Bill Russell: 00:01 welcome to this week in health it news where we are looking 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, Cerner, CEO unveils, next generation cognitive platform in health conference, keynote, Allscripts Northwell. Uh, a bunch of EHR, uh, stories actually this week, Allscripts Northwell, uh, code develop next generation EHR. Second next generation EHR being developed. A Meditech works with Google to host the EHRS to the public cloud intros, iPhone support. So exciting. Uh, news within the EHR front. Uh, we're gonna take a look at the HHS announcements around the stark law changes and uh, not comprehensively but uh, as as much as we can. And, uh, then given enough time, I'm going to talk about the VA shifting, uh, to opt out model for sharing health data. And InterSystems unveils a clean data as a service solution, helping normalize datasets for analytics and ROI.

Bill Russell: 01:06 I have six other stories here, but we'll see what we get to. My name is Bill Russell Recovering healthcare CIO and creator of this week in health. It is set of podcasts and videos dedicated to developing the next generation of health it leaders. This podcast is sponsored by health lyrics. Professional athletes have coaches for every aspect of their life to improve performance. Yet many CEOs and health executives choose to go it alone. Technology has taken center stage in health care. Get a coach in your corner, visit health Lyrics.com To schedule your free consultation. If you're going to the health conference in Vegas at the end of October, you'll want to stop by discussion. We're going to be having that. I'm actually going to be moderating for a VMware on Tuesday, October 29th at 1240 and a it's VM-ware intell Deloitte and others, uh, it's going to be a discussion on the opportunities, challenges, and promise of leveraging multi-cloud environments.

Bill Russell: 01:56 Uh, if you're there, please stop by. I would love to see you. All right, let's get to the news. So Cerner CEO unveils next generation cognitive platform and health conference keynote. This is actually, I pulled this from the Cerner blog. Why not? Um, because I'm going to go back to why I chose the blog to, uh, to do this, but a healthcare, here's some quotes from it. Healthcare will change more in the next five years than it has in the past 30 a Shaffer. The CEO, uh, told the audience of 5,000 clients, innovators and other healthcare industry professionals during the keynote address as we have for the past four decades. Cerner's technology and collaborative programs along with the most respected providers, will lead a wave of disruptive innovation focused on making healthcare better. Great. We're all for it. Let's hear what you're going to do aligning with the conferences theme of now.

Bill Russell: 02:45 Next Schaefer shared enhancements to benefit Cerner clients today. Now then announce next generation health platforms. Next generation seems to be the new buzzword. Uh, maybe the buzz word for 2019 we'll see a code named project Apollo. This initiative brings a more cognitive approach to practicing medicine. Uh, let's see. Leveraging the powerful combination of its healthcare technology with AWS infrastructure. Cerner's new cloud based platform will accelerate the speed, uh, that innovations are integrated by removing manual steps that the, uh, for clients that slow the pro, the pace of adoption. Additionally, Cerner is creating an intelligence ecosystem to innovate the next generation user experience and care delivery algorithms. The future innovations will support caregivers and giving them full focus to delivering high quality patient care support by the power of Cerner's intelligent, uh, platform. Um, once again, I'm going to go back cause I shared this a, the, you know, the signing day announcement, Cerner going with the AWS and going with Amazon.

Bill Russell: 03:54 And, uh, I, I believe that the announcement has a lot of promise. And directionally I like this. This is directly, uh, pretty interesting to Mary. Uh, Amazon's, uh, AWS intelligence platform with a Cerner's, uh, EHR I think has a lot of promise. Um, I don't think much has been, much more has been shared here. Um, but I think what you're going to see in this story the next and the next is, uh, cloud is becoming central to the, to an effective EHR strategy. Uh, EHR is, are not going to be able to live on their own and be effective anymore. They need to plug into cloud. They need to plug into, uh, this is, this is me going off here, but they need to plug into cloud. They need to plug into the, uh, tools that are available in the cloud. The, uh, cognitive tools, intelligence tools, analytics tools, uh, the ability to share the, uh, API APIs that are available, the ability to plug into, um, the market and the innovators in the market.

