This Week Health

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Marc Probst, CIO of Intermountain Healthcare joins us to discuss the news of the week. CMS presents the final rule to remove the administrative burden and promote interoperability, plus we visit on the Apple Health initiative.


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

 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 31. Today we take a look at the C M S Final Rule and we discuss Apple's healthcare initiatives in more detail. This podcast is brought to you by health lyrics.

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Visit health to schedule your free consultation. My name is Bill Russell, covering healthcare, c i o, writer and advisor with previously mentioned health lyrics. Before I get to our guest, an update on our listener drive, our sponsors have agreed, as we've talked about before, to give $1,000 for every additional hundred subscribers to the, uh, to the podcast, either iTunes, Google Play, or YouTube channels.

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The c i o for Intermountain Healthcare, mark Probes. Good morning, mark. Welcome to the show. Morning Bill. Good to talk to you. We've got, uh, got a neighbor right across here doing, uh, some weeded whacking. So if, if that gets in the way, just let me know. I'm actually broadcasting from outside today.

Man, you've been, you've been at the same health system for 14 years. I, I bet you a lot of CIOs would like to know what, what, I mean, what do you attribute that to? How have you been able to do that? Oh, I think Bill, it's working for an amazing organization that's really been forward thinking and, uh, and not trying to screw up too many of the things that we're already in motion, but we have changed a lot.

I mean, we put in. We were completely self-developed for about 40 years, and we just replaced all those with, uh, Cerner and Oracle PeopleSoft and, you know, some legacy or some off the shelf products. Um, but I don't know. But, you know, longevity, I think it has to do with the ability to work with others, you know, not, not be a no it all, um, and, uh, keep my head low when it needs to be low.

Yep. And, uh, relationships are the key there and a great forward thinking organization. Uh, also, um, and then obviously doing a great job. I, I, I realize you wouldn't say that yourself, so I'll just say it. You know, the making that transition, that was a huge transition. You guys had a, a, a homegrown e h R for many years, and then it just got

Too unruly towards the end, right? It just got so big and so massive, it just didn't make sense to try to keep maintaining that. And so you, you went out and did your, your R F P and ended up with Cerner? Yeah. I mean, we'd really built applications to support the clinical and the financial functions, but not really to automate them, but to support with automation, certain aspects of the caregiving process and when meaningful use came out and as technology.

It really got much better. I help, help, which is our longtime electronic medical record was, you know, ask at Aski Green screen, you know, very, very fast, but mainframe based, um, and clinicians were looking for a lot more from the system and to rebuild that, what we tried, we tried with GE for about six years and, and that turned out to be just too heavy of a lift.

So we, uh, we did go with Cerner and it's been, uh, it's been good. Good. Well, that's great. Uh, well, let me share a little bit of your, uh, a little bit of your background. You're, so you've been obviously there for a while, uh, 30 years in the industry. Prior to Intermountain, you were with, uh, Deloitte. So you've been with Deloitte and with e n Y.

So you've been with, uh, two of the large, uh, firms and you've been a C I O for, uh, t p as well. Um, and we'll talk a little bit about this. So past board chair for Chime and the Chime Foundation member of the original i t policy committee. Uh, in the early stages, stages of meaningful use. So we're gonna talk about both those topics you're walking the halls of, of, uh, of the Hill and, and what that was like.

And we'll talk about meaningful use a little bit in our first story this morning. Uh, resident of Utah for the past 21 years. Uh, salt Lake, I assume. Yes. And, uh, and you've lived all over. So you've, um, You know, Virginia, Tampa, uh, grew up, uh,

On the main line of Philadelphia as well. So, uh, you're married, have five children, um, older children. So you've, you've actually, uh, made this transition from children to, uh, you've done the college tours and whatnot. Any any words of, of wisdom for me as I'm, as you can see, I'm off today. I've got the college hat on.

I'm taking my daughter to college stores. Any words of wisdom of how to make that transition successfully? Oh, I, I would say get a bunch more subscribers and watch your checkbook pretty closely.

they definitely don't get cheaper as they get older, but they get better as they get older. Uh, yeah. Well, we don't, we don't make any money from the podcast. You know, you're the second person who sort of intimated that and asked me that this week that there's, uh, this is really more of a public service thing of, of just getting.

On the, and asking you questions and getting the benefit to as many frontline staff as can get it. Uh, one, one of the things we like to do is we like to open it up to our guests, uh, before we start the show and just say, you know what, excited about what are working on today and, and, uh, just give you the floor.

So, um, so what do you got, man, I gotta tell you, bill. What? I'm excited. So I'm in the latter part of my career. I do have older children, and I'm older because I have older children. Um, and I am so excited. I think it is such an amazing time to be involved with technology and healthcare and having been a C I O and whatever that role turns out to be in the long run.

