working on ethics and really [00:35:30] focusing on the ethics and aspects of it instead of the politics aspect of it. Not coming out, trained in a certain way of thinking, but coming out and looking at it from the different perspectives that are out there. What does this mean to the individual? What does this mean to the rights of the individual? What does this mean to the rights of the the whole, the group? Right. So some of this stuff might impact more than just me and my organization might impact others that maybe that’s why they did that work.

[00:35:57] Again, you might be right. There might [00:36:00] be some piece of information we look at and go, yup. That was the right move. Yeah. I just want to know that they’re following a framework of some, right. 

[00:36:08] Drex DeFord: [00:36:08] And I, you know, some of this is do you trust that whatever the reason was that the judge gave them permission to do this. You know maybe, maybe I mean, certainly that’s the role of judges in granting these kinds of actions is that you know they, they get [00:36:30] a brief that if we looked at it, you know, 80% of it would be redacted. There’s something else in this story. I think we don’t know, but yeah, based, like I said, based on what I know I’m with you, I would not want to come home and find out that the FBI had gone through my house and done something but they didn’t ask me permission.

[00:36:53] There’s something not right but there’s something absolutely. Right. I don’t know which. 

[00:36:56] Bill Russell: [00:36:56] It’s always fun for you and I to talk about such [00:37:00] things. So Biden outlines health IT funding priorities. Always, always a good topic for us to Biden administration. This past Friday released a letter outlining president Joe Biden’s request for fiscal year 2022 discretionary funding in advance of Congress’s annual appropriations and budget process, the consequences.

[00:37:19] Anyway they want to talk about some stuff. I’ll skip that and just get down to what they are. The  additional funding would go towards modernizing public health data collection nationwide in [00:37:30] addition to supporting care core public health capacity improvements in states and territories, training, new epidemiologists and other public health experts and building international passenger capability capacity to detect, prepare for, and respond to emerging global threats, according to the letter.

[00:37:51] So let me give you some of the numbers. 153 million would go towards the CDC social determinants of health program to support the States and territories and improving health [00:38:00] equity and data collection for vulnerable populations, 6.5 billion would go towards advanced research projects, agency ARPA for health a new agency ARPA for health aimed at driving transformative innovation in health research.

[00:38:17] And speeding implementation of health breakthroughs. In addition, the requests would provide 65 million to 2021, an active level of rural each connectivity program reconnects for [00:38:30] rural broadband, which we’ve talked about the wishlist and also includes 39 million for advanced communication research at a national telecommunications.

[00:38:39] And information administration, which would support the development and deployment of broadband and 5G technologies by identifying innovative approaches to spectrum sharing. Interesting infrastructure, 2 million would go towards expanding scientific and technology research. Three, a 2.1 billion for cybersecurity and [00:39:00] infrastructure security agency.

[00:39:01] 20 million for new cyber response and recovery fund three, 500 million for technology modernization fund. And let’s see, 4.8 billion for VA 2.7 billion for two of which 2.7 billion is going to the modernization of the electronic health record for the VA. I think that Cerner upgrade. Yeah, I think that’s a, I mean that covers the majority of what’s in there.

[00:39:28]I mean, what are your thoughts? [00:39:30] You’re a fan of the president. So I assume that you’re going to support most of these initiatives, right? 

[00:39:37] Drex DeFord: [00:39:37] You know, I mean, I have to dig into them too and kind of see, you know, what the story is. But I mean, a lot of these things sound very infrastructure improvement, preparing for the future,  rural broadband.

[00:39:53] You know, the VA EMR upgrade, I think, is going to be one of those things that we’re going to see go [00:40:00] round and round and round, because there’s a, I mean, you know, this is a this is a takeout an EHR that has a legacy HR that’s working and put in Cerner. And that project seems to be struggling. We see regularly stops and starts and yeah, reboots and change 

[00:40:19] Bill Russell: [00:40:19] How many EMR projects do you know that didn’t struggle that would, that would wither under this kind of scrutiny, 

[00:40:26] Drex DeFord: [00:40:26] Especially. Yeah. And you know, that size of a [00:40:30] deployment, right? I mean, I deployed the first two different generations of electronic health records in the department of defense. And, you know, it’s a super com I mean, it’s healthcare, it’s super complicated. And that’s inside the federal government, which makes it even more complicated, filled with lots of additional regulations and like you said, oversight and politics. 

[00:40:49] And politics around, you know the whole procurement process and all of that too. So it is, it is very complicated. I know it’s not going to be easy to do, [00:41:00] but yeah, I mean, I think continuing to make you know, good investments in public health several of the items you read out for sort of public health modernization, which we sort of figured out over the course of the pandemic, especially in the early stages tons and tons of problems with public health and the lack of investment at the local and state level over the past several years. And, you know, maybe we’ll be able to catch up, but to your point, this isn’t [00:41:30] about just catching up and you know, and other conversations that I’ve had. 

[00:41:34] This isn’t about necessarily just catching up and building the things that we use today. This is about spending that money to build the things that we want to be in the future and it’s you know, we, we really have to sort of keep that in mind because if we just build stuff that we already have, then we’re not, we’re not spending the money well.

[00:41:55] Bill Russell: [00:41:55] Yeah. I’ll tell you, this might surprise you. I have no problem with any of [00:42:00] this. I really like the cybersecurity stuff. This is way past due. I think we need to shorten, this is one of the areas where I believe the federal government needs to take a leading role and that is in cybersecurity. And not that I think they should, you know, you saw what you know, private industry is doing.

