Jun 28, 2021: Sue Schade from StarBridge Advisors joins Bill for the news. What does telehealth look like now? Dr. Joseph Kvedar shares his lessons learned from his 2021 keynote at the American Telemedicine Association conference. A HIMSS’ survey reveals 60% of patients are looking to return to in-person care post pandemic. What will the hospital room of the future look like in 5 years? How do CIOs plan for future technologies when new buildings are several years away from opening and the technology continues to evolve? HHS and ONS have established an $80 million program to diversify the health IT workforce. And Senators introduce a bipartisan bill to fight cybercrime.
Newsday – Will National or Local Providers Lead the Future of Telehealth
Episode 419: Transcript – June 28, 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. We set a goal for our show. And one of those [00:00:30] goals for this year is to grow our YouTube followers. We have about 600 plus followers today on our YouTube channel. Why you might ask? Because not only do we produce this show in video format but we also produce four short video clips from each show that we do. If you subscribe, you’ll be notified when they go live. We produced those clips just for you the busy health IT professionals. So go ahead and check that out. We also launched Today in Health IT. A weekday daily show that is on [00:01:00] todayinhealth it.com. We look at one story each day and try to keep it to about 10 minutes or less. So it’s really digestible. This is a great way for you to stay current. It’s a great way for your team to stay current. In fact, if I were a CIO today, I would have all my staff listening to Today in Health IT so we could discuss it. Agree with the content, disagree with the content it is still a great way to get the conversation started. So check that out as well. Now onto today’s show. Let me give you some of your time back.
[00:01:29] All right. It’s [00:01:30] Newsday and we have Sue Schade with us today. Sue, welcome back to the show.
[00:01:35] Sue Schade: [00:01:35] Thanks. Good to see you Bill.
[00:01:36] Bill Russell: [00:01:36] Good to see you. You’re moving pretty quick. How’s how’s the search going at Boston.
[00:01:41]Sue Schade: [00:01:41] It’s going well. In fact, we are at the point of deciding on who we’re bringing in for first round interviews. So we reviewed a very good, strong slate of candidates and unconfident that we’ve got someone there and we’re going to move this along.
[00:01:59] Bill Russell: [00:01:59] Fantastic. [00:02:00] So for people who don’t know, you are currently the interim CIO for Boston children’s in addition to your role as a principal at Sturbridge advisors, which is not a small job, either you guys have a lot of people that, that work with you at Starbridge advisors at this point.
[00:02:16] Sue Schade: [00:02:16] We do we have about 40 plus advisors who have served in senior leadership roles in health. It that are working on a engagements available for interim and advisory work. Yep. Good team,
[00:02:29] Right. So
[00:02:30] [00:02:29] Bill Russell: [00:02:29] you’re, you’re pretty much not paying attention to your dogs and your, your husband at this point cause you’re you have all that other stuff going on.
[00:02:37] Sue Schade: [00:02:37] Well, you know what the, the advantage of this particular interim both given the proximity to where I live, as well as the virtual world that we’re living in still at this point is that I am home all week. I am not playing Monday morning coming home Thursday night or Friday and in a hotel every night. So yeah, I see my husband and my dogs [00:03:00] every day.
[00:03:01] Bill Russell: [00:03:01] That’s that’s fantastic. What’s the major projects you’re working on? The EHR or you’re working on what other things you’re working on.
[00:03:08] Sue Schade: [00:03:08] That really is the priority at this point, the business case around the EHR path for the future and what we’re going to do. So we’re circling in on that and along with all the other projects going on and day to day, but that’s where I’m spending most of my focus with the team.
[00:03:25] Bill Russell: [00:03:25] Well, we have some fun stories. It’s this week. We we’re going to look at telehealth. [00:03:30] And telehealth cybersecurity. I’ve gotten emails, where people are like, you talk a lot about telehealth and cybersecurity. I’m like, plus it’s top of mind it’s these are the number one and number two things that CIOs are talking about. Is that just me dreaming here? Or I think it’s the conversation?
[00:03:45]Sue Schade: [00:03:45] I would agree with you. The other is the people side and the virtual and the return to the office. That is, that’s a big topic to be figuring out right now.
[00:03:57] Bill Russell: [00:03:57] Yeah. All right, so [00:04:00] I’m going to tee up the, the first story comes from. Dr. Joseph Kvedar’s keynote address to the American telemedicine association. He was a guest on the show. You’re very familiar with them having works up there in Boston with them.
[00:04:15] So let me give you some of the things that he talks about. So he said last year, at this time, they’ll help us on the top of the mountain from March to June 30% of all outpatient activity was conducted via telehealth in contrast [00:04:30] to 0.8% in 2019 0.8%, 1% to essentially 30%. That’s a huge show. The virtual visit became the universally accepted concept and by all accounts patients loved it.
[00:04:43] Here are a few snippets from the COVID-19 healthcare coalition survey of which ATA is a member. 83% of patients reported overall high quality visits. 78% said the virtual care visits or with their regular provider. And he comes back to that theme later. And over 75% [00:05:00] said they would continue using tele-health for chronic disease management.
