Bill Russell:                   00:08                welcome to this week in health it news where we looking at as many stories as we can in 20 minutes or less, that's going to impact healthcare and health it. It's Tuesday news day and here's what we have on tap. Inter Mountain is tapping 500,000 patients for genetic database, one in six er visits or hospital stays, triggers a surprise bill and Congress is going to take a look at that. Uh, also in the government, FCC is looking to approve 100 million in new funding for telehealth to expand the use of telehealth. And we have a bunch of uh, cloud computing stories and I'm looking forward to talking about that. My name is Bill Russell, recovering healthcare CIO and creator of this week in health it a set of podcasts and videos dedicated to developing the next generation of health it leaders. This podcast is brought to you by health lyrics.

Bill Russell:                   00:54                Every health system needs to do more with less. Let's talk, visit HealthLyrics.com to schedule your free consultation, want to support the fastest growing podcasts and the health it space. Here are five easy ways you can do that. Number one, share with peer a follow our social accounts, linkedin, Twitter, youtube, interact with and repost their social media content. Uh, you could also send me feedback questions, guests recommendations, or new storage. You want me to take a look at [email protected] or subscribe to our newsletter on the website. So let's get to the news. Inner Mountain healthcare seeking 500,000 patients for genetic database, unmatched in scale and scope. Erin Alberty, uh, from what source of Salt Lake City Tribune. So she starts with a story, Floyd Hatch’s little brother was just 23 years old and seemingly healthy when his heart abruptly stopped and he dropped dead while playing football with a friend.

Bill Russell:                   01:49                10 years later, Hatch said his sister 47 collapsed and died. Hatch had run 41 marathons. When at age 64, his heart began to fail him. The culprit was plainly not lifestyle. Hatch had a dangerous genetic mutation that affects of protein in the walls of his heart. Further testing showed his 28 year old daughter, Courtney had it as well. So, uh, this just drives home the need for a genetic testing genetic databases to be more proactive, uh, with healthcare. Uh, here's a quote from a actually pretty short quote. This is the Marc Harrison Ceo of inter mountain. This has the potential to change the way we think of disease. Uh, the article goes on to say, uh, they're seeking 500,000 patients who are going to provide two vials of blood each for genome mapping to study the links between people's genes and their heart on scales. Doctor say, hasn't been done before.

Bill Russell:                   02:41                Uh, let's see. We will take the whole genome sequence and combine it with clinical outcomes to generate a largest of its kind database that, that has ever been configured says physician, Lincoln Nadauld, Intermountain's chief of precision health. Uh, there are other large genetic databases. He cites some of those. Uh, what makes this one different is the health system also is the participants healthcare provider that enables the researchers to track patient's medical histories and outcomes in conjunction with genetic information they provide to identify genetic, a genetic determinants of health. Thank you. Mandela said, so, uh, you know, so what's the, so what of this story? First of all, uh, Kudos to Inter Mountain. I love this, uh, exciting, uh, to knit together research and the practice of medicine, uh, in more closely and to get a proactive in the way that we do this. It's just great work from inner mountain.

Bill Russell:                   03:38                Um, you know, this is, this is healthcare is changing rapidly right before our eyes from reactive to proactive. This is one of those steps from a experiential that datadriven um, just, you know, we used to rely on the gray hair of the physician and much more of it as being datadriven and will continue to be. So, um, we'll also continue to, to, uh, transition from, from episodic to more of health as a service. For those of us who want it, we're going to be able to have a lot of sensors and be connected directly to clinicians who are also giving us proactive information on, um, uh, based on our genome, based on our, a sensor data based on other things. Uh, so I think we're going to just continue to see this from a health it perspective. Uh, this, this is knitting together an awful lot of different technologies, huge datasets, by the way, huge datasets.

Bill Russell:                   04:33                huge, data requirements, bandwidth requirements are going to be significant. The, uh, uh, so this from a technology perspective is no small task. Uh, the good news is I don't think it represents a lot of new technologies, just a way of knitting together a lot of technologies that are already in place. So let's move next story. So our next story is a one in six er visits or hospital stays, triggers a surprise bill. And this is Ricardo Alonson-Zaldivar wow. What a great name. Uh, AP news and, uh, you know, the fact that this is AP news, the fact that it's a getting that kind of coverage, uh, I think is going to be the story that I'm going to focus on. So the report from a nonpartisan Kaiser Family Foundation finds that millions of people with what's considered solid coverage from large employers are nonetheless exposed to out of network charges that can amount to thousands of dollars.

