Bill Russell:                   00:00                Welcome to This Week in Healt IT news where we're looking at as many stories as we can in 20 minutes or less that are going to impact health it. It's Tuesday news day and here's what we have on tap the house votes to remove a federal ban on national patient Id. Amazon launches personalized a Ai powered service that a you can now subscribe to, intense hospital consolidation, increases patient costs and many more stories. My name is Bill Russell, recovering healthcare CIO and creator of this week in health. 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. Every health system needs to do more with less. Start allocating more of your money to innovation and less to daily tasks. We know where to look. Let's talk. Visit Health lyrics.com to schedule your free consultation.

Bill Russell:                   00:55                If you want to support the fastest growing podcasts in the health it space here are five easy ways you could do that. First, as you could share it with a peer. Second, follow our social accounts, linkedin, Twitter, Youtube, interact and repost our social media content. The fourth way is you can just send me feedback, questions and recommendations at hello at this week in health it, .com and I thank all of you that are sending me emails and suggesting stories. Really appreciate it. Uh, and the fifth way, subscribe to our newsletter on the website. So let's get to the news. House votes to remove federal ban on national patient Id. I got this from the healthcare innovation group. There's many articles out there, but healthcare innovation group, Mark Hagland and Rajiv Leventhal. Uh, let me give you some of the details. On Wednesday, the US House of Representatives passed an amendment that would end the current ban on funding on national patient identification strategy in an action that was hailed by leaders of chime.

Bill Russell:                   01:49                This action was applauded by the senior advocacy leaders at the Anarbor, Michigan based chime. Uh, vice president of congressional affairs, Leslie Krigstein, wrote on a blog and the association's website. Great News. Yesterday evening, the House passed an amendment that would remove a prohibition on funding for national patient identification strategy. And our members have seen that 20 year prohibition as a barrier to interoperability and a risk to patient safety. Thank you to everyone who helped us reach this milestone. Uh, let's see, uh, from an article, Marianne Kolbasuk McGee, wrote, uh, healthcare security is the article how spruce lifting HSS man, uh, many healthcare and health it industry groups have long been urging Congress to lift the ban saying identifuer could be used to help match patients with the correct electronic health information from multiple sources to improve care quality and patient safety.

Bill Russell:                   02:47                But privacy advocates worry that the identifier could lead to an inappropriate exposure of sensitive information. The bipartisan passage of the amendment by the 246 to 178 vote, um, is first time either chamber of Congress has approved the initiative to lift the ban. Uh, it goes on to say that the house still needs to approve its appropriation bill plus a similar provision lifting the band would need to be approved by the Senate in its funding bill. That final funding bill containing a provision lifting the band would need to be signed by president Trump. So, um, you know, China did this initiative a little while back. It was about a million dollar crowdsourcing to do a national patient identifier. It didn't really work out that well and uh, that's noted in the article and for various reasons, mostly the complexity of it, uh, industry stakeholders are hailing it.

Bill Russell:                   03:39                You have a American Health Information Management Association, the American Medical Informatics Association chime among others who are saying, hey, this is great. Uh, however, so here's the contrarian view. The ACLU, the American Civil Liberties Union, uh, took the opposing stance of the healthcare groups stating that the amendment could be interpreted as allowing the development of a national unique health identifier without legislative approval. The ACLUs letter wrote the dangers of having a system like this, a compromise or inappropriately used or access to track individuals are profound. For this reason. The ACLU has historically opposed national ID systems like the national unique health identifier because of the threat they pose to privacy rights. The group also attested that absent strong privacy protections, use of unique health identifiers could empower HSS and potentially other federal agencies including law enforcement to gain unprecedented access to sensitive medical information. That was a huge wall of text. Um, but I think it's important on this lead story to really get this right.

