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Should we grade healthcare on the curve? What is the real reason that Allscripts on Azure is a big deal? Why are healthcare startup investors in New York getting antsy? and Stephen Klasko from Jefferson Health welcomes us to a brave new world of digital transformation. 


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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. It's Friday, February 16th, this week chime. Cheers, bipartisan budget act, all scripts on Azure, and implementing a cloud first strategy. This podcast is brought to you by Health Lyrics, a leader in digital transformation in healthcare.

This is episode six. My name is Bill Russell, recovering Healthcare, c i o, writer and consultant with the previously mentioned health lyrics as it's going to happen from time to time. My co-host for today, uh, was called into an urgent meeting that makes the show, uh, a second priority, I guess. Go figure. So David Chow will be back with us in a month, but the show must go on as they say.

So I'm going to switch up the format a little bit and uh, I'm gonna take a look at four stories and skip the second segment where we talk about leadership or the tech talk, and I. We'll, we'll close out like we normally do with, uh, I guess my favorite, uh, social media posts for the week, or at least one. I, I believe, uh, we should, uh, should take a look at.

So here goes, uh, wish me luck. I. Okay, so in the news this week, I'm gonna cheat a little bit. I'm gonna start with a, uh, with an email I received from Chime instead of a story received this email, it was on the Bipartisan Budget Act. This is sort of an abridged version of what the, uh, What the letter says.

And there's, there's two things I disagree with in this, and one thing that, um, that I agree, uh, strongly agree with, so I want to talk about those things. There's, uh, an email from, uh, Kaus Earl Chair. Uh, The chime board of trustees, c i o of, uh, Kaleida Health. Uh, we are pleased to share good news about the Bipartisan Budget Act of 2018 that passed today.

It includes provisions to lessen the burdens of meaningful use programs and help expand access to to telehealth services. So let's take a look at this. So last July as chime, uh, then board chair-elect. I testified on a bill, uh, that removes the clause from the original high tech statute that stipulates the meaningful use program must be more stringent.

Over time, this language has been used to ju as a justification for the, for C M Ss to move to new stages and tougher measures In response, chime has often had to advocate for. Reasonableness to be applied to these proposed measures and objectives to avoid significant portions of our membership being penalized.

So I, I'm gonna stop there. There's, there's three main points here. It's this, it's telehealth and it's the, uh, opiate, uh, money that was, uh, set aside. So on this alone, I'm not sure how I feel. I actually, I think I, I, I don't like this. And, uh, primarily the reason I don't like this is essentially Chime is advocating to great on the curve.

While I understand how difficult it can be for some systems to, uh, meet the requirements for, uh, meaningful use and some of the, uh, some of the requirements have been crazy over the years and Chime has helped to really ratchet those back to something that was a little bit more sensible and actually, Uh, had an impact on the community health.

Uh, I, I don't like grading on the curve because at some point it's gonna be me in that hospital, it's gonna be my children, it's gonna be my grandchildren in that hospital. And I, and I don't feel good about the fact that it's being graded on the curve if the health system can't, I. Deliver on these things.

I'm not sure they can deliver on security. I'm not sure they can, uh, protect my health record. I'm not sure. Uh, they can ensure that the systems are gonna stay up while I'm, I'm on the operating room, uh, floor. So I don't like grading on the curve in healthcare. I think it's, I think it's a bad precedent. I understand smaller health systems don't have as big, uh, budgets.

But, uh, this is sort of what drives consolidation. If you cannot keep your records secure, if you can't meet meaningful use, you should be looking for a larger partner to, to fold into. Um, you know, and there's a lot out there that are looking to, uh, expand their footprint. They have very sound, uh, uh, it strategies they can make this thing work.

The, uh, I guess the other argument is, oh, it must be easy if you have a really large health system and you have money to, to meet these things. And I can tell you, as someone that had 16 hospitals and had to run this, it wasn't any easier for 16 hospitals than it is for, for one or two. It is, uh, it is very complex.

You're across multiple times zones, you're across, uh, multiple health systems, multiple, uh, governance structures. It's, it's hard, it's hard to matter if you are a one hospital system or a 20 hospital system. Uh, and, and, but I just still don't advocate grading on the curve. So, uh, additionally, the bill included language that will allow increased reimbursement for provisions of telestroke tele dialysis services.

