This Week in Health IT Top 10 Themes for 2019

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Bill Russell

This Week Health IT 2019 Themes

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We published close to 90 episodes this year with wicked smart industry leaders.  This week we take a look back at the top themes from 2019 straight from the people who are on the front lines.  Hope you enjoy.

Bill Russell: 00:03 This is the first of the two end of the year episodes for This Week in Health IT. We have the top 10 themes from this year and then we just have the flat-out top 10 countdown of the 10 most listened to podcasts from, uh, from our show for this past year. So sit back, relax, uh, you know, grab a latte, grab an eggnog, whatever. I have my, my, a red sweater on. For those of you watching on YouTube, you know, we’re at the vacation place. The kids are home for the holidays. Uh, we are, uh, going to start celebrating as soon as I’m done recording these last two, uh, shows for the year. My name is bill Russell, CIO, coach and creator of This Week in health It, a series of podcasts and videos and collaboration events designed to develop the next generation of health it leaders. This episode is sponsored by health lyrics.

Bill Russell: 00:53 I coach healthcare executives on technology, a strategy, vision and execution. Uh, you know, coaching was instrumental in my development as a CIO. And I’m excited about the progress my clients have made over the past year and really over the past couple of years. Uh, you know, I have one more spot open for 2020. So if you’re interested in talking to me about coaching, please visit Health Lyric’s dot com to schedule your free conversation. A reminder, we need your feedback. Uh, you can go to this week, health.com/survey to complete the survey. Uh, in fact, uh, you know, I can’t begin to tell you how much it is, uh, really helped me. The emails that you send me [email protected] Um, and the survey from last year really changed the show. In fact, if you go back and listen to 2018 to 2019, you’ll know that we changed the show pretty dramatically, and that was all based on your feedback.

Bill Russell: 01:43 I really appreciate your feedback. And you know, one of the more funny things I received in an email recently was please do not do a trends for 2020 episode. So, um, it sort of made me giggle because after I read that article, now I’m seeing these trends, posts and trends, articles everywhere. So, you know, it’s that kind of feedback that keeps me from stepping in it and just, uh, you know, doing things that are kind of trendy. So, um, you know, if you get the opportunity, your feedback is really helpful this week. health.com/survey will really help us to make a better show for you. Uh, before we get started, I want to thank everyone who appeared on the show this year. Uh, we had so many wonderful guests, uh, and I really just appreciate their time. You know, sometimes I’m interviewing at conferences and there are two and three people deep waiting to talk to these people and it is just, um, you know, I, I just appreciate them taking the time and, uh, sharing their wisdom and their, their insights with us.

Bill Russell: 02:38 Um, and I think, you know, I’m, I’m really grateful for it and I know that our listeners are grateful for it as well. And we appreciate your dedication to developing the next generation of health leaders. Now, without further ado, the top 10 themes. Uh, we tried to do this scientifically, that didn’t work. We tried to do this with big data and AI that didn’t work. So I just, you know, had to go through and look at, uh, you, you’d laugh at how I came up with it, but I looked at, you know, which, uh, I did, uh, a word we transcribe every episode. So I’m able to look at how many times certain words are used. Uh, and that got me relatively close and then I just did a little bit of, uh, things. So even though we’re talking about AI, machine learning, all this really cool stuff, uh, I still did it by hand.

Bill Russell: 03:21 So, uh, you know, this year, top 10 themes, we have to start at HIMSS. HIMSS really sets the direction for what conversations are going to be front and center for us this year. And, uh, this year was no exception. We, uh, you know, we had at the HIMSS at the center stage for the first day. We had uh, you know, four administrations represented, uh, talking about the governance approach, uh, to really two themes but really one theme, which is interoperability and data liquidity is the other. And uh, this was a recurring theme this year and I thought I would share a clip from Aneesh Chopra who was one of the people on that stage and he has been a champion for interoperability for many years, have a listen.

