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Good morning. 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 number 19. It's Friday, May 18th. Today we talk about the present and future of telehealth and the role of the C M I O. Is brought to you by health lyrics.

Get a plan for agile, efficient, and cost-effective it from people who have been in your shoes. Get ahead of the wave. Visit health lyrics.com to schedule your free consult. My name is Bill Russell, recovering Healthcare, c i o, writer and consultant with the previously mentioned health lyrics. Uh, before I introduce our guest today, I want to share with you an exciting opportunity.

We've reached some milestones on the show around listeners, production quality, and uh, just the, the wonderful guests that we've been able to have on. Based on your feedback, we know that the content is relevant, timely, and, and very useful. Uh, over the next couple of months, we are going to focus on getting this content into the hands of more current and future healthcare leaders.

That's why I'm really excited that our sponsor has agreed to give $1,000 for every a hundred new YouTube or podcast subscribers over the next 90 days to an organization called Hope Builders. So Hope Builders provides Orange County's most disadvantaged youth. The life skills and job training needed to achieve enduring personal and professional success.

Uh, I had the opportunity to hire some of these graduates. Their stories are, are really incredible. Anytime I. Uh, somebody chooses to reboot their life. Uh, I find that to be heroic and it really points them in a great trajectory. So I'm, I'm really excited about this opportunity. We hope you'll join us by sharing the show with your peers and friends, uh, to maximize this opportunity.

Um, so today's guest is, uh, no stranger to the show. He is been on with us before, Dr. David Van, former c i o for Baptist Health. And, uh, Three time co-host of the show. Good morning, David. Good morning, bill. I appreciate the chance to be back with you. Yeah, I'm, I'm looking forward to it. It's, uh, it, it's been a little, been a little while, but you are, uh, uh, you, you're one of the people who I, I love having back on the show for the, for the fact that you've been a C M I O, you've been a C I O, uh, practicing physician, so you have so many different perspectives to bring to the show.

Um, you know, and I, I just find that so valuable, so I'm, I'm looking forward to our conversations. Appreciate it. So we have, we've, we've modified the show a little bit since the last time you were on, and we still do, uh, we do in the news. We wanna make sure that we're, we're hit hitting the current, uh, news that's going on.

We do now do a section called Sound Bites, where I, I put the, uh, The co-host on the spot and ask them, you know, four or five questions and give you a two or three minute, uh, answers to come back. Uh, every now and then one of the, one of the, uh, co-hosts will fire a question back at me and catch me off guard, which is what David Munz did last week, which was a lot of fun.

He asked me a highly charged political question, which was fun to try to dance around, uh, which he got too much enjoyment out of, but we'll, And then we have the social media close and, uh, I, I really love your poster this week and get. So I, I, I picked, uh, I picked the story, VA finalizes interstate licensing rule that will open the aperture for telehealth.

This is on Fear Fierce Healthcare. And, um, you know, the story is that the department of, uh, I'm just gonna read some of it. The Department of Veteran Affairs finalized the much anticipated rule. That allows providers to treat patients across state lines using telehealth. A critical element of the virtual care initiative launched last year.

Currently, the VA patients can receive care via telehealth by going to one of more than 700 community clinics, so not directly to the home. They actually have to go to these clinics. That's how it was before. Now they're going to be able to do these telehealth visits, uh, to the home. Uh, bypassing the state licensure, uh, requirements and regulations.

So the new rule overrides state licensing re restrictions so clinicians can treat veterans anywhere in the country. The rule is critical piece of the anywhere to anywhere Telehealth initiative, uh, launched by secretary, uh, uh, Shulkin. Um, the finalized rule is limited somewhat, but the, uh, the House and Senate are looking to address that.

It doesn't cover the VA choice. Uh uh. So, um, I'm gonna, I'm gonna stop there. I'm gonna come back to the story, but. Uh, you know, one of the things I've heard over and over again as I've talked to healthcare leaders is that they believe that telehealth could be a, an amazing, um, opportunity to reduce costs, increase access.

But the, uh, state run medical licensure prohibits physicians from practicing medicine across state lines. They are license. So this, this, this roadblock to tele is really a roadblock to the proliferations telemedicine. I was curious from your physician's perspective, is the state medical licensure still relevant today?

