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Welcome to this Week in Health It where we discuss the news, information and emerging thought with leaders from across the healthcare industry. This is episode 51. This is a special end of the year episode, actually the first of four episodes that captures the best of the first 50 episodes from 2018. A little reflection on the past year and what our awesome guests have shared with us.

More on that in a minute. This podcast is brought to you by Health lyrics, be a market leader. We help you to clarify your health IT plan. Eliminate confusion, align your work experience breakthroughs. Visit health lyrics.com to schedule your free consultation. My name is Bill Russell. We're covering healthcare, c i o, writer and advisor with the previously mentioned health lyrics.

Okay, here's what we're going to do. I have four end of the year episodes for you, the CIOs, the the Innovators, and the Top 10 episode. We're gonna end with the top 10 episode. Um, what an amazing group of guests we've had this year. It is so hard to narrow down the content. Uh, for the end of your shows, my production staff and I have been working on this for several months.

I, I really do hope you enjoy it. Uh, couple quick thi quick things, couple things about the show that you may or may not know. Uh, we don't make money. We're not trying to make money. In fact, quite the opposite. Uh, we do have a sponsor. However, the sponsor is my company Health Lyrics. I own the company, which means I sponsor my own podcast.

Uh, we have two young and talented people working on our production team. Uh, I really could not keep up, uh, without them. Most of the videos you see on the social media are produced by Justin Russell, and, uh, most of the website work on both the Health Lyric site. And this week in Health it are Curated by Holly Russell.

Uh, we started the show and continue the show for the next generation of health IT leaders. I have a network of some of the smartest people in healthcare and, and really outside of healthcare as well for that matter. Uh, I get to have fantastic conversations with them about so many relevant topics. I know that most IT staff will not get the opportunity to interact with these leaders.

I. I wanted them to benefit from their experience and expertise as I have. So, uh, here's what we do. We just get on a Zoom call and we record our conversation, uh, to guide the conversation. We've come up with three different formats. Our standard show is a, a news and questions kind of, uh, we cover some news stories and I ask them a series of questions.

Uh, our deep dive episode is, uh, another of the forms. This is where we go deep on a specific topic. . And, uh, finally we just introduced a new show last week, which we were calling our case study episode. A case study is where we create a fictional health system and we present our guest with similar problems to the ones that our listeners face.

And asked them how they would solve those challenges. Dale Sanders was kind enough to come on our first case study episode, and we had a blast. Uh, it went a little long, probably over an hour, probably a little long for what we're trying to do here, but, uh, it was such great content. And the genesis for that was, uh, you know, we did an m and m and a kind of case study with che.

We did, uh, uh, first 30 days of, of being a C I O. Case study with, um, with Ed Marks and that just, uh, we got such great feedback. We decided, hey, you know, we're just going to have a, uh, an episode format called the case study. So I hope you enjoyed that. Love to get some more of your feedback on it so that we can fine tune what we're doing.

Okay. Just a little background on the, on the podcast. The first episode, uh, aired in January of 2018 and it was downloaded 28 times during the first week. That's right. 28 times. And, uh, I think half of those were from my family members. I. And my really close friends trying to figure out what the heck I was doing.

I recorded the first episode on my iPhone using the Voice Memos app. It was highly technical and, uh, you know, high tech. It was just essentially me talking about the show and the JP Morgan conference, which I had just finished attending that episode, has since been downloaded over 200 uh times. The show now gets between about 700 to 1500 downloads per week, uh, for the audio, and many of you tell me that you haven't even visited the podcast, that you just wait for the video clips to show up on YouTube.

LinkedIn and Twitter, and that's how you've been picking up on the content. And, uh, and, and those get thousands of hits, uh, every week. Um, and so the, you know, my goals for this year were pretty modest, uh, to prove that there was value by getting about 500 consistent listeners every week. Uh, we've exceeded that goal.

Another goal was not to miss a week of production. This was a little bit harder, 52 straight weeks of the show. And, uh, we produced a show. Through vacations, through my kids moving through, uh, and, and through my day job. Uh, not the least of which, uh, we've had guests cancel at the last minute and other wonderful, uh, challenges to overcome.

I had to do one show without a guest and when my guests actually canceled on that Friday morning. And as you know, we, we, uh, put the show out on Friday and the guests canceled on Friday morning, which is understandable given. The caliber of guests that we have on the show. Sometimes they're called into board meetings and, and, and those kinds of things.

And so, uh, so I went in alone. I talked about four different news stories, uh, on my own, not my favorite way to do it, but, uh, the show must go on, as they say. So, 52 straight weeks of production, uh, was a goal. And, uh, and we've exceeded that. So, Actually we're close to exceeding that. We have to do one more show.