Chimes will continue to support legislation that will enable expand access in improved reimbursement for telehealth services. This is a, a phenomenal, uh, stance for Chime. They should be pushing this, uh, in every aspect. I think it's, uh, it is crazy that, uh, you could have a health system in Pennsylvania.

The border is literally, you can see the border from their hospital, but they cannot practice telehealth across that border. I think this is one of the things would really drive down the cost of healthcare, open up access, and, and create all sorts of new, uh, competitive models that would benefit the uh, Benefit the patient.

And I think that's, I think that's what we're after. I think that's what's important. I think the, uh, the, uh, regulations, the state regulations predominantly have held back telehealth. And, and I, for one can tell you that, uh, when we went to roll out telehealth in Texas, the, uh, The legislation there was, was archaic and we really couldn't roll out the same telehealth program we were rolling out in California.

We could not roll out in Texas. They have since changed that and, and we applaud that. I, I think this is one of the areas. Where if the government could just level the playing field, we would see all sorts of new models. So I think that's a good thing for China to be pushing forward. And then finally, uh, they're pleased with the $6 billion to help combat the opiate crisis.

And don't get me wrong, I, I, I believe this is a crisis. I believe we should be combating this. Uh, I saw at the, uh, JP Morgan conference this year. A lot of health systems are doing great programs and really making an impact on the, uh, opioid, uh, opioid epidemic. But I don't think we should celebrate when money gets spent.

I think we should celebrate what the money does. I think this $6 billion that the government is going to spend, uh, would be better off in the hands of, uh, uh, a thousand other entities other than the federal government. And we shouldn't measure them on when they spend the money. That's great. It'll get somebody elected.

It'll feel good that they're spending the money. But at the end of the day, let's measure results. Let's not measure, uh, the fact that they're spending money. So, uh, maybe we'll applaud it. Maybe not. I'm not as passionate about that as I am grading on the curve. But, uh, again, that's, uh, that's what Chime is doing for, uh, health systems and I really do applaud them getting involved at the, uh, national level and starting to have those conversations.

I think that's, that's very important. Let me turn off my email here so that we don't get those. Uh, bings along the way. Here we go. Healthcare startups are flushed with cash. Here's our second story. And, uh, I think this speaks to an interesting dynamic within the startup world within healthcare. So healthcare startups are flush with cash, but investors are starting to worry.

This was in, uh, modern, uh, healthcare and I think it's actually a reprint from a crane story out of New York. I. And, uh, let me just read a couple things here for it. Uh, New York healthcare companies continue to attract hundreds of millions in venture capital funding last year, but some private investors said they're growing more concerned that investments are resulting in either mergers are, are not, uh, are not resulting in mergers and acquisitions or IPOs.

Investors are particularly concerned about the lack of exits in the digital health sector, although there were dozens of, uh, life sciences IPOs, no digital health companies debuted on public markets, and they quote, Wow. Can't read that name. Uh, there was a, a gentleman from uh, Navim Me Capital said he expects to see investments in health tech sector companies decrease next year worrying that the current model is overheated.

I hope for the state of the ecosystem it does decrease. That's an interesting, uh, point of view. 'cause we know it has been just, it has that hockey stick curve that's going on right now. One of the issues is that health tech startups often lose money initially, which makes it more difficult to find a buyer or declare an I P O, uh, said the vice president of Manhattan based, uh, orbit.

This is a, this is an interesting story and I, I, I think it's starting to touch on something. These, uh, you know, the venture capital gets in because they wanna return on their investment, and at the end of the day, Doing a digital health startup takes time. I was a part of several, uh, we incubated a couple.

One of them, uh, did go out of business. Another one, the, uh, uh, is still going strong, and, but it was a, it's a very rocky road. Those first couple years are very difficult. It's a very long sales cycle within healthcare. There are a lot of competing firms. There's a lot of not invented here. Uh, you know, there's a lot of health systems with innovation programs, and even if you take the best things in sliced bread to them, they will look at it and say, no, no, we're, we have something better.

Even if their thing is. Is crap is trash. So, um, so there's a lot of things against healthcare startups, uh, in the space. And uh, I think it might be overheated right now. I think there might be too many things. And there, there needs to be shakeout and, and we'll probably see that over the, just naturally we'll see that, we'll see some, uh, some businesses go out, uh, we'll see some not get to their, their true valuations.

