Bill Russell: 00:01 welcome to this week in health it news where we look at as many stories as we can in 20 minutes or less that will impact health it. It's Tuesday news day and here's what we have on tap. Our lead story for this week is the EHR vendors say onc proposed rules are too broad and would stifle innovation and that's from healthcare it news. We're also going to take a look at uh, some work Andy Slavitt is doing around transforming Medicaid. I think that's very exciting and a really cool story that amongst six total stories for this week is what we're going to try and get through. My name is Bill Russell. Recovering healthcare CIO and creator of this week in health it at set of podcasts and videos dedicated to developing the next generation of health it leaders. This podcast is brought to you by health lyrics. Every health system has one or two projects that aren't going well.

Bill Russell: 00:51 We specialize in turnarounds. Let's talk visit health lyrics.com To schedule your free consultation. Want to support the fastest growing health it podcast. Here are five easy ways you can do that. Uh, first as you share with a peer. Second, follow our social media accounts, linkedin, Twitter and Youtube, interact with us, interact with our social media accounts and repost our content. That would be great. Uh, you could send me feedback questions or a guest recommendations @billatthisweekinhealthit.com. And uh, finally you can subscribe to our newsletter on the website. Let's get to the news. So EHR vendors say ONC proposed rules are too broad and will stifle innovation. Mike Maillard health it news. So let's take a look and get a flavor for this one. The uh, the members of the Hymns Ehr Association support the rules goals, but say that as drafted, it goes beyond Congress's intent for the 21st century cures act and is too loosely defined, has to tight tight timelines and requires too much IP sharing.

Bill Russell: 01:50 So that's the gist of it. Let me give you a little bit more color. The association says it pulled its members, uh, its member companies including allscripts, Cerner, epic, eClinicalWorks, Meditech and many others to get a sense of the development resources that would be needed for vendors to comply with the voluminous proposed rules from the onc. The general consensus is that while some updated functionality or proposals may be straight forward to achieve in a short timeline the proposed 24 month for development testing, training and implementation across all clients is not feasible for the more challenging proposals. So it goes on and talks about language ambiguity. Certain sections of the proposed rulemaking offer room for interpretation such things as uh, the words reasonable as soon as possible near real time. All of those things are vague and need to be clarified. Uh, there's innovation concerns as well.

Bill Russell: 02:42 Ehra said it's a concern that as written, the proposal would discourage innovation by imposing limitations on profit as well as compulsory licensing terms for new intellectual property created through extensive investment in development. The blog posts points out that essentially it requires each developers and others to share their intellectual property with anyone who asks under fair, reasonable, and nondiscriminatory terms. Normally companies choose when and to whom they contribute their technology such as through the standards development process. But a compulsory licensing model means that anyone could ask for in intellectual property and for a reasonable price capped fee, they'd be able to layer their own work over ours or otherwise repurpose it. Um, I'm going to be honest with you here. I, you normally, I do a, so what, so what on this story, um, but what you're going to end up with here is more observations than anything.

Bill Russell: 03:41 Not a potentially a rant. I'm going to try to stay away from that, uh, on this. But, um, so my first observation is there's no other industry on this planet where the software vendor holds as much sway as they do in healthcare. Uh, you know, we don't hear from Erp providers when talking about banking and manufacturing. But somehow within healthcare, anytime we talk about what we're going to do in healthcare, the, the EHR providers are a center stage. They need to step off the stage. It, the, it's the provision of healthcare. The providing of healthcare is something that the health care providers do a in support with other community partners and, um, it's software manufacturer should not be in the middle of this thing. So that's just one concern. Uh, and, and one observation. The second is, you know, the nature of their concern indicates that they have an architecture problem.

Bill Russell: 04:35 Uh, I will agree that the way the solutions architected today, it's probably going to take four years to implement it. It'll take a couple of years to program a bunch of years to test because these are big bang projects. It's not, it's not created on a new and modern, uh, architecture stack. And because it's not, you don't have microservices, you don't have the ability to do incremental changes to the solution over time, that makes it better. You have to do these, these massive projects with and with the number of variations of their code that's out in the market and, uh, things they have to consider. Uh, it's tough. It's going to take them four years. There's no doubt about that. The third thing I will say is that, um, yeah, you know, the sharing of data doesn't require a solution to share their IP stack.