Aneesh Chopra: 04:04 So there were really three things that captain that I think are going to make, I don’t want to say that this is the year that we see material progress cause it may feel a little bit like, well everyone says that I genuinely believe in three things we spoke of. One, the new default in interoperability is that the patient and the apps that they choose will be the destination for health information. So the standardized patient centric interoperability. That’s right. That, that, that was the default. And that came through not just in spiritual language. Like aspirationally, we should do this. And even came out of economics, the rules now say any consumer app, uh, with the uh, consumers opt in will have free access to the data, no fees, no burden, no special effort. So that was point number one, consumer at the center. Point number two, and this is interesting, the decades you’ve been at this have been about EHR doctors, hospitals, we’ve now introduced regulation on the health plans.

Aneesh Chopra: 05:01 That’s a pretty bold statement. And now we’re going to have standardized claims data to combine with standardized clinical data. And I think it creates the momentum that basically says we’re going to be unfettered and moving all of healthcare data towards a common language that’s available to consumers via open API. And that will cover social determinants of health. It’ll cover prescription data, pricing, data quality, got a whole range of topics. That’s 0.2 and then last but not least, and this is the interesting one, I’m going to float this idea with you bill, and you’re going to react one way or the other, I think we’re entering into a net neutrality era for healthcare data business models. And so what that means is that the rules, information blocking the rules allow that if you’re holding data and you have to invest in API technology in order to release the data, you can recoup those costs by charging fees to the applications that wish to connect.

Aneesh Chopra: 05:54 Not the consumer’s fees, uh, apps, but the, uh, physicians apps and other apps. But those fees have to be tied to the marginal cost of the program. And that also means that you are allowed to provide value added services, but they have to be non-discriminatory and they are likely to be competitive. So you can’t have the fact that you’re in possession of the data to be the sole source of sad value added service, a prediction model or service here, there, and the other. But rather others should be able to compete to deliver that last mile to doctors, to insurance companies, to anybody else. That’s a powerful concept because it puts in place a nice rule the road for what’s been a gray area about economics. As we move to an API based, uh, uh, interoperability, market polls,

Bill Russell: 06:40 great stuff from Aneesh. I really appreciate his, uh, uh, you know, his leadership in this area and his energy, quite frankly. I mean, every time I see him, he has a smile on his face and is happy to see me. Uh, and uh, you know, it’s just one of those people you just like to be around. Um, we’re going to stay with HIMSS for our next conversation about emerging technology, really emerging technology in 2019 but, uh, probably a breakout technology for 2020, and that is a voice in conversational technologies. We caught up with Joe Petro, the CTO for nuance, uh, to discuss, uh, an exam room without a keyboard. And, um, they were actually displaying it at the show and I thought it was amazingly creative how they did it. They, uh, they set up a room, it was like an exam room. They had places for you to sit and then they actually did an exam and they showed the technology working with just voice, voice and cameras and it was recording the whole thing.

Bill Russell: 07:36 And, um, you know, this clip is actually a bit of a commercial, um, in, in terms of the conversation when he covers, but you know what, I give him credit for sharing the vision. I think they shared the vision really well with that, uh, with that room at HIMSS. And I think Joe really captured it on this. And I think that vision is something that is exciting for us. The promise. And I think it’s something that, uh, that, you know, it was a theme for this year. I think it’s gonna be a theme for next year. So let’s have a listen

Joe Petro: 08:04 downstairs we have what’s called an experience room. And, uh, the, uh, the name of the product or the solution that we’ve created is called ambient clinical intelligence. And fundamentally it’s, it’s almost a combination of everything that the company has been doing literally over the last 20 years. So, uh, it’s a combination of, um, a hardware device, which basically listens to the patient, um, and the doctor conversation it, uh, and it as it’s actually listening and turns that into a, into a, a transcript and a diarizes the speech, which means it splits it up. So it, it separates out what the patient is saying versus what the physician is saying. And then it starts to derive meaning. And this is where the intelligence part comes in, provides the physician with feedback, uh, as, um, as the conversations goes in real time at the point of care, uh, and, and we’re extracting facts and evidence and we’re creating documentation. So it automatically is generating the documentation and it allows the physician to stay engaged with the patient without turning their back and go into the computer. So it’s super exciting stuff

Bill Russell: 09:09 as you can tell. I’m bullish and excited about, uh, what voice can do in terms of increasing access to care and, uh, and, and delivering a much better experience for the clinicians. Uh, in the coming year, you know, 2019 saw many health systems finally put together a cloud strategy. It’s amazing to me that it took this long, I don’t want to be negative, but it’s, it’s uh, uh, you know, it’s, it’s something that I really thought we’d get to a little earlier than, uh, than 2019 and 2020 with the cloud strategy. Here’s the conversation with ViK Nagjee. Uh, at the time he was the acting CTO for the Cleveland clinic and, uh, he is a consultant with a serious, uh, solutions, computer solutions. And, uh, we talk about a simplicity, simplifying your architecture and, uh, and about cloud and work where it’s going to be used.

