August 30, 2021: Dr. Eric Quiñones from World Wide Technology joins Bill for the news for some post HIMSS talk. Plus how can your IT team prepare for a COVID surge? Crisis teams have been sent to hard-hit COVID hospitals in Oregon. Tom Burton from Providence St. Joseph reveals how they are generating patient engagement ROI. NYU Langone experienced significant growth in digital engagement. The May cyberattack cost Scripps nearly $113M in lost revenue. And The National Emergency Tele-Critical Care Network (NETCCN) is here with their clinical care teams to help you.
Newsday – HIT Strategy on Surge Preparedness, Digital Foundations, and Engaging Patients on Bundled Payments
Episode 439: Transcript – August 30, 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: Today on This Week in Health IT.
[00:00:01] Dr. Eric Quinones: You have to be able to pivot. And if you don’t have that core infrastructure to be able to be agile, you don’t know what’s going to be thrown at you.
[00:00:09] Bill Russell: It’s news day. My name is Bill Russell. I’m a former CIO for a 16 hospital system and creator of This Week in health IT. A channel dedicated to keeping health IT staff current and engaged.
[00:00:24] Special thanks to Sirius Healthcare, Health Lyrics and World Wide Technology who are our Newsday show [00:00:30] sponsors for investing in our mission to develop the next generation of health IT leaders.
[00:00:34] Just a quick note, before we get to our show, we launched a new podcast Today in Health IT. We look at one story every weekday morning and we break it down from a health IT perspective. You can subscribe wherever you listen to podcasts. Apple, Google, Spotify, Stitcher, Overcast. You name it, we’re out there. You can also go to todayinhealthit.com. And now onto today’s show.
[00:00:57] Today on news day, Eric Quinones, [00:01:00] Dr. Q with World Wide Technology is here to discuss a lot of different topics and we’re looking forward to that. So Eric, welcome back to the show.
[00:01:08] Dr. Eric Quinones: Thank you Bill.
[00:01:10] Bill Russell: Yeah, I’m looking forward to this. There’s a lot going on in healthcare. You just got back from HIMSS. So we can have a little conversation of what went on at HIMSS and those kinds of things. We’re going to cover a bunch of stories straight out of HIMSS. These are the presentations that went on. A great one from NYU that we’re going to cover. There’s one Providence St. Joe’s talking about bundled payments.
[00:01:29] I think [00:01:30] that’s a good one. Tom Leary from HIMSS talked about patient identifier. So we’ll hit those things but you were actually on the. But you were on the safety committee. Is that what you were a part of?
[00:01:39] Dr. Eric Quinones: Yes. I was a part of the health and safety committee for HIMSS. It was made up of myself Dr. Kohler at World Wide Technology and a few others. We started way back in March to to really
[00:01:55] Bill Russell: It was a different world in March, wasn’t it?
[00:01:58] Dr. Eric Quinones: Very a different world [00:02:00] Bill. And it kept changing as we know and as things change, we had to change and pivot our strategies and how we’re going to handle this. But I think from the get-go we unanimously believed that we had to have a a mandate if that’s a bad word or not, but we had to have a way to control the bubble, if you will of HIMSS and the easiest way to do it was to ask everybody to be vaccinated appropriately and fully vaccinated prior to coming to [00:02:30] HIMSS.
[00:02:30] Bill Russell: But that’s part of the challenge. You really can only control the bubble. Like the the, the floor, the booths, the, I mean, that’s the only part we can control. And when I heard people saying, Hey, the reason I decided not to go was because it’s Vegas. And Vegas is Vegas. I mean, it wasn’t, it wasn’t that they were concerned about the conference itself. In fact, Drex last week said if the conference were anywhere else, we may have gone.
[00:02:57] Dr. Eric Quinones: Right. Right. And you’re absolutely [00:03:00] right. So we knew that within the reality that we live in, we couldn’t control anything outside of the bubble. Yeah, we were fortunate that the Nevada gaming commission and the state of Nevada actually mandated masks wearing as well within the casino.
[00:03:13] And surprisingly when walking through the venues and walking through the casino, what I noticed where non attendees were compliant, they were wearing their masks and folks that I just thought maybe they just [00:03:30] didn’t or wouldn’t care, they would walk in off the strip into the casino and put their masks on.
[00:03:36] So people were pretty pretty compliant with that which made me feel comfortable and I’m sure others. But you’re right. You can’t control things outside of the bubble. And we knew that from the get-go,
[00:03:47] Bill Russell: I’ll tell you that people who went and told me it was a really great conference. You cut the number from 40,000 to whatever the number ends up being. They’d announced that prior to the event, it was somewhere around 18,000 or plus. [00:04:00] And we don’t really have a final number yet, but when you cut that event down, I could see it just being much more personal, much more intimate. A lot more access to the speakers, a lot more access to each other. And I mean, not that there isn’t a place for a 40,000 person event, but you know, some of us just want to be with people again. I mean, that was one of the reasons I really was sad that I wasn’t able to go.