[00:05:05] What’s going to be the driver. If you think about this, what’s going to be the driver for tele moving forward. Do you think it is going to be patients asking for it? Do you think it’s going to be a systems transitioning as the payment models adjust to telehealth visits? It’s just more, it’s a more efficient way of doing some visits. I mean what’s where does the conversation lead us? What drives it moving?
[00:05:28]Sue Schade: [00:05:28] I think that [00:05:30] first one about patient asking and convenience is probably the biggest so many people figured out that it works that they can have their, to have their visits with their with their physician from home. I just there is some, this is the article that has some stratification by age groups, right? Or is that the other article that we’re going to talk about in terms of.
[00:05:54] Bill Russell: [00:05:54] No, it is the other article talks about this stratification fleet. The younger population is absolutely asking for it. [00:06:00] The older population is sort of looking at it going I want to go back to where we were before. And when you think about that older generation, they’re, in some cases they’re isolated and lonely that visit to the doctor. When I talk to my parents, they’re like, oh, we’re going to the doctor today. That’s an event for them. And they, they enjoy that.
[00:06:18] Sue Schade: [00:06:18] I know, and maybe you’re the one who has said, or someone else has said their mother in particular, maybe not so much their father elder dresses up. It’s a big thing to go to the doctor. If you’re if you’re younger, you’re [00:06:30] working you got commitments at home. It’s like, okay, what time is my telehealth visit today? I got to just squeeze it in amongst everything else. So clearly convenience, I think for not just young people, but many generations.
[00:06:42]And obviously the reimbursement, he’s got something in there about the original legislation that still needs to pass relative to reimbursement. So that’s got to go hand in hand with it. And he also talks about now I’m going to confuse the two stories, the brick and mortar story, but I think Dr. [00:07:00] Kvedar in this one also talks about physicians falling into their old ways. Yeah. Just come back into the room. Yup.
[00:07:07] Bill Russell: [00:07:07] Yup. And that’s actually one of his big, big themes. So he goes on to talk about the numbers have come back Commonwealth funds at 50% less, the another survey by fair health tele-health tracker found that claims have dipped from 7% in January of 21 to 5.9% in February.
[00:07:28] And he says, this is [00:07:30] about really the, hybrid model sort of kicking in and all the normal return to what is common to us? What is familiar to us and whatnot. And he talks about an example of a dermatologist and they say if they do the FirstNet for caring for acne via telehealth, they’re more prone to do the second visit as a followup, as a telehealth visit. But if the first is the first as it happens to be an in-person visit, they’re more likely to just schedule another [00:08:00] visit for that person to to come back. So there’s, there’s sort of this magnetic pool. So that’s one aspect. The other is reimbursements. And he says, when I’ve talked to other provider organizations, I hear common themes dragging them back in.
[00:08:14] To an in-person dominant care model theme, such as filling beds and charging facility fees come up repeatedly, not to mention the threat of lower reimbursement for telehealth visits compared to in-person this payment and this is one of the things that the [00:08:30] ATA is really heavily focused on this and making sure that you can practice telehealth across state lines or two, the primary things I think they’re focused on right now.
[00:08:39]But this, this payment model is one of those things that’s going to be the sticking point. What do you think providers want it to look like going forward? I mean, is it truly reimbursement at parity?
[00:08:53] Sue Schade: [00:08:53] I would think it’s reimbursement at parity. And I would think that provider organizations want to [00:09:00] work with their patients over the full spectrum of continuum of care. So let’s just go back to the bed point, feeling that. I mean, who’s thinking that in outpatient in-person visit, an ambulatory in-person visit versus a telehealth visit is going to make a difference on filling beds. I mean, does that make sense?
[00:09:19] Bill Russell: [00:09:19] No. I mean, an ED visit would fill a bed, but not an ambulatory visit.
[00:09:23] Sue Schade: [00:09:23] Yeah. But ED visits are happening. You’re not doing, you’re not scheduling a [00:09:30] telehealth visit instead of an ED visit. Right? So what’s the right balance to really have patient focused care over in, in, in the right care setting. So I see provider organizations as long as there is the right reimbursement model continuing to encourage and figure out how to support virtual care and individual physicians working that into their their cadence and their schedule.
[00:09:59]Bill Russell: [00:09:59] It’s [00:10:00] interesting as I look at this because there’s almost, there’s a call later on in this and he says, providers must resist the strong mandate with horses that draws them back to in-person brick and mortar world and find the right balance of in-person and virtual care.
[00:10:16] Which I agree with. We need that balance. And it’s not going to be everything’s going to virtual care cause everything’s, can’t be done in virtual care. It’s going to be some balance there, but then he says, health care systems must. I love when I hear that you [00:10:30] must, you but anyway, healthcare systems must embraced value-based care rather than fee for service model that brings people into facilities. This is difficult after experiencing a period of significant financial loss. It’s interesting when we look at healthcare systems and we say, Hey, you must do this. It’s not in your financial best interest.