Uh, and these end of the year episodes will take us through that. So I want you to know that your feedback has been extremely valuable, uh, to shape the content and provide encouragement, uh, to continue the work. If you want to communicate, just to let you know, if you want to communicate with me or the show, you can always email us at, uh, bill at this week.

In health, it, it's just the easiest way. Um, it's not a huge staff as you understand, and I will read each one of those emails. Um, okay. Uh, enough reflection on the show. Uh, today we're gonna start with the innovators. So this is the Innovator show. You remember, we're gonna do innovators, clinicians. CIOs and then we're gonna do the top 10, uh, episode, and that will be the last episode we do for the year.

Now, you know, innovators, all of our guests really are innovators. There's no doubt about that. But these are the people that have either started their own company or are in instrumental in developing solutions for healthcare that are . Um, new or, um, based on some new technology that is presenting itself.

So here we go. Um, first one, Charles Boise is the Chief Innovation Officer for Clearsense, an AI and machine learning company. . Uh, Charles has a clinical background and he is a data genius. Um, you know, uh, my interactions with Charles, the, the one thing that strikes me about him is I can't believe he is as humble as he is given, uh, all that he has accomplished and how smart he is.

So the first two clips are really about gaining AI adoption in healthcare. Uh, AI being artificial intelligence and how to introduce AI to your clinicians. So, uh, here goes, the first one is about, uh, using AI as a cognitive trigger and not a club. And the second one is on, uh, how we gain adoption within healthcare.

I. So, back in the late eighties or early nineties at, uh, at LA County, U S C, I'm, you know, I'm also, you know, a trauma nurse and whatnot. We did a lot of predictive models and so forth. I worked with a Dr. Williams Shoemaker, who started the Society of Predictive Care Medicine. We actually built predictive models that, uh, uh, for patients in, in trauma that would predict, depending on the therapy, what the outcome would be.

Uh, we made a really big mistake back then. We call it prescriptive analytics. The clinicians went nuts. Uh, they didn't want a machine telling 'em what to do. Um, and this is really what this article is all about. And this is, you know, this is almost, oh my gosh, this is almost 30 years later, right? So, um, so again, with AI we can build out, you know, beautiful models, um, that.

I would like to say can assist. I like to call it intelligent assist. To be honest with you, I don't like the idea of using this technology to tell somebody what to do. Um, I'd rather produce a cognitive trigger, and this is what is described in the, in the article. If, um, I can give you a heads up that something's going on.

That you may not have been aware, aware of, that's fantastic. Then you can, you know, make a clinical decision and, and move forward. And now gaining artificial intelligence adoption with the clinicians. How do you get, how do you get that adoption? And really, this article really points out that there needs to be an adoption.

And the really, the way you do it is you don't black box any of this stuff. Uh, many folks out there have, you know, their models or their proprietary models and you know, this, that and the other thing. You've gotta show how you got to, you know, how you got to, where you got what you used, what weight you.

Was it a neural network that was employed? Was it random force? What did you go through all the way through the process to get to the point that, um, you're at now? And how accurate is, how accurate is it? You know, do you have an r o c curve to show, um, you know, the, the, you know, the various matrices and so forth?

Um, what's the precision, what's the recall? You have to be able to demonstrate that, and you have to be able to demonstrate with their data. And, um, you really can't make statements like, you know, uh, you know, this model will work everywhere. 'cause they, they won't, they're very geo geospecific. What works in Southern California isn't gonna work as well in Sarasota, Florida.

It's gonna need some tweaking because of the demographic nature and even some of the, the external factors. So it's interesting to watch these old clips to see how our production has changed. We like just cut things off right at the end. Um, yeah, great insights from, uh, Charles Boise. . Okay. We're gonna continue.

And, uh, our, you know, the, the next couple of videos I'm gonna share with you is . Uh, interesting from this perspective. It's from, uh, Dr. John Halamka, c i o, for Beth Israel Deaconess Medical Center, and, uh, so many other titles that go along with, uh, John. Um, and most of our listeners know John. He is a frequent speaker, guest, blogger.

Uh, he is out in the community and really a leader. Um, and one of the interesting characteristics of John is he shows up in all four episodes. So he will show up in the innovators . Episode, the clinicians episode, the CIO's episode. Uh, as well as one of his clips got into the top 10. So we're gonna share that.

If you're wondering, none of these clips that you're gonna hear today are in the top 10. And I, I pulled out the top 10 clips, uh, to be, to standalone on their own. Uh, John came, uh, came on the show twice with us this year. It was phenomenal, uh, to have him and we really appreciate his time. He, uh, In the first clip here, he's gonna share, uh, his work with the Gates Foundation, which I find just fascinating what they're able to do with technology in, uh, in Africa on, you know, your, your standard flip phones, uh, using blockchain, moving the, uh, technology around.

