May 19, 2021: In healthcare, a significant portion of the workforce have to be on site. How do leaders of today support and manage flexible, hybrid and remote work? Our guest today is Andrew Rosenberg, CIO at Michigan Medicine who shares his insights on virtual care, 21st Century Cures, innovation, information blocking, telehealth and the cloud. How do we take the lessons of virtual care and continue to really shift the paradigm, not just with care at home, but how do we improve capacity in our tertiary hospitals and improve patient engagement in clinics? Are we at a point now where technology is driving the business strategy? Or are we still at a point where technology serves the business strategy and therefore the business strategy dictates the technology? What about application modernization and how it relates to cybersecurity and business continuity? Have we entered a new era in our cyber journey? And do you build your own technology products or buy them from vendors? There’s a reason for both.
Next in Health IT with Andrew Rosenberg, M.D.
Episode 405: Transcript – May 19, 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] Thanks for joining us on This Week in Health IT influence. 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 our influence show sponsors Sirius Healthcare and Health Lyrics for choosing to invest in our mission to develop the next generation of health IT leaders. If you want to be a part of our mission, you can become a show sponsor as well. The first step [00:00:30] is to send an email to [email protected]
[00:00:33]Common question I get is how do we determine who comes on This Week in Health IT? To be honest, it started organically. It was just me inviting my peer network. And after each show I’d asked them, is there anyone else I should talk to and then the group, obviously the network group larger and larger and it helped us to expand our community of thought leaders and practitioners who could just share their wisdom and expertise with the community. But another way is that we receive emails from you hey, cover this topic, have this person on the [00:01:00] show. And we really appreciate those submissions as well. You can go ahead and shoot an email to [email protected] It will go to the entire team. We’ll take a look at it, reach out to these people and see if there’s a good fit to bring their knowledge and wisdom to the community as well.
[00:01:16] Just a quick note, before we get to our show, we launched a new podcast Today in Health IT. We look at one story every weekday morning and we break it down from a health IT perspective. You can subscribe wherever you listen to podcasts. Apple, [00:01:30] Google, Spotify, Stitcher, Overcast. You name it, we’re out there. You can also go to todayinhealthit.com. And now onto today’s show.
[00:01:39]Today we are joined by Andrew Rosenberg, CIO for Michigan medicine. Andrew, welcome back to the show.
[00:01:45]Andrew Rosenberg: [00:01:45] Great to be here. Thanks Bill.
[00:01:46]Bill Russell: [00:01:46] Well, I’m looking forward to the conversation as is usually the case. You and I have already had a 10 minute conversation that I wish I’d recorded the whole thing but we will get into those things. I saw that you moderated a session at the CHIME forum. How was [00:02:00] that to be on the moderator side of the equation?
[00:02:04] Andrew Rosenberg: [00:02:04] Well, you know, we were just talking about on one hand it’s extremely efficient and great of course, during as we recover out of COVID to still be able to get together, to still hear great ideas, to be connected.
[00:02:19]On that hand moderating or participating is fine, but you know my style at least, and one reason why I love meetings like CHIME or [00:02:30] Scottsdale Institute or Health Management Academy or whatever is, especially when you’re a moderator you really, you have the ability to draw in people in the audience.
[00:02:39]We’re a big community, but we actually know each other a lot. And one of the parts that I am missing tremendously are the meetings in person. I get the efficiency of doing it remotely, and I know we’re going to still be doing some of that. But it offers such a deeper [00:03:00] experience.
[00:03:00] You can look at people’s expressions, you can follow up on something that you get a sense that people want to hear more about. You can try to move away from something that we just keep repeating over and over and over, and it doesn’t add value. And you can add a little bit of spice. I’ve done that before at some of our meetings and I don’t do it to be a jerk.
[00:03:21] It’s more, I just try to emphasize theme. And in this case, for example, I had talked to John Halamka [00:03:30] before the meeting. We were emailing with all the participants because I wanted to be able to connect and not, and make sure that people were not just repeating with each other. And I love the debate about buy or build your own, especially in the areas of health IT that are new. We go after vendor products or do we have to develop our own? And there’s a reason for both. It just so happens that Mayo clinic and the Mayo platform is extremely well known for [00:04:00] building their own. And yet I’m finding often when you try to build your own. You run into all sorts of conflicts of the resources to do it, or the priorities or things like that.
[00:04:12] So it’s not a right or wrong answer but what it is, it’s a topic that I know you can draw other people in because we all have these issues. And as a moderator, it’s essentially impossible via Zoom or Teams to spark that kind of fun and educational debate. [00:04:30] So I’m looking forward to doing it in person.
[00:04:33] Bill Russell: [00:04:33] I had my first meeting in a long time. Yesterday a CEO for a startup startup, a 20 year old startup in healthcare. It happens to be in our area. And so we decided to get together for lunch. And it was the first time in a long time that I had sat across from somebody.