[00:04:24] Dr. Eric Quinones: Right. A hundred percent. And when we first started opening up here in California, it was [00:04:30] nice because, so my kids play plays for us to play soccer and to be able to get back out on the pitch and to see them doing what they do best. And to see the smiles on their faces was really heartfelt and was very positive. But we haven’t had meaning on the adult side, the professional side, we haven’t had that opportunity.
[00:04:52] So HIMSS was kind of like going to the soccer pitch for me. And it was great. It was seeing a lot of great colleagues that I [00:05:00] haven’t seen in a long time. And being able to reconnect was very valuable. And I think the level of conversations that I know I had we’re very meaningful and I can say that for sure. And I actually had more time now to actually attend some really I felt important sessions, so that, that was also nice.
[00:05:23] Bill Russell: Yeah, I’m cheating. What I did is I went through looked at all the sessions and then invited the people on the show [00:05:30] that I wanted more information on the sessions and they sent me their slide decks. And I’m going to do one of those interviews afternoon. I’m looking forward to it on data supply chain. So it’ll be fun. And we’re going to hit five stories here real quick. You know your, your kids are into soccer and a friend of mine just said, Hey, you, you have to watch Ted Lasso. So have you happened to see Ted Lasso?
[00:05:48] Dr. Eric Quinones: Yeah
[00:05:49] Bill Russell: Not that that’s the kind of thing you watch with your kids, but it is exceptional. It was it’s so good. I can’t believe how good it is.
[00:05:54] Dr. Eric Quinones: They did, the writers did a great job of that, and it’s not overly you don’t have to be a soccer fan or [00:06:00] football found to really love it. Right. It’s just more about the characters and his particular characters is so positive putting a situation that he has no business being in, but yet he’s just got this attitude that just radiates.
[00:06:13] I put it this way. He’d be a coach that I think most people would like.
[00:06:16] Bill Russell: Oh yeah. Well it’s not that he’s niave. This is what I like. He’s positive, but it’s not that he’s naive. He sees it all. He just chooses to respond in the positive. So it’s really, anyway, it’s, it’s really exciting. So my wife and I [00:06:30] just finished watching all the episodes up until the one that gets released tomorrow. So we’re, we’re all cut up and ready to go in season two. All right. Let’s, let’s hit a couple of these. Biggest story right now is the surge, obviously that’s going on and we’ll touch on this briefly.
[00:06:45] And here’s the story that I pulled on this. And it happens to be a CIO that I was in contact with this week and had texted with earlier who’s affected. So Oregon is hit pretty hard. Crisis teams are being sent to hard hit [00:07:00] COVID hospitals in Oregon. Essentially what happened is the state governor went out and contracted with a firm staff medical staffing company.
[00:07:08] They have 500 some odd care medical professionals going around. They have some breakdown of the numbers here, 61 certified nurses, 20 paramedics, 34 respiratory therapists, so forth, but they’re going to be sending them to places like let’s see St. Charles health system in bend and Redmond, Oregon.
[00:07:29] These are mostly [00:07:30] the rural areas. Portland is doing okay right now. It’s the remote areas, Southern Oregon to support Asante hospital in Medford, Ashland and Grants Pass as well as Providence Medford medical center and Mercy Medical center in Roseburg. So they’re going to be sending all those people out.
[00:07:45] And I don’t really want to talk about the surge per se. What I want to talk about is really getting ready for that as an IT organization. Because there’s a lot of stuff to do. I texted with one of the CEOs at one of those health systems [00:08:00] and they were just talking about, Hey, we’re right back into the thick of things converting their, our spaces and other spaces into ITU spaces are ICU spaces.
[00:08:10] And they have all these people coming in. So there’s a lot of it related activities. You would think we have experienced with this over the last year and a half, but not every area searched some of these areas, this is potentially the first real search that they had, even with the [00:08:30] initial bout with the pandemic. It sort of came in in early spurts early on and Southern Oregon is one of those where it never really surged in the first half, but right now it’s overflowing. Their hospitals are incredibly full. How can an IT team prepare from your perspective for the tasks and things that they need to put together to take on these new staff people that are going to be showing up?
[00:08:54] Dr. Eric Quinones: Right. Right. So there, that’s a huge logistic issue, [00:09:00] as you can imagine you, new people coming into your environment, be part of a care team, if you will, to be able to triage patients, to be able to identify those that do need to be admitted. And those that maybe just need to be surveyed maybe at home. So there’s a lot of things that go into play there. Early on in the pandemic I was involved with, so Mtech, which is the medical technology enterprise [00:09:30]consortium, which is made up of the military and academic and also industry as well. It’s basically a way that the government fast tracks ideas to get implemented when situation, when they need these kinds of technologies.
