Bill Russell: 00:10 welcome to this week and health it news where we're 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. We have a, a indepth article on voice assistance, uh, based on a conference that happened a couple of weeks ago in Jersey. We have a virtual reality training for empathy and a, we're going to take a, we're going to take a look at these a US news and world report rankings of hospitals. What does it mean? Is it really that important? All that kind of stuff. So, uh, I look forward to that. My name is Bill Russell. Recovering healthcare CIO and creator of this week in health it, a set of podcasts and videos dedicated to developing the next generation of health it leaders. This podcast is sponsored by health lyrics. Professional athletes have coaches for every aspect of their life to improve performance, which I think makes sense.

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Bill Russell: 02:05 So, uh, let's get to the news. There's a great article from our, uh, recent guests this past Friday Anne Weiler, uh, who attended a conference and a, the voice summit in New Jersey just a couple of weeks back. And, um, I'm going to go into this a little bit because it was really fascinating to me as I sort of dug into it. Um, you know, they, they talk about the fact that voice is a voice was one of those emerging technologies really going to impact healthcare. And this conference, uh, not only, uh, delved into voice, uh, across all industries, but even had a healthcare track where they talked specifically about, uh, about voice. So let's see. Uh, this is what Ann, uh, shared with us. We are at the beginning of the end of the first phase of voice. James Poulter, CEO of vixen labs, the beginning of the end of the first phase might be optimistic for voice, but it did not dampen the enthusiasm at the second annual voice summit in Jersey this week.

Bill Russell: 03:03 Another speaker, a liking, a voice to being at the same stage of technology as the release of the first iPhone. If you remember at that time, everyone else had a feature phone and android didn't even exist at that point. Uh, let's see, she goes on. One of the great things about this conference is that it's cross industry events, so specific healthcare and there was a specific healthcare track she talked about and there's an opportunity to learn from other industries as well as focused on healthcare. So let's get into some specifics. Amazon Alexa. So Dave Isbitski. Alexa, developer evangelists kicked off the summit with a couple of announcements for Alexa skill connections, which enabled one skill to invoke another skill. That's pretty interesting. It's a huge value in healthcare where every skill shouldn't have to recreate of medications, left medications, lifts or a full lexicon of disease education.

Bill Russell: 03:54 And it would be better to call on a proven authority like Mayo or web MD to get that information. Uh, he went on to talk about some dialogue flow in some of those things. Another interesting announcement. What is the ability to have one skill that uses two languages rather than installing a separate skill for each language, which will be beneficial in healthcare to provide patient instructions, especially the family members who may have a different first language. Um, so those are two interesting announcements from a Amazon and the direction they're going. A Samsung has some announcements. So Samsung has, is now in the, uh, voice assisted business with the, what'd they call it? There's this called Bixby. Wow. Interesting. Which was designed to be a developer platform for people to insert voice into any type of device. A Microsoft has that same strategy with Cortana, the differences that Samsung, a ship's television, their refrigerators and can be, uh, that can be voice enabled.

Bill Russell: 04:50 So Samsung is also the voice and category with screens being a key part of the delivery. This has some really interesting implications for healthcare. If you think about the television as the focal point of the living room, health reminders and actions delivered there could have great impact. And uh, we talked about that a couple of weeks ago, uh, on the show. Uh, the challenge, uh, and it goes on and says the challenges with these modalities though, is that it may take generations for the technology to become ubiquitous versus a $39 echo. Dot. Samsung sees the world where the voice system knows you across all your devices, which would definitely be helpful in a, in a health context. So let's see. Uh, Microsoft, Microsoft's, uh, the voice as an ingredient, a part of Iot and AI strategy was echoed by Microsoft. No surprises since Cortana doesn't have a body or even a hockey puck to go with it.

Bill Russell: 05:47 This strategy could be very interesting in healthcare if you think about it. Um, say a, an epipen with, uh, with voice enabled, uh, why when all devices complex equipment have voice prompts for both patients and providers. There was also a meetup group at the conference demonstrating voice running on an arm chip, which could be very interesting for cheaper medical devices. So those were just some of the, uh, some of the announcements and some of the conversations that were, uh, being had by some of the, uh, early vendors in the voice space. Uh, let's see. Um, so from the trade show floor, here's what they found. Uh, uh, most, uh, most of the developer, let's see, it was full of mostly developer tools for building, testing and securing voice applications. And a rallying cry in sessions was for the platform providers, Amazon, Google, apple, Samsung, Microsoft to standardize their approach to voice.

