May 24, 2021: Mark Weisman, CMIO at TidalHealth System joins Bill for the news today. Researchers at Columbia University have developed a microscopic implantable chip for physiological monitoring. HIMSS and HLTH require proof of COVID vaccination. Ascension’s technology business is laying off 651 employees. A new legislation in Congress requires Medicare Advantage plans to create an electronic prior authorization process, targeting a major source of administrative burden for providers. What’s next? What are we driving toward? ONC launched a new project called “Health Interoperability Outcomes 2030.” Telehealth has undergone a radical transformation during the course of the COVID-19 pandemic. The potential for overutilization and its financial costs is a long-term concern for all insurers.
Newsday – Implantables, Conference Vaccine Policies and Prior Authorizations with Mark Weisman
Episode 407: Transcript – May 24, 2021
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[00:00:00] Bill Russell: [00:00:00] Welcome to This Week in Health IT. It’s Newsday. My name is Bill Russell, former healthcare CIO for 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged.
[00:00:18]Special thanks to Sirius Healthcare, Health Lyrics and World Wide 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 [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 Dr. Mark Weisman, pinch hits as a [00:01:30] guest host and we discuss the news. One last quick note, we’re going to a summer schedule starting on June 1st.
[00:01:36] Monday will be news day. Friday is going to be the influence episode. With an occasional solution showcase on Wednesday. The big differences were making no commitment to doing a Wednesday show. That’s a break for the team, which has been doing eight shows a week and a chance for you to catch up on some of the shows that you may have missed.
[00:01:52] If you miss my commentary, you can always check out Today in Health IT. We’re still going to be doing five episodes a week, one [00:02:00] a day, about eight to 10 minutes. So pretty easy to fit into your day. All right, let’s get to it, Mark. Welcome back to the show.
[00:02:07] Mark Weisman: [00:02:07] Thanks Bill. Thanks for having me on again.
[00:02:09]Bill Russell: [00:02:09] It’s been a while. How are things going at TidalHealth, right? It’s not Peninsula anymore. It’s Tidal.
[00:02:15]Mark Weisman: [00:02:15] Things are busy. We’ve got exciting projects going on. We’re not only focusing on COVID anymore. We have a Cerner to Epic conversion we’re doing at a hospital. So that’ll keep me on my toes for a little bit.
[00:02:29]Bill Russell: [00:02:29] I noticed [00:02:30] your CMIO podcast has not been staying current. Is that, because the demands of the job have been a little bit much over the last couple of months?
[00:02:37] Mark Weisman: [00:02:37] It has been. These podcasts take some time. You’ve got a staff of 50 people behind you.
[00:02:44] Bill Russell: [00:02:44] It might, it might as well be a hundred I think.
[00:02:48] Mark Weisman: [00:02:48] That that make it so easy for you. So I do feel that the tug to get back to it and it’s, I love doing it. I still want to do it more. [00:03:00] But Hey, if I get a chance to come on and still get my, this scratches, my itch to get out in front and help educate others about what we do
[00:03:10] Bill Russell: [00:03:10] Well if you want to get the CMIO podcast going again and want to tap into my production team, although my production team is listening to this right now and they’re cringing, but but if you want to tap into my production team, we can probably make that happen.
[00:03:23] So, cause I do miss it. You were one of the podcasts I listen to on a pretty regular basis [00:03:30] because you were filling in that gap of things that was maybe more medically inclined and more clinical in nature around the technology side. And that was, that was extremely helpful for me to stay current on that stuff.
[00:03:43]Any suggestions on who I would listen to today, if you’re not putting out podcasts?
[00:03:47] Mark Weisman: [00:03:47] I haven’t. The reason why I went into doing the podcast because I couldn’t find the content that I wanted to listen to you all with a little more clinical slant. I’m a regular listener to your show. I get a lot out of those. [00:04:00] And you will occasionally have CMIOs on any touch, into great topics. And my interest as a CMIO has happened to broaden more I’m at, I’m interested in it. Security. I’m interested in moving to the cloud. Those kinds of things are very exciting for me. So your show is the one I go to, but no, I don’t have a clinical show that I can go to on a regular basis.
[00:04:21] Bill Russell: [00:04:21] Well I’ll tell you what, we’re not going to talk about security today. Although I did make the joke over the last couple of weeks that we could easily turn this into a [00:04:30] security show. There are so many security stories going on right now. And obviously the one that my heart breaks for is Scripps.
[00:04:38] Really trying to get their system back up and running. And I didn’t get an update today, but I know that earlier this week they were still down after two weeks so. That is a very difficult situation to be in as a health system I’m sure. And I hope they are.
[00:04:53] I hope they’re able, I know a lot of smart people are working on it and I’m sure they’ve called in some, some really great [00:05:00] vendors to help them as well. And I know that the federal agencies are probably helping them as well at this point. I mean, it’s pretty much a ransomware situation so.