Bill Russell:                   04:48                Um, also because it is the foundation for my rant of the week. And my rant of the week is what are we thinking? This is like the complete wrong approach to trying to do this. Let's get the government involved more in healthcare. Let's get them, uh, doing research on a national ID system. But let's start with the basics. One is, um, you've just, you just, everyone who, who's approving this feels good about themselves. They feel like they've solved the problem. They have solved nothing. They've started the, uh, the funding mechanism for solving a problem, which means we're looking at five to 10 years before anything of substance really happens in this space around this national id. That's number one. Number two, it's just the wrong solution. It is the wrong solution for the second. So this the right solution if you're wondering, um, is, is the the patient, the patient should have the data.

Bill Russell:                   05:51                Apple's already figured this out, the unique identifiers is your telephone number and then you request the data from your health, your health system gives it to you on your phone and now your phone is the unique identifier and you are the aggregator of that data. We just need systems that allow for that to happen. That I can get all my data delivered to my phone, I can now go to the next health system and give them temporary access to my medical records so that they can use it to care for me. And you know what, they can give it back to me when I'm done because I don't want them to have it because what they're doing is they're selling it and most of the times it just sits there and it's not a complete record anyway. I am the aggregator, I am the constant at the point of care at every time there is a point of care.

Bill Russell:                   06:34                I am the constant. The patient is a constant. At the point of care that is who should have the data. It shouldn't be the government, it shouldn't be the health information exchange. It shouldn't be the uh, it shouldn't be the health system. It never should have been. We are horrible aggregators of data. We are horrible sharers of data. So I think Seema Burma and, secretary Azar have this right, any patient day for that matter. Give me my damn data, get it into the hands of the patient. Let me be the aggregator. You know, the other thing that's going to happen here if I become the aggregator is there's going to be a whole new set of data brokers that, that start to emerge this ecosystem of data brokers and it will have a clinicians that help us to organize our record, that help us to, uh, to, to make sense of our record.

Bill Russell:                   07:19                There are those within the healthcare community who feel like we can't trust the patients, that's not the right way of saying it. The right way of saying it is they believe that we have to protect the patients from themselves. They won't know what to do with the data. Okay. I agree with you. I don't know what to do with my data. I don't understand my health data. But with that being said, I think I can find a data broker that can help me. And I think that if we start giving it to the patients, those brokers will emerge. Now if you want to manage those brokers, if you want to put regulations on those brokers to make sure that they have good interests and, and uh, and in the best interest of the patient at heart, by all means do that. But what you're doing now is you're continuing to, to propagate this broken model of health systems and all these, all these competitive forces are going to share data through this national patient id.

Bill Russell:                   08:12                The problem isn't the national patient Id. The problem is the competitive nature of healthcare and the inability for, uh, for some health systems to share it because they have bad contracts with their EHR providers, Ehr providers having too much power within the, uh, within the whole ecosystem itself. And then health systems, just choosing not to share data with other health systems. I had that situation as the CIO. I sat down with another CIO and said, hey, let's talk about our sharing strategy. And he said, there is no sharing strategy. I don't want to share my data with you. I'm like, okay, where do you go from there a national patient id isn't going to help that situation, get the data in the hands of the patients, um, and not to be over overlooked. The ACLU's warnings here about a dystopian future where two things, one, we make it really easy for hackers by aggregating all the data for them, tying it up in a little bow.

Bill Russell:                   09:02                We haven't proven that we can secure it. And then the second thing is, um, we were not creative enough. We don't think creatively enough about how nefarious hackers are going to use this data. And a lot of times we think, oh, well, you know, what is, uh, you know, what his country x, Y or z going to do with this health data? And that's not my concern. And that's not the ACLU's concern either. ACLU's concern is what is HSS and other federal agencies going to do with the data. Think about that in, in light of our current, uh, political and, uh, a climate that we have. When your political enemies, uh, essentially look at the things you say and say, I don't like what he, he or she says, let me go into their health record and see what sensitive information I can get to.