Vik Nagjee: 10:00 A lot of the startups that are coming in, they’re cloud first, right? They have to be, they don’t have the ability and capabilities to be able to, you can’t scale up, can scale. Right. Um, they’re, they’re seeing and they’re running into the problems that, that, you know, all of us, both of us for sure have told them that they would, they would run into, which is a big burly sort of, everything is in within my four walls, healthcare organization with a lot of data and data all over the place. Right. Um, and so how do you actually connect the two, uh, very poorly or, or very expensively, right? Then you have organizations like Google, I don’t know if you’ve walked around and seen their booth. The Google cloud, the GC people is massive. It’s about half the size of the Epic booth, which is saying something.

Vik Nagjee: 10:42 Oh, wow. Uh, and so GCP has made a big, huge investment in healthcare. So what they’re trying to do is they’re trying to fund, uh, healthcare organizations to try to get some of their data into GCP so they can take advantage of some of these machine learning algorithms and so on, so forth. But for the most part, we’re still seeing folks trying to cobble stuff together and say, okay, how can I actually take advantage of the cloud? What I really feel we’re ready to do now is working with partners like VMware, Citrix that have been in healthcare and get healthcare for a very long time and deal with all the peripherals and deal with all the stuff that you have to deal with in a healthcare environment. Working together with them to take this whole hybrid approach, right that says I have stuff on premises. How can I actually start to migrate some of these things to the cloud? The things that make sense for example, and still have a single pane of glass. That’s the most important. Again, operational simplicity. We talked about that, you know, the hyperscalers don’t have 17 dashboards and 27 widgets that they have to deal with. They had one. That’s where we need to go. And even automated workloads, movement route, you know, cloud in and out. Exactly.

Bill Russell: 11:47 Uh, you know, I, I think 2020, we are going to see a lot more strategic application of cloud in healthcare. The uh, you know, top 10 list, top 10 themes, of course security comes up, right? Uh, I think security this year though has finally gotten elevated to the, uh, to the level of conversation, to the point of conversation that it should have within healthcare a long time ago, which is, uh, it’s at the board level. It’s at the board level. Uh, it’s at the executive level. People are talking about it. Uh, it’s good that we’re talking about it. It’s good that it’s getting funded. Uh, we caught up with, uh, Michael Hamilton, the founder and chief information security officer, uh, for Seattle security who discusses a points of vulnerability within healthcare. Have a listen,

Michael Hamilit: 12:33 how are we getting in? I mean, the easiest is through people, right? Right. Absolutely. It’s, you know, fooling somebody is a, a, a time honored tradition. And, uh, if I can get you to give me your password so that I can just March into your network, maybe implant some kind of malware that’s uh, you know, put it on your computer. Cause now I have access to it. Um, and you know, uh, start a ransomware event or something like that, uh, in order to extort the hospital. It is, but I would make a distinction here because there is a difference between, um, a targeted attack and actual attack where somebody did some research and they penetrated your organization on purpose with the intent to steal records or to extort you versus somebody visited a website today that was bad when yesterday it was okay. That is the background noise of the internet and tripping over the background noise of the internet isn’t personal.

Michael Hamilit: 13:32 It’s not targeted. It wasn’t meant for you. Um, and, and there is a difference there, but yes, that is actually a, another way that’s fairly prevalent is a, it’s called, you know, just a drive by attack. You, you hit a website. Now there are times when, um, uh, there are websites that are known to be frequented by a certain sector or another. You know, I’ll, I’ll, I’ll just pick one out of the air. Uh, uh, you know, the Becker’s hospital site, I know the kind of people that visit that site. And so if I can compromise that site so that the visitors then are compromised with whatever malware I throw at them, I’m pretty sure I’ve gotten people in hospitals, uh, that’s called a watering hole attack. So that’s out there too. But you know, I think it’s, um, good to distinguish because the motivation of the threat actor, um, is something that we need to keep in mind here when we’re talking about risk and, and just let me,

