Ed Marx This Week in Health IT Newsday
February 15, 2021

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February 15, 2021: Edward Marx, Chief Digital Officer at Tech Mahindra Health & Life Sciences joins Bill for the news today to discuss telehealth, state reimbursement, remote patient monitoring and the emergence of the Chief Digital Officer role. Who is the voice right now? Is it a combined CIO, CDO role or does it require separate skills? No health system is 100% in the cloud yet. Why not? We know data is key to the future of health and medicine. 14 leading health systems have joined forces to form a new data consortium named Truveta. How is digital health being integrated into the medical school curriculum? And HOW huge is Optum’s role in healthcare? 

Key Points:

  • The emergence of the Chief Digital Officer role [00:03:05] 
  • We know de-identified and securely aggregated data at scale can produce valuable insights and have the potential to revolutionize the way to prevent, treat and cure disease [00:09:15] 
  • It’s great that we are starting to look at larger data sets to try to take out some of the bias [00:12:25] 
  • Everybody’s trying to disintermediate the patient from the health system and that’s going to be a significant financial problem coming up [00:19:05] 
  • State reimbursement [00:41:50] 
  • Digital Voices with Ed Marx podcast 
  • Tech Mahindra Health & Life Sciences

Stories:

Newsday – Truveta, Patient Data and Remote Patient Monitoring

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Newsday – Truveta, Patient Data and Remote Patient Monitoring

Episode 365: Transcript – February 15, 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 a 16 hospital system and creator of This Week in Health IT a channel dedicated to keeping health IT staff current and engaged. Special thanks to Sirius Healthcare, Health Lyrics, and Worldwide Technology who are our Newsday show sponsors for investing in our mission to develop the next generation of health IT leaders. We set a goal for our show. And one of those [00:00:30] goals for this year is to grow our YouTube followers. We have about 600 plus followers today on our YouTube channel. Why you might ask because not only do we produce this show, In video format, but we also produce four short video clips from each show that we do.

[00:00:45]If you subscribe, you’ll be notified when they go live. We produced produce 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 today in health it.com. [00:01:00] We look at one story each day and try to keep it about 10 minutes or less.

[00:01:04] So it’s really digestible. This is a great way for you to stay current straightway 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, I agree with the content disagree with the content. It is still a great way to get the conversation started.

[00:01:21] So check that out as well. Now onto today’s show. All right, today we are joined by ed marks and is a friend of the show been on many [00:01:30] times. Welcome back to the show 

[00:01:32] Ed Marx: [00:01:32] Bill It’s like really exciting to be with you. I really appreciate the invite. 

[00:01:36] Bill Russell: [00:01:36] I’m looking forward to it. So you are launching a new podcast, you are competition, which I don’t really care about. I’m always about getting the best thinking out there and you have some great thinking so I’m looking forward to it, but tell us about the podcast. 

[00:01:50] Ed Marx: [00:01:50] Oh, yeah, man. There’s no competition to Bill Russell when it comes to the podcast. So it’s different. So it’s called Digital Voices and it launches [00:02:00] officially next week we’ve actually recorded.

[00:02:01] I think the first five or six episodes we’ll just drop weekly. And what it’s meant to do is cross all of health and life sciences. So instead of just the payer said, it’s just the provider or pharma, we’re crossing all of it. So digital voices so includes like Chief Digital Officers and another interesting people of interest from all those different segments, including patients.

[00:02:22] So actually our very first drop is the digital voice of a patient and it was quite powerful. So I’m really [00:02:30] looking forward to it. And it’s really meant to just add to the discussion and try to break down the barriers between payer provider. Payer pharma, you know, the whole continuum. So that’s what it’s all about. And hopefully it’ll be enjoyable. 

[00:02:44] Bill Russell: [00:02:44] Yeah. And we’re going to, we’re going to talk a little bit about that divide and things that exist today. So it should be interesting. So focus, I mean, the unifying principle is really around digital, right? 

[00:02:56] Ed Marx: [00:02:56] Correct. So, you know, there’s the emergence of the Chief [00:03:00] Digital Officer as you’ve spoken about quite well.

[00:03:03] And who is the voice right now for the Chief Digital Officer? And you’ve covered it really well in terms of some CEOs are capable of doing both. In many cases, CDOs have been brought from outside industries and CIOs are reporting to them and it’s really quite an emerging field. So it’s really about capturing that field across again, that health continuum and really creating a forum for them to interact, [00:03:30] to talk about issues that crossover all the way into the patient side of things. So that’s why digital voices and why we created it. 

[00:03:38] Bill Russell: [00:03:38] Yeah, I it’s interesting because in the last 90 days, just the interviews in just the last 90 days, So Tressa Springmann now has the CDO role. Jason Joseph at Spectrum has the CDO role Craig Richardville at SCL has a CDO. So a dual role CIO CDO role. So the more established CIO is who’ve been around a while are latching onto as well as [00:04:00] some others we know that have both the CIO and CDO role. 

[00:04:03] Ed Marx: [00:04:03] Some are able to pull it off well and are well-trained and kept up with the times and are easily able to operate in both. But unfortunately it’s not the case for the majority. And so that’s the other thing we’re trying to do with digital voices is bring outside the industry. So one of our first guests, again, these pods don’t start dropping until next week, but yesterday we had a guest from Telecom and how they’ve digitally [00:04:30] transformed their particular telecom company and how it might help healthcare.

[00:04:34] So there’ll be a lot of external guests coming into our digital officers and what have you. From other companies and the hope is that we can all learn from them so that we don’t need them to come in and displace us, but we can learn from them and upskill and lead all things digital. 

[00:04:53] Bill Russell: [00:04:53] Yeah one of the podcasts I listened to is the Accenture podcast. And one of the reasons I do that is because their CIO has [00:05:00] boldly gone to the cloud to the point where there is nothing, but the cloud left at Accenture. And they talk about the agility of that and being able to ramp things up and being able to write applications on top of a well architected cloud stack.

[00:05:14] And it’s you know, it’s really fascinating. I haven’t seen the health system that boldly has said a hundred percent in the cloud yet. 