So I'll let him explain that a little to you. And then the second . Is a really just a wildly innovative, uh, solution. When John and I got into a back and forth on cloud computing and how it could be applied to healthcare, uh, he gave me an example of how, uh, using Amazon and, uh, you know, and essentially a credit card, they were able to, uh, gain a significant amount of efficiency in their or.

So here are the next two clips on the show, John Halamka. Last time you were on, we talked, uh, you shared about the, uh, gates Foundation, the work you're doing in, uh, in Africa. It it, can you give us an update on, on what's going on there? Sure. So the challenge in South Africa, 65 million people, 16% of the population is H I V positive and the challenge of coordinating care across what is a very heterogeneous country, right?

There's urban, there's rural, there are issues with infrastructure, network bandwidth is expensive and slow. And identity management, who are you, is actually a challenging question because names are misspelled. Workers move around. So with the Gates Foundation, we took the the process of care delivery and broke it down into several, what I'll call APIs or core functions.

So core function one. Who are you? So we'll do identity management and we'll do it based on biometrics because name, gender, date of birth, match doesn't work so well issue somebody identity cards, hard to know, but biometrics, if I say I'm gonna take, you know, fingerprints, ican, you know, retinal or IRIS, um, palm vein geometry or whatever.

Is the biometric of the future, but build a system by which I can link your data by biometrics. That's an interesting infrastructure. So sort of a p I. Number one is a general biometric infrastructure, and we've deployed that. In the right to care clinics and now can tag your H I V laboratory data to you.

So you just walk into a right to care clinic and it says, ah, here are the last five viral loads that you've had showing your medication is working very well or not. So those are problem one. Problem two is how do I share the data with a patient, right? As we'll talk about, I'm sure there's this increasing trend in the US of patients getting access to their own data, their notes, et cetera.

Well, hey, bill, do you have an iPhone 10? Well, imagine that in South Africa, my lowest common denominator is the Nokia flip phone you had in 1997 running on A G S M network. Maybe. So we've had to create a medical wallet for the patients that runs on a feature phone over very low bandwidth. And that's, uh, something we've deployed.

We did a lot of usability testing and keeping a, a good number of folks in South Africa on the team really helped us what the needs assessment was. And then the final question is, how do I deal with population health and data aggregation and look at variations in care quality and understand trends? So what we're working on currently is, is how do you expand what our early work on biometrics and this, uh, medical wallet to something that's gonna help for countrywide population health analytics.

And that of course could be machine learning. And it could start in South Africa and scale to other countries. So what's the platform? So we're starting to think through that. The great thing about the cloud is that you could, you literally could fire it up this afternoon with a credit card and you're totally right.

So when I talk about the machine learning applications we've deployed, they're literally like written in a weekend. And so here's another example. I built an A P I into our OR scheduling system, and I now have access to millions of previous or cases doctors and patients. I don't use the names, that's not important, but the patients say, what is the procedure or what is the comorbidity?

I. So what if you say, Hey, Amazon, um, bill needs an appendectomy. How much time should we allocate? Well, oh, bill is a 53 year old person with no comorbidities, and the surgeon is Dr. Famous who's done a million appendectomies. The answer is 25 minutes. So we just did that and what did it do? It freed up 30% of our OR schedule.

30%. That is just amazing. Okay, I'll, I'll be honest with you guys. There are times where, um, I send out invites to people that I didn't really have a relationship to, uh, with prior to doing the show. And one of those people was, uh, Daniel Kraft. Now I had met Daniel, uh, before and we had some mutual friends.

Uh, I met Daniel at the Exponential Medicine Conference. Down in San Diego, which is a phenomenal conference. If you get the opportunity to go, uh, you should do that. Um, and we had some mutual friends and I put out the invitation for Daniel to come on the show and he agreed. And uh, I was really excited.

Let me see. His title is Physician Scientist and Chair of Medicine at Singularity University. And exponential medicine. Uh, he is a, a fascinating individual, a physician who just, uh, is on the cutting edge talking to all sorts of people around the world on what they are doing, um, in the area of exponential.

So the first clip here is to explain what exponentials are, and I'll let him do that. And then the second is a, uh, I thought an interesting conversation I had with him. On augmented reality, just one of the many ex exponential technologies that he's following that he talked about on the, uh, on the episode when he came on.

So here's Daniel Kraft talking about exponentials in augmented reality. Just an idea of how exponentials. Uh, are going to address some of the biggest challenges we have in healthcare. We have, you know, cost access, fragmented care, uh, care variation, uh, even within our communities in the us but care variation around the world.