Bill Russell: 14:26 yeah, Michael was a fun guest. I really appreciate how he takes these really a lot of times these difficult concepts and makes them really a digestible and easy to understand. I think that’s something we will need to continue to do as health it going into the new year is making a security something, uh, a narrative that, that people can grasp on to understand where they’re going to, uh, uh, where, what part they play and how they’re going to be a part of, uh, making the health system more secure. Uh, 2019 saw a, uh, uh, an interesting article got released by a fortune magazine death by a thousand clicks where the electronic health record went wrong. Uh, I thought that was interesting for a couple of reasons. One is it, it elevated the conversation to the general public. Uh, it’s not a conversation that we weren’t familiar with, but it, it’s getting out there to the general public.

Bill Russell: 15:18 We heard a lot of, uh, I’m talking about this in this sense in that, uh, you know, the, the, the theme here is, uh, really EHR optimization improvement. Uh, it, it fell into the category of clinician burnout a lot of time came back to this technology, um, frustration, uh, those kinds of things. So I, I, I’m lumping them all in there and I’m going to take a little bit of a positive approach here. We sat down with Taylor Davis, the, uh, from the arch collaborative and class put together the arch collaborative to really do research on EHR implementations and what subsystems do well and what some other systems may skip and not do well. And, uh, you know, they have looked at hundreds of implementations. They’ve, they have some great insights as to what’s working and what’s not. Have a listen to this clip

Taylor Davis: 16:07 in order to not feel stupid, I need to be a master around the EHR. It’s a core piece. And then there’s, there’s a lot of studies. Stanford did a study, uh, showing that that a majority of the time of my patient engagement is actually spent in the EHR. So the EHR is becoming something that I spend a half or more of my time in as a clinician or a physician depending on my specialty. And, uh, and so if you’re not spending half of your time in a tool and you don’t know the tool very well, you’re going to hate your life. But the, the flip side of it is, is that organizations that do at least six to 10 hours of training for new positions and three to four hours of training a year on the newest functionality. But even more than that, they have great trainers.

Taylor Davis: 16:51 So Deaconess health system, uh, they, their traders can’t get hired until they can teach their it and informatics leadership how something really cool, like how to barbecues, you know, and, or how to cross stitch or they have to be engaging and interesting, right? And, uh, they have to be able to capture your heart. So, so first, in order to not feel stupid, you have to create mastery. And we all know what a great teacher looks like. We’ve all had those in college, in high school and, and uh, um, and so you need to have those in places in organization. The second piece is, is this is kind of one size fits all. This isn’t for me. And, and I, I present a lot out in and this is one of my favorite things to do and, and, and steal it from me cause it works really well and it communicates things really well.

Taylor Davis: 17:35 But, but I always say, Hey, especially if I have a group of physicians in the room, I say, what is the what? Uh, technology works the very best for you. And so, and, and, and I always see 10 people pull out their cell phones and hold them up, right? So I walk over to one of the physicians. I’ve done this a bunch of times, I walk over to one of the physicians, I say, can I see your cell phone? They pulled out the hand. It’s me. Can I say, can you unlock it for me? Then they get nervous and it’s great. And uh, um, and, and so then they unlock it. And I say, okay, this, this iPhone right here, mine is not an iPhone, but, but it always is an iPhone. If it’s a physician, and I say this iPhone right here, uh, you say is the most usable piece of technology in your life. Yes. What would you grade this? iPhone. Oh, I’d give it an a minus. It’s super usable. Okay, great. I’m now going to take your phone. I’m gonna wipe out all of your personal preferences. I’m not going to delete anything. So all of your pictures, your emails, everything’s going to be here, but I’m just going to put your apps in alphabetical order and your last screen is going to be default and all that sort of stuff. It’s just going to all be default.

Bill Russell: 18:29 Does, does the person tackle you to make sure you don’t do it?