Bill Russell:                   09:48                And if you don't think that that's a possibility, the ACLU thinks it's a possibility. And I think a lot of other people think it's a possibility. I am really kind of shocked that we think this is the solution first of all. And then second of all that it passed with the majority in this, in this environment. I think people want to wash their hands and say, hey look, we did a good thing. Um, I think directionally it's the right thing to do. I think directionally getting a complete medical record at the point of care is absolutely the right thing to do, but gosh, think it through. Anyway, that's my rant for the day. Uh, you know, as I say, let the emails commence, I'm sure people are going to a, not be happy with what that little rant, but, uh, uh, but I, I really believe, I believe that patient at the center of the data aggregation and data brokers, uh, starting to a data broker ecosystem starting to be created is the way that this is to be solved.

Bill Russell:                   10:44                It, it was always the way this was to be solved. I, anyway, enough of the rant. Okay. So Amazon launches a, a new service personalize, is an AI powered recommendation service. So let me give you a little detail. Amazon today announced general availability of Amazon an Amazon personalize and AWS services that facilitates the development of websites, mobile apps, content management, et Cetera, that suggest products, provides tailored search results and customized funnels on the fly. So this is their service that gives you recommendations on the Amazon website. They've now opened sourced this capability, uh, for others to use. It's available and it gives a couple of other locations, uh, that a couple of data centers. It's available out of suffice to say it's available everywhere in the us, Japan, Singapore and Ireland. If you're interested to overseas for our overseas listeners. Um, personalize, which was announced last year at Amazon reinvent conference is a fully managed service that trains tunes and deploys custom machine learning models in the cloud by provisioning the necessary infrastructure and managing things like data processing, feature extraction, algorithm training and optimization and hosting, customers provide an activity stream from their apps and websites, eg clicks, page views, sign ups, purchases, et Cetera.

Bill Russell:                   12:01                In addition to an inventory of the items they want to recommend, such as articles, products, videos and music and optional demographic information like age, geographical location, and they receive results via an API and only pay for what they use, the beauty of the cloud. So a, so what on this? Uh, uh, you know, I just wanted to make people aware of this AI powered recommendation service on the go. We know that this is a powerful engine. It's one of the things that, uh, makes Amazon Amazon and makes them successful. I think there's applications within health care. Obviously. Recommendation engines are a pretty powerful, I, I would like to see some, uh, some of the more advanced health systems start to play around with this. I also think there's an opportunity for a startup here. So if you're one of the people in the startup world who's looking at things, I think if you get a headstart on this and bring it to the health systems that, uh, there's an opportunity here for, and an enterprising, a person or organization to take advantage of.

Bill Russell:                   13:02                So just wanted to point that out and make you aware of it. Let's go onto the next story. So, intense hospital consolidation increases patients' costs. So there was a study, and this is a from definitive healthcare blog. So this is actually pushing definitive health care services a little bit, but it talks about their, um, talks about some studies that were done and I think the numbers are interesting and worth sharing. So cost reduction for patients and providers has argued, arguably the primary driver for health care, mergers and acquisitions and to shockingly mergers may benefit the acquired facilities more than the buyer. According to a report by NCCI insights acquired hospitals reported a reduction in operating costs between 15 and 30% through economies of scale. That makes sense. In addition to coordinating care delivery between inpatient and outpatient centers, consolidation can also help prevent patient leakage through referrals, mergers and acquisitions reduce the need for out of network referrals, keeping patients and payments in network, something every is looking to do however long operating, uh, lower operating costs do not always equal lower prices for patients receiving hospital services.

Bill Russell:                   14:07                The scene NCCI report claim hospital mergers increase the average price of hospital surfaces by six to 18%. So if anyone from the federal government is listening to this, mergers are not driving down the costs of health care. Additionally and analysis of 25 metropolitan areas with high consolidation rates showed that the average price of a hospital stay increase from, uh, from 11 to 54% according to a study commissioned by the New York Times of the 19 metropolitan areas highlighted in the graphic from the report only five showed a decrease in the cost of an average hospital stay. Uh, all right, one more and let me read one more paragraph. So according to the 2015 study, hospital mergers may increase the likelihood of intensive surgery without improving patient outcomes. This is a contrast to another study from 2017 which reported a 30 day readmission rates for heart attack, heart failure, and pneumonia all dropped by about 1%.