[00:10:48]It’s not in your normal practice. So you’re going to have to change a lot of things. You’re gonna have to invest in the future and do all these things. You must do these things, even though financially. It’s not in your best interest while these other players are standing.
[00:11:00] [00:10:59] These, these new entrants are standing these things up without the legacy and the overall infrastructure to move forward. I mean, when I hear that thing, if I were as a CIO, if I just put my hat back on, I’m a CEO at St. Joe’s and we were mission-driven and we tried to do the right thing in all cases. But there was a certain reality, certain financial reality that we had to look at all the time.
[00:11:22]All right, we’re going to go to telehealth and we’re going to start losing, I dunno, $30 a visit $40 [00:11:30] visit. Are we going to be able to make that work and does that work for increasing access, improving quality and those kinds of things. So we have to put this, put metrics around those things to make sure that what we’re doing is not impacting the quality of care, obviously. And it’s increasing access.
[00:11:44]There’s no question that it does increase access. In fact, there’s an article I covered on Today in Health IT last week, which said, in fact it is driving over utilization in that people are, once they realize how can be it is they’re more prone [00:12:00] to call in.
[00:12:01] But this shouldn’t be a bad thing, right for us. We want more touch points with especially chronic patients, but you know, people calling in saying, Hey, I’ve got this. We want to avoid ED visits and whatnot. This is, and he even says it in here. This is sort of tricky. What’s the hybrid. What’s the balance. Do you have a comment there?
[00:12:18] Sue Schade: [00:12:18] Balance. I, Again, I’m going to bleed into the other article that we shared on bricks and mortar. And I think that’s where there was the example of of a mother who [00:12:30] has had 60 what’d she say over a period of time, 60 specialist visits for her a child who’s got significant medical issues. And how often does she have to drag her? Right. How often does she have to move go in physically with her child for those visits versus the telehealth. So I just go back to convenience and finding the right [00:13:00] balance. The other thing is if you, as I’m sure you’ve seen in metropolitan areas that you’re in, I can say it here in, in new England and specifically around Boston a push to build out new ambulatory centers in the surrounding towns and suburbs so that you’re not driving in to the heart of Boston and all the traffic hassle, but you take that one step further. You’re making care accessible. They’re one step further. What can be telehealth visit instead of coming, even into [00:13:30] one of those satellite centers.
[00:13:33] Bill Russell: [00:13:33] Yeah. And it’s interesting to me because United healthcare did this retroactive look at ED visits. And then we’re going to deny claims based on the criticality of the nature of the care. But the reality is some people have been trained to go to the ed and I think it was New York Presbyterian and they find out I’m sure with New York Presbyterian Daniel, Barchie talked about this on the talk. And he said they actually created a pilot where they had [00:14:00] a one door, went to the ED and then the other door went to a a telehealth visit essentially. So they could get triaged before, or they could even be sent from the ED over to that saying hey, look, you could, you could do this over here. It’s just a lot better experience.
[00:14:18] I don’t remember all the details, but the costs on one side was almost like seven to 10 times the amount as the costs on the other side. I never [00:14:30] really understood that. It’s in the same building. It’s because you’re seeing your primary care doctor instead of seeing a an emergency visit kicks off a lot of, a lot of things.
[00:14:38] And there’s a lot of infrastructure to support that. I get the, I get that from that perspective, but that’s why we need more ambulatory surgery centers. It’s also why we need a very clear message, I think, to our communities that says look, start, your visit here. Unless you’re bleeding and, and those kinds of things starte it here. Start a conversation with this doctor via telehealth. In [00:15:00] fact my insurance carrier, I don’t have it in front of me now, but my insurance carrier sent me a thing that said start all your engagements with your healthcare system through through Teladoc offered through my insurance carrier. It’s really not a bad model because you don’t want me self-diagnosing I can’t diagnose myself and it’s great to have a trained medical professional on the other line of the phone who could potentially do what 20 25 30 visits an hour really is depending on how long the call.
[00:15:31] [00:15:30] Sue Schade: [00:15:31] So I’m curious. So in that plan is that through Teladoc? Is the provider you’re actually talking to part of the health system that you would ultimately go to?
[00:15:44] Bill Russell: [00:15:44] Actually, I don’t think.
[00:15:45]Sue Schade: [00:15:45] Okay. All right. So this is where I’m, I’m not familiar with, with how all these telehealth companies are working from a model perspective, but provider organizations want you in [00:16:00] their system. Right. And they want you to enter in their system. So if there’s the partnership between those telehealth companies and the provider system, the health systems, so that they it’s a smooth transition, maybe a front end triage, right through a provider. And then you get to someone in your system.