Taylor Davis: 18:33 But that’s the point right, is you want to see those personalizations are like sacred to you, right? They matter a lot and you hate getting a new phone. You have to go and put them back in. And I never, I never of course erase it, but then I, then I turned to him and I said, okay, let’s say that I actually did that. W what is, how would you grade your phone for usability? Now they say C minus D plus, right. And then I, and then we say, look, you lose your phone from a C minus or a D plus to an a minus because of the effort that you put into it to just set it up to make it work. Well for you. The same is true for the EHR, but, but bill, I don’t know if I said this out at Chime, but guess what percentage of physicians to taking the time to set up their, their EHR, it’s less than 40%. And uh, and so of course they’re walking around, they’re all walking around saying, I can be stuck with C minus and D plus technology. and we go, Oh my gosh, it over 95% of organizations, those who’ve taken the time to personalize their environment are dramatically more satisfied than those who haven’t. And it is a group in the organization where that’s not true. They have a really problematic EHR and a, so you need to look at the technology itself.

Bill Russell: 19:43 Yeah, great. Work by class in this area. I look forward to more progress in the next year. Uh, if you haven’t watched this episode, it’s, it’s really worth the digging it up, uh, on the, uh, on the podcast or, uh, on the YouTube site. Uh, uh, you know, Taylor does a great job in, uh, in breaking this down for us. Uh, gender diversity as part of a larger diversity problem that exists within health. It, um, was a primary theme this year, you know, specifically women in healthcare. It, uh, and especially leadership roles was something that was discussed on several occasions. Uh, we caught up with Carolyn Magill, the CEO of Aetion, uh, at the health conference in Vegas and she shared a pragmatic, pragmatic approach to, to really addressing this challenge.

Carolyn Magill: 20:29 So I think we covered multiple, I think that taking the parity pledge is a good place to start. So making your commitment known. I think leading by example is a second. And I think making it clear to your recruiters that this isn’t just a nice to have but it’s actually critical to your relationship with them. It’s a requirement is also quite

Bill Russell: 20:50 have we created the, uh, frameworks, the mentoring frameworks to help, um, to help. So I know that as, as a, as a male leader, I had a ton of different mentors frame, uh, just things that helped me to get to the next step. Does that same thing exists for women

Carolyn Magill: 21:12 to varying degrees? I think it depends on the company. And actually that would’ve been the fourth thing that I’d mentioned is that it’s not just about recruiting in the right women as an example. It’s about giving them the support that they need to progress. And as we think about leaders in the organization, we don’t just always want to hire from the outside. We would love to promote people from within as well and have that balance. And so providing mentoring relationships and support. And for us it’s not just about the fact that you have a mentoring program as an example, but it’s about the substance. So how are you counseling these women as an example to advocate for themselves? Or how are you ensuring that you’re giving them the opportunity to get exposure to a new area of the business or to take on additional accountability for something that those are the ways that they start to get the skills that make them qualified for the next level of promotion. And so if we don’t think about that from the time they’re an analyst or more junior roles in the company, then they might never progress to where they have a significant leadership role.

Bill Russell: 22:15 You know, I, I really appreciate our guests helping us to understand the challenge and giving us really practical ways to to make progress in 2020 we’ll get back to our show in just a minute. As you know, health catalyst is a new sponsor for our show and a company. I’m really excited to talk about in the digital age, Cloud computing is an essential part of an effective healthcare and precision medicine strategy and we’ve talked about it many times on the podcast, but healthcare organizations themselves are still facing huge challenges in migrating to the cloud. Currently only 8% of EHR data needed for precision medicine and population health is being effectively captured and used. That’s 8% one of the things I like about health catalyst is that they are committed to making healthcare more effective through freely sharing what they’ve learned over the years. They published a free ebook on how to accelerate the use of data in the delivery of healthcare and precision medicine. You can get that ebook by visiting this week, health.com/health catalyst. And, uh, you know, this is a great opportunity to learn how a data platform brings healthcare organizations the benefits of a more flexible computing infrastructure in the cloud. I want to give a special thanks to health catalyst for investing in our show and more specifically for investing in developing the next generation of health leaders. Now, back to our show.