[00:05:08] Mark Weisman: [00:05:08] Why does it take so long to get back up after. Is, is it because of the work of putting stuff into servers or is it the bad guys are still in there and you gotta get them out? I mean, what’s the
[00:05:17]Bill Russell: [00:05:17] It’s a combination of things that the bad guys being in there. I hadn’t thought about that, but yeah, you, you do have to make sure that you clean it up and you’re good to go. But the reason is because [00:05:30] a lot of our backups have gone. nNearline. So they are actually on the network because we have to back up so much data.
[00:05:37] They have to be faster. And so we’ve gone away from tapes. We didn’t like swapping tapes and sending them off site to somewhere else. We thought hey, we’ll be smart. We’ll start putting them on a on essentially storage arrays and stuff that we have in our data center. And we’ll trickle that out to other offsite or near-site storage.
[00:05:59] The problem is all of [00:06:00] that stuff was on the network. And one of the first things ransomware attackers do is they follow that trail. They find your backups and they make sure that you can’t restore. They ransom, they lock upt he backups is one of the first things they do. And then they start locking up your core systems.
[00:06:17] Mark Weisman: [00:06:17] That makes sense. That’s why it’s so hard. You don’t have the backup. It’s a back up to you.
[00:06:21] Bill Russell: [00:06:21] Yeah, one health system I did talk to, their leader and it was not on the air but he essentially said we’ve lost every image we’ve ever done. And I was like, [00:06:30] that’s serious. I mean, every patient that comes in now has to have their imaging re work redone.
[00:06:36] But it’s bigger than that. Right? So you lost all the historical data you lost. I mean, it’s just, it’s just gone. It’s nowhere and they can’t be rebuilt. So tThat’s probably an untenable situation for Scripps to be in that predicament. And we saw the the pipeline, Colonial pipeline.
[00:06:54] They actually paid the ransom because they couldn’t fathom we couldn’t [00:07:00] get gosh we’ve gone another couple of weeks without that pipeline. We would, we’d be back to a work at home situation cause it’s going sort of be no gas up and down the East coast. Right. Yeah. So that’s yeah, so, but we’re not going to talk about security because it depresses people.
[00:07:16]It is top of mind, it’s really important, but gosh, I pulled some things I think are interesting in the one on my, you over a story this morning on the tiny implantable ultrasound chip for physiological [00:07:30] monitoring. I thought this was really interesting, a really interesting story.
[00:07:33] And since you’re a physician, it’s a perfect topic for you. So researchers at Columbia university who have deployed a microscopic implantable chip for physiological monitoring, it has a total volume of less than 0.1 millimeters. To put that into perspective. The chip is as small as a dust mite and can only be viewed using a microscope.
[00:07:54] The goal of this research was to create a device that can be injected using a standard [00:08:00] hypodermic needle, and which then beams their readings wirelessly to external displays, such as patient monitors and smartphones. The Columbia team used externally applied ultrasound through a conventional ultrasound image to power and communicate with the implant.
[00:08:17] And we’re, we’re getting to that point, we’re getting to that point where we can actually have things that get injected into the bloodstream, that report things back. I mean, what, what’s the promise of that kind of [00:08:30] technology do you think?
[00:08:31] Mark Weisman: [00:08:31] So this is remote patient monitoring on steroids, I guess. I mean, this is well or miniaturized to the enth degree. The device that’s in that article is measuring temperature, which is one use case. That’s interesting. But probably not where the biggest clinical need is. We probably diabetes and glucose monitoring is the one that, that is the the use case that would get the most attention right now.
[00:08:56] So when they have the ability to have something like that, that’s [00:09:00] monitoring your glucose in real time and reacting, and it has to be incredibly accurate, but then adjusting your insulin levels that that’s going to be really valuable.
[00:09:11]Bill Russell: [00:09:11] Do we need to make it any smaller than this. This is incredibly small.
[00:09:15] Mark Weisman: [00:09:15] I think it matter where it goes and it’s ability to not get attacked by the immune system and be seen as a foreign body and kicked out. Those are going to be, the challenges is as being to be implanted in stable. Now they’ve solved that for, [00:09:30] for other we have other implantable devices that do just fine. But you’re talking about some something that’s so small. You’re not retrieving this out again. Once it’s in, it’s in. And you don’t want to floating around somewhere where it doesn’t belong.
[00:09:44] So there’s going to be some interesting challenges with it. It can’t can’t work forever. And then what
[00:09:50] Bill Russell: [00:09:50] So what’s the power source?
[00:09:51]Mark Weisman: [00:09:51] The power source on this one, I recall was ultrasound waves that were external that would then penetrate and then generate the power [00:10:00] source which is phenomenal. Thatconcept of not having to walk around with a battery.
[00:10:06]Bill Russell: [00:10:06] People are going to, this is just the joke. I mean, people are going to essentially say, Hey, what about privacy? And it’s a fair question, but you know, it’s something like this. It just has to get to the point where the use case has greater value than the risk of privacy. And I think we’ve signed up. We’ve seen that all over the place. I mean with, [00:10:30] with smartphones and tracking, I mean the Android device tracks just about everything you do in life, but people just don’t care because there’s so much value in carrying that device that they they don’t really push back on that much.
