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December 27, 2021: What were the biggest moments in healthcare IT in 2021? What do you think will be the biggest movement in 2022? Bill is joined by the Advisors to This Week in Health IT, Drex DeFord of CrowdStrike, Lee Milligan of Asanta Health, Anne Weiler of AWS and Frank Nydam of Tausight. What did the Scripps Breach teach us about cybersecurity? Will life in a health system ever be the same as it was pre-pandemic? Are we going to lose critical interactions between the analysts, the technologists and the clinicians if we continue to work remotely? 21st Century Cures didn’t come easy but it had a huge impact. And why is it that the VCs are throwing so much money at all of these health startups but the hospitals are still losing money?

Key Points:

00:00:00 - Introduction

00:04:30 - Healthcare is really, really hard and Big Tech knows it

00:05:00 - One of the biggest stories of the year was the Scripps breach

00:06:45 - 2021 was the year of The Great Resignation. In 2022 there will be IT staff shortages, nurse shortages and even more people leaving their jobs.

00:26:15 - Hats off to the many primary care physicians who have sat down one-on-one with many of their patients and walked through the pros and cons of vaccination. That is really, really hard work to do. 

00:34:50 - Investment in healthcare inequities was big news in 2021


Health IT Leaders Weigh In On Biggest Moments of 2021: Drex DeFord, Lee Milligan, Anne Weiler & Frank Nydam

Episode 474: Transcript - December 27, 2021

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Bill Russell: [00:00:00] Today on This Week in Health IT.

Lee Milligan: We spent the last decade putting in place this kind of base digital infrastructure that's been pretty onerous. But it's helped us get to a certain level. But I really feel like 2022, 2023 are the years when we're going to begin to be able to see the fruits of our labors.

Bill Russell: Welcome to This Week in Healgth IT. This is one of our end of the year episodes. I hope you enjoy. My name is Bill Russell. [00:00:30] I'm a former CIO for a 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff` current and engaged. I want to thank you again. In December we do a bunch of end of the year episodes. I think you're going to enjoy them. We do two with our advisors. I did one just me talking through chronologically the news of the year, and then we're going to do two, one where my staff selects the best news day episodes from the year.

The second is you're going to get to meet the team and they're going to come on and talk about things. So this is [00:01:00] one of those episodes. Before we get there though I want to remind you that for next year, we have some changes to This Week in Health IT. We're gonna have four channels. Four distinct channels on iTunes next year. We're going to have this week health academy, this week health community, this week health conference and this week health news. So, if you are already subscribed to the Today show that will become the this week health news show, and you're gonna have the today show and the newsday show in there.[00:01:30]

If you're subscribed to This Week in Health IT that will become this week health conference. And that's where we're going to have keynote. And we're going to have solution showcases and some other campaigns around specific topics. This week health academy is new. It's really around education.

We're gonna have a show called insights in there where we take the highlights from the last four years and we break them down into 10 minute episodes. They're going to air three times a week. I would use this show to mentor people, to talk about what the various leaders in the industry have said over the last four years and [00:02:00] how it relates to what you're doing at your health system. I'd also use it to bring people up to speed. If you hire somebody new into healthcare this is a great channel for that. And in this week health community is the channel where we're going to have guest hosts who are going to tap into their network.

And we have CIOs. We have CMIOs. We have clinical informatics. We have data scientists who I've tapped on the shoulder and asked them if they would essentially interview people within their networks about topics that are a little closer to what [00:02:30] you're doing on a daily basis. And we're excited about airing those channels again. Four new channels.

If you're not subscribed to all four of them, you're going to be missing some content. We'd love for you to subscribe to all four. Go ahead and hit and there's information there on how to subscribe. You can also hit iTunes and search for this week health. Any one of those academy, conference, news or community.

And you can subscribe that way. And we would love to have you be a part of the community again [00:03:00] next year. Special thanks to our influence show sponsors Sirius Healthcare and Health Lyrics for choosing to invest in our mission to develop the next generation of health IT leaders. Now onto our show.

I am excited to do this show. We have Drex DeFord with us, Lee Milligan, Dr. Lee Milligan, Anne Weiler and Frank Nydham have all joined us for this end of the year episode. And we're going to, if you're not watching this on video, it's worth looking at video because we're going to do this Brady bunch style, which we don't usually do on this show.

