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This week we cover a Wall Street Journal article on the future of Hospitals. Is interoperability possible through a single vendor? Finally, we dive deep on the subject of Physician Burnout and what can be done to stem the tide.

Transcript

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 Welcome to this Week in Health It where we discuss the news, information and emergent thought with leaders from across the healthcare industry. It's Friday, March 2nd this week. What is the future of hospitals? Epic's, new sonnet, E H R, and what it means for interoperability. And we dive deep on the role of technology and physician burnout.

This podcast is brought to you by Health Lyrics, a leader in digital transformation in healthcare. This is episode number eight. My name is Bill Russell, recovering Healthcare, c I o, writer and consultant with the previously mentioned health lyrics. Today I'm joined by a relatively new friend and first person to appear on two episodes of the show.

Dr. David Ziba, former c i o of Baptist Health in Kentucky, who has started his second round of work in his, I guess, your pre-retirement phase of retirement. As we all know, you don't just go off into the sunset, people tend to pull you back into work. So, uh, good morning David, and welcome back to the show.

Good morning, bill. Appreciate chance to be here again. Yeah, I'm looking forward to our conversation. A lot of good topics this morning. So, uh, this appearance is, is through a scheduling mistake on, on my end and, and I appreciate you being so gracious to come back on the show. So, so normally we ask our guests, you know, what are they working on?

What are they excited about? I guess since you're the first returning guest, we'll, we'll modify it a little bit. What have, what have you been working on since the last time we spoke, and, and what are you, what are you excited about these days? It well, um, actually you stimulated what I'm excited about at the moment.

Uh, you wrote an article about, uh, budgeting and the need to plan to cut today for tomorrow, and it got me thinking about the process that we had put together. So I just submitted, um, a, uh, piece to health System, the cio.com. On the daily discipline of budgeting, um, hoping that people can understand that budget cycles shouldn't be as traumatic as they've been in the past.

And, uh, provide some insight from the three and a half years of stumbling that I had. So hopefully some others can, uh, find a smoother path to their budgets. Yeah. And there's, there's an awful lot of, awful lot of talk going on right now around, uh, uh, reducing the budget as more and more pressure comes on the, um, on the hospitals, uh, from a budget standpoint.

Uh, what, so did you just recently write an article for, uh, health System c i o Just submitted, uh, the final draft yesterday. Great. So, uh, can you give us like a preview of, of what your, what, what you discuss in the article? Yeah. Um, part is that your managers have to have a regular cadence of looking at their human resource spend, uh, to be able to track when whether un contracted or employed individuals, they're getting out of line.

Either a positive variance, in which case you wanna find out how can you perpetuate that positive variance or the negative or harmful variance where you've gone over budget and catch it early so you can make course corrections and, uh, make sure you don't let something balloon because the HR spend is our biggest.

And then the other piece that I think is most relevant is in yours and my role, and in other CIOs and executives role set the example. And so we don't need the latest bright and shiny. You and I answer emails. We do some podcasts, we do some webinars, but we don't need the most powerful, lightest laptop in order to do our job.

And I think showing that fiscal restraint is a good example for our teams. Yeah, I agree. It's, um, yeah, I used to have a, I, one of my, uh, uh, vice presidents used to have the oldest iPhone he could possibly have. 'cause he wanted to communicate to the organization that, you know, really the iPhone hasn't changed much since he got bigger screens and whatnot.

But it really hasn't changed much in terms of its functionality. And he wanted to show them that. You know, essentially we're still doing the same things we were doing then. And he also wanted, he was sort of a no man left behind kind of thing. And he said, you know, I will be the last person to get the newest iPhone.

So once everyone in the organization has one, I'll, I'll move up. And, uh, and, and I think people appreciated that. They appreciated the, uh, the fiscal restraint and the fact that it wasn't the one walking around with all the shiny new objects while the rest of the organization was, uh, stumbling along. So, Exactly.

Great move on his part. So, uh, so okay, let's jump news. So let's jump into the news. Uh, you know, first section, David, have.

The future of hospitals is, uh, an article that appeared in the Wall Street Journal, uh, this past Monday in the health healthcare section, which is a great section if you, if you, uh, get that. I, uh, I'm a former paper boy, so no matter what I do, I always have one paper delivered to the house so I can, so I can read a, uh, newspaper.