[00:16:19] Bill Russell: [00:16:19] Yeah. Yeah. Well, yeah. I mean, when you think about it United healthcare, which happens to be my, the plan that I’m on there, we’re [00:16:30] essentially paying them so much per month. So that’s what they’re on the books. And they’ve done the analysis from a financial standpoint, maybe not even an access or quality of care standpoint, but they’ve done it from a financial standpoint to say, look, we can reduce the number of visits to the, to the provider by offering the service in the middle.
[00:16:48] And there there’s a fee associated with it. And yes, from a, from a patient standpoint, there is going to be a continuity of care. That’s I think lost [00:17:00] in that. Right.
[00:17:02] Sue Schade: [00:17:02] Yeah, I’m smiling because the whole interoperability continuity of care is something that my husband and I have experienced very personally in the recent period after a couple of ED visits and hospital admissions hospitals, not part of the system that we are connected to.
[00:17:24] So trying to get the right people, talking to each other and the [00:17:30] records over and what tests were done and what were the results. It’s like, I I could write a whole blog on, on this at some point. I just haven’t done it yet bill.
[00:17:39] Bill Russell: [00:17:39] Well, Dr. Kvedar make this as a point. He said, I recently talked to a friend who works at the one of the largest national payer organizations, which led to an important insight from January through October of 2020 local providers, local healthcare provider, your doctor generated 96% of their tele-health claims and only [00:18:00] 4% came from the national providers, which is the Teladocs, the AMLs and others compare that to 2019 when 54, 50 4% of the claims were from national providers.
[00:18:10] And obviously 46 would’ve come from. From the local healthcare providers. And he said, the trend is moving back in that direction right now, providers to the national providers. Once again. Now there’s a lot of ways we can address [00:18:30] the continuity of care between a tele-health are between the Teladoc and Amwell and going to the local provider.
[00:18:37] It if, if they are FHIR enabled and we have decent systems on both sides, we should be able to move those records and the notes back and forth pretty, pretty easily, I would think. But the other way to do it is to have local healthcare providers provide the right hybrid model that works for their community and I think it’s gonna be different, right. It will be different depending on what market you [00:19:00] live in.
[00:19:00] Sue Schade: [00:19:00] Yeah. Yeah. Well, and you’re not always going to be, this was our case. You’re not always going to be in your market when you need that care. At least if it’s if it’s ED kind of visit.
[00:19:12] Bill Russell: [00:19:12] Yeah, we’ll see. Yes. My mother is looking forward to going back to her doctor and that’s, that’s one of the one of the things this, a brick and mortar story talks about. Patients are looking to go back to brick and mortar post pandemic, and they cite a HIMSS study. So the HIMSS study said [00:19:30] essentially that 60% of patients want to return to the pre pandemic experience. By the way, I think part of that is we want to return to our pre pandemic experiences just in case.
[00:19:40] Sue Schade: [00:19:40] Exactly. I don’t know that it’s 60% really want to go back to sitting in traffic and trying to get to a doctor’s appointment. But I’m used to sitting in traffic because of where I live.
[00:19:53] Bill Russell: [00:19:53] Because of where you live. Exactly. A few thouseand versus, a little over 2000 participants [00:20:00] between March and April of 2021. And they asked them those series of questions, but they also found that Gen Z and millennials are most likely to open a telehealth visit. 47% of millennials saying they would prefer tele-health over in-person visits once the pandemic has ended.
[00:20:17] Ut these are the, the healthy ah the young invincibles, I think was the category that we the people that don’t need healthcare, all that often they’re saying, look what I do. it’s usually not chronic care. It’s usually not. [00:20:30] I just, I just want to talk to a doctor about fill in the blank.
[00:20:33] Sue Schade: [00:20:33] Yeah. Yeah. I go back to the balance. How do they characterize the okay the silent generation, the baby boomers. Okay. Were baby boomers? Not the silent generation, but you know, my husband’s got a series of appointments scheduled with specialists sub-specialists and we’re just looking at what’s the right balance. When does he need to be seen and touched by them with some associated monitoring and tests and when can it be a, Hey, we’re going to call, we’re going to review the results on the phone and we’re going to [00:21:00] decide what’s next. So what’s that balance.
[00:21:03] Bill Russell: [00:21:03] Yeah, I think this segways pretty good into our next story. The hospital room of the future five, innovative innovation execs outline what to expect in the next five years. And as, as some great content Tom Andreola at UC Irvine, Nick Patel at Prisma and Columbia Albert Chan at Sutter, Daniel Duran at LifeBridge in Baltimore and mark Weisman who has been on the [00:21:30] show before at title health system.
[00:21:32] And the overall we’re going to go into this in a little more detail, but the overarching theme is we’re moving into the home. I think almost three or four of them said, Hey the, the hospital room or the future is going to look dramatically different in the, in the building itself.
[00:21:49] But they are very much thinking about what does the hospital room or the, or looked like in your home, well, if you can get to higher levels of acuity in that. I would assume we can [00:22:00] do some of that monitoring. And some of those other things that we were talking about and telehealth visits to sort of augment those things.
