Bill Russell: 00:11 welcome to this week and 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. C suite executives are finally saying consumer experience is top priority for 2019 a healthcare industry adds a bunch of jobs. Uh, some say data sharing, encourag patient risk, we'll look at that and Microsoft and providence come together. Uh, uh, president Trump shifts, uh, dialysis care to the home and uh, the LVAD migrates to epic EHR. I'm going to talk a little bit about that. Uh, from a perspective of what is cloud and what is cloud to healthcare. I think there's a huge amount of misconceptions around the cloud and that will be the last story we cover. So hopefully you'll stick around to hear that. I have a little rant planned for that.

Bill Russell: 00:57 So 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. So we have something new for you in that vein of developing the next generation of health it leaders. A quick question. Is anyone helping you to advance your career? For too many people The answer is no. And that's really not okay. You know, every person deserves a chance to learn. But developing people is time consuming and expensive and uh, because it's difficult, most businesses don't develop their people at all. Uh, this week in Health it daily is designed to help every professional developed through daily short videos that you can begin to apply today. Subscribe to this week and health it daily at this week health.com/daily and get a five minute video in your inbox every weekday morning. That gives you insights from leaders, industry leaders to advance your career.

Bill Russell: 01:50 Think of these videos as a graduate school for health it in, in small, in bite sized chunks except, um, you know, except as opposed to a most graduate schools. This is totally free. Uh, so, so start investing in your career today. Check out this week in health it.com/daily to sign up for these insights from industry leaders. Um, one last thing before we get to the news. A quick shout out to Ed Marx CIO, Cleveland Clinic, a huge part of our community who's recovering from surgery to address prostate cancer. Uh, all reports are good. Uh, he even shared, uh, pictures on Linkedin of his physician and his wife at the bedside. Uh, you know, as only ed can do, he has written five amazing posts on Linkedin, uh, to remove some of the uncertainty, doubt and fear that goes along with this, uh, cancer diagnosis. Uh, ed is a courageous leader and we wish him a speedy recovery.

Bill Russell: 02:44 All right, let's get to the news. Uh, six stories. Looks like we're going to do six stories. I'm still trying things out here today. We're going to try to go broad, but not deep here goes, uh, most, most, most healthcare c suite executives say improving the consumer experience is a top priority for 2019. Let's see. So sage growth partners and docent health did a surveys. 69% of respondents said improving healthcare consumer experiences in their organization is their first or second top strategic priority for 2019. Uh, let's see, uh, to improve the consumer experience, organizations are using an array of technologies including telephone calls, EHR and patient portals. Only 35% report using centralized customer relationship management platform. Fascinating to me, that number, uh, is a lot lower than I thought it would be. A 32% of dedicated c suite executives such as chief experience officer Oh, have added a chief experience officer whose sole roles improving the healthcare consumer experience.

Bill Russell: 03:45 So, um, yes, 32%. So a third now have an experience officer, uh, top three service lines, which this is, uh, being done on our oncology, orthopedics and cardiology. Again, no real surprise there. And, uh, though 43% of respondents do not yet have patient engagement program. A third of them plan to implement one and the next one to two years. So there's a new role opening up for those of you in it who are looking, uh, to do something a little different. Uh, so what on this, uh, you know, this is going to be the differentiator moving forward. Uh, care is a point of parity, but experience is the differentiator. Uh, convenience is king. Got To get on this. Gotta stay ahead of it. All right. We're going to keep moving a health care industry adds 35,000 jobs in June. Healthcare Finance News. Uh, this is from Susan Morris.

Bill Russell: 04:36 While other employment rate remains relatively unchanged at 3.7%. The unemployment rate in hospitals stands at 1.6%. That's low a. While our unemployment rate remains relatively unchanged, the unemployment rate for hospitals, uh, continues to decline. 61% of the insurance companies pulled, including those outside of healthcare, intend to increase staff in 2019 according to semi annual us insurance outlook study conducted by the, uh, Jay Jacobsen group and Ayaan. So what? Take care of your staff. I think that's the, the biggest so on take care of your staff. They're in high demand. Um, competition for staff. It's going to be tough. You've got to get good at this. Uh, you know, this is what happens in a thriving economy. Don't make the mistake of thinking that a, uh, that strong hiring is necessarily good for all areas of healthcare. Cost reductions will continue to be the norm and automation is going to continue to be a theme.