Uh, how, how does, how does exponential start to change that paradigm? I, I think in a sense, you know, there's lots of challenges and healthcare is kinda like politics. It's a bit local, so, you know, so many different healthcare systems, as you know, might have different challenges and needs. Some, which are overlapping.

I think where it provides. The biggest opportunity is to move from, you know, again, somewhat buzzwordy. We want personalized and precision medicine, but in reality today we're still practicing. One, one size fits all, uh, medicine off the same dose of statin. We start with you're managing a patient with hypertension or diabetes, starting with the same drugs, trial and error, broken feedback loops still communicated by fax machine, uh, in many cases.

Um, and so the opportunity now to take the. Increasingly exponentially more available, accessible data, you know, whether it's our digital exhaust that can be picked up by our wearables or our smartphones or our connected mattresses, and start to connect that into our healthcare system. And, and as you discussed in prior shows, kind of meld that information.

So understand what it means, what it, what does it mean If my, my Fitbit or my mattress sensor tells me that my resting heart rate are only 55, but it's last couple months, it's creeped up to 75, something might be happening. How do we take that baseline of data, data like barely is doing with the baseline trial or now that all of us trial out at nih and start to understand what are some of these new biomarkers, digital, omics, uh, social metrics start to mean and be then much more proactive and start to shift our sick care system to more of a, of a healthcare one where we can utilize this.

Sometimes overwhelming amount of data and turn it into proactive, useful information that fits into the workflow of the poor of a work clinician. There's some great solutions already here today, but they're not being utilized for reimbursement issues or, or someone moving someone's cheese, you know, uh, turf battles.

Um, there's a lot of other elements beyond the technology itself, the incentives, the user interfaces that need to be put together as well. And now augmented reality. So augmented virtual reality, uh, you know, we're seeing just some really neat use cases at, uh, at Cedar-Sinai. I know they're using it. Um, and, and, and other health systems are really using it to sort of almost reprogram the, the, the brain, uh, as you know.

Just, um, talk a little bit about that. I'm sitting right across the room from me. I already have my antique, uh, um, Oculus, uh, device from Facebook. Um, and I barely ever used that one. It's connected to, you know, it was $600 originally, I think it's now $200, but I had to get the, you know, $2,000 fast computer.

And then just two months ago I got the Oculus go. It's the same basic form factor, but now I can take it on an airplane. It's really fun to give demos and put people on their first rollercoaster ride. But, uh, work's been at Cedar-Sinai, led vibrant and. Is really catalyzing use of VR and AR and XR extended reality across so many different areas.

Um, As people Google up, I gave a, the keynote at the augmented, uh, vir, sorry, the virtual medicine conference that was held at Cedar-Sinai last spring. And, you know, some great examples of now taking these often gaming platforms initially catalyzed by the gaming world. And, you know, the, the, the reality engines in there to now enable you to create an environment for someone in pain, for example, to be in a cold environment through snowballs and penguins.

And that has been shown to reduce, uh, the need for opiates, for chronic, uh, for acute. Chronic pain patients. There's obviously the use of VR and ar now in surgical training. Some very exciting startups from, uh, oso vr, for example, can take a, uh, an orthopedic surgeon. Put them in the virtual operating room, give them the actual kit from Stryker or another orthopedic company.

Let them practice with essentially the actual instruments on the patient or the fracture type that they're about to do a procedure on. So we, I was trained in a C one D one, teach one world. It's gonna be a future of C one sim one, sim one one, until you get it right and often simulate that . Exactly, exactly on the anatomy of the patient you're about to operate on.

Yeah. And then there's obviously augmented realities, which can be used in a variety of ways of several interesting companies and academic groups. Blending that so the surgeon can see through the body, uh, or blend that with robotic surgery, um, all the way to patients to, to improve their gamification of, uh, recovery from physical therapy can make it much more, uh, empower empowering.

And so I think that's a great example. A field that, you know, five years ago you could have bought . An Oculus type thing for $5 million. Now it's essentially, um, $200 available on amazon.com. And these systems are being democratized, where, where folks around the world you don't need, need to be an academic center or you can be in Timbuktu and be programming for these and, and, and, and selling them online and even doing virtual trials that could accelerate the use of VR and AR and XR in, in a variety of ways.

Exciting stuff. Okay. Um, you know, sometimes I, I have people on the show. That I, uh, have interacted with . Uh, you know, many times, and I just enjoy their company. Actually. A lot of people fall into that category. Uh, Anne Weiler's, one of those people. She is the, uh, let's make sure I get her. She's the c e o and co-founder for Well Pepper.