Are we gonna see that sort of go to the wayside? I mean, what, what's your personal thoughts on this? I, I think the state's licensing is still relevant. Um, I think because of that type of impediment to telemedicine development, into the movement of physicians, into areas of need, um, including the fact that, you know, Kentucky's a state that borders on seven other states.

We have the most borders of any state in the union. We recognize the need to the licensing process. I'm not in favor of the federal government.

And going ahead and just bypassing the states. 'cause I'm kind of a state's rights person, uh, just bluntly. Um, but we're already working with the interstate medical, uh, licensure compact. And 22 states have already passed legislation allowing their physicians to participate in the, uh, compact rather than strictly with their state licensure board.

So their state licensure board works in contractual agreement with. Allows a physician who's, let's say he's getting licensed in Tennessee, is also then able to be licensed in 21 other states at the same time, it allows us as physicians and the states, um, to ensure that the vetting process is written, um, is strong, is thorough, and is consistent with their desires.

There's eight more states that have introduced legislation, so that would be 30, and we're at a, a tipping point with this. I would've really preferred if the DA had thrown the weight of their organ, of their, um, organization, their department, and the weight of our veterans. Our veterans would get this done.

Then we could do it within the states with control by the states without bypassing them. So that's my political take on it. Now, my c I O hat and C M I O hat is the sooner we get telemedicine to be fully robust and without barriers, the better. The patients need it. We don't have the ability to put mental health providers, primary care providers in every single site where they're needed.

We don't have specialty access everywhere. We need it. Telemedicine provides that bridge. And it's gonna be critical. So I don't like the way they did it. I completely agree with their goal. Yeah, that's interesting. I was, I was not, uh, really aware of, uh, 22 states and eight, eight are in the process of passing.

So 30 states outta 50, that is definitely a tipping point. Um, I, that's interesting. I, I, I may throw together that map. Where we're at. I know that, uh, you know, some states I've heard, uh, you know, the, the c e O for Jefferson talk about the fact that they can see the New Jersey border from their hospitals, but they can't do telehealth.

Sure. Across that state line. And, and, and, uh, it would be interesting to see who the, who the holdouts are on that. 'cause I think we all agree. You know, for, for follow up visits, for, uh, for, uh, tele, telepsych, tele, uh, I mean, there's, there's just so many opportunities. Oh, yeah. To keep people outta the waiting room, to, to reduce the, the pressure on our, uh, uh, on our uh, uh, ERs and those kind of things.

Um, this, we've gotten to the point where this, this is, is really necessary. Yeah. I think about my po, my, uh, orthopedic colleagues post-op orthopedic visits are largely, you know, driven by a goniometer to measure the angle that the patient can achieve and to make sure the wound's okay. You can definitely do that with a telemedicine visit.

You can accomplish that and save the patient to trek up. Um, if they've already traveled three hours to have their surgery, why should they be coming back three hours for a postop visit? Yeah. And I. Yeah. A a friend of mine, well a friend of my son's was saying, Hey, you're in healthcare. Lemme tell you my story.

And he, he told me this story of, you know, waiting 30 minutes in a waiting room, getting in and waiting another 30 minutes in the, in the exam room. And then he saw the doctor, and the doctor says, yeah, I looked at your results. They looked fine. Uh, you know, you know, diet and exercise, you should be okay. And he thought, I just waited an hour.

Isn't there a better way to do this? And telehealth would be a good way of him to just, you know, to just have that, that consult. Yeah. And, and away they go. Um, and in line with your barriers. Um, you know, one of the barriers has always been reimbursement and for once, um, and actually more often than people think Kentucky leads the way, and in this case, Kentucky's leading the way 'cause we just passed Senate Bill one 12 that allows and in fact requires equal reimbursement.

For equivalent care. So if I can do a telemedicine visit for mental health or a follow up visit through telemedicine, that is equivalent to what I would've done in the office. It requires the insurers to provide equal pay to the physician for it. That's been a barrier all along. If I'm not seeing a decrement in my revenue stream, then I'm gonna participate more.

And once we get the patients demanding it and the physicians not resisting it, it's gonna take off like a jet. Yeah, I, I agree. So that gets to the next part of the story where they talk about some of the, uh, percentages. So during 2017, 12% of the VA patients recorded at least one encounter with the system, received a portion of their care via telehealth, and that translated into more than 720,000, 727,000.