Bill Russell: 06:41 If you remember back in the early days, I mean, it's, it's gotta be very difficult when you have different, uh, ways of, uh, address I guess outside of like the, the, uh, activation, you know, hello, Siri, hello, uh, or Alexa or whatever. Um, I would imagine this is the wild west in that each of the vendors is still doing their own thing. And so you hear the, you hear the developers as always happens in the maturing space saying, hey, let's, let's, let's see if we can't get some standards here so that we can do cross platform development. Uh, there was also an admonition not to build apps for the sake of building apps, but to focus on the user need and to understand what the users want most of all is convenience and they will use the most convenient interface for the task web, mobile TV, phone voice.

Bill Russell: 07:35 So That's interesting. There's also a little, a conversation in this article, which is by the way on the uh, wellpepper.com a website to their blog and a little conversation about ethics, a brand I thought brand was an interesting, uh, along the same lines of not building voice apps for the sake of it. There was also a lot of talk, uh, how your brand is reflected in your app. Not all healthcare systems think of their brand impact, although they should. And the voice skill is an extension of that. And interestingly, David Ciccarelli from voices.com which has, uh, says voice talent mentioned that most developers use the standard Alexa voice. It's not surprising as it's a expensive to have someone record every possible response for your application. Although it's interesting to think about a world where the healthcare app actually has a physician speaking and uh, and he talked about, uh, really brand, uh, getting a voice brand for your, uh, for your specific health system.

Bill Russell: 08:39 So that's, uh, that's fascinating. You know, itself. Um, users, I mean, the key thing about this user aspect is, uh, a voice is for every generation and there is this a new vioce first generation that's coming up. They tend to know how to use voice and how to get the most from voice. And uh, and that was interesting, but they also talked about seniors and everyone's really using voice a, actually, here's the wrap up. Uh, we've written before about the use cases for voice in healthcare and there are many from documenting clinical visits, transcribing physician notes and medication inherits education and patient care plans as well voiced biomarkers, uh, which my fellow panelists called a huge pool of untapped diagnostic dead data. If we're at the early days of voice apps, we're also at the early days of voice data. There's a ton to be discovered in the research, especially in healthcare is just starting our expectations for voice are high.

Bill Russell: 09:37 Let's hope it delivers. Uh, I, I find that to be a great, uh, summary of the conference and the things that are going on within voice seems like a conference that, uh, has some value, especially for for healthcare. They have that healthcare track. I think a, you'll probably see this start to pop up at the, uh, Himss, uh, conference as well. Um, a lot of talking about voice and how it can be used in healthcare. It's already being used. I mean, we did the, uh, we did a, uh, interview with nuance. We got to see their, uh, how they are taking it into the, uh, the exam room, especially around orthopedics and other things. Uh, voice is the next generation. It is early. So let's say, uh, the things you're gonna be doing today are going to be cutting edge. Uh, within about five years.

Bill Russell: 10:28 They're going to be a pretty standard and within, uh, let's say seven years, uh, it's going to be a price of admission. Uh, if your health system doesn't have a way to interact with you via voice, uh, you're probably going to be left out. Hopefully by then there will be enough vendors hopping into the space. So that's the, so what on that article I find, uh, voiced to be really interesting space and a loaded with opportunity for, um, startups, developers and, uh, health systems that have the skill to invest in it. So let's go to the next one. Uh, again, another interesting application of technology. If you're wondering, this is a very slow news cycle. August. It tends to be slow. A lot of people on vacation, uh, not a lot of, uh, announcements coming out. So, uh, I'm really focusing in on three things and, uh, I'm also, again, I'm still on the road two weeks straight of being on the road, doing a client, uh, work.

Bill Russell: 11:27 And so I am again, broadcasting over the weekend from outside. So, uh, this story is from Georgetown University Medical Center. Virtual reality training helps medical students develop real empathy, fascinating use of this. So imagine your favorite grandmother is showing signs of dementia. She progresses from forgetting who her son is to forgetting what day it is. And she's supposed to host Easter dinner. When your family arrives that day, doesn't seem to recognize you. She's still in her bathrobe and hasn't made her traditional stoop or her traditional Su. Um, well what's it like for her? A new virtual reality software is allowing students at Georgetown University School of Medicine to get a better sense of what aging parents, aging patients experience. And to see the decisions and emotions that patients and their families may face at the end of their lives. Using a virtual reality headset and m a embodied labs software students enter the body of the patient who is experiencing one of three conditions, macular degeneration, hearing loss, uh, cancer and end of life or memory loss.

Bill Russell: 12:33 Uh, users watch and participate in a three d video as the patient's family members talk to them and expect them to respond. And here are the thoughts of the person whose body they're in. The aims to teach empathy said Linda Van Keuren, assistant dean of resources and access management at the doll granite memorial library. Uh, the graduate health. And Life Sciences Research Library at Georgetown University Medical Center. We think it's a unique combination. Uh, for instance, in the dementia center scenario, the viewer sees how difficult the experience is for the patient as well as the children who are slow to realize that Alzheimer's disease is affecting her in part because it's hard to let go of their expectations of who their mother is. A Pamela Saunders Phd who directs the two week clerkship, says software helps students get exposed to different medical conditions and exposes them, uh, so that they can see the limitations of things like macular degeneration.