[00:09:47] So Mtech actually sponsored what was called the National Emergency TeleCritical Care Network in the early days of the pandemic. And with this was put out as a think of it as an art. [00:10:00] Out in public and about 79 folks 79 teams, I would say actually responded of those nine were selected of those it’s down to four.
[00:10:11] And we’re part of one of those teams that my previous employers which is awesome. And what we had to do is come up with a platform to be able to quickly bring up pop-ups if you will, or situations where we would use either hospitals, brick and mortar [00:10:30] hospitals, o schools, auditoriums concert facilities, whatever have you, but to bring up those, those mash units, if you will, and not just that, but also the infrastructure and the technology and the staff to be able to help triage patients and to care for them appropriately. And so and part of that was to be able to monitor patients remotely in the event that they did not need to b e seen in a more higher acuity [00:11:00]environment. So, so anyway, fast forward at HIMSS as a matter of fact on the DOD side and the DHA side of HIMSS they were promoting the national emergency tele-critical care network NETCCN. They were basically letting folks know that, Hey, this is available to you.
[00:11:18] You just need to sign up and you’ll be connected to the right team and they can come out and help you actually with the logistics and a lot of the technology platforms that you really need. [00:11:30] So it’s not like it hasn’t been done. So I guess instead of reinventing the wheel my bias would be to reach out to N ETSCCN.
[00:11:39] Bill Russell: Yeah. So those teams coming in, I just jotted down a couple of things, as I was thinking about this you want them to practice medicine. Right. So you want them to come in and get practice medicine as quickly as possible. So they, if they’re coming inside your four walls of your hospital, they’re gonna need access to your systems while standing up groups [00:12:00] of 30 or 40, that is a logistic logistics challenge.
[00:12:04] Hopefully you have the tools to provision and deprovision users pretty rapidly and pretty effectively. Grant the right access to tools and permissions that they need. If you’re going to give anyone access to your network, you obviously have to do some training. They have to understand your documentation procedures within a certain parameter to be able to do things, obviously you don’t want to hinder them delivering care, so however you do that, maybe you’re using scribes. [00:12:30] Maybe you’re using something to sort of create a barrier. I’m not sure what you would do there. It really depends on your budget and depends on what you’re trying to accomplish there. The other is any time somebody accesses your network, concerned about the cybersecurity risks. I wouldn’t be giving these people access to email. I wouldn’t be giving them email accounts or those kinds of things, unless it was required to provide care within your health system, in which case you have to. And if you do then there’s just different levels of training that they have to go through.
[00:12:58] If they’re going to be [00:13:00] accessing your thing. And then obviously I think the last thing for me is information. They they’re gonna need access to information if that’s your EHR, just for the basic medical record, but also probably some analytics. Somebody needs to be looking at the bigger picture.
[00:13:13] I’ve thought of some questions that I have. As I’ve seen these numbers and these numbers are too generic for me. I, I have too many questions. So they say this many unvaccinated and this many vaccinated are coming in and it’s like roughly 85, 15 percentage [00:13:30] wise. And I say the 15%, I want to know, I want to know which vaccine, right. So if it’s 15% and they’re all Pfizer, I want that information aggregated as quickly as possible so that we can escalate that. And someone’s looking at it going, Hey, Yeah this Pfizer vaccine needs a boost a lot quicker than we thought, or if it’s modern or whatever it is. So there’s, there’s analytics around that that I’d want to know.
[00:13:53] I’d want to know how many people that have had COVID are coming back in with COVID a [00:14:00] second time. If that’s even a thing. I would assume it is a thing. And I, I would want to know those percentage. I, I I’d want, I’d want to know so much more detail. I’m seeing these charts and they’re great charts, but I’d want so much more detail.
[00:14:13] So you know, I, I think the information and the analytics team. Need to be agile and really go on overdrive. And it’s really almost a demand driven in a Linux effort that’s going on right now. It’s just what do you need? This is what I need. Look at the data [00:14:30] supply chain and build those things as quickly as possible.
[00:14:32] I think when the surge is going on, those teams need to be incredibly dynamic. Let me ask you this, from an education standpoint, I’ve seen some good posts and I saw you. You highlighted one of the posts where health systems, we went through this shaming phase of, I can’t believe you’re not getting vaccinated.
[00:14:51] And as it’s sort of like looking at your kids saying, I can’t believe you didn’t do your homework. They just sort of looked at you like, okay. But once a kid understands, [00:15:00] Hey, I want to go to a certain college cause I’d like to see Ohio state football games and whatever. And the GPA required is X.
[00:15:07] Once you educate them, they sit there and. Hey, you know what? I think I’m going to do better in school cause I want to go to Ohio state and watch the football games or whatever whatever it happens to be. And I’ve started to see some better posts Lee Milligan at Asante put out a post just as the statistics.
