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Today on This Week Health.

all the external factors, temperature, humidity, food, you can't, as a human, figure that out for each patient. But, now that we've had open AI's release, you as an individual, have basically that feedback, on a daily basis  Welcome to Newsday A this week Health Newsroom Show. My name is Bill Russell. I'm a former C I O for a 16 hospital system and creator of this week health, A set of channels dedicated to keeping health IT staff current and engaged. For five years we've been making podcasts that amplify great thinking to propel healthcare forward.

Special thanks to our Newsday show partners and we have a lot of 'em this year, which I am really excited about. Cedar Sinai Accelerator. Clearsense, CrowdStrike,. Digital scientists, Optimum Healthcare IT, Pure Storage, SureTest, Tausight,, Lumeon and VMware. We appreciate them investing in our mission to develop the next generation of health leaders.

Now onto the show.

(Main)   📍 all right, it's Newsday and Happy New Year, we're recording this in December, but it's gonna be Happy New Year by the time this airs out on the channel. And today I am joined By one of my favorite I call you a CTO, Chief Technology Officer or Innovation Officer or whatever.

Charles Boicey with Clearsense is joining me. Charles, Happy New Year and welcome to the show.

I think this is the first time I've ever said Happy New Year a month in advance. Happy New

Year to you too. Charles, we try to stay ahead of the curve here.

Very forward

thinking. Very forward thinking.

Actually, I think if you blink It's going to be January 6th anyway. It's just right around the corner. We're going to do something we do every year is we take a look at the predictions. So you and I are going to take a look at some of the prediction articles that are already out there.

You had a mentor or a person, we did this once before on the show, where you said, we had to give like different categories to different things. Oh, yeah.

Yeah, I can't remember exactly what it was, but let's let's give a special category to something.

Yeah. Yeah, it was like is this fiction or is it Oh, real?

Yeah. That was like a tooth or dare a thing. Yeah.

And can you guess what the number one is?

For them? Maybe home monitoring? Monitoring

in the home? Or the home hospital? Actually, I'd be shocked if it's not the number one for all of these. It's AI powered workflow automation and optimization. There you go. Not really a surprise. As healthcare organizations are faced with persistent staff shortages, They are adapting their workforce strategies to attract and retain talent, offering more flexibility, so forth and so on.

We're going to be talking. How much progress will AI make in healthcare next year? Yeah,

Bill, I think we'll see the continued success in the call center environment. And, information regarding the healthcare system, patients need to, understand who the providers are, how to get appointments, prescriptions, all that good stuff.

I think we're going to see, more advances there. 24 7 now with with the technologies that, that we have.

I like that they've married AI and automation and working with automation. Yeah,

we used to, Bill, we used to call this robotic process automation but has a new name which is fine, but there's a little bit better technology around that, and yes.

Some of these things, can be automated, but I think the real measure of success is for those that are partnering with the healthcare systems to really understand what the goal is. And it's not what we did, Bill, when we gave the developers our charts and said, hey, make me an electronic record just like this.

And we handed off the charts and they gave us exactly what we asked for. That technology combined with a with a re imagination, if you will, or, redoing the workflow, will be successful. Those will be the successes. Those that try to automate things that aren't working very well right now, it's going to be worse.

Yeah, so clearly every IT project continues to be an operations project. It is interesting to me because I think the first iteration things that we are seeing is just layering AI and workflow automation on top of existing processes. And this is the trap that we're all going to fall into is Hey, we can make this process better.

Like we can make a better, buggy for the horse drawn carriage. Like it's going to be. More aerodynamic, it's going to be faster, it's going to be whatever. But at the end of the day, it's still a buggy. We now have automobiles. We didn't need better buggy. And I think this year we're going to see a lot of automation of buggies throughout healthcare.

we'll have to accommodate. I'll give you a quick analogy. You mentioned buggies to automobiles. You know what the industry that was hardest hit when we made that transition? Was the buggy whip industry. They were pretty much wiped out.

And what did they transition to? They transitioned into leather seats for those automobiles. So I think we gotta, take that and kind of those things that drop off. We gotta turn it into something else. IGY

whips divert to leather seats for the automobiles.