Bill Russell: 13:26 Uh, there's that hole in your vision and you're moving all your, your head all over the place to see, uh, to see a specific spot. It's hard to imagine what it is unless you get that opportunity to use this type of virtual reality software. Saunders said one of the clerkship participants wrote afterward that because of the vrs great, a greater in interactivity, the student felt a stronger connection to the patient's family members and could see how patients might be saddened by the effect of his diagnosis has on them. Uh, the kids compare it to the magic school bus. If you can remember that, uh, said Angela bar reference in digital information services coordinator at the, at the library. Many of those kids have not had any experience with virtual reality before, and most of their responses are quite enthusiastic.

Bill Russell: 14:15 Uh, this is a great use. Um, this is a phenomenal use of virtual reality. Uh, you know, this is the one thing that's really hard to teach either, uh, people, um, come to healthcare with it. And most people in healthcare do you have a strong sense of empathy? Uh, but this is, uh, you know, this is really interesting and it's, it's something I think that will help, uh, future generations that'll help me, uh, potentially with my kids to understand their, uh, grandparents and what they're going through. There's a lot of practical application for this. Uh, we'll see, uh, w we'll see how it expands over the, over the coming years. And I look forward to really more virtual reality type use cases. You know, one of the use cases I think was, uh, we, we took a look at it a little while ago, I think it was UCLA. Others were using it really around macular degeneration, virtual reality headsets to, um, or augmented reality was actually enabling people with macular degeneration to see, because it was able to bring in those things and to focus the eye on those things.

Bill Russell: 15:20 So a lot of great use cases, uh, just around the corner for virtual reality. I hope we can tap into them. Um, you know, it was interesting, I was out on linkedin and it seemed like every other post was our hospital was the u s news and World report best fill in the blank. And, uh, there was, I'm not exaggerating, there's probably about 20 of these on a, on linkedin and when I sort of tooled around, so I thought, you know what, it would be interesting to do a little bit of a dive into this to a, to c, you know, what's the value of the u s news and World Report, uh, top list and it doesn't really make a difference in and who's really watching and who really cares. Now this might sound cynical, but in my research I found it really does matter and it's really interesting.

Bill Russell: 16:07 So, um, you know, first, first thing you need to know is there's a lot of lists. I mean, US news is just one of them. You have health grades, you have, uh, let's see, you have blue cross does one care checks does one. Um, healthgrades, I think I already mentioned you have leapfrog, you have a l LGBTQ, you have uh, Parkinson's does one, you have presganey does one. Um, it's uh, you know, so you can understand how I start off. Watson, uh, does one as well. You can understand how I start off and I'm a little, and actually this list goes on and on. Holy Cow. There's, there's just a ton of these lists and a, so if you don't get on the u s news one, tried to get on another one so that you can, you know, publish that in your community. So there's part of me that was a little cynical because you see these lists all the time and, uh, you know, every hospital has their little banner that says, you know, we're, you know, top on Watson's lists were top on.

Bill Russell: 17:09 This list were top on that list. Um, and I thought, you know, do, do hospitals really care about this? And then I found this story. Uh, so, uh, and this is recent. This is, uh, from August 1st, 2019, Duke University Hospital falls out of nation's top 20 hospitals. Uh, and this is from the, uh, the Duke Chronicle. So this is in, in Carolina, in that community and said, Duke University Hospital did not make the cut for the u s news and World Report. 2019, 20 honor roll. The best hospitals on rural evaluates hospitals, performance and medical procedures and specialties. According to the Tuesday news release that announced the rankings, this year's honor roll included 21 hospitals for more than 4,500 facilities, but it did not include Duke University Hospital last year. The hospital said at 19 barely making the honor roll. It was deemed to be the 17 best in the country two years ago as a health system that prides itself on continuous improvement, we are not satisfied with the results of the 2019 20 us news and World Report, best hospitals rankings.

Bill Russell: 18:10 But we also know that they are not a comprehensive reflection of the outstanding care that we provide to our patients. Every day wrote Thomas Owens, president of Duke University Hospital and an email to the chronicle. You know what's interesting to me, first of all, it matters. It got written up in this way. I mean, you fall out of the top 20, uh, you're known as a prestigious university and, uh, you, uh, drop out. Uh, I, I think it matters. I think it matters to them, to them, and they're sort of communicating that it matters to them. Yes. It doesn't reflect the fact that it doesn't reflect on the people of Duke University Medical Center. They provide a phenomenal care for their patients. Uh, but the prestige of the university takes a hit and the prestige of the hospital takes a hit as a result of this. So it does matter. And people, um, you know, and people especially, uh, people who work at the, at the institution, uh, do care about these things.

