August 16, 2021: Anne Weiler and Bill talk HIMSS, the HLTH Conference, Salesforce and Netflix. What does the future hold for HIMSS? How can we enable a better digital experience for live and hybrid events? If you want to find the deal makers, the money people and the start ups, you really have to go to the HLTH conference. While digital adoption has come a long way, for tech to take off there are four questions that doctors really want to know. Does it work? Will I get paid? Will I get sued? Will it work in my practice? Salesforce rolled out cloud-based remote monitoring patient access tools. Healthcare should take cues from consumer-centric companies such as Netflix. The idea is to stop thinking about people as patients and consider them instead as consumers who should be known entities to hospitals and health systems before they even need care.
Newsday – HIMSS and What Healthcare can Learn from Netflix
Episode 435: Transcript – August 16, 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: 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 World Wide Technology who are our 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 [00:00:30] 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. We also launched Today in Health IT. A weekday daily show that is on [00:01:00] todayinhealth it.com. 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.
[00:01:26] Today, This week in health IT, it’s Newsday and [00:01:30] HIMSS is over. Technically it’s over, but we’re recording this on Wednesday. So we are just in the beginning. So we have some stories from HIMSS and we’re going to, we’re going to go through those.
[00:01:40] We’re actually going to focus in on a theme today with our guests Anne Weiler, who is the Former health tech founder and Advisor to This Week in Health IT and we’re gonna focus in on digital. We’re gonna focus in on some of the announcements. Some of the interesting talks that were out there. And see where it takes us. So Anne, welcome to the show.
[00:01:59] Anne Weiler: [00:02:00] Hello. I’m happy to be here as always.
[00:02:02] Bill Russell: I wish I could say I was happy to be here. I’m happy to be here with you, but I, I really there’s part of me that misses going to HIMSS. It sounds kind of weird because it is sort of love, hate.
[00:02:15] I mean, there’s aspects of it that I really dislike and then there’s aspects of it that I miss. I mean there’s such a concentrated, for somebody who really loves this stuff, there’s such a concentrated content. I mean, just great people talking and it’s that part of it too. It’s [00:02:30] great people.
[00:02:30] So it’s interacting with great people, really understand and have a passion for healthcare and it’s just a week of that. And it’s a lot of fun. And so we’re not there. So we are experiencing this remotely. When I was CIO, it was kind of funny cause we had 10 spots that we could send. Allright, I had 700 people that reported to me which didn’t include a whole bunch of other things and I could send 10 people to HIMSS. And now I know what it feels like for the other [00:03:00] 690 who didn’t get to go to him. So you read about it and the news, you follow it on social media and you hit some of the digital sessions, but it’s really it’s not the same.
[00:03:11] Anne Weiler: No definitely not. I didn’t even think about that having been there as a vendor and we had to go, but you’ve got to be there as a vendor. If you’re not there, it’s are you actually even in healthcare? On the health care organization side, the number of people who were in the organization who [00:03:30] wanted to go each year and probably never got an opportunity to and maybe didn’t have many conferences they could go to. There’s always conferences.
[00:03:38] Bill Russell: I’ve got a couple of comments for people. A comment on HIMSS and that kind of stuff. I don’t think I’m going to do it. And the reason I’m not going to do it is because I don’t think it adds to the conversation. I don’t think it benefits.
[00:03:49] I think they, they were thrust into a very difficult situation last year. They’re doing the best they can this year. And it’s just I mean, it’s like [00:04:00] bad luck at the beginning of the pandemic. And right now, when it’s you have the Delta variant at its peak right now that they couldn’t have had worse luck over two years if they tried.
[00:04:10] Anne Weiler: I will say that’s just like just conferences in general. I think there’s been a huge span of how people have chosen to go digital. And HIMSS, I think HIMSS could do a little being a tech conference. At the very beginning of the [00:04:30] pandemic, I think it was like CNBC. It was back when Christina Farr was still there and they had a full day conference. And the whole thing was online. But it was designed to be online. Like it really had that you could actually chat with people online. And I’m hoping that as this continues, we actually get better at this because thinking about your 700 people who didn’t get to go to H MSSI imagine that they actually got more, not just viewing this content because the contents [00:05:00] great but the interactions, as you mentioned are also great. How can we enable a better digital experience for live and hybrid events? And I think all the whole conference industry has gotten shaken up by this. And I hope that they, they realize it’s not. It’s not a cannibalization of an event that they’re actually increasing their market size.
