July 26, 2021: It’s Newsday with Ed Ricks, CEO, Director of Healthcare at Sirius Healthcare. A Gartner CIO report shows that IT spending is expected to increase for cyber, analytics and cloud. McKinsey reports that telehealth utilization has stabilized at levels 38X higher than before the pandemic. Why are states against easing licensing for telemedicine? Does it make sense? Walmart Health is getting licensed in 37 states to offer telehealth. What does that mean for the industry? Truveta Grows to More Than 15% of US patient care. HIEs are exploding globally. Why the exponential growth? And in hospital telehealth is not an oxymoron. During COVID, the benefits of it were obvious. However, what happens after COVID?
Newsday – IT Spending, Telehealth Expansion, and State Licensure for Telehealth
Episode 428: Transcript – July 26, 2021
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[00:00:00] Bill Russell: [00:00:00] Welcome to This Week in Health IT. It’s Newsday. My name is Bill Russell, former healthcare CIO for 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged.
[00:00:17]Special thanks to Sirius Healthcare, Health Lyrics and World Wide Technology who are Newsday show sponsors for investing in our mission to develop the next generation of health IT leaders.
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[00:01:01] Today, it’s Newsday and we have a full slate. In fact, I dunno, we have like 10 stories. I have a very conscientious guest, Ed Rick’s from Sirius Healthcare who has sent me a couple of articles which includes some really interesting stuff around HIEs. I think is interesting in the state licensure for telehealth ad this is going to be a fun conversation. Thanks for coming on the show.
[00:01:24] Ed Ricks: [00:01:24] Yeah, thanks for inviting me Bill. I’m looking forward to it. I always learn from you so it’s kind of fun for me too.
[00:01:28] Bill Russell: [00:01:28] Absolutely. Well, I [00:01:30] learn from you as well. I see your office has gotten a little messier. You’ve got the guitars behind you. You’ve got stuff on the ground and so the travel schedules kicked up again.
[00:01:38] Ed Ricks: [00:01:38] Yeah, definitely traveling more, which again, I’ve missed that. I was just mentioning, but there’s good and bad in there. Right? So you don’t get to take care of things when you probably should.
[00:01:48] Bill Russell: [00:01:48] Well people are, most people are going to listen to this on the podcast, so they’re not going to be able to see what, what I’m looking at, but clearly you play the guitar. I think you have Actually, I [00:02:00] can’t tell what kind of guitar that is.
[00:02:02] Ed Ricks: [00:02:02] Well, Hey, you’re not allowed to figure out how much I spent on them, nor are you allowed to tell my wife. Luckily, my office is my safe harbor probably gives
[00:02:12]Bill Russell: [00:02:12] Well, I’m getting on a plane right after we record this and I’m going up to Pennsylvania for my father-in-law’s celebration of life.
[00:02:22] He died in December. We weren’t able to do a funeral. In fact, the funeral requirements were in Pennsylvania. I think [00:02:30] we could only have 15 people at the funeral or something. Like that. So we did the burial back in December and now we’re gonna do a celebration of life and we have so many really cool videos of him playing his Martin guitar.
[00:02:42] He loved his Martin guitar. He took it with him, when he joined the military, he joined the air force. He took this Martin guitar with him there. He’s had it ever since. We have videos of him playing to the grandkids, to our kids and stuff. And it’s kind of interesting to watch the evolution. [00:03:00] And one of the last videos, it was him playing the Martin guitar and my son on piano going along.
[00:03:05] And it you go from when they’re a baby and he’s playing the guitar to them to they’re actually playing along with. It’s, it’s actually a really, it’s a really neat montage of how you brought music into the life.
[00:03:16] Ed Ricks: [00:03:16] That is very cool to me, and I know this is off topic, but that has been probably one of the saddest things from the pandemic last year, were those who did pass away and whether you could celebrate with your family and friends appropriately. [00:03:30] Cause my father also passed away last summer and same thing, Michigan that’s where he lived. And we were unable to really do anything traditional. What’s honestly he didn’t want that, but we’re all getting back together in mid August. So we’re doing something very similar we’ll just make it more of a fun remembrance and we’ll go from there.
[00:03:47]Bill Russell: [00:03:47] It’s amazing to me how many people I have on the show that have guitars or some aspect. If we put together the This Week in Health It band we’ll we’ll give you a call.
[00:03:56] Ed Ricks: [00:03:56] Yeah. Yeah. I mean, I’ve got a lot of hobbies that I’m really bad at. That’s [00:04:00] just one.