There's still, CIOs will be leaders in what we do in technology, I believe, and I'm excited about the confluence of so many technologies right now and, and the potential that that has, not to just help healthcare, but to absolutely change it. Improve it and probably save it for our country and, you know, globally, I suppose, if you wanna think that way.

I mean, if you think about artificial intelligence and the potential that has, as it gets coupled with the cloud and all the data that exists, as it gets coupled with what we're doing around interoperability as it goes mobile and what, with the power that we now have with the mobile devices and I, I see a day from the consumer perspective where, Dr.

Google or Dr. Apple or whatever we want to call it, is there, that's where they're gonna go for their initial primary care is going to be the device and all the knowledge that that device has. Um, that's gonna help healthcare because we don't have enough clinicians to start with and it'll really help focus what they do.

And it'll be way more real time because, well rebar all wearing and monitoring devices and, you know, we're learning a lot more about ourselves. You know, the human body's actually becoming its own. Um, platform for, for, uh, for computing. So I'm excited on that side. Continue to look at the confluence of capabilities.

I look at what we're doing around, um, natural language processing and voice, so nuance and some of the companies that, that work in that space. Um, we have been working with Stanford around computer vision. Actually teaching the computer to see. So think about the, the triad of being able, the computer, being able to see computer, being able to hear an artificial intelligence.

Can we create Jarvis? Can we create what was an Ironman three? And just have the clinicians do their job and ask the computer for support and we'll do all the documentation and all the, you know, the dirty work behind, which is what we should be automating. Because to me to today, We don't facilitate care with technology.

We facilitate creating a record. We get information to clinicians that's a little more useful to them, but we don't facilitate what they do day to day. In fact, we get in their way, and we hear that all the time. But again, there's confluence of so many new technologies that are at the very heel of the hockey stick.

These things are gonna take off. I mean, I know they're, we all know they're gonna take off. I'm not telling anybody anything they don't know. But it is so exciting and I, I think I'm gonna witness in kind of the twilight of my career, an absolute shift of how technology is used and helps what we're doing in healthcare.

So I think that's really, really exciting and, and it's a great, like I said, it's a great time to be a c I O in healthcare. I agree. Yeah. In the next decade you're looking at, uh, precision medicine and what it can do, and that's, that's just amazing and nanotechnology and whatnot. But in the short term, we're not that far away from being able to interact with the computer by just saying, I mean, we're already doing it with our phone, but just saying, uh, you know, Hey, Cerner, open up a medical record.

Hey, uh, you know, tell me what my schedule is today. All right, gimme the vitals on that patient and all that information just coming back to you and potentially being spoken back to you, so you're, you're actually interacting. With a computer more like what we, you know, envisioned all those years ago. And this, this really is an exciting time.

And, um, I think we're gonna see just exciting things in the next couple of years. And then in the next decade, I think we're just gonna see advances that are, are really gonna make our lives. Um, Uh, you know, fundamentally better as we, as we move forward. So, yeah, it's, it, it is definitely a fun time. Let me, uh, so let me transition.

So we're, we're, uh, we do two things on the show we do in the news, and the second is we do soundbites, uh, in the news. We each pick a, uh, story and we discuss. So, um, so I picked, uh, I picked the obvious story for this week. Uh, I'll be the, um, You know, every week there's, there's sort of, sort of a story that just sort of drops out and you just have to do it.

So, c m s proposes the final rule, uh, for the Promoting Interoperability program. Let me read a couple things here. So, uh, today c m s finalized the rule to empower patients and advance the White House, my Health e Data Initiative and the c M s. Patient over paperwork initiative. This final rule and others issued earlier in the week will help improve access to hospital price information, give patients greater access to their health information, and allow clinicians to spend more time with their patients.

So if you break those three things down, you have, um, while the agency previously required hospitals to make publicly available, a list of their standard. Charges or their policies for allowing the public to view this list upon requests. C m s has updated its guidelines to specifically require hospitals to post this information on the internet in a machine readable format.

Uh, and I suppose that's mostly for organizations that want to start. Creating comparison apps and those kind of things. You just download that and look at it, and we'll talk about that a little bit. And then the final rule also reiterates, uh, the requirement for providers to use the 2015 addition of the certified Electronic Health record technology in 2019 to demonstrate meaningful use, uh, to qualify for the incentive payments and avoid, uh, reductions in Medicare payments.

And then finally, the, the final rule removes unnecessary, redundant and process. From several pay for reporting and pay for performance quality programs. C m S said it eliminates a number of measures. Acute care hospitals are currently required to report across four hospital pay for pay for reporting and value-based purchasing quality programs.

And it deep duplicates. Certain measures that are multiple programs in all these changes will improve a total of 18 measures from the programs and de duplicate another 25. C m s said it's, it's changes in hospital quality and value measures will eliminate more than 2 million hours of work saving providers almost 75 million annually.