[00:05:22] Ed Marx: [00:05:22] Really tough to do as you know, just the legacy, the history, the culture, difficult to move with agility and velocity in [00:05:30] healthcare. And it’s sorely needed. Right?

[00:05:32] It’s one of those key tenants that have held us back, although, as you’ve pointed out and others during COVID remarkable job, remarkable leadership across the board. So that, that gives me a lot of hope and I’m really hopeful that will continue, you know, that it just wasn’t a blip in the radar, but that’s the new way of operating. 

[00:05:53] Bill Russell: [00:05:53] I remember in our cloud journey, we were, I asked the question. I was like, can we move PACS into the cloud? [00:06:00] And they’re like the operational packs. I’m like, yeah, can we move that into cloud? And they’re like, no, you can’t put that in at the time. I’m like, okay, here’s what I’d like for you to do for me. Tell me why I can’t. And they’re like well it’s going to be too slow.

[00:06:13] I’m like, give me the math. Well no one’s ever done it. I’m like that’s a different, that’s a different argument. No one’s ever done it. Give me the math. Let’s see if we can do it. And then we eventually did it. And I think to this day, if you walked in and said, can you run PACSin the cloud? Most people would say, Oh, you [00:06:30] still can, it’s too transactional, whatever. I’m like, well, if you architect it correctly, you can. You just have to get people to stop saying you know, it can’t be done and start answering the question of why can’t it be done? I mean we can do a lot of things clearly. 

[00:06:44] Ed Marx: [00:06:44] Yeah. And sometimes you just have to allow that person that has, that doesn’t have the same confidence level to have the experience. And so one of the things that we did, I’ll never forget this because, and I think it’s cool to talk about who it was in the [00:07:00] organization, because it’s a very positive story but it was at the Cleveland clinic. We’re number one in the heart’s right for 27, 28 years in a row global leader. So there was a lot of skepticism about moving to the cloud.

[00:07:11] So we got the lead of Cleveland Clinic, a ,cardiovascular surgeon, top of the world, you know, the division lead to come out to our data center. Okay. So we still had a data center, which I was trying to get rid of and all those things, but at least gain some [00:07:30] confidence that we could do some of these PACS and some of these other really intense imaging remotely.

[00:07:36] So that was like the first step to take it from the closet. Next door to the data center. That was a big, bold move. Before we moved to the cloud, just to show that can be done. Well, he spent I left before he did. So we had an hour to do a tour and to talk about the data center, how it worked, he stayed, he took pictures, selfies.

[00:07:56] I have selfie with him cause he was so excited because [00:08:00] it dawned on him that the data center or the cloud was like the cardiovascular system and how it worked and how you had to sort of center the data. And then you had arteries and how things flowed. And so we just started using that sort of venacular in our explanation about why it’s beneficial, you know, to move to the cloud and how it really works.

[00:08:21] And you’re still connected and there’s still blood flowing through and that was a magical experience. And so sometimes you have to let your, the [00:08:30] doubters sort of the doubting Thomas, you know, touch the wound or see the, see what the cloud is and kind of have more of an experiential as opposed to philosophical discussion.

[00:08:39] Bill Russell: [00:08:39] Yeah. And that, you know, and that gets us to our first story. And I’m just gonna, I’m going to share this because I didn’t share this with you ahead of time. So this is the Truveta announcement and this is. A post from Rod Hochman, president and CEO of Providence. When Providence established our vision of health for a better world, we knew data was the key to the future of health and medicine, healthcare providers across the country, [00:09:00] maintain and protect copious records, serving as the custodians of vital health information.

[00:09:05] Some of this is obviously grandiose words to announce a new offering. But here’s why I want to talk about when de-identified and securely aggregated data at scale can produce valuable insights and have the potential to revolutionize the way to prevent health, prevent, treat, and cure disease.

[00:09:24] Toward that end Providence has been working to build a coalition of the nation’s major [00:09:30] healthcare providers with the goal of bringing our de-identified data together onto one secure platform. Today, they are excited to announce 14 health systems,  Advent Health, Advocate Aurora, Baptist Health in Florida, northeast Florida , Bon Secours, Mercy, CommonSpirit, Hawaii Pacific, Henry Ford Health System, Memorial Hermann, Northwell Health, Novant Health, Providence, Sentara Health, Tenant Health and Trinity Health. So that’s no small, that’s a [00:10:00] pretty sizable dataset. Truveta is in the early stages.

[00:10:03] They’ve hired a person. Let’s see Terry Myerson, a former executive vice-president of Microsoft has agreed to lead the charge. In his 21 years at Microsoft he oversaw windows Xbox surface. And I would say that’s not nearly enough experience. When he gets into health care he’s going to realize what he’s signed up for as we all have over the years. As we’ve seen with COVID-19 data insights cannot come fast enough. They are essential for quickly understanding [00:10:30] new viruses and other diseases. And so they’re going to bring that together. The time is now for healthcare community to step up and lead the way big tech companies and even foreign entities are vying for access to patient data as healthcare providers. It is one of our highest stakes to safeguard the personal health information on our patients. And trust us entrusted to us. “Truveta is our answer to putting those safeguards in place and we can ensure that privacy is paramount. That health information is protected.” Okay, so couple things. [00:11:00] I wanted to talk about this with someone and you’re here.

[00:11:03] So this is perfect. You know, we have an Epic’s cosmos. I think it is. We have, I think Mayo is putting something together like this. This is clearly a huge dataset. And we’ve always talked about you know, data is the new, this is the gold rush of data. Your data is the new oil. I guess, as they say, and specifically with regard to healthcare, if we can bring that data together, we can create a more precise , I don’t [00:11:30] know, determinations of what people have. We can prescribe things more accurately. We can identify things more earlier, faster as we just saw with, with COVID. So that’s the promise of this whole thing. They use the word trust in here about a million times. So clearly they believe that that is going to be the cornerstone and it should be after the Ascension mistep.

[00:11:54] Let’s call it a misstep earlier last year with Google. You know, they took a lot of heat because their [00:12:00] people didn’t know that what they were doing. What are your first thoughts? I mean, that’s one of my first thoughts on this is do the patients know that their data just went into this de-identified things and cause my data is in there.