[00:05:20] To your point, you’ve got 10 people imagine that you could have paid some smaller amount of money and had 700 people participating virtually. That’s an opportunity for both [00:05:30] your staff and the conferences.
[00:05:33] Bill Russell: It’s going to be interesting. The CHIME conference is in October, HLTH conference is a little bit before that. It still might be in October, but it’s actually before the CHIME fall forum, which is in San Diego. So San Diego and Boston. Those are going to be probably masked mandatory states if I thought about it, maybe by October it’ll change. I think those conferences will, it’ll be interesting to see if they’re able to break through.
[00:05:58] I [00:06:00] for one wish they would be just easier, the content would be easier to navigate. One of the things I used to do is the CHIME spring forum used to be the day before HIMSS started and I’d go and I’d go and sit in there and the some of the talks were phenomenal. Some of the talks were not really geared for me.
[00:06:24] So I would take that time with my laptop and I’d go through almost every presentation that was going to be [00:06:30] done at HIMSS and I would organize it. Maybe that was the start of where This Week in Health IT came. But I would organize it and then I would send it out to my teams and I would say, Here are the five presentations on data science.
[00:06:42] Here are the five presentations on digital infrastructure. Here’s the, and I’d send it out to my team. So to give them sort of a taste of, Hey, here’s, what’s being presented. And then I’d asked them do you want me to connect you with the people who were doing the presentation or that kind of stuff?
[00:06:57] That’s how I would go through that. It was [00:07:00] arduous back then. It’s not that much better now. There’s just, there has to be a better way to organize it. And someone like HIMSS has the resources to do it really well I think.
[00:07:12] Anne Weiler: Yeah, we used to do that too. We would, before HIMSS, some want someone on my team would go through, pick all the sessions that we needed to get to and then assign them to people. To make sure that it was both education and seeing what health systems and competitors were up to. And yeah, it’s, that’s a [00:07:30]huge effort.
[00:07:31] Bill Russell: Yeah. Let me ask you this. I didn’t really want to talk about HIMSS as much. We have five stores.
[00:07:36] Anne Weiler: Oh come on it’s HIMSS.
[00:07:37] Bill Russell: I’ve interviewed you from the floor. How beneficial is it having space on the floor? Maybe not talking about this year, but when you did it.
[00:07:46] Anne Weiler: As a small company, it’s hard because, you’ve seen the Epic booths. And there’s also like the do you have coffee? And what are the things that you have to get people to hear?
[00:07:58] For us, it was an [00:08:00] anchor that we could use to set up meetings. We didn’t get so much like serendipity cause we’re off on the side with all the startups dDepending on the year. Because you never knew exactly where you were going to be. And sometimes there was the two floors of the trade show, and that was a hard one in Orlando.
[00:08:15] Anyway, it was really important so that people could find us. So we would set up the meetings in advance. And then I think it also provided a little bit of, I want to say legitimacy, but certainly oh yeah okay., you’ve got a booth. There you are. There are [00:08:30] people. There was one year we were in the startup area and we took five people, which doesn’t sound like much, but it is when you only have a kiosk and we were so busy and all the other startups around, I could tell we were a little envious.
[00:08:44] So I think it is important. It’s important to be there and having just even, it’s not about not so much about is your booth really fancy or anything it’s just to be able to actually have a place, especially for the people that you [00:09:00] contact beforehand, who are like, yeah, I’ll stop by, but they don’t give you an exact time.
[00:09:03] Cause it’s getting somebody to commit to a meeting can be hard, but everybody always came by. They sought us out. And so it is important I think to have sadly some presence and the thing about HIMSS is they do recognize the importance of startups and they have options. If you can’t get a 20 by 20. But that’s, I think the problem was like, you go from the startup kiosk, you basically have to go buy a 20 by 20 or nobody sees you.
[00:09:29] Bill Russell: And [00:09:30] it’s significant uptake in cost isn’t it?
[00:09:32] Anne Weiler: Significant yes. But yeah, I think it’s important.
[00:09:35] Bill Russell: Do you think they’re going to be able to retain the mantle. They had the mantle for years of you you had to go to HIMSS. You talked about legitimacy. Do you think they’re gonna be able to maintain that mantle after two years of sort of false starts.
[00:09:50] Anne Weiler: I think so. I remember the HLTH Conference? The HLTH. When that one started, I mean, first of all it’s backed by Venture. Second of all, [00:10:00] it’s a team that has actually discrupted the conferences, the go-to conferences in other industries. They became the defacto conference for retail and FinTech. The conferences that they ran. You’ll see, same thing with the cartoon faces and everything. Same model like machine.