Bill Russell:                   15:02                In addition, studies have shown that competition in healthcare market actually has positive effects for patients, particularly in areas such as care, access and mortality rates. So, um, you know, this is, there's another one that's thinking, I think I've said this a couple of times now, uh, who would've thought that reducing competition increases costs? And I think the answer to that is anyone with a high school class in economics would have thought that reducing competition increases costs. Um, this is not, should not be a surprise to anybody, should not be a surprise to anybody with an economics degree. The other thing is you have a low margins within these health systems. They are not coming together because they, um, you know, for, to be honest with you, they're not coming together for their coming together for business reasons, I guess is the way to say this.

Bill Russell:                   15:57                They're coming together because they can get economies of scales around labor and around supply chain. Those are two of the big cost drivers. And so they do drive economies of scale. Now, to be fair to the health systems, a lot of the savings that they're driving through that is being eaten up by drug costs. So it, it, it doesn't necessarily, this doesn't all fall on the hospitals of not driving down the cost of health care. Actually, I think they're pretty much remaining flat. I don't think there's a lot of increases. I think you can spread this blame around pretty easily. Uh, across the Pharma and drug prices, you can, uh, uh, you could easily talk to the payers whose contracts are as convoluted as they possibly can be, uh, with the health systems and, uh, you know, some health systems are not doing their mergers well.

Bill Russell:                   16:42                So there's, there's a lot going on here. Um, and I think there's some macro factors as well. So I'm not, I'm not putting a ton of stock in this, but I will say this, that, uh, this is an election year in healthcare spend a will come under significant scrutiny over the next two years. It's going to be under, under a microscope and a health care is going to feel like it's under attack. And this is the, you know, this article and other things are going to be cited by, uh, candidates and they're going to be cited by, uh, uh, presidential, uh, in presidential debates. And we're going to pull out horrific stories of, uh, leans against homes and those kinds of things, uh, that people can't afford healthcare. And so this is going to be a tough couple of years for healthcare. And I would just say hunker down, get, get ready for it.

Bill Russell:                   17:34                It's going to come up at dinner parties and other places you go. Um, and just highlight the good things that you're doing and highlight the good things that healthcare is a, is, is doing and trying to do, uh, understand, uh, that people's experience are, it's still confusing when get the bill. They don't understand why they get multiple copies. They don't understand why they're billed from multiple entities. They don't understand why the cost is going up. You're not going to be able to argue with the person who has a lien against their home because a health system wants to ensure that they get full payment. Uh, you know, these are things, there are still some practices that are really hard and those are going to be the things that get really elevated during an election cycle. So, uh, just be ready for it. And, uh, you know, just know you're doing heroic work.

Bill Russell:                   18:18                It's great work. It needs to continue. Um, but, uh, but this is going to be a tough time, the tough time over the next couple of, uh, next a year and a half. I guess this is going to be a long election cycle anyway. Last story. Patients say physicians with mobile apps are faster, convenient offer better communication, healthcare it news, Nathan, Eddy, um, this is another one of those like who would have thought it, I don't know anybody who's ever used the mobile app for convenience purposes. So here's what he has to say. Uh, chief finding of the survey of 550 us consumers commissioned by a mobile device management specialists Soti. Uh, the survey also found that half of the u s physicians, 57% offer their patients and mobile APP to do tasks like schedule appointments, access, personal healthcare information and view lab results. Uh, more revealing was the fact that three quarters of the patients surveyed said physicians who integrate mobile technology are able to provide a faster, more convenient experience.