[00:04:50]I’ve forgot how dynamic it can be. and this sounds silly to even say, but I forgot how dynamic the conversation could be, how one thought leads to another thought leads to a discussion [00:05:00] and how he was sort of trial ballooning, his thoughts and ideas on me. And part of that is seeing, you know, is this resonating with this person?
[00:05:08] Are they, you know, what’s their facial expression? Are they grabbing onto it? And I was doing the same thing with, with him. I was throwing out some of the ideas that I’d heard. Over the last couple of months and he was responding to it and it, there’s just something about that that helps us to fine tune our thinking.
[00:05:25] Fine tune our presentation of the facts and of the [00:05:30] argument so that we can be better the next time we’re going to have that conversation. And that was just a one-on-one lunch. I really miss it. It’s I don’t know about, are you having pretty often lunch meetings with people sitting across from them or are things still pretty much remote?
[00:05:47] Andrew Rosenberg: [00:05:47] I would say Michigan, unfortunately had this bizarre and still not quite explainable surge in the US of cases more than any other state. And so [00:06:00] socially within the state, at least I think we were more restrictive than we might ordinarily have been. I’m finding it personally a little bit challenging because most of my professional colleagues, who’ve been vaccinated now for several months in the data, I think are pretty strong to support an extremely low risk of contracting COVID, let alone really getting sick because I think the real issue of course, is not just you get COVID, but you get really sick by it.
[00:06:29] So [00:06:30] I’ve been feeling much less restricted. And I do go out and I do have meetings or lunches. I would say overall, we haven’t been there, but you know, your earlier point I think is relevant about where we’re going to be with remote work. I know that’s a topic we’re all talking about. So why don’t we just dive into that very briefly?
[00:06:50] Bill Russell: [00:06:50] Sure.
[00:06:51] Andrew Rosenberg: [00:06:51] I think this kind of format that you and I are doing are actually still really good for the one-on-one type meetings. And I [00:07:00] do think one of the areas that we’re going to see persistence of remote work that will be different than before is that we’ll use video meetings to do what you and I are doing right now, because I can’t actually see your expression.
[00:07:15] I can see it mimics the in-person experience pretty well. Add a third and a fourth and a fifth person. And that benefit diminishes, I think very significantly. But the other piece of course is especially with groups of people, it’s [00:07:30] not just what we’re talking about right now. It’s the, Oh, Hey, I got a quick item just afterward.
[00:07:35] And they’re grabbing someone in the hall or just running over to their office that you can do quickly versus having to, you know, drive to someone’s office. So I do think the one-on-one and especially where we couldn’t do it before, much different than a phone, that’s going to process where I were. And I might be different than my peers.
[00:07:58] I feel like I’m in the [00:08:00] minority on this one. When it comes to our, we’re calling it flexible first, most of our IT colleagues when we’d surveyed and we’ve done some really good surveys, which I would say is one of the most important things to do is survey the groups, find out where people are now and where they think they’re going to be wanting to be in six or nine months in terms of working remotely, whatever.
[00:08:24] I think in two years, more than not, people are going to be back together [00:08:30] than remote. And I think the advantages and the desires that people are expressing now to be able to work remotely, not have to be in the office, things like that, I suspect are going to be two drivers for why they’re going to be back in the office more than not in two years from now.
[00:08:49]Bill Russell: [00:08:49] By the way, I have some thoughts on that as does Jamie Diamon from from JP Morgan. He was very vocal on this in his annual letter to shareholders but I’m [00:09:00] curious what are the two reasons that we’re going to end up back together? Do you think.
[00:09:07] Andrew Rosenberg: [00:09:07] The two are as follows. The first is the biology of humans being social animals and the biologic drive to group and be together more than not. And there’s a variability. I get it. I think the advantages of the [00:09:30] flexibility that remote work offers, which are very real will over time, just diminish a bit.
[00:09:37] And the biology of people wanting to congregate will will change that equilibrium. So that’s first the human need to stay connected in person. By the way, my point about the meetings is as much that I also think that we do need to, and we want, and we seek to disconnect from the routine in [00:10:00] order to have a more creative, more flexible kind of thinking that we seek at meetings, a change of pace, whatever those things are. But I think those are partly driven by human psychology and human biology. But the other one, which I think is more interesting will be the I guess I’ll call it the peer pressure maybe.
[00:10:27] I think it’s going to be a little bit difficult [00:10:30] to fight the pressure that one will feel all of us when a group of peers or your boss is meeting in person with people and you’re not there. Right. And I think that’ll also be variable. I think different people will react to that very differently. I know that when I think about what I’m going to be doing as the CIO, I need to be really clear to people.