[00:04:01]Bill Russell: [00:04:01] There’s a lot of stories. Gartner reported increase in spending in IT, Walmart’s push into 36 states to support their telehealth initiative is interesting. McKinsey has a telehealth update, Amazon jumps into data lakes, telehealth within the hospital, I think would be an interesting conversation. Amazon has an attribution problem. United healthcare. Truvata and a new sent along the HIE story of the state [00:04:30] licensure for tele-health. Let’s see, what should the lead be? Let’s start, let’s start with the Gartner report. So you’re traveling around again. You’re with Sirius. So you talk to a lot of different health systems.
[00:04:42] What are you hearing with regard to spending? I was kind of surprised that this report talks about an increase in spending. It doesn’t surprise me that we’re spending more in certain areas in cybersecurity. Surprise me, we’re spending more in that area or data analytics or even digital front door.
[00:04:57] Those kinds of areas don’t surprise [00:05:00] me that we’re spending more money, but just the whole aspect of spending more money, given the loss in revenue last year, kind of surprised me. I would think that budgets would be flat if anything. What’s the sense you’re getting at?
[00:05:13]Ed Ricks: [00:05:13] And I think we’re hearing both things, right? People are still saying we have to do more for less which I get that. I think everyone should always sort of have that as the plan, but they’ve still got to invest to move forward. And I think what we found over the last year went through the pandemic was we haven’t really figured out in healthcare, [00:05:30] I don’t think, I mean, some people do a great job at this, but I would say overall. Like how to really improve that patient and clinician experience. And that’s got to be a focus. And so the telehealth things came into play while I think the budgets are going up, maybe in IT. I don’t know if that’s coming out of other areas in healthcare and whether that’s good or bad cause something’s got to give. You can’t take away, but you’ve got to be able to invest to move forward.
[00:05:54] You can’t let infrastructure fall apart. I think you’re seeing people shift away from traditional [00:06:00] infrastructure and it does probably take some effort and money to make that happen but that’s probably an investment in the future and how you’re able to build up the resiliency into what you do.
[00:06:08]Bill Russell: [00:06:08] Couple of CEOs I’ve talked to about cybersecurity, they have said they’re taking their three-year plans and reducing them to one-year plans. I’ve heard people swinging as much as a million dollars in the direction of cybersecurity in the next six months to shore things up so that they don’t become one of our feature stories. [00:06:30] Are you hearing that same thing, are you seeing a lot of money flow in the cybersecurity direction?
[00:06:35] Ed Ricks: [00:06:35] We are and a million dollars is nothing right for some of these initiatives. But to me what’s cool to see is probably how we should have been thinking maybe a little differently for the last 15 years. Not looking at cybersecurity as a technology problem and what do we invest in, but looking at it as a risk management problem and how do we invest to not become one of your feature stories. And If we can’t learn from things that have happened to some of our friends, you know what I [00:07:00] mean? I think that we have to. And most people are really good well sharing what happened and why, and maybe how they could help prevent it to somebody who mitigated it and then learning from that with everyone else.
[00:07:10] Bill Russell: [00:07:10] That’s an interesting comment. It’s not a cybersecurity problem but a risk management problem. Because in our organization, it actually reported up through the risk management organization and people were like, you’re kidding me, security didn’t report up. No, it was, it had nothing to do with IT. It was a risk management.
[00:07:26]The chief security officer was a peer of mine. And we had, we had [00:07:30] to work closely together, but it really came down through risk and compliance is where it reported up into. And for the most part, I would say we had to do all the controls and the software and those types of things. But the agenda was really driven by a team of people. And it was really board directed as well. I mean, cause we were talking about the various roles. They would determine what the highest risk was, or we would make recommendations based on the risk they [00:08:00] would chime in and then we’d come out and we’d develop budgets out of those conversations.
[00:08:05] And I think Karl West, who’s also with Sirius, we’ve had some conversations. He talks about the same concept of having a comprehensive risk mitigation strategy, as opposed to just plugging holes.
[00:08:16] Ed Ricks: [00:08:16] No, I totally agree with that. And that’s the way we try to handle it. Also the CISO did report to me directly, but I didn’t necessarily even want that. Right. So it came in hand with our compliance officer and risk management was a piece and [00:08:30] reported through the audit committee, the board know, into the board for everything. Because I agree. I don’t think cybersecurity is necessarily a technology issue. It is managing risk and we have hundreds of other risks in the healthcare organization.
[00:08:42] So you’ve got to balance that. And where do you make the investments. It takes technology and probably education. You have to really improve a lot of the risks that you have in cybersecurity, but I don’t think that you should drive it from a technology perspective.