Bill Russell: 23:38 You know, if there’s one person we talked about more than anybody else this year, it’s probably CMS, administrator Seema Verma. Um, they were active this year. They, they, they just did a lot of things. They were a highly visible, a lot of articles, a lot of appearances. I saw health conference and, and others. Um, and I’ve reached out to Seema Verma to have her on the show. I, I, I, you know, I would love to, uh, to have her on the show to ask a couple of questions around the direction of where they’re going. But I have not had any success in doing that. So if any of you have access to, to a administrator Vermm and can tap her on the shoulder and say, Hey, there’s this great podcast, you should really go on and talk to bill. Um, that would be fantastic. I’d appreciate that.

Bill Russell: 24:23 Um, you know, what CMS is really trying to do is to make a healthcare into a true market. Uh, you know, data liquidity is about making it into a market, uh, price transparency about making it into a market. And, uh, you know, I was able to sit down with a colleague of, uh, Seema Verma and that’s dr Don Rucker, the national coordinator for health information technology, uh, for the, uh, ONC and uh, and ask him about the federal initiatives and, and, and, you know, what were the goals and the aims of those federal initiatives. And here’s a clip with Don and I apologize in advance. I didn’t have my camera at the health 2.0 conference. And, uh, so you’re going to be looking at shots of DC in the background. As you hear Don and I talk about what it’s going to take for healthcare to become a true market.

Don Rucker: 25:10 Well, we’re really talking about is does the patient have a right to get their data right? All the people who want to protect the patient, pretty much all of them seem to have huge economic interests and having no transparency on their business models. It should be the patient’s choice. If you don’t want to put your data at risk, you don’t have to download an app and you’re exactly the way you are today, but it’s the patient who should choose that. Not um, you know, some paternalistic self interested, you know, provider organization.

Bill Russell: 25:44 Right. And uh, you know, we could close there except I want to do an assignment Sinek on you. So we became, we begin with why and the why. So what does, what does healthcare look like once we let, let’s assume 21st century cures we were publishing, you know, prices people could see and have we create, will we create a market that, where the market actually works in healthcare?

Don Rucker: 26:10 Will we or is it possible? Is it to build a market where people can look and say, Hey, this provider’s good. There’s a better cost. Yeah. I think. Yes, it’s absolutely, it is. Absolutely. And equivalently a goal. Um, it’s the central goal in fact is to put the consumer back in charge. Consumers are in charge when there’s a free market, nobody tells you what kind of car to buy, right? There’s a free market and you pick what car you want. You don’t wanna junk or beat up. We’re here in Silicon Valley. People seem to have a lot of money and drive fancy cars, whatever. Um, the, what we’re trying to do here is by having information empower consumers to do that. Now clearly we’re in a funny kind of world where, um, we have a lot of third parties buying our healthcare, whether it’s the federal government through Medicare or Medicaid, whether it’s employers, and so that if a third party is buying it, it’s sort of taken away from us.

Don Rucker: 27:19 It’s worth noting, however, that increasingly because of the costs, the more and more of these costs are actually being shifted to the public. So roughly, roughly half the spend for people who are covered by private payers is born by the patients directly, not via the insurer. Of course economically they bear the entire cost cause that’s coming out of their paycheck in that world. There’s going to be a lot more shopping. We’re already starting to see that and add a whole bunch of edge cases and it is going to happen more and more and more. Um, frankly in some of the Medicare world, you know, there’s starting to be cost shifting copays. Um, and you know, Medicare beneficiaries have a number of out of pocket costs that ultimately they’re responsible for. So I think the combination of modern information technology and folks who are at economic risk is, is going to power that even, even if we don’t really make any fundamental legislative changes.

Bill Russell: 28:32 Yeah. The, the rules that the federal government are coming out with was definitely a major theme for this past year. Uh, you know, our final three themes can sometimes sound like buzzwords and I, and, and that’s probably because in the hands of the wrong people, they are buzzwords. But in the hands of the right people, uh, you know, it, it elicits really, you know, wonder and excitement to think about what is possible, uh, within healthcare. And, uh, you know, the first major theme is innovation. And you know, I had a lot of conversations about innovation this year, but the, the, the one I seem to be quoting the most, uh, as I talk to clients and I talked to others is a conversation I had with Nancy Ham, the CEO of web PT and her insight got me to be, it got me thinking and it, I’ve had several really good conversations about it since then. So I just wanted to share that, uh, this piece with you and uh, as, as something to think about as we’re talking about innovation,