Veterans engaged in some form of telehealth. Now remember, they had to actually physically go to a location in order to get this telehealth visit, but, but it's still equated to about 2.2 million visits. And, and so now we're gonna have the ability to go directly into their home. I think we're gonna see, uh, significant, uh, uptake in success in this program.

Now, as you noted, one of the benefits of the VA is that there really isn't money changing hands. So we don't have this. This reimbursement, uh, challenge. Uh, but you're starting to see movement. I mean, you're starting to see movement in c m s. You're starting to see states, uh, insurance carriers. You're starting to see movement in this reimbursement model.

Um, and, and again, I've talked to some leaders that are saying, you know what, even without the reimbursement, we see this as a, a strategic opportunity to provide, uh, a better experience, better care for our communities. Plus they want to establish. Uh, the capabilities operationally and, uh, technically because they see it as an opportunity that once those barriers come down across the states, that they're gonna be able to expand their markets.

Um, and expand their presence without really expanding their, their overall cost structure. Right. And be able to service, uh, a lot more of their, uh, a lot, a lot of other, and new communities. I mean, do you see, absolutely. Do you see that as, I mean, what are the implications to healthcare long term? Let's, let's, let's fast forward three years.

Let's assume that the barriers come down, uh, reimbursement's there and you can practice, uh, all the, all the states, uh, sign an agreement. So all 50 states you can see somebody via telehealth. What do you think the implications are for healthcare and healthcare it in, in that scenario? I, I think the cost savings are huge.

Um, it's so much easier to scale up, um, telemedicine because to your point, you don't need additional infrastructure to manage additional volume. I. Um, as opposed to clinics or bricks and mortar, which are quite, um, capital intensive. So I think that will help people to expand their offerings and their availability.

Um, for the healthcare it, the complication becomes, are we going to store and retain all these video, um, it visits, or are we going to really, really push the envelope of natural language processing? Get that to the point where we're able to extract the needed documentation without the physician having to distract themselves.

You know, now I'm looking over here and I'm, oh, I'm here with you patient. No, you're not. You're, you're doing typing. And in the office we already complained. The disconnect in a telemedicine visit is so much easier to have happen if my eyes avert. So I need to figure out if I'm a C I O and a C M I O. E h r provider, how do I build the televisit in in a way that allows the provider to stay in contact with the patient?

Because the patient's gonna notice when I lose eye contact, and that's all we got going right now. And it's so critical. Yeah. And I, I think we'll see more of that. We'll, we'll bake it into the e m r, bake it into the workflow and you're, so, you're gonna see, because you'll, you're gonna see it become tightly integrated with the E H R.

'cause right now a lot of people are doing, uh, solutions and they're, they're great solutions, but they, they have to be integrated after the fact to the E M R. And, uh, and, and that creates, uh, an interoperability problem, a data record problem, documentation problem. Um, but you know, people think this whole thing of doing these video visits is, is easy.

But, you know, the minute I take my eyes off and look at the notes for this meeting, you know, it looks like I'm not paying attention. It is, there's actually a certain amount of discipline to, to conducting these video calls so that people feel like there's a connection, uh, that I contact and it's, um, You know, and, and so we will have to make, uh, I don't know.

I, I, I think the other advance I'd like to see in technology is, uh, the camera to be embedded somehow right behind the screen so I could be looking at the screen and at the notes and not have to worry about it. And, and, and, 'cause my camera's at the top of my computer right now. My notes are down here. I think that would be a great advance for, for an Apple or a uh, uh, or, or Dell or one of those providers to put that ca somehow figure out a way to embed that camera right there at the center of that screen, I think would be a huge Yeah, I agree.

I agree. Keep, keep the contact because it's gotta have the warmth. Um, and we'll talk about this a little bit more later, but it's gotta have the warmth, the relationships, um, have gotta be built. So I, I'm gonna kick it over to you. And in fairness, uh, you didn't select your own story. I don't want people to think you're a narcissist here.

I actually asked you if we could talk about your story, 'cause I thought it was so good on the, on the role of the C M I O. So I'll let you set it up. Yeah. Um, you and I both have the pleasure of working with HealthSystem cio.com and Kate Gamble has been a good friend to both of us, and she asked me if I could.