Bill Russell: 04:54 As a, as I have said, and I'm sure I stole it from someone I don't know who, uh, you can out innovate the market and the market is catching up to these EHR vendors and a Cerner. I applaud them. They're taking the lead here and getting out in front of it. Um, and not only that focus of, of taking cognitive, uh, into the EHR. Again, it's, it's kind of nebulous because I think their solution is kind of nebulous at this point. It's more of an announcement kind of thing and the conference sort of snuck up on them. They don't really have real live use cases. Uh, I think if at this time next year or maybe at HIMSS, if we're not talking about solutions coming out of this partnership, uh, you'll know that the, uh, bureaucracy within the organizations has gotten in the way and it is not as advanced as quickly as it can.

Bill Russell: 05:43 The normal healthcare thing is slowing it down. Um, that would be the bad news. The good news is if we start to see things, you will see the ability for these next generation, and I'm not talking about the EHR, I'm talking about the next generation cloud platforms being able be overlaid on top of these legacy platforms and really move the needle forward. That's the hope. That's the promise of this. And a, I think it's an exciting announcement and I wish they had more to share at this point. Again, let's look to, uh, let's look about four or five months out at himns, see what they're showing off at their booth, see what they're talking about. Uh, and then let's give them about a year to see if they're really moving the needle, uh, with this. But, uh, again, directionally great, uh, love the, uh, uh, love what they're doing.

Bill Russell: 06:27 Allscripts Northwell, next story, Allscripts Northwell health to co develop next generation EHR, a next generation EHR. Wow. Uh, well, anyway, next generation, David Ralph's healthcare innovation group. Let me give you a few quotes from this new, uh, the new platform will be cloud based, voice enabled and artificial intelligence, uh, based. So it's cloud-based, artificial intelligence based and voice enabled. I, and that sounds like a good combination and you're seeing, you saw that also at the UGM, uh, this year of voice enabled, uh, artificial intelligence. You saw, uh, the thing I think you're seeing that uh, Epic might be a little slow here on his, this whole a cloud adoption. They believe in building it all themselves and I think that is going to be one of their downfalls. I, I, I hope that someone in there is whispering and Judy's here to say, Judy, uh, you know, which cloud platform are we going to embrace?

Bill Russell: 07:26 Because most clients I talked to that are looking at the Epic cloud environment are finding that it is too expensive. That's what I'm hearing right now. Uh, maybe it's just a simple, uh, reconfiguration and a rearchitecting of the platform or maybe it's adopting a partner that helps them to, uh, scale it, uh, national and even globally for that matter. But anyway, this story is about Allscripts and Northwell. Uh, EHR vendor Allscripts announced it is working with a New York based Northwell health to create what it describes as the next generation EHR, which will be cloud-based voice enabled artificial intelligence based. The EHR will be designed and tested using input from Northwell clinicians, information technology experts and administrators with the goal of ultimately deploying it system wide. Allscripts said increasingly health systems and health it vendors are looking for ways to work more closely together on technology innovations.

Bill Russell: 08:20 Northwell health is New York state's largest healthcare provider and private employer with more than 13,600 affiliated physicians. It has been using Allscripts since 2009. Okay. A Chicago based Allscripts, uh, will provide the development of systems integration expertise, Allscripts in Northwell. We'll jointly develop and pilot its new EHR while continuing to support and enhance Allscripts sunrise. Uh, the HR platform currently in use at the 19 Northwell hospitals and Allscripts Touchworks in use have more than 750 outpatient practices that Northwell owns and operates throughout. Uh, New York area. Uh, we're excited about the possibilities. You get the idea that goes on to, and it has the, uh, the normal stuff. Again, I think this is directionally a fantastic, uh, and, it's adopting the right things. Cloud-based voice enable artificial intelligence space. Again, this is early on. This is, uh, the followers of Epic trying to figure out a way to leapfrog them.