Bill Russell: 05:22 I'm not even sure I understand that argument. Somebody will probably have to educate me a little bit more for me to understand why they're even making that argument. Uh, there's all sorts of solutions on the, uh, on the web that share, you can share data and, uh, you know, I don't have to know slacks underlying Ip to be able to share data in and out of slack. I don't, and slacks, just the easiest example, I mean, salesforce, workday, you name it, there's thousands of solutions. Uh, newer technology stacks, uh, enable the inherently you build out your APIs on top of it with data sharing in mind from the get go, because the Ehrs weren't designed with a data sharing as the core fundamental, uh, design requirement from the get go. Uh, they're architected incorrectly and because they're architected correctly, they think they have to share their intellectual property in order to do that.

Bill Russell: 06:12 That's just not the case. Um, I think the fourth thing, and this, this one is a rant for me is, um, the, the data doesn't belong to the EHR providers to even dictate whether it should be shared. You know, at worst it's owned by the provider or health systems, and it really should be there. Their choice, whether they're going to share it with the patient at best, it belongs to the patient as a, as many shared share. My, uh, my belief in this, uh, including Rod Hochman who the CEO of providence who's on the show and said that very thing, that the patients should own their record. And a, if the patient owns a record and they have access to the record, uh, it's going to spawn this whole new ecosystem of, um, this data ecosystem of, let's just call them, uh, surrogates, people that can help us with our data.

Bill Russell: 07:04 If we get messy data from the providers, we're going to have this data ecosystem where we can go back and get trusted care providers who are going to step into that space and be able to make sense of that data for us. So I think that that whole thing is just being slowed down by these a specious arguments that are out there. And then, uh, you know, finally in terms of slowing down innovation because there's just too much work to do here. Uh, you know, I the, here's my recommendation to the EHR vendors. If they want to jumpstart their projects, they think they should just partner with a company that already has addressed this challenge and there's many of them matters. Innovate, sir. There's heart, there's clear sense a health catalysts, NPH Rx, which is part of HCI. Uh, heck, they could license license, Irish from intersystems.

Bill Russell: 07:48 Uh, there, there's so many players that's already live here and are you live on top of their technology that could really catapult them forward? Um, this having to create it all internally is I think slowing them down for the most part. And, uh, I think there's just some options there. So I, you know, I, I apologize if that sounded like a rant. That's probably enough on the topic. And, uh, let's, uh, let's move on to a better story, I, a more feelgood stories. So, uh, transforming medicated, transforming Medicaid, how Andy Slavitt, Avia and 28 health systems plan to improve care for the underserved patients. I really like this story. Um, mostly because it's a, it, it's addressing a real need within healthcare. So let me give you a little flavor for this. Um, Andy Slavitt says we need to change the way we invest in communities that are underserved.

Bill Russell: 08:41 Um, Slvitt says further testing that the current healthcare system primarily focuses on an invest in commercial populations, quite frankly, white, middle and upper class populations of people that are already pretty healthy and have very few issues, healthcare systems and uh, so enter the group that the bringing together is called MTP. Uh, and I think it stands for Medicaid transformation partners. Uh, it's part of a, an obvious going to be running it for them according to the project leaders throughout the next two years, participating in health systems will be implementing innovative solutions aimed at addressing several critical challenges facing vulnerable populations across the country with a focus on four core four core target areas, behavioral health, women and infant care, substance use disorder and avoidable emergency department visits. Um, let me go on here a little bit. The core goal is to share those experiences and lessons learned with other health systems.

Bill Russell: 09:40 If not, uh, it's not as if we are trying to do something proprietary. Quite the contrary. These 28 systems aren't engaging in a project to create a competitive advantage, but rather to create a better model to test the better model and to get results from a better model and to prove that out and share it more broadly. Slavitt says, uh, the official, uh, the initial focus of phase one of the MTPs work centered on improving linkages from the Ed and other critical parts of the delivery system, namely primary care, behavioral health, specialty care and social services. And finally, what MTP allows you to do is ask the question, what are the 27 other healthcare systems doing about this problem? So I, I love this story. I love this approach. Um, you know, Kudos to a Andy Slavitt, a Avia and the 28 health systems that are doing this.