Nancy Ham: 29:36 I have started saying lately that healthcare does not have an innovation problem with, we have just a straight up adoption problem. And so there are plenty of great solutions that have demonstrated in the pilot they can work. The problem is startups focused on their technology and they don’t focus on sales and distribution. So it starts with what is your go to market model? And I can’t believe how many CEOs of digital health startups I asked that question. It’s not a very good answer. They’re all over the place. They’re trying to go multichannel. If a small company, you cannot go provider and payer out of the box and you can’t just go payer. Well which payer? Medicare advantage managed Medicaid commercial like laser focus on your go to market is what I see as completely lacking. There’s also the sad fact, we’ve trained the industry to be a bad buyer.

Nancy Ham: 30:33 Uh, somebody said that, you know, payers have more pilots than American airlines and I just love that. But it is so sadly true when we’ve been willing for decades to do free pilots, to do cheap pilots. You know, other software companies don’t act like that. If I want to buy Salesforce, Salesforce does not come over and offer me a free pilot. They offer me a very expensive contract. And so I don’t know why we trained our buyers to be dapper. It’s really bad form and people need to quit doing that. It’s really not helpful. Um, the other thing is you have to be brutal on your ROI. I don’t care how pretty it is, I don’t care how cool it is. Show me ROI and then you can make the product better. The last thing, people spend way too much money. You know, we’ve been through this arc of time where it was easy to get money.

Nancy Ham: 31:26 I actually think that’s bad for a company. A web PT only ever raised $4 million into this company and one of our eight core values is Masa Manos do more with less. And if you are ruthless about making it on a little money as possible, that tyranny will force you to make better decisions. It will force you to get into market earlier. It will force you to be more focused on what your customer’s saying. It’ll force you to me more focused on ROI. So, um, I think people have too much money and I don’t think it’s good.

Bill Russell: 31:58 That’s interesting, isn’t it? I mean, do we have an innovation problem or do we have an adoption and implementation problem? I, it’s, it’s an interesting conversation. Uh, you know, the second one that could sometimes be a buzzword and sometimes a, uh, exciting thing is digital. In fact, a lot of times when I hear people talk about digital, I’m reminded of a Princess Bride Inigo Montoya, you know, you keep using that word. I don’t think it means what you think it means. Um, but, uh, you know, I think one system really does have a good idea of what it means. And that’s banner health. And we sat down with Jeff Johnson to discuss, uh, you know, what they’re doing in this space. And I, you know, I learned a ton from, uh, from sitting down with Jeff and I think it’s some of the things they’re doing. So have a listen.

Bill Russell: 32:42 So Sophia is your, your digital consumer persona. Yeah.

Jeff Johnson: 32:49 Did I say Sophia? Cause I, it’s such a habit here that if I say it, I apologize for saying it without telling you who she is. Uh, yeah, you did say it. so elaborate at the library on your persona. Yeah. So this, this is really, uh, I think something that’s really worked really well and this is, this is the, you know, all credit to our chief marketing officer, Alex Morehouse, Sona, uh, named Sophia. And we have, you know, we have multiples personas that we might use in product development to represent different, um, you know, segmentation. What Sophia is, is a way to take this, you know, this, this idea, this, this value that we have that we’re customer obsessed and this mission statement that we have that we’re going to make life easier and make healthcare easier.

Jeff Johnson: 33:35 So life can be better to really start to translate that into something tangible that every employee in this organization can rally rap. So it became the face of that. And she’s a real person. Um, she shows up at a leadership events, we have videos with her. Uh, we have cardboard cutouts of Sophia that people take selfies with and our hospitals. So every employee rallies around this persona of Sophia and they think about what they’re doing in terms of, as this impacts of ESL kind of cool. It’s really helped and digital and all of the spaces, I’m sorry, she’s actually a real like person who’s, who’s, who receives care at your facility. No, I mean she’s a, she’s a an actress. I should stay for purposes of pictures of her and those kinds of things. But you know, he needs the real face. Yeah. Yeah. So human being that people, people know, like if you saw her and people have seen, or if you see her in the grocery store, you would say, Oh, that’s Banner’s Sophia.

Jeff Johnson: 34:37 Even though that’s not her real name.