So we'll be able to see other people's [00:03:30] reaction to things that are said. And we're just going to look at two simple questions. What are the biggest moments of the year from this year from a healthcare and a healthcare IT standpoint? And the second question towards the end we'll get to is what do you think is going to be the biggest movement or the biggest thing going on in 2022?

Two questions sounds pretty simple, right? If we got a two question test in college, we'd be pretty happy, but I have a feeling this one's going to be a, going to be fun. I, I'm going to kick [00:04:00] us off because I did the Today show and I've done 230 episodes. And so I've been following the news probably closer this year than I ever have.

For instance, Haven ended in January. The JP Morgan, Amazon Berkshire Hathaway thing ended in January. And that feels to me like it was a lifetime ago. And it's kinda crazy that that happened this year.

When I think about the impact of that, the initial impact always I think, is the wrong impact where healthcare goes, see, this is really hard. You [00:04:30] can't do this. And I'm not sure that's the right response. The right response is it is really hard and and big tech knows it's very hard, but each one of those companies is moving on and doing something else.

And they're just failing forward. They're saying, all right, that didn't work. What's next? What's next? And I think we're going to keep seeing that happen. I'm not sure that was the biggest moment of the year, but that was definitely one of the moments I wanted to start with. Drex, how about you? WE'll go around the room, give everybody a chance to throw one out and then we'll see what happens.

Drex DeFord: [00:05:00] I'm going to go down the cybersecurity path. So I think one of the biggest stories of the year was probably the Scripps breach and the reality that kind of ransomware everywhere became a public health issue. And that led to cyber security, cyber liability insurance companies, trying to find the exit when it came to providing insurance to healthcare organizations.

I mean, I kind of put all of that in one big bundle. It seems like every time we talk and every time pick-up a tablet and look at the [00:05:30] news, there's a cybersecurity breach going on, or somebody is struggling to find their way out of a cybersecurity breach. And that seems to me to be one of the biggest stories for healthcare IT this year.

Bill Russell: That has to be true. One of the things with the insurance I thought was interesting. I'm talking to people now and they're saying heck the requirements that the insurance companies are putting around the cyber liability insurance, at this point, if you follow it, you're not going to get breached. It's like you have to stand up, dual factor authentication.

You have to, I mean, all the technologies [00:06:00] out and it's just, it's getting to the point and I've heard some companies say, look, we're, we're heading in the direction of self-insuring for cyber liability because it's.

Drex DeFord: I've seen and heard more healthcare organizations than ever before tell me that they are going to self-insure because either the price tripled, the deductible tripled the, the amount of inspection in control that the insurance company wants, should something happen, is just overwhelming or they weren't able to qualify for insurance.

And so [00:06:30] they're taking that money and spending it in another way to sort of shore up their cyber programs. So there's there's a lot more people taking a lot more risk out there than there has been in the past I think.

Bill Russell: So for the rest of you, was there a bigger story than that this year?

Frank Nydam: I will take it. I like the, how Drex wraps these things. I don't want to thinking about this and it's, there's so many things that happened this year. And what was that common interesting thing that happened? I'll call it the great resignation, right? I think one of the things that's coming IT staff shortages. Nurse [00:07:00] shortages, people leaving their jobs.

I think it was in the Wall Street Journal. The other day, 2 million people retired early and they're never coming back. 16% of nurses leaving. So, I guess I would say what's the impact across the board on all these technologies under people. And I think the good side is stats, show there's more companies are starting up now than ever have started in the last five years. So maybe the dark polite side of this last year being so dark as a people getting out, trying to do these crazy things that they always wanted to do. The [00:07:30] bad side though, is, as being a technology vendor nobody has time to do anything. This has tremendous impact.

Bill Russell: Well one more stat. 3 million women have left the workforce through the pandemic. So, those are also some startling numbers. The nature of work has, has really changed. What does that look like today and what does that look like going into 2022? Is the nature of work going to fundamentally shift how we deliver healthcare?[00:08:00]

Drex DeFord: Is that a general purpose question for everyone?

Bill Russell: I'm throwing that to, I'm throwing it out to everybody because I think it is one of the bigger things that's going on right now. In fact, I think it's one of the top of mind issues for most healthcare organizations, is the nurse shortage and the battle for talent has gotten to be pretty, pretty robust. Let's just say that's the nice way of saying it's gotten pretty robust.