[00:15:23] Hey, 85% unvaccinated, 15%. It’s a nice graphical chart to just look at it. A number of people who are vaccinated [00:15:30] in ICU is only two. And the number of people unvaccinated is like 30 some odd. So percentage wise that tells a story. And I think it tells a good, it’s an education story. It’s not a guilt story. It’s not a shame story. It’s a really good way of doing that. Have you seen some others that they’re starting to really go after this educating people through social media or other platforms?
[00:15:53] Dr. Eric Quinones: Yeah, I mean, I think that’s been a big thing when we see the, I saw something just the other day, [00:16:00] it was kind of sad to see, but because the clinician was so overwhelmed, the headline was basically, I just don’t have empathy anymore for folks that are not getting vaccinated because he’s taking on so many back unvaccinated patients in the ICU for COVID. And that’s kind of hard. I get that because there’s a ton of reasons why they may not have gotten vaccinated and I don’t want to get into all those, but I think your point is really well taken.
[00:16:26] And I think that we live by the numbers at least most [00:16:30] of us, we try to live by the numbers and numbers can really tell a great story. And what you’re saying is really important. So yeah, I am seeing that more and more. I am seeing folks that may have a platform, if you will, a voice that folks follow, whether they’re celebrities, whether they’re of some sort of celebrity, but you know, they’re actually touting those numbers and saying, look, it’s, this is why it’s [00:17:00] important.
[00:17:01] Every, every bed that’s taken up in the ICU from a patient that is COVID positive. You know that didn’t have to be there because if they were vaccinated it has taken away a bed that, you know, somebody that doesn’t have COVID, but has another maybe medical or traumatic injury.
[00:17:17] Bill Russell: I happen to be sitting in a chair yesterday, getting my haircut and the person happened to give me a I mean clearly non-vaccinated, doesn’t want to get vaccinated has listened to all the myths. And [00:17:30] she said, well my sister got COVID from getting the vaccine and I’m like, really?
[00:17:34] Which vaccine did she get? She said oh, she got the Pfizer vaccine. I’m like, you realize that’s impossible. And she goes, oh no, it’s not there’s a lot of cases. I’m like, no, it’s impossible. There’s no virus in the Pfizer vaccine. It’s not a traditional vaccine. Right. When you get that information out, I can have a conversation with someone like the hairdresser to say, what you are saying is a myth and they have five [00:18:00] myths on it, down the left side.
[00:18:02] It changes your DNA. The vaccines were rushed and are not safe. They are new and much is unknown about them. It makes women infertile. It makes you test positive for COVID-19 on a viral test. And these are questions people really have the vaccines are rushed and not safe. And I’ve heard this over and over again from people.
[00:18:23] And it says MRNA vaccines have been held to the same rigorous safety and effectiveness standards as all vaccines [00:18:30] in the US and MRNA is not new either. We’ve been working with MRNA for, for decades. And look, I got the vaccine. There are people in my family, my direct family that have not gotten the vaccine. And that’s their choice.
[00:18:43] I don’t have a problem with them not getting the vaccine but I want them to know the facts. And I think that’s, that’s the kind of stuff I like when we’re doing as health systems, where when we’re educating people because if you want to get the message out, it’s not your post, that’s going to do it. It’s someone who reads your [00:19:00] post, that’s going to do it and goes and gets their haircut and talks to a family member or that kind of stuff. So I think the education stuff goes far more far better, and the empathy for for healthcare workers. We have it because we’ve worked in healthcare, but the average hairdresser doesn’t really unfortunately.
[00:19:22] Dr. Eric Quinones: And I think you’re right. A lot of folks are speaking from a place where they haven’t been in the situation where they’ve cared for patients at bedside.[00:19:30] And my colleagues have, I have, and it’s when you’re in there doing it, and then you’re doing it, you’re focused on the patient. You’re focused on their outcomes. Right. And then you stop and you think like, why did they come here? Why did they get here? How did that happen? What was the story behind that? In the ED right, there’s a lot of reasons why people come into the ED. And especially prior to COVID there’s a lot of different reasons that people are [00:20:00] coming to the ED.
[00:20:01] And then when you look at when that patient ends up in the ICU that that patient journey has been a downward spiral, but maybe it didn’t have to be. And again, it goes back to your point because of the information they may have been listening to it wasn’t factual.
[00:20:18] It was again, maybe coming from their hairdresser in this example. Right. And they act on it. And again, that’s, I don’t think people necessarily ask the questions that they should [00:20:30] ask. Dig deeper. Really look at where the facts are coming from. Investigate yourself.
[00:20:36] And I get that. I get that. That’s just not maybe general human nature. But to question, right, to hear some of these some of these reasons why a vaccine is bad is bad for you is actually, you can write that stuff in Hollywood, quite frankly. So I trust the science, I’m a scientist.
[00:20:59] And I’m [00:21:00] going to continue to trust the science and look at that. But I also question the science too. So but again, consider the source where you’re getting your information.