[00:10:17] And when that one started, I was like, Oooh HIMSS had better watch out because this is a modern conference and it’s the visionary and they’re not allergic to vendors. That was the one thing that I was kind of bothered me and I get it. Sometimes [00:10:30] vendors get on stage and they just they’re pitching, instead of talking about the outcomes that their customers had.
[00:10:36] But that conference, I felt like, Ooh, they’re gonna draw, they’re gonna take the innovation piece of the market from HIMS and that’s going to be challenging for HIMSS. I feel like now there’s been a little bit of reset cause that conference, it went online and I heard it’s good. I didn’t attend it. But it sort of seems if you think about the anchors, I don’t know that that conference was around long enough.
[00:10:58] I think what’s going to hurt is all of [00:11:00] those smaller conferences that were attempting to challenge HIMSS, I don’t know if they’re going to make it. HIMSS is gonna make it, if I said to you, if HIMSS is going on next year and it’s safe, you’re going to go, right? Like you’re not,
[00:11:16] Bill Russell: Yeah, I’m going. And somebody asked me, do you think this is the end of HIMSS? They still had 19,000 paying customers. It’s a seriously, I mean, yes. It’s still an ongoing entity. Will they have to tighten their belt? Will they have to do things a little [00:11:30] differently? Yeah. But they have a formula. If they maintain that mantle of you have to go, it’ll be back up to 40,000, within two years.
[00:11:38] Anne Weiler: Right. And then there’s pent up demand from people not going. There’s people that have never gone, like some of the people on your team. I think that that the opportunity is that whether they fixed some of the stuff that didn’t work as well. That’s the opportunity hat before everybody comes back. Is to actually learn the lessons from these innovation conferences [00:12:00] that had more future looking stuff and learn those lessons and fix that.
[00:12:03] If we all go back in two years and it’s the same old HIMSS, that’s when I think they may have a risk.
[00:12:09] Bill Russell: Yeah. The HLTH conference is a very different conference. You’ve attended that in person?
[00:12:15] Anne Weiler: Yeah, I’ve spoken. I spoke at the first one actually. It was really fun. Really good.
[00:12:19] Bill Russell: It’s is. It has a different feel to it. Definitely a modern conference as you, as you called it. I think the other reason it’s very different. The first one at least was a lot [00:12:30] of tech, startups and venture. It was a lot of money and almost took the place of the HLTH 2.0 conference. Right.
[00:12:38] Anne Weiler: Yes. It did.
[00:12:39] Bill Russell: It had that feel to it. And HLTH 2.0 was bought by HIMSS and they proceeded to pretty much drive it into the ground because they didn’t really know what to do with it, which is sort of what I’m trying to say here, which is the HLTH conference. If you want to be in deal flow, if you want to be talking to the money people, if you want to be talking to the startups, you really do have to go to the HLTH conference.
[00:12:59] It is [00:13:00] a really dynamic place to have those conversations. And it’s interesting because there’s a group of people that I will see at HLTH that I’m looking forward to seeing that I would not have seen at HIMSS. They’re just not even going.
[00:13:12] Anne Weiler: Well, I will say that yeah, it was money but the health systems were all there. I had so many meetings with big health systems at that conference. It wasn’t just Venture.
[00:13:22] Bill Russell: Yeah. I’ll tell you. What’s different though. The first one was not CIOs. But the CEOs were there. [00:13:30] They got the, they got the CEOs in as uh, speakers. And so they were roaming the halls and I was sitting there going, okay that’s another thing that made it very distinct. The other thing is they brought in the insurance, they brought in pharma, payer, pharma. They brought them all in and I thought this is interesting because they see it as an entire ecosystem addressing this, this challenge. It was a pretty interesting conversation.
[00:13:52] Where do you think Health Evolution Summit, where do you think that fits? That’s a smaller conference. And, but also has that [00:14:00] also has that same HLTH feel to it except really high-level talks. I found those talks to be some of the best that I’ve ever attended.
[00:14:09] Anne Weiler: It offers the no press, right? So people feel more comfortable saying things that they might not say if the press were there. So from that standpoint that was a lot of the value and also just the small setting and the invite only. So if you got to be there, the [00:14:30] access to people there was incredible. Because they were just like, oh, you’re here. Okay, I’ll talk to you. I actually sort of had lunch with Judy at that conference.