I try to take a look into the future, uh, regarding C M I O roles because of my kind of unusual perspective on things. And so I started thinking through this and what I realized is we are in a world of specialists and we tend to become focused on our specialty. And I wanted to direct CMIOs In particular, though, I think it's valuable to all leaders.

To become a generalist in your knowledge, and a specialist in your focus on the population or the team or the group that you are serving. And so my push for CMIOs, um, was really more about them becoming more diverse in their knowledge base to read about finance and to read about nursing, to read about, um, Business operations to make sure that they understood the needs of their customers because the whole healthcare system is the customer of the C I O and the C M I O.

But to know their needs and then be able to anticipate where that puck is going so they can be more useful. Um, the other thing that I see for CMIOs is the need to. Take what is already a physician advantage, the integrative mindset. We listen to disparate information coming from the patient. We have the chart, we have labs.

We take all that disparate information, we integrate it into a differential, and then we. Test our hypothesis and make rapid course corrections to arrive at the correct diagnoses and treatment plan. Well, that's integrative thinking. If we can apply that to the rest of the healthcare system and to our interactions with the healthcare system, we will be more useful.

And then finally, uh, really develop your skills and strategy and ensure that you are in a position to influence strategy. And have a deep knowledge of what the system strategy is. So whenever folks are coming with the bright and Shinies, you can point 'em back to the system strategy. You know, what is this really helping us move forward?

Is, is this in the same vector direction as our strategy or am I pulling energy in another, um, vector, uh, direction? 'cause if I'm starting to pull in multiple directions, you know, and I know the cart doesn't move very fast forward and in fact usually gets tipped over. Yeah, the, the, uh, you know, one of the things I've been thinking about is the, the C M I O role.

Just like the c i o role. Um, you know, the, the eye stands for information, so Chief Medical Information Officer. And, and in, in so many cases now we're talking about, uh, innovation, intelligence. Um, I really, those two are the only eyes I can think of. You know, the Chief Medical Intelligence officer sort of talks about where we see the, the, the C M I O fitting in.

So every, uh, every specialty has a need for intelligence. They're gonna, uh, advance analytics, uh, AI machine learning, and how, how is that gonna be applied to their practice? And I see the C M I O being one of those key, uh, people that does the translation between, uh, the practice, the algorithms that are going to be helpful.

Uh, the algorithms that we can actually get data and, and make practical to, to that specific practice. And, and translating that also to the, to the, uh, systems and understanding the systems, which is what you were talking about. So it's the person that can bridge that gap between understanding, uh, the, the technology and where, where it's at and where not, not understanding a deep dive into, Hey, here's how we make, here's, here's the framework for setting up.

Um, artificial intelligence for our healthcare system that's on the technical side, but really being able to say, I know what it's capable of. I know the information we have, I know the needs of the practice and we're, I can help us to map that course for applying advanced analytics to cardiology, to oncology, to all different practices.

Absolutely. Absolutely. And, and becoming an enthusiastic. Um, change management, um, change leader, helping people understand the value of the change as opposed to focusing on the pain of the change, helping them to find a reason to want to change. Um, part of that requires that you know what is in the digital space, that you fully understand it and you understand to your point, you know, which algorithms, which products can benefit.

Your particular system and every system's gonna be unique. That's why at the end of the article that I wrote, I, I said, there is no canned formula for this. There is no program. Every system's gonna have unique needs at a unique moment. And trying to be like everyone else is really not your best choice.

Being the best you or being the best system you can be for where you're practicing is the key. And so I think the C M I O really needs to be a discerning enthusiast for the IT world as opposed to a, gosh, let's play with all of it. 'cause it's all cool, it's all techy, it's all, you know, it's all fun. Um, but let's focus on what's really beneficial to us.

So, strategy, strategy, technology, and practice. They're the, they're the person who sits in between those three and, and really makes it work. Um, what's the, what's the mindset that you would, uh, not to take it negative, but what's the mindset that you would, uh, caution people to, to warn them against? Uh, you know, 'cause we've all run into CIOs that they really see their job as protecting the status quo, uh, or those kinds of things.