[00:10:56] To be very sincere in the way I want to do it [00:11:00] to support our flexible first, the way I want to do it is to have our meetings set up as for our case zoom or team meetings. Now, if the person happens to be in the office, when I’m in the office and we realized, you know, we’re doing this as teams and we’re literally three seconds away from each other, I imagine we’ll just shut off.
[00:11:23] Our video and we’ll go to one of the other’s office. That’s what I suspect will happen. But instead of saying, [00:11:30] Hey, I’m going to be in the office on Monday, but we can do teams. I think the way I’m going to do is say, Nope, it’s going to set up as a remote meeting so that I can at least support the flexible first a style.
[00:11:41] I don’t want people to feel wow, Andrew’s in the office. Therefore I have to be there because I don’t want to do the same thing for my boss. We have a couple of leadership meetings that have been very difficult for us to come to because some of us who are not in that exact building, we have to drive, we have to park, we have to find it.
[00:11:58] And then 45 minutes later, [00:12:00] then we have the reverse. I think a couple of our leadership meetings will stay virtual meetings because we know so many of the leadership at a large place like Michigan Medicine, not everyone is all on the same floor to get there. But two years from now, I’ll be curious how that works out for those people who are physically around and can be with the boss and those who are logging in remotely and what will be the social dynamics.
[00:12:27] So my bottom line is in two years [00:12:30] from now, I think we still will be taking advantage of flexible remote work, especially with hiring people who will be in different parts of the country that I do think. There’ll be more of that than we’ve had before. But I think more often than not, people are going to feel some pressure to be congregating in person.
[00:12:48] Bill Russell: [00:12:48] Yeah. I think that’s true. And that’s along the lines of what I heard from Jamie Diamon and he just went through his workforce and said, look, these people have to be onsite these people. And when he got done, he’s like, okay so [00:13:00] 60% of our workforce at JP Morgan has to be onsite, period. I mean, they just, there’s no way to be a bank teller remotely at this point.
[00:13:09] And we you know, we went away from bank tellers and everything was going to be done online. Now we went back to bank tellers because we want to be more personable and service oriented and those kind of things. Well, the same thing is true in health IT. Or just healthcare in general, a significant portion of the population has to be on site.
[00:13:27] And so there is that peer pressure that draw [00:13:30] of not being there. He also talked about mentorship. It’s hard to do mentorship. Remotely. So bringing on new employees, training them in some of the skills that they’re going to be required to have is is, is hard to hard if not impossible to via Zoom.
[00:13:47] And so there’s, there’s, there’s a lot of different aspects to it, but I liked how you’re approaching it in that there, you know, the satisfaction with it is pretty high for those people who can take advantage of it. And [00:14:00] the reason that is, is obvious. And it’s the flexibility. It is a less commute. It’s all those things that we know are an advantage.
[00:14:07] And I think people like it today, but I think they’re going to, everybody’s going to need to find their balance with it and what really works.
[00:14:16] Andrew Rosenberg: [00:14:16] And I think what’s really going to persist though is, and that’s why we’re calling it the flexibility, you know, it’s not remote, it’s flexible and snow days, there is no reason why someone should drive in if they physically don’t have [00:14:30] to be. Sorry, kids going to school from now on. But I think when someone is needing to do something else, but they have really, what is important, it gives them the flexibility to remote in for that one thing that’s important. And I think that’ll help with work-life balance perhaps more than anything else we’ve ever done.
[00:14:49] On the other hand, of course it does. I think we’ve all experienced some sense of we’re actually working harder in some ways, you know, meeting after meeting, after meeting, after meeting, never getting up, never moving [00:15:00] around. So I think for us, one lesson is, and I’ve already alluded to this. We have to make some efforts to really sincerely demonstrate number one.
[00:15:13] I think it’s perfectly fine. If you want to meet with me like this and number two. I’ll do everything I can to try to promote it in certainly decrease any sense of obligation to not do it at the same time. I don’t want to somehow [00:15:30] artificially keep people from joining and getting together because not only do I miss it, I do think that there are a lot of opportunities.
[00:15:36] You mentioned a couple about a mentoring. I would add serendipity and creativity. You know, often it’s that hey, we’re just going to go get a cup of coffee. It just changes the dynamic to think a little bit more expansively, especially around complex and difficult problems that don’t lend themselves to just being solved easily.
[00:15:55]Yeah, I believe there’s something about, how you can bring people together that’s [00:16:00] still lets them have that flexibility. But I also don’t want to artificially create more remote everything and not allow people to come together. So I think we’ll find the balance, but I do think it’s going to take us a bit.
[00:16:12] Bill Russell: [00:16:12] You know, I, as you know, I have a bunch of different questions. We can go in a lot of directions here, but I want to, I want to start with, and I meant to start with this. We just tend to dive into it. What’s top of mind at Michigan Medicine these days? What is like front and center for you guys?