In fact, uh, if you haven't heard her story, it's really, uh, kind of compelling how she started up Microsoft, uh, through an incident that her mom had and, uh, really trying to . Coordinate her care plan and got motivated to, uh, solve that problem. Started well, pepper, and, uh, it's really going well. They have, uh, a lot of, uh, Uh, really, uh, great announcements this year.

Some work with Mayo and some, uh, some new client work and, uh, and just really enjoyed my conversation with her. Uh, a couple of things I'm gonna highlight here. One is, uh, she sort of encapsulated what some of the big tech companies were doing, uh, in the space this year. So we talked about Google, Amazon, other things, uh, topics that continue to come up on the show because it's, uh, so prevalent in the news.

And I thought she encapsulated a lot of that. Uh, really well. And then the other thing I asked her was around, um, the second clip, I asked her about what makes a good healthcare partner. I know a lot of these, uh, innovators and tech startups struggle to really be successful within the healthcare environment.

The cultures are so dramatically different and sometimes plugging them in, uh, together is really hard. So I wanted to hear from, uh, the innovators. . Um, what really makes a great, uh, partner for them and, uh, makes their projects go, go well and gets their technology implemented well within the health system.

So here's Ueler sharing, uh, two, uh, two things. One, uh, what the big tech companies are doing. And second, uh, what makes a great healthcare partner? That's the, the age old problem. I, I'm gonna throw out a bonus question here, just 'cause I'm curious. Your thoughts, you know, big tech, uh, players coming in, doing things.

Amazon, obviously they have, uh, not only their acquisitions, but the J p m Berkshire thing, you know, Microsoft, uh, re-engaging in healthcare, uh, a couple years ago and, and still moving Google, whatnot. Of the big tech health, uh, moves that are going on, who's gonna have the biggest impact? I don't, honestly, I don't know who's gonna have the biggest impact.

Google's taking a lot of Betts, they've got DeepMind, they've got Verily, they've got Onduo. Probably a whole lot of other things. I'm not thinking about the baseline study. Um, so if if even one of those pays off, it'll have a big impact. Um, I think everyone wants to Amazon to have a big impact so that we all get better customer service in healthcare.

Um, but then thinking back to the beginning, I, I don't know that I would rule out China. I think there, we don't know. At least I don't, I'm not paying a lot of attention, but there's, they can do things with a lot less regulatory and they're very incented because of the population and the fact that the government is, you know, needing to provide care for this population.

So I think you know, it, it's exciting. I love seeing big tech and consumer-focused organizations taking a swing at that. This I agree. Um, but I don't know who's gonna win. I think. We'll, hopefully we'll all win. . Second question. So what, what makes a great health system partner for, uh, for a digital health startup?

Well, you, you actually just said it. Uh, it's that understanding the bigger picture vision and knowing where to plug things in. Because we're not coming in saying we have to be the only system. And in fact, you know, we're not the system of record, but we have a very important part to play in helping patients.

So wherever we come in and they see. The vision of where they need to get to, even if it's not to get there today, and they can see that, you know, today we may deploy like this specifically for these scenarios, but in the future we're gonna be part of a larger ecosystem, a larger overall digital patient experience.

That that's a great partner. So anyone who comes in says, yeah, we're going this way. This is a, it's inevitable that we're going to interact, do all of our patient interactions digitally. Not all of them, but like that there will be a consistent patient digital experience. Right. Tho those are the easiest ones to work with because they can also look at us and know that they're not gonna get backed into a corner because we have an a p I, we have microservices.

You know, you can deploy us white labeled, you can deploy us part of a larger system. Um, and budget budget's. Budget's always really helpful. Yeah. Um, yeah. Um, people, people with a budget and a problem to solve, uh, tend to be, I. Uh, and a and a sense of urgency tend to be great partners. Okay? If you're in healthcare long enough, you're gonna run into some phenomenal people.

And one of, uh, one of my favorite people, and I know I'm gonna say this about a bunch of these guests, but one of my favorite people is Anise Chopra, who is the, uh, president for Care journey. He actually worked in the, uh, Obama. White House and, uh, has been instrumental in a lot of, uh, things that are going on behind the scenes.

Uh, in healthcare. He's, uh, he's, uh, an influencer within the industry. Does a lot of speaking, especially on the area of, uh, uh, data interoperability and, uh, And, uh, so he, and he came on the episode one of the early, uh, episodes and we talked about a handful of things and he so articulate that he is going to get three clips on this show.

Uh, the first is around health interoperability and what we're doing in that area. Uh, the second was this, this whole concept of the rise of the digital experience officer. So, Uh, there's just new roles that keep popping up as, uh, healthcare starts to realize that it and digital are completely different.