[00:14:41] Bill Russell: Yeah. I’ve gone to that several times. And it’s, it is an exceptional conference. It was very personal. I mean, you have great. And it’s at the Ritz Carlton too.
[00:14:53] Anne Weiler: It is ridiculously expensive. Again, as a startup, I got startup rates [00:15:00] because they had to because there’s still a way we can pay what the health systems were paying but I still had to stay in an Airbnb.
[00:15:08] Bill Russell: I lived down the street, so I commuted every day to the conference. All right we’re going to get the stories. Let’s let’s get some of these real quick. So doctors looked at tech. I like this one, doctors looked at tech for future but need assurance it’s going to work. Jesse Ehrenfeld former chair for the board of trustees of the AMA.
[00:15:27] And he says a couple of things here. I want to get your comments. [00:15:30] The aim AMA compared to survey on digital health adoption collected in 2019 and 2016 and found a small but significant increase in the advantages that physicians feel digital health can bring to their patients. Clearly that’s changed. He goes on to talk about that.
[00:15:47] I can only imagine what these data would look like today. Ehrenfeld said noting that the data was collected pre COVID. The survey is zeroed in on seven types of tools. This is what I’d like to talk to you about, including remote [00:16:00] monitoring for efficiency, remote monitoring, and management for improved care clinical decision support, patient engagement, televisits, point of care and consumer access to data. He goes on to say, doctors are especially interested in monitoring their patients outside the four walls of the hospital or clinic, which happens to be where you were living while all digital tools have seen an increase in it well I mean, I’m going to just skip to the end here. But the survey results show that the number of [00:16:30] physicians interested in adopting augmented intelligence tools is very high however current adoption at least as of 2019 is very low. Let’s talk about this statement. Doctors are especially interested in monitoring their patients outside the four walls of the hospital or clinic. Do you think that was the case a couple of years ago? And do you think that’s changed?
[00:16:52] Anne Weiler: You can talk about doctors as a monolithic entity. I think it totally depends on what type of doctor, what [00:17:00] type of patient. Specialists who work with people with chronic diseases, absolutely. And they’re frustrated that it’s first of all, hard to do. And second of all, how do you get paid for it? Your average sort of primary care pprobably doesn’t want to. And maybe there’s also the, they want someone to do it. I don’t know. The doctors want to do it which is probably correct. Right. The orthopedic surgeon wants good outcomes from the patient but they’re not the [00:17:30] ones who are like, do your exercises.
[00:17:32] I think doctors want the access to the information. They want to help patients, but there’s also a little bit of stuck in the system. It’s all about reimbursement. And so the reimbursement, it’s three things, reimbursement, liability and time. Those are the barriers for them.
[00:17:49] Bill Russell: It’s interesting. You bring that up. Cause he goes on to say while digital adoption has come a long way, he said for tech to take off, generally, there are four questions that doctors really want to know [00:18:00]and you just nailed it. Does it work? Will I get paid? Will I get sued? Will it work in my practice?
[00:18:06] Right. So the reimbursements matter. They matter a lot. Will I get sued? Is there a liability if you’re going to put this information in front of me, do I have to act on it? Do I have to review this information? It’s just an interesting, it’s an interesting concept. But doctors, I love the fact that you’re saying don’t talk about them as monolithic. Can we at least talk about certain practices as monolithic or not?[00:18:30]
[00:18:30] Anne Weiler: Well, I think setting of care matters but at the same time I think there, you can definitely talk about types of practice because that will impact their need to engage with patients outside the clinic as well.
[00:18:44] I think your average primary care doctor in the current model. Absolutely not. If we moved to a different model for primary care and they have wraparound services, then they have team-based models and then maybe they do. But for an average healthy [00:19:00] person, like why does a primary. Imagine that my primary care doctor had to have all my vitals. I’m fine.
[00:19:07] Bill Russell: If you were developing a new tool. So you, you developed one before, if you were developing a new one, would you focus in on a specialty or would you try to address a broader challenge within healthcare that could be addressed to multiple different specialties across the healthcare continuum?
[00:19:25] Anne Weiler: Well what I did was a broader tool and I think maybe [00:19:30] this is hard. This is a very hard question.
[00:19:34] Bill Russell: Yeah that the draw. You want something with enough market share obviously. You want something that’s
[00:19:42] Anne Weiler: Well enough market share, but also like when you’re starting, you used to be a CIO, the CIO wants to standardize, which is why you come in with a an individual tool and they get frustrated. It’s why Xealth exists. It’s why people want to use the patient engagement stuff in [00:20:00] Epic, because they don’t want a thing per specialty.