Bill Russell: 19:05 Uh, let's see. I another thing which, you know, do people care about these? In October, St Anthony Hospital in Chicago sued the leapfrog group claiming an organization knowingly used inaccurate information to downgrade it safety grade from an a to c. The safety net hospitals said it repeatedly press leapfrog to correct the score before the report's release date and said the group's failure to respond and magnitude defamation leapfrog eventually took a St Anthony off the website. The lawsuit has since been dismissed. In another case, the Ohio plastic surgeon filed defamation lawsuit after a patient wrote an anonymous online reviews criticizing the doctor's work. Um, you know, these reviews and these rankings, uh, means something. And I think hospitals recognize that they mean something and the fact that, you know, people are shopping a little bit more and people are paying attention a little bit more, uh, to these kinds of things.

Bill Russell: 19:55 When they have a choice, they, uh, they're taking them, uh, very seriously. So, um, the next question I had was, does it matter if I go to one of these hospitals versus one that didn't get ranked? Does it matter? And sure enough, uh, the Jama Network has actually done a study on this. Uh, I'm going to skip to the results cause it's uh, uh, I'm already past my 20 minutes here. So the results, 30 day mortality rates at top rank hospitals compared with non ranked hospitals were lower for a whole bunch of, uh, cardiovascular, uh, uh, conditions, which is interesting. However, 30 day readmission rates in the top rank hospitals when compared to non ranked hospitals were similar. So, um, and patient satisfaction was higher at the top ranked hospitals compared to the non ranked hospitals. So it turns out that the rank hospitals actually do perform at a higher degree in some cases, maybe not, not everything.

Bill Russell: 20:53 30 Day readmissions are not so much. Um, so u s news last thing on this. So u s news published, they made a whole bunch of changes this year as a response to the industry. Uh, they included a patient centered outcome measures. They included patient experience data. That's what I wanted to point out from this uh, part. So patient as previously announced, uh, we incorporated a measure of patient experience in all 12 data-driven specialties, drawing on data from Federally Mandated Hospital Consumer Assessment and health, uh, h caps surveys a positively, uh, a positive patient experience is a crucial element in maximizing patient-centered quality as it has been shown to correlate with better objectives. Uh, and they did some risk adjustment change, a new definition of volume. Now our inclusion, uh, in criteria, orthopedics and other stuff, um, I wished they weren't using h caps. I think h caps is a f, uh, you would never use something like h caps in another industry.

Bill Russell: 21:52 It's a, it's a pretty weak, uh, measure of patient experience. But alas, it's, uh, one of the, uh, measures that we probably have the most information from. So, uh, that's why they're using it. So anyway, they made these changes as a result of the industry. Uh, new process measure, additional outcome, a certain ratings, uh, removal of magnet. So, uh, so now, drum roll please. Um, US news and World Report on Tuesday releases 30th annual, uh, best hospital ranking with Mayo Clinic topping the publications honor roll for the fourth year in a row. Uh, I'll skip a bunch of this stuff. Let me, uh, you know, it's, uh, it's looking at cancer, cardiology, diabetes, ear, nose and throat, geriatrics, uh, gynecology, gastro, uh, gastroenterology, neurology, GI surgery, nephrology, urology. You get the, you get the picture. So you got mayo number one, Massachusetts general number two, uh, Hopkins number three, uh, Cleveland Clinic, a New York Presby, a UCLA, UCLA Cedars, uh, NYU, Northwestern medicine.

Bill Russell: 22:56 There's your top 10. Uh, and then you have some great hospitals just beyond that. Uh, University of Michigan, Stanford, uh, Brigham and women's, uh, Mount Sinai UPFC, uh, Presbyterian Shadyside, uh, Keck hospital, USC, uh, u w, uh, Madison, Wisconsin Hospital, University of Pennsylvania. Uh, Penn Pro Presbyterian, uh, Mayo Clinic, Phoenix while Mayo Clinic got there twice, uh, number one, uh, for obviously, uh, there, uh, Rochester, Minnesota location. And then number 18 for their Phoenix location. And then you had two, two tied at, uh, number 20. You had Huston Methodist Hospital in Houston and the Yale new haven in Connecticut. Wow. So, uh, you know, we're going to end on that. That's about 20 minutes. Uh, that's all for this week. Every Friday. Check out our interviews with industry influencers. I keep the comments coming. I love them. [email protected] Good, bad or indifferent. It all helps. Hopefully make a better show for you. Helps make sure I'm talking about the things that you care about. The show is a production of this week in health it for more great content. You can check out our website at this. We can help it.com or the youtube [email protected] slash video actually this weekhealth.com gets you there and a just click on the video link. Thanks for listening. That's all.