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. I. My name is Bill Russell. We're covering healthcare, c i o, and creator of this week in Health. It a set of podcasts and videos dedicated to developing the next generation of health IT leaders today, Walmart, epic, and Cerner new entrance into the market and our national approach to five G.

In short, we're gonna, we're gonna look at the news this week as something that we haven't really been doing the last couple of weeks, so I, I wanted to . Push as much into it as possible. This podcast is brought to you by Health Lyrics. Have a struggling healthcare project you need to get, need to go. Well.

Let's talk. Visit health lyrics.com to schedule your free consultation. We have an exciting lineup over the next couple of weeks. Jonathan Manus, formerly with Sutter, now with Christus Health in, uh, Dallas. It's gonna be here next week. Andrew Rosenberg is gonna join us in a couple weeks, uh, from the University of Michigan Medical Center, uh, Chad Brizendine St.

Luke's University Health Network. Charlie Low heed former c e o of Explorers is now starting a. Blockchain company in healthcare. I'm looking forward to catching up with him. Uh, Eric Yolana from, uh, Stanford Medical Center is also going to be here. And, uh, that is our next five weeks. It's pretty loaded and, uh, there's a couple people out there I just haven't been able to get scheduled yet, but they have agreed to come on the show.

Uh, so I'm really looking forward to, uh, some, some great guests, some great conversations. I really do appreciate each of them taking time out of their, uh, amazingly busy schedule to lend their voice to, uh, to this growing community. Uh, before we get to the news, my team, my team has encouraged me to share some of the things about the show and our program and, and our progress over the last year with you and some of our plans moving forward.

So we have a small team at this week in health. It, it's, uh, me, uh, part-time production person, Justin. And, uh, my consultant on the project from the beginning has been Jonathan Russell, my son, who has been gracious enough to share his thoughts on the show over the, the last 90 episodes. So if you don't know it, here's how the story goes.

In 2011, I was named c I O for St. Joseph Health System, $7 billion health system, 16 hospitals in Southern California. And when I came in, that was my first job in healthcare and I was struck by two things and uh, I mean, just the amount of change that was going on and the amount of change that was required were probably the two biggest things, uh, that really struck me.

So here's some quick stories. You know, we moved to the cloud back in 2015, meaning we were in the process of closing down all of our data centers. We moved to, uh, cloud data centers. I. Uh, back in 2015 in the process, our operations team went from 35 people, uh, to only needing about five people in that. And that really drove home the need for me.

Uh, I really understood at that point the need to retool many of the skills that exist within health. It. Uh, the second story was, was one where, and it happened often where I'm sitting around the table with several CIOs. Uh, either at a conference or at a, an event and, and we're discussing our challenges that we're facing and how we're, uh, uh, doing certain things.

And a c I O would share something and I would say, man, that, that's invaluable. I wish you could address my team. And I would literally be writing things down and, and, uh, taking notes. And after one of those conversations, I, I just struck me and I was left wondering, I wonder, . What value there would be to just start recording those conversations and then sharing 'em with my staff.

And that was, um, I was really the genesis for the show. I thought, Hey, you know what? I have this network of CIOs. They're all great friends, and they're all willing to, to share their, their successes because they believe in what we're doing in healthcare. And, uh, it, it, it really has been amazing to me to just send out the invites, have all of 'em say, Hey, I want to be a part of this.

They come on the show, they take the time and we get to discuss these great topics. So when I left St. Joseph Health, health, I started a, uh, consulting practice and, uh, but I still had that desire to, to sort of take that out. And I, when I started contacting these people, they said, yep, I'll do it. And so in uh, January of 2018, we launched this week in health.

It, uh, really with a simple goal in that first year. And that was . Uh, to make sure we did one podcast per week for 52 weeks, and at the end of that year, We wanted to just see, okay, so what happened? And we, you know, we've now recorded over 90 episodes, produced over 400 videos. We've reached about 2,500 people a week with our show.

Uh, we've discussed all sorts of technology topics, business topics, uh, shared many success stories, some failures. We've had over, uh, 30 CIOs on the show. Uh, startup CEOs, health system CEOs, former White House officials, and anyone who might bring value to the next generation of health IT leaders. Um, you know, throughout the life of the show, we've really had one sponsor from the beginning, which has been my consulting company.

Health lyrics. Uh, the show has done ex uh, you know, the show has really helped the company and, uh, the company has done extremely well. Um, and, and, and so it's sort of a, a, a nice relationship between the two. Uh, you know, the executive coaching of CIOs has grown as a business, as has the, uh, uh, the project worked for the business as well.

And, and so, you know, our goal for the first year was to build a following. And so as the story goes, the first episode I put out there, And you know, you just, you put an episode out there, you send a couple of emails, you put it out on social media, and the first week it had 28 listens. And you know it's good to commit to 52 weeks when you start, because when that first show has 28 listens, you realize

Wow, this is gonna be a long, a long road. But it wasn't that long of a road. It wasn't long before we hit a hundred, then we hit two, then we hit 300, 400 in the first week, 500 in the first week. Uh, and it just grew very rapidly, uh, because I think we hit a sweet spot talking to CIOs, talking to CEOs about, uh, the news and the topics that matter.

Uh, what really resonated and, uh, it started to, started to grow. So, um, you know, that was our goal for the first year, was to just do the 52 episodes and build a following. Our goal moving forward really is to build a community. So this is where you come in. Uh, if you have ideas for how we can do that, we want to hear from you.