I, it's just old habits die hard. So we get the Wall Street Journal. Great. Uh, great article. Let me, uh, give a recap real quick. The days. So, uh, first couple paragraphs. The days of the hospital, as we know it, uh, may be numbered and a shift away from their traditional inpatient facilities. Healthcare providers are investing in outpatient clinics, same day surgery centers, freestanding emergency rooms, and micro hospitals, which offers few as eight beds for overnight stays.

They're setting up, setting up programs that monitor people 24 7 in their homes, and they're turning, uh, to digital technology to treat and keep tabs on patients remotely from high tech hubs. Uh, they go on to talk about the economic drivers. There have been, uh, fewer admissions, uh, fewer, uh, overnight stays, uh, although the, the patients have gone up.

And essentially what they're saying is there's just an awful lot of economic drivers in one of the, uh, uh, one of the, um, sections that's cut out from the story. They have, uh, some statistics of the total savings, uh, inpatient versus outpatient, for instance, uh, hysterectomy. There's a total savings about, you know, $4, uh, per procedure.

Uh, four 80 out of pocket. Uh, they go on with, uh, cardiovascular, uh, angioplasty, and they, they just have these numbers there and they're, they're pretty significant numbers. Uh, The procedure done in a, in a traditional hospital gets to be, uh, pretty costly. So, uh, I'll summarize where, where do they think we're going?

They, uh, they believe hospitals are going to more helping patients at home and they, they cite Mount Sinai's Hospital at home program, which has saved Medicare $45 million. Uh, they're talking about building smaller facilities, and I have personal experience with this. We're doing, uh, my, my company's doing some work for my hometown, uh, hospital system and there's literally a street corner that has, uh, three buildings for.

St. Luke's University Health Network, and, uh, each of the buildings represents, almost represents a different department that used to be in the hospital. You have, you know, women's on one, orthopedic on another, oncology on the other, but there's smaller buildings, nice big parking lots, easy to to navigate if you're going there.

They're finding new uses for old hospitals. Uh, I thought the most interesting part of that was a Geisinger set up of a, a food, a fresh food pharmacy, uh, that they're, uh, they're converting so that the community, the, the community actually has a, a 50% predisposition towards, uh, diabetes and, and they're recognizing, uh, the whole population health move.

That if we really want get in front of this, uh, it's, it's better to help people with, with their, uh, help. And we've talked about this before. H C a Intermountain and, uh, mercy Health in St. Louis all have digital hospitals set up and they're providing services to, uh, rural facilities. They're providing services to even some other large health systems where they're monitoring, uh, you know, certain situations and, uh, even, uh, some, uh, post postop and, and those kind of things.

So they're, they're providing remote support. And some expertise, uh, through that. So these are some of the things that they highlight in the, in the story. Um, so let's talk about this a little bit. I'll, I'll, I'll kick us off. So, uh, you know, hospitals still will absolutely, will make up a significant portion of the, the revenue for health systems in the foreseeable, uh, future.

There's no doubt about that. The big box hospital.

But, uh, you know, what I wanna talk about is what do we, as CIOs and technologists do to prepare for this, this next wave of change, which is already really upon us. And, um, you know, as, as the phrase goes, and we talked about budget already, show me your checkbook and I'll tell you your priorities. The same's true in healthcare.

It show me your budget, and I can tell you an awful lot about what you value and what you're going to become in the, in the future. Future couple of years. Um, if I were looking at health systems budget right now, there's a, there's a couple things I'd look at and I'd ask, you know, how much are you spending on things connected to the hospital versus new models of care?

I see a lot of budgets. Very focused on the E H R, you know, how many resources are you putting on the E H R, which is predominantly a system to run a hospital or, or to run a health network. And so much money is being still, even after the big E M R Implem implementations are still being focused on that.

And, uh, not enough is being focused on the, the consumer. You know, how much of the analytics budget is, is being spent on the consumer. How much of the, uh, budget is, is spent on the, uh, on the. Uh, changing the way we experience healthcare and, um, those questions will lead you in the directions you need to, to look within the health system.