Bill Russell: 05:33 So, uh, I just wanted to share that, um, unemployment means getting those people is going to be hard. Keeping those peoples' can be critical and uh, and retraining them, retooling them is going to continue to be a priority. So, uh, just want to get that out there. Uh, politico, politico shared some say data sharing, uh, encouraged patient risk. I've heard this a couple of times. I wanted to get it out there. Uh, some state data sharing and acures patient risks. Okay. Free the data. Then what? That's the question some provider groups have, have, uh, as uh, have asked as they prepare for upcoming rules, making it easier for patients to access their own data. Sure. Patients should be able to download their own health records and even send it to a health app of their choosing. They say, but are patients really savvy enough to protect themselves from the data mongers who want to sell an exploit their information?

Bill Russell: 06:27 The answer to that is who cares? It's, that's not your me, sorry. This is a rant, but that is not your responsibility. And seriously, I mean, you're protecting me from me. I, this argument really gets me going. And actually there's a quote here from somebody and a, I'm going to leave the name out, but um, but just to give you a gist of it, there's going to be new apps coming online every single day. Um, uh, clinical informatics person for this large organization said most patients who are using these tools don't fully understand the privacy implications. You know what, most healthcare organizations don't understand the, uh, privacy implements implications, the amount of breaches we've had, the amount of information we've had go out of health care organizations. It's really disingenuous for health organizations to look at me and say, you can't have your data about your health.

Bill Russell: 07:20 There will be an ecosystem. There will be accountability. Um, I've covered this in detail on previous episodes. I quite frankly, if you gave me my data, I'd like the ability to click a button and not have it on your system. I'm not sure you can be trusted with it. I'm not sure you can secure it, but, uh, I think I can find a group of people that can secure it. I can do it for myself. I can do it for my 87 year old father, uh, father and father-in-law. I can do it for my family. Uh, I can see I can secure this data better through a series of people that I select then, uh, that the most health organizations, and quite frankly, my family isn't as much of a target as your health system, as a target. I don't have to defend against China.

Bill Russell: 08:01 You have to defend against China. So this is silly. Uh, let's see. So other say, this is part of my argument right here. Others say that the perspective is paternalistic, pointed out that consumers regularly download apps outside of healthcare and can be trusted to protect their own privacy drafts of upcoming information, blocking interoperability rules from the onc. And CMS suggests that HHS believes patients are responsible for their own information. Cedar Sinai, CIO and previous guests Darren Dorkin said at the end of the day, we're entering a brave new world where patients will choose what they want to do with their information and how they want to share it. Darren is right. Give the patient their data. Okay. Let's move on. Microsoft joins, hospital chain, providence to build hospital. The future. A Christina far CNBC A, this was published on the ninth. So, um, Microsoft and providence health system are working together on a new high tech hospital.

Bill Russell: 08:55 The site will be in Seattle area. Providence CEO, Rod Hochman said also a previous guests. Uh, let's see. Uh, they're both headquartered in Seattle. Makes perfect sense. The two companies have discussed this vision for a hospital of the future for months, Hackman said, including during several one-on-ones with Microsoft CEO Satya Nadella. And I can't think of a better dream team of people to be together than a doctor Rod Hochman and Satya Nadella. I think that is a, that is a strong pairing and uh, I'm excited to see what they do. This chief priorities for the new effort involve improving the, uh, improving the electronic medical record so that it is easier for doctors, nurses, and other health providers to find and share information. The companies also plan to use technology like natural language processing and machine learning to help clinicians diagnose and treat patients. I know some people from UPM c are going to be saying, hey, we did that, you know, half a decade ago, a decade ago if I think about it.