Bill Russell: 10:38 You know, the so what is, you know, we've got to leverage the great work that's going on on across all these health systems. There is not a lot of money to be made in this space and, but there's still a ton of work to be done. And the a shared collective knowledge and the shared collective work and bringing that together and sharing that, uh, is a, is really great. So they're going to identify solutions. They're going to validate those solutions. They're going to provide a platform for sharing them and hopefully replicate the results across, uh, across many health systems. A fantastic, a fantastic work and a really appreciate, uh, those, uh, organizations and Andy Slavitt and Avia coming together to do that. Uh, next let's take a look at a Wall Street Journal article. So data challenges are halting AI projects. IBM Executive says, and I'm not going to go into too much depth here, I just, I thought it was interesting.

Bill Russell: 11:33 Um, I thought it was just interesting to take a look at. So Ibm Corp Executive, Arvind Krishna said data related challenges or top reason IBM clients have halted and canceled artificial intelligent projects. Uh, Mr Krishna's IBM, senior vice president of cloud and cognitive software said about 80% of the work with an AI project is collecting and preparing data. Some companies aren't prepared for the cost and work associated with that going in. He added a, and so you run out of patients along the way because you spend your first year just collecting and cleansing the data. Said Mr Krishna who was interviewed at the Wall Street Journal's future of everything festival last week as you say, Hey, wait a moment, where's the Ai? I'm not going to, I'm not getting the benefit and you kind of bail on it. So a couple of other things, a report this month, my force research inc found that data quality is one of the biggest AI project challenges.

Bill Russell: 12:32 The uh, you know, I just brought that story out to, uh, just to highlight that a, you know, good data proceeds every everyday to project period. Uh, there are no shortcuts as some have found out and uh, you know, and, and some are much publicized, uh, IBM has taken a black eye here as well. Uh, it starts with good data and if, uh, if you're planning an AI project and machine learning project or if you just planning a straight up analytics project, it starts with good data and a, you need to get started on those projects. Uh, today. If you haven't already and if you, uh, have underfunded them, uh, it may be time to fund them cause data data is the, a single, uh, single most important thing I believe to a transforming healthcare. And I think we're gonna see more and more data projects lead to the transformation of healthcare.

Bill Russell: 13:22 So a, so that's the third story, a real quick and worth taking a look at. Again, that was Wall Street Journal. The uh, let's see. Let's go to um, physicians foundation launches, Hie Fund for physician interoperability. This is from healthcare it news and uh, the, the gist of this is that a nonprofit group is joining with six state Medicaid, our medical societies to incentivize practicing physicians to link their Ehr as to help information exchange financial barriers, preventing buyin to a health information exchange. Just got lower in six states in partnership with the Physicians Foundation, the medical associations and the information networks in those states. Law for funding grants for any physician with an electronic health record that wants to send and receive interoperable patient data. So they go on to say why it matters. The program, which is starting out with about half a million dollars in funding this year, seek to increase physician participation in Hie by covering costs, uh, to a physician practices.

Bill Russell: 14:27 So, um, you know, that's interesting and you know, you and my, so what on this as you, you have to applaud the initiative. Uh, anytime we're sharing data and trying to get it to the point of care, it's great. Uh, I will say that in my experience, in my experiences across metro and rural, uh, kind of settings, uh, it really wasn't the money that was the issue for connecting to the Hie. Um, I think what I heard from the physicians was, uh, they, they didn't value the data that was coming across. It was too messy. It was too hard to digest. Um, the, uh, data wasn't presented in a way that was easy for them to just, uh, bring into their workflow. Um, they didn't want the liability related to having the data. I, again, don't hear me saying that it's that I'm saying that my experience, that these were some of the limitations.

Bill Russell: 15:19 This is what people were telling me, where the barriers to, uh, to connecting into our HIE in the multiple markets that we serve. Uh, money is just one of them. Uh, it's good to get one of them out of the way so we can move on to the others. And so again, I applied this initiative. This is a physician's foundation launches Hie Fund for physician interoperability, healthcare it news. Um, check that out if you're a, if you're interested or looking at HIE work. Uh, let's see. Let's go to a newly merged dignity's Chi health system offers patients home recovery care services. So, um, common spirit health, uh, dignity and Chi mergers called common spirit. A common spirit health has partnered with a company called Contessa to introduce a new home care option, which offers patients a virtual physician visits and remote monitoring among other features. And a talks a little bit about.