Lee Milligan: Yeah Bill. I can speak to that. Here at Asantee, three hospital system and we've got massive [00:08:30] shortages as it relates to talent right now,. We've got a 16% open rate right now. Highest we've ever had.

And we're, we're doing everything we can to understand what this new landscape looks like. And I don't know that anybody has this perfectly figured out. I do think one of the main keys is to be open and creative to new ways, to engage with folks who perhaps will work here. And we have to kind of understand that historical ways of doing business may not be the best way to approach it [00:09:00]moving forward.

So here within our system, we have a whole group of folks we're focusing on. But we also have docs who are leaving as well. I, I was talking to one doc who's a really respected cardiologist here who was considering as, as was mentioned, just hanging it up for a little whil e and just be done for 18 months and then maybe come back at some point.

So these are really unprecedented times for, for our system. For sure. From an IT perspective we really have to be creative about [00:09:30] how we create an environment that is really welcoming, enticing. It really creates a family environment for folks. I've really tried to focus on kind of four main elements.

Pay is obviously huge, right? You gotta make sure you get the pay piece right. But that's not the only piece and pay alone will not keep people around. We've got to figure out a way to have a balance, true balance for folks so that they can have a real life while they're also contributing. There has to be flexibility built in so that it is kind of normal, like clocking in at eight o'clock and clocking out at five o'clock.

That's no [00:10:00] longer something that we need to hold. And then lastly, we have to make sure that we're doing everything we can to have both satisfaction and professional development in this space. So we're working really hard to try to create a framework to allow that to happen. One of the things that we've recently done is we stood up a local, a group of folks from our organization to look at work from home. To really make some recommendations around how we can stay connected to one another and how we can keep leadership connected to frontline staff because [00:10:30] given the work from home dynamic and the challenge of being geographically disparate, we really need to think outside the box in terms of how we stay connected to our folks and remain that family that we're trying to create.

Bill Russell: I notice you're in your office.

Lee Milligan: I am.

Bill Russell: So was the number 15% or 17% open rate right now?

Lee Milligan: 16.1 right now.

Bill Russell: 16.1 open rate. The other metric I'm curious about is, there's a certain percentage of the total population that will be onsite every day, right? Healthcare is delivered [00:11:00] face-to-face. So what percentage of your population just is going to work on that campus?

Lee Milligan: I can't give you that exact number. I can tell you from an IT perspective, 85% of my staff is work from home right now. So we got, people have to stay on prem are networking folks, some of our folks working on the servers. Engineers, field support and then biomedical engineering. Those are kind of the main areas that are on prem. Everybody else is work from home.

Bill Russell: But what about clinical informatics? What about that tie that we used to have where the clinical informaticist were saying, Hey, round [00:11:30] with them, see how they're using the systems and that kind of stuff. Are we going to, we're just going to give up on that?

Lee Milligan: Yeah, the rounding piece has been interesting. We've kind of gone back and forth on rounding, depending on what kind of, where we're at with our numbers. When the Delta surge was, was really at its peak around here, and we had 190 inpatients with COVID and 60 on, on vents. At that point, we were backing off on rounding.

Now we're actually going back to doing rounding with appropriate social distancing. In the interim we did virtual rounding and I'll tell you, it just was not [00:12:00] as effective.

Bill Russell: Interesting. Anne you did a lot of work with health systems and you saw the value of rounding and those kinds of things. Are we going to lose something from a culture standpoint of that interaction between the analysts, the technologists and the and the clinicians?

Anne Weiler: W we could, I mean, I think the question is how, do we go back to doing more of this in person and maybe also understanding, I I'm hoping what happens is we actually understand the value of in-person and where that's necessary [00:12:30] versus the it has to be in person. I have to say, when I was doing our startup, we bucked the trend of health systems constantly wanting us to be onsite for things that were very easily handled over the phone. But you know, the same time, the value of when we were developing sugar pod, the scale for diabetic patients to be sitting in the clinic, in the wounds and foot clinic, all that was absolutely huge. And same thing with, with Wellpepper.

We sat beside [00:13:00] the surgical schedulers all say to see what they were doing as they were moving from you know this screen to this piece of paper. So I think it's a matter of like understanding the right times and I'm hoping what it also does is, for startups as well, and not just for startups, but for the environment that health systems realize that an awful lot can be accomplished on a conference call. On a Zoom.