[00:21:09] Bill Russell: Yeah. Absolutely. All right. I want to hit some of these stories. COVID-19 accelerates ongoing digital transformation efforts at NYU Langone. So NYU is one of the first hit. Downtown New York City. And let me just give you some of the some of the story. So because of this because of its investments in its foundational [00:21:30] technology, NYU Langone in New York city was able to quickly scale its digital solutions. Not only to meet clinical demands, but also develop ways for patients to access care despite the physical restrictions inherent in various pandemic protocols, NYU Langone experienced significant growth in digital engagement. As a result, Nader Merabi who has been on this week and health. It is their EVP, Vice Dean and Chief Digital and Information Officer. My gosh, he has four titles. That’s a [00:22:00] lot to do. Spoke on this issue at HIMSS 21 in Vegas. It was titled Riding the wave of digital transformation. How technology can enhance the patient experience. And he said in the past eight years, we’ve focused on building the, found a fundamental platform of digital infrastructure from each ours to connecting in the cloud in the right way to AI and machine learning.
[00:22:22] All of these fundamental building blocks, you need said, Merabi, you need to build your digital experience. On top of that, the sound digital [00:22:30] strategy he said is about synergy from the operations team. To the technologists and even marketing all constituents need to work together towards common goal. All right.
[00:22:38] So let’s stop there. There’s a lot in this and I do want to read a little bit more later on what NYU did, but if we stop there, what is it, I mean, there’s two key points here. One is they were able to scale because they had put in the right fundamental platform. And so what does that mean? And we talk about synergy of operations, and we actually talked about it a lot on the [00:23:00] show cause people will tell me that’s an operational project or that’s a clinical project.
[00:23:05] And what we used to do is everything was an IT project that had clinical involvement. And now we’re starting to recognize that a lot of these are operations projects or clinical projects that have an it involvement, which is a completely different way of approaching these things. So You picked this story. What struck you about this story?
[00:23:23] Dr. Eric Quinones: Like you said, a couple things jumped out at me was, one that NYU Langone had [00:23:30] the foresight to pay down their technical debt early on. And they were really bringing in an infrastructure, core IT infrastructure that can support not just cloud, but AI and other initiatives that they were looking at to do. They knew that they had to do that to be able to grow and be competitive and, and all that stuff. One of the things I heard at HIMSS at in the future of healthcare presentation was a new [00:24:00] technology. Plus an old organization is a costly old organization. Okay. Right. So I think they, they saw the crystal ball and knew that this had to not be the case.
[00:24:13] And so that was one thing I think they did exceptionally well. Yeah, the other thing is they’re thinking when it comes down to collaboration, so whatever the objectives are and the projects they are there, they’re bringing in the right stakeholders, the end users. And so they call [00:24:30] it, I think, design thinking which is really human centered process problem solving. And so they do that and bringing in all the right stakeholders to, so IT supports right. A lot of these initiatives whether it’s clinical, where it’s on the business side, but IT supports that looking at the current infrastructure and what, what tools do we have to actually do the, solve the problem.
[00:24:53] And then on the end user side, is it going to cause more friction? Does it reduce the friction for all those [00:25:00] people that are that are involved. So I think that’s, that’s really the two points that jumped out at me on this and kudos to them for really driving and being ahead of the game here.
[00:25:12] Bill Russell: Yeah. This is where we were. When I talked to people, I talked about the importance of architecture. You gain agility and you talked about retiring debt, which is also part of good at architecture, right? So it’s knowing what parts of the building are sound and what parts of the building need to move on as it, [00:25:30] but in our world it’s not because its dilapidated and falling down it’s because they can’t keep pace with the agility that’s required moving forward. And we have all sorts of new internet based technologies, APIs. We have new tools like AI and machine learning. We have telehealth, which has just grown and telehealth is just a combination of technologies.
[00:25:51] It’s a video technology, it’s an audio technology, screen capture technology. There’s a bunch of technologies that come together and it actually, it’s a good example. [00:26:00] Well you take those technologies and you deploy them at scale and you can take your telehealth from a hundred visits one month to 25,000, the next, because it’s architected correctly and a lot of people were able to do that because it was architected correctly because they chose a cloud provider.
[00:26:17] A lot of times we do things, build your own. And I’m a fan of build your own and in a lot of cases and other cases, we’re not ready to build our own because we haven’t we haven’t mastered the [00:26:30] internet architectures yet that we need so that we can scale these things up. Here’s some examples of some of the things they did.
[00:26:36] The academic medical centers, digital efforts have been consistent and progressive throughout the pandemic. In particular, it created an AI risk scoring system for COVID-19 patients. Phenomenal. Created a comprehensive coronavirus dashboard for clinicians and executives. Again, fantastic. Supported the peak of more than 7,000 virtual patient visits in one day received an FCC grant has played telehealth in converted ICU rooms [00:27:00] and began messaging patients to schedule vaccine appointments.