Bill Russell: 16:14 So headquartered in Nashville, contessa operates risk based home recovery care models for acute care, post acute care and surgical procedures. As part of these models, a registered nurse conducts in home visits and patients receive access to care coordinator who is available 24 seven patients also get medical education from nurses and access to virtual in home visits from a physician. Additionally, home recovery care includes remote monitoring of vitals, biometrics, and adherence to the care plan for 30 days. But it's a, it goes on. Overall, the goal of home recovery cares to improve patient outcomes. For instance, at Marshall, uh, Marshfield clinic health system in Wisconsin, the use of home recovery care reduced readmission rates by 44% and decrease the mean length of a hospital stay by 35%. And uh, let me just share one quote. Let's see. Our work with contessa will bring recommended intensive outpatient care into the comfort of one's home so that we can improve health outcomes and help enhance the overall health of our communities, which Roth who leads strategic innovation for common spirits said in a statement, finding ways to improve high quality access to care in low cost settings as an essential component of how we must deliver care in the future.

Bill Russell: 17:29 Uh, couldn't agree more with a rich on that. And uh, so, you know, so what's the, so what on this the, so what on this is that this is the new norm. Integrating solutions from outside of the system to provide home care and home care itself is, uh, is the new norm. We're going back to Marcus Welby, but trying to do that in a way that it's not just carrying the bag, but you're carrying a whole tool set, uh, that is giving you access to the entire patient record. It gives you a new set of tools for monitoring on an ongoing basis. And we know that when we drive care into the home setting, that it provides much better outcomes. The data is really your irrefutable on this. Um, the, so what for health it is be ready to integrate these solutions into your environment. There's just an awful lot of them coming down the pike.

Bill Russell: 18:15 We can't build them all out ourselves, nor would we want to. And, uh, this, uh, presents a, a pretty good, um, opportunity for a improving care. Let's see. I have one last story cause I had six that did that one did that one. Medicaid Ehr vendors, a banner health launches, Banner Innovation Group. So, uh, don't really have a lot to say about this other than, um, I could read some of this. So Scott Norling, chief strategy and growth officer, banner health is leading this initiative. Norlands responsibilities encompass strategic planning for merger acquisition and Partnership Development, marketing communications, consumer engagement for growth of four major service lines. Uh, so that's what he's doing. He's in charge of it. Um, it's called banner innovation group. Big. The big has some ambitious goals which include enabling entrepreneurs, helping champion colleague ideas and having accelerated or partnerships that can commercialize great ideas and also create a new avenue for entrepreneurs as well.

Bill Russell: 19:20 So, um, you know, I just pulled that out mostly to the, you know, the, so what on that is that these models are becoming, um, pretty common. So this is just another one of those innovation models and a it, you know, these are exciting. There's many models to choose from. The only wrong thing to do here is to not be associated with an innovation model. If you're too small to have your own innovation model, then you need to find the ones that you're most comfortable in working with and create those partnerships. If you're large enough to have an innovation model and you, you haven't, uh, kicked one off yet, uh, it may be a, it may be time to, uh, to get that going. So, uh, that's probably enough. Six stories in 20 minutes or less. So that's all for this week. This Friday we go deep into blockchain with Charlie Lougheed successful entrepreneur and CEO of Actual, a company that's going to be coming out with some solutions this fall.

Bill Russell: 20:12 I'm looking forward to, uh, that conversation. Uh, you know, we're quickly approaching our hundredth episode, so we're planning something special so that you want to check that out. It'll be in the next three weeks. So you may want to mark your calendar. We also have Eric Yoblanca for, from a Stanford, Jeff Johnson from banner, Andy Crowder from scripts. And we have a special episode coming up with Nassar Nizami Cio, uh, for Jefferson health, with his CEO, Doctor Steven Klasko, uh, in a joint interview, uh, as you've heard on the show before, I've, I've wanted to have a doctor Klasko on for awhile and, uh, uh, Nassar has made that happened and, uh, I'm, I'm excited about it and I hope you're excited about it as well. Uh, if you want to hear from someone that hasn't been on the show, just drop me a line at bill@thisweekinhealthit.com. Uh, and let's see what we can do. This show is a production of this week in health it for more great content. You can check out the website @thisweekinhealthit.com or the youtubechannel @thisweekinhealthit.com/video. Thanks for listening. That's all for now.