[00:16:27]Andrew Rosenberg: [00:16:27] I think we talked about probably the number [00:16:30] one thing that’s both new and front and center. All things. How do we support flexible hybrid, remote, whatever term you want to use work? My peers and I, everything from what kind of scheduling system you’ll be using to policies that are in place are being changed to what’s your best guess of your workforce who will be working to recruiting, retaining?
[00:16:54] All of those things are front and center, not only in IT but really throughout the health system [00:17:00] and the university. And so, you know, at least for us being at the university of Michigan, all those things play pretty, pretty heavily. But from that a few things are also gaining some momentum. One that I’m most interested in dealing with which is a massive project or series of projects. And it’s almost difficult to put it into words, but I’ll try. It’s something like this. Creating the framework for moving [00:17:30] workflows infrastructure to cloud solutions, to a variety of as a service software infrastructure platform.
[00:17:42] And how do create that framework with also thinking about your application, we’ll call it application modernization and how that relates to cybersecurity, to business continuity [00:18:00] and frankly, even some overall principles of how one will engage with cloud. I’ll call it cloud for now. I think most of your viewers and listeners, we understand what we mean by the complexity of that term, the cloud.
[00:18:15] So all those things are wrapped together. And for us one of the instigators of this has we have to update or replace our secondary data center. And immediately as you start getting into that discussion, there are a lot of [00:18:30] circular items that I’ve had to deal with. So I’m trying to figure out how to tackle all of that and not just move to the cloud. Or what Epic hosted is going to look like.
[00:18:42] Because we do have investments in data centers that still are financially high value for us. As opposed to perhaps others who’ve had you know leased data centers where it just makes sense that you have to go to someone else. So [00:19:00] that’s probably the among the biggest things that I have to deal with and that’s going to be a ten-year project.
[00:19:08] The other one are some of the new areas of care I’m extremely interested in, now this is partly because I’m doing TeleCritical care with VA, but I’ve always been interested in this around remote patient monitoring, true hospital care at home. How to take the lessons of virtual care and really continue to shift [00:19:30] that paradigm, not just care at home, but how do we improve capacity in our tertiary hospitals, improve patient engagement in the experience in our clinics so that there’s less wait time in part by shifting some of the work to areas where people really wanted IE at their home. And I do think that’s an area, whether it’s edge computing and IOT with 5G capability over time, really allowing that to [00:20:00] happen. That’s another area where I really see a number of themes only growing.
[00:20:04]Bill Russell: [00:20:04] Here’s what I’d like to do. I’d like to start high and then move low. You gave me a lot of things to think about there. Let’s start at the high level, which is, are we at a point now where the technology is driving business strategy? Or are we still at a point where we’re saying no, no, no technology serves the business strategy and therefore the business strategy dictates the technology? [00:20:30] Does that make sense?
[00:20:31] Andrew Rosenberg: [00:20:31] It does. And you know, my experience has been, they it’s almost like a quantum state. No matter what angle you try to view it, at the other angle can be equally relevant at the same time. I’ve been doing some reading about quantum these days and superposition, so I might inadvertently or inappropriately add too much of that to this conversation, but I really think it’s true.
[00:20:57] You know, I, I would say a classic [00:21:00] teaching would be start with your business strategy and have the technology support the business strategy, whether it’s a clinical item or an academic item or an education item. And conceptually, that makes a lot of sense but I’ve seen equally where because we don’t really define that business strategy or do it well, or the governance is such where you can’t really quite define it, crisply enough, where then [00:21:30] the technology actually helps to constrain or shape or direct.
[00:21:36] I mean, this is the classic example years ago, when we were all doing it, EHR implementations, we would say, let’s get our workflows right. And aligned, and then build the EHR to support that. But often the EHR kind of helped constrain what was otherwise an ungovernable series of requests ambulatory care and [00:22:00] inpatient care specialty in primary.
[00:22:02] They could never agree on a very precise. Strategic and tactical alignment. So you would say, I know you want to do that Bill and you want to do that, you know, Sally, but the EHR just allows us to do it this one way. That’s the way we’re going to do it. Now, if we did that all the time, that would break business.
[00:22:21] So I see them as being very interwoven and in some ways, one will get out ahead of the other. And you just want to try to keep them in [00:22:30] reasonable balance, but not lead with one and let the other follow up.
[00:22:34]Bill Russell: [00:22:34] That’s a really interesting and phenomenal answer that really that’s gonna stick with me. I’m going to stay at a high level here for a second. You know, the history of Fortune 500 companies like that you used to last as a Fortune 500 company for like 60 years that it’s down to. I think now it’s down to like 25 or 30 years for the average fortune 500 company. But the reality is that a majority of the largest healthcare companies have been around at their [00:23:00] level for over a hundred years. So we were built as an analog kind of of, of business, right? Things were paper-based, things moved by word of mouth, things moved by papers, moving around on clipboards and those kinds of things. And now we have this technology, first of all we’ve digitized the medical record.