[00:10:43] And if you have diabetes and this helps you to maintain your insulin levels and a bunch of other things I have a feeling you’re not going to be overly concerned. Plus this thing doesn’t exactly have a range. I mean, when you’re talking that size, And the limited power to has.
[00:10:58] It’s not like it’s it’s [00:11:00] beaming it from New York to LA. It’s just not that powerful a device.
[00:11:03]Mark Weisman: [00:11:03] I agree with you. If I had congestive heart failure and was being repeatedly admitted to the hospital, the current technology in remote patient monitoring, you’re talking about blood pressure cuffs and pulse oximeters. We’re really not moving the needle from a technology standpoint in changing the trajectory of that patient. Now if you can get a device in there that measures the pressures inside the vessels of the heart, the pulmonary [00:11:30] artery pressure. And if you can tell what’s going on there, there is a study out that says, yes, you can start to change that trajectory.
[00:11:38] And that’s the kind of really invasive but done with such a microscopic level. Maybe it doesn’t have to be so invasive in the future where we can make a difference and have remote patient monitoring hospital at home. All of those exciting technologies as this stuff gets smaller. That becomes more possible.
[00:11:57] Bill Russell: [00:11:57] Yeah. Well, not to put you on the spot, [00:12:00] but conferences. Have you gone to any yet? And do you plan to go to any of the big ones? HIMSS 21’s coming up, HLTH. Any of that on your radar or just too much going on these days?
[00:12:12] Mark Weisman: [00:12:12] Great question. I have the Go Live happening July 1st. So August conference season.
[00:12:17] Yeah. I’m excited. I’m going, not going to do HIMSS this year. We can, talk about their health passport and we probably should in a minute, there’s an article on that, about them checking [00:12:30] COVID on everyone. I’m a little, I’m a little disgruntled with HIMSS from last year and their hotel cancellation policy.
[00:12:36] So I think they blew it on that one but I’m going to do Epic, the UGM at the end of August, and then CHIME, I’m going to catch, I haven’t been to CHIME yet. So I’m looking forward to doing that in October.
[00:12:48] Bill Russell: [00:12:48] Well, yeah, I mean, October seems like a pretty safe time to do a conference. At that point I think the CHIME event in San Diego is going to be pretty well attended. HIMSS is the first one out of the [00:13:00] gate. So let’s talk a little bit about that. There’s a couple of stories that are out there. HIMSS and HLTH have both said, essentially, if you’re coming on site to these conferences we want you to show proof of vaccination.
[00:13:11] So. You can do that through and they have various ways. Actually HIMSS hasn’t figured out how they’re going to do it yet HLTH has a method for, showing your proof of vaccination. For onsite you have to be vaccinated. You can still do it offsite virtual if you are not vaccinated. [00:13:30] And I think there’s a lot of reasons around that.
[00:13:33]Part of it is just marketing, right? So you just look at it and go, Hey, Look we’re putting on a healthcare conference. So a majority of the people we’re dealing with are going to be vaccinated anyway. So number one, you’re, you’re not limiting your population at all. Number two, you get to sort of tout that we’re going to create a safe environment for you to come to.
[00:13:52] And if you didn’t tout that and you probably are going to lose some of the people that are vaccinated, they’re not going to be able to tell them because we have to make the case, [00:14:00] right. Because a lot of health systems still are not allowing travel for things like conferences. So you have to make the case for this is important enough for me to go to and Oh, by the way, it is a safe environment.
[00:14:13] So I think it was a no brainer to sort of put this in place at least for this year. And that’s why they’re doing it.
[00:14:22] Mark Weisman: [00:14:22] Technologies there Bill though, well let me rephrase that. Do you think that data is there? So I got my vaccine at the hospital. [00:14:30] So it put into Epic. It went to the state vaccination registry.
[00:14:34] So all of these apps, we’re fragmented now, right. There’s no one app that you could go to that says I am the passport app. The federal government has said it’s not going to do that. It’s not getting into that business. There’s no federal COVID vaccine registry out there. So how has HIMSS by August going to have a vendor that can connect to all of the state registries, bring that data [00:15:00] together, no duplication and have accurate information to tell my COVID status when I walk in the door.
[00:15:07] Bill Russell: [00:15:07] No. So, so let me, let me tell you how I think they’re going to do this. And I could be proved wrong. The vaccine credential initiatives out there, there’s 300 participating organizations, but again, and that’s ready to be deployed, but it’s a framework that others consume, right? So you have, you have these passports that can bring the information in.
[00:15:27] I went to Costco the other day [00:15:30] and I’m walking in and I’m searching for my car. And I realize I don’t have my mask on. And I show him the card. I said, Hey, what’s your mass policy. He said, well, if you’ve been fully vaccinated, you don’t have to wear your mask. But if you have not been fully vaccinated, you are, we would like you to wear your mask.