Interesting. Their second one is virtual collaboration, addressing staff and expertise shortages. We're seeing, I think virtual nursing is the most. Yeah, prevalent conversation that I'm having with people when I delve into this, Hey, how is medicine changing? How are we addressing staff shortages and that kind of stuff?

This is this isn't as much a prediction as just telling you what's already really in motion right now. And there's a significant amount of momentum around this. We're taking advantage of the experience, not losing the experience of people. that maybe don't want to do the physical aspects of nursing at the bedside, but you don't want to lose that.

It's a prediction of what's really already moving at a pretty good clip right now. Yeah. And my

colleagues, my nursing colleagues that are doing this work really love doing this. And again, there's nothing better, more enjoyable than mentoring newbies at the bedside and whatnot, and be able to help them and.

More importantly, the technology combined with these experienced nurses you get ahead of things a lot quicker than we did, in the past. it's like a combination of AI, ML nurse situational awareness and, the ability to treat it going on.

This one's interesting. Integrated Diagnostics Supporting Multidisciplinary Collaboration. It's a lot of words, but essentially what they're saying is, hey, we're collecting sensors. And we're bringing these huge data sets together, we have digital pathology, we have genomics, we have just straight up sensors all over the place now.

And what they're saying is there's going to be either a new field or a field that really has healthcare specialists that are looking at this data and bringing it together and finding new things. It's finding. New ways of doing diagnostics finding new relations and correlations between the data and the diseases.

You've played a lot in this space. What are your thoughts on this? Yeah.

The burden on a single individual or a single team is great, but having the technology that brings in, all the data from, again, like you mentioned, sensors that we're used to working with sensors external, this doesn't play just for, an inpatient or a patient coming for a visit or for a diagnostic, this also extends into the home bill, and that's why I said in the beginning that my prediction is We're going to see a continued shift towards doing more in the home environment, but yes, putting all this together in a single environment with a little bit of assistance, say, hey, pay attention to this, pay attention to that get, getting to differential diagnoses and so forth, and getting to a treatment plan much quicker and much, to be able to execute it, evaluate it, and make core course corrections, much timelier than we had been doing in the past.

Let me ask you this. Yesterday I interviewed Mickey Tripathi, ONC Head of Healthcare Technology, and he and I talked a lot about interoperability. We talked about 21st century cures and, It's been a long time coming, the TEFCA is now in place. Some of the penalties for information blocking are now defined and in place.

continue to get better, Bill. Will it do some, really abrupt change?

How did we get the medical records in place? Electronic medical record.

Yeah, that took a long

time. Yeah, but we paid people and then we beat them up if they didn't do it. A little bit of carrot first and a big stick at the end usually works for us, unfortunately.

Yeah, is one of those things we've been watching for a fairly long time.

And the anticipation is that we're going to we're going to be able to move this forward pretty. Rapidly, now that these things are in place, but I think even Mickey sounded a a cautious tone of, this is foundation. The QHINs give a massive ability to move data.

And one of the things we ended up talking about a fair amount was public health. He's I, people aren't going to see this flat out, see this. It was behind the scenes. That's going to be one of the bigger things that we immediately, we're going to be better prepared for the next pandemic.

During the pandemic, we were trying to move information to the state, then move it to the federal level, then move. And won't say everything broke, but a lot of things broke. Like it just didn't move. Bill,

over 10 years ago, smart on fire, Boston Children's pediatric growth chart within the EMR.

Yep. Yeah, so it's all there. We just

need to make it happen. All right, we're going to move away from Philips. Let's see, this one looks generic. This is a LinkedIn. Somebody posted, telehealth and remote care will improve AI machine learning. So this is pretty general.

We're essentially processing it, and now we're starting to deliver a much more personalized care plan for Charles or for Bill as opposed to a population.

Bill, still think it boils down to this The ability or inability to bring in all of the data that's generated external to the healthcare environment everything that's going on in your 24 7, daily life all the, I call it exposome, all the external factors, temperature, humidity, all pollen count, traffic.

Food, social determinants, as we call it. aLl that data together, you can't, as a human, figure that out for each patient. doesn't make any sense. But, now that we've had the first anniversary of, open AI's release, I think you can see more and more technologies improve so that you as an individual, me as an individual, have basically that feedback, on a daily basis.

more progress there.