I believe you need to look within the health system and find some people that are doing some interesting consumer-based, uh, projects, and it may not always be in the traditional, uh, part of the organization and begin to partner with those guys and look for new initiatives that are going to lead. And this is one of those areas that we lead as CIOs.

We identify areas that have promise and, and utilize some of that margin budget that we have to support those and move them forward. So anyway, I thought it was an interesting, uh, interesting article. David, you know, um, I guess my question to you is, have you seen this, uh, transition away from hospital strategies, um, in the health systems that you work with?

And, and where do you think this is going to lead? I, I think we've seen it to a large degree in the health system that I was with. Um, we started in 2006 already looking to the ambulatory, uh, sites decentralizing a lot of the care, uh, imaging centers moved off campus, uh, infusion centers. So there was that, but they were still trying to do it on the hospital based reimbursement model.

Um, now with c m s, uh, declining to, uh, accept or approve additional sites that are off. Hospital based reimbursement systems are having to figure out how to live on my old primary care budget. I'm an internist by training and practice and you know, we learned how to run things tight and I think hospitals are starting to learn that.

And so we're certainly seeing that we're seeing a much more aggressive acquisition or alignment with home health to try to reduce the readmission rates. Um, Move the care back into the homes. Uh, we saw a significant investment in the system that I was with right as I was leaving in telemedicine, uh, both for visits, um, so communicating as you well and I are right now, but also for, uh, telemonitoring, uh, home blood pressure, home weights, uh, being, uh, fed back in through to the home health.

I think the other thing that has helped is the investment in the EHRs in some systems, if they did a good cross system integration, allow you to decentralize that care and do a better job of making sure that the patients are cared for, where it's most appropriate for them. Then the, the final was the ambulatory surgery centers, um, association.

You saw systems that fought that a decade ago, and you saw systems that embraced it and partnered with their physicians. And now if you look at the systems that still have a margin, I bet they have some relationship with their, uh, independent physicians in an ambulatory surgery center and in other investments where they didn't fight physicians, but they joined with them.

Yeah, I, I found it interesting, um, at our budget in. Uh, the, the medical group it budget was, was really kind of poultry compared to the, to the hospital. And there were many occasions where I sat down because we, we tightly partnered with them, but it was a separate budget and there's many times where we had to sit down with them and they said, well, we can't really afford that analytics package, or We can't afford that pop health package.

And, uh, that partnership became really key because, I, I, I, first of all, I didn't understand that and because of the way we did budgeting from the article you talked about, we always had some margin dollars to spend and invariably it, it went to those guys. It's, it was, it was, uh, an opportunity to really bring that, those capabilities forward so that we can do a clinically integrated network better.

We could do the a c o better, we could, uh, do analytics on that population. We could keep 'em out of the hospitals. And for some reason, uh, I, I don't know if it's just history or whatever, uh, they, that side has been starved and the hospital's been, been pretty well fed and, uh, do, do you think that's gonna continue to evolve and change or do you think we're gonna, uh, do you think we're ever gonna get to the other side of that?

'cause it really does take money away from the, the hospital when , I, I know there's incentives, but it takes money away from the hospital when people don't come in for. Procedures and those kind of things. Yeah. And, and I think we will see that shift over, uh, I think in the system again, that I left partially because when I was c i O, it was as we were transitioning to the integrated E H R, we were tearing out our existing systems.

And so we did bring the physician enterprise under the same umbrella as the hospitals, and I was able to communicate to the executives and to the board. The need to think about them as a continuum. And I think as more and more people think about the care continuum and drop the walls of the hospital, at least figuratively, and think about how the patient moves through the system, through care, uh, systems will start to shift the budgets and understand that.

I think it's still going to come down to, you've gotta have, and I've seen a couple of articles now that say you need about 62% of your patients, uh, where you are at risk, where you are accepting whether it's capitation or some form of full, um, risk. In order to pay for these systems and to make that critical mass that tips you over to being able to successfully do that, then you benefit from reducing your admissions.

Right now, you know, we're still trying to drive fee for service in most, uh, sectors of the markets. And that stops you or blocks, um, you from shifting money away from the hospital. Yeah. And I think we, we see a good model of that in, uh, sharp Healthcare down in San Diego. If, uh, people wanna look into that when they have a pretty high percentage of, uh, uh, at risk patients and they are, um, Uh, on, on a managed service contract.