And, uh, be rolled up into other organizations. So just wanted to make you aware of that. That's a, a very interesting trend. Uh, this is a short one, Allscripts to show new, uh, Microsoft Azure powered e h r at HIMS 18. And let's see what Paul Black s s a built from the ground up natively within the Microsoft Azure Cloud.

It functions like an app, not a traditional e h r, and gets technology out of the way of patient care. This is a bold, imaginative, new e h r, not simply a series of incremental advances on existing software. If that's not a marketing statement, I don't know what is. Uh, I'm gonna talk about why this is, this is actually a good trend, but, uh, uh, you just gotta call the marketing statements out when they're made, uh, by focusing on a user-centered design, the new cloud-based e h r addresses usability and efficiency issues, black said, and in turn,

Improves consumer experience because by making it more, uh, realistic for patients and care teams to interact, uh, okay. I, I mean that's a marketing statement. I think it, it misses the point almost completely of why it's a good thing that, uh, Allscripts is going to Azure in the cloud. The, uh, the primary reason this is, there's, there's two primary reasons this is a good thing.

Uh, three actually, if I thought about it, the first is that, uh, the Allscripts infrastructure is . Awful in its current iteration. Uh, just gonna say it like it is. We were, we were an allscript shop and we had, uh, their enterprise in our ambulatory environment. And to be honest with you, it was, uh, it was hard to keep the thing running.

There was a lot of things I liked about it. It was a very open platform, good set of APIs. Uh, we could do some very interesting things on top of it, but let's not kid ourselves. The, uh, Microsoft platform that it was built on is circa, I don't know, 2002. I. 2005 and, um, it was really, they just hadn't invested in bringing it forward like they should.

And so I think this move, uh, will give them, uh, a new modern stack. And I think that's important. I think the second reason this is important is if they allow, uh, allow the health systems to tap into Azure. So Azure actually ha is a, is a great ecosystem. If you can move that data in there, there's a lot of powerful things.

You're, you're gonna start to see, uh, some AI and some other things layer on top of the Azure platform. If, if Allscripts as an e H R can be built on top of that, open up that data and make it accessible to those platforms. Now you can see some health systems start to play around with . Uh, play around with, uh, machine learning, play around with artificial intelligence, and I think that is huge.

And then finally, uh, the, uh, The, the Microsoft Cloud platform is more stable and secure than most other, most health systems out there. So I think this move is a very strong move from a technical standpoint. I understand why, why Paul Black is not talking about those things. Those things don't sell. What sells is we're gonna make the.

The, uh, life of the clinicians better and it's gonna be a better user experience. And it, it may be those things. I'm not, I'm not putting those down, but I don't think that that's the main reason. This is a big story. That's, this is a big story because it's going on the Azure, uh, on the Azure platform. I wouldn't be surprised to see, uh, more EHRs make this move.

I'll be interested to see the first one that makes the moves and puts it on the, uh, puts it on the Amazon, uh, uh, a w ss platform that will be interesting to me. Okay. Take a little drink of water here. Gimme a, a second. Sorry for that. Dead air. Let's see. So, uh, our final story. Is, uh, uh, you know, one of my favorite people in healthcare.

I haven't met him yet, and I, I look forward to, uh, uh, to the opportunity to, uh, getting to meet him. He's from, uh, Philadelphia home of the, uh, of the, uh, super Bowl champion Philadelphia Eagles, and the c e o of Thomas Jefferson University and Jefferson Health in Philadelphia. So, He, uh, he wrote an article in Modern Healthcare in response to the, uh, Amazon, Berkshire, JP Morgan really focusing on what the impact could be of this.

It, it, it's a great, it's a short read. It's a great short read. I'll give you a little bit of, of what's in it, and then I want to talk about the implications for, uh, for it. So, uh, let's see. Are, are we, are we ready for OneClick Healthcare? This is the title. Are we ready for OneClick Healthcare? That's, One of the promises of the partnership announced recently by Amazon, Berkshire and JP Morgan.