Not completely different, but, but different, uh, served by the same technologies, but just different focuses and different, uh, outcomes. And so, uh, Anish and I talk about the rise of the digital experience officer. And then, uh, finally we talk about . Uh, something that we're all looking forward to, which is, uh, applying internet economics to, uh, to healthcare and healthcare innovation.

And we believe that things like fire and advances in interoperability. And APIs and the work that Apple's doing and the work that Amazon's doing and, and Microsoft and others, uh, is really gonna lead to this internet economy, uh, this digital economy, uh, really exploding on top of healthcare and, and, uh, and we're looking forward to that.

And so here are these three cliffs from a niche interoperability rise of the digital experience officer and, uh, internet economics on top of healthcare. Uh, SEMA Verma came to, uh, himss. She did, uh, my Healthy Data initiative. She did the Blue Button 2.0 initiative. Uh, do you wanna give us a little, little background on the two of those and, and where?

Well, let me begin by saying, uh, the announcement that she made, uh, couldn't have been more bipartisan, or maybe we would call it non-partisan. Uh, if you removed the, the voice of CMA or the Voice of Jared and simply read that presentation, uh, without knowledge or context as to who might've delivered it.

You could have imagined anyone from the Obama administration carrying that message forward. So this is really building on progress and really pushing it further and faster in a direction that it desperately needs to go. So that's why you saw me applaud, uh, a great deal of the work that was done. Uh, the big message I would say is that the healthcare, uh, delivery interoperability strategy that I mentioned before, the B two B model was built on the foundation of, uh, HIPAA authorizations where you.

You may share, uh, you're allowed to share, but it doesn't compel you to share. So you could put a request in as a physician, Hey, I've got this patient. Could you send me the records? And if they chose not to respond, then you wouldn't get the data. But they were legally allowed to respond. And so we had this framework of you might be able to share, but you didn't, you didn't have to.

What Sima's saying is that the other half of hipaa, the individual right of access. It doesn't mean you own your medical record bill, it means you're entitled to an electronic copy and in a readily producible format. These are words that are gonna come into play in the a p I discussion. So Sima basically said, I'm gonna pivot and embrace information exchange tied to that consumer's, right.

And that I think is the kind of sea change that naturally is a progression of where we learned as we went. And that's the model. I think that's gonna carry lowest cost, highest data liquidity, because it is a legal right to request a copy in a readily producible form. And she built on that. Well, let's, let's talk about, so this show, uh, originally did this show for CIOs to share with their staff so they could stay current?

Let's, let's get into a little bit more of the technical aspects. So you have Tef, you have what, what does a, what does a c I o tell his organization or what does, um, you know, what does the, the, the, the. Uh, frontline staff do with tef, FCA and fire. And, and where, where should they start and where are we at?

So, uh, this is a conundrum, which is, uh, you can either be a supply sider, which is your job is to envision the infrastructure that you're responsible for, modernize it and prepare for the future. Uh, the other is a listener and responsiveness to the clinical leadership. I'm generally on the side of listen first, which is to say there's a signal out there that you're hearing from frontline clinicians, from physicians that are involved in these new value-based models, and they're complaining about something, about the difficulty to do their job.

And of course there's general complaint, but then there's more specific complaint. I would like to know this at this time and this way so I can make a decision without, uh, weakening my productivity. So my sense is that if you start to listen, if you're the C I O and you start listening to the customer's needs in a manner that perhaps we don't quite do today, 'cause we make a single decision, I've gotta make a big E H R decision and I gotta maintain it, uptime security, that's its own job.

Now I'm listening and saying, well, wait a minute, I'm no longer deciding what . E H r to buy. Now I'm thinking what application might write on top of the E H R that might delight my individual care teams or clinicians and patients to have a better experience. So think of it like a digital experience officer.

That role, that listening function, I think is the missing link today, because what their job is to figure out what it is that people need or want, and then map it back to what are the underlying data assets that we have available. And if you kind of do your job right, you serve up the data in a format that allows a random app developer on the street who can do the day-to-day app development for that doctor and not crash your secure systems, or require you to allocate limited resources.

So are we finally at a point where the. Uh, I, I mean, that's an interesting distinction. I, I don't own my medical record, but I have access to it electronically. Yeah. Does that, does that create a new ecosystem where the, the Apples and the Googles and, and Amazon's and the others of the world, uh, can now say, Hey, the, the patient is the center of medical record, not necessarily the health system.

So now we can create, um, we talked about these ecosystems that I think will, will arise where the cloud providers will say, Hey, , If you as a patient want to give us your data, we can now add value to it, or we can now add other data to it and make it, enhance it and make it better. Uh, are we at a point where the, the patient is finally the, the, the locus of, of, of this, the, the medical record or we're not there yet?