[00:42:19] And the great security companies that we have that are advanced in technology. But they need to think about it like they do national defense. And [00:42:30] this 2.1 billion, and it was a couple of hundred million here and there is probably still not even enough. I’d like to see them really invest in, in that area.

[00:42:39] None of these, none of these really jumped out at me. I do agree with you. We talked about this earlier. I I did have a problem with the, all the money that went to health systems as a result of the pandemic, all the recovery money  and not because I didn’t think it was necessary. I did think [00:43:00] it was necessary.

[00:43:00] I just think it went in a lot of cases to the wrong places. It shored up balance sheets that didn’t need to be shored up and other balance sheets that were teetering are still teetering after the money got distributed. So I just, I’m not sure that was, that was well thought out. And I’m not going to call anybody out on that in terms of who took the money, who didn’t take the ACA did not take the money, which is interesting.

[00:43:30] [00:43:30] But I agree with you, you know, we are, we need to leverage this funding to create the healthcare we want to see, not necessarily to support the healthcare that we’ve had in the past. And that’sgoing to be the key.  Oh, my gosh Drex we’re almost

[00:43:46] Drex DeFord: [00:43:46] How long have we been going? 

[00:43:47] Bill Russell: [00:43:47] Well, let me ask you, let me ask you about this Mayo Clinic launched two new companies. And Halamka is going to come on the show. By the way do you say Halamka or Halamka? 

[00:43:59] Drex DeFord: [00:43:59] Halamka.

[00:44:00] [00:44:00] Bill Russell: [00:44:00] That’s what I say as well, but I heard him introduced at the CHIME event today as Halamka. I thought, man, I don’t know. Maybe I’m saying it wrong. 

[00:44:08] Drex DeFord: [00:44:08] I’ve known him for years. I think I’m right. 

[00:44:10] Bill Russell: [00:44:10] Well and and yeah he was a professor in one of the courses I took up in Harvard and he introduced himself as a lot because I assume unless he is changing the pronunciation. But it just comes up from time to time.

[00:44:23] So head of the Mayo clinic platform, I love what they’re doing by the way. So essentially what they’re saying is [00:44:30] we need a platform to support healthcare moving forward, and that platform has to be able to meet people in their homes and where they live right? In motion. Not necessarily only within the four walls of the health system and that requires a certain level of technologies to be stood up so that we can collect the information from. these diagnostic devices and in motion at work feed that information into a [00:45:00] sophisticated algorithms that are AI enabled, ML enabled machine learning, enabled AI. I realize some people have gotten on my case and they’re like, you realize you’re being redundant.

[00:45:09] I realized that ML is a form of AI but it’s a very different form. But they’re feeding it into there, which is helping them to respond to` you know, larger groups of the population and only put that information that is really necessary the insights in front of the clinicians so that they don’t have to Wade through the mountains of [00:45:30] information.

[00:45:30] And it’s really interesting. So they’re launching two new companies. I won’t go into details. I did go into it in Thursdays Today show. Two interesting companies and I like the direction here. Here’s my question for you. This is a tough one. I’ll close you on a tough one, which is, do you see other health systems doing this level of forward thinking movement to move into the home in this way? I know everybody has a hospital at home initiative but [00:46:00] this seems to me to be sprinting towards a blue ocean, as they say. Sprinting towards that area that really nobody else has really taken a hold of yet. 

[00:46:10] Drex DeFord: [00:46:10] Yeah, no, I think John’s you know, Mayo hired John because John and I think he even said it today, something to the effect of John is a builder, right?

[00:46:20] John is a maker of things but only where things need to be made. What he’s really good at and what he’s good at from my experience with [00:46:30] him in Boston too. He’s really good at putting together teams who look and understand problems and issues and challenges around the delivery of care and how that delivery of care is changing for us moving more and more to outpatient, more and more to home, and then figuring out how to solve those problems kind of using a criteria of is there something I can buy to do that? And if there is, then we should definitely buy. And if there’s not something to buy, then maybe we partner with somebody to invent something to make that work. And if nobody wants to do that, and then we have to build it ourselves and [00:47:00] he has a platform, he, and I don’t mean the Mayo platform, although that is what it is.

[00:47:05] He has a place that is willing to make investments to facilitate what in many ways is kind of the cutting edge thinking on on how to deliver on this. And you know, he’s, I think he’s the right guy, but he’s the right guy at the right place at the right time to make some pretty cool stuff happened that could wind up being the standard [00:47:30] that everybody else winds up following.

[00:47:32] Bill Russell: [00:47:32] Yep. Absolutely. I could hear your voice is already starting to go after two days of just doing nothing but talking. 

[00:47:39] Drex DeFord: [00:47:39] It’s been a long, it’s been a long couple of days. 

[00:47:41] Bill Russell: [00:47:41] Yeah. So I really appreciate you doing this. 

[00:47:43] Drex DeFord: [00:47:43] And the sun’s shining and Seattle’s as you can see. 

[00:47:46] Bill Russell: [00:47:46] Wow, well, we should have covered that news story.

[00:47:50] The sun is shining in Florida as well, not as much of the story. As you can imagine. Hey, thanks again. It’s always great talking to you. 

[00:47:59] Drex DeFord: [00:47:59] Of [00:48:00] course. Same here. I’ll talk to you soon.

[00:48:02]Bill Russell: [00:48:02] What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to this show. It’s conference level value every week. They can subscribe on our website or they can go wherever you listen to podcasts, Apple, Google, Overcast, which is what I use, Spotify, Stitcher. You name it. We’re out there. They can find [00:48:30] us. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders. Those are VMware, Hill-Rom, StarBridge Advisers, Aruba and McAfee. Thanks for listening. That’s all for now.

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