Bill Russell:                   19:14                54% of the survey respondents said they thought physicians who leverage mobile technology cut down the physician wait times, which is awesome as well. A 57% said they prefer communication with physicians through Mobile Apps as opposed to calling the doctor's office directly. That again is not surprising. I don't think to any of us, a 67% of their sponsors prefer, uh, in, in office visits over telehealth. Again, not, not surprising where there's still a cultural change that's happening around telehealth, but people still want that face to face visit. Um, and uh, I think once they get used to that first visit being over the, uh, over the video conference or whatever, the more that that happens, the more people are gonna realize that this is a natural way to see a physician. Um, let's see, the top three functions which patients use mobile apps includes scheduling appointments, viewing lab results, and requesting a prescriptions.

Bill Russell:                   20:12                So, uh, you know, what's the, so what on this, I just wanted you to have this kind of, uh, you know, it's a good article. I would grab this statistics. If you have any laggards within your health system that are uh, pushing back on doing these kinds of initiatives within your health system. This is the kind of data that's helpful. I wish the and on this was a little higher than 550 us consumers and I'd recommend you, but just do it in your own market. These numbers are true across the board there. Uh, you know, people like using their mobile phones. Go figure. We all know this. Uh, we all know this, we've all known this, so nothing, nothing else to really talk about here. And actually let me, let me do one more story here real quick. So CFOs planned more active role in healthcare, digital transformation.

Bill Russell:                   20:58                Uh, this again is a healthcare it news. Nathan Eddy. Uh, so what's happening? Black box did survey 16 hundred hospitals and CFO's are saying, hey, we've neglected our side of the thing, uh, for too long and it's time for us to start investing. Uh, among the technologies they're talking about is data mining for a strategic analysis, reducing operational costs and streamlining financial reporting. I think this trend is worth, uh, knowing the survey results indicate future investments are moving towards improving patient experience and differentiating from the competition through a slew of technology innovations ranging from financial systems to patient payment interactions. Uh, so you're going to see a fair number of Erp, uh, projects kick off. You're going to see, it also goes on to say that CFOs, uh, see themselves taking a more proactive role in this and a, that they see that the technology has a lag behind other investments such as the EHR.

Bill Russell:                   21:53                So I think you're going to see some money start to, uh, go away from the EHR. You're going to see that enter sort of a steady state, uh, optimization cycle and you're going to see a lot of money had in the Erp patient experience, uh, financial billing analysis strategy. That whole area is going to get a lot of investment. And also I would say welcome the CFO in as a partner, uh, in innovation, uh, for, for a long time they've been sitting on the sidelines and being passive except to tell you you're spending too much money. And I think a welcomed the, welcoming them into this and having them be more intimately involved will help them to understand how technology is improving things and how, what are the challenges of getting, uh, technology to improve things. And I think one of the big benefits is them realizing that most technology projects now are not about the technology anymore.

Bill Russell:                   22:47                It's really about, uh, implementing them within the operation. So there's significant operational changes and that lift is a majority of the costs for most of these projects. So, uh, so I think, uh, all in all good, good trend and looking forward to that. So that's all for this week. Uh, this past week we had Eric Yablonka, and he is the CIO for Stanford Medical Center and a, I think the university as well. So, uh, he discusses architecture and health care and how that, uh, enables innovation. I think it was a really good conversation. Hope you get a chance to check that out. We're quickly approaching our hundredth episode and we're planning something special on that. So stay tuned. And in two weeks, I'm excited to do a show with a Jefferson health CEO, Dr Stephen Klasko, someone I've wanted to have on the show for a long time and we're going to do that, uh, in tandem with a is CIO, Nassar Nizami, who was on the show earlier. And hopefully we'll be able to do that interview person in Philly. And I'm looking forward to that. I want to thank everyone for your comments and your suggestions on new stories. If you want to contribute, just drop me a line at hello@thisweekinhealthit.com this show is a production of This Week in Health IT for more great content. You can check out our website @thisweekinhealthit.com or the youtube channel @thisweekinhealthit.com/video. Thanks for listening. That's all for now.