[00:20:04] I know from having. The tools that the repeatability is huge. And yet at the same time, I know that the specialties think that they’re special, right. They’re called specialties. Like mine couldn’t possibly be the same. I think there’s something to be said for if you take the approach of just saying which I didn’t so we have learned from my lessons okay, we’re only gonna do this specialty [00:20:30] until we have one the specialty over, and then we’re going to do the next one.
[00:20:33] And that does get to, if the specialists can actually make the decision, that’s part of the problem. Right? Then we go back to who has to make the decision and are they going to buy a tool just for the specialty? Or are they going to look for something that everybody can use?
[00:20:46] Bill Russell: Yeah, it is a challenging problem. And the age old thing I hear from CIO after CIO is if my EHR provider has a tool for it, that’s what we’re going to use because it’s integrated. It’s built. I don’t have to worry about the conversation [00:21:00] between the tool and the EHR provider and getting it integrated and that kind of stuff, because it should be there and should be working. Let me give you the next story and
[00:21:09] Anne Weiler: Wait before you do, I want to point something out on, when you were describing all those capabilities from the standpoint of the health system, I was thinking about it from the standpoint of the patient. And from standpoint of the patient. That should just be one thing.
[00:21:23] Bill Russell: Right. But we can’t get, yeah, no, I, I agree with you. That’s where [00:21:30] we should be going. We should be going to the point where the patient is interacting with the health system more frequently. So more digital touchpoints. This is what we were going for back in 2012 when we founded our digital group. We wanted more touch points.
[00:21:44] We only saw them once every, for some people you didn’t even see them once a year, but our average patient, if I remember correctly was 1.2 times a year. The number of times we saw them and I’m like, well, digital gives us the opportunity to [00:22:00] increase those touch points, but they’re not going to be opening six apps.
[00:22:03] They want to open one app and say, schedule an appointment. Text my doctor. Text a nutritionist. They want, that’s what they that’s Nirvana, but it’s so hard to get there. Because the back end for this, we had 800 apps and 1600 instances of those 800 apps.
[00:22:24] So even though we had 800 apps, you’d think, oh, you have 800 instances. No, we didn’t. We had the same [00:22:30] app you know instantiated four different ways across the health system. And we had trouble just bringing all those together to get a single built. Right. So the backend is disjointed which makes the front end in orchestrating the front end.
[00:22:43] And so in steps tools for our second story, like Salesforce, who says we’re going to live one layer above the EHR. I always thought this was an interesting strategy and I want to talk about it. So we’re going to live one layer above and where we’re going to live is [00:23:00] between where the consumer lives and where the health system interacts with that consumer.
[00:23:06] And oh, by the way we’ll move information in and out. And so Salesforce rolled out health cloud in 2015. And full disclosure, I was on their advisory board back then. I think I was on for a year and a half before I left St. Joe’s. And let me give you the story. So Salesforce rolls out cloud-based remote monitoring, patient access tools.
[00:23:26] Sound interesting. We just talked about this. So [00:23:30] Salesforce virtual care solutions also include patient self-scheduling tools that suggest the right appointments for the patient at the right time, whether at home or in the office to reduce no shows, administrative costs. And time spent on calls, technology company.
[00:23:43] Salesforce has rolled out updates to its health cloud. That advances its strategy of providing a front door to electronic health records, which by the way, I think that phrase is wrong. We are a front door to electronic health records. I don’t want a front door to my electronic health. [00:24:00] I want a front door to my health.
[00:24:03] Anne Weiler: Or to, or at least to my interactions with my healthcare provider.
[00:24:08] Bill Russell: Yeah, it’s them. Somebody else wrote the article. They probably had something in their marketing and probably rolled their eyes when they read this. Ah, I can’t believe that’s how they put us the company, which launched health about 2015 as a patient relationship management tool added new tools that enable providers to reach patients where they are company executives said.
[00:24:28] So here’s the big [00:24:30] problem. I was a Salesforce customer. So we had an EHR, we have Salesforce. The integration was not simple by any stretch of the imagination and the especially scheduling. And I mean, there’s just a lot of challenges for it. The other thing is Salesforce is, might as well be another EHR it’s really expensive.
[00:24:50] Anne Weiler: Yes. Really expensive and requires huge amount of specialists.
[00:24:56] Bill Russell: Yeah, well, and that was the other thing. So we made small [00:25:00] pilots and small investments and every time we sat down, they were like the reason you’re not getting the most out of this tool is you need 15 people on staff dedicated to Salesforce.