So, um, that's a, that's a high level, uh, overview of, of the, uh, final rule. So let's just start with a, you know, a pretty open-ended question. So what's, what's your initial reaction to the final rule? Uh, directionally correct. Um, It does show that the current administration, c m s, even the White House, are listening to some of the things that are being asked of them from people like Chime and, and us as a voice, as a healthcare community.

So I think directionally very good. Um, I'm happy that they're making some changes, um, but excruciating, it's excruciatingly slow in getting to the actual solutions that we need. Is what, what I believe so, uh, And if you want some context to that bill, I mean, I did, I was part of the h I T policy committee and our job was to define meaningful use.

Um, I won't go into the nuts and bolts of that, but it was a fairly liberal group. Um, and I'm a pretty conservative guy and, uh, I, I think what we did, Although in, again, the intentions were correct, it really wasn't an healthcare improvement bill. It was really part of the stimulus package. So, you know, the intent was to get more out there.

Um, but in through meaningful use, we created such a rigid structure that what it ended up doing was really tamping down any kinda innovation. It didn't help interoperability very much. Um, and what I like today in the final rule and what you outlined is that it. It is minimizing some of the rigidity that was in meaningful use, but still trying to get some of the benefit of, of technology out there and, and incentivize people to use that technology correctly.

Yeah, we don't have enough focus and, you know, I'm a one trick pony When I go to DC I, I pretty much talk about the same thing in that standards. And I think we're excruciatingly slow in getting to standards within our healthcare, uh, environment in the United States. And that's hampering a lot of the benefit that c m s and the administration are trying to get.

But I'm, I am happy with the rule because again, I believe it's directionally correct and, um, and easing some of the burden that meaningful use and some of the programs have put on us as providers and us as a healthcare community. I think, um, one of the things I've heard over and over again is, uh, the meaningful use got much more, uh, Directive in, in two and three.

So in the first one it was, it was directional. It said, you know, here's, here's directionally where we want to go. And in two and three, they really expanded on that and told you exactly how they wanted it done. Uh, I think this goes back to that directional. Um, uh, you know, it's not telling CIOs and, and health systems and E H R providers, this is exactly what we want you to do.

They're, they're being much more, much more open. But I want to touch on that. A and, and just case in point, you know, they're not saying, Hey, this is what the E H R has to look like. They're saying we're removing these measures. Okay, now go practice. And, and you know, the 2015 rule is really mostly about APIs and it's saying, alright, here's all we want you to do is we want make that data available.

So that other systems can inhale it, use it, and, and, uh, make it readily available not to be, uh, captured and in the confines of the E H R or the provider, we want it to be, uh, accessible and interoperable. So they're, they're getting directional again. But what do you say to those people? So this is the thing I've always struggled with.

There are people who say, Hey, c m s needs to set the standard c m s, you know, we're not getting enough direction. But on the other hand, we have those same people will say, uh, you know, too much government oversight. They're telling us too much. And, and those kind of things. Uh, you know, we just, we just wanna practice medicine.

I mean, it is such a, a fine line to, uh, to walk to say, um, Do we really want the O N C setting? What kind of standards do we want them? Um, do we want them setting data standards so that that data will flow more freely? Uh, do we want them to set, um, uh, E H R standards so that, uh, One e h r to another will be pretty standard for a physician.

They can go from a Cerner shop to a, uh, epic shop, to a Meditech shop and be able to practice medicine pretty readily because it's, it's common. Uh, what, what kind of standards would you look for from the government versus just, just let us alone and eventually healthcare, we will work it out. Okay. So I come from the Reds state in the nation, , which is Utah, and I mentioned earlier I'm pretty conservative.

I have to tell you though, when I go back to DC and I talk standards, I think the government needs to define data standards so that we can get to a level where it is truly fluid data that's moving between the systems and it means something, even using fire and some of the A P I work that we've been talking about and you know, frankly, we've been using for quite a while and pushing here at Intermountain.

It doesn't get to a level of specificity where you really have this fluidity of data and where it can be used and computed. So what we'll do is we will get more data into the hands of the consumer, which is good. There's nothing wrong with that at all. We'll get the ability to shift data between systems or health systems or or hospitals, but it won't be readily computable.

So either we're gonna have to go through . Some pretty, um, challenging work to get that normalized into the system so that it can be consumed by the computer and provide insight that our clinicians are looking for, or I think they're just not gonna look at a lot of it, and, and it's likely to be the latter.

They're not gonna look at a lot of it. Um, it's funny, and, and you could stop me whenever, bill, but you know, probably five years ago I went out and I did, um, 23 and me, you know, I was gonna go out and get to some of this precision medicine and I was gonna understand more about my D n a. And I went and I did it.

And it wasn't all that insightful. Took it to my physician, he didn't even wanna look at it, you know, he didn't even care. Um, and it's because it's not relevant to what they're trying to accomplish. We're giving physicians, what, eight minutes on average to deal with a patient? They don't have time to consume this stuff.