Bill Russell:                   05:30                So this has caught the attention of Congress. And, uh, next Wednesday, the Senate health education, Labor and Pensions Committee, uh, is set to vote on a bipartisan legislation that would limit what patients can be charged in their in network deductibles and copays. Uh, tied it to their in network deductibles and copays. The bills from senators Lamar Alexander Republican from Tennessee and Patty Murray, Democrat from Washington would require insurers to pay out of network doctors in hospitals, the median or mid point rate paid to in network providers. The House Energy and Commerce Committee is working on similar legislation. President Trump has said he wants to sign the bill. So, um, you know, this is one way to address the problem. The other way to address the problem is through, uh, setting up, uh, uh, arbitration, which has been done in New York and some other, uh, some other locations. This is, uh, considered a less bureaucratic way of doing it, just tying it to a, the median or the mid point, uh, that way you won't have to build this massive infrastructure that does arbitration on these kinds of bills.

Bill Russell:                   06:39                Um, but what I want to really focus in on this story is that again, I just keep coming back to election cycle. Election year. These stories are going to be a front and center, um, congressional leaders and people who are running for office are going to be going out of their way to, uh, try to address this issue. Not, not, not, not in a bad way, not a bad thing. But as these stories get s escalated healthcare, um, healthcare leaders, healthcare providers are going to be, uh, called to talk about what they're doing in this area. Uh, and, and my recommendation around this, this is just get in front of it. Um, you know, be able to answer the question of what is your strategy on price transparency? What's your strategy on helping people to navigate the financing of healthcare? And, uh, you know, you're just going to want to get in front of it.

Bill Russell:                   07:30                I mean, the best case scenario is to have a plan or a strategy that the next is to have actual progress being made towards that plan. And the best case scenario would be to have, um, you know, solutions in place with testimonials from, uh, from your patients. So I just think you're gonna want to get in front of this, at least have your story straight. At least have something that you are heading in this direction. Congress is gonna do what they're gonna do. You can't impact that. But, uh, it's good to have these, uh, programs in place for the communities that we serve. Okay. Let's talk cloud. There's a lot to talk about in terms of cloud. I'm going to pull a three stories out here. I'll go through them very rapidly. I'm not going to hit on all of them. Uh, the first is a two thirds of enterprises disappointed by cloud migration journey.

Bill Russell:                   08:16                Uh, says Accenture, um, the, uh, source is which 50, which-50 on it's their staff writers. A couple of statistics here based on the survey of 200 senior it professionals from large businesses worldwide, not necessarily just healthcare, the report, uh, it's called perspectives on cloud outcomes expectation versus reality suggests that cloud migration journey is more complex than anticipated for innovation and efficiency. While the vast majority of companies, uh, cited achieving some level of their desire to outcomes, roughly 90% of those, only about one third of the companies on average reported that they have fully achieved, uh, their expected outcomes across four categories, cost, speed, business enablement, and service levels. And in those, the rough, uh, uh, percentages, roughly about 30 to 35% have achieved their goals in those areas. Uh, the barrier for realizing the benefits of cloud that survey respondents noted most frequently when asked to identify the top three were security and compliance.

Bill Russell:                   09:20                Risk of was cited by 65% of the respondents. Complexity of the business and organizational change, 55% and a legacy infrastructure and or application sprawl, 43% and lack of cloud skills in organization within the organization, about 42, uh, percent. Uh, one other thing of no companies employing private clouds tend to lag their counterparts employing public cloud or hybrid cloud models when it comes to fully achieving expected outcomes. 20, Eh, 28% to 42%, roughly. So, uh, you know, so what's so what on this? Um, I, I think the reason people are struggling, it's because cloud is not a monolithic technology. It's not like I, you know, we're going to adopt Microsoft office. Cloud is a set of technologies. So there's platforms, there's applications or infrastructure, there's native cloud, and each one of those has different characteristics and can be applied differently within, within healthcare. Uh, definitely. But within business, just in general, um, you know, you're, if you're going to do applications as a service, if you're going to do workday, that's one way of going about it.

Bill Russell:                   10:29                If you're going to do infrastructure, say an AWS or um, or even an Azure, which Azure is more of a platform, but, uh, as, as AWS, I mean they have aspects of infrastructure and platform across the board. Um, they are different. They're very different. Uh, the other thing I would say is lift and shift to the cloud will cost you more money, period. You have to change the way you're doing things from how you're doing them today to realize the benefits there. There's no way of getting around it. You shouldn't need, um, like you'll only need like 15% of the people you need today. If you don't have a data center, you don't have a raised floor, you don't have to put a servers into racks, you don't have to do, uh, you know, tapes and those kinds of things for backups. We'll just radically changed the way you're doing things.