[00:22:07] Healthcare could look very different in the next five to 10 years, in terms of sending people home with certain monitors or maybe even they have bought devices that have no, that are FDA certified to monitor some things and we’re doing, we’re getting more, we’re getting more signal back from them on an ongoing basis.
[00:22:26] And where it’s not as required for them to come into the office and we can [00:22:30] see them via telehealth. So it’ll be, I think what you’re what you described the experience for your husband. Will be different in hopefully in five years but definitely in 10 years.
[00:22:45] Sue Schade: [00:22:45] Yeah, absolutely. When I teed this article up with you and send it to you in advance it is what you’re saying in terms of what is that balance? What’s that spectrum? What a hospital room is gonna look like. What are we going to do in the home? [00:23:00] And there’s still new hospital buildings happening. We’ve got one opening up at Boston children’s hospital next summer. It’s the Hale family building. It’s been in planning for over 10 years.
[00:23:14] It’s 11 story 700,000 square foot building. And we will, once we have those inpatient rooms open, there will be some retrofitting of rooms. Now in the current [00:23:30] building that are double rooms into private rooms. I think that the common trend, when you see new inpatient facilities opening up, but You’re also going to see, I think, much more of the high-end ICU care in hospital buildings going forward.
[00:23:48] I know we have every room I think in our new building is going to be ICU capable. So that’s, that’s a trend in new hospital buildings. So another [00:24:00] point that I think that I want to make here is, and I went through this when I was at Brigham and women’s hospital. We opened up in 2008 a new the Sphero cardiovascular center, which was new inpatient bed and procedural areas. And we had a visioning. I remember we had a visioning session where we tried to project what’s care, gonna look like in 30 years. Okay. And this was probably in 2005. So [00:24:30] do you remember 2005 or 2008 or 2010 and trying to predict 30 years out it’s nearly impossible. Right? So how do organizations and CIO’s planned for the future with the technology evolving as fast as it is.
[00:24:47] Bill Russell: [00:24:47] Yeah. And you have these trade-offs. I had a conversation with the CIO that’s a part of building a new building and we were talking CAT6, CAT6 E wireless, and you [00:25:00] sit there and go, well, there’s the, there’s the limitations of what’s actually available. There’s the demands that don’t exist today, but you’d know are going to exist right around the corner.
[00:25:11] And so, and then there’s budget, right? And so there’s, there’s a lot of trade-offs you have to make in terms of, yeah, we know it’s going in this direction, but this is all we can do today. This is all we can afford today. That’s all we can do today. You want to make sure that the physical, whatever physical in the walls in the building can handle [00:25:30] as much as it possibly can because it’s going to require more.
[00:25:34] Sue Schade: [00:25:34] Right, right. Dejavu here, when we were planning that building back in the 2000’s we had an issue as the wiring was advancing CAT which I think it was CAT 5 then and we had to make a decision. This is, this is what we can do right now. We know what’s coming, but it’s too late to make that switch given the stage of the building.
[00:25:57] So those are just some of the challenges you have to deal with with [00:26:00] technology, but let’s talk about some of what’s in this article.
[00:26:03]Bill Russell: [00:26:03] Tom has some good stuff in here. He said switching gears to the traditional hospital setting. So this is the room in the building. We’re seeing significant opportunity for improvement for both medical professionals and patients for patients.
[00:26:14] We’re seeing, creating better experiences in their stays through personalization of the room, amenities and services, tiny home concepts to better accommodate families. And solutions using IOT, AI, and wearables that make the room more quiet, safe, and even provides for [00:26:30] mobility where appropriate. That’s one of the things I think I would, I would love, I I’ve been in the hospital room, I think twice in the last year.
[00:26:39] They’re still loud. There’s still a lot of beeping and buzzing and, and that kind of stuff that you would think we’d be past that by now cause no, one’s listening to it except for me the patient. I mean, I know they’re watching it somewhere. But yeah you want to sleep while you’re in the hospital?
[00:26:57] Sue Schade: [00:26:57] Yeah. I that was exactly the [00:27:00] experience a couple of weeks ago. Small room, double room with another patient, a lot of beeping, a lot of monitoring. There was the ability to order room service on your schedule, food service for restricted diets. I think we should be past that.
[00:27:14] You’re absolutely right. When I think about the hospital rooms though the importance of the amenities and the service the combinating families I do think going forward, [00:27:30] hospital beds are going to be more and more and more the really seriously ill ICU beds. And some of those amenities and services really don’t make a difference.
[00:27:41] It’s how was that room fitted out to best take care of that patient? But I think we need to be accounting for the convenience, the services, the amenities at the same time.