[00:27:03] These changes all occurred very rapidly because they had that infrastructure where they said, okay, we need to start doing, and we don’t know what to use case. Right. This was a pandemic was a great example of, we don’t know what the use case is tomorrow. Therefore, the infrastructure needs at its core. It needs to provide the one thing that needs to provide is agility. Now, obviously these provide security. It needs to provide performance and all those [00:27:30] things, but it needs to be agile as well, so that you can go, all right, where are we going tomorrow? Oh, we have to get all these people vaccinated. Okay do we have a way of getting information out to them? Oh yeah. We thought about that when we put our digital tool together. Cause you know, if you just have it in your digital tool, they may not open that digital tool because they’re not going to the hospital. What we found is people only go when they’re going to a doctor’s appointment or going to the hospital. So you need, I mean, just basic texting actually is a very effective [00:28:00] tool for getting the word out.
[00:28:01] Dr. Eric Quinones: It is. Yeah, no, I think those are great. You nailed it. I was thinking again, you have to be able to pivot. And if you don’t have that core infrastructure to be able to be agile, as you said you don’t know what’s going to be thrown at you. And because they did that, they were able to do a lot of things, a lot of things in less than one year. And you think about it if they wouldn’t have done those, those things in terms of creating that core IT environment, how long would it [00:28:30] really have taken them to do all those things.
[00:28:32] Bill Russell: So I want to hit this story with you because I think it’s really interesting and I think we’ll have interesting perspectives on it, which is Providence St. Joe’s had a Tom Burton director of operations and of orthopedics in neuroscience at Providence health. And he was talking about the bundled payments, right? Total hip and knee replacement bundles from CMS spurred risk bearing organizations to seek new ways to maximize savings. That’s the title of the [00:29:00] presentation? I don’t know if that’s the title, but that’s the title of the article. And so Burton talked about it and he said we tried this way of measuring the physicians and clinicians and doing all these things to try to make sure because here’s what happens. Right? So CMS goes out, they look at knee and hip replacements in a certain geographic region, and then they get an average and then they say, that’s what we’re paying.
[00:29:26] Right. So Providence is automatically signed up for whatever reason. I’m not sure [00:29:30] why, but he says it in this article that we were automatically signed up. All right. So now they’re on the hook for. All let’s just for argument’s sake, let’s just say knee replacements, all knee replacements for a certain amount of money and that’s from diagnosis to complete rehab.
[00:29:45] So in a lot of cases, this is going to sniffs, his is going to outside care. And so it’s not even all managed within the four walls of your acute care facility. And they looked at it and said we’re a risk-bearing organization. Now [00:30:00] this is the number we get. Our cost is higher than this. How do we get there?
[00:30:04] And their first approach was to look at the, to try to knit that whole thing together and put metrics around it and put things around the physicians to get there and it didn’t get them there. And so they changed the approach and went the patient route and said, we’re going to educate the patients and have the patients really drive this thing.
[00:30:24] And that was successful. It’s really interesting. You picked this article and I love [00:30:30]this article. I mean, I can read more of it if you want me to read that, just sort of gave a synopsis but is that a model that we should be really looking closely at for other health systems?
[00:30:40] Dr. Eric Quinones: What I liked about it was it kind of, it flipped the script in terms of, instead of putting this on just alone on the clinicians, but also putting something. Responsibility in a way, if you want to think of it that way on the patients, right. That’s more scalable, number one. But you have to engage them in a [00:31:00] positive way that they’re going to want to take ownership and they’re going to be educated and why why am I doing this doctor?
[00:31:07] So they need to know why they’re doing it. And obviously to have good outcomes so they can get back in ambulation and do the things that they love doing to be able to spend time with their family, go on, walks, whatever they do. Right. But it has to be shared with them that’s really meaningful in a way that this is why you’re doing it. So I think they did a really good job here. It kind of [00:31:30] flipping the script and they use technology to help do that. So if you want to read on yeah, I think it kind of explains a little more and I think you want, before you do that, they had to take a snapshot of the current state. So looking again, how much are they at risk?
[00:31:45] So looking at the snips again, what patients have been, what they’re going to a skilled nursing facility, they saw a 30% patients at about 30% of the patients actually went back to the hospital, [00:32:00] were readmitted. That’s a big number. So that’s that alone, you have to find a solution for that.
[00:32:07] So there was a lot of reasons. And I think putting the responsibility the physicians to educate and do that it’s not scalable. They’re doing everything they can, but to have technology help in that respect, I think was the right way to go.
[00:32:23] Bill Russell: And that’s essentially what they did. They found ways to engage the patients from the diagnosis all the way through the entire process. [00:32:30] Right. So they were able to communicate with them and help them through the process. It says Providence was able to save $365 per joint replacement resulting in roughly quarter of a million dollars in savings annually.