So, uh, that's pretty interesting and you brought up, you know, talking to the board and educating the board. That just reminds me of a, that's probably a good topic for a future, uh, episode of the, the role of the c i o in that. But let's kick to, uh, kick to our second story, epic. Uh, well, actually it's your story.

I'll let you give it to us and give us a. So I saw the article, and of course we'd heard Judy announce, uh, last year that they were going to be introducing new e H r, um, options. And sonnet Sonnet is going to be introduced at himss. Um, my take on the article is that it's kind of like Epic light, um, is in the article they talk about the, you know, smaller hospitals get it at a lower price, doesn't have all the functionality.

Doesn't have all the modules, but then they can add them later, which. You know, obviously I'm an Epic fan. I, I installed Epic. I, I worked well with them. I think, um, there's a lot of great things going on, but in this, I think there's that blind spot where Judy sometimes thinks that it's gonna be world domination by Epic.

And so this is declared as a advance of interoperability as they do the care everywhere more robustly for Epic users. It doesn't say anything about how they're gonna communicate with the others. And I know they're in this Sequoia project and I, you know, I think there's gonna be advances outta that. But this article leaves people with that same sense that you've seen in the editorials and you've heard in, uh, some of the discussions that Judy's not really playing with all the other players in the market.

Um, it's great if you're epic and I, you know, I think she is moving to. In making the care everywhere more robust, having, uh, social determinants follow them wherever they are in the us being able to communicate that. So if my, uh, snowbirds go down to Florida from Kentucky, they're gonna get the same information shared in their epic everywhere.

That part's good. I think Sonic getting into smaller hospitals, good, but I think I personally wanna see the whole world moving much more aggressively towards interoperability. I think the O one C missed it originally. I think their idea that you could fix it after you allowed all these disparate EHRs to be built without it.

Um, they've, we've got a mess. And I don't think sonnet solves it, but I think it's, it's a nice additional solution for Epic. Yeah, this is, this is, uh, one of those areas that I, it's, it's being from the outside of healthcare, seven or eight years ago, the first conference I went to, uh, there was. I don't know, I guess there's 12 CIOs sitting around the table and they asked us to all do our introductions and they went around the table and whoever the first person was, they gave their name, their system, their revenue for whatever reason.

And you know what e h r they were on. And I thought, well, that's interesting. Okay. So it got to me and I said, you know, here's my name, my system, and you know, both are impressive numbers. So the numbers are impressive. And then I said, my E H R, and it was, it was like, I had said, Hey, I, I, I didn't really graduate from college.

I, you know, I only got an associate's degree. And I mean, you could see people look down their nose at me and I was like, oh, this is, this is fascinating. There's sort of a culture around what e h r you're on. Um, and uh, it sort of reminds me of the OSS wars back in the day when people would take sides and say, you know, I'm an OS two guy, or I'm a Windows guy, or, or, I'm a no guy.

It really doesn't help us at all, to be honest with you, to be so passionate about the hr. My, my experience, and I've research this. The, the, the net distinction between these EHRs is, uh, in terms of overall running a hospital and being efficient is not that distinct. In fact, we were a Meditech shop with 16 hospitals, $6 billion, and, uh, I mean, people would say, well, you know, it's, it was, that's an awful system to run that kind of health system on.

And, and I'll just tell you from a number standpoint, it's highly efficient. Uh, it, it, it, it does lag in terms of the user experience. Overall in terms of running the health system. It was effective, it had very good, uh, technology and modules. It didn't go down. It, it, it was a, a very stable system. And, uh, I find people get so passionate about this and, uh, it's a little off topic.

Let's talk interoperability on this. So the interoperability, uh, I agree with you. I believe that Epic believes that the path to interoperability is if everyone gets on an Epic platform. We will get to a, a longitudinal patient record. And that's just never going to happen. And we don't want it to happen and we don't want it to happen for, I think the primary reason we don't want it to happen is 'cause we saw the same thing in the E R P world.