[00:08:57] Bill Russell: [00:08:57] All right, we’re going to go to the first of one of the two stories [00:09:00] that you sent me. This is an interesting one. This is about state licensure for telehealth. There was a wall street journal op-ed on July 20th, Joseph Bernstein MD and Shirley Svorny PhD shared insights on state licensing laws and why they believe the regulations are restricting virtual care practices, which they do. They absolutely do. Dr. Svorny is economics professor at Cal state Northridge. Refer to the current state licensing laws that have barrier to interstate commerce. Okay. Why not to [00:09:30] find the location of telemedicine treatment via the via an act of Congress as the doctor’s location, as she wrote, seeking care from out-of-state physicians via telemedicine would be treated as no different from traveling to the physician’s office for care. Dr. Bernstein is an orthopedic surgeon. He makes the case that, Hey, I’m nationally certified. So why all of a sudden would you break it down by state? He’s a member of the American Board of Orthopedic Surgery and US medical licensing [00:10:00] examination.
[00:10:00] You get the picture. And then for these reasons he said, let’s be honest, state opposition to medical licensure reciprocity is all about protecting local physicians from competition. So why did, why did you pick that story? What’s your take on this?
[00:10:14] Ed Ricks: [00:10:14] I’ve always sort of had a question around the licensing, both from nurses, I mean, all the licensed healthcare providers and physicians. Like if you think of that as a patient perspective, right. If you travel from one state to the next, I live 20 miles from a state [00:10:30] borderline if I’m shopping 40 minutes away someplace and twist my ankle and go into urgent care I have the same expectation of level of care from the providers I would have at home. Right? Why would they need to be licensed in every state other than a control and the state to have some revenue stream from that passively? I, from the telehealth perspective, I don’t know that I agree that it’s to protect the local providers.
[00:10:53] I mean, I feel like the local system should do everything they can to be able to compete with their providers and that will protect your [00:11:00] business because those non-local providers can still get licensed in the state. I mean, you look at all the Nighthawk imaging services, all the American Wells, things like that.
[00:11:09] They have to providers licensed in multiple states that don’t live there. So that already is happening. Right. I think it’s more about the speed control around that. But if you look at it from the other perspective of the patient why not make it as easy as possible to get care? Where do you need augment specialties of necessary drive? Maybe the [00:11:30] competition I think in some areas around that.
[00:11:33] Bill Russell: [00:11:33] Yeah. I looked at this I would take three perspectives. One is the physician. The second would be the patient. Third would be the system. And and maybe even the new entrants. So from a patient standpoint, absolutely turn down the barriers, make it easier to bring more competition into the space, create more access points.
[00:11:53] Give me more choice, more options in terms of how much I’m going to spend for the care. Absolutely. Now clearly we want [00:12:00] medical care to have oversight and we want it to be done well. And so, but from a patient standpoint, I think it’s a win to head in this direction.
[00:12:09] Now there’s two ways that can head in this direction. Obviously the Cal state Northridge is in California. So you can get an idea of where the political leaning is. I’ve heard other people say, yeah, we’re doing this just differently. And that is compacts between the different states to certify licensing across different states.
[00:12:26] And I think there’s, it’s up to about 30 to 35 [00:12:30] states that have licensed together to say, look, if you can practice in this state, you can practice in this state kind of thing. So there’s two different approaches to getting a natural sort of approach to this. As a physician, the I’m not sure I would be as concerned about it as a physician.
[00:12:49] I think physicians need to get more savvy with regard to technology. That’s just the case all the time. And their practice needs to be more efficient. It needs to be able to handle [00:13:00] some digital tools for scheduling and those kinds of things. And so those are additional burdens in additional costs for local practices.
[00:13:06] This is why a lot of practices and cybersecurity and other things. This is why a lot of practices are folding into IDNs because they just can’t afford the outlay. Now the good news is I think there’s a lot of cloud plays that make some of this stuff available to them at lower costs and whatnot.
[00:13:22]But so the local, I’m not sure as it impacts the local providers, as much as it does the health system from this perspective. [00:13:30] Yeah, you’re right. The Amway Wells, the MD lives, the Teladocs, the Amazon cares the MI MD Walmart thing. Those are companies that scale. They have a lot of money.
[00:13:42] They can come in here, they can get licensed in all those states and they have a lot of runway, so they can do those kinds of things. But what this really enables is smaller players. So if you, and I decided, Hey, this is, this is an up and coming space. This is where healthcare is really going to start in the future. And we want to get into this. We go [00:14:00] raise $20 million. We haven’t raised enough money. We have to raise $90 million to get the kind of runway we need to build this out with the licensing that we have to do across all 50 states. If you tear down that barrier, we could potentially do it on $20 million and stand up a pretty good practice, target a few handful of locations and those kinds of things. So I mean, I looked at it from that perspective. I think there is some [00:14:30] anx within health systems that if this barrier comes down, the competition will go up. Now they’ll frame this in quality of care and those kinds of things.