Let me see when this was written. November 20th. All right, so staffing, 36 percent availability of skilled workers, 35 percent supply and general cost, 32 percent competition in the medical industry. This is the top three external factors shaping healthcare business goals today. Insight number two is most healthcare organizations take three to six months to purchase new software and review.

Reviews play a key role, and insight number three, security is a top priority for healthcare organizations. All right, so these are worth breaking down a little bit. Staffing challenges. So we have, we've had a staffing issue, primary care, nursing, whatever. for a decade now, but it became very acute over the last, let's call it 18 months.

It feels to me the healthcare systems I'm talking to have gotten in front of it, or no, let me say this differently. They haven't gotten in front of it. They have stemmed the impact of the extreme nature of it. Because we had a ton of traveling nurses and all this other stuff, it was just costing them so much.

So I feel like they've gotten in front of that aspect of it. They've figured out a way to control the costs, control the aspects, but this staffing challenge isn't going away. What's the role that technology is going to play? We've talked about some of it, but what's the role technology is going to play to address these staffing challenges?

Yeah, I think it's, Bill, I think it's really the clinicians in ways that we may not have, thought about. Can I present a nurse end of shift note that she can edit really quick or accept it? Yeah, absolutely. That takes, you've got, whatever the number of patients is, ICU 2, 1 to 2, on the floor, maybe up to 5 plus, depending on what state you're in.

Those kinds of things Making sure that, nurses and others aren't hunting and pecking for things. Again, the workflow within the electronic medical record, cleaning that up a little bit, stopping this crazy documentation, of documenting every single thing that you think of, as opposed to, Forrest Nightingale said it better than anybody else document if you must.

But only document that which is required. No more, no less. So I think that's something we gotta, look at too. I think there's a a lot of things we can do that, make sense. That are basic and whatnot. Before we start looking at, technology to, solve, everything we've got going.

But, again, there is an adjunctive nature of technology to, to help. Let's not implement, and let's not push technology on people if we haven't really thought it well through, and we haven't demonstrated that it is going to make things better, and not.

It's interesting.

I wonder if we were to start Greenfield, like we were starting a new health system, how would we do this differently? And how would we approach it?

Bill, I think that you're going to see, and I said it again, in the UK, they'll go down this track. There's going to be more care being delivered in the home.

From a recruitment perspective, especially for nursing, they're finding out that nurses would much rather do a shift, a 12 hour shift, a couple blocks away from their home and then they go home. We have the technology that allows for that with the advent of 5G and then, eventually 6G. We can do that.

The bandwidth is there, the prioritization is there. So I think that's something you'll see more and more of and 20. 24 is more and more being accomplished in the home.

I'm gonna marry the second prediction here with so Gartner's second prediction. Most healthcare organizations take three to six months to purchase new software and reviews play a key role, and they go into the reviews.

I don't think that's all that. important right now, but the, Sachin Jain did an article in Forbes and he talks about mega mergers. He talks about Medicare Advantage growth slowing down. But he goes into the startups will vanish and be replaced by new ones. And, one of the things I'm hearing as I'm talking to money people, private equity and VC and whatnot is how hard.

The sales process has become, with the U. S. healthcare system, it has slowed down significantly. The decision making process is even slower. If that is possible, it's even slower than it was before. And the other thing that I'm hearing about this is that essentially because the process is taking so long and because of the sales process that a lot of these startups, a lot of the, Organizations that were planning on selling it to health care providers are now.

Pivoting very rapidly to the payer market. Pivoting rapidly to, other areas. Or essentially face running out of cash. And plus, the game's changed completely in terms of fundraising. A lot of the fundraising now is based on your ability to show that you can sell into these organizations and that you have a run rate.

And you can continue to grow. And so I mirror those two together. And I guess my conversation, my question to you about this is I'll stay high level with this because I know this kind of question could get you in trouble where you're at in your position. But are we going to see any more turnover than we have seen?

It seems to me like every time I go to a conference, like a bunch of companies are gone and a bunch of companies are there. It's there's still a huge desire to be in healthcare.

Here's the deal Bill, private equity. Yeah we're with you. We're for you from a growth perspective. And then all of a sudden that changed to when are you going to be profitable?

What do you need to be profitable? So a lot of these healthcare startups and even some established ones cut costs, do what they need to do to cut costs. Change their projections what is it going to take to get to a steady state or even a, in a profitable state and, many of these private equity folks are not interested in, funding anymore.