Bill Russell: 09:25 And, uh, this has the most potential to be honest with you. If they could figure out a way to get much more efficient using cloud, uh, much more, uh, integrated, uh, using API APIs. Uh, not only fire, but other APIs that might be available to them. Uh, being able to leverage a new, uh, way of interfacing with the EHR. We've heard that most people don't like the HR because it's a way to burdensome. They're spending extra hours in the office. A voice has that potential, hopefully something beyond what Nuance's doing. Uh, but nuance is doing great things, and artificial intelligence based, right? If we can overlay artificial intelligence, which right now is kind of a buzzword in these marketing things, um, but I, you know, I am seeing more and more use cases for how it's being used to predict issues and, get ahead of get ahead of the curve on some of these things.

Bill Russell: 10:19 Not only sepsis, but code blues and other things. So, very exciting possibility. But again, these are early announcements. Let's see what's happening on this one. I'd say give them a year. Uh, give me a year and let's see, uh, you know, what Northwell and all scripts are doing together to really advance this. And then finally, um, you know, one of the interesting things here, finally, we're gonna talk about Meditech. And one of the interesting things here is people forget how big Meditech is. Meditech's actually a pretty large provider of, uh, EHR software, not only in our country, but, uh, in other countries. In fact, one of the largest providers, uh, in, uh, Canada across the entire, um, it's not a province country, uh, but the major provinces, uh, are predominantly using Meditech. So it's, it is, uh, pretty extensively installed. It is still one of the least expensive EHRs to run, which is what makes it so attractive when you get into that case of finally looking at the numbers and saying, you know, we can't afford a $500 million rollout.

Bill Russell: 11:22 And Meditech is, you know, half of that or a quarter of that, uh, to roll out. And actually some of this announcement here is gonna talk about how they've really driven the cost out even further. Uh, okay. So Meditech works with Google to host EHRS to the public cloud intros, iPhone support, uh, support, uh, Mike Malliard healthcare it news. Uh, the co, uh, Meditech this week revealed that it's expanse platform, which is their sort of EHR as a service kind of platform will be made available via Google cloud. And another announcement said that it now supports health records for the iPhone two completely separate, uh, conversations. Uh, you know, uh, Apple's health record is available on several EHR, I think Allscripts a Cerner and Epic, it's now available on Meditech, which is great. Now, um, gosh, I mean you're going to cover probably 85% of the market in terms of the EHR.

Bill Russell: 12:20 Uh, so Apple's health record is a, is it expanding in that's a, that's a good sign, um, to get the information into the hands of the patient. So, uh, let's see. Meditech is collaborating with Google cloud to offer its electronic health record through his public cloud platform, which essentially will boost security, interoperability and scalability for it's EHR customers. That is absolutely true. Um, you know, I, I really don't trust the EHR providers to build out a cloud. They shouldn't be building out a cloud. There's too many clouds out there that are already secure. They're a interoperable and uh, they're much more reliable than anything that they would build from scratch. So, uh, by working with Google cloud platform, Meditech, uh, will be able to offer options aligned with Meditech at a service subscription model. The company said on Tuesday with faster and more cost effective implementation of evolving EHR technology.

Bill Russell: 13:14 Public cloud also helps healthcare organizations with finite resources for cybersecurity, bolster their info sec, uh, preparedness and protect against ransomware attacks. And Google cloud collaboration also extends to application development plans are underway to develop a native cloud product as well as APIs to be used on these products. Says Meditech president and COO, Michelle O'Connor. So the innovation will be extended to our on premise customers as well. Uh, on Thursday, meanwhile, the company announced that it will support health records so forth. So we already talked about that. Um, this is an interesting announcement. Uh, I think it's an interesting announcement because this has the ability to, you take a low cost, fully functioning, very high functioning, uh, EHR that can run a, um, anything from a federally qualified health clinic to a 16 hospital system. Um, not expanse, but, uh, Meditech has that capability, uh, to run those kinds of hospitals.