[00:15:45] I said, okay. I said, well, I’ve been fully vaccinated. I’m like, would you, would you like to see the card? He goes, Oh, no, we’re not checking. I’m like, okay cause I have my card with me just because I had it with me for whatever reason. [00:16:00] Plus I have it on my phone. I took a picture of it. Right and put it on my phone. Because I was done at the health department and I got the old vaccine card. Hand signed little thing. And I thought, I even said to the guy, as he was writing it, I’m like, how hard would that be to forge? He goes not hard at all. I said, how’s that? And I also asked him, I said, how’s that going to get into my medical record? He goes, it’s probably not going to get into your medical record.
[00:16:25] I’m like, yeah, that makes sense to me. I don’t know how you would have access to my medical record to get it in [00:16:30] there because it wasn’t done by a health system. It was done by. By by the health department and everything was really paper-based. And so here’s what I think is going to happen at the conference.
[00:16:40] Okay. You have to provide proof of vaccination, which a lot of people are going to have the card and you can provide that. And they’re going to say, okay, you’ve provided proof of vaccination and it becomes an honor system. Really? Yeah. Because if I want to forge the card as an unvaccinated person and go to the conference, I guess I could, [00:17:00] I’m not sure why I would do that, but I guess I could do that.
[00:17:02]From their standpoint, Hey we checked everybody to the best of our ability, given the technology that’s currently available, we didn’t like scour the registries or anything, but we, we checked everybody. And at the end of the day, to be honest with you, and again, you’re a physician, I’m not a physician, but this is just my I’m just reading the data that and I’m reading this straight from the CDC websites and others that the chance of someone with the two shots of the [00:17:30] Moderna or Pfizer vaccine actually getting COVID is 0.07.
[00:17:34]All right. So if my chance of getting COVID is 0.07, that is well within my parameters for leaving the house and interacting with people because I do that every day when I get in my car and I do other things. So I recognize that there’s a chance I could get COVID. But the other thing I would say is there’s no surge going on in the hospital.
[00:17:53] So I’m not really concerned if I have to be taken to a hospital. The third thing is that the vaccine is actually [00:18:00] proven to reduce the impact of the virus on me. So that’s the third thing. The fourth thing quite frankly, is we know more today. We’re over a year into this.
[00:18:11]We know which treatments are working, which treatments aren’t working, and we’re just better at this. Now I don’t want to get COVID. And I don’t want to like unduly increase the risk of getting COVID for any reason, but I’m also not worried if a handful of people happen to be there that have COVID. Cause [00:18:30] first of all, it’s in Vegas.
[00:18:30] You’re going to run into people who have COVID or un-vaccinated. You’re going to sit at the blackjack table. You’re going to interact with the hotel staff. You’re going to Uber. You’re going to get on a plane. So there’s no way to really create it, the true bubble around this. So that, that’s just my thinking. So how, how crazy am I with with the stuff I just said?
[00:18:49] Mark Weisman: [00:18:49] I think you’re spot on. I think the question is more about will you get the experience that you’re used to getting at HIMSS, where I’ve gone to [00:19:00] to go get into a presentation and you can’t get in the door. Well now they’re going to block off seating it sounds likeit. On their webpage, they’re talking about how they are going to separate. The presenter is going to have a shield, a face shield on. Is the experience going to be the one that you want? The downstairs floor, the vending they’re going to space them out differently.
[00:19:22]Maybe they have less vendors coming. And so that’s my question for HIMSS is can you pull off the production [00:19:30] and the show that that is HIMSS that, that that circus atmosphere and maybe it’s good. Maybe change is good. But I think people have certain expectations around HIMSS and I wonder if this year’s gonna meet it.
[00:19:47] Bill Russell: [00:19:47] Well you, you mentioned a bad taste in your mouth based on the hotel.
[00:19:52] I’ll tell you the vendors. I’ve yet to talk to a vendor that hasn’t had a bad taste in their mouth by how HIMSS handled the [00:20:00] cancellation last year. I think that is going to be one of their challenges. I think people are going to be there because they paid the money to be there from last year and that they’d have to carry it over and whatnot.
[00:20:10] I don’t think there’s a bunch of them that aren’t going to be there because again, their travel policies as a some global companies are essentially saying, look, we’re still not, our travel policy. Isn’t get on a plane and go visit whoever you want. Now with that being said, a lot of my clients, a lot of health systems now are saying for the first time.
[00:20:27] Yeah, you can come on site again as a vendor, [00:20:30] whereas just even three months ago, people were still saying to me now we still don’t have any vendors coming on site. So things are
[00:20:38] Mark Weisman: [00:20:38] factor. Don’t you think Bill that budget’s going to be impact now because the hospitals we’re not, at least the friends that I’m talking to, we’re not getting travel budgets like we were in previous years. It’s pretty lean now. So
[00:20:54] Bill Russell: [00:20:54] Yeah, I mean, it’s always the first budget to go, right. The travel and the education budget. It’s one of the [00:21:00] reasons it’s so valuable, the CMIO podcasts, and it’s so valuable what we do and what we see ourselves as. It’s really a conference that goes on all year.
[00:21:08] We bring on great guests, we have the conversations we do round tables, and the podcast has become sort of the conference that can go on year round, that people can attend those things. It’s not a complete. Clearly it’s not the same because you don’t have that face-to-face interaction.