[00:14:40] And, but at the end of the day, it’s somebody going to be getting in between the health system and. They’re patient and the consumer and starting to direct care. So this is a, this is a tough question. I’m not sure this is going anywhere to be honest with you. I’ve talked to influential doctors that [00:15:00] support the state licensure and the most interesting one to me was Dr. Joseph Kvedar who’s the head of the American Telemedicine Association and he supports it. He supports state licensure. So while I hear people saying, Hey, let’s nationalize it. I hear some very influential people in positions that you would think would say, Hey, let’s, let’s make it easier. And he’s saying no. No their, the state licensing boards oversee quality at [00:15:30] a closer level to where care is happening.
[00:15:33] If you did it on a federal level how much oversight would you really have over how care is provided. He made a case around it on the show, and I was kind of surprised that he made that case. I asked the question to sort of have that clip going forward, where he would say, yeah, this needs to go forward. And he was just absolutely surprised.
[00:15:52] Ed Ricks: [00:15:52] I mean, in our case here where I used to be the CIO at, when we brought in Amwell not only did the all the providers have to be licensed [00:16:00] and we’re South Carolina but they also had to be credentialed on our medical staff because we were integrating them into our own primary care providers, urgent cares and things like that. So that is even another level of complexity. Again, it is another good way to sort of keep your arms around the local quality and things like that, but definitely makes it more complex.
[00:16:19]Bill Russell: [00:16:19] There’s a bunch of telehealth stories. The Walmart story is pretty straightforward. They’re getting licensed in 37 states because of the BMD acquisition and which I don’t think it’s about through regulatory [00:16:30] yet, but it’s heading in that direction. So Walmart’s getting into the telehealth space. We have Amazon care getting into the telehealth space, obviously. And there was an article here, Amazon care Intermountain, Ascension launch Hospital at Home healthcare Alliance. That’s interesting. Isn’t it?
[00:16:47] Ed Ricks: [00:16:47] Yeah, that is really cool.
[00:16:49]Bill Russell: [00:16:49] So now you see traditional players Intermountain, Ascension partnering with new entrants. So let me give you a little on this one. Intermountain Healthcare, Ascension, Amazon Care are founding members [00:17:00] of a new healthcare coalition aimed at expanding home-based clinical care. The group dubbed moving health home will support and update healthcare policy changes to. Home as a site of clinical service, according to a news release. So this, this was from a little while ago, but I bring this up as sort of a there are opportunities not to just look at these players as competitors, but there’s really opportunities to look at them as potential partners.
[00:17:29] Ed Ricks: [00:17:29] I [00:17:30] think if you don’t, you’re going to carry yourself out of the future to some degree, and definitely in different communities. That’s going to be the case because those companies understand distribution at scale and how to reach out to customers and certainly how to focus on that patient experience. I’m sure there will be speed bumps along the way, but it makes more sense to partner.
[00:17:50] And again, you’ve seen some of that, even with smaller people. Again, I’ll go back to my system. We partnered with in this geography, Publix is a big grocery store [00:18:00] chain, just to partner with them to get urgent care centers within the grocery stores. You can also, we had telehealth center near, they would provide the tech and if needed and we had the equipment and then telehealth in it. And I think it makes sense because it’s just a way to reach out to other customers and other patients.
[00:18:15] Bill Russell: [00:18:15] Well, this is an interesting article because this is a little different take on telehealth. And this becomes a definition problem. The headline is in hospital telehealth is not an oxymoron and here’s why. And I think one of the [00:18:30] problems people have is they think telehealth and they think direct consumer. Consumer patient, we’re just setting up a connection. But the reality is we use telehealth all over the place. Telehealth we use it for consults. We use it for telestroke care across different venues where you don’t have the the the funding to set up a stroke care.
[00:18:53] So we did stroke care out of one of our hospitals was the expertise area and we did telestroke to a bunch of [00:19:00] our outlying in some cases, rural type location. It was our telestroke program. So it was all done via technologies, via video visits, via shared monitoring of the patient.
[00:19:13]That was a really effective way of getting people that kind of care in places that normally wouldn’t be able to afford it. So in hospital telehealth. Talk about that a little bit. What areas have we seen that or where is it [00:19:30] growing or how has it been used? I would assume COVID-19 revealed a lot of use cases here.