It has to be brought to them in a meaningful way. And so I, I'm a big proponent of the government being much more aggressive in defining standards and putting it out there for us. Now, there's a lot of things around that and how we use the data, how our systems look like, how we present it, how we do ai, and those kind of things that would actually be facilitated if the government would get to that.

Basic standard. It's, it's like the government tells us how to build a road, speed limits and those kind of things. But the cars that are on it, you know, there's regulation, but they, they're able to consume that they're able to use those things because the government took care of the basics. I don't think the government's taking care of the basics, and I, I'll readily admit, it's really, really hard, but it's not a simple solution, but it's the right solution and, uh, I will continue to purport that.

Um, in my discussions. And the thing I always say to CIOs is, you can start this work today. I like to start with transparency for two reasons. Um, the first reason I like starting with transparency is, uh, it, it's such a great foundation to sit in front of the physicians and they go, you know, why can't we get to this?

And then you give 'em transparency into the data and they go, oh my gosh, this is crap. And you go, okay. You know why it's crap. It's because we need to start internally with data governance across our medical group and our acute care facilities and our long-term care. We need to get our house in order so that A C B C is a C B, C is a C B C across, across the entire system.

And they get it. As soon as they see it, they get it and they go, yeah, yeah, we need to do that. On the, on the flip side, one of the most underused people in in data governance is the patient. And it's interesting when you start putting that data out there and the patient can consume it, they can easily look at it and go, I don't live at that address anymore.

I never had that test act or that's not me. Um, now all those things are a little, some of those things are a little scary. It's like, hey, you know, you're giving the wrong information to the wrong person. But, um, if that's what's reflected, if what you're giving the patient is what's reflected in your system, you're going to uncover a problem that could potentially lead to a medical error later.

So that's why I like, I like the interoperability that they're doing. I like the transparency to it. 'cause I, I always think that transparency is the beginning of transformation. Usually. Yeah, I think that's great. Well put. Um, alright, so, so we'll transition. Let's, let's go to, uh, uh, what's your story for this week?

Well, I know last week you talked about Apple and the hiring that they're doing and that is actually what, when we communicated earlier, what really came to my mind as something that I think is really interesting in the press right now. You know, they're hiring physicians, aligning with, um, providers on a.

On the provision of care for taking care of their own employee base. And I do think it's interesting what they're doing and, and opening up their system for healthcare. And we're actually involved in that. I don't know if it's trial, pilot, whatever. I mean, we're doing some work in that space. Not a ton yet, but we're involved in it.

Um, but I'm really interested in the changing dynamics of healthcare. That, um, people are taking, you know, think of the, the, um, uh, the buffet and JP Morgan, and I'm gonna miss one Amazon and, and what they've put together around, they're going to go after healthcare and they just hired a towane right. To, to lead that effort.

All of the, and, and so the Apple article in and of itself that you've already talked about is interesting and what I was interested in, but it's really more the broadening of how healthcare is being provided. Across, um, across the industry and how it impacts us as a provider organization. Um, let's, let's talk about one that's probably hitting your area.

So you have C v Ss in, in Salt Lake, in your, your area. We don't have c v s, we have Walmart and Wow, interesting. So you don't have, you don't, you don't have to deal with this one. So, uh, announced this past week that they're, uh, explaining, expanding their telehealth initiative and, you know, some of the players are, Come into your market and do the same kind of thing, right?

So they're gonna, um, you're gonna have the blurring of lines between, uh, you know, who, who's the, who's the first point of contact. Do you go to your employer clinic, do you go to your pharmacy led telehealth initiative? How are you guys preparing for potentially new partners and new, um, new directions that people are gonna come into your, your health system.

Um, it, it, I wouldn't say we have it solved. Um, we are in a fairly unique situation in Utah. We're by far the largest provider of healthcare in the state. A little over half of it's provided by Intermountain Healthcare and that's, and, and, and an insurance product where the largest insurance product for healthcare in the state.

So we have some unique, you know, that you're not gonna find in New York, right? That kind of situation. You have a lot more competition and so, People like, um, it wasn't c v s, but um, one of the, the, uh, grocery store chains really wanted to get into the retail clinic healthcare. They came to us to work through it, and ultimately they didn't implement it.

But, um, I think right now we're okay because of our size and the stature that we have. But, you know, if United wants to come in here and make a player a C V S, who's a huge player, wants to come in and make a play, We're gonna have to figure out exact, and we're talking about exactly the problem you're talking about, bill.

Um, what's it, what's gonna happen? A lot of this primary care, a lot of this urgent care work is simply not gonna be controlled by us any longer. When you have people with $6,000 out pocket limits that they're gonna have to hit and they can go to c b s for 39 95 and have an interaction, or they can go to their iPhone and do it for next to nothing.

That's what they're gonna choose to do. What we need to become then are the specialists that they can't do over the phone. Now you pretty tough to do a, a prostate, uh, surgery, you know, over your iPhone. I suppose we could figure that out someday, but I'm not gonna try it. You know, pretty hard to have your annual physical where you have to be touched.