Bill Russell:                   11:18                If you don't change the way you're doing things. What organizations are finding is cloud costs more just flat out does. Um, if you're going to do it the same way you're doing it today, I have to say the third thing is your biggest obstacle to adoption isn't the business. The business is going to say, Hey, I use this cloud at home. I use the cloud for email, I use the cloud for storage, I share my photos, I use the cloud all the time. It's really kind of cool. You're not going to get a lot of pushback from the business. You're going to get it from the it staff because it's a dramatic change for it. You have to do your change management within the it staff first and foremost before you move out into the organization. And I think what you're gonna find within the organization is not much pushback.

Bill Russell:                   12:00                So a couple of stories sort of back this up. Hunterdon Healthcare migrates to Google cloud g suite and saves one point $3 million. This is bill. So wiki healthcare it news, you know, uh, I'm not going to go through the story. So a Hunterdon of smaller health system. Uh, they, uh, decided to do the migration. A department by department, not necessarily in a big bang approach. Uh, again, highly recommend that, um, you know, things like office did not go away completely. You're not going to get a excel out of finance department. They've written too many macros. You need Vba. Uh, there's a whole bunch of other things that are going on. They just know excel, it's going to stay there. And there's a handful of other areas where they left a office in place. Um, they engaged an outside partner because they did not have the skills internally and a, and they realize those savings over three years.

Bill Russell:                   12:50                So you're talking about a really small health system saving $1.3 million. That's significant. I share that story just to say it can be done. And the story is recent. It's just picked it up this past week. So, uh, it can be done and it is getting done. Another case where it's getting done a cloud summit, a Geek Wire's cloud summit, 2019 business sessions. I pulled up video, Bj moore talks and Bj Moore's the CIO that just came from Microsoft to providence health and services or providence Saint Joseph Health in, uh, in, uh, Washington state 51 hospitals across the the entire west coast, one of the largest providers if not the largest provider on the west coast. And BJ moore. It gave about a 30 minute talk, really worth listening to. So Geek wire search, um, cloud summit, 2019 business sessions, a great talk from him. He shares a couple of really cool stories, uh, around migrating to the cloud.

Bill Russell:                   13:50                And uh, it just shares how it can be done and um, why it's, uh, not as hard as what your people are telling you. And uh, finally I have another story. A former apple CEO, John Sculley, predicts how technology will change healthcare. Uh, this from the Mac Institute for Innovation Management From Penn University, uh, where he was a couple of weeks a couple of weeks ago, uh, during the, uh, and I'm just going to share this one quote. So during the decade that I was CEO of Apple, I witnessed the change in the world to how we went from computers being focused on institutions to computers being empowering tools for individuals doing amazing things. And I think this, and he goes on to talk a lot about cloud in this. Uh, it's actually a podcast interview. He goes on to talk a lot about cloud in this and cloud's going to enable a different focus for healthcare. It's not a, it's not going to be as much focused on business to business and business to doctors and institutions to doctors.

Bill Russell:                   14:47                We are going to start to figure out how to go directly to the consumer so much the way that a technology changed, uh, during Scully's time at apple where we were focused, IBM was focused on selling computers to businesses and it was going to change the way business was done. And during that timeframe, we, we, they started selling computers to individuals and it changed, just changed everything. Uh, really, uh, that same thing's happening in health care cloud is one of the biggest enablers there. Cloud is possible and it works. We just need to think about it a little differently and, uh, you know, take the steps we need to take to get there. Next story. So telehealth set for big boost with a $100 million, a new funding from the FCC, speaking in rural Laurel fork, Virginia, Carr who's, over the FCC announced that the new funding is meant to increase access to care to patients and veterans in remote areas such as Appalachia, uh, with advances in telemedicine.

Bill Russell:                   15:57                Health care is no longer limited to the confines of a traditional brick and mortar healthcare facilities said carr and a statement, I think the FTC should support this new trend towards connected care, which is the health care equivalent of moving from blockbuster to Netflix. That's why the FCC will vote to advance my hundred million dollar pilot program. At our July 10th meeting, he added that the program will focus on ensuring that low income Americans and veterans can access this technology particular, particularly in rural communities such as Laurel fork, uh, where the nearest hospital is in a different state. Access to tell health can make lifesaving different differences. So, uh, you know, telehealths still remains one of the most disruptive forces going on in the health care. Uh, we're going to see more visits, shorter visits, no wait times. Uh, we're going to see access to specialists, uh, from afar.