That I'm hoping will change. And I'm hoping, not just because of the the time and the environment of people flying and the [00:13:30] cost for startups, but also just because of the openness to not have to have all of your vendors on-site all the time. And that gives more diversity to health systems of what vendors they can work with.

You end up in a situation sometimes where it's like, if you can't drive there and talk to them, then they don't want to talk to you. And it's very hard to run a global company that way.

Bill Russell: I want to go around the four of you real quick. Are we going to snap back? Let's assume we're beyond the pandemic. 90% vaccination rate. Clearly we're [00:14:00] living in and I'm, I'm making a scenario here. Yeah. 90% vaccination rate. Are we going to snap back to where we were before our have things fundamentally changed? And the nature of consulting has changed. The nature of how IT is delivered. The nature of hiring has changed. Culture within the health systems has changed. The dynamic of agility has changed. Are we going to snap back or are we going to establish a new norm? Frank, we'll start with you. Do you think we have a new norm or do you think we're going to snap back?

Frank Nydam: I don't think we ever go back. I don't think we ever [00:14:30] go back. They're going to work full time and the office. I don't think anything goes back. You know to your opening question, what was the biggest story? And I think all you will laugh at this. Remember three or four years ago, a healthcare would say no way would we ever go to the cloud and now look at this.

I mean, thank goodness for all the clouds out there. Thank goodness from work from home. And I just think people have gotten so used to it. We've gotten good. Tons of Startups, we don't really need to be all over the place. So I don't think we ever go back again. I think that's going to be good for technology.

I [00:15:00] think, and, and Drex'll back me up here, I think because as IT vendors, we need to get better at what we do. We need to make sure there's, you don't have to have the person sitting there hitting the blue button every time. I don't think we ever go back Bill. Ever.

Drex DeFord: Yeah, I definitely, I would agree. I don't know that we're ever going back, but I mean, I think Anne's caution is a, a really good one for us to pay attention to. Health systems and other organizations have years and years and years and years worth of habits built up that say, nobody works from home. Everybody has to come to the organization and [00:15:30] work.

And at the beginning of the pandemic, you saw organizations who said, nobody can work from home. On Monday, on Wednesday, say we're sending 6,000 people to work from. And I don't think they've gotten over that habit yet. And so to Anne's point, I think there's organizations who are leaning back into their old habits saying, you have to come here and you have to work in person.

You have to do it just because I said so. That's how we work. And I think the organizations like Le's that are more [00:16:00] flexible, figuring out when people really need to be there. And when they don't. How you can work remotely, those are the organizations who ultimately are going to kind of take the lead and continue to thrive.

Lee Milligan: And I thought that was a really interesting conversation on one of our executive team meetings where one of our senior executives asked, asked the question, well, let's get everybody back on prem. Let's put together a team that's going to be able to kind of, create a framework to make that happen.

And there was kind of a a pause for a moment. And one of the other executives asked a good question. They said why? [00:16:30] And that sparked an interesting conversation around kind of what is the ultimate goal? And I don't know that we've fully figured that out, but to Anne's point from before, I think we have to be thoughtful about when it makes sense to be on prem. Because there are right, there are certain scenarios or certain like one-on-one scenarios for certain individuals where that connection that human, you know, one-on-one connection might be important.

And there are other scenarios where from a practical and efficiency perspective, it's just way better in a virtual environment. And I don't know that we figured that out. The other piece that kind of [00:17:00]is separate but attached to this a little bit is we've introduced so many communication mechanisms.

Between texting and Teams and Jabber and email and Slack. Right. And so I think our staff frequently, they don't know which communication mechanism to leverage for which particular circumstance. And so I don't know that, I certainly have not done a great job so far at kind of identifying what are the kind of the appropriate channels for [00:17:30] folks to use based on the appropriate circumstance.

Drex DeFord: There's also the Box and SharePoint and you've got four or five of those things that you're dealing with too. Like trying to remember where have you put things or where did somebody send you something?

Bill Russell: Did you guys ever see the McLaughlin Group? And he used to do this show and you would try to pinpoint it. So Frank's saying, we're not going back. Drex hedged and said, yeah there's, there's some, whatever going back, Lee, are we going back or have we fundamentally changed? One of the two?

Lee Milligan: [00:18:00] We have fundamentally changed.

Bill Russell: Fundamentally changed. Anne going back or fundamentally changed?