But from a C I C M I O perspective, what, what, what mindset would you, would you like to see if you were hiring a new C M I O right now? Yeah. Uh, if I was hiring a new C M I O I would look for somebody who does not speak defensively, um, regarding their physician colleagues, but instead, uh, speaks engagingly.

So the difference is I'm not going to protect my physicians from change 'cause change is inevitable. How am I going to engage them in change? How am I going to engage the nursing staff in change? When I hear that from A C M I O, who understands how they're going to help move the system forward and how they're going to help lead change, that's the person I want, not the one who says, you know, oh, you know, physicians hate clicking through all this.

Physicians hate the hr. Okay. I think we've heard that before. Yeah. Tell me something positive. You know, it's the same thing you've always looked for and, uh, you and I've had this conversation. I look for the person who's bringing solutions, not the person who's bringing problems. I'm fully capable of identifying every problem I can look for negatives.

I need the person who's bringing solutions, not panaceas, not plum, but real solutions. Yeah. And the thing I'm always looking for is give, gimme a list of the problems you want to try to solve. And when, when people are saying, well, I want to protect this, or I want to protect that, that, that's usually a, a red flag for me when they say, You know, I, I, I see that these clicks are causing, uh, physician burnout and I want to figure out how to solve that problem.

I go, yeah, all right. That's a, that's a good problem to solve. Or I, I wanna figure out how to bring, um, augmented intelligence in. I don't think that computers are gonna replace physicians, but I see a place where they can help physicians to be more focused during that, that visit. Or I want to take computers out of the room.

Or, I mean, when they start saying, Hey, here are the problems I feel like could make a, have a meaningful impact, I go, Yeah, those are the right problems to solve. Let's, let's move forward. Yeah. Yeah. Um, all right. So we introduced a section called Soundbites, uh, since the last time you were on, uh, during this section, toss out some questions, one to three minute answers.

And, uh, you know, if you want, you could throw back some questions at me, but, uh, let's start, I, I only have four questions for today. So what is the distinct advantage of being a physician, c i o over a non-physician, c i o?

To my mind, the distinct advantage of being a physician c i o is I have been through the workflows that we are impacting. Um, and particularly being a primary care physician who also is old enough to have practiced in the hospital and then let us, uh, um, hospitalist program, I know the workflows that we're impacting and I can identify more readily.

And empathize more readily with the pain points that we inadvertently sometimes create, but I can help us to avoid some of that. So I think that's one of the big advantages, ex experience and empathy. Yeah, and, and typically when I hear systems going, Hey, we're gonna hire a. Uh, we we're looking to hire a physician, c i o is because the previous c i o did not show empathy , or take the time to really spend understanding the clinical workflow and the challenges that we're facing.

So I, I love that answer. If you had the power, what changes would you make to the E H R to make life easier for, uh, physicians? Oh, this is one of my favorite subjects. And in fact, I was talking with Dr. Brett Oliver, who replaced me as C M I O. My, you know, I had the dual role and Brett became the C M I O as I left while Tricia Julian became the c i o.

Brett's A voice you ought to hear. Brett is a phenomenal voice. But first and foremost, the things that are immediately achievable, um, is voice recognition for order entry, um, and notes so that we can get. So many of our colleagues who struggle with the keyboard off of it and speed the order process. Um, another area would be to enable, um, how do I say this?

Uh, better exchange, which actually requires that we tell the e H R providers that you have to have the standard format and the process interoperability is only gonna happen with a deadline. And with some mandates, um, the e H r manufacturers and systems that like to protect their data are not going to come to the table until there's those two pressures, time, pressure, and um, uh, mandated structure.

Um, that would, that's critical for exchanging patient data. Um, so in a meaningful way so that the physicians can use it within their workflow. As opposed to looking at horrible line after line, after line of, um, some of the formats that we've seen. And then third, um, and this one's kind of con conjecture, um, it, it's a little aspirational, uh, not quite ready yet, but get the analytics, get the artificial intelligence.

Thoughtfully built in with input from physicians. You know, this time around, let's not build it and then put it in front of physicians and say, use it. Let's get the physicians to help us build it. Get that artificial intelligence in place. Create the ability to say, you cannot be as good a physician as you want to be without your E H R.