It is difficult to say if Amazon if this partnership is going to disrupt the American health system, but one thing's for certain, we're gonna learn a lot from the experience. Their announcement, uh, he goes on their, their announcement is significant for reasons that go far beyond the combined 1.2 million employees whose medical costs they hope to bring under control.

This is a landmark event because it means the world's most innovative employers are no longer content with healthcare to remain stuck in the nineties. This is something we said a couple weeks ago on the, on the, uh, on the show. It means they're tired of the lack of transparency, the massive inequities.

In care across the country and the utter lack of focus on what consumers need, the qualities that define our current health system, uh, uh, you, you have to love, uh, Dr. Klasko for just saying it like it is. So healthcare is the only consumer product or service that doesn't focus on the needs of the consumer.

I. This has to change. Health focused corporations need to become consumer healthcare entities where the patient is the boss, and he goes on to say further that the major healthcare industries have taken a slow and steady approach to changing dynamic because of preserving the status quo. We don't have the time for slow and steady only, or one can imagine Bezos Buffet, Jamie Diamond screaming, we're Matt as hell, we're not gonna take it anymore.

They're taking matters into their own hands and we should all join them. And that's great for a health system, c e o to be saying that. Here's a list of things that he says, uh, that this partnership says about the future of healthcare. He says employers are watching their health benefit contracts ratchet up without an apparent end.

Uh, that is one of the things that's driving this. Second, health systems need to get ready for a world where consumers can pick, uh, with a click. If you've ever been in one of these benefits meetings, you know that the, the employees have different expectations of what a health system should be. You just sit there and they're like, where, where?

Where's my app? How can I do these things? And that's one of the things that's driving this, is the, the, you know, Jamie Diamond probably doesn't want to go to another meeting of employees where he just gets hammered because of the healthcare experience. And he's sitting there going, I don't understand how I can be spending 1.2 billion or whatever the number is on healthcare, and the experience is this bad and there's nothing I can do about it.

So you have to applaud that they're getting out there. Obviously the, the rising out-of-pocket burdens and, uh, political grid gridlock are, uh, scaring people and companies into action. He went on to say in that section that it's, uh, it, it is time for us to stop sitting back and waiting for, for, uh, these things to come out of the government.

We should be initiating. And, uh, a, a great read, great, uh, great story. If you get a chance to, to hit that, hit Modern Healthcare, read this story, it's, it's really worth, uh, really worth the, uh, worth the read. So, you know, so what is our response? What should our response from an IT perspective be, uh, around this?

And I think it, it comes back to a conversation we've had a couple times on the show around digital transformation. and there is this, this, uh, concept within healthcare that the consumer is finally starting to take center stage. So, There should be a, a, we should be cultivating a customer obsession. It should be a, a significant priority of the chief digital officer, chief information officer, chief Technology Officer.

What are we, uh, what are we doing to foster that customer obsession? And, you know, just some of the things to think about is identifying, uh, one or two, uh, service lines or specific, uh, the specific conditions and creating a, uh, customer centered journey. That really focuses on the experience of the consumer over that of the physician.

Not that we don't think about the physician experience or the clinician experience, but that we focus in on the consumer experience and say, how can we make this the best possible? You're not gonna do it across the entire health system. Pick one or two parts of the organization that is, uh, that's receptive, that's open, that might already have a bent towards a consumer focus.

Partner with them, uh, educate them on what's possible. See if you can start to do some small experiments, move the needle forward. The, uh, the second thing, and I think we'll talk about this somewhat next week when we have Charles Boise on the line, is, uh, look at artificial intelligence. You should be doing pilots on artificial intelligence.

It's, it's not something that we should, uh, be all in on just yet, but we should be doing pilots, we should be learning what does this technology have for us? Because it has a, it, it will enable an awful lot of new . Models and new workflows that we haven't even considered yet. So get your hands dirty, even if it's a small pilot, even if it's taking your favorite, uh, uh, nerdy tech and saying, I want you to dig into these, uh, to these platforms.

And by the way, there's, there's, there's o there's open platforms out there that they can tap into, uh, that are free, that they could start to, uh, play around with. We did that at, uh, at my previous health system. And, uh, it, it did some interesting things, uh, not things that you would roll out, but we were, we were learning as we were as we were going.