[00:27:52] Bill Russell: [00:27:52] Yeah. I like his perspective because he then goes on to talk about the the care professionals. And he said [00:28:00] technology is wall for more intelligent real-time delivery of data to where they are and not confined to a single place, for example, to a nursing voice assistant where wearable based alerts will be used to monitor for sounds that indicate a patient safety issue or immediate alert for the care team mobility and miniaturization will also allow for more services to happen in the room, allowing for shorter cycle times and reduced risks. And finally, if we can figure out the great balancing act [00:28:30] around augmented intelligence, we can do a better job making the right decision for the patient at the right time while having better predictive capability to minimize adverse events. And that’s one of the promises of data, right? So that we’re going to be able to look at the data over a larger population and be able to say, look, we, we anticipate a code blue event before it actually happens.
[00:28:53] And we anticipate a fall before it actually happens. We’ve we’ve been advancing those technologies [00:29:00] for years and, and in healthcare and in the world. And the promise is that we have more data, we have access to more data and we’re building out more AI models that we might be more predictive and be able to deliver that.
[00:29:16] But then there’s the other aspect where he talks about delivering it to where the physicians at. So the physician no longer has to be at a certain location to receive the alerts in a, in a timely fashion. These are challenging things for CIO’s aren’t they?
[00:29:30] [00:29:29] Sue Schade: [00:29:29] They absolutely are. Scroll Daniel Durant from LifeBridge I think he had some good points here where he talks about clinical and he’s the chief clinical officer as a physician at LifeBridge Health in Baltimore clinical innovations will involve gathering, ever more signals from the patient. Infrared sound electrophysiology pulse about the middle of April 15th.
[00:29:50] To be sifted in real time to machine learning algorithms that will help physicians to find their understanding of diagnosis and prognosis in ways we can only [00:30:00] imagine today. I think that’s critical and I’m just gonna take it back. I feel like I’m always taken back to some practical experience.
[00:30:10] I watched the video this morning and I’m going to share it on social media today. It’s a video that’s now available on the Hale building that we’re opening up next year at children’s hospital. The two leaders featured in are the chief nursing officer and the chief that the EVP, while the EVP for patient care [00:30:30] family services and the EVP for health.
[00:30:35] And the EVP for health affairs Dr. Peter Lawson talks about the space and he’s walking through and the video and how the space is designed. He talks about being an Orr and I have what I need here. Right. So that the space works for me. And I’m thinking to myself, okay, CIO, we’ve got to make sure that technology works for him and all his colleagues as well.
[00:30:59] So that, as he [00:31:00] says, in the video, this base works, I can do my job. I can tell this I’m doing my job. So we need space and technology design so that the clinicians can do their job. And what Daniel Duran here is talking about in terms of More more information at the bedside for the clinician to, to use in caring for the patient is also part of the future.
[00:31:29] That’s [00:31:30] kind of a whole different work stream. If you will, then the amenities, the services, how do we make it convenient for the patients and the families?
[00:31:37]Bill Russell: [00:31:37] It’s interesting, as I think through that there’s a challenge here, right? Are we just going to wait for those capabilities to show up in our EHR, which is our EHR providers are going to build out some of those capabilities for sure.
[00:31:51] And they have a vast data store, not only from our health system, but also from other health systems. When you think about some of, some of the data sources they can pull [00:32:00] together, are we going to look to a third party a health catalyst or someone like that who also has a fair amount of data and has really has built out.
[00:32:11] A secondary type system that can collect information, not only from the EHR, but from other ancillary systems. And are we going to have to look at those systems, especially when we start thinking about social determinants of health and social factors and bringing all that data and and then the other thing, so our EHR providers [00:32:30] can do it.
[00:32:30] It’s going to be a third party. I, I don’t think we can rely on public health and I don’t think we’re going to get a lot. Great things out of the government at this point. I think they have a lot of things to work on.
[00:32:43] Sue Schade: [00:32:43] They have a lot of table stakes and basics to work on your infrastructure.
[00:32:47]Bill Russell: [00:32:47] So, so we’re not going to see it there, but you know, one of the things that just strikes me is we’re going to have to become health systems are going to have to become. Okay, this is going to sound silly cause it’s so obvious and it was obvious 10 years ago, but we’re going to have to become data ninjas.
[00:32:59] I mean, we’re going to have to [00:33:00] be so good at data that bringing it in from disparate sources essentially making that data usable identifying the, the places where we have to clean the data up and whatnot. And then, feeding them. into these models and understanding the ramifications of feeding that into the models and the bias that exists and all those things.
[00:33:21] So we’re going to have to be really, really good at that at data. Is that something we’re going to be able [00:33:30] to build out internally or is that something where more and more are going to have to rely on external third parties to help?
[00:33:37] Sue Schade: [00:33:37] I think it’s a combination and it’s a great question. One of the things that I’m starting to think in the past, you’d think build versus buy, I think it’s John Halamka who talks about build buy partner. And the Boston children’s hospital we’re looking at it that way. Buy, build or partner. Whatever order you want to put it in, but why should we [00:34:00] be building it? If there is some new entrant in the market that’s already doing it and that we can partner with that we then can hopefully integrate well with our core platforms.