And when you get down to very few vendors and you get down to a certain market share for those vendors, uh, the innovation slows down. And, and it is not because they don't have huge staff and huge budget, the innovation slows down because they have to innovate in a way that they're taking into account their, their European clients and their Australian clients and their, you know, 55 different clients in the US for large hospitals and their small hospitals.

It just gets too complex. To innovate. And so we actually slow down innovation. We slow down, uh, the market. So I'm not sure we ever want to get to a epic world domination anyway, so we should continue to look at things like the Sequoia project and, uh, the Karen Alliance and, uh, and, and some of the other initiatives that are out there as really the, the, the start of this interoperability journey.

I'm, I'm, I'm, I sort of rambled there for a little bit. I'm curious what, what your thoughts are, um, in terms of what's, what's next, um, on this and what's next on interoperability? Yeah. Well the next on this is I think you're going to see Cerner and others work towards the comprehensive health record more and more.

Um, so. The large players are going to be doing that. I agree with your assessment about, um, the need for the competition to create innovation. You and I grew up with the big four and we both drive better vehicles now because there's competition from overseas and from all around. Uh, so the innovation's there.

Um, I think the other thing on interoperability, I think the high tech, um, I hold some hope that that group is going to come to an understanding that interoperability is the must have. And we have some legislation that's driving it. Um, I, I think you know the physician voice and, and you're gonna get to that in a moment.

The physician voice more and more is demanding. Interoperability. We're wasting too much of our clinicians' times. Um, physicians, APRNs PAs, nurses looking for information that ought to just be there, and it ought to be in a usable format when it gets there, not in a linear format. Um, the horrible, uh, uh, c uh, CCDs that we saw, um, the last several years, it's gotta be better than that.

I agree, and I am, I'm looking forward to jumping to the next section, talking about physician burnout. I mean, one of the, when I sat behind a physician at one point and, and just, you know, mirrored them for the day, I was shocked to find, you know, they were jumping into all these essentially P D F files and they, you know, so they have 15 minutes with a patient and they're

Think about it. Like you have this folder full of, you know, 25 PDFs and you're just rifling through 'em real quick. It's, it really is an impossible job, which gets to, you know, our role. So, uh, you know, in our tech talk, uh, leadership, we're gonna talk a little bit about, uh, the role of IT and physician burnout.

Uh, the reason I, I, I just appreciate your physician background. I'm use it so on. Uh, article and I'll just read, you know, only C and C M SS officials got an earful for a day long listening session at, uh, health and Human Services on Thursday about reducing provider burden from health it. Speaker after speaker said, physicians and nurses are on the edge of a nervous breakdown over the depressing hours they spend struggling with bad E H R workflows and government reporting requirements.

So, Let me ask you this. Let's start with the current state. Where do you think we're at with regard to, uh, physician burnout today? And, and, and, you know, what are you hearing out there? I, um, hearing a lot about it. Um, the last, uh, a m a annual meeting, I'm a delegate for the state of Kentucky to the a m a.

The last meeting was dominated by, uh, conversations regarding physician burnout. It continued at the November interim meeting, um, of the a m a, uh, we, a year ago, year and a half ago, almost now, had the ran study with the A M A that showed. Um, that physicians were spending two times as much time on the E H R as they were with patients, um, that the burnout level was going up, that the physician's, uh, career satisfaction was plummeting.

We've seen some of this for years. I think, you know, it. For my experience, I came into practice in 1990, I think in 95, 97 when they came out with the e and m guidelines. Uh, some of that coding documentation came from outside. It had nothing to do with how we really take care of patients or what was relevant to taking care of the patients.

Physicians felt the pressure of that documentation got more and more copious. Then you get EHRs and you get no bloat and you get. All the meaningless use, meaningful use, uh, requirements that tell us to tick some boxes that showed functionality of the E H R in terms of it had this code, this, um, capability, this field was able to be populated.

But it didn't do anything for the patient physician interaction and for the quality of care we were delivering to patients. All of that builds up on the physicians. And so now we are seeing a critical mass. We're seeing that over 50% of physicians interviewed and surveyed are lamenting, um, that they're losing their satisfaction, they're losing connectedness.