Over the, the iPhone. So we're gonna have to become better at what we do. We're working a lot on access. So where the hours used to be eight to five, you know, the hours now start at six 30 and go till nine because that's what our consumers want and we're no longer gonna be able to direct them as well as we were able to in the past.

Um, because of all these options. I think that's great for the consumer, by the way. A little harder on our clinicians, but. For the consumer. So I, we're just gonna have to change our access methodologies. I think we're gonna have to become more specialist focused because that's what they're gonna need to come to us for.

If they can get the answer to their otitis media for their three-year-old, um, either over a Telehealth visit or through their iPhone, then they're gonna do that. But there are things that we're gonna, will be able to do that you can't yet and probably never will be over those, those technologies. So I, I, I do wanna talk to you about the, uh, the Apple Health, uh, iPhone app and the, and the work there.

But the, the, the, the last thing on, on this before I, I go there, is, um, so telehealth can be, we talked about it sort of defensively, like who are you gonna partner with, how do you keep other players from coming in? But it can also be an offensive strategy. And, uh, I think we've noted on the show before that you guys, you guys have launched a, I think the terminology is digital hospital.

Where it's essentially virtual hospital. Um, and so you have, I mean, you're, you're overseeing, um, intensive care units and kind.

Telehealth program across states that you're looking to get into or looking into the future of getting into, uh, out of that as well. Are, are you guys, well, I mean, not to reveal strategy, but do you think health systems, let's talk this way. Do you think health systems will start to enter markets that way?

That they will enter first through these convenience plays or these convenience options and then start to stand up clinics and the, and the physical infrastructure will follow after they've established a base. Absolutely that's happening and will happen. We're doing it not, we haven't built any, built any clinics out of the state, but we currently provide a lot of telehealth.

Again, kind of specialty things that they may not have in some of these rural areas or in Montana or Wyoming, and some areas that we serve. Interesting. We use Telehealth to provide some care in Alaska and, uh, And, and it was incredibly successful. There was an Alaska law and, and don't take this as gospel, but I'm pretty sure this is correct.

What I'm gonna tell you, there was an Alaska law that said if it couldn't, if the care couldn't be provided in Alaska, it had to be provided in the next closest US state. Well, that would be Washington, right. And, um, through the work we've been doing in telehealth, because our costs are, are so competitive.

For, for actual care. And our care quality is high. Um, this is primary Children's. So our children's hospital, we actually were able to, we didn't, but Alaska changed the law so that the patients could come to Salt Lake City and go to our, our, our Children's hospital. So I, I think, I think that's an absolute strategy, a really good one, and we will continue to deploy that.

Our c e o has said a number of times, Mark Harrison, that, you know, we really don't want to build a lot more. Capital asset buildings out there. But if we can do this virtually and really be helpful to the communities that we serve and the communities outside of where we serve, we want to be able to do that.

I think we'll be doing it not just in neighboring states, but internationally as well. Yeah. So, uh, so today was the final day of O C's interoperability forum and uh, one of the, one of the big headliners was, uh, Ricky Bloomfield, uh, apple Health. It. Uh, a physician who works for Apple and he, uh, demoed their, their Apple Health app.

And, uh, let me just read a little bit. So Bluefield took the audience through all the cool nooks and crannies of the iPhone app. Mainly its ability to vacuum up medical data, uh, to an appreciative audience with their oohs and ahss. Uh, it's a real fire app, not a pretend watered down app. Bloomfield said another entry into the ongoing conversation over fire.

That's been moving past simple boosterism, I'm tremendous, tremendously optimistic about health IT ecosystem today. He continued crediting the work of tech pioneers and some of the regulatory and legislative efforts that have been, uh, opening up the data. So you guys are a part of this, uh, beta program.

There's 80, uh, some odd, uh, systems now that are, are participating in the beta program, uh, which moves data out of the E H R. Through fire, obviously a limited data set, but through fire and into the Apple Health app. Can you give us a little bit of an update or, you know, just anything on how that's going or, or what your thoughts are?

Well, I, it's going well. Um, we also would share in, um, Ricky's, um, approach and, and, and beliefs that having that data, I won't say we have any appreciable apps built right now or uses by our consumers, but directionally again, we like. Strategy, we're able to use the technology so we've proven we can take fire and we can move data to those apps.

So I think we'll start to see development and improvement in that area really soon. But I, you know, I don't have anything to point to and say, bill, hey, look at this great thing we're doing. Yeah. And I think part of that is just the, uh, you know, this is still early on in the process. Fire's still early, early on in the process, so we need to expand it to other data sets.

And, uh, and Apple's still new in the, obviously a. I agree with you directionally, if you get that data into that central repository, open it up to the, uh, app development store and, and all those developers, uh, can start to access that data and, and utilize it. Obviously it creates a whole bunch of questions for physicians, and in the back of my mind as I'm even saying it, it creates some questions.