[00:12:10] My data’s in there. I didn’t get any email. I mean, this is the first I’m hearing about it. I guess they think cause it’s going in de-identified I’m okay with it. So I that’s the first thought I have. What are your thoughts? 

[00:12:23] Ed Marx: [00:12:23] Well generally from an altruistic point of view, I think it’s great that we start looking at larger [00:12:30] data sets to try to take out some of the bias that are in some data sets.

[00:12:34] And, you know, it enables some great opportunities for research and to doing really a lot of public good, but it does come with a lot of big red flags. You talked. About a few of them and probably the primary one is, you know, did I agree to, is there some form that I already signed that said, yes, you can share all my information as long as it’s de-identified [00:13:00] and that’s something that we need to talk a lot more about and to make sure that the appropriate safeguards are in place because many will argue that there’s no such thing as de-identified data. Is there a way to break it back the other direction? 

[00:13:14] Bill Russell: [00:13:14] I’ve heard that I’ve had data scientists sit with me and say, you gave me the, you give me the dataset and give me enough time. I can unde-identify it pretty, it depends on what data elements you give them, but they’re like, I’m pretty sure I can de-identify any data set.

[00:13:30] [00:13:30] Ed Marx: [00:13:30] Yeah. As opposed to the alternative approach, although it’s a little bit more challenging and has its own issues but that is why not ask someone like I would freely give my data if I knew that it was going to help the common good. So they would get my data so that people could avoid having cancer, as an example, I would freely give that data.

[00:13:52] And so, you know it’s one of those things where I think the more transparent you can be with the patient [00:14:00] the better. Because it’s the patient data. You’ve made that argument pretty clear in your podcasts previously. And I believe that to be the same. So I think you need to ask them straight out. 

[00:14:12] Bill Russell: [00:14:12] But yeah, I have made this before. Hey, one of the things you’re gonna learn in the podcast. Yes. As you repeat yourself, if one of the reasons you repeat yourself as no one has listened to all 380 of my episodes, so you can just, you’re like, okay, do you have new, you have new listeners coming on all the time who were like, yeah, But, and this is one of my biggest [00:14:30] arguments against the national patient identifier.

[00:14:32] And I understand. I get it. It is a good effort, right? We’re going to bring all that data together. We’re going to deliver it to the point of care, have the longitudinal patient record. I get why it’s important. And it helps us at a time of mass vaccination and whatnot. I understand the argument for it.

[00:14:47] So I don’t want the angry emails. I’m willing to have the conversation but one of the primary reasons I’m against it is it changes the focus. The focus, if you go in with a national patient identifier, is that the [00:15:00] information is the property of the health system. And that’s where you need to bring it all together.

[00:15:07] And what I’m telling people is. I don’t want it to be brought together at the health system I want it to be brought together at me. I’m the locus of information. I want to bring it to me. And so when all these guys say, Hey, I’m going to put, we’re going to put all this information. And I said, great. That is a great endeavor, but here’s what I want you to do.

[00:15:25] I want you to pass it through the patient first. Give it, [00:15:30] all these health systems should give it to the patient in some app that I can look at and then say, all right, do you want to participate or not? Yes. Yes. 

[00:15:36] Ed Marx: [00:15:36] Yeah. I agree completely. That’s what I was trying to articulate. And you did it much with a much better, a more clear example, but yeah, at the end, at the beginning of the end, it’s gotta be all about the patient. It’s gotta be patient centric and allow them to see, Oh, what information are you passing along? Okay. Yes, I consent. Do that. And I think there’s going to be more opting in then organizations think, and plus it’s just the absolute right [00:16:00] thing to do. 

[00:16:01] Bill Russell: [00:16:01] Yeah. I think they’re afraid that I’m not going to give it to my health system, I’m going to give it to Amazon or somebody else. And we already are. We’re giving it to Apple, right. I mean, a bunch of us are . it’s interesting. You know, I want to talk a little bit about Optum. So you teed up a story  from Becker’s. Why don’t you talk a little bit about it and then we’ll go from there.

[00:16:18] Ed Marx: [00:16:18] Yeah, because I just think when I think about digital transformation and from a provider centric point of view, and from a hospital point of view, when I read announcements [00:16:30] about how big Optum is not just Optum, it’s all the payers, how large they’re getting in terms of primary care. They now represent the largest primary care base in this country.

[00:16:41] So Optum specifically has about 55,000 providers going to add another 10,000 by the end of the year. So it used to be the way the ecosystem works, right? Is you have a hospital and they attract a medical staff and that medical staff is largely PCPs who then refer to their specialists who then bring [00:17:00] patients to the hospital.

[00:17:00] That’s sort of the ecosystem in a very generic sense. Well think about the fact that all of your PCPs now are being disintermediated, that they are being taken away. There’s no longer this sense of loyalty necessarily to a hospital, but the affinity becomes to your employer naturally. So in this case, it might be Optum and you know they have all these 1500 clinics and growing. So what does that mean for the hospitals and their future to sort of [00:17:30] control patient flow and I’m, and it’s not being done in secret. And then if you take it to the next step, so what the payers are also doing is they’re doing virtual health.

[00:17:40] So the lead commercial in the Dallas Fort worth market from the blues is telemedicine. So I’m thinking to myself, Hmm. If I’m a provider in Dallas Fort worth, and this is all over the country. Wow. They have more PCPs than I do, and they’re doing telehealth visits. That means those patients aren’t [00:18:00] coming to my practice or to my docs that are affiliated with my hospital.

[00:18:04] And they’re doing remote patient monitoring, and they’re starting to do hospital at home. What’s left for me? And. I don’t know that I’ve seen a lot of reaction yet by providers. And so that’s really why I thought it was a good item for discussion. And what does it mean from a health it perspective if you’re a CIO or CTO at one of these health systems or hospitals and your primary [00:18:30] care base is being taken away. And how do you, why is that happening and what can you do to stop that flow?

[00:18:38] Bill Russell: [00:18:38] That’s a great question. And it’s only Optum, those numbers did surprise me when you shared them a 50, 55,000 and 10,000 more physicians this year. You know, we’re gonna, we’re gonna see the same thing from Walmart. I’ve talked about that a bunch of times . CVS is the next one.