Bill Russell: 09:53 Um, and we, they had a Microsoft platform and they had, uh, tiles which brought, uh, EMR data to the forefront and those kinds of things. I quite frankly, I think the technology is different. I think the leadership is vastly different. Uh, Satya Nadella is, is a far cry from a previous leadership at a Microsoft. I think cloud, the adoption of cloud technologies is going to make this, uh, potentially a new interface for getting to the EHR. And I think we do need other interfaces to sit in front of the EHR that help the, uh, physician, uh, in ways that we haven't imagined. Uh, and part of that, quite frankly, is you just cannot hire enough people at epic enough people at Cerner, enough people at Meditech and the rest, uh, to move this forward. And so if we can open this up to the, a innovative community to take clicks out and make it easier to interact with the EHR while maintaining the integrity of the data, the integrity of the workflow, the integrity of the, um, uh, w workflow really covers what I was gonna say.

Bill Russell: 10:56 So, uh, the care protocols and other things. So, uh, let's see, what else did they say? Another focus is on improving healthcare and lowering costs by working closely with Seattle's largest employer, Amazon. Another Seattle company is also looking to focus on employer experience through its partnership. With JPM and Berkshire Hathaway, uh, the effort was called haven as you know, so what, I love the concept, uh, choose a hospital. I think every system should do this. Choose a hospital that's maybe lagging within your system and make it the hospital of the future and, uh, start innovating around the experience in that a specific hospital. Is Microsoft the right player? Um, uh, for Providence, absolutely. They're headquartered in Seattle. The teams can get together, they can have off sites. There's not a lot of travel involved, so it's absolutely the right partner for, for Providence. I think that goes without saying outside of Seattle, I think you have to examine a lot of different factors, but in many cases, Microsoft makes sense only from the fact that it's existing technology.

Bill Russell: 11:53 Your team's used to SQL here, there'll be used to Azure there. Um, you know, it, it's just a natural migration of skillsets. Uh, with that being said, I'm going to say something negative here about Microsoft. I apologize. But you know, Microsoft eats up a bunch of the health it budget every year and a, and there's no alternative. There just is no alternative. I, I looked at it, you, you'd say, wow, you could go to, you know, Google's platform or something to that effect and you really can't, I mean, it's so, uh, it's so tightly ingrained, uh, into these large health systems and integrated with the EMR and some other things, uh, that it would just be a very difficult process. Um, with that being said, I'd like to see Microsoft pricing models changed. I, I think they are. I think they're goofy. I think they're of, they've, they've moved their technology stack to the cloud and they're going to the cloud, but their pricing models haven't gone to the cloud and they need to be more cloud, like pay for what you use a too much in the license agreement today, you know, never gets implemented.

Bill Russell: 12:54 I've seen people with these agreements, they go, I have these 16, 20, 30 apps that we've never implemented, but we're paying for from Microsoft because we, you know, check a box or because they're included that that's, uh, that's a, that's a bad model. It's time to change that model. If you're moving everything to the cloud, move the pricing model to the cloud. Um, so, you know, we're going to, I, I've already reached out to BJ moore. We've were corresponding when he gets back from vacation. I'd love to have him back on the show. Talk more about what this means and where they're going. This is exciting stuff. Uh, let's see. So Trump did this little thing using oddly enough, using the affordable care act, uh, authority, um, to shift dialysis care to the patient's home. This is from Kaiser Health News. Phil Galewitz. So, uh, Trump announced Wednesday bold plan to improve care for patients of kidney disease, which he claimed could save thousands of lives each year and billions of dollars for taxpayer.

Bill Russell: 13:52 Uh, it could be higher if it works as anticipated. Trump boasted that and a 25 minute speech. The initiative aims to dramatically increase the number of patients getting dialysis home rather than the costly costly dialysis centers and double the annual number of kidneys available for transplants. About a hundred thousand Americans are waiting for kidney transplants. 10 Americans die each day because of shortage of organs. Trump said, um, I mean, I can't speak to, you know, the, the viability of this. Uh, here's what I will say. So what, uh, home care is a thing. It's coming. It's been coming. Um, and there's really going to be no excuse for health. It once it gets here, if you're not ready for, um, you know, internet of things, collecting device data, uh, and empowering your physicians to interact with the EHR when they're out at people's homes or your physical therapists or whoever happens to be doing the home work in the future.