[00:23:20] We’ve gotten to that point where I think we can safely say we’ve digitized the medical record. Now we have a ways to go still on cleaning up. [00:23:30] The content of that and whatnot, but we’ve digitized the medical record. Now we have all these other technologies out there. We have artificial intelligence machine learning.
[00:23:38] We have really some powerful data tools and data insight tools. And we have things like this. We have things like the ability to see a patient remotely. We have remote patient monitoring type of tools and that kind of things. And so when I, when I hear you say it’s both. It almost [00:24:00] feels to me like we’re at a point where we’re, we’re taking this analog, we’re taking this historical process that we’ve had in healthcare.
[00:24:07] And there’s really two approaches that people are taking. They’re either just overlaying the technology on top of it and hoping that it sort of works out. And that seems to be the predominant approach. It’s like, we’re going to inject this here and inject this here. Do we have any, appetite for rethinking it from a digital mindset, from a [00:24:30] digital world and saying, Hey, is there a different way of approaching healthcare given this new set of tools that we have?
[00:24:39] Andrew Rosenberg: [00:24:39] I think we’ve been constantly trying to do that. I think that the shift from inpatient care to ambulatory care the shift of procedures from hospitals to dedicated surgical sites, the [00:25:00] shift from big open procedures to more and more. Laparoscopic and catheter-based E the shift to trying to completely eliminate diseases.
[00:25:12] Now, with gene editing, CRISPR and gene therapies and immunotherapies. The goal is constant to try to shift from those things that we, deem as inefficient to a more patient centric more humane, [00:25:30] less expensive, whatever. This is the pursuit of healthcare. This is the basis of disruptors trying to come into the market. So what, what I’m finding is, you know, I sure hope I’m not proven wrong, but I hope my CIO and it colleagues would agree. I’m getting a little bit more comfortable now than I was before when I’m talking to really innovative and. And energetic, younger people who [00:26:00] want to disrupt healthcare and I’m finding myself being one of those people, starting to smile a little bit more calmly, like, yeah, I know it.
[00:26:09] Sure. Sounds like you should just be able to go in there and with this technology or this new workflow or this methodology just disrupt things. Healthcare is really complicated, very heterogeneous. And one thing that you think of that might be healthcare is very different for someone else. So. I am much less worried [00:26:30] that our directions are being dictated by new technologies or somehow technologies are leading the way.
[00:26:37] And at the same time, I also think it will be through technology where the real big shifts in healthcare will occur. So there’s this duality that I mentioned before that I see so frequently wrapped together. And by the way, this is why. I’ve said this before on your show. And I really mean it [00:27:00] it’s less IT, it’s less technology.
[00:27:03] And what we’re really just speaking about is how we do healthcare. My shift to becoming a CMIO and a CIO was not because I started out as an it or technologists it’s because this was the way I deeply believe we’re going to do the changes in healthcare. It’ll be predominantly through technologic breakthroughs.
[00:27:24] Whether it’s molecular medicine, whether it’s sensor and whether [00:27:30] it’s deep analytics like AI and other tools, it’s going to come through technologic breakers. But at the same time, at the end of the day, it’s probably among the most human of behaviors we do, which is healthcare. So these things to me are extremely wrapped up.
[00:27:49] Your question to me is difficult to disarticulate because of how tightly they’re wrapped together.
[00:27:54] Bill Russell: [00:27:54] So, so let’s move down a layer and get to more of where care is happening. And you, you [00:28:00] sort of alluded to this, that the locus of care has shifted and it’s been shifting, but we just had this pandemic has that accelerated the shift in where care is delivered and where we see care being delivered as we move forward. What are the ramifications of that to healthcare IT?
[00:28:20]Andrew Rosenberg: [00:28:20] Like you said earlier about facilitating a meeting, I really would like, I, I, I wish we were at a meeting right now because I would love to become slightly [00:28:30] controversial on this topic. I think where healthcare is shifting you have to follow the money. I would love to be able to say we shift based on what makes the most sense and adds the most value. But let me give you, let me give you an example. Ford Coals from the advisory board gave a great talk a couple of months ago, and he showed some data where while most of us achieved these [00:29:00] unbelievable number of virtual care visits.
[00:29:03] The vast majority of us have returned back to some relatively low volume of virtual visits. Now The graph had a peak sometime somewhere up into the 70 and 80% of all ambulatory visits, being virtual, depending on the organization. And those places have gone back down to something around 20% only.
[00:29:23] And that absolutely mimics Michigan medicine. And one of the reasons is [00:29:30] that. We want to be sure we generate appropriate revenue for our visits. I think that the ultimate amounts of virtual care will be based on what will be reimbursed and what will not. And it’s not just the professional fee.