[00:18:52]And you know, Walmart for their part is getting into insurance. CVS bought into insurance, I guess. I’m not sure if Etna is the controlling entity [00:19:00] or CVS is the controlling entity. It’s the two very large companies coming together. Everybody’s trying to disintermediate the patient from the health system and that’s going to be a significant financial problem coming up for the health systems.

[00:19:17] So if I, you and I, so let’s assume we just became CEOs. What would we do here? You know, I think the first thing is look we already have a base, a significant base of doctors in our market. [00:19:30] How do we get them out in the community? How do we make sure we shore up our primary care physicians and make them as convenient as possible to access, not in the old medical office buildings, but in a locations where they’re very accessible, including the digital routes, right?

[00:19:45] It’s accessibility, it’s convenience. You know, it’s after hours access. We have a majority of that information. We have the leg ups still, probably still today. We still have the leg up. If we start to make moves, if you’re the [00:20:00] CEO, what are some things you’re doing? 

[00:20:02] Ed Marx: [00:20:02] Yeah. So I think it does come down to two broad areas. One is the patient experience that you’re alluding to and the other is the clinician experience. So what I’m understanding from some of my friends that are in this PCP mix with companies like Optum, is their lifestyle’s much better. So they are given, you know, the equivalent salary with, you know now they’re part of a for-profit company and incentives that come with that and their is better.

[00:20:28] So they’re given [00:20:30] finite hours in which they work, as opposed to, it’s just kind of an open-ended expectation. So I would do everything I can to ensure a great quality of life for my clinicians. That they would want to be part of the hospital and the health system. That they would have this affinity for working together to serving the community.

[00:20:52] So that would be number one. So like I said, it could be, lifestyle-related like work hours. It could be having the right digital [00:21:00] tools. So they don’t have to go in seven different systems that there’s one platform that they might work with. So that’s one thing. And then the other one, like you were talking about bill is the whole patient experience.

[00:21:10] So we are going to have office hours in the evening. I remember how hard it was. I know you’re a long time CIO as well. Having those discussions with medical staff, like, no, we don’t work, you know, Wednesday evenings. Well, there’s a way to do it and still have quality of life. Right. It doesn’t mean that there are working all day, Wednesday and Wednesday evening.

[00:21:27] Right. You have shifts and things like that. So there’s a lot of [00:21:30] things that you can do to make it a better experience for the patient because you’re right. You’ve got retail coming in. You’ve got the payers we’ve just talked about, you got retail. It’s very convenient. You just walk in. Or a lot of them with their apps, you know, for tele-health they can press a button and talk to someone right away.

[00:21:48] And I don’t think we’re there yet on the provider side and the hospital side making it that convenient. So that’s what I would stress out. CEO I’d make, make sure my clinicians were all happy, had a good [00:22:00] lifestyle, had all the digital tools they required. And then of course all about the patient experience and patient engagement 

[00:22:05] Bill Russell: [00:22:05] Yeah cause the patients really do follow the physician. If the physician goes from one group to the next they’ll figure out a way to go to that physician won’t they.

[00:22:13] Ed Marx: [00:22:13] Yeah. That’s the key relationship. That’s the trusted relationship, you know, trust has eroded in so many different verticals. You know, you’ve seen the reports, especially politicians, probably at the bottom.

[00:22:24] And the one that has been maintained is nurses and doctors have always had this trust. [00:22:30] And so I would just leverage that trust and really just you know, make sure that my clinicians felt like their job had meaning their work had meaning that they had ability to influence the organization and that they had the digital tools, like we mentioned to ensure, you know, quality of life, 

[00:22:49] Bill Russell: [00:22:49] You know, so you and I are going to close this with three stories, which are related. We’re going to talk telehealth. We’re going to talk remote patient monitoring because that’s what you’re doing with health next. And but before we get [00:23:00] there, Yeah. You shared an interesting story about the next generation of physicians and their training. Why don’t you see that one up for us? 

[00:23:07] Ed Marx: [00:23:07] Yeah. This has been really interesting for me. So my wife, who you might see her pictures in the background, she’s getting her DNP. So her doctor of nurse practitioner, she’s been a longtime nurse. Who’s been a nurse like. If I told you how many years it might be mad at me, but she’d been a nurse for like 30 years and she’s really digitally capable.

[00:23:26] And in fact, she led Epic implementations at her particular hospital [00:23:30] in a big health system. So she went from bedside nursing. Into tech for about five years, led Epic implementation, represented, you know, basically the hospital. She was like the liaison to it for multiple years and then went back to bedside nursing.

[00:23:45] And then the last couple of years she’s really been focused on getting her masters and her DNP. So I’m always asking, cause I’m always curious, like, what are you learning? What are you learning? So there’s some, there’s some journal articles now that are out there about. What they are learning and it’s kind of [00:24:00] scary maybe, cause it just takes many, many years, but for modern digital practice to be folded into the clinician training.

[00:24:08] So this is clinician training for both doctors and nurses. And you would think right that they’re learning all that digital tools. That they’re learning remote patient monitoring that they’re learning about virtual care, but they’re not, you know, and so and when my wife was picking her dissertation, I was like, pick virtual care pick digital medicine, because that is the [00:24:30] future and you’ll be set, you know, you’ll be the expert with your doctorate and her advisors kind of poo-pooed the idea. And I think one of the reasons why is because they didn’t know anything about it. So anyways, I think it’s becoming, going to become more mainstream in our education. It just takes a little, many, many years almost like healthcare bench to bedside. Similarly, I guess in the educational side. 

[00:24:54] Bill Russell: [00:24:54] Yeah. You know, the abstract says this is a perspective piece, seeks [00:25:00] to highlight areas of concern related to a subset of areas. Of the digital health environment and provide potential educational pathways to prepare students. And the two of the things that they highlight is rapid technology development and the generational shift that’s going on, the rapid technology development you and I can appreciate.

[00:25:18] I mean, we’ve been CIOs during a time of just amazing change. I mean, you mentioned one earlier, we used to have to convince people to take the computer, the server out of their department and move [00:25:30] it to a data center. Right. I mean, think about it. We used to have doing, they were scattered to and fro. Well you know all these things and, you know, it’s, this is now as powerful as most of the servers we installed back in 1990 or whatever.