[00:19:35] Ed Ricks: [00:19:35] Yeah. I mean, literally the telehealth provider could be on the other side of the wall and just didn’t want to gown up and off and on and all that stuff. And it’s almost wwell, this is going to sound really counterintuitive, but it’s almost more personal than walking into a room with a mask on, a face shield, the gown and all that stuff when you can actually be in your office and communicating with the patient more frequently and easier I think. So that definitely saw a [00:20:00] spike like the ESU stuff that’s been around for 20 years now and worked well. And I think that you’re seeing that just the same way as a stroke, you’ll have the center of excellence and then all the other folks who are the hubs, then that would connect to it.
[00:20:13] But then as the EICU, you starting to see that now. So places have some of the capabilities in a more rural environment yet need that intensivist that could be always available when needed this tied directly to what’s going on. So your DNC now we saw a [00:20:30] lot of work flows. We didn’t have an opportunity while I was still in the system don’t implement some of them, but we certainly did. We had some world clinics and even just orthopedic visits and things like that you could do through telehealth. Maybe the non traditional. A lot of people think of just the urgent care telehealth visit. But I agree, there’s so many workflows, no different than a provider to provider picking up the phone 20 years ago, just to call a colleague to ask for some advice on it.
[00:20:58] Bill Russell: [00:20:58] Yeah. We did [00:21:00] a telepsychiatry was one of the things we did within the hospital. After hours, when people come into our emergency department and a certain percentage of the cases we had to do psyche evals, and it didn’t make sense, given the volume to have a clinical psychiatrist or a psychologist in each one of those locations.
[00:21:20] And so we had one or two on call and it was all telehealth to even some of our larger locations. And they would have [00:21:30] a pretty full slate through the night. But if where they were at any one location they would have had almost nothing to do.
[00:21:37] Ed Ricks: [00:21:37] Very efficient. But you know what’s interesting in that article, I think it broke down like the different disciplines and what percent of visits were telehealth visits.
[00:21:45] And the number one is behavioral health. And even that, not just on the acute side, but I think as a clinic side and so I was trying to figure out why, why that is. A, you can reach more people obviously. Right. But I, then I wonder, is there like a stigma to [00:22:00] people and outpatient setting to go into an office or versus being able to just sit at home?
[00:22:06] I would have thought and years ago that behavioral health would be like the last place adapted for telehealth. But I guess I’m thinking of more acute cases. But when you look at what’s really happening, it is it’s really driving the market a little bit.
[00:22:19]Bill Russell: [00:22:19] Yeah, it’s interesting. I gave you so many articles. I think you just confused two of the articles. The McKinsey article has a bunch of where telehealth [00:22:30] happened and it was very, very interesting. Psychiatry was the largest area far and away. Substance abuse disorder treatment was second. Endochronology, rheumatology, gastroneurology. And then it goes down from there.
[00:22:44] But let me go back to in hospital telehealth because one of the biggest problems, let’s see, I was in the hospital once, my father-in-law, before he passed away was in several times. And one of the biggest challenges is the doctor’s going to be in to [00:23:00] see you too. Well, nothing more frustrating than that statement. Today. Today is 24 hours. When am I going to see the doctor? And the reality is we’re not real tight with regard to those, that kind of scheduling, and we want to give the flexibility to the doctor to make rounds when they’re going to make rounds and those kinds of things. We can really tighten that up with telehealth.
[00:23:23]In my case specifically, I would not have minded if on the TV, the doctor popped up and we had a conversation [00:23:30] and he could share some of the findings and that kind of stuff by father-in-law may have been a little miffed if the doctor didn’t show up in person and showed up on a TV.
[00:23:39]But we can determine that stuff upon admission. And to be honest, the level of frustration, my father-in-law and my wife and I felt, you know, the doctor will see him today. And then at the end of the day, well the doctor wasn’t able to make it in. And you’re like, I mean, literally he died in December. So I mean, it would not be out of the ordinary to [00:24:00] say, Hey, he’s dying.
[00:24:02] The doctor can’t see him today. The doctor can’t get in. I mean, can’t we be more efficient around this. And I would think that doing some sort of rounds or integrating this into their rounds in some way, would make clinicians more efficient across that aspect. Am I, again, I’m not a clinician, I’m not a trained clinician. And am I smoking something here or is that a valid assertion?
[00:24:29] Ed Ricks: [00:24:29] Right. I mean, [00:24:30] it makes sense to me, right? It’s clearly more efficient. If nothing else through the pandemic we saw that. The adoption of some of these telehealth processes are clearly more efficient and hopefully that will give us a momentum to keep moving forward.