Uh, depression rates have gone up among physicians. They were high to begin with. I mean, it's always been a stressful, difficult, uh, role. It needed com compartmentalization. Now we don't have time to compartmentalize. We, we are racing from patient to patient and still have the record waiting for us. And then we go home and we, uh, feed the kids, tuck them in, and spend another two and a half, three hours on the computer.

And you hear this over again, the thing that. Kind of amazes me about, uh, H H Ss and O N C doing this listening session. You do these listening sessions when you really don't want to do it something or you're not ready or capable of doing something, right? 'cause they have all this information I just mentioned a year and a half ago we had it.

I think that's one of the things that galls me about this. This was just plication and delay. If they really wanna get something done, get to work on interoperability. Reduce some of the cumbersomeness. They are at least talking, uh, h h s and I think they mentioned it. They're talking about, uh, reducing some of the, uh, mips uh, requirements and easing some of that burden.

But they've, they've gotta quit being in the physician patient business as much as they are. Um, I have a very good friend, uh, Dr. Sean Jones, former president of the Kentucky Medical Association, who just published a book, finding Heart and Art. It's about his journey of burnout. I think it's an incredibly brave thing for him to do.

He's a prominent ears, nose, and throat physician in his community and prominent within the medical community at large. But it was a great gift on his part to other physicians. It's not every physician's journey, but the fact that he would take the time out of his life and his wife would allow him. She's also a physician, would allow him to expose himself this way.

Tells you how severe this is, how critical burnout for physicians is. And I think we as CIOs have an opportunity to help by really looking at the workflows and demanding of our vendors improved workflow. Wow. So do you, do you think there is a, um, I mean, is there a risk in speaking out against some of these things?

I mean, is there a risk right now of. Of talking about, uh, you know, certain technology. So if, if I were to sit here and say, you know, epic and Cerner, you know, have created way too many clicks and way too much, or if I sit here and say, health and human services, o n C, macro emits, these things have put way too many burdens.

Is there, is there a blow back that happens to people that are speaking out about these kinds of things or. Are, are we past that now, where there's just so much of it going on that um, it's just a matter of getting to the right, uh, the right people to get the right things done? Yeah, I think the risk, um, is probably perceived to be there more by folks who don't have a clinical background.

Those of us who have been practicing physicians, I think we're past worrying about the risk. We're desperate to find the right answer, and we feel that for the sake of our patients and for access to care. 'cause when you burn out physicians, they resign their physicians, they leave the practice and access goes down.

So if we're gonna do that, I think we get over the fear. I think, and I know from conversations with the folks at Epic, I haven't talked to the folks at the other large EHRs. Um, but with conversations with folks at Epic and I watch at U G M and at, um, some of the other conferences, folks are getting in their face, um, they're doing it in a civil way, which we always ought to do it in a civil way, but people are being very forthright about what the problems are and they are starting to respond.

And you're seeing some of that in the workflow changes. You're seeing some responsiveness. I think they built, to your point, these very cliquey systems that are incredibly complex, uh, coding. And to go back and correct that and to streamline workflows is a big lift. And I think it's just getting a critical mass of all of us saying, okay, no more.

We're not gonna tolerate this any longer. You've gotta do better. And then I think they'll start moving. They also know, you know, and I know, but the, the barrier to change in it health, it is huge. 'cause the cost is so high to change. Tear outs and rein implementations, I just went through one. They're expensive and you do everything you can to not do it again.

But I think if we're gonna be good partners, and I always talk about, uh, good partnerships, um, our E H R providers. And we as the users have got to have these hard conversations and be good partners and help each other to improve and get it right. What is the, so we, we've talked a little bit about the, uh, the IT side of it and the E M R providers.

What needs to change on the, on the, on the regulatory side that, I mean, we talked about, you know, the MIP burdens coming down and, and maybe even some mu things have been, uh, uh, eased. Are there some other things we can look at to maybe roll back or, uh, some conversations we should be having that, that really drive forward, not just a listening session, but that we as, uh, health IT leaders or maybe even a couple of the people at, at, uh, HIMSS that are listening to this or Chime that they could advocate for on, on Capitol Hill and, and really move things forward.

Yeah, I think H H SS showed us a first step in eliminating the requirement for attending physicians in the academic centers to duplicate what's in the student note. They're starting to recognize that if it's in the record and it's available, it's in the record. It doesn't have to be duplicated. That's a great start.