[00:25:42]And so I was pointing to my phone. to those people are watching the But the generational shift is something that I thought was very interesting because they say this in the abstract, the digital natives are a POTUS. Although this article postulates, these students who may be [00:26:00] starting postdoctoral curriculums or other health sciences are inclined to be digital natives and accepting the use of technology in their lives.

[00:26:08] They are not necessarily well versed on how to use it. The expectation for this generation to anticipate the use of technology, maybe beyond what their professors can envision in patient care. So you have that aspect of their professors can’t really envision what’s going to be next, but they also slide this little slight in, on that generation [00:26:30] saying, yeah, they’ve used it since they were born, but they don’t really , they don’t have the vision for what it can do either. They’re just business users of the technology. That’s an interesting perspective. I don’t know if I agree. 

[00:26:43] Ed Marx: [00:26:43] Yeah, it is. It’s interesting too, because I had this opportunity to help write the first, I think it’s the first textbook. That’s really aimed at this problem for medical school.

[00:26:54] And it’s probably going to be released sometime this year imagined by two wrote one of the chapters. And so I had to do a lot of [00:27:00] empirical research. So this wasn’t sort of my opinion, but you know what? The research shows out there and they really are lagging quite a bit, which then impacts us from a health it leadership point of view.

[00:27:11] Because even your digital natives that are coming two on your medical staff. Now they’ve finished residency. They’re not necessarily super adept at all the medical tools. They are at the consumer tools, but at the medical tools, because they’re professors, there’s just a lag. That’s the only way to describe.

[00:27:29] So I think it’s [00:27:30] still going to take another five, 10 years before it all becomes mainstream and they actually have in courses, right. Their coursework should be. Should be on digital tool with digital tools and, you know how long it took the EMR to get studied. It took it a long time to get studied in medical school.

[00:27:47] So I think we’re seeing the same sort of lag, but there’s hope it’s changing. It just takes a little while, but people, the point is people should just be aware of the fact that just because it’s a digital, native and generation of a different [00:28:00] generation, they’re not necessarily gonna come in, ready to practice with digital tools.

[00:28:04] Bill Russell: [00:28:04] All right. So we’re we’re getting into your wheelhouse here and that is remote patient monitoring. So one of the articles is Remote patient monitoring goes mainstream and the healthcare transformation follows. The next one is doctors. Virtual visits jumped 5600% during COVID. This is actually about Canadian healthcare, but still that those are generally the numbers we heard.

[00:28:25]In the States as well it jumped dramatically. And then I [00:28:30] highlighted a report that shows fast improvement in state tele-health reimbursement policies. And there’s just a ton of information in that. Let’s start with remote patient monitoring. So it highlights the tailwinds that are lifting the plane and it identifies some of the headwinds. Talk a little bit about what we’re seeing in remote patient monitoring these days. 

[00:28:51] Ed Marx: [00:28:51] Yeah. And I think bill, all these topics, again, that we’re going to cover here pretty rapidly are really important for healthcare it professionals, to really understand [00:29:00] because we have to lead, it goes back to what we talked about earlier with the CTO and CIO, we have to lead.

[00:29:05] And I know you’ve written some art. There’s been some articles out there about CIO is becoming key leaders. Not just operational leaders, but more strategic, which is something we’ve always desired. Some have done it most haven’t and here’s really an opportunity to lead and lead the strategy and the organization, obviously, along with your clinician counterparts.

[00:29:24] So. Yeah with RPM. So we saw, we did see the big bump in telemedicine. I think it’s come down depending on who you [00:29:30] study, you know, 20% or so, some are still higher. Some are a little bit lower, but I think 20% is obviously an empirical number that’s been researched and you know, RPM has taken off as well.

[00:29:41] Not as much because the use cases aren’t yeah. Are quite as strong yet for RPM. But it’s something definitely to keep your eye on, right. RPM, meaning remote patient monitoring. So especially with COVID. So instead of filling up all your beds with COVID patients, many progressive institutions. Found, if you were [00:30:00] pretty low risk, they could send you home with an RPM kit.

[00:30:02] Maybe it’s a pulse ox temperature reading, and they would review it on a daily basis and make sure you were okay. Very popular, simple use case, but I even better use cases are for acute care conditions like maybe a C H F and congestive heart failure.

[00:30:17] But anyways those sort of acute care conditions are really prime but I really think that you’re going to see the shift. That’s just the beginning. So while the penetration [00:30:30] isn’t the same as it is with a tele visit a visual visit. It’s going to start creeping up in, essentially, I believe go past that because the hospital at home, and one thing is you’ve seen with the government recently announced, you know, they’re allowing certain organizations that met certain criteria.

[00:30:50] To experiment and get paid for it in hospital at home. So they’re testing the waters right now, and we’ve seen this before with CMS, they test the waters, they make some adjustments and then [00:31:00] pretty soon it goes back. And I think that’s really mainstream. I think the articles that we talked about was out of Denver, Humana, maybe in, in Denver and maybe some other markets Lewisville where they are really offering this type of service.

[00:31:13] So it is. Hospital at home. It’s daily visits. It’s daily encounters, but with the appropriate technology. And so far, the early results are that the patients and families are happier because no one wants to be in a hospital. The financials on it can be [00:31:30] up to 50% less cost. And the clinical outcomes appear to be the same or better.

[00:31:35] We actually did this for several years with maybe about 1500, 2000 patients where I came from and had that same sort of experience. So I think you’re starting to see it build up. RPM is a key component of that but that’s why I think it’s really relevant for healthcare. It leaders to be w how have this on your radar and have a plan partnering with your clinicians and other leaders and making sure that your organization [00:32:00] takes advantage of this, because I believe that in the future, that hospital care, as we know, it will be only for the very, very sick hi cute surgical patients, high acuity patients that need an ICU. But other than that, people, patients will convalesce at home. 

[00:32:15] Bill Russell: [00:32:15] Yeah, my gosh you gave me so many directions.