Bill Russell: 34:38 Right. But what that ends up doing is, uh, personifying the people we already know, the people we work with, the people in our community, people who stop us at dinner parties and say, Oh, you work for banner. You know, what would be great if you guys did this. So she sort of personifies that voice of the consumer saying, Hey, this is how I want to sort of interact with healthcare. Can you guys do this for us?

Jeff Johnson: 35:03 Exactly. And uh, you know, yesterday was interesting. I did a walkthrough almost all day with a big consumer tech company. I won’t mention the name, I don’t know if they want me to, but you’d know who they are. Um, and w they came out to explore some things that we could do together and health. And so we walked through our cancer center. We walked through an emergency room, we walked to an urgent care center. At the end of the day they said, wow, never been in a hospital system where everybody’s cohesively talked about either Sophia specifically or knowing, talked about the customer as the very first part of the interaction. It would. So, so it’s worked really well to help, you know, do that translation of the, of the mission to something tangible.

Bill Russell: 35:46 Like I said, I, I get excited when, uh, when the right people talk about innovation, I get excited about the potential within healthcare. Uh, finally, if you’re wondering, this list is in no particular order. Uh, but the final theme we’re going to talk about is data. Uh, you know, it’s, it’s far and away. The word that was used the most within our podcast this year was the, was the word data. You know, what’s happening with healthcare data. How are we using it? Who’s using it? Um, we need more of it for AI and ML. Uh, you know, are we using it without the patient’s consent as in the case of Nightingale or, uh, are we using it to advance medicine as in the case of Mayo and you know, they both go to Google and you have to really different responses to it. Um, you know, we sat down with several people who live in this space.

Bill Russell: 36:33 Uh, these people are so smart. I, I, I really could’ve pulled up any one of them, uh, any one of these clips. Uh, but I’m going to leave you with a little bit of a warning on this since I think it’s hitting that frenzy pace where everyone’s going to start rushing at these data projects. And, um, I had a really good conversation with Ann Weiler and Mike Van Snellenberg from Wellpepper on the topic of data bias and as usual and delivers a succinct response, which helped me to really see the problem more clearly. And I wanted to share that with you. How does bias presented itself? I assume it presents itself through the data. And then what are we doing about bias? How do we, how do we prevent bias?

Anne Weiler: 37:17 Uh, I mean, Mike point pointed this out, like the, the EMR data is biased because it’s biased towards billing for the most part. And you know, unfortunately a lot of the data is, it’s not clean. You know, if there’s, you’ve seen the, the burdens of documentation stuff gets copied and paste and stuff. It’s like, you know, we’re going to, we know that this, you know, this billing code applies and the patient is sort of has this, but like the number of times, I’m sure you’ve count this as a patient where you know, someone is reading something back to you and saying, is this correct? And you’re like, no, you know, the one that always gets me this, when they read the medication list, I’m like, are you still taking them? Oxacillin well, of course not. You know, it’s a seven day course. So, you know, the data is missing a lot of information.

Anne Weiler: 38:07 Um, it’s missing what happened really with the patient. It’s missing what’s happening with the patient. And their daily life, which is those, the activities of daily living are the things that really affects your health. It may also be missing the opinions of the full care team. So you know who hit, who has actually done the documentation in the EMR. And you know, I was thinking back, you know, we don’t know how it does it, but it doesn’t think about like when you, you see doctors, you know, especially new residents are told if you see, if, you know, if a nurse thinks something is wrong, believe that nurse. So you know, is that, you know, that hunch that a nurse had that a patient is about to code or something like that. Is that in there too? So what is the, when we’re looking at, you know, we’ll look at patient when we’re looking at patient data, is it the full spectrum of what’s happened happening with that patient?

Bill Russell: 39:00 Yeah, these are just some of the themes for this year. Gosh, there are so many great clips. We really could, uh, it wouldn’t be hard to do a two hour episode and, uh, potentially just do a year in review kind of thing. Uh, but this will have to do for now and, uh, you know, don’t forget, next week we’re going to do the countdown of the top 10 most listened to podcasts from this past year. This show is production of This Week ine Health It for more great content. Check out our website this week, health.com or the YouTube channel as well. Special thanks to our sponsors, VMware and health lyrics for choosing to invest in developing the next generation of health leaders. Thanks for listening. That’s all for now.