[00:24:45] So I totally agree with you and it is frustrating. And then you wait all day and you don’t see the doctor, or maybe the PA or something will show up. And certainly just as probably capable, but it doesn’t feel the same to your father-in-law or may feel the same way [00:25:00] but maybe not to him. And so I get it. And if you can integrate that seamlessly into the workflow. It would make sense, just like we’re starting to integrate telehealth visits into clinic office visits. Can be right on the schedule. It’s just your next patient is telehealth. It’s not somebody sitting in the lobby.
[00:25:16] And so if you can make that seamless, it makes sense to me. How do we make that seamless to the physician who got caught up in surgery longer or whatever their specialty is. Things happen throughout the course of the day that keep them from visiting in [00:25:30] the hospital. But there’s got to be a way to make that more easy. I think technology is going to be the answer somewhere around that. Probably cultural is the other component you got to jump over.
[00:25:41]Bill Russell: [00:25:41] I want to get to both of your stories. I think they’re are two really good stories. Unified data, the key to HIE success, actually, I’m not going to go into this story too much, cause it’s just going to sound like I’m being critical. It is an ad piece, by the way. It’s written by somebody, who’s a solution director for an organization that’s on healthcare IT today. They make the case [00:26:00] for essentially master data management across HIEs in order to do this. And part of my problem with it, as I read some of these things. With human guided ML for data mastering ML does the heavy lifting to consolidate, cleanse and categorize data, enabling healthcare teams to drive better outcomes faster. This approach can also vastly improve patient analytics and allowing for targeted care geographic trends and predictive analysis. Great couple of sentences. It’s just so whitewashes how [00:26:30] hard this is. I mean, it’s just like, oh yeah, just plug in cloud native master data management, and all of a sudden the machine learning is going to take care of all the problems that you have.
[00:26:39] The reality is, there’s a couple of problems with HIE. A couple of challenges. But the problem is at the point of entry of the data. We have different definitions of data. We have different standards for our data entry clerks, otherwise known as clinicians. We have clinicians that we don’t have agreement across our individual hospital, how we’re going to [00:27:00] enter data in certain cases.
[00:27:02] And now all of a sudden you’re saying, Hey, the HIE serves the region. And if you think we’re going to be able to control or get closer by, by just plugging some technology on top of it. For a region like Southern California where my clinicians can agree with the clinicians within our own health system. How are we going to do that across a region? What’s the state of [00:27:30] HIEs today? And where do you think this is going?
[00:27:34] Ed Ricks: [00:27:34] And that’s sort of why I landed on that article. I again, while some of it sounds really cool. I don’t necessarily agree that HIE’s have solved a lot for us in healthcare from the broader concept. It has brought a lot more data and information to be available to providers, but is it when they need it and where they need it and something they trust and all those things people talk about for 10 years now. I [00:28:00] think that the plan right. The long-term concept is if you’ve got one sort of unified medical record, but none of that helps unless it’s fully integrated into the workflow of what the physician is doing.
[00:28:11] So the example I think I mentioned earlier is, has it really kept people from ordering unnecessary CTs whatever, if you’re the ER, physician somewhere presents and that’s sort of in the care plan that’s going to happen for you. Is it integrated real time that someone across town from a different system actually just [00:28:30] got a CT last night.
[00:28:31] It may be available to you, but it may not in your EHR, which is probably different from theirs while you’re ordering that as you go through, how long has that happens? It just like a lot of the other information that’s out there. It just. Information overload. How important is all of that?
[00:28:49] But still it down and drive insights while you’re delivering care, and every, just as you said, everyone thinks of everything different. They used to crack me up. So a hundred years ago, before I became a [00:29:00] CIO, I was a software developer and we did sort of EHR before they weren’t very clinical.
[00:29:05] Right. But it was a lot of, it was. Billing and things that we did at the time. And I love the fact that our actual billing forms, where the UBS, whatever they were at the time you’d be 82 is whatever they were and you’d be was uniform billing. Well, yes, everyone used the same piece of paper, which later became the same electronic form.
[00:29:25] And while it was called uniform billing, every organization, including all the payers did each [00:29:30] one of those fields differently. So while they were putting it out, they looked the same when they were printed but the information on it meant something different to every organization. It is no different in electronic level of information.
[00:29:42]Bill Russell: [00:29:42] In this area, I really like it. The work that ONC is doing, I like the work. I like how Micky Tripathi is continuing in the work. I think some of the most important work that is talked about within our industry is the work in the USCDI. It is [00:30:00] around the core dataset that that is being developed and what people don’t recognize it that the federal government is sort of the floor. They’re looking at it saying, all right we need to have at least this core data set. Right? So they’re putting that together. What they hope will happen is that healthcare is an industry, or even as a region will self-organize and come together and say, we’re going to design a core data, set around, fill in the blank, whatever the area [00:30:30] is, it doesn’t have to be comprehensive.