[00:34:13] Bill Russell: [00:34:13] Yeah. That’s going to be the interesting balancing act. I think moving forward, I think the battle for talent is just starting to be honest with you. I think it’s going to heat up and get harder and harder. Especially as funding keeps coming into digital health. I mean, the, the offers outside of [00:34:30] healthcare are somewhat more lucrative than they are within healthcare.
[00:34:35] Sue Schade: [00:34:35] You mean within private industry technology firms than within a provider based health?
[00:34:43] Bill Russell: [00:34:43] Yeah. I mean, I get people asking me about we’re looking to hire a doctor for this role within this new startup or private equity back or whatever. And some of them don’t pay as well. I mean, doctors generally have done pretty well in [00:35:00] this, in this space. Do pay pretty well.
[00:35:03] And there’s, there’s, there’s going to be a battle for talent. And I think let’s say let’s hit the last two stories. HHS allocates 80 million to diversify health IT and the OMC for health IT has established $80 million program to strengthen us public health informatics and data science by diversifying the health IT workforce they said on June 17. And let’s see here, this is from their actual health [00:35:30] IT gov.gov website through a four year cooperative agreement, a PH IT workforce development program. Recipients will be a part of a consortium that will develop a program curriculum, recruit and train participants, develop internship opportunities and assist in career placement at public health agencies, public health focused nonprofits for public health focus, private sector or clinical.
[00:35:54] Again, talking about the talent. They identify that this is going to help 4,000 [00:36:00] individuals and that organizations can apply for this. Let me see. I want to be real clear here. Yeah, there’s a, there’s a, there’s an application process for the program is to train more than 4,000 people over four years through an interdisciplinary approach.
[00:36:20] ONC will award up to 75 million to cooperative agreements recipients and use the remaining 5 million to support per administration. So there there’s a process to [00:36:30] getting access to that money, but that the real goal here is 4,000 people within minority or underserved communities being trained in the area of public health in data, specifically data and informatics to support them. So interesting initiative. Curious. I mean, you, you brought this story to me, but.
[00:36:51] Sue Schade: [00:36:51] Well twofold. One, we need to be investing in the public health infrastructure and this is a drop in the bucket of what [00:37:00] is probably from the federal government going into public health infrastructure. At this point in time. I don’t know what that number is, but it’s good that as part of that current administration’s plans in terms of healthcare nationally, that there will be more money in public health infrastructure. The second part of the, the good or the win-win is recognizing that we have to grow our health IT workforce and we need to have more diversity. And a program such as this to [00:37:30] train and make opportunities available to people of color is a positive thing, in my opinion. So it will help with talent overall and it helps with broadening opportunities for communities that maybe didn’t have him in the past.
[00:37:45] Bill Russell: [00:37:45] Yeah. It was interesting to hear the seven previous ONC coordinators at the CHIME conference talking about this and how historically underfunded public health and spend and all of them agreed. It’s like we all brought it up. We all made work. And, but the [00:38:00] problem is we invested significantly on the provider side on this side, I think they said to the tune of $40 billion has gone into the medical record. And they said, one of the things that happened during the pandemic is all of a sudden we had this really robust.
[00:38:16] I mean, we don’t think of it as robust, but it is fairly robust. Architecture over here on the provider side and the public health side was completely underfunded. So we, we turned this and said, all right, we’re going to give you this data. And you said it was like, it was [00:38:30] like taking a firehose at this cop and say, trying to sell a cup and the public health infrastructure just buckled under that need.
[00:38:39] And so there, there’s a, I think a uniform recognition that money has to go in that direction. It’ll be interesting to see. If we have a unified vision for what, what that should look like, I think.
[00:38:53] Sue Schade: [00:38:53] Yeah. Well, you, you, because you have both federal and state public health and, and [00:39:00] states can vary widely. I know it’s not in this story, but I think one of the tragedies, there’s so many dimensions and tragedies to the pandemic, but one of them was how many public health leaders. Came under fire and decided to leave their positions. So there’s a lot of need in the public health space.
[00:39:25] Bill Russell: [00:39:25] Yeah. I think you have to take everything with that. [00:39:30] I recently did a review of Sky Lakes Medical center and their response to the ransomware attack. And I give them a lot of leeway because quite frankly, there it’s a small organization. That has all the same regulatory requirements that you would have at a very large organization with a lot of staff and a lot of budget.
[00:39:49] And I know how that goes. So they just carve off what they can towards cyber security and they do what they can every year. And the same thing with [00:40:00] public health. I mean, you could put those people under scrutiny, but it’s not like they haven’t been asking for more money for decades. Right.
[00:40:06] Sue Schade: [00:40:06] Right. So. Good segway to the last story on cyber, right? Yeah.
[00:40:13] Bill Russell: [00:40:13] Yeah. Cyber, I think cyber is getting the attention it needs. It will get a lot more money and a lot more funding. Senators introduced bipartisan bill to fight cyber crime. This goes along with the story we covered, where president Biden has really put together the executive order, which is moving this forward. A lot of focus on [00:40:30] this from all sides. Also Congress from the president military, just
[00:40:37] Sue Schade: [00:40:37] Bipartison just say it Bill. It’s bipartisan.