[00:29:54] It’ll also be the facility fees. That ambulatory sites either [00:30:00] continue to get, or if they don’t get, they’re not going to just continue to support a lot of virtual care now that I don’t want to sound overly cynical. I think virtual care is an incredible patient satisfier and providers satisfier as you and I are talking, my wife is seeing patients in the other side of our house, and many of those patients don’t have to drive eight and six hours for a 45 minutes visit with her. They love it. We don’t want that to go away [00:30:30] but a locus of care is still going to be where payers are paying us to provide that care. So if we’re going to shift this care, and that’s an example of some of the pilot programs we’re doing with some of the private payers to do true hospital care at home, one of the most challenging aspects of this.
[00:30:54] It’s to figure out the payment models, so that doing this care and all the investments we [00:31:00] need to do, it’s super safely and then efficiently will require the payments to model that shift and locus of care. The other one is then where is the efficiency? I don’t study this, so I don’t have really precise answers, but what are the financial models for the cost effectiveness of seeing patients in a facility versus seeing [00:31:30] patients at their home or some other locations? Bottom line is I think we’re going to see more virtual care, but I don’t think we’re necessarily going to see the kind of expansion of virtual care that a we saw at the peak of the pandemic, or be even some people would envision.
[00:31:48] We want to do in this disruptive manner in part, because who’s going to pay for it being the Don in this distributed manner versus that facility.
[00:31:58] Bill Russell: [00:31:58] Follow the money [00:32:00] is I’m not sure it’s cynical as much as it is just practical. And we’re seeing the healthcare associations and we’re seeing hospitals and others make the case today to the regulatory agencies and to CMS and others, that, and to commercial payers that we need to expand this, funding. If we truly believe that this is a more efficient and more effective way of distributing the the care provider [00:32:30] resources across a larger population. And we want to keep that momentum going for tele-health, then that it needs to be funded.
[00:32:38]I’m not sure what the right question here is. Is there any way to do this other than government and regulatory funding for telehealth expansion? Is there a model? It would appear that there is a model because you have, you know, you have Teladoc, you have a Walmart, just this last week, buying a huge telematics company, you have Amazon Care sort of [00:33:00] coming into the market.
[00:33:00] It would seem like they’re not basing their entire model on a reimbursement from CMS and others that they’re building out a different model. Is there any I don’t know, direction for a healthcare provider to build out that same kind of model or is that not necessary?
[00:33:19] Andrew Rosenberg: [00:33:19] No, no, no. I think it’s a, it’s a great question. I would say if you look back at the history of where telehealth has been very successful, it had started in areas that [00:33:30] I’ll use the term that had capitated reimbursement. It has been very successful at the VA. It’s been very successful in DOD and the military it’s been successful in some areas that well prison systems it’s been very successful also in specific areas where it’s been difficult to get care. [00:34:00] Specialty care, mental health care. I think one of the things that will emerge out of our discussions around COVID will be this enormous amount of recognition for the burden of mental health and the really successful ability to provide those services remotely or virtually in some ways.
[00:34:23] It’s actually better than in persons for both the patients and the providers. But to me, one of the key drivers is the [00:34:30] just ongoing challenge of getting particularly specialty care out into remote areas. All of those, I think will only expand because of this natural experiment, if you will, over the last year and a half, but the other ones are where we already have capitated payment models or bundled payment postoperative visits are a great example where the [00:35:00] virtual visit is only aligned with all the things that we’re doing.
[00:35:05] Patients love it. They don’t have to drive and wait to literally to be seen for two minutes. Because it’s already part of a bundled plan the providers can see more new patients and relatively quickly do a virtual visit. So I think as we look at where those natural areas are, those will only continue to expand.
[00:35:28] In fact, they really hadn’t [00:35:30] expanded before because we just didn’t have the catalyst at COVID and the pandemic has created. And from there. I think we’re going to see other things start to grow out patient visits, and this is where the disruptors really will put appropriate pressure on those hundred year old healthcare businesses that have, well, of course, I’ll just have people wait in my waiting room for 45 minutes.
[00:35:56] Yeah, no, you know, a lot of [00:36:00] young people a lot of young workers, a lot of companies. Are going to say, look, we’re just going to reimburse you to do a virtual visit with X, Y, and Z company, because it’s worth it. It’s worth to us for you not to be gone for two hours to go to this old brick and mortar place to get their visit.
[00:36:20] Those are the areas that I think we’re only going to see expand. And from that, we’ll get a better idea of what’s going to change.
[00:36:28]Bill Russell: [00:36:28] Let’s sit on a couple [00:36:30] of regulatory things and I want to come back to the cloud, but 21st century cures information blocking any, where is this going to lead us? Do you think?