Uh, but I'm sure that there's, uh, you know, I like the fact that, um, you have a physician who's, who's at the helm there, who's, uh, aware of, uh, some of the issues of people misinterpreting data or, uh, putting the wrong data out there. So, yeah. Um, alright, so let's transition to soundbites. So soundbites, I have five questions, one to three minute answers.

Um, you know, don't feel the need to. You know, go into a, a volume on it. Just, uh, you know, what's, you know, just what's out the top of your head on these things. So the first question I have for you is, uh, you've been an advocate for easing the burden on physicians and patients. Uh, how have you seen technology be used to reduce that burden?

Yeah, and I think I started that when you asked me what I'm excited about. Um, you know, what's happening in. Technology. I, I, I really believe our ability to capture information, not through traditional keyboards or poking on a, on a screen, but through voice, through image, through all these other CA capabilities that we have, that's gonna be the biggest burden, easier for our clinicians.

It's out there. Um, and then what we do with that data, uh, once we've got it into computable data, we got all kinds. Getting the computer out of the way of the clinicians or the consumer and making it just a facilitator of what they're trying to do. That's the, that's the win here. And honestly, I mean, I never, I never thought we could teach a computer to see, not, not when I, early in my career, we can and, and it's amazing what you can do when you have some of these new capabilities.

So it's, it's two directions, right? It's getting data in. So you see advances in helping, helping us to, to just get the physicians to get the data in a lot easier, and then getting the data out. So one of the things I've heard from physicians over and over again is, look, I've gotta go to six different screens to get complete picture.

And that's where we're gonna see a lot of advances in the next, uh, the next couple of years, is really consolidating that overall snapshot so that they can get that information very quickly. And also just getting the information in is gonna be a lot easier. Yeah. So I mean, technology is, it's really interesting where we're at.

Um, you know, we, we think of the EMRs. The EMRs are fairly old. Technology. I mean, they've done a good job at the concern, but all, all the providers in refreshing some of the things that they're doing and modernizing some of the look and fill. But the baseline is they're pretty . They're older technology, right?

I mean, they're, they're like me. They're older. Doesn't, doesn't make us irrelevant or bad. It just makes us older , but some of the new technologies that are coming out today and our ability to be able to feather that into these core processing systems, pretty exciting. And, and, and I'm, well, like I told you, I'm really excited about the future.

Yeah, absolutely. Your, your c e o is actually one of the CEOs I love to listen to at the JP Morgan conference. And, uh, he shared, That Intermountain has, has partnered with Medicaid on a specific, uh, zip code, uh, that is sort of a, uh, an underserved or a, um, uh, a market with, you know, just generally poor health for various reasons.

Uh, but you guys have partnered with Medicaid has assumed risk. And regardless of if those reasons are, You know, it's a food desert or, or, uh, other issues you guys have partnered with them. Uh, can you give us a little bit of maybe background on that or, you know, how it is playing a role in that, uh, in that initiative?

Sure. So I. Our, our main office building is in downtown Salt Lake. And if you go up to the 22nd floor, which is our top floor, it's not the top floor of the building. We don't own it. But you go to the 22nd floor and if you look out to the east, so you look out the windows at Face East, you got the Wasatch Mountains and they're beautiful, great skiing up there.

And um, and then if you walk to the other side and you look at the neighborhoods that are going to the west, There's a massive differential even in our estimate, you know, the mortality rate between those two vistas. Out to the east. Very wealthy population, uh, very educated. The University of Utah's up there, a lot of you know, it, it's just a really good demo demographic.

You go out and look to the west, you have a different demographic and I believe it's like 10 years is the difference in mortality rate between those two areas. So that's really, I don't know that that's exactly what got Mark Harrison thinking about it because he's pretty wise anyway, but it is a stark reality.

That there are things we can do to improve the healthcare across our community and that we have a responsibility to do so. So, uh, we, we, uh, we brought in a gal. She actually already worked for us, but we made her a senior vice president. Over our community care. Her name's Mikel Moore and she's done an excellent job in aligning us with Medicare, aligning our own insurance products, aligning the delivery of care.

And all of this requires technologies you might understand, you know, underlying it, the data requirements to even understand those demo demographics and, and the difference, the hotspotting that exists in there. So we had a lot of analytics involved in it. Yeah, there's a lot of technology supporting it, but really it's a moral issue.

I. Know, just because you live to the east of our building shouldn't make healthcare better than, uh, than any other area of our, of our state. So we're learning a lot. We are. Immensely committed to value-based care as an organization. Um, I think we may be one of the leaders in the country and actually taking on risk, not in sheer numbers, but certainly on a percentage basis for the population.

We have a much smaller population than a lot of states. Um, but from a percentage basis of the work that we do, we have really moved a lot into value. And, and that's caused us to build new tools, new, um, data warehouses or data lakes and, and the analytics and support it. So it's been very good for us to take the challenge that Mark Harrison laid out at the, uh, JP Morgan conference.