[00:40:39] Bill Russell: [00:40:39] It’s just beyond bipartisan. They could shut down our pipeline. They can shut down our hospitals. They can shut down our meat factories. They can, I mean, at this point we’re, I think we’re all afraid that they could start.
[00:40:52] They could just shut down our power in large sections of the, of the country. So there’s a lot of things that this particular [00:41:00] bill says if passed the bill would allow authorities to confiscate communication devices and other tools used to commit cyber crime enhanced, which I can’t believe we don’t already have enhanced prosecutor’s ability to shut down botnets and other digital infrastructure used for a wide range of illegal acts.
[00:41:17] Which is great. As we know, there’s probably still a lot of computers across the country where the, the users of those computers don’t realize they’re a part of the illegal activity. Cause they’ve been compromised create a new criminal [00:41:30] violation for individuals who have knowingly targeted critical infrastructure, such as dams, power plants, hospitals, and election infrastructure prohibit cybercriminals from selling across two botnets to carry out cyber attacks.
[00:41:43] And I saw an article this morning. The FBI director is strongly encouraging. The words were stronger than that. I forget what the words were, but essentially telling people stop paying ransomware. But what’s the alternative? I mean, I [00:42:00] mean the, the alternative, now let me be clear here, paying the ransom doesn’t necessarily mean you’re going to get the information back doesn’t necessarily mean they’re not going to ransom you at a later date with the same information.
[00:42:12] So I understand why not to pay them. But when you’re talking critical infrastructure, when you’re talking about can I bring my hospital back online? How do I get my images back? How do I or the pipeline, how do you, how do you get things going? I mean, we’ve, we’ve seen cases [00:42:30] recently where the pipeline, I, I forget the number, but I know it was, it was upwards of five, 5 million bucks was, was sent out.
[00:42:38] And I think the meat packing situation was another 5 million that was said. So I don’t want to put you in the spot of saying what, what do you do? But it is a, it’s a tough spot. And I think this is a conversation you need to have before you’re ready.
[00:43:00] [00:42:59] Sue Schade: [00:42:59] Exactly. And I think the series you’ve done and may have listened to all of them. Maybe I’m a little behind on your podcasts given my schedule, but you did a lot of good coverage on ransomware and cyber security and preparedness, and that’s where the focus needs to be. How do you get ahead of it? How do you prepare. It caused me to revisit where we are with Boston children’s and looked at some stuff and I’m, I’m relatively confident.
[00:43:27] Can you ever be truly confident in terms of your preparations, [00:43:30] but I think you’ve done a great service to the understand. Let me say that Bill by highlighting this and educating everybody and focusing on the preparedness. I am very happy to see the, that it is getting more let’s say, coordinated national attention with this legislation potentially.
[00:43:50] I see that one of my senators, Sheldon Whitehouse, I live in Rhode Island is one of the one to introduce this bill with senators, Richard Blumenthal of [00:44:00] Connecticut and Lindsey Graham of South Carolina. The article. After scripts by their CEO was excellent. I know you shared that with me. We, we don’t have time to talk about it, but being willing to say, it’s going to take a village.
[00:44:15] It’s not one hospital that missed something and therefore they, they were subject to this everybody’s vulnerable to some extent. And how are we going to combat this together?
[00:44:26] Bill Russell: [00:44:26] Yeah. And last week on This Week in Health IT I tell you, we had Karl West on, [00:44:30] that was a great episode. And on Friday we had Mitch Parker. Both who are pretty active out on social media. And I, I like where they I just like the experience they bring. And I like the fact that they, they believe that we can fight this with was sharing with knowledge, with getting, with helping each other down the road. This is not an area of competition. This is an area where we are. Well, we’re trying to help each other. And that goes across industry lines as well.
[00:44:58] Sue Schade: [00:44:58] So thank you for flying [00:45:00] in those. I haven’t listened to them. I’ve been listening to the Today snippets, but historically and from being a CIO, it’s not something you talk about publicly.
[00:45:09] Cause you do not want to show your organization’s vulnerabilities if you have any. Right. And everybody does. We know that. So I think we have to figure out how’s that crime. Sharing gonna happen across industry. So it does. And talk about what we can talk about with each other.
[00:45:30] [00:45:30] Bill Russell: [00:45:30] Sue thank you for taking some time to sit down with me. I appreciate it. I know that you, you have a lot more time when you’re not on these interim roles, but I also know that you love doing these roles and serving these great organizations. So.
[00:45:45]Sue Schade: [00:45:45] I’m helping them. They’re happy with what I’m doing. We’re moving the ball along. We’re going to find the right next permanent person and. I’m always happy to talk to you and share with others. We have to learn together, right?
[00:45:57] Bill Russell: [00:45:57] Absolutely. Absolutely. All right. Sue [00:46:00] back to work.
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