I think they need to look at the 95, 97 e and m coding guidelines, and I know they are and say, is everything that we're demanding necessary in the world of an E H R where so much of that social history, you know, if, if I'm. Simply reviewing and moving on. I don't have to document it in every single note.

Um, you can follow my clicks. Um, if you really wanna audit me, it's auditable. Uh, but quit making physicians be, um, uh, scribes responsible for counting the number of boxes checked and trust them that when they say it's a 9 9 2 1 4 visit. It is. And if you wanna trust and verify, because I believe you know Reagan was right, trust and verify.

Um, then go ahead and look at the clicks. Periodically do some random audits, but don't make people put all this cumbersome stuff into the note. It's time consuming. It fills up page after page. If you do a printout, it's just ones to go through it. I think we can have those conversations. We can make those steps.

But this first step by h h Ss to re eliminate the redundant documentation for medical students, great first step. There's a lot more steps to be taken. Absolutely. And we talked about that last week with, uh, Charles Boise on the show. Just how much data is in those e H R logs that you could actually just retroactively go through and create, uh, a lot of that instead of putting the burden on it.

Position and that's just probably one of many cases. The only other thing I would, Wes last time, uh, which is one of the ways to ease yesterday. Uh, uh, a post by, uh, razu on what, uh, U P M C is doing with Microsoft in terms of, uh, uh, having the machine, uh, do the do to do the notes and, and record the notes while they're in the room.

So that was a partnership with U P M C and Microsoft, so hopefully more things will happen in that area. But as is always the case with you, I, we. Uh, , it's time to close the show. So, uh, favorite social media posts of the week. Uh, I'll kick us off. So, um, wow, I can't even read this. My eyes are getting so bad.

I don't know what age that happens, but it's happened to me. So, um, this is, uh, titled How how You Treat Your Loyal Employees determines your Future. Uh, Polsky, who I'm sure is an avid listener of the show. Um, but he, uh, posted a cartoon. I love these cartoons. And it says, think twice before losing your best employee.

And it has the, uh, has a, uh, like a plank out over the, uh, cliff and the employees, uh, walking the plank except they're walking to land while the, uh, executive who's losing their best employee is sitting out on the other end of the plank and about to fall into the abyss. And, uh, I think that's just a great reminder for us.

So, uh, over to you. What's, what do you have for us? Yeah. Um, I didn't go for a social media post. I went for something that was ringing in my ears this week. Um, a comment by my dear friend, Steve Heck, I don't know that he originated it, but he was the original person that I heard it from. Um, execution trump's innovation.

The reason I'm bringing that up is a lot of our friends are gonna be at HIMMS and Chime, and particularly at himms, there's lots of bright and shinies out there. We have all these opportunities to innovate. First we'll execute, get it done right. I'd rather do old school right than new stuff, wrong. And, um, I think it pays off.

You saw this in your work, uh, going to the cloud with your system. I saw it in the work of the team that I got to lead, uh, in the implementation. Epic execution means everything. So will you be at Chime or be at himss? I will not be able to. I had a family obligation not going to be able to make it out.

Yeah, it's, uh, well, I'm going to, uh, I'm gonna drive over there and, uh, look forward to catching up with some friends. So if you are a listener and you're gonna be there, I would love to, uh, catch up with you. I'll be at the, uh, at the chime event, the c i o forum on, uh, Monday, and then HIMSS the rest of the week.

And, uh, still have some time slots if people wanna get together. I'd love to, love to catch up. So thank you again, David, for being on the, that's all for now. Please, uh, you, um, Follow? Well, actually, I guess usually I say you could follow us. Do you have a Twitter handle? I don't know if you do. I do not. Oh, okay.

Well, you, well, let's, let's just say they can follow you on, uh, your articles you're writing for HealthSystem cio.com and, uh, my articles are over there as well. So, uh, great publication. Love those. Uh, love those guys for the service they provide. Uh, you can follow me at, uh, the patient c i o on Twitter. Uh, don't forget to follow the show on Twitter this week in.

And, uh, don't forget. If you like the show, please take a few seconds and give us a review on iTunes or Google Play. And don't forget to come back every Friday for more news commentary from industry in the.

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