Bill Russell: 14:18 And you now overlay, quite frankly, the, the power of the Google cloud platform and you get those two organizations working together and you now might have a much more cost effective, high functioning EHR. I don't know if that's the case. Again, this is an announcement where kind of stuff. Um, but directionally it's correct. This is how you, uh, this is how you start winning bids in the future against a, against Epic and Cerner and, um, you know, we're lower cost and higher functioning. It seems like a no to me, but, uh, we'll see. They have to work on their user interface. Clearly, I haven't looked at the experience platform. Maybe they have a, but their user interface, well actually all the, all the EHR user interfaces, uh, look like, u, DBAs for, uh, kind of, uh, applications going back to that. So anyway, uh, let's go to the stark law.

Bill Russell: 15:10 So HHS proposed to stark law changes that would broaden provider's maneuverability under APMs Mark Hagland healthcare innovation group. So CA CMS, administrators Seema Verma announcement stated we serve patients poorly when government regulations gather dust in the attic as the stark laws have the announcement continued to start claws. New value-based, uh, exceptions under the proposed rule issued. And I'm only gonna focus on a portion of this by the way, a proposed rule issued by the center. And if you want to see the whole thing, it's out on the CMS website. cms.gov proposed rules issued by this. CMS acknowledged that incentives are different in a healthcare system that pays for value rather than for volume of services provided. This included preference safeguards that ensure that the Cirque law will continue to provide meaningful protection against overutilization and other harms while giving physicians and other providers, uh, added flexibility to improve the quality of care for their patients.

Bill Russell: 16:06 Uh, it talks about the penalties and other things. Uh, the important thing here is that the stark laws were, uh, put in place to protect patients, protect from over-billing and, uh, unneeded, uh, uh, services and those kinds of things. And also to protect against kickbacks that would, uh, allow health systems to create an unfair advantage within the marketplace. And so some of the, as you know, the stark laws allow you to go out to your clinically integrated network and help to pay for certain aspects of their technology. But it's, uh, it's more of a gift than it is a, uh, uh, it's, there's no quid pro quo as they say. Uh, and there's no kickback. So, uh, they, they, they thought they would update this because one of the things that was happening was health systems. We're looking at this and saying, Hey, you know, stark laws don't allow us to help them with cyber security and stark laws don't allow us to continue to do enhancements and don't allow us to do certain things like that.

Bill Russell: 17:05 And, uh, and Seema Verma and the team, again, being very proactive and I really like this. They, they looked at it and they said, you know what, that was not the intention here. The intention here was to, um, to, to modernize obviously through the electronic health record, but to keep that secure. And if all we do is give, if all health systems do is give the, um, uh, the medical practice, the technology in order to run their EHR, but they don't give them the right cybersecurity overlay on top of it on an ongoing basis, uh, then you have a problem. And what they're essentially saying here is a, there's a whole host of things like, um, some IOT IOT things around pillboxes a cybersecurity, their EHR, uh, that can be given. Again, it's pseudo gifts to the, uh, medical groups, uh, so that, uh, we can continue to maintain a high level of security and interoperability and integration, uh, for those clinically integrated networks.

Bill Russell: 18:06 So I, I didn't do a great job on that. Again, hit cms.gov uh, chime is also, uh, doing a great job following this and uh, and uh, promoting it and, uh, lobbying for the right things to be, uh, included in it. So, uh, keep an eye on your chime emails. Uh, you could also see at the Chime website, I'm sure they have something out there for it and uh, you could also, uh, hit the cms.gov uh, but good move directionally. Great. Uh, I'm seeing that a lot directionally. Great. Uh, this is good stuff. Well this is actually pretty tangible, so we'll see where it goes. I want to hit two things, 1840. We're at on this episode. Let's see if I can hit two things real quick. VA shifting to opt out model for sharing health data. David RAs, healthcare innovation group. This is actually a pretty big announcement, and I'm not going to do it justice, but I'm going from opt out to opt in.

Bill Russell: 18:57 Opt in meant that the veterans would have to actually go out there if they wanted to be a part of being able to share their VA health record to the a surrounding a community health systems. They would actually actually have to go in there and opt in, which we know is very cumbersome and it's very hard to do. And they are now shifting that to an opt out model, which means that all veterans will be automatically enrolled. And if you don't want to be in it for whatever reason, um, and I'm sure there's some good reasons, uh, maybe privacy or some other things that, uh, some veterans will, uh, want to not be included. They can do that and they can opt out. So this will get much higher participation and probably serve the, our veterans a lot better. The final one is a final story.