[00:21:26] That’s I think what we really [00:21:30] miss. So, all right. We have a bunch of different stories here. We have interoperability 3.0, they did that initiative. We have prior authorizations, we have telehealth reimbursement, Parity has insurers worried about over utilization. We have Amazon, there’s always an Amazon story.
[00:21:49] They’re launching a home medical testing, Ascencion IS group laid off 651 employees. I lay all those stories out to say, pick one. Which direction would you like to go?
[00:22:00] [00:22:00] Mark Weisman: [00:22:00] Let’s cover the Ascension story. It came out a few weeks ago. I want to pick your brain on this one about what this holds for our future. Cause I think it raised some alarm bells in the back of my head. The article is it’s out there in a variety of different places, but I think the one where I saw it on was Becker’s.
[00:22:21] Bill Russell: [00:22:21] Yeah, so here I can set it up. So it’s, Becker’s Ascension technology business to lay off 651 employees.
[00:22:27] And St. Louis based plans [00:22:30] laid off estimated 651 remote workers this year, according to the St. Louis post dispatch. Ascension Technology said that we’ll begin working with a third party to take on the tech support for EHR and revenue cycle management responsibilities. Its employees had been performing the company said and enabled 27 notice that had filed.
[00:22:50] None of the employees affected in the layoffs are based in Missouri. But all the positions report to an office in St. Louis. This is obviously from the posts [00:23:00] St. Louis Post-Dispatch is the reason they’re focusing on St. Louis, essentially technology plans to facilitate the layoffs between August 8th and December 10th.
[00:23:09] All right. So what’s your question on this?
[00:23:11] Mark Weisman: [00:23:11] So I’m not so worried about the employees here. This is an Epic shop. I believe Ascension is in and they’re going to get picked up in a heartbeat because they can work from home. They can work anywhere. There’s hospitals clamoring for Epic analysts all over the place.
[00:23:27] But the question is as a [00:23:30] smaller health system that’s on Epic. What should I be thinking about? Here’s a large health system outsourcing should a small health system had 50, 60 Epic trained analysts to hang on to on our budgets, or is outsourcing attractive for this kind of work. Will you guys still get the product I want?
[00:23:51]Bill Russell: [00:23:51] I I remember why I liked talking to you. So you’re putting me on the spot. So here’s the hard thing about this. I don’t think you have that choice by the way, as an Epic shop. [00:24:00] Ascension is not an Epic shop. Ascension is an everything shop. They have 105 locations.
[00:24:07] Literally they have everything. It’s one of the reasons they did the Google deal that they did. Was to pool all their information, all their clinical information into one repository, and then they created an interface that you could see the entire clinical record normalized, homogenized across all those disparate systems.
[00:24:25] And it gets baked into the EHR somehow. There’s like a button you press and it pulls in all [00:24:30] the other things in a really nice Google searchable mMethod and it’s really, it’s like I saw a video on it. It’s really slick. With that being said 105. They’re cutting those people. The reason I don’t think you have that choice is as Epic is there’s no way for you to stay on honor roll.
[00:24:48]Epic in their wisdom put financial. One of the things that Epic does is they’re very deterministic. They make sure that you’re going to be successful in your implementations but they do that by [00:25:00] taking a lot of the levers out of your hands as a CIO. They’re like, Hey, we can’t allow these systems and these CIOs and the CEOs to cut the budget in places that hurts the Epic implementation.
[00:25:12] So they create this thing called the auto roll there’s financial incentives around it. And if you don’t meet it, that money goes away. So when you’re sitting there going, hey we could, we could cut $10 million here. If we cut this stuff immediately, you come back and go. Yeah, but we lose honor roll.
[00:25:29] And if we lose honor [00:25:30] roll, we lose 15 million. So that doesn’t make any difference. It looks somewhere else, which is really interesting because there’s a fixed cost to doing Epic and there’s decisions that you cannot really make. So you’re not gonna, you’re not gonna make any cuts there. You could do it with outsourcing, but when you outsource one for one, there’s almost no savings.
[00:25:53] Mark Weisman: [00:25:53] Sure, sure. As we grow our health system that we have found. Okay. We’ve added another hospital. We [00:26:00] didn’t have to add another 50 analysts though. So there’s, it’s not a linear as systems start to combine, there’s not linear growth in your Epic team. So if you could get a pool together of hospitals and have a centralized Epic team that manages them. That would be a great way to save money. There’s probably a business in there somewhere.
[00:26:24] Bill Russell: [00:26:24] Oh yeah, no, look, there’s a lot of players you could go to. Providence has a [00:26:30] team that does that. Sirus Healthcare who’s a sponsor of the show does that as well. There’s a bunch of players out there that you could go to that are leveraging their capabilities across multiple clients. That’s absolutely something that you can do. I, yeah, part of me is I’m choosing my words here cause it’s an interesting, it’s an interesting challenge. It’s an interesting problem to have but I’ll just go ahead and share the story when we did our analysis of what it was going to cost not to implement, but [00:27:00] post-implementation.