[00:32:18] We have over-hyped this in the past, we are guilty of over-hyping this in the past of just, you know, remote patient monitoring hospital home. And we got out over our skis and said it was gonna be there, but now what you [00:32:30] have is it feels to me like a race for the home. Like you know, more services, more things going on and it’s being led by it.

[00:32:38] It really is being led by whoever’s taking risks. Right? So you mentioned Humana is going after  that. And  and there are health systems that have risk-based contracts and they’ll do this because it is a lower cost of care to do it out of the home than it is to do it in that, in the facility.

[00:32:55] And so if you get good at this. You can, you can actually drive some costs out of the [00:33:00] system and still get reimbursed at rates. That, that, that makes sense. There’s a lot of other, they talked about the tailwinds patient habits changed during COVID physician habits changed during COVID. EMR integration is way down the road for a lot of health systems.

[00:33:16] I realized. I shouldn’t speak so broadly there, there’s still some health systems that are implementing their EMR and whatnot, but workflows or their reimbursement is starting to catch up. And then the technology is there, right? So we didn’t even hit on the fact that my gosh, [00:33:30] you can’t open, you can’t open social media or something without seeing the announcement of some new device that somebody is funding and you know, when we saw the Livango deal and how much they you know we’re able to sell for and whatnot. So there’s a race of money, minds and talent running after the technology to really perfect this. And then you’re starting to see some things sort of coalesced around this, not the least of which is, this is one of the areas that competitors see as the [00:34:00] opportunity to get in between.

[00:34:01] Right. If I can go right into the home, either through televisits or physical visits. And then direct the care I’ve now again, disintermediated the health system. 

[00:34:11] Ed Marx: [00:34:11] Yeah. And this goes back to our earlier part of our conversation. If you don’t take action and I know there’s always that sort of fear or governor that we don’t want to get too far out ahead, but if we don’t do something and take some risks, we are going to stop one day and look and say, where [00:34:30] are our patients? Where we don’t, we’re going to keep, you know, what we’re going to keep doing is budget cuts.

[00:34:35] Yeah, we’re going to keep, okay. Take another 10% out. Take another 20% out. Why? Because the volumes are way down. Revenue is way down because the care is now being done by the payers. It’s now being done by retail and you know, the other category, there’s a bunch of other categories, but the other category is digital first companies, digital only companies that do some of these things.

[00:34:56] So, you know and concierge medicine. And pretty [00:35:00] soon, there’s not gonna be anything left. So that’s why. Even if you, even if it’s an experiment, Or a demonstration project as CMS would call it, I would get something going in my health system and start working it and seeing what happens because otherwise you’re going to be caught flat footed.

[00:35:18] And I don’t know that there’s going to be time to pivot and catch up. 

[00:35:20] Bill Russell: [00:35:20] All right Ed, let’s get a little free consulting here from the health next, whatever your title is. I’m not sure what your title is, so let’s just call you a CIO for now. So how does a health [00:35:30] system wade into RPM? Right. And everybody has a little bit of this going don’t they? At this point, is it just a matter of expanding it? What is it? 

[00:35:37] Ed Marx: [00:35:37] Yeah, so I, my official title, I’m Chief Digital Officer for Tech Mahindra Health Life Sciences and in the United States, a lot of people would know us more as a HCI Group. But we’re part of tech, Mahindra health and life sciences. So here’s, what’s going on with most health systems is they’re all interested in RPM, but I would say only 10 to 15% are actually doing [00:36:00] RPM.

[00:36:00] So there’s high levels of interest. So because of COVID and the amazing televideo response that happened. And as you know, for some organizations that went as high as 80% of all visits were virtual there for awhile. Some back as we mentioned to 20%. Now they saw the success of that. And now they’re thinking, Oh, we should probably, we move into RPM.

[00:36:21] And again they’re smart leaders out there and they’re reading things and seeing what competitors are doing or planning on doing. And so their initial forays usually pretty [00:36:30] good, low risk, and COVID is a really good example because it’s, it doesn’t require a huge amount of technology. And it’s pretty simple from a, from an end user, a patient point of view on how to operate these things.

[00:36:41] So that’s what I would recommend. Start with something. It could be COVID. It could be a small demonstration project, maybe for CHF patients. You know, when I was at the clinic, we had to develop for our areas sort of a vision statement or, you know, a broad, you know, some people can’t be hags, big, hairy, audacious goals.

[00:36:59] And for [00:37:00] IT, and I led digital and IT, it was a 50% of our visits would be virtual. Outpatient visits would be virtual. And as a regular thing, not a COVID thing. This was pre COVID. And 25% of our inpatient days were at home. So that’s what we were shooting for. So you got to put up some sort of goal and objective.

[00:37:19] And so for us, that was pretty, a big, hairy, audacious goal. Think about that 25% apples to apples comparison. You would start treating those patients at home. So that would mean early discharge for some, and it would be no [00:37:30] admissions for others. And that’s what we were working towards. So you have to start someplace, so you get the vision.

[00:37:36] Then you take a demonstration project or to find your clinicians that are really progressive and there’s those sort of collisions everywhere. In fact, they’re usually waiting on it and they get frustrated and go out and do their own thing. So find them partner with them and start doing things and then collect the metrics.

[00:37:56] So it’s really important, I believe to be metric driven. So [00:38:00] collect the metrics. Did you reduce length of stay? Did you. Reduce costs. What was the patient satisfaction like? So the more you can measure, the better evidence you have and the better you can make your arguments for additional funding, then you start getting funding saying, look we need to move this direction.

[00:38:17] And we have a very progressive unit here and we’re willing to do it. And that’s what I’ve done pretty much a whole career. And I know you’re the same way. If you wait. It’s too late. You’ve got to take risks. You’ve got to push the envelope. People may laugh. People laughed at me. You [00:38:30] know Bill, I don’t know cause 15 years ago, cause I was a big work from home person and I took a lot of grief from HR.

[00:38:37] Took a lot of grief from a lot of people about how work from home doesn’t work. They ultimately. Let us do it. And then we were hit one time with a major blizzard, and then we were hit another time with a major oil spill outside our corporate headquarters, just like a typical disaster scenario that you make up.