Because for precision medicine, for all the things we wanna move through population health, you can't do that without any E H R. I can't gear carry that data in my head. You and I can memorize a lot of things. We are talking to a very smart audience. They can memorize a lot of things. They can carry a lot of information, can't carry all of it.

So we need the help of the augmented, uh, intelligence of the artificial intelligence. We need that, but we need it in a way that we can say, you can't be as good a physician as you wanna be without it. Yeah, I think, I think one of the exciting things is that, uh, the VA did finally sign the $10 billion e h R contract with, uh, Cerner.

But part of those stipulations are really around the adoption of fire open interoperability and whatnot. And I think, you know, when you get a $10 billion enabling contract, And you have those kinds of, uh, stringent requirements tied to it that I think you're gonna see Cerner's product get a lot better over the next, uh, couple years with regards to interoperability just based on that contract.

Yeah. Plus, um, you know, I think, I think the fire movement has really left the, uh, left the barn and I think the, uh, I'm hoping that the people in, uh, in Madison and Kansas City, uh, do move this thing forward. We, we can't do it without 'em. Yeah, well, I, I look at what's come on to App Orchard in the last year and the number of APIs and the facility of working with those is so much better than it was even 12 months ago.

So I think you're right. I think it is moving, I think you're correct that Cerner's gonna move forward more quickly, uh, because of the VA contract, and that's gonna catch everyone else in draft and they're going have.

But we still, you know, I think ultimately we still need to put some timelines on them. Um, because, you know, we don't prioritize until we have our reasons for prioritization and deadlines are terrific prioritization tools. So you, so you've had a lot of successful IT projects. Um, and I asked a similar question last, last week for David months.

He, he said, you know, we, we live at 120 projects a year. You don't typically get to, to, you know, call your shots, call your timeline as a c I o unless you're doing success successful projects. What's the one thing you would share that has led your teams to delivering successful IT projects? Uh, I, I think we ultimately put it into three words and it became the, uh, um, motto of our culture, which was one with intent.

And it meant that our IT team, even though we're divided across seven Hoss or eight hospitals now across an entire state and 240 ambulatory sites of care, we're one. And so we communicate aggressively with each other, meaning, I, I am transparent with the senior team now, Tricia's transparent with the senior team, you make sure everyone stays in the loop and it gets passed on so that everyone's on the same page.

So when they get an asked a question in the markets, they're given the same answers. What are the prioritized projects? What is your list of projects? Everyone's up to date and we keep up to date. Um, the with intent means that we do some of what I talked about with CMIOs. We study. Our customers, we study their workflows.

We study what they need so that we can be intentional. In how we prioritize projects. We understand how they interact with one another. We understand where the benefit is in, um, sequencing so that we don't get a project that's really waiting for two other projects to be fully utilized. We get them in the right order and we're able to explain that to the C-suite and to the presidents out in the markets.

Um, so intentionality is, I think the number one thing that we brought that we were able to change during my tenure. From the previous reactive. Here comes another one over the wall type. Um, typical it shop response to, Hey, if you really wanna move, here's how you can sequence these, and here's how long it's gonna take.

You give some realistic numbers to things and then as always, you, you don't fudge in terms of, you know, holding back and creating false numbers, but you still strive to outperform your promises. If you do that with intentionality and then outperform your promises, um, they allow you so much more leeway.

And allow us to help drive the tactics, if not the full strategy. Yeah, and I was, I was talking to a client this morning and uh, you know, we talked about why, what and how, and why is the vision, what is the strategy and how is the tactics? And one of, one of the things that gets it backwards is they start with tactics.

They say, oh, this new thing just came out and it's really cool, it's really awesome and we should implement it. And, you know, even if it's part of the E M R suite and those kind of things, they, they just unilaterally make a decision that, well, this came out, we're gonna implement it. And, and I was talking to the C E O and I said, you know, you just gotta flip that on its head.

I mean, why are you doing it? What, what's your vision for the organization? And then, You know, what, what are you trying to do strategically this year? If you're strategically going after, uh, ex expanding telehealth or expanding your clinically integrated network, then your projects, your, your how should be aligned with those things, not, not the other tactics shouldn't wag the dog, uh, in terms of that.