And, uh, I think the, the, the last thing I would say on this thing is, uh, we've gotta start focusing on speed more. Uh, speed, agility, uh, move faster, so don't worry about. Perfect. Uh, I had a conversation with one of my former employees this week, and he was frustrated on how many things they've started and had to trash because it just, They get down the, the path and they're, they, uh, find that something's not gonna work in the data.

The data's not clean enough. The, uh, app, the, the, the tech stack doesn't, doesn't work and they can't scale it, whatever it is. And I would say you, you, you've gotta kill this mindset. You gotta kill this big project rollout mindset. You've gotta do these little pilot projects, little projects incrementally focused in, uh, uh, little, uh, steps.

Building on top of it, obviously choose the right underlying stack, the right underlying, uh, infrastructure that's going to be able to scale. You can look at, uh, you can look in the Amazon direction, the Google direction, uh, the Microsoft direction. That's if you are not a big budget organization that's gonna build it out from scratch with, with a bunch of open source things.

That's where I would, I would head, if you have the money, . The talent. You could look in that open source direction and and build it out, which is, which is what we did, but we had a little bit more budget than, than most do. But you could do it on those, on those open platforms and stop thinking about, we've gotta build the perfect portal, roll out a portal with one feature.

Roll out a portal with, you know, just get it out there. Uh, iterate to perfection. Don't strive to perfection before you get it out there. We've gotta start focusing on agility, speed, getting it out there. That's the only way we're, we're gonna be able to respond to this, this consumer obsession in the, in this move towards the consumer.

So that's probably enough. Uh, new stories, uh, for this week. Uh, I'm gonna close on a serious note and, uh, highlight a, uh, uh, post from our co-host from last week, SU Shade. She, uh, wrote a, uh, a short but thoughtful piece on the, uh, the shooting in, uh, Florida. And, uh, her blog post, uh, she talks about the shooting and her, the title is, this Can't Be the New Normal and we've gotta do something about this.

And I think we can all agree on this. This really cannot be the new normal. And de, despite what people are saying about thoughts and prayers, I believe empathy and, and prayer have great impact, and it's the right place to start. So my thoughts and prayers do go out for the people affected. Uh, but now we have to get to work.

And I think that's the point of Sue's story. It's, it's not enough to end there. Uh, it does have great impact, but it, it requires more. We have to look at, uh, the underlying causes now, uh, I'm really gonna talk about this from a, uh, mental health perspective. I, I think this is a mental health issue and I, I just wanna highlight and applaud the systems that have made huge investments in mental health.

And I know there's a ton of them. I, I'll just, I'll just mention too, and, and I apologize. If you have a, a great mental health story, please send it to me. I'd be more than happy to highlight it. Uh, you know, Providence. Back when I was with, uh, Providence St. Joe's, uh, just, uh, before the merger, uh, pledged a hundred million, uh, towards mental health in 2016.

And I think it's those kinds of commitments that are gonna make a difference. Intermountain integrated, uh, mental health screening with primary care and specialty practices. And I think those are the kinds of things that are going, going to identify, uh, issues before they become, before they escalate. And, uh, and, and, and we do it is a hard issue.

I was talking to my daughter about this last night and she's like, you know, you can't solve this from a mental, only a mental health approach. And I agree with that. You, it is a very multifaceted. Uh, problem that we are facing, and it's not gonna be easy, but I, I would encourage us not to take the easy solution.

The, the, the quick, you know, we, we banned this clip or this assault rifle or whatever. There's still thousands of guns out there, and if this person wanted to kill, they could have done it with a car, uh, or, or with a drone or, or any number of things that are, are going to be around, uh, around the house that.

They could have done it. I, you know, it's, and so we have to address this from a lot of different angles, uh, from a, from a gun's perspective, but also from a mental health perspective. I'm just gonna close with the words from, uh, C e o of Ascension, who after the, uh, last Florida shooting, the nightclub shooting, uh, had these words to say, and I think it's, it's fitting, uh, let us together as one nation turn our words and raw emotions into action with positive public policy that more effectively addresses the growing challenge of mental and behavioral illness.

Uh, I can't say it any better than that. That's, uh, so that's all for now. Uh, please follow me at the patient cio and don't forget to follow the show on Twitter this week in Health It and check out our website at this week in health. It please come back every Friday for more news commentary and, uh, information from industry influencers.

That's all for now.


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