[00:30:31] You’re not trying to do this across the entire EHR. You can do it in just, in just oncology or just it just one area. If you can get a group of people in a region to sit around, they can start to define some of those standards and that team will help you to establish how to put that stuff together.
[00:30:52] And if we do that on a regional basis, some of those regional standards can then essentially move around the country that work [00:31:00] at USCDI is so important, but if we don’t self-organize and we have very little propensity to self-organize, the federal government is just going to keep going down the line. It’s going to take a lot longer, but they’re going to go down the line.
[00:31:11] They’re going to start with the core clinical data set that they have now. And they’re going to start to move in into other areas. I hope we’re smarter than that. I think some health systems are trying to lead the way in this, especially coming out of the pandemic and the needs that [00:31:30] were unmet because of the quality of the data and how we were putting the data in there.
[00:31:33]I hope to see that not require a federal mandate but that we just recognize as an industry where we can, we can really address this problem with with standards around just sets different sets of data. And then the transferring of that data obviously fires there and we have a different, a couple of different ways to move the data around. So it’s not the that’s not the [00:32:00] hard part. The hard part is getting quality data in.
[00:32:05] Ed Ricks: [00:32:05] And I think what people have to, there’s gotta be incentive to do it, and I don’t necessarily need a financial incentive. So I feel like most organizations, probably all organizations, right? They want to deliver quality care and they want to improve the lives of the people in their communities.
[00:32:21] And so that should be the incentive enough to do those things. And I think you’re creating efficiencies though, in your organization when you can do that. And you’re going to [00:32:30] definitely lower expense to deliver that care over time. If you’re measuring that quality and making improvements based upon what you learn, but there’s something that’s got an incentive to happen for most people I think.
[00:32:42] Bill Russell: [00:32:42] All right, so Ed, let’s close with this story. As I said, I’m getting on a plane after this so we’ll, we’ll cut this one a little short. So Truveta grows to more than 50% of US patient care with three new members. So Truveta is this partnership that [00:33:00] has formed. They’ve raised a hundred million dollars giving it probably a billion dollar evaluation if I’d thought about it. I’m not entirely sure what it is, but essentially they pulled data together. The initial health systems, Advent Health, Advocate Aurora, Baptist Health, South Florida, Baylor Scott and White, Bond Scores Health, Common Spirit, Hawaii Pacific Health, Henry Ford Health System, MedStar Memorial Hermann, Northwell, Novart, Providence, Sentara tenant, Texas health resources, Trinity Health. And actually I threw in the ones [00:33:30] they added, they added three recently, and those are Baylor Scott and White, MedStar and Texas Health Resources. This is an awful lot of data.
[00:33:40] They have a hundred million dollars that has been invested in the organization. And they’re going to be bringing this together for the good of main time. I mean, that’s the whole premise around this is we’re going to bring all this political data together, make it available to for anonymized, of course, for research and those kinds of [00:34:00] things.
[00:34:00]It represents a significant clinical data set. Mostly, it’s just making people aware that this is, this is growing and it’s a growing trend. That the aggregation of this data. How I view this as this is all in all this is a good thing for healthcare and for patients in that hopefully this will take us closer to identifying cures and getting closer to personalized medicine and those kinds of things.
[00:34:26]As I look at this, there’s a couple of things that are really [00:34:30] interesting to me. One is, it appears to me to be more of a capital capitalist kind of thing than a, for the good of mankind. I’m not questioning people’s motives here. I think there’s an awful lot of good value.
[00:34:45] I just said that around this, but it’s a hundred million dollars has been raised. The valuation is a billion dollars and all these health systems are investors. And I think you’re seeing more and more health systems. All right. It’s a [00:35:00] $4 trillion market. We’re not only going to make money as healthcare providers.
[00:35:03] We’re going to make money as providers to other healthcare systems. I’m, we’re going to start leveraging the assets that we have to greater value in one of the greatest assets they have is that medical record that they have amassed over the last decade or two. And so I think they’re just tapping into other value streams within the health system and really monetizing them. That value stream. I’m curious what your thoughts are on [00:35:30] Truveta and their direction.
[00:35:31] Ed Ricks: [00:35:31] I mean, I think I pretty much agree with you a concept that’s kind of cool. Right. But it’s all going to be retrospective research. You know when maybe someday, I guess this is probably the holy grail, is can that help drive insights to deliver care to you when you’re in the hospital in real time. What does that mean? And that’s to me, a completely different story, and what’s kind of happened from a mechanism perspective. But that’s a lot of data normalizing that data you’ve [00:36:00] got all that work to do to make it all make sense, but you ought to be able to drive some insights from that kind of data set.