Bill Russell: 19:40 InterSystems unveils clean data as a service solution, helping normalize datasets for a analytics RI. Mike Miliard healthcare it news, a new offering from InterSystems. And I am a huge proponent of InterSystems. They're not a sponsor of the show. Um, but I have purchased their software before as a CIO. Uh, it's really good software. Uh, and I'm not promoting for that reason, but this clean data as a service solution is like the Holy grail. And that's why I wanted to, to bring it up. I think they're not going to be the last to do it, uh, but a, they're one of the first to do it that I, uh, really have seen. Uh, so here's essentially what it does. In an effort to help healthcare organizations achieve more from their analytics, uh, better position and better position to them to take, take advantage of the new artificial intelligence and machine learning initiatives.

Bill Russell: 20:33 InterSystems has launched a new service called clean data as a solution. The service, which the company says can help not just hospitals and health systems, but also payers, life sciences, you got the picture can help position health organizations as they move towards more AI and automation to help manage data sets. Uh, from multiple sources. Clean data as a solution offers product and data normalization functionality to support specific use cases such as integration, patient matching, aggregation, normalization terminology and enrichment, a D duplication and into a unified care record. Uh, clinical viewing capabilities and more according to InterSystems, it's delivered as a service. Um, as everyone knows, data governance is one of the hardest challenges facing health systems, payers, providers, everybody. We do not have a common, model data model across all the HRS and across all the payer systems. And so we are constantly having to normalize the data in order to make it effective.

Bill Russell: 21:33 And the ability to offer that as a service is interesting to me. Again, this is announcement where, and I apologize, I did a lot of these announcement were kind of, uh, conversations, but this is one to look at and keep an eye on if they're able to really make inroads and really make this work. Um, this is a huge, huge, huge expense in the industry. Um, I, I can't tell you how much money gets wasted on not wasted, gets spent on really good, productive work around normalizing this data and making it available and making it, um, effective for good analytics within the health system and to be shared across the clinic, clinically integrated network so that we can coordinate care better and do all those things. So this is an interesting service. I am going to keep a close eye on this. I will, uh, talk to these guys when I see them again.

Bill Russell: 22:27 Who knows, maybe one of these conferences coming up. Maybe there'll be a Chime, maybe it will be at a HIMSS in early next year. We'll have to see. Well that is, uh, that's all as much news as we can do in 20 minutes or less with me just rambling as fast as I can. Um, if you want to take a look those stories, again, a lot of them came from healthcare, it news and a healthcare innovation group. My to go to sources really for news. Um, and I recommend you hitting those stories. A well worth reading. So that's all for this week. Every Friday, check out our interviews with industry influencers and uh, you know, keep the comments coming. I, you know, one of the things I'm trying to do is, is keep refining this show some, some of you are telling me, Hey, go deeper on the topics.

Bill Russell: 23:16 Some of you are telling me cover more news stories. Uh, I'm going to see which one I get more feedback on. If I get more on one or the other, I'll, I'll do more shows, but I will bounce back and forth when there's something to go deep on. I will do that. And when there are just so many stories that I think are worth covering, that's what we're going to do. Um, so thanks. Keep the feedback coming [email protected] Um, I'm going to be at the health conference coming up. Also going to be at the chime conference coming up. So if you're there, please reach out. I would love to talk to you. This shows production of this week in health it for more great content. You check out our website at a this week, health.com, uh, YouTube channel off of that. Plus I did a complete redesign of the website, have gotten some help from some younger people who have told me, ah, my website looked too much like a, uh, like a 50 year old engineer had designed it, which a 50 year old engineer had designed it. So, uh, that was pretty accurate. And they have helped me to, uh, um, rethink how we organize the websites that you can find the information you're looking for. So again, give me feedback. Let me know how that looks to you. Thanks for listening all for now.