[00:38:50] We actually had one of those happen and lo and behold, you know, pretty soon the rest of organization started working from home as well. So you just got to [00:39:00] push the envelope a little bit and I think you’ll find people out there, clinicians out there that’ll push with you. So that’s some of the things I, if I can recap really quick, Is, you know, you’ve got to have the vision you find collaborators, you push the envelope, you measure, then you go back and ask for permission.

[00:39:16] Bill Russell: [00:39:16] Yeah, you should. You should always have a bunch of tiny projects going into tiny, a bunch of projects going on. Small projects. For sure. Something that you can almost fund out of your operating budget within it and just keep them going. I love the I [00:39:30] know I’m not going to hit on the meat of what you just said.

[00:39:32] I love  the physician. There’s a physician that wants to partner with you, but can’t wait any longer and they say. And I remember just, I just these stories, I remember people coming into my office saying you won’t believe what Dr. What’s what’s his name did. I’m like, well, what’d he do? It’s like, Oh my gosh.

[00:39:48] He signed up for Dropbox. He’s putting his images in Dropbox so he can share them with his patients. I’m like, all right, I want to have a meeting with them. It’s like, Oh, you’re gonna, you’re going to slam them. I’m like, no, he’s, [00:40:00] that’s perfect. What he’s trying to do is solve a problem and meet the needs of the consumer and you know what we’re going to step in and we’re going to partner with them and we’re going to start doing that.

[00:40:09] And they’re like, But he’s not doing it right. I’m like, yeah. Coz We’re not helping them. Let’s go help them. Let’s do it. Right? Yeah. 

[00:40:15] Ed Marx: [00:40:15] I, it reminds me too. We had a community at the clinic called brain ex. And nothing to do with it. Are you kidding me? It would have squashed them. They are a bunch of smart physicians.

[00:40:24] They met after hours and they were talking about AI and machine learning and they were actually [00:40:30] getting data and they were building an AI machine and capabilities and like actually impacting positively the quality of care. And so I heard about it. So I showed up at one of their meetings and they was the same sort of thing.

[00:40:41] It’s like, yeah. Oh my gosh, you know, the CIO is here. He’s going to shut this thing down. I was like, no, man, how do I officially, how do I officially become a member? And I did become a member. And the funny thing was, they all expect that it needs to be, you know, super smart. And so at these meetings, they would talk to the most complex things.

[00:40:59] Again, these are [00:41:00] all highly trained clinicians who, for fun, do all this AI machine learning programming at night. And they would always turn to me after the data presentations every time that would just boggle your mind. And then it turned to me and like, what do you think? I just didn’t have anything, any pearls of wisdom for them other than to say that is awesome, you know, but that was my role.

[00:41:21] Sometimes your role is just to encourage that sort of innovation, encourage that sort of leadership and partner with people. Remove obstacles. I couldn’t add any value from [00:41:30] an intellectual point of view. They were way beyond me but I could remove obstacles. And give them safe guard rails and allow them to do amazing things that would save people’s lives.

[00:41:39] Bill Russell: [00:41:39] Yeah. Yeah, last thing here was, we’re not going to get to cover it. We’re already beyond our time, but you know, it was a good article. I covered it in Today in Health IT. It’s just the the article on state reimbursement. And, you know, you mentioned earlier, and so I just say that to, to tee up this question, which is, you said earlier, you know, 50% of [00:42:00] visits via telehealth and 25% of inpatient days at home. Is that right? 

[00:42:06] Ed Marx: [00:42:06] Yeah. Perfect. 

[00:42:07] Bill Russell: [00:42:07] So that requires a business model change, right? And this is the thing we keep talking about CEOs stepping into those business model changes. Most of the iOS don’t want to wait in there. They’re like, well, that’s not the business model.

[00:42:19] We’re not, we’re not ready to go there instead of saying, you know, I think this is the future. Let’s let’s encourage this conversation. Like I think we can do this with technology [00:42:30] and if we can do it with technology, I think somebody else can do it with technology. So, you know, at what point do we start to see business models change?

[00:42:38] And at what point are we a part of those conversations? And did you guys have those conversations? 

[00:42:45] Ed Marx: [00:42:45] Yeah, absolutely. And then that’s what we were talking about when talking about the CDO and why our CDO is coming from other industries. And it kind of may, I’m glad because we need to learn from others and the same time I’m like, come on, because if you want to be the CDO it’s they shouldn’t have to get someone from [00:43:00] outside.

[00:43:00] Cause you can do it. And so that’s one of these areas where you have to leave. You have to be a business person, you have to be a clinical person. So don’t be afraid. Don’t say, Oh, watch this idea or operations. Well, then I wouldn’t hire you as a CDO. If that’s the way you felt. So you gotta be bold and take risks, even if he means you lose your job.

[00:43:16] So what you’ll get you’ll if you’re good, you’ll get picked up somewhere else. So you got to be bold. That’s the worst thing, right? I know this isn’t what you asked, but the worst thing is someone who just becomes assimilated. Like they’re bold. They get hired. They’re so excited. And then they get pushed back, pushed [00:43:30] back, pushed back and they decide to play it safe.

[00:43:31] And that’s why healthcare so far behind, because so many of us have played it safe over the years. So it’s time for bold new leadership, whether it’s outside or inside. So to answer your question. Yes, of course. And so. We really had to work through it. So I led it, I pushed her way through it and we changed it.

[00:43:47] So what it was, I’ll give you two really good examples. One was how physicians were compensated. So I can’t get into the specifics, you know, to reveal sort of the magic sauce of where I came from, but there was a definite way that [00:44:00] physicians were compensated, you know, productivity was analyzed carefully.

[00:44:04] So suddenly you’re doing telemedicine visits. Which at the time, we’re not on parody in terms of reimbursement with an in-person visit. So how do you make that change? So what, what do you do you get with the chief of staff you get with the CFO, you start laying out the arguments of why this is the future and why we have to go this way and why we have to make accommodations in that productivity formula.

[00:44:28] And that’s what ended up happening. [00:44:30] They made accommodations in a productivity formula so that you were not penalized for doing a telemedicine visit. That was number one, the second one, which I was not successful with, but I bet if I had another run at it today, I would be. And that is why do we have urgent care?