Bill Russell:                   16:51                Uh, I, it just has the opportunity to really transform the landscape. Probably the, probably the most in the near term. Um, and I don't think it's necessarily a bad thing. I'm going to see my doctor more because I'm not going to have to take off from work. I'm not going to have to sit in a, uh, in a sick room, in a waiting room with a whole bunch of sick people so that I can get sick. Um, and I'm going to be able to do it just like I'm doing it right now on this podcast, but I'm going to be sitting across from my doctor. And quite frankly, as we get better at this as a society, uh, I think the consumer's going to start to demand this from healthcare. So a great move from the FCC, FCC, uh, in creating funding for those areas that quite frankly don't have the business models to support taking telehealth out there.

Bill Russell:                   17:39                That is where the government belongs. That is where they help, uh, taking this to places that are not supported by business models. So, and let's do, uh, let's do one more. I, you know, I want to point out just every now and then I see a success story and I think it's worth pointing out a, this is how advocate Aurora health streamlined prior authorizations. This was in revcycleintelligence.com. Jacqueline Lapointe. Uh, so, uh, let me just share a couple of things here. So 91% of physicians in the Ama survey reported that care delays associated with prior authorizations and equal amount and an equal amount. Also said prior authorizations have a significant or somewhat negative impact on clinical outcomes. I've heard the same thing. And working with doctors prior authorizations are a pain and slow things down, frustrated with using phones and fax machines to manage the increasing burden of prior authorizations.

Bill Russell:                   18:34                Harden turned to Advocate Aurora's EHR system. Make sense? Harden is the CFO for Advocate Aurora uh, don't have his first name here. Uh, about three and a half, four years back, we realized that prior authorizations were a problem and we wanted to see if we could try to spend our speed up the process and take advantage of the EHR system we had at the time. We thought what functions are available? One, once our pharmacy does go live on the system, uh, and what do we have available to us. One of the functions we saw was electronic prior authorizations, uh, from their heart and assessed the, a market of technology solutions that could work with the EHR, electronic prior authorization capabilities. After the solutions analysis, the health system decided to implement an automated prior authorization solution from surescripts with the solution providers.

Bill Russell:                   19:26                Uh, trigger an automated prior authorization workflow by prescribing a medication or service that requires payer approval prior to delivery. The solution has a lot of pharmacy benefits management information already built in. So now the typical prior authorization process happens automatically Harden, elaborated. The clinic staff never need to touch about 80 to 85% of the authorizations for our patients. Uh, so what I just like ending the show with this, this, these are the kinds of stories that it organizations need to get out there. Now, I'm sure if I went to advocate Aurora and talked to a lot of people, um, you know, we tell the best side of this story, I'm sure there's some challenges and whatnot, but at the end of the day, when you get 80, 85% of the prior authorizations, uh, not requiring, uh, the clinical staff to do extra work, giving them the ability to go home, these are the kinds of stories we need to be telling and we need to be shouting from the rooftops.

Bill Russell:                   20:22                So, uh, you know, great work tackling this problem with technology, reducing the burden on clinicians so that they can spend time with their family. That's a big win. So that's all for this week. This Friday you're going to want to check it out. We had a great time recording an episode in Philadelphia with Doctor Stephen Klasko CEO for, um, for Jefferson health as well as Nassar Nizami the CIO. A great time, great conversation. Uh, you're gonna want to check that out. Phenomenal episode. So, um, and uh, you know, we, it's kind of funny I've been saying we're quickly approaching our hundredth episode. We're going to do something special. We are planning something special, but here's a little side note. We already did a hundred episodes. Our hundredth episode was last Friday. Uh, I'm a little behind on getting this scheduled. We're going to do something great. I'll let you know when it's going to be.

Bill Russell:                   21:13                You're going to want to mark your calendar once I figured out what we're going to do there. Uh, but, uh, it's going to be fun. And, uh, if you want to hear from someone that, uh, that we haven't talked to on the show, make sure you drop me a line at [email protected] and that's also, this shows the production of this week in health it for more great content you can check out our website at thisweekinhealthit.com or the youtube channel @thisweekinhealthit.com/video thanks for listening. That's all for now.