[00:32:43] But the re-admissions was 831,000 per year which is a significant savings. And really it was, it was just that transition of saying we’re putting it on the physician who were already pretty well burdened with stuff we’re giving them to do to [00:33:00] what, we can do this through technology.
[00:33:02] They used Twistle, I believe. Yeah but you know, there’s a lot of different ways to do this, actually to create a good engagement strategy. And they were able to decrease decreased length of stay, increased, discharged straight to the home bypassing sniffs all together. And it was all education. People thought, well, this process is baked so I have to go from here to here, to here to here and instead they got educated and they got. Hey, you know what? I don’t fit that category. I probably don’t need to go here. I can probably just go straight to my house. So they’re the [00:33:30] ones having a more informed dialogue with their physicians and that’s that’s always great to have that level of it’s good to have an engaged, informed patient, I guess.
[00:33:44] Dr. Eric Quinones: Well, and I think I’m gonna engage, inform patient. And again, getting back to our earlier discussion regarding the informed part. Getting goo d evidence-based information, right? Not some hairdresser [00:34:00] stuff, but really evidence-based information.
[00:34:02] Bill Russell: Are you getting on my case because I talked to my hairdresser about it and actually to be honest with you, I didn’t even bring it up. I made the mistake of wearing my hat which said This Week in Health IT and she saw the hat and she goes healthcare huh? And then she gave me her, all of her theories and everything on the vaccine. I was like, okay,
[00:34:21] Dr. Eric Quinones: It’s good and good for them for doing this. This is this is great.
[00:34:24] Bill Russell: You picked out, we talked about this story. I talked about this story last week with Drex. You picked out this story. I’m curious [00:34:30] what your take is on it. The may cyber-attack cost for Scripps. Scripps they had to report their financials and in their financials, they talked about 113 million in lost revenue as a result of the ransomware attack. About 15 of that they’ll get back and insurance, but the overall revenue hit was about 113 million. What jumps out at you on that? What aspect of that story do you think is important?
[00:34:54] Dr. Eric Quinones: I think what’s important there is that one, as an organization Scripps what is a medium [00:35:00] size healthcare facility? About five hospitals or so, and under 20, I think outpatient facilities.
[00:35:09] So they’re responsible for a pretty tight knit population and one it’s very bad that any organization you’d be hit this way. It’s how to ransom if you will, or cyber attacks and breached. But another is when that information is actually stolen. [00:35:30] So there was also financial and healthcare information that was taken, went from about 147,000 records.
[00:35:37] So or patients. And so there’s that component of it too. It, it hurts them from a credibility standpoint. There’s the direct cost that we can, we can look at, but there’s that indirect cost as well. Do patients trust them now and things of that nature. And I think with some of the lawsuits that, that I think are facing [00:36:00] them we’ll see as time goes on, but could these things have been avoided if they’ve taken a stronger stance on zero trust. So I again, remains to be in to be seen but you know, this is a significant.
[00:36:16] Bill Russell: Yeah. Here’s my take in a sentence. It was Scripps is three billion. A $3 billion health system, clinics, hospitals you name it across San Diego. It’s pretty much in that market. They lost [00:36:30] over a hundred million as we talked about. 30 day ransomware event. They were essentially down for about 30 days. EHR was offline for, we don’t have the specifics yet, but for at least 20 days the EHR was really offline. And what I said is if I were a CIO today, I’d be using that information to estimate what my health system’s vent exposure would be. So for instance St Joe’s was six and a half billion so roughly double that size. If we had an event, it would be probably 200 plus million in lost revenue. [00:37:00] And I said I get that number in my head, 250 ransomware events, roughly 250 million in lost revenue for our health system.
[00:37:08] And then what I’d do is I’d go in and start talking to the executives and eventually to the board about getting about 10% of that number. Over the next 18 months to spend on cyber security, to make sure that we can avoid that $250 million outage, which as you noted, comes with a lot more baggage. I mean, you end up with reputational loss, you end up with lawsuits, you end up with a lot of other [00:37:30] challenges and and quite frankly, I would want that money cash upfront. I want to start investing in ransomware. A lot of times comes through the front door, which is your email system. I’d make sure that that was locked up pretty good. I would look at you know your processes and your procedures. A lot of stuff is human error, which causes the the gaps.
[00:37:56] I’d look at smart tools that are going to be able to know [00:38:00] what’s going on on our network. It turns out that these people are on our network for close to three months. Before they actually launched these events. So as the the CTO for Proof Point was on my show and he said how would you feel if I told you, Hey, I’m going to go ahead and put someone in your closet, in your home for the next three months to observe how you’re I’m like, that’s kind of creepy.
[00:38:25] He goes, that’s what they’re doing in our health systems right now. They’re on the network [00:38:30] watching what you’re doing. He goes, it is creepy. And we need to know that they’re on there so that we can limit what they’re doing. It’s usually a three month lag or lead time before they actually launch an attack.