Bill Russell: 14:50 So get ready for that. Be ready for that. Create your, uh, security models around that. Create your, uh, your user interfaces around that as well. So here's our last story. I tried to save some time for this. So Novant health migrates to epic EHR system in the cloud. Uh, it's being built as one of the biggest yet cloud migrations of an epic electronic health record deployment. Novant health has moved its mission critical applications to virtual streams, cloud hosting servers. Now this a lot of this article is an advertisement for virtustream, so that's less time you're going to hear that name. Uh, a way to streamline efficiencies and more ease. This is why it was done a way to streamline efficiencies and more easily comply with EHR security and value based care requirements. Novant first rolled out the epic system in 2011 and it deployed at its hospitals, physician practices, outpatient clinics and other providers sites more than 640 of them across the southeast.

Bill Russell: 15:47 As the health system expanded, it realized that the legacy it infrastructure wouldn't be optimal for its technology plans going forward. So it looked at new ways to ensure among other goals a more predictable cost model and approved agility for clinical and operational innovation. Novant can make future enhancements to its system without having to rearchitect its system every time new changes where necessary. The vendor said, noting that Davon and extreme care service team were able to complete the cloud migration in just six months, which is phenomenal. After co-designing, it's technical and there's a little bit more here. I'm going to talk about in a minute, but I want to go back to this thing. As the health system expanded and realize its legacy, it infrastructure wouldn't be optimal for its technology plans going forward. Uh, this was done in 2011 shows absolutely no vision whatsoever in 2011.

Bill Russell: 16:37 Uh, they were rolling this out essentially at clinics and patient sites across North Carolina made absolutely no sense to do that. Even back in 2011 made no sense to do that. And so, uh, the only reason I bring that up is not to point out what Novant did wrong because, um, quite frankly they have a different CIO since then and other things. Um, the reason I point that out as to say we can still be making those same mistakes today, we can still be rolling things out thinking, ah, you know, this architect, we can stay on this old architecture. Um, and the reality is business is changing. The business requirements are changing. You need to, um, look at the business requirements and where, where healthcare is going. It's going out of the home. Uh, more and more, uh, devices are going to be connected. Internet of things.

Bill Russell: 17:27 Artificial intelligence is a, is a thing. It's a trend. Um, uh, machine learning, these things are all trends. How are you going to access it? Uh, architecture matters. We talked to Eric Yobanka about that. Architecture does matter and if you make the wrong architectural decisions today, you will have to rearchitect to take advantage of some of these things. So here's the larger trend. More and more health systems are deciding that the cloud is right for them, attracting, um, attracted to its agility and resilience that having been convinced that security of remote hosting has sufficiently evolved in recent years. UC San Diego switched over to epic hosted Cloud EHR two summers ago for example, setting an improved operational efficiency and enabled allowing you to invest more resources in patient care as well as the ability to share the EHR with partners such as UC Irvine health still a just this week we showed that even health systems are more intrigued with cloud hosting.

Bill Russell: 18:22 Many are still slow to take the leap, uh, either wary of lingering security concerns or hampered by tight budgets. And it has a great quote from class here, which I think really gets, it's a, the majority of the organizations we speak to are doing more in the cloud or considering a move to the cloud. Explained Ryan Oliver, research director at class, uh, costs and security are usually the first considerations mentioned, but it's important to maintain a disciplined approach to decisions that also include considerations for scalability, uh, integrations, governance, operational readiness to manage multiple cloud vendors, impact of staff and total cost of ownership. And he's right, he captured an awful lot of the things that, uh, need to be considered a cloud hosted cloud host environment for epic will help the health system meet all of our business security, technical and cost requirements. He added noting Novants plans to expand, uh, in these, this is the vendor talking, uh, cleft couple going forward.

Bill Russell: 19:16 Uh, that's a, that's a sales pitch. So, uh, so what, there continues to be a fundamental misunderstanding in healthcare of what the cloud is and what it does. So in two minutes or less, as you give me two minutes, I'm going to tell you what it is. So the cloud has five characteristics. Number one, pay for what you use. So if you have a hundred users, you pay for a hundred users. If you go down to 95, you should pay for 95 you shouldn't have to keep paying for a hundred if you have 95 so it's paid for what you use, which gets to that next point. Scalable scale up, scale down. The ability to do that without costly infrastructure associated with it. The reason you go to the cloud is because you don't have to have a data center in crack units and air conditioning and a fixed building.