[00:27:01] So we looked at Cerner, we looked at Epic and we were on Meditech and we were again, 16 hospital system, about six and a half, $7 billion in revenue. And what we had was we were running all those on Meditech. And the reason why they were on Meditech is they all started as individual hospitals. And then they were brought together as an operating company, as opposed to a holding company.
[00:27:23] And so now we had all these disparate systems. And now it was time to bring them all together. And so what we ended up doing [00:27:30] was we just upgraded to a single instance of Meditech. And one of the reasons for that was the ongoing cost to maintain Meditech from just the ongoing staffing to maintain.
[00:27:43] It was about two and a half to two and a half times less than maintaining an Epic system. And those are just the numbers and it was a long time ago and maybe those numbers have changed, that was our experience. And it requires you to add a lot of staff, to have a lot of staff [00:28:00] dedicated to that system.
[00:28:02] And again with honor roll and other things, it’s really hard to cut that staff or to make any adjustments to that staff. So finding savings in that area, the best way is the way you just said it. It’s to grow. It’s to buy another hospital and another hospital and another hospital. That is the best way .Scale is the best way to make that investment in those people make sense.
[00:28:26] Mark Weisman: [00:28:26] Yeah. That makes sense. So you call the show, the education of Bill Russell. [00:28:30] Today is the education of Mark Weisman. So I appreciate that.
[00:28:34] Bill Russell: [00:28:34] So one of the misnomers, we think every major system is on Epic. And Ascension probably has some Epic, if you think about it, 105 hospitals. But you know, there’s, there’s still some Cerner shops out there and there’s still some Meditech shops.
[00:28:48] There actually, there’s a fair amount of Meditech shops. The smaller health systems have a choice of going community connect or going in the Meditech direction. And if you want to have any autonomy [00:29:00] whatsoever you don’t go into the community connect direction because it’s, you give up a lot of autonomy when you go in that direction.
[00:29:06]Mark Weisman: [00:29:06] I was hoping to do the the interoperability article.
[00:29:11] Bill Russell: [00:29:11] All right, so I’m going to throw this one at you. Interoperability. Is that top of mind that you guys have, you guys have a group of people leading your IT efforts. Are you guys talking about interoperability as you’re getting ready to do new standing up a new EHR?
[00:29:26] Mark Weisman: [00:29:26] It is the biggest thorn in our side and [00:29:30] clinically when I’m in the exam room, it’s the biggest thorn in my side. I think about it constantly. Now other doctors probably aren’t say, Oh, I’m thinking about interoperability in those terms. But what they are saying is I can’t see where my patient went when they got their colonoscopy and someone was going to fax it to me if I asked for three times. And then I’ll get a piece of paper on my desk.
[00:29:55] Bill Russell: [00:29:55] Is that because they’re moving in and out of your system, your health system,
[00:29:59] Mark Weisman: [00:29:59] They do, they, [00:30:00] they. Sure the world’s great if everyone’s on the same electronic health record, but when they’re not and you need discrete data that you want to alert off of or trend off of.
[00:30:13] No. We don’t get any of that coming in through the care everywhere or carry quality and all those, even the state HIE, we don’t get discrete data in a complete data [00:30:30] sets. And there’s some errors that can happen that are quite scary. The EHR is a very dangerous tool in the wrong hands. And when you try to bring in this data and if you have matching problems or things that air out and go to pools that no one knew about and is now being monitored, you can get yourself in some pretty quick trouble.
[00:30:52] Bill Russell: [00:30:52] Yeah. It’s getting the longitudinal patient record into the hands of the care provider at the [00:31:00] point of care has always been a challenge. Here’s my question. I mean, I’ve sat across from doctors who were like, look, I don’t even care because I have a series of questions I’m going to ask anyway. Now once I ask those questions, I’m going to want to do some research into the medical record and hopefully find the things that I need to find based on those questions.
[00:31:18] But for the most part, if I don’t, I’m just going to order a test. I mean, is that still the thinking.
[00:31:24] Mark Weisman: [00:31:24] Very much so. Although many of our doctors now have [00:31:30] their staff go out and ping individual databases that are out there to say, okay, for tomorrow, schedule every patient, go look and see if they’ve been to those locations and bring that data in copy and paste it into my note, prep my note for me so that I’ll have all that data so I can make a decision with that patient.
[00:31:52] At that moment, not, they don’t want to have to go back and do research and cause that’s, what’s called pajama time now. Now that work [00:32:00] gets done after five, they want to do it with the patient in front of them and have that conversation once. So the interoperability pain points that clinicians experience, yes, they will simply go oh I’ll just order another test but quite frequently, they want to compare to old tests. They want to understand how things are changing. And they still want that data.
[00:32:23] Bill Russell: [00:32:23] Yep. No, I can see that. Brett Oliver, who you’re familiar with from from Baptist [00:32:30] put a post out on LinkedIn about this. This is the interoperability outcomes 2030 ONC is putting it out there and he sort of phrased the question of if in a perfect world, if interoperability in a perfect world were in place I would be able to do what? Essentially is what he said. And so health interoperability outcomes 2030. In a perfect world is interoperability worked the way it should work. Mark, what would it look [00:33:00] like? What would the, what would it look like for a physician?