Anne Weiler: Fundamentally changed. And I'll use this to talk about what I think is its still the top story of the year, which is COVID.

We saw health systems and governments, governments move into digital communications with their patients and their constituents at a speed that I felt was impossible. And I've been saying, I work at, I work at AWS now and I can almost never talk [00:18:30] about. what we're doing but I run a service called Pinpoint, which is for multi-channel communications.

So I was nodding a lot about the, which you know, which communication channel do we use. But you know, our, our customers are health systems and governments sending COVID notifications, vaccine appointments, contact tracing all of this to their constituents. And those governments got up and running faster than I've ever seen.

Sending millions of messages. And so all of the things that you said of why, this, I think it [00:19:00]was a myth-busting year. All of the reasons that people had for not doing things went away when there's an emergency. And now the awesome thing is they've got that infrastructure stood up. They see how people are reacting.

I'm thinking also about like, the things you get about well, old people can't communicate this way and you're leaving them behind. Well, my parents are walking around with their COVID passports. They are in Canada but other COVID passports on their phones and showing them when they go to a restaurant or, or whatever.

[00:19:30] So there's so much, that's not going to go back. It can't. Like, you cannot say all these things of patients. HIPAA can't communicate with the patient's HIPAA. Old people can't do this. Like all of those things are not true anymore. They've been proven wrong. So we can't go back. That's my take.

Bill Russell: If it weren't for one other factor, I think we would absolutely go back. Like a hundred percent snapback and that other factor is labor. There's just a shortage of labor. If we didn't have this shortage of labor, I think health systems right now will be planning on how to bring [00:20:00]everyone back.

And if not today, within the next 48 or 24 months everyone would be back because it's what we know. It's how we operate. And for one team. And you have this idea of fairness, all of our clinicians have to come onsite. Why do these people get to live at the beach and work at the beach and that kind of stuff.

We need our Epic analysts next to, I mean, I hear all the arguments. It absolutely would happen, but the problem is it's coinciding with this labor shortage which I think is going to make us [00:20:30]continue to be creative and whatnot. Anne, you brought it up, biggest story has to be COVID. COVID yes. And vaccine, I think are probably the two big stories for the year. Do you want to tee that one up or.

Anne Weiler: I think like for us, everything that we're talking about, all these trends have happened because of COVID. And I think as well, when we were talking in 2020, I don't think we knew that that would still be the biggest story of 2021. And the changes and the repercussions would keep happening.

I [00:21:00] certainly thought we would be back in the office by now and, and we're not. And we're still seeing people meeting new. I mean, this is so funny I think. At the beginning of the pandemic we saw a lot of customers coming on and it's like, okay, we've got to send COVID related messages.

And they were around contact tracing and just general stuff. And then the customers were telling us, and this was state and local governments and hospitals like, oh, we're going to stop sending so many messages because this [00:21:30] event is ending. Well, guess what? They had vaccine appointments, they had vaccine availability, they had new regulations.

They had the, where to go get COVID tests. Like the messages are still going and so I was actually prepared for it. Okay some of these customers, we have to figure out what they're going to do next. Don't. We don't. Cause they're still doing these things. And now that they're doing them, like there's absolutely, I don't see us. Why wouldn't we send flu shot notifications now that we can? We will. Most basic one. I don't know why everyone's not doing that.

Bill Russell: It's [00:22:00] interesting as you talk about that cause I went back and did a little research before we jumped on this call. So we had an election that proceeded this year.

And so we had a changing of the guard and changing presumably, a changing of approach and those kinds of things. So we had a minimal amount of vaccine early in the year, so that was the big story. What are we going to do with the, we didn't have like a full supply. We had people driving 200 miles to get their first shot and that kind of stuff.

We had all sorts of scheduling challenges, distribution challenges and [00:22:30] production challenges. Well, that gave way through the year. But I think we need to remember that the year started there. One of the stories I covered was Disney World. Going to Disney World in, I think it was March or April.

It was a big deal. It was a huge deal. I mean, Disney World had opened. What were they going to do? And they had social distancing in their lines. If you thought their lines were long before their lines were massive with social distancing. I mean, it was, they wrapped them around, outside the park. I mean, it was, they were [00:23:00] all over the place.