[00:25:10] And eventually that number got to be 30 and I’m sitting there going, oh my gosh. I mean, just based on the amount of usage and the amount of people you’re asking me, this will literally. Be about the same size as handling my EHR team. Right. And it made almost no [00:25:30] sense, but still you have that, that need for something that the EHR providers are still clunky at, which is that patient engagement area.
[00:25:41] I didn’t really phrase that as question, but it’s more of does that tool that lives above the EHR, is there a space there or is that just getting squeezed to the point of, Hey, if I have Epic, I’m just going to wait for Epic to come up with their thing or,
[00:25:56] Anne Weiler: Yeah. I mean there’s a lot of that. [00:26:00] Definitely.
[00:26:00] I know the question is things shift. I mean, even in non-healthcare, right? Like where you go from the best of breed point solutions to the platform and back again. Right now I think Epic is trying to be all things to all people. Will that change? I think the other question is, is there a third party layer or is it like all these health systems have huge it groups that are basically trying to build that layer. And maybe they should, [00:26:30] because I don’t know. I don’t know what that layer looks like that brings everything together but you don’t have to manually bring together. Like it’s a weird thing. I mean, unless, unless you, somebody, at some point, I’m trying to remember who this was, but I looked at them, it really felt like their strategy was to get on a surround Epic and make them just be like kind of a database as opposed to an interaction.
[00:26:57] I forget what company that was, but obviously whoever it [00:27:00] was didn’t succeed. I think it was like a big tech company, but they didn’t succeed in it because that hasn’t changed.
[00:27:08] Bill Russell: It’s interesting cause I, I do a fair amount of our programming over here myself. We’re a small company and whatnot and we’re always selecting tools that have the a modern internet architect. So they have the interfaces, they’re designed to work this way. And for example you can go into our WordPress site, [00:27:30] you can register for something, it automatically moves it over into Zoho. It automatically signs you up for something else and I’m connecting to four different tools.
[00:27:39] But to the end user, they just went to our website. And in the backend, the people who are doing this stuff around the CRM have access to it there. And the people who are doing different aspects of our production whatever, have access to it there. The difference is that modern architecture is by design for most of these tools. They realize they [00:28:00] live in a world where they’re going to interact with things that they haven’t even imagined the different use cases. They just build the links. I use it, I use Zapier a lot and it’s an engine that just goes in and taps into these APIs and makes it really visual for me to go into. Those tools are not as prevalent in healthcare and I think the deficiency is the EHR providers haven’t wanted that and have not made the investment in that.
[00:28:29] Anne Weiler: Yeah. And they’re, oh, [00:28:30] not that we have time today, but at some point we should talk about with Jonathan, what’s his name? Sorry. Jonathan Bush is doing that.
[00:28:43] Bill Russell: Not, not today. I would love if anyone hears this and has access to Jonathan, I would love to have him on the show yet. The zoo, the zoo stuff is really interesting as is the other company that he helped foster up there in Boston as [00:29:00] well.
[00:29:01] All right. We’re always trying to learn from other industries. And that was sort of the point of my story of if we put the right architecture underneath this healthcare would be a lot better off but there are still people that are not incented to put that kind of architecture in place.
[00:29:16] Anne Weiler: Who’s going to do that? How are they ever going to get incentives?
[00:29:21] Bill Russell: It’s interesting because today’s Wednesday. On Friday, we released the episode with Glen Tullman from Transcarent. [00:29:30] So I interviewed Glen a week and a half ago and I asked him that question. What’s the future of the EHR. And he’s uniquely positioned to answer that question because he’s trying to disrupt healthcare with Transcarent. Has disrupted healthcare with Livongo and he used to be the CEO at at Allscripts. And he really just talked about the fact that the innovation has left the EHR. The innovators have gone outside and they’re saying we’ve got to do something completely different. [00:30:00] And so you don’t have the significant innovation. You also have fewer competitors. So you just don’t have the innovation that you once had in that space. They don’t have to move as fast. There’s no threat of anyone coming in and stealing your client. Cause it’s a couple of hundred million dollars decision every time you want to switch the EHR. And plus, you’re going to lose your job 50% of the time too, if you do it wrong. So there’s just not a lot of innovation there. So likely what we’re going to see. [00:30:30] We’re just going to see from outside somehow some way shape or form, and potentially what’s going to happen is the healthcare providers become acute care centers and a whole bunch of other care is delivered with with new technologies in different ways. Likely.