[00:33:05] Mark Weisman: [00:33:05] I would have a complete data set in my EHR that is accurate without duplicated data that the patient has given consent for me to bring it all in together so I can get that view. I don’t have to send off a release of information form to get it.
[00:33:28] It’s like real time. It’s [00:33:30] all there where I can get it into discrete data. Yeah. So I’m bringing in a note, but I want to be able to extract from that. Okay. Note the important parts so that I can fill in my. Health maintenance or my quality metrics that need to be satisfied. Or if I want to trend the lab values that are being reported by a consultant, that’s what it feels like.
[00:33:54] It feels that’s the easy button for healthcare. For me, that’s what I want. I want the easy button of all the [00:34:00] data right in front of me. Curated. And then I want to be able to ask my, EHR. Hey, I’m dealing with an abdominal problems today. Show me the relevant data, but EHR can’t do that until we have a complete set.
[00:34:13] Bill Russell: [00:34:13] Yeah, it’s interesting. When Brett posted that I was a little bit of a wise guy and I just kept posting. I think I did four posts. If interoperability were perfect this would happen. This would happen. And I just kept going because it really is endless. And one of the things I’m always [00:34:30] looking at it from is the patient perspective.
[00:34:33]If interoperability were perfect in 2030, I would have my complete medical record available to me. Like accessible or even downloadable by me. So I would be able to do that. Not only for me, but for my care circle, my family members, my parents, where I’m trying to care for and whatnot, I would be able to engage a series of fiduciaries, a health fiduciary is what.
[00:34:59] Aneesh Chopra [00:35:00] called them, but healthcare fiduciaries, who I could give access to my information and they would provide me value in some way, shape or form. They would either provide value and caring for my parents. They would provide value in caring for me and to a certain extent I could be the carrier. When I go to your health system and you say, Hey, we don’t have your complete medical record. I could say Hey, this app, I made the request with just a click of a button. I made a request from the 15 health systems I’ve been to over [00:35:30] the 50, some odd years. I’ve been on this planet and I have the complete medical record.
[00:35:34] Would you like me to click this button and give your health system access to it? And so as the carrier, as the common person, at the point of care, I would be able to give it to whoever’s caring for me at that moment, whether it be EMT or a primary care physician or or whoever it is. That’s that, that to me is sort of a Nirvana from the patient perspective.
[00:35:59] Mark Weisman: [00:35:59] I [00:36:00] would think the doctors would love that that. There would be no pushback. Some doctors are this, my medical record. Now we w we just want data that’s for the most part clinically. That’s what matters. Personally, my wife’s going through some health issues right now, now, and trying to get a prior authorization and the data that has to flow back and forth between provider and insurance carrier to get that prior authorization, what would interoperability look like that we wouldn’t have that, that we would have real-time [00:36:30] authorizations based on algorithms that say, okay, you’ve gone through XYZ yet.
[00:36:35] You’ve got a tumor on your spine. We know we’re going to approve this every single time. Absolutely. So why do we torture our patients?
[00:36:44] Bill Russell: [00:36:44] So let’s step back. So this is this week in health IT so we have a bunch of technologists they may or may not understand prior authorizations, help us to understand what are prior authorizations and to say, why are they the bane of some [00:37:00] people’s existence?
[00:37:00] But what’s the challenge around prior authors and authorizations?
[00:37:05] Mark Weisman: [00:37:05] All right. I guess I can’t use a lot of curse words on this show when, as I described prior.
[00:37:09] Bill Russell: [00:37:09] No that wouldn’t be good.
[00:37:10] Mark Weisman: [00:37:10] All right. So I’ll clean it up. So as a physician, I’m seeing you for a medical issue and we want to do a test. It could be a genetic test. It could be an imaging study. Your insurance company gets a say in this, they want to make sure that we’re not ordering unnecessary tests. [00:37:30] And so there is a authorization that is needed.
[00:37:33] Bill Russell: [00:37:33] That’s because that problem does exist right. There is there’s an over I forgot what the word is.
[00:37:41] Mark Weisman: [00:37:41] It’s overutilization. So that does exist. And their, insurance companies have a business model.
[00:37:49] Bill Russell: [00:37:49] It, well, I’m just, I’m just ratcheting you up just by asking that question because they’re insurance companies, they’re not doctors or I don’t know. [00:38:00] So they’re essentially questioning you whether this test is necessary.
[00:38:03] Mark Weisman: [00:38:03] Correct. And. They will use evidence-based guidelines to give that, to have a fair balance shown here, they do, they will have evidence-based guidelines, but they need data to see does this patient meet our evidence-based guideline? And so there’s this game of, if we frustrate the patient, the doctor enough, they’ll give up, we’ll give up on the test or the problem will go away.