Um, alright, so last question here. Let's assume right now you're, you're able to this, on this podcast, every IT person in the country is gonna be tuning in. What's the one thing you would tell all these IT people that they need to hear from a prac practicing physician that they may or may not really appreciate or understand

when I ask for customization. Or personalization. Please understand that it's driven by my customized, unique patients. Every patient is special, every patient comes a little bit different. I don't get the opportunity to have a standard patient interaction. Every patient comes with their own needs and expectations.

I'm trying as a clinician to adapt to that and provide the most personalized. Care that I can, the most focused care that I can to that patient, that sometimes causes me ask it to do things that it really can't. So hear me with empathy and explain to me in a way that I can understand how you can get close through personalization, how I can learn other workflows in the E H R.

But don't tell me no knows the wrong answer. It's have you thought about this? Have you done this? Because I need, as a physician to tell you every one of the patients I deal with is special. Right. Needs practice. Alright, well we're getting close to the end of our time, so we'll do the social media close.

I'll let you, uh, you kick it off with your, uh, with your post. Yeah. So I was looking on, um, Kevin md and by the way, if you're a C M I O C I O or C-suite occupant, I pick up on Kevin m md. Um, it is your best access to just keeping a finger on the pulse of physicians throughout the country. What are physicians thinking?

Because as a blog, um, aggregator, uh, Kevin Foe has done a wonderful job of bringing information together. The one this week was physicians let us rise, let us lead. I've always been in leadership in my medical career, and I started in practice in 1990. I was already taking time out every week to, uh, uh, contribute.

Uh, a lot of our colleagues do. But you're hearing this voice and we've heard it before, but as I said in my, uh, little, uh, note to you, the forcefulness of it, the committed tone of it is different. We need to be aware of that. The physicians have finally hit the point where, you know, we didn't like DRGs, we didn't like the 95, 97 coding guidelines.

Still don't. Um, but now we've coupled it with EHRs, we've coupled it with the demands of ACOs and population health and all these other things we're asking of physicians. They've hit the point where they're going to push back, and the way they push back is either they're leaving medicine. We've talked about burnout before.

Or they're going to rebel in a way that is gonna be painful for systems. Make sure you hear the voice. That's my message to CMIOs and CIOs. Make sure you're aware of the voice of the physicians. Make sure that you're thinking about how to help them join you in leading, um, engaging your physicians is a whole lot better.

Than being by your physicians. I love that post. Uh, in fact, I'm gonna skip mine just to read a little bit of this. So, uh, I'll just read the part of the end here. So let us ride. Let us, this is what it says. Let us rise. Let us lead, let us show humanity. What we are, what we can do. We cannot move forward with a culture of infighting and antagonism.

We cannot move forward with expectation that everyone around us will see the world as we see it, and we cannot move forward speaking partially informed truths or pointing fingers. This is a call to action to my physician colleagues. Be angry. We've earned it. Be skeptical. We've earned that too. Our profession has been taken advantage of and abused.

But then let's take a step back, gather ourselves and begin moving forward. It's time for us to stand up and lead by example. Let us lead with patience. Clarity, strong backs, and integrity. We can say no. With dignity and grace. We can move forward with strength and collaboration and above all through our actions, our advocacy, our work, and our words.

We can hold fast to our oath, to our promise to do no harm. No harm to our patients. No harm to each other. No harm to society. No harm to our profession. No harm to progress. Let us rise. I think that's a, a great, uh, ending to the show and I think it's a, a great call to action. So, uh, you know, thanks again for coming on the show.

How, how can people follow you? Um, I'm on LinkedIn so they can, uh, link in with me and follow me through LinkedIn. Um, and if anyone needs to contact me, the email and phone number are on my LinkedIn profile. Sounds good. Uh, awesome. You can follow me on Twitter, the patient at the patient ccio by writing on the health lyrics website.

You can follow both David and I on the health system cio.com, uh, website. They pick up our articles, uh, pretty often. Uh, you can follow the show on Twitter at this week in I. Check out the website this week in health it.com. If you like the show, please take a few seconds, give us a review on iTunes and Google Play.

Uh, catch all the videos on the YouTube channel now up over 120 videos. And after this week it'll be 26, 27, uh, videos. And, uh, we'll share those out on social media. And please come back every Friday for more news commentary, uh, and information from industry influencers. That's all for now.

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