[00:30:49] Anne Weiler: Right. I hope so.
[00:30:50] Bill Russell: Yeah, me too. Here’s an article I thought was interesting. Digital patient experiences can take cues from consumer centric companies such as Netflix. So [00:31:00] what can, and this straight from the article, what healthcare can learn from Netflix. As it turns out, healthcare can learn a lot from the streaming giant, particularly when it comes to engagement. This was a talk that somebody gave, I should give them credit. Of course, I can’t find their name. So
[00:31:14] Anne Weiler: I saw this one too. It was League, which is actually, I’m not entirely sure what they do. I think there’s sort of an in-between insurance and provider.
[00:31:26] Bill Russell: Andy Harlan. He’s the head of platform [00:31:30] partnerships and business and new development at a cloud technology company called League. Okay. There you go. What can healthcare learn from Netflix? As it turns out they can learn a lot. When Netflix began, it offered DVD by mail service. Do you remember that DVD by mail? Do you know what the driver for Netflix was?
[00:31:48] He had a he had a video that was late. It was Apollo 13 and it was late and he had a $40 fee late fee on the video. And he’s this is insane. [00:32:00] This should never happen. And then he was also, he was looking at it and he said well there has to be a better way to do this and he looked at the membership model, he looked at his gym membership and he said, there’s has to be better model.
[00:32:13] That’s what he did. So they offer DVD by mail that engaged with its users based on a monthly or perhaps weekly basis. This is analogous to typical approach of health care providers. Which is touch base with patients only a couple of times, and in a given year flash forward to today, [00:32:30] and Netflix engages with its users on a daily basis through content streaming with customers able to access content at home or on their devices, anywhere in the world.
[00:32:39] It’s a model healthcare should emulate said Harlan. The healthcare system looks like my grandparents old fashioned cable TV. When people want Netflix, you need to expand your mindset and your addressable market. To do so Arland suggested thinking about a tenfold increase in interaction per year.
[00:32:57] The idea is to stop thinking about people [00:33:00] as patients and consider them instead consumers who should be known entities to hospitals and health systems before they need care. That’s what we can learn from Netflix. This isn’t the first time I’ve heard this concept. This is actually well-stated but it’s not the first time I’ve heard the concept.
[00:33:19] The question becomes given that it’s hard to make the transition, right? It’s incentives and payment models and those kinds of things. How do you [00:33:30] make the transition when Hey, they come in once a year and we get paid X. We want to touch them 60 times this year. And and knowing full well that your reimbursement from the payer or your reimbursement from Medicare is not going to cover a majority of those visits.
[00:33:49] If you’re sitting as a provider, that becomes the biggest challenge. How do you get past that?
[00:33:54] Anne Weiler: Well you become a payer. That’s what a lot of them do.
[00:33:58] Bill Russell: Yeah.
[00:33:58] Anne Weiler: It’s interesting if you look at [00:34:00] the payer provider pharma. Each one of those. So when people say healthcare each one of those is a huge industry on its own, but they all work together. Like where else do you have that level?
[00:34:16] I don’t know what differences and I have actually, if you think about where things have been disrupted before. It’s like supply chain, you have to let Amazon become it’s own supply chain. Looking at the pieces between them that’s not working and how do you actually disrupt [00:34:30] there? And when you were reading that to me, for the audience out there, you weren’t just reading it to me about how he thought about Netflix. That was where I was thinking. Okay. That’s actually how to think about it. Which is like, what are those assumptions that are wrong? Cause the core assumption there was that you can’t keep a DVD as long as you want. And Netflix was like, at the beginning, it was like, you can keep it as long as you want you just not getting another one, which is brilliant.
[00:34:59] Right? [00:35:00] So where’s the assumption of that? I think some people have tried to do this but it’s almost like you’ve got to do it through the entire process. Like I’ve seen that the assumption that it’s better to have a 10 minutes with the patient than an hour. There’s some things that you can’t do care outside the clinic, but it’s it’s almost like each one of those is chipping away at a little thing whereas Netflix in the beginning kind of just went to the core of Blockbuster’s business model.
[00:35:25] Bill Russell: Yeah. It’s interesting when you look that the DVD by [00:35:30] mail kind of thing that disrupted the go down to Blockbuster and actually pick it up and those kinds of things. And if you look at you, look at healthcare, you’re like, okay, there’s parts of it that are still like Blockbuster. There are parts of it that we call cutting edge that feel a lot like Netflix when you were mailing your DVD back and forth. But the way to make that transition is to really fully embrace the digital tools and to re-imagine what healthcare could be around those digital tools.