[00:38:30] [00:38:29] Or that they’ll end up in the hospital and we’ll deal with it then, because you don’t have to do prior authorizations when you’re in a hospital bed for the most part. So yes, there are, but the prior authorization process is slow. It is labor intensive and it is typically frustrating. It’s being done by first, the first review is going to be a clerk and then maybe it goes to a nurse and eventually you can escalate it to a doctor and you usually can have [00:39:00] a conversation, but you can take time out of your day to go talk to a doctor about this case and explain why you think and justify your medical reasoning which is uncomfortable.
[00:39:12] Bill Russell: [00:39:12] So this house bill is going to mandate Medicare advantage plans adopt electronic prior authorization.
[00:39:18] So if it’s electronic. That me it’s really on the insurance carrier side. Right. I’m going to be able to submit it electronically and they need to respond electronically. And in theory, that should take that, that gap [00:39:30] down for the amount of time it takes to get that prior off.
[00:39:34] Mark Weisman: [00:39:34] And it does. So we have this in the prescription space now. There are vendors out there that offer the ability to do electronic prior authorization of medications. And that’s another area you got to go and play mommy may I. And get your approval on the drug you want to use, and it works, but again, you it’s not complete interoperability yet, so [00:40:00] we’ll send it electronically and we’ll get back a PDF that someone wants, because if they’re not playing with that particular vendor, well, you don’t have interoperability.
[00:40:10] So then we get a PDF that someone has to fill out. It’s going to go back by fax or filled out on the PDF. That’s not a electronic automated response. We want, if the insurance company feels they need something, let them ping the record. See if the patient’s had a prior [00:40:30] MRI or a prior that they’ve done physical therapy before they get their MRI of their spine.
[00:40:36] Sure. Go ahead and look, give me an answer back and I’ll move on.
[00:40:42] Bill Russell: [00:40:42] Yeah, this is, this is that, that use case that Halamka was using AWS for. The the prior house would come back into a fax and he was using NLP essentially in the AWS cloud. It was reading all the faxes as they came in. If any of them were prior us, he was [00:41:00] actually using a, I don’t know if he was using FHIR back then but essentially he wrote the EHR that they were using at Beth Israel.
[00:41:06] So essentially he was, he was funneling that information right back into the record. So it was as quickly as you could get a response, it was getting back into the medical record and he took out any manual back and forth that might happen in that process. So that prior authorization, without going too far down the insurance side, and it is this right? Is it [00:41:30] wrong? Kind of thing is it’s a form of rational red rationing or that kind of stuff. But the electronic aspect of this really should be. Basic blocking and tackling. At this point, we have an electronic medical record there. I would assume on the insurance side they’re using TriZetto or something to that effect.
[00:41:50] They should be able to get that information. To funnel back and forth between the medical record.
[00:41:54] Mark Weisman: [00:41:54] Algorithms are computerized. I don’t don’t think they’ve got people going through [00:42:00] paper, of turning the page, our IOC, if you’re on the flow sheet, they’re eighties computerized. They do buy the insurance companies will buy this these algorithms.
[00:42:08] They’re not usually coming up with them on their own. Yeah. I think, I think this should be faster. This is a pain point or the patient’s frustration for the doctor, but it’s the patient who has to wait. Or hear from their doctor. I’m sorry, your insurance company didn’t cover that. Let’s go to plan B. Wait, why am I getting plan B [00:42:30] again? I didn’t ask for plan B.
[00:42:33] Bill Russell: [00:42:33] Yeah. And I can be critical of healthcare’s experience that we’re creating for patients from time to time. But this is the underside of it that people don’t see. And they say, well, the health, they it took the health system this long to allow me to get the test when in reality, It’s not the health system.
[00:42:52] That’s slowing it down at all. It’s this process that’s behind the scenes and health systems are doing everything they can with regard to that. I [00:43:00] don’t have the answer for this. Obviously one of the first steps is to get it electronic. The next step I would imagine is to publish those algorithms so that the physicians are looking at them going, look, I’m ordering this test.
[00:43:12] It meets the algorithms. Yeah, they’re just a process. It’s an almost instantaneous because I can get my loan approved almost instantaneously. Now you would think that this could be done in that same manner.
[00:43:27] Mark Weisman: [00:43:27] We have a discrete data problem don’t we. I mean, we, [00:43:30] we have this unstructured data that until we can, that’s where that’s what the insurance company wants.
[00:43:36] It’s the stuff that’s in that unstructured data. And they want it in the street fields which is why we are manually typing into their portal, the information so that then they may have some automation on their end. It’s getting it there. That’s where we have the trouble.
[00:43:54] Bill Russell: [00:43:54] Gosh, shoot me typing into their portal. What’s wrong with that sentence. [00:44:00] Manually portal anyway. Mark thanks for coming on the show and pinch hitting. It’s always great to catch up with you and I really enjoy the conversation. It always challenges me. So I appreciate you coming on.
[00:44:12] Mark Weisman: [00:44:12] Thanks bill. It’s a great time. I always love coming on the show.
[00:44:15]Bill Russell: [00:44:15] 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 [00:44:30] level value every week. They can subscribe on our website thisweekhealth.com 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 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. [00:45:00] That’s all for now.