Bill Russell: 20:01 You can get out of that. Uh, heavy capital resource intensive, slow moving environment. So pay for what you use. Scalable programmatic access to resources. Cloud is written in a way that you can create automation automation of just about everything because you can access it programmatically. The four thing, granular accounting, you should be able to tell how much each resources costing you. Most it organizations can't do that today. Uh, you know, a lot of them spend, spend some money to uh, install things like aptio just so they can get to that granular accounting cloud is designed from the ground up to have that granular accounting. And then the fifth thing is ubiquitous access. If you're a person is on the road in uh, wherever, as long as they have an internet connection, they can provision new servers, they can provision new users, they can fill in the blank.

Bill Russell: 20:54 So ubiquitous access. So five characteristics, pay for what you use, scalable programmatic access to resources, granular accounting, ubiquitous access. There's probably more, those were the five that I generally focus in on a remote hosting of Epic isn't cloud unless it has these characteristics or remote hosting of any EHR is not cloud unless it has these characteristics. It's a form of outsourcing. It's not really cloud. It's a way of saying I don't trust our it department to run this anymore. We're going to, we're going to move to a third party because they will take care of the servers better. Their uh, their data centers better, whatever. It's just transferring costs from one to the other. More Times than not. That is not going to save you a nickel. So anyway, that's, that's that I have very little time left. The, the models really haven't changed much for cloud.

Bill Russell: 21:41 I mean new ones come up and down, but at the end of the day there's three infrastructures of service. That's where we get our data center through, uh, equipment and networking, all provided by a player. This is what AWS is. It is what a Azure can be. Uh, and some other players out there, there's a, there's a lot of them. So a platform as a service, this is a more, uh, solutions that you're going to write code on top of. You're going to write applications on top of it. Um, you know, like a salesforce started off as a, uh, software as a service and still has components that are software as a service, but you can actually write code and write applications on it. Platform as a service. Azure is a good example of platform as a service. So is a, again, Amazon is a pretty good, uh, solution as well.

Bill Russell: 22:27 And then the final is application and service or software as a service. Those are the three primary, new and you know, these, I mean it's Workday, it's fill in the black. There's a, there's a, a gillian of them. So it's generally those three models. Cloud can cost less, but it's, it's not necessarily one of the primary benefits of cloud. The primary benefit of cloud is getting to yes, most health it in most it prior to moving to cloud models were just no it's it, you know, it's going to take, uh, you know, thank you for the request. That'll take six months and $3 million. And when you get to the cloud, you're able to do things in a granular fashion. You're able to scale up and scale down. You don't have to do a lot of the heavy lifting because of the heavy lifting is being done by the cloud so that you can focus on your client requirements, programming and access.

Bill Russell: 23:16 Um, so you know, businesses, uh, you know, businesses moved from old tech models and healthcare needs to do the same. Cloud is the only thing that from an architecture standpoint that we have today, that it's going to be able to keep up with the business demands and the business requirements as they come down. So that's all I can really cover in three minutes or less. If you have other questions, you know where to reach me, bill@ this week in health it.com. that's all the news for this week, if you want to support the fastest growing podcasts in the health it space, here are five ways you can do it. Share it with a peer, follow our social accounts, linkedin, Twitter, Youtube, a interact and repost our social media content. Uh, the fourth thing is send me feedback.

Bill Russell: 23:57 You know, did the broad, uh, broad, not deep, uh, approach these things work or not work? Tell me if you like this format, not like this format. Uh, tell me what guests you like to have on the show. Really appreciate it, Bill@ this week in health it.com and you can subscribe to our newsletter. And now you can subscribed to a this week health daily on the website. Uh, this show is a production of this week in health it.com uh, for more great content. And you check out our website @thisweekinhealthit.com or the youtube channel @thisweekinhealthit.com/video. Actually go to this week in health it.com and click on the youtube link, plus all a ton of the videos are on our website. Thanks for listening. That's all for now.