And I think health systems that assume risk in any way, shape or form. I know in southern California we had about 250,000, uh, lives at risk and, and we had sharp on, they have a lot of lives at risk. And, and you have, uh, uh, uh, insurance product. Uh, U P M C has an insurance product. When you take that risk, uh, it really does sort of, uh, help to fund, help to get you the investments you need, uh, to put the technology around that.

Uh, The numbers tell the, and, um, it's, uh, it's, it's pretty, pretty apparent, um, in Intermountain is considered pretty, a pretty forward thinking health system. Exceptional results. Talk about how you get ahead of the curve, uh, specifically, uh, how do you set technology and when does, when does technology lead.

I know that gets kind of iffy. When does technology lead and, and when does technology really just sit back and support the strategy? You tell me what we're trying to do and, and we'll find the technology versus, Hey, you know what, this is a technology that's, that's probably something we need to start playing with immediately.

'cause it's going to change things. Um, yeah. You know, early in my career we were the guys that did that. Right. We surfaced. Look at these cool new things called keypads or CRTs and you know, bring those into your, into your, uh, system. We looked at, um, some of the early EMRs and said how to bring them in, and it was all driven by us as geeks, as technology guys that, you know, that's what interested us and.

Most of the, the providers and most of our business partners, they didn't, they didn't think that way. They were still using electrics and, you know, a lot of manual process. And that's not a negative. That's, they were doing a really good job with the tools that they had, but we were interested in it. Well, that's completely turned around from my perspective, bill, where they actually know more about technology, at least in their specific areas than I'll ever hope to know.

I'll stay interested. I'll stay on, try and stay on top of it. I will go learn things and go to conferences and look at podcasts and, and, and learn things. But, but they are really the ones that are, they understand everything about technology. I don't have to teach 'em how to use a mouse. I don't have to teach 'em how to use an iPad.

They've got that because it's embedded in their everyday lives. So I think to answer your question, In an innovation perspective, in maybe, you know, I'm really interested in AI and I am, so I'm going out and doing a lot of research I can lead to bring those ideas to management and what we might be able to do and then try and secure funding to, to go do more with it.

Or another area I'm really focused on is virtual reality. I can lead those because I have an interest and they're different than what. Our typical consumer would be, but I gotta believe 90% of this is business led and as IT professionals, we need to figure out how to. Facilitate what they want to do with that technology.

And it's not easy with all the integration requirements and security requirements and, you know, frankly, all the overhead we have to put on it to, to make sure it's safe and usable. Um, but most of the time I would say it's business driven at this point. I'm happy with that. I think it's great. That shows we've been successful, right?

We, we've brought technology from abacuses, ands to, uh, the men. They're really, they're used leveraging it big time. They're, they're pressing us. S just announced, uh, getting rid of fax machines. So if you have any selects around there that I'm, who should I send your message? I'm pretty sure that they're gonna want you to get rid of the, uh, selects as well.

So, well, the Smithsonian might like 'em, but , um, so this is a little tougher topic. So you re recently outsourced, uh, 80 plus jobs. Um, talk about the decision. Why, why did you decide to outsource and how did you make the transition really work for everybody involved? We're still trying to make it work, bill, so we haven't succeeded.

Um, why did we do it? The employment rate for technologists in the state of Utah is pretty much a negative number right now, so it's a very, very competitive, um, environment. A lot of what's happening in Silicon Valley, we now have, have what we call Silicon Slopes. Um, so a lot of it's moving into Utah because it's a favorable business state.

There's good talent here, but it, it really did put a press on us to say, wow, we've gotta figure this out. I mean, short term it's gonna be hard, but long term we gotta be in a situation where we can support Intermountain Healthcare. And so that was part of the decision making. The main reason we did it is we believed we needed to get to the cloud more quickly.

So we got a partner that, you know, They are outsourcing jobs, but that wasn't the primary reason. The primary reason was we needed to get to the cloud and there was a certain set of people that work for us today that wouldn't, we wouldn't need. Right? I don't need a lot of data center people. I don't need a lot of DBAs and a lot of essays if I've got everything in the cloud.

And so it was a better transition from our perspective to get us to the cloud quickly and actually take care of those people that work for us because at scale. These cloud vendors do need DBAs and essays and, you know, some of the people that we're working with. So that was the thinking and it been really, really hard.

Hardest thing I've done in my career. Um, and I know some of the people that listen to this are gonna say, what a wuss. I mean, it's only 80 people. We did, you know, we did 2000. Um, but for me it, it's, it, it's been a challenge to maintain the culture of the organization, to maintain the trust of my employee base.

And so we're still working through that and, um, You, you used the term transparent earlier. Um, that, that's been my goal in this. Just to be completely transparent, be completely honest with my people. Lots of them are coming back around. Some of 'em are probably never gonna come around and, you know, they're not gonna think I'm a, uh, anything but a, you know, nasty c i o that did something bad, but, um, tough transition for sure.