Hey, we gave you 30 million, 50 million, whatever that might be, or less, and You don't seem to be making any type of market penetration. Yes, you're pivoted from provider to to payer, but that doesn't seem to be working for you. They're, most folks are on the startups are, drastically, changing, maneuvering, all of that.

And your sales cycle. It, COVID gave us a real quick sales cycle. That's gone. Prior to that, it was anywhere from 6 to 12 months. Now we're looking at 12 to 18 months, right? Depending on how much runway you have, depending on how much the equity folks willing to, fund and or be patient with you, it's going to determine your outcome.

We've seen, reductions in force, and we've seen quite a few go already. I would expect to see that, going forward.

and we have to be careful because pivots take time, right? We're like, oh, we're just going to pivot. Oh, seriously, like you're going to go from selling to this market, and you're going to do that in what amount of time?

It does take some time. We're close to the end of our time here. We could talk security. I'll probably end up talking security with David Ting or or Direx. So we can hold off on that. I do want to ask you about AI. APIs for healthcare. So there's a bunch of players out there.

Who's going to make the most progress in, specifically in healthcare

I'll tell you, first I'll tell you who's going to win, Bill. Okay. We're going to win. Healthcare is going to win. Having these entities all going at each other to see who's going to be the best of the best is going to be very beneficial for us.

And, Because of this competition they can't black box any of this stuff. It's all open. It's there. You can actually understand what Google's doing. AWS, Azure it's all, freely there, freely available. And even we're going to pay for it eventually, but and they're taking our input, where before it was, hey, we know what healthcare needs and we build it for them, right?

Now they're actually taking our input. AWS is coming on pretty strong, but again, a lot of us are in Azure, a lot of us are in AWS, and then Google, is pretty cutting edge on tech, and they've done, quite a bit to advance healthcare, so I'm going to say we're all going to win, and I'm going to say that because of these technologies that they're all producing, it's going to be easier for us to build things in their tech.

Where before you had to have quite a high level of skill, the skill level is going to come down and it's going to be something we can use. We just got to make sure that we do all the requisite from a security, compliance, and responsible and ethical use of data. We got to do all those things and then we'll all be successful.

I'm just going to agree with you. It's a political year. This is an election year, so I'm just going to agree with you. That was a really good answer. and I think there's a lot of truth to it as well. We're democratizing access to this technology. It is really advanced technology, but I think, you look towards the middle to the end of this year and I think you're going to see clinicians directly interacting with these AI models as natural language front end.

And the AI is going to be building out these complex, really cool things on the back end. We're only going to be limited by our imagination, but it's not going to be what it used to be where it's, Oh we've got to put together a project. It's multimillion dollars.

We've got to bring in data scientists. We've got to bring in programmers. We've got to bring in, Oh, and if we're going to do the program on a mobile phone, we've got to. We need Android programmers and we need, it literally, I think we're going to start seeing access to those things unlock to the frontline caregivers and, people that normally would just look at something and say, that's going to be too hard.

And I think now we're just going to unlock it. And I think you're going to see that start to happen this year. And I think it's going to really accelerate in 25. And I think we're all going to be winners. I agree with you. Looking forward to it. Charles, always great to start the year with you. And Thanks for coming on the show. Hey, it

was good to start the year in advance with you, Bill. Happy New Year to you and everyone. Yeah.

  📍 And that is the news. If I were a CIO today, I think what I would do is I'd have every team member listening to a show just like this one, and trying to have conversations with them after the show about what they've learned.

and what we can apply to our health system. If you wanna support this week Health, one of the ways you can do that is you can recommend our channels to a peer or to one of your staff members. We have two channels this week, health Newsroom, and this week Health Conference. You can check them out anywhere you listen to podcasts, which is a lot of places apple, Google, , overcast, Spotify, you name it, you could find it there. You could also find us on. And of course you could go to our website this week, health.com, and we want to thank our new state partners again, a lot of 'em, and we appreciate their participation in this show.

Cedar Sinai Accelerator Clearsense, CrowdStrike, digital Scientists, optimum, Pure Storage, Suretest, tausight, Lumeon, and VMware who have 📍 invested in our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.