[00:36:40] Andrew Rosenberg: [00:36:40] Well, you know, it’s funny, I got an email from a patient’s mother just two days ago, and it was a patient who had cardiac surgery. A child had cardiac surgery and she was fantastic. She was concerned about data in the patient portal, not being there. And she said, look, I’m just reaching out to you. She didn’t know me at all.
[00:36:58] She literally [00:37:00] found the CEO’s email and I was really impressed with, I got in touch with her right away. And I said, listen, this is fantastic. Let me see what I can help answer with. I’ll connect you to the CMIO and all that. But fundamentally what she was asking for were more data to be available because she is, she said, I am my child’s advocate at the heart of, I really wish the ONC had used a different term because it’s not about information blocking. It really is about interoperability and [00:37:30] availability. So I think that the push that the ONC and CMS are doing to encourage us as providers, payers, and even to incentivize third parties is probably overall in the benefit of everyone. So I think that, like I said earlier, even with remote care, the the catalyst for data, particularly with open API APIs and open web [00:38:00] services to be available also for innovation that will occur.
[00:38:04]Aneesh Chopra has been really articulated about how the government, when they made data available like GPS data or weather data, think of all the uses we now have for making those data available. I think ultimately that will be good if I have a concern that I’ve expressed publicly and I’ve been criticized by at least one or two CEOs is that it’s not, I don’t think of it as the CIO, as [00:38:30] my data or the institution’s paid up, but I do think of us as the as the custodians of those data. I do think that the typical person does not really know or understand the depth of their medical data and that they seek a trusted provider, a nurse, [00:39:00] a physician speech language pathologist it doesn’t matter. They seek a trusted professional to help them with their cherished really important healthcare data. And I think it’s complicated and their data all over the place and that the average person, including even myself, would not a less than average person really understands the depth of that.
[00:39:29] So if I [00:39:30] have a concern it’s, I would like us to go into it carefully and responsibly and not just open up. Enormous portals of patients data at the individual or the bulk level and have data migrate out. And then we start to learn, well, that really wasn’t good that everyone now knows about this genetic marker that I have, and now I’m not insurable or whatever, whatever.
[00:39:58] So I’m [00:40:00] just a little bit on the conservative side of how we open up, not the idea that we do. And of course that that would go against other people would say, it’s not yours to choose. It’s the patients they’ve given permission. I just, it sounds very paternalistic, but I just don’t think the average person really understands the sophistication of their healthcare data.
[00:40:21] Bill Russell: [00:40:21] Yeah. And in the interest of time, cause you and I could have a whole hour conversation around that because I think it would be interesting. But I do want to hit [00:40:30] on one other regulatory, then get back to the cloud real quick. So price transparency. AAJ AHA contends. it’s really hard to do. We have to put 200 shoppable services, the price for those online.
[00:40:44] I guess my question around this is. The, you know, we’ve heard arguments that this is not going to make any difference. People aren’t, even if they had this data, they wouldn’t know, again, wouldn’t know what to make of the data. It’s not necessarily going to change [00:41:00] behaviors in terms of making the consumer anymore activated in terms of shopping for services, thus, the term shoppable services. My two-part question on this is what makes this so hard and will it make any difference or is it the foundation for making a difference later?
[00:41:21] Andrew Rosenberg: [00:41:21] You know, this is not my area of expertise, so I’m just going to speak like an average civilian on this one. [00:41:30] I think where services are elastic. Some of these data may shift them. I just don’t know how much I saw a very cool app two years ago at a, a advisory meeting that I was at with United healthcare, as it turns out where there was a insurance company that demonstrated with a really, really very user-friendly app.
[00:41:58] The ability to find out [00:42:00] the cost of a variety of services in an area. I don’t know exactly how accurate those costs were, but I’m going to make a presumption. They were reasonably accurate, or if they were inaccurate, they were reasonably inaccurate. Similarly. So if I have a need to get a skin tag removed from my I’m going to go to the place.
[00:42:27] That’s going to do it at the least amount of cost and [00:42:30] closest to me. And uh, so if I can just find an app that I can put that in and I can find out for you, you’re charging me $125 and she’s charging me 10. I’m going to do that. When I need a liver transplant, the price transparency is just not going to be as important.
[00:42:47] And when I have a broken arm or I have a gash in my child’s head, I’m going to go to the nearest place. And if they’re going to charge me double, I’m just going to pay it. So I think that there’s a certain degree of [00:43:00] human behavior and PR and via last city of the thing we’re talking about that will drive that.
[00:43:08] And then of course, there’s the whole issue of the accuracy of the data. And I just don’t know how accurately are or not, but I think those are probably at the core of, of where some of that comes in.