[00:36:06] Bill Russell: [00:36:06] Yeah, and I think they’re going more in the research direction than the real-time insights at the, at the point of care.
[00:36:14] Ed Ricks: [00:36:14] Well, the biggest thing, I guess both. I see a big impact research. Like you said, if we can help find cures for things that bring all this aggregated data together will drive that it does make a lot of sense, right? Because it takes a lot, the more data the better. There’s no doubt about it. But [00:36:30] when you talk about personalized medicine and how do we really impact each patient at the point of care to me, that’s where someone’s got to make that happen from that level of data set.
[00:36:41]Bill Russell: [00:36:41] This whole data supply chain is getting really interesting to me of which data is really good at the point of care. And how do we make sure that that data has a really good supply chain to get from it’s source to the inside of the clinical workflow. And then identifying what data is only mucking up [00:37:00] the clinical workflow. There’s too much data in the clinical workflow today. And how do we take that data out and do the analysis we need to do, get the insights we need to get and just deliver those insights into that workflow.
[00:37:11] And will doctors trust that or do they need to see every aspect of how that data was derived before they will trust it and be able to take take action on it. And there’s, there’s a lot of cases to be made. IBM Watson being the biggest. We’ve had a couple of [00:37:30] missteps with regard to data in the clinical workflow.
[00:37:33] And we have a trust gap to really fill. And I think that’s one of the reasons you take a startup like this and you focused it on research because you can Yeah, there’s a bunch of different ways that you can address any data gaps or data quality issues along the way. If it’s being used for research, as opposed to real-time delivery of care.
[00:37:54] Ed Ricks: [00:37:54] Right. No, I agree with that. I think ultimately physicians will trust. I mean, we’ve sort of landed [00:38:00] on evidence-based order sets. It took some effort to get away from 20 different specified order sets down to one or two or three, perhaps as you go through medical staffs. And so this to me doesn’t seem a lot different other than the fact that order sets going to differ for patient a versus patient B versus patient C based upon what the evidence and the insights are driven from it.
[00:38:22] Bill Russell: [00:38:22] Ed I want to thank you for doing a whole show where we only marginally talked about cybersecurity. It feels like every show I do now is [00:38:30] really focusing on cybersecurity and we have risk management cybersecurity. We had that short conversation earlier on, but it is such a top of mind topic. So many news stories out there right now around cybersecurity. We end up talking about those a lot so.
[00:38:44] Ed Ricks: [00:38:44] It is super relevant for sure.
[00:38:46] Bill Russell: [00:38:46] It’s super, it’s super relevant. Yeah. You’ll come on a little later, maybe in a few more weeks. What topics do you think are going to be hot over the next couple of months? We have HIMSS coming up
[00:38:58]Ed Ricks: [00:38:58] I was just going to say, I’m [00:39:00] sort of curious to see how HIMSS goes and what if we learn from an industry perspective, much of anything through that other than it’s hot in Vegas in August. I think we all know that going in. So that, that part will get for sure, but I think that’ll be interesting. I am still curious to see how people are actually going to focus their spend over the next couple of years and that’s starting to sort of shape up. And we did address that. At most, a lot of cases of one thing I left out was I think it’s actually reducing [00:39:30] complexity on what they’ve gotten their environment, but still being at a higher level of what they’re good at putting out at the end of the day. And I think that you’ll see that ??.
[00:39:37]Bill Russell: [00:39:37] Yes, I think that’s true. That will be an interesting topic to see where we start to do budgets. Some of the budgets will come in July 1st for a bunch of health systems is their fiscal year. So we’ll start to have conversations with CIOs around where they’re, they’re placing bets as a health system. Some have September end of fiscal years as well. Not as many have [00:40:00] January 1st fiscal years anymore just because closing the books is hard and you don’t really want to be doing it over the month.
[00:40:05] Ed Ricks: [00:40:05] Well, I think a lot of organizations line up with a CMS or the federal government year, which is October 1.
[00:40:11]Bill Russell: [00:40:11] Yeah we did July. It was just easier to get resources to work on the books and get all that stuff done. Always a pleasure to have you on the show. Thanks. Thanks for coming on.
[00:40:20] Ed Ricks: [00:40:20] Great talk to you soon.
[00:40:22]Bill Russell: [00:40:22] 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 [00:40:30] team, your staff. I know if I were a CIO today, I would have every one of my team members listening to this show. It’s conference level value every week. They can subscribe on our website 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. [00:41:00] Those are VMware, Hill-Rom, StarBridge Advisers, Aruba and McAfee. Thanks for listening. That’s all for now.