But that was sort of the precursor to, okay what does it look like to try to ease back into a normal? And we get to the end of this year and we have the HLTH conference and they have everyone gets tested right there on site. Get your results within 30 minutes. So you have a conference with forty-five hundred ish people. They say 6,000, but I think the number was about 4,500 that were on site. And you knew that everybody you were talking to was just tested [00:23:30] yesterday and everybody came back clean. So we were working through how, how to function. We did mass vaccination events for the first time.

I think for the first time. I can't remember a time in history where we sort of did it this way or at least tried to enable it digitally. A couple of really cool stories that you had Atrium Health, do it on one of the NASCAR speedways. So the people drove in, drove onto the NASCAR track, drove into the pit, got their shot and drove out on the pit.

Other [00:24:00] organizations did it on football fields. I know that University of I think it was one of the Colorado health systems did it on the football field. So people actually got to go down on the baseball field and the football field. So that's some of the things that we did. But this year and we're still not through it, I think a majority, I know our state's at 60% vaccinated at this point. We just went through a major surge I'm in Florida. I know California. I was looking at the numbers they're at 62% fully vaccinated. It's hard. I think what we learned is it's [00:24:30] really hard to get a hundred percent of Americans to do anything.

Heck it's hard to get a hundred percent of my family to do anything if I tell them to do it. This was an interesting learning year. Lee, I'm going to go to you. I mean, what have we learned going through this year, since you're the only physician on the call. I, I feel safe going to you.

Lee Milligan: Yeah. So I think one of the things I learned is that when it comes to these public health scenarios that the public health infrastructure was much less robust than I think any of us anticipated. I [00:25:00] think, even being deep within our health system here in Southern Oregon, there was an expectation that the public health infrastructure would be either a partner or really be kind of a strong ally in moving forward.

And although they had good people, great intentions, trying to help and partner with that. They certainly did not have the resources and the infrastructure to partner in any meaningful way associated with this work that you were just describing. And so we really fell to the individual health [00:25:30]systems to put the that responsibility on their shoulders to carry the communities to be able to make this a reality. And if you look around the country, really the points you made were, were, were accurate. Really amazing and creative ways to deliver this medical scenario to huge, massive amounts of people in innovative ways. So I think, to me, it's a testament to the creativity of the individual local geographies and making this work within their system.

I [00:26:00] also would mention that I do think there's huge value in kind of understanding both sides of the argument and being able to have these kind of human one-on-one conversations with folks around the vaccine itself. We did find, is that just making a proclamation about what is right doesn't work. Doesn't work effectively for folks. So, hats off to many of my primary care fellow physicians who have really sat down [00:26:30] one-on-one with many of their patients and kind of walk through the pros and cons of vaccination. That's hard work. Trust me. That is really, really hard work to do for these folks. And I, again, hats off to those folks, who've done it because it is meaningfully changed the dynamic.

Drex DeFord: It's hard work too that they're doing in a system where they're not being reimbursed to do that particular kind of work, right. They don't get paid for the 20 minute, 30 minute conversation they may get into around this.

Lee Milligan: That's [00:27:00] right.

Bill Russell: It's amazing. Who has another story or another event from this year. Clearly, I mean, COVID the vaccine labor cybersecurity. These are some of the biggest things that happened this year but anything else that you think really shaped this year?

Lee Milligan: I got, I got one that probably would have been a bigger deal had COVID not still been prevalent. I think, I think Anne's exactly spot on. That is the story. Continued story. But 21st Century Cures is a big deal to our patients and to our [00:27:30] providers still. And if you intersect with the health system at all and you're able to immediately and transparently, see, physician's notes, laboratory results, imaging results, that whole scenario has been, has been huge. At least for our folks here. I think the interoperability pieces will play out over time and I think some of the businesses are going to line up behind a newfound capability. And so that is yet to be unpacked fully, but in terms of the [00:28:00] immediate impact to the, to the patients, it's been huge. Now, it didn't come easy. Right? A lot of our physicians initially had a lot of reticence around the concept of a patient receiving their laboratory results prior to the doc, having a chance to look at it.

And we had to work through a lot of those issues, including kind of restructuring our conversations with patients about what to expect. And what those results might mean, but the reality is patients have a level of transparency to their own individual health that they've never had before.