[00:35:59] And I know those [00:36:00] are buzzwords, but let me tell you what I, what I’m thinking. There’s an awful lot of ways to interact with your patient on a daily basis that isn’t going to cost you incrementally that much more money. Right. You can create scale around put a bunch of clinicians and nurse practitioners, whatever in a building and they are your digital arm and we’re not talking a thousand of them, we’re talking 50 of them because they’re going to be able to handle thousands of digital [00:36:30] interactions. And so you create that model. And now you can scale that way beyond what you could, the traditional campus and building and clinic.
[00:36:40] And you can increase your touch points, even if you increased it, you doubled it to two you’re better off than you were before, but just know this, every day, you don’t do something around digital there’s a competitor out there trying to figure out how am I going to deliver care with 60 touch points a year, a hundred touchpoints, a year. [00:37:00] 200.
[00:37:00] I want to help them with all their health decisions. Their eating, their exercise, their breathing, they’re caring for their parents. They’re figuring out their insurance bill. I mean all those are opportunities for a digital disruptor to come in and that’s where they live. That’s where they’re spending all their time right now. One of the things Glen and I talked about was when Haven failed healthcare breathe a sigh of relief and said see, I told you, so it’s a lot [00:37:30]harder than you think it is. And Glen came back with Transcarent. You know what Transcarent is? It’s Haven. I mean, I’m looking at him going, dude, this is all the promise of Haven, except it’s being built by somebody who really understands healthcare, really understands the incentives and has access to they’ve raised over a hundred million dollars already. So
[00:37:52] Anne Weiler: Understands the business side of it. I felt like Haven was a little bit too much think tank and not enough on the nuts and [00:38:00] bolts of how do you run the business?
[00:38:02] Bill Russell: Yeah. If I sound like a fan of Glen Tullman at this point, it probably is because I think everybody should listen to that episode.
[00:38:10] Anne Weiler: Well, I mean, he’s got an incredible track record. Does anyone else have that kind of record and healthcare? I don’t know. Allscripts. Livongo.
[00:38:18] Bill Russell: Yeah. And you know we were an Allscripts customers where I first met Glen. And one of the things is I came in from outside of healthcare and I’m like, Hey, we need an API and [00:38:30] Allscripts had it. Had a phenomenal API.
[00:38:32] We had no problems getting data in and out of Allscripts. Now we had Touchworks, we didn’t have their, they ended up buying an acute care hospital package, which was separate. And we had a different EHR for our acute care facility, which had no API. Like never even dreamed of an API. Would never even consider an API.
[00:38:51] It was like night and day. And that’s the kind of thinking I think that we are w we’re missing right now. I really wish.[00:39:00] Like this year I wish I saw a ton of announcements from Epic on how they are going to fuel interoperability and unleashe the healthcare ecosystem.
[00:39:11] But we haven’t seen it and you’re laughing at me cause you’re like, do you ever really expect to see that?
[00:39:16] Anne Weiler: That was why I was laughing. Yeah. Also it doesn’t really feel like the year where they need to do announcements. I mean and to their credit, right, there’s a lot, there was a lot of rapid change for COVID and they had [00:39:30] to take that on so
[00:39:34] Bill Russell: It’s 21st century cures. They have to be doing some work around interoperability and I think. Yeah. I mean, yes, I’ve been dying to see these announcements for the last seven years. So yes, I’m hopeful that we’ll see them sometime soon. And it’s always great to talk to you. We always have fun conversations. I really appreciate you coming on the show.
[00:39:58] Anne Weiler: Great to talk to you as [00:40:00] well. I always enjoy the conversation. It’s great fun to spitball on stuff.
[00:40:04] Bill Russell: Yeah. Well, we’ll have to get you back. You’re going to start something up again. You and I are going to think of something you’re going to start. You’re looking at me like I’m insane.
[00:40:11] Anne Weiler: I’m not ready. You need a break. I’m not Glen Tullman. He doesn’t need a break. He goes from one to another to another.
[00:40:20] Bill Russell: I know. And no one’s thrown 100 million dollars a year.
[00:40:23] Anne Weiler: Yeah, that’s true. If someone threw a hundred million dollars, lets just put this out there right now. If someone wants to throw money at me. I will do something in healthcare. [00:40:30]
[00:40:32] Bill Russell: All right. Sounds good. Till, till we get back together again. Thanks. Thanks Anne.
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