[00:44:48]Why do we have urgent care clinics? When we have virtual care capabilities, why do people go to virtual care? Okay. You go to the ED ideally because your artery [00:45:00] is wide open and you need life something quick. Lifesaving. That is good. Virtual care is not going to help you very much there, but urgent care.

[00:45:09] Why do you go to urgent care? Because it’s less costly than ED care is usually less wait a little bit more convenient and there’s more and more locations typically. But that’s exactly what virtual care score. So I took that on, Bill. I wasn’t successful, but I took it on. I said, look, we want to go to 50% of outpatient visits being virtual, [00:45:30] but yet we’re advertising and pushing our urgent care centers.

[00:45:33] We don’t need urgent care centers. It’s brick and mortar. It costs a lot of money to run those brick and mortar centers. And we can do about probably 95%. Because the argument is you can do about 80, 85% of what happens in the ed. You can do it virtually or what happens in an outpatient setting. So in urgent care, it’s probably like 90%.

[00:45:52] Okay. So let’s argue, you’re a clinician. I’m not, let’s just say it’s 80%. Okay. Whatever that number is a [00:46:00] high amount of the reasons you would go to urgent care can be done virtually. So don’t have urgent care centers. Let people go to the ed that needed to go to the ed, handle everything else with virtual care. I did not win that one because why urgent care makes a lot of money. 

[00:46:13] Bill Russell: [00:46:13] Yeah. Hey, let me let me close on. Let me close on this question, which is you’ve done podcasts now for awhile. And then this is consulting for bill. You’re going to give me some free consulting here. What’s the most challenging thing of doing a podcast?

[00:46:30] [00:46:29] Ed Marx: [00:46:29] Well, I’ve only hosted six or seven. So are you asking as a host? 

[00:46:35] Bill Russell: [00:46:35] Well, no. You, you used to do that other seriesthan you did as well. 

[00:46:39] Ed Marx: [00:46:39] Yeah. Okay. It’s preparing, preparing. It takes a lot. People don’t realize it. I know you do. It takes a lot to prepare. My episodes are short, maybe 25 minutes and it takes a lot of preparation to do it right. So anyone can sort of wing it, but if you want to have that professional level of quality, you know, giving out [00:47:00] great information like you do, it takes a lot of preparation. So it’s hard to fit that in my regular job, you know, to add that in, it takes a little bit of effort. 

[00:47:07] Bill Russell: [00:47:07] Yeah. And I would say that’s the number one thing that people don’t realize people are starting podcasts all the time.

[00:47:13] And I have a whole thing of show notes right in front of me that I prepared and it took me an hour and a half or so, plus you and I both read about six or seven articles to go along with that. And so even though it sounded like a spontaneous conversation that’s part of the gift right? It’s [00:47:30] figuring out how to make it feel like a spontaneous conversation, even though you prepared for almost two hours  for a conversation. 

[00:47:39] Ed Marx: [00:47:39] That’s why, and I hope you keep this in the show that what I’m about to say, bill, that’s why I’m so thankful for you and all the work that you do. And you put into the show. I know you do it because you’re passionate about it. And I also know that, you know, obviously you make a living from it, but what you’re really doing is investing in the next generation of leaders.

[00:47:58] I know that’s part of [00:48:00] your. Your statement as well, your passion and what a gift to have someone else put in all that investment, and then to bring in the most important things and talk about it. And then you always have fascinating guests because, you know, it’d be boring, right? As great as Bill is or great as Ed or Drexel is or Sue is, we get boring after a while, but you bring in these other guests with these different perspectives that are clinicians and digital people and all that kind of stuff.

[00:48:26] And it just adds so much value. [00:48:30] So if I were a CIO today, I’d almost make it mandatory that you’re listening to all these things from Health IT from Bill Russell, because it makes you a better. Employee, it makes you a better leader. And so I’m really thankful. And you know this because I’ve told you this privately, but you’re the main thing on my runs.

[00:48:50] I run a lot. I listen to podcasts. I keep up to date. Thanks to you. I don’t have time to do it otherwise. And I really appreciate all that you do for the industry. 

[00:48:58] Bill Russell: [00:48:58] Well, I appreciate that. I’m [00:49:00] going to start leaving like codes in the show for you to pick up on. Anyway. Ed thanks for stopping by. I appreciate it. Where can they find your podcasts? What’s digital voices. 

[00:49:12] Ed Marx: [00:49:12] Yeah, digital voice. Is that spelled like D G T L trying to be like hip. DGTL voices, and we’re on everything. I imagine. Spotify and Apple podcasts and whatnot, but yeah. Thanks again for having me. 

[00:49:24] Bill Russell: [00:49:24] Oh yeah, that’s fantastic. And by the way, you were the number two runner up in referrals for the ClipNotes [00:49:30] program, which is why you’re here. Just so you know.

[00:49:32] Ed Marx: [00:49:32] I’m going to be number one next time, because I didn’t blow it up as much as I had intended to. But I have shared it with all of our leaders of our organization. And it’s funny, I’ll tell you one quick story. We have a new person that came from outside of healthcare and that’s the one thing I told him. I said listen, follow Bill Russell. You’ll catch up on healthcare. And now if you were to meet him, he’s only been in healthcare about six months. You would never, you would think he’s been in healthcare for six years. [00:50:00] And a lot of that has to do with you because he’s listened to all your stuff. 

[00:50:03] Bill Russell: [00:50:03] Yeah, why I appreciate your support. Frank Nydam for those of you who are wondering, who was the top referral, it was Frank Nydam from VMware, and he has agreed to come on the new state show. We haven’t scheduled it yet, but he has agreed to come on the new state show.

[00:50:19] So I’m looking forward to that. He’s a great guy and I appreciate his support. He’s with VMware. 

[00:50:24] All right. That’s all for this week. If you know someone that might benefit from our channel, please forward them a note. They can subscribe on our website this [00:50:30] week, health.com or wherever you listen to podcasts, Apple, Google, overcast, Spotify, Stitcher, probably some other places that I’m not even familiar with. We want to thank our channel sponsors who are investing in our vision to develop the next generation of health. It leaders VM-ware Hill-Rom Starbridge advisors, Aruba networks, and McAfee. Thanks for listening. That’s all for now.

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