Bill Russell: Absolutely. I think that is a big [00:28:30] story. I'm going to, I'm going to throw out two more and then we're just gonna go onto the next question. And that is Kaufman Hall reported big losses for health systems. And so I think there's a lot of financial stress within healthcare, and that's definitely one of the stories and it wouldn't be a show if we didn't talk about the fact that there's just gobs of money in health tech investment right now. I just went to the HLTH conference and just watched people walk around with cards and wallets. Like you need money well how much money you need? What series, what [00:29:00] round are you on? Can we, whatever. And this year Transcarent raised a hundred million dollars without batting an eye and I think that's more indicative of what they're looking for.

Cause I asked a couple of, of the investors, what's the number one indicator of success for you? And they say someone who's done it before. So a leader who has successfully gone through the gauntlet and gotten through the other side. And so that's why someone like Glen Tullman has no trouble raising a hundred million, but somebody else might have trouble raising five million.

Drex DeFord: I think that there there's something [00:29:30] tied to that too around Theranos has come back to the top as the trial has continued on. And so somebody who hasn't been through the gauntlet the first time, a lot of highly overstated expectations that were not met. And there's a lot of, for folks who are interested in this space, there's a lot of interesting pieces to that story that are still coming out as part of that trial. And it's a cautionary tale for the VC world to measure twice and cut once.

Bill Russell: Yep.

Anne Weiler: I don't know. I think it's super frothy right now. [00:30:00] I just saw, I just saw a company, never heard of the person. I mean, I didn't dig into it, but it was 25 million series A doing home health. Been in business for one year. 25 million series A. Like somebody just sent me Xealth have their series B 24 million. And I was like, Hmm, that seems low considering considering.

Drex DeFord: Because they've been around for a while. Doing some stuff yeah.

Anne Weiler: And everything I see this is, this is like scary to me because I was once the naive, like, no, you [00:30:30] can solve healthcare.

Everything I see is like, wait a minute, we've seen this idea before. I saw Jack Starter, his new thing. I'm like, I don't understand the difference between this and Iora. The money. I think that's the thing with COVID is actually the VCs suddenly went, oh, healthcare.

Very interesting. And the cognitive dissonance here is that the hospitals are losing money. And yet, like the VCs are just throwing so much money at all of these startups. They all have so much money. They're [00:31:00] all going to be fine next year. But I think the year after that is going to be really interesting. Plus we've seen so much consolidation already.

Frank Nydam: Is that a bad thing? I throw that out there. Right? I mean, maybe for the LPs are throwing you know, good money after bad, but again, to my opening statement about the great resignation, everybody's changing jobs, or just thinking about the folks that have been working at hospitals, vendors always have this good idea and finally got the money and an opportunity to go do it. So let a thousand different companies go to try [00:31:30] solve XYZ. I think we'll all be better in the end. It does look frothy from the outside and your, your right Drex, I mean, even in my company, David Ting with this is his second company. I think they're looking for leaders who have been through it before and understand health care, but I think it's a good thing. There's really no downside. Save some of the investors.

Bill Russell: Yeah. I was there when Anne was trying to raise money and whatnot, and it was a lot harder back when you were trying to do it. Alright, let me do this. This is the out question. What do you think is going to be the biggest movement, biggest story going into 2022? We've got two [00:32:00] minutes per person. Drex, we will start with you. I'm just going to go around. I have Drex, Lee Anne and then Frank. Two minutes. What do you think the biggest movement or story's going to be going into next year?

Drex DeFord: I, you know, so I think, we've passed the infrastructure plan. That's really big news this year. I think next year is the year when a lot of this really begins to shake out and we start to really understand what a lot of that spending means for healthcare in cybersecurity, in broadband and telehealth, how [00:32:30] fast it's actually going to happen. I think that's a thing that I'm going to be watching for throughout next year.

Bill Russell: Fantastic. Lee?

Lee Milligan: I agree with Drex. The broadband piece is huge. I think for rural communities, there's still this Delta that, that exists out there that we have a lot of work to do to, to uncover. One of the things that I wanted to mention real quick is that we spent the last decade putting in place this kind of base digital infrastructure that's been pretty onerous. But it's helped us get to a certain level. But I really feel like [00:33:00] 2022, 2023 are the years when we're going to begin to be able to see the fruits of our labors. And one of the ways I think that's going to happen is just the pure digitization of elements that haven't been digitized before.