[00:43:19] Bill Russell: [00:43:19] Let’s talk about cloud for a second. Thanks for that answer by the way. I appreciate it. And I agree with you as an economics major, that you, you explained elasticity [00:43:30] of demand very well. but you know, as we look at cloud, you talked about this decision around the build versus buy. You’ve talked about the data center versus essentially cloud would be a pay as you go kind of model It really is a very complex. Set of questions because the cloud itself is a significant amount of technologies.
[00:43:55] There’s applications as a service, there’s platforms, as a service there’s infrastructure, as a service. [00:44:00] And, and that’s just the main aspects of cloud. And then you have all these other sub components that you can really buy as needed and access to components as needed. And does the cloud represent more than just access to those technologies?
[00:44:18] Does it represent a new kind of architecture that could potentially lead to more flexibility, more agility for healthcare. Is that, is that one of the drivers or is it [00:44:30] financial? Is it access to those technology components? What drives the move to the cloud at this point?
[00:44:37] Andrew Rosenberg: [00:44:37] Yeah, I feel like talking about Jay Gatsby, looking out at the future and all of the possibilities. I think the reason why the clouds both a great word and a terrible word all at the same time is that I think it encompasses everything that you just said. So the way I would think about it is that there is no matter what, in the [00:45:00] next horrible move for applications, let’s just start with applications being hosted outside of your environment and residing, not on your device. I, the irony of ironies is we’re moving back towards the hub and spoke model of computing in the eighties in a way, but now in a much more sophisticated manner. So no matter what you want to do or [00:45:30] not, you are not downloading, you’re not buying your software on a CD or a DVD, and you’re not in less so are you now even downloading that software via the internet to your device. You are using it in the cloud. Take Microsoft 365, just a perfect, simple, complex answer because you can’t avoid moving towards Microsoft 365, if you’re a Microsoft customer and you’ve [00:46:00] always been in the cloud.
[00:46:01] If you’re a Google customer, always have been. So that’s a great example. So now the infrastructure before we had to buy and maintain infrastructure to support our Microsoft tools and now less. So the EHR is the other one for us in healthcare, we all will be moving to some form of a hosted version of our EHR is over time.
[00:46:24] Whereas up until now, we’ve been spending millions of dollars to replace [00:46:30] our infrastructure compute and storage and networking to run our EHR is that’s going to change over the next five to eight years, and then we can start getting into more and more applications. So the way I think about it is, and it’s circular, but I try to incise that circle and try to make some things, at least linear is what is our overall application strategy?
[00:46:54] Where are we moving? What are we moving to? And when do we think we’ll move there knowing [00:47:00] that. How does that inform our infrastructure strategy? Do we continue to buy and replace on-prem or do we start using more and more of these services than someone else’s data center? I E the cloud. Is it public? Is it private?
[00:47:13] And I think that’s what, we’re all seeing a significant movement to what I know on the other hand is it’s not all things cloud. We’re not moving every one of our services to the cloud. Some of our storage just makes a lot more [00:47:30] sense to do it on premise. Some of it depends on the size of the institution as we have more and more consolidated health systems.
[00:47:38] It makes sense for outlying hospitals and clinics and practices to use the services of a health system, not necessarily consume it through public cloud. So I do think that these are interesting discussions and then let’s take an extreme. So I started raising this question to a few people. Are you going to build your own quantum computer?
[00:48:00] [00:48:00] The answer should be no, of course not. Or you can, are you going to consume the services of quantum computing? I hope the answer should be. I think I will, but will you do it primarily yourself or will it be. Part of the vendor application that you’re using that will periodically reach out to cloud computing to do some computations.
[00:48:22] I currently can’t do that, I think is what we’re going to be doing. So in a sense, you’re still using cloud services. So [00:48:30] we could, I really could go on about this, but for me, the bottom line is, is that a data center question? Is that an application question or is it a business continuity? Question and a cyber security question. Well, they’re all wrapped together.
[00:48:47] Bill Russell: [00:48:47] Yep, absolutely. And we didn’t even talk about cybersecurity. We could probably talk about that for a while because it’s such a, a hot topic right now, but Andrew we’re we’re up on the time and I want to respect your schedule [00:49:00] here. So hey, thank you. This is, I love our conversations.
[00:49:03] I look forward to the next time we get to actually sit across from each other, have a cup of coffee and have this conversation, but I really appreciate you coming on the show. Thanks for being here.
[00:49:13]Andrew Rosenberg: [00:49:13] Oh my pleasure. As always Bill. Thank you.
[00:49:15]Bill Russell: [00:49:15] What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to this show. It’s conference [00:49:30] level value every week. They can subscribe on our website thisweekhealth.com or they can go wherever you listen to podcasts, Apple, Google, Overcast, which is what I use, Spotify, Stitcher. You name it. We’re out there. They can find us. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders. Those are VMware, Hill-Rom, StarBridge Advisers, Aruba and McAfee. Thanks for listening. That’s [00:50:00] all for now.