We are closer. Uh, but what's missing right now, bill, is that delightful application that helps my mom and my dad on Medicare make the best use of that information. So we've got the plumbing technical standards, right? We've got a legal and regulatory framework that encourages it. We've got the cloud providers and others helping to facilitate adoption and use.

But that last step, Who's gonna help read my mom's, uh, Medicare blue button file and remind her when she should get care or where if she needs care, she can choose the right provider that meets the the needs that she has to have addressed. And my personal opinion, bill, is that this is gonna look a lot like the transition from pension plans to 4 0 1 Ks where we used to have these employer, uh, fiduciaries that would take our money and make big judgements even if we might have wanted to do something else.

Or someone else could have given us advice to have a better, uh, and more reliable retirement. The move to 4 0 1 Ks gave rise to companies that didn't exist. Or if they did, they were modest, vanguard and uh, uh, fidelity and others. So I think there's gonna be a new rise of what we'll call a health information fiduciary.

Who will work on the cloud platforms to do the plumbing of getting the data, but it is gonna be their last mile application that will help make sense of that information. So I can shop smarter for supplemental plans so I can navigate the delivery system more effectively and I can access and use the preventive services to keep me healthier.

Uh, a whole range of other things that we'll we'll see happen. Denise Chopra always leaving you, uh, energized and informed. My most recent guest is, uh, Dale Sanders. Dale Sanders is the, uh, I think president of technology. Let me look it up just to be, uh, . Correct here, president of Technology for Health Catalyst.

And Dale is a new friend. Uh, in fact, he's one of those people that I ask people who should I have on the show? And the most common answer to to that, uh, question was Dale Sanders. Uh, and, uh, so I, I reached out to Dale and he, uh, offered to come on the show and he has since, uh, been on twice this year. And I love Dale 'cause he is so technically adept.

He has such empathy for the clinicians and, uh, he has done such great work in the data space and his experience is, is phenomenal. Uh, he's been a c I O so he has a lot of different, different perspectives he brings to the table. He is, uh, so easy to talk to and again, uh, very humble. For the, uh, amount of experience and knowledge that he has.

In fact, all of my guests, I could say the same thing for. And, uh, in this clip, Dale and I talk about a modern platform for healthcare. We're really geeking out at this point, but, uh, I, I think it's a, it's a, it's a really good I idea of what healthcare could do if the E H R was this modern health platform, what it could do.

Uh, but we, uh, I think we both believe that it's gonna be outside of the E H R. And so, uh, here's Dale talking about that. What kinds of things would we look for in a modern e h R from that would define a, a technology platform that, that you think would work well? Um, it, I would say let's give the attributes of the platform and then.

You can spin off whatever you want to, including an e h R from a platform. Right. Once you have the data, then you've got the platform. There's like unlimited use cases with it, literally, right? Correct. And, and so you, you have to have sort of the abstract layer and the reusable content and logic, the curated data that's facilitated with APIs.

That's fundamental. In healthcare so that the application doesn't have to constantly do that. So registries, you know, core things like registries, um, uh, metrics, value sets, embedded machine learning so that it's not something that you do as an afterthought, but you can call an a p i and you can bind your data to a machine learning AI model without doing it externally to the application.

It's a natural part of the . Of the data first application, um, it certainly has to support real time. It has to support batch analytics, right? Yep. It has to be microservices based. Um, and there's a lot of debate about what does microservices really mean. We can talk about that, but it, it, what it means is continuous delivery, right?

No, more of the, I mean, what, remember back to the days when you had to upgrade an E H R. Uh, it was, um, it was a thousands of hours initiative that took months and months to plan and execute. And even then it was painful, right? As opposed to the microservices continuous release cycle that we see now. But, so lemme comment on that, by the way.

So this, the data operating system we have right now is microservices based, and we're able to push out updates to our apps and the platform now faster than the cultural. Ability of health systems is to adapt to it because the culture, you know, our IT shops are accustomed to very rigorous configuration control and release schedules.

At best, it's like once a month, generally speaking, it's certainly not daily. So that's, that's an interesting thing that's evolving back to the attributes of the platform. Um, it, it, the platform has to support the integration of text discreet and image data. You have to be able to support that and make that a natural part of the data ecosystem.

Um, I think I mentioned realtime streaming. It has to do that. Batch analytics. By the way, the, if folks wanna study this a little more, it's an easy study. Kappa and Lambda architectures in Silicon Valley are, um, the role model that we should all be following. Those design patterns are what is what we should all be following.

Okay, so we're coming to the end of our, uh, first of four end of the year episodes. This is The Innovators episode. Uh, the last two clips come to us from, uh, Charlie Lowed. So Charlie was, uh, has done a ton of work with Cleveland Clinic and actually a lot of health systems across the country. He was the co-founder of Explorers, uh, and Explorers.