So for example, the OR. I really feel like this concept of a single surgeon going into OR after they've you know finished their residency and have their board certification and then practice for 40 years in a silo, that's going to be blown out of the water. I feel like ORs are [00:33:30] going to be digitally connected. There's going to be surgeon A and surgeon B having a conversation over this. I think augmented reality is going to play a role in that as well. And I really feel like the patient ultimately is going to be the benefactor of this digitization in the OR.

Bill Russell: Fantastic. Anne?

Anne Weiler: No, I actually don't make predictions.

Bill Russell: Is that your, is that your final answer?

Anne Weiler: That is my final answer. I mean, I, my, I think my only prediction is I think this digital process is going to continue. [00:34:00] I think we're going to see the companies that have been around for a while, we're going to see more consolidation because there is a limited pool that everybody can go after. It seems like it's unlimited but even you know, like they have to find customers somewhere, and those customers are either patients or health systems or payers. And I do think that you have too many people knocking on anyone's door not everybody is going to get in. So I think you're going to see consolidation in the company that's been around a while. These new ones have raised a whole bunch of money are going to be good for quite a bit. And then [00:34:30] some of those start failing, then we're all going to say oh no healthcare is hard. That's as far as I've got to go.

Bill Russell: We're printing money. So the value of everything has gone up. A gallon of gas is now a ton more money. So I think that's one of the things that's driving is the returns that people are getting in the market and whatnot have really driven them to be a little bit more aggressive with their money.

You have a lot of private equity money that has grown to points where I literally people were telling me. We have more money than we know what to do with like, we, we [00:35:00] can't find places to put it and we don't want to have it sit in cash during a high inflationary period. We want it to be working somehow. And so they're under pressure to put it somewhere. It's really kind of an interesting dynamic. Frank next year, 2022. What do you think?

Frank Nydam: I agree with Anne. I think there's going to be a lot of consolidation, but maybe from an IT perspective, honing in on my, my first comment about IT labor shortage, rationalization of everything, facilities, applications, what have you. I think just there's just too much stuff in [00:35:30]the system. I think Lee also said it or Drex. There's so much stuff that people in the hospital's have been doing for so long. Giving that up is tough. And I think there's going to be a mass rationalization. I'd say if I had to put right behind it, automation. Again, tying back into this labor shortage. There's just so much stuff that involves people every day. Companies like UI Path. There's just amazing amount of robotics automation going on up there. Just again, not enough skilled labor, IT shortages what have you. [00:36:00] So my 2 predictions. Rationalization and automation.

Bill Russell: I was going to take your second one. Automation. I think automation is huge in 2022. I mean, if I was looking longer, further out than 2022, I'd probably talk about some other things, but I think next year it's going to be about automation. Click automation, automation in the back office both the clinical or the healthcare operations, as well as the IT operations. I think we're just going to see significant moves in terms of automation because you [00:36:30] can't do all the things we're being asked to do with the number of people we have left really. So, it's I think there's just gonna be a big push. I think it's already started and we'll see. It's interesting. None of us talked about cybersecurity in 2022.

So I guess we'll figure that out in 2022? We'll have no, no, no more. Draex, just out of curiosity, which way is your, because you track this, which way is the breaches going? Is it still growing every year?

Drex DeFord: I think it's still growing every year. I think it's still going to be a challenge for a while. I would make a 2022 [00:37:00] prediction though we're starting to see it now. I think we're going to see governments and associated cybersecurity businesses working together to go on the offense a lot more than we have in the past. And probably not a lot of identifying who's doing what, but there'll be some, some good work going on in that space.

Bill Russell: Fantastic. I want to, I want to thank you guys. Not only for coming on the show and doing this end of the year show, but just thank you for your ongoing partnership with This Week in Healt IT. And helping me steer the ship and figure out what we should be doing [00:37:30] next. It's greatly appreciated. So thank you again. Thanks for for all you do. And thanks for your insights into what's going to happen next year. We'll put all these on paper.

Frank Nydam: Thank you for everybody out there. I think you've got a great service and people are learning a lot and bringing people together that probably have never talked before, so.

Drex DeFord: For sure.

Bill Russell: What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to this [00:38:00] show. It's conference level value every week. They can subscribe on our website or they can go wherever you listen to podcasts, Apple, Google, Overcast, which is what I use, Spotify, Stitcher. You name it. We're out there. They can find us. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders. Those are VMware, Hill-Rom, StarBridge Advisers, Aruba and McAfee. [00:38:30] Thanks for listening. That's all for now.


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