You know, we want to bring down the cost of healthcare. There's a couple ways to do that. That's, you know, one of them is by reducing the labor, uh, component, which is always gonna be a, a reality. And then the second reality, uh, I had the same challenge in Southern California. We were competing for, uh, competing for talent with literally with Google and, and, uh, Silicon Beach and um, and even Silicon Valley.

I mean, literally people were. We're we're short plane ride up to there. And, um, and we, we had to take, and it was selective outsourcing, right? We didn't, we didn't go and outsource all 700 jobs. We just looked at specific areas where we're, we're struggling. Uh, like for instance, our Citrix environment, uh, we were struggling to hire new talent and we finally just threw up our arms and said, you know, there are, there are several really good vendors.

Uh, we should just start talking to them. They have scale, they have talent. Um, Because they have multiple clients, they were able to service us better. But I agree with you that the, the, the challenge with culture, the challenge with walking the organization through that is, uh, it's one of the reasons that, uh, yeah, it's a leadership position.

It's, it's a tough, tough spot to be in. I got a lot of gray hair for a 40 year old, don't you think?

I've, I'm wondering how early you started having these kids. So the last I do want to touch base. I was down in DC today, looked at George Washington University with my daughter, uh, where you, um, went, got your M B A from, um, and uh, just being in DC it is such an amazing city. Uh, and you've had the opportunity to walk the halls of Capitol Hill work with lawmakers.

Uh, what would you tell us about that experience and, um, uh, what can we do as CIOs are, are our representatives really informed? Can we help in the process, uh, you know, how would we be involved? Yeah, sure. Um, so a plug for Chime. I think Chime does as good a job at advocacy on a federal level as anyone for what we do, right?

Healthcare and it, they are incredibly, um, they, they have a small team, but they're incredibly well integrated into that environment. In DC I, I enjoy it a lot. I mean, the thing I've learned the most is that, uh,

Our representatives listen to those 24 year olds. So, you know, we spend a lot of time talking to those, um, to their, to their staff. But, um, they're really smart and they're really good people. You know, if we wanna make a difference, we're gonna have to do these things. , these are the people at a federal level that are making decisions, whether it's meaningful use or the use of fire or standards or any of those things.

They can do it at a scale that we just can't do as an industry. And so I, I, I encourage everyone to get involved that's interested in doing it. And, uh, you know, there's certain vehicles we have our own. Staff within DC that supports us, but we leverage Chime a tremendous amount as well. So I dunno if that answers the question or not.

Yeah, no, I agree. I, I think the thing that fascinated me about, about, uh, the couple of, uh, congressmen and senators I've chatted with is, um, They, they almost start to break down in terms of their specialization as you would think. You know, you have, you have a hundred senators and some of 'em are former physicians, and they become sort of the healthcare experts that are informing the rest of their delegation of, you know, hey, here's, here's what this means and here's how the E H R plays.

So not every, every congressman or senator you sit across from is gonna be an expert in, in health it. Uh, but some of 'em really are. Some of 'em really have a very right. Firm foundation for it. And uh, and I think when those other, uh, those other representatives have questions, that's what they direct them over.

And I love your comment that 24 year olds are, are running the world. That's the other thing that struck me is how many young, uh, energetic kids are running around Capitol Hill. It's unbelievable. Well, contrary to what we might have seen with Obamacare, A c a where it did seem like a really divisive issue.

When you get and work with the congressman and the senators, they all want to do the right things around health. They don't have the right answers. They don't, you know, and I don't mean they have the wrong answers either. They don't know the exact right answer, but they do want get to the right solution.

And I've had the pro leverage of working with our Senator Hatch. Quite a bit and we're gonna lose him. But you know, he was just one of these across the aisle kind of guys, let's solve the problems. And I see that over and over in DC and so it's pretty refreshing from that perspective as well. Yeah. And, and modern, uh, what I say is, modernizing healthcare is a bipartisan issue.

I mean, you're not gonna find anybody on either side of the aisle that says, let's not modernize healthcare. And so that's, that's what we're doing. Uh, hey Mark. Thanks. Thanks again for coming on the show. Uh, is there, is there a, I mean, is there a way for people to follow you? I'm, I, I assume you're, you're on social media, you're not using this electric to type up

You know, I'm on Twitter, I think it's at Propst mark with the C and, um, you know, you can be one of the other 10 followers. Uh, awesome, awesome. And well, you can follow me at the patient, c i o, um, my writing on the, uh, health Erics website. Uh, you follow the show at this week in h i t, uh, and you can check out the website this week in health and, uh, the YouTube channel.

Easiest way to get to.

And it'll redirect you over to the YouTube channel. Uh, please come back every Friday for more news information and commentary from industry influencers. That's all for now. Thanks, bill.


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