Uh, You know, did a lot of, uh, really interesting big data work, uh, early on, and they sold to I B M a little while later. And, uh, since then, he's technically not in healthcare right now, but he's on the periphery. He's, um, he's, uh, co-founder of the Unified Project, and you can look that up online. And, uh, Charlie is always looking for what the next thing is in healthcare.

He's having conversations and so I like to, I like to tap him for just his, his ideas on startups and on new technologies. And, uh, Charlie gave me one of the most articulate answers on blockchain this year. And, uh, I realized that blockchain was over-hyped and so people don't want to talk about it so much.

But, uh, I think we are going to see over the next 12 to 18 months, uh, some solutions, you know, we're going through that trough and you're gonna start to see some solutions actually come out, uh, that are based on blockchain. It will be interesting to see how healthcare adopts. Well, Charlie gave us a really great answer on some of the use cases for blockchain.

Uh, the second, uh, second clip here is . Healthcare startup economics and Charlie just shares some great, um, if you are thinking of doing a startup, if you're thinking of, uh, or even evaluating startups. . He talks about the economics and how, um, people should be approaching it and how they should be thinking about the value that they add to healthcare.

So here are these two, blockchain and healthcare startup economics. So that's a great setup. So, uh, you know, distributed, so the nature of blockchain is distributed, immutable records, smart contracts. So I'm gonna give you five, uh, healthcare use use cases. And, uh, let's just go through, you know, um, You know, likelihood of happening and impact on healthcare.

So here are the five use cases, uh, provider licensing and credentialing. Do you think blockchain has application there? And then what would the impact be? I think it has incredible potential there. I, and, and it would've a big impact. Uh, the process of credentialing is, is slow. It's cumbersome, it's redundant, it's expensive.

Uh, if you're gonna get to a gee economy in healthcare, it's absolutely critical. Blockchain based, h i e based, uh, know between, well, actually between anyone, payers, providers, whatever. But blockchain based, h i e. What do you think? It could be the next generation of h i e. I mean h i e technology has, has struggled, right?

For a lot of business reasons, but some technical reasons. So I think it's got a pretty good chance there. Not as high as. Credentialing, but a decent chance, uh, medication, supply chain. A lot of talk about that. Uh, what are your thoughts on that? Yeah, the question is as to what degree the, the, the consumers really care.

Uh, you know, I've heard a lot about this in the food industry. Uh, I, I think it has publicly. I think it's really more regulational drive that though. Okay. How about revenue? Uh, revenue cycle and more specifically fraud prevention and auto adjudication of medical claims processing. That's another one I think will be a big opportunity.

Uh, you know, that, we all know that process today is fairly broken. It's extremely expensive. It's a big part of the cost of healthcare. So I, I, I'm bullish on that as well. Uh, efficient prior authorizations and referral through smart contracts. I don't know. We'll see. I think we've got some pretty good systems in place to do that today.

Uh, uh, maybe later, but that one doesn't come to the forefront for me. Uh, right now you've had a successful entrepreneurial venture in health. It. Um, so I really have two questions around this. Uh, what was the one thing that surprised you as you got into healthcare, and what's the one thing you would tell someone going into this space today?

I, you know, I think the one thing that surprised me getting into healthcare, not knowing anything about healthcare, Was how gracious and helpful the healthcare community was, particularly to me and, and Steve and others that didn't have experience with it, uh, about getting up to speed. They knew that we had something to offer from data, so you have to bring something to the party.

We understood big data, we understood different industries, but it is a good market to be in. Uh, a lot of really smart people, people that like to teach, and if you, if, if you give 'em the respect and, and, and be patient, uh, they'll do that. They'll coach you. They'll, they'll, they'll tell you what they need.

So that is something I really do love about the, the, the market and still do. Yeah. So what would you tell somebody who's just starting off their health tech firm and they're going into the space, you know, maybe something you've learned as they, as they get started on this, on this path. Yeah, I think, you know, understand the, the economics that's absolutely critical.

Um, you know, you have to follow the money. You have to understand how, how these models work because you can have a great idea, great technology, but if it doesn't improve the situation for the provider, for the payer, for the patient, or at least two, two of those three, uh, Know, it's, it's, it's gonna be a tough sled.

Well, I, I hope you enjoyed, uh, the Innovator's episode. If, um, you know, one of the things I'm gonna really encourage people, if you're listening to this podcast, share it with somebody. We, uh, I believe that this content is really valuable. I believe it's valuable to, uh, healthcare IT staff, to, uh, digital staff, to strategy staff.

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