[00:38:42] Dr. Eric Quinones: That’s a visual that I’m not going to get out of my head. Now it’s going to haunt me somewhat.
[00:38:47] Bill Russell: I’ll tell you, I’ll tell you thatv isual is in every CEO’s head right now and they’re, I know a lot of them. A couple of them, I have talked to, have [00:39:00] gotten board approval to escalate some spending on cybersecurity. I think that’s the right move. If you’re a health system of a certain size of billion or more. I would talk to the board, make them aware of what’s going on. Don’t assume they know what’s going on. We live in healthcare, so we’re like, everybody must know that healthcare is under attack. They may or may not know some of them are running businesses. Some of them are very busy people. You might need to educate them on. Hey, did you hear about the script’s event? Let me tell you about the scripts, but let me tell you about Sky [00:39:30] Lakes Medical Center. Let me tell you about, and you can just go through, I mean all the incidents are there.
[00:39:35] I mean, some are more detailed than others, but you can share that information, make them aware of the risk and exposure. And I think you have to end that conversation with an ask for money and say, look, good, cyber security costs some money. And and I don’t like the throwing up your hands that I’ve heard from some where it’s like if someone [00:40:00] targets us, they’re getting it. I’m like, that’s not, that’s not acceptable.
[00:40:04] Dr. Eric Quinones: That’s not acceptable. I mean, if you think of the logic you just said okay let’s say $113 million, that actually were indirect costs, right. And direct cost. So that was the loss of revenue plus the cost of consultancies to help get them back on online.
[00:40:22] That was for about a 25 day period. Let’s say that’s quick math, 4 [00:40:30] million, four and a half million dollars per day. Okay. What they’re getting hit on, and then you think of, okay, you said 10% take 10% of your budget or what your, what that cost was. So 11, 11 million to $13 million or $12 million, whatever it is. So say 12 million bucks over what’d you say? A year and a half year period?
[00:40:53] Bill Russell: Yeah. It’s going to take me 18 months to do the projects I need to do anyway. So no need to ask for more money than that. [00:41:00]
[00:41:00] Dr. Eric Quinones: Right. So then let’s just say that you were paying for 4 million, four and a half, a million dollars a day. You can break that down that 13, 12, 12, 13 million to
[00:41:12] Bill Russell: Three days.
[00:41:13] Dr. Eric Quinones: Yeah. Well, not only that, but let’s say if you compare to for an 18 month period, you’re paying about $20,000 a day on, on the cost to bring in that infrastructure up to snuff, right. Versus the four and a half million dollars. So yeah, it just makes a lot of [00:41:30] sense to ask about money. Get ahead of it. You don’t want to have this kind of headline about your organization.
[00:41:35] Bill Russell: Yeah. And for those who were saying, bill, you talked about this last week, you gonna talk about this every week. I’m like, this is important. I hope everybody gets that story and is putting a slide deck together. If they want a slide deck, shoot me a note. I’ll throw one together for You It just needs to be four or five slides. Put it in front of people and said, here’s what’s going on in healthcare. Here’s what our exposure is. Here’s what I’m asking for. It’s almost that simple. It’s not a 20 slide slide deck. [00:42:00] It’s a five slide slide deck to really set it up.
[00:42:03] Dr. Eric Quinones: Yeah we’re hvaing these conversations today with our clients and this is a, it’s really important because this is some of the work that we do and helping them get ahead of it, it’s really a critical.
[00:42:13] Bill Russell: Yeah. And then the other thing is, if you don’t know what you’re doing and you get the money. Call somebody. There’s a lot of really good people to help you. And I’ll be honest that people are like, oh Bill, you probably didn’t call anyone in.
[00:42:26] I had consultants all over the place where I was. I mean, we had [00:42:30] our auditor was there on an ongoing basis, helping us. We had a well WWT was there as well as others that I utilized. And so, yeah, there’s going to be areas where your team is not as strong as a consultant’s going to be.
[00:42:45] Yeah, go ahead. Go ahead and bring them in. That’s. What they’re there for is that one time expertise that you may or may not have, or need on an ongoing basis. That’s perfect example of when you use those kinds of people. Dr. Q thank you for your time. Always a [00:43:00] pleasure to sit down with you.
[00:43:01] Dr. Eric Quinones: Great to talk with you Bill. I look forward to hopefully seeing you in three-dimension someday soon. Do you plan to be at CHIME?
[00:43:08] Bill Russell: I do plan to be at CHIME. Is that the next event? I, no, the next event for me is the HLTH conference. HLTH whatever you want to call it. And then the then the CHIME Fall Forum in San Diego. So I assume you’ll be down there.
[00:43:21] Dr. Eric Quinones: I’ll be down there. I’ll hit you up and let’s let’s connect over a cup of coffee.
[00:43:25] Bill Russell: Sounds good. Thank you again.
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