Uh, email address for me is Bill at this week, health it.com. Uh, that comes right to my inbox. Uh, just send me a note. Love to read what you, uh, ideas you have, thoughts you have. If you wanna see someone on the show or recommend someone to come on the show, please drop me a line. If you have a story you want us to cover, please let me know.

Uh, we're going to explore, you know, how to do more live sessions this year. Even play around with some shows where we have more than two people on. Uh, see how that goes. Uh, we, we love experimenting and seeing, uh, seeing how things go. We, we did, uh, some live things this year. Uh, some went great and some not as great, but you know, we're learning as we go.

Uh, what it takes to do, to do live shows. Um, but again, we'd love to hear from you. Please drop me a line. Uh, let me know what your thoughts are. If you know of any potential sponsors, please let us know that as well. We're in conversations right now with, uh, some new sponsors and we hope to, uh, introduce them to you, uh, here shortly.

So, We love doing the show and plan to keep doing it for as long as you get value from it. So, uh, hope, uh, hope that is a long time. So let's, uh, let's jump to the news. Let's see what story, and I'm gonna, I'm just gonna riff here. So, um, I, one of the stories I thought was the most interesting, uh, came from Becker's.

Walmart has no shelf space for hospitals with shoddy healthcare. And, uh, Lisa Woods is their senior director of US Healthcare at Walmart, and she talked about their Center's excellence program, which launched in 2013 and is available to 1.1 million people in Walmart's medical plan. Uh, she recently co-authored a story in the Harvard Business Review on the topic.

You can find that in the, uh, March. . Uh, March episode as well as this story on the, on the Becker site, uh, under the, uh, program that they launched. Walmart partners with top health systems that have demonstrated appropriate high quality care and outcomes for defined episodes of care, such as joint replacement, spine, cardiac weight loss surgeries.

Um, current centers of excellence include Geisinger and Danville, pa, Cleveland Clinic, Johns Hopkins Systems in Baltimore, among others. And, um, You know, one of the things she challenged this group was to say, go home and take down your billboards that have advertising, that are advertising your ER wait times.

And you know, when, when when you think about it, it makes perfect sense. You know, it's, it, we, most of us would say it's really inappropriate for every patient to seek care in a hospital emergency room, but yet we advertise, Hey, if you need somebody, go, go here. Um, And we just know that the emergency room is not, not nearly as good as going to a clinic and definitely not as good as going to a primary care physician.

Uh, and she challenged them to, to take those signs down, which they have done all throughout, uh, Arkansas as they've engaged their local community. Um, so they spent a lot of time on this, uh, on this topic of . Uh, or, or on this subject of appropriate care. Uh, and here's a quote from her to us. That means making sure our associates get the right diagnosis and the right treatment plan.

Uh, she noted on Sunday. Then then quality is how we ensure they go to the best doctors, the best health systems, and receive the best quality care available. So it's an interesting model. They essentially have contracted with these. Uh, entities. And then when they're, uh, when their patients, uh, when their employees have certain conditions, they send them to these centers of excellence and she has shares a couple stories and it literally gets.

I, I've seen one of these at the health conference last year, and it will get, uh, it literally gets audible gasps, you know, uh, consider associates who have received diagnosis of cancer from their local medical providers, of those who are approved by Mayo Clinic, which is Walmart Center of Excellence for Cancer, to travel to Rochester, Minnesota for an evaluation.

More than 10% learn that they, in fact, do not have cancer. , they receive a di different diagnosis entirely while 55% receive different treatment plans. Think about those numbers. 10% learn they don't have cancer. 55% end up with a different treatment plant. So, um, you know, those are amazing numbers. Uh, here's another, there are other staggering numbers from centers of excellence and conditions like 54, 50 4% of Walmart associates who were told they need spine surgery locally.

Only to visit to the Center of Excellence to learn that they could avoid surgery in their treatment. So, uh, you know, she shares those kinds of stories. So how do they do that? Uh, it's pretty interesting. So Ms. Woods and her team gather massive amounts of publicly available data on health systems, and it is publicly available.

Uh, they actually, uh, because they have so many employees, they distribute requests for information and conduct detailed onsite visits. Which involve determining precisely which physicians do and don't participate in the centers of excellence. And, um, so they're collecting all this information, plus they have detailed information of which physicians are doing a good job and which physicians aren't doing a good job, as well as the AV publicly available data on that as well.

Walmart is also acquiring information about which healthcare providers in the United States have failed its associates with inappropriate care and misdiagnosis. So, um, She goes on to say, you know, what's next? And she hints at some of the developments. Uh, the first thing is the company's ramping up telehealth for their associates, and it's a huge, uh, patient satisfier as you would imagine.

They've partnered with grand rounds. Uh, their copays for virtual visits, uh, have dropped from $40 to $4. Um, I, I mean just that in and of itself would be a huge, and as we talk about the consumer and healthcare, this is a consumer play in healthcare and this is what future models look like. So if health systems can start to figure out a way to replicate this with the clinically integrated networks and other things, which is very difficult, Walmart's doing it.

Uh, I think health systems are gonna have to replicate it. Uh, next Walmart is readying quality, uh, center. Networks in, in radiology as well. And then the final thing she hinted at was, um, you know, they're right now taking their associates that get certain diagnosis and taking them outta those communities to places where they can get better care.

And now they're trying to figure out how to bring better care into the markets, into the communities where they're, um, where their, uh, employees live. So, um, . Interesting model for consumer in healthcare. Great read from Becker's. Uh, also recommend the, uh, Harvard Business Review article. Next up, epic, Cerner continue to dominate the US hospital, e h R market.

Uh, this is a class study. Gosh, do I have the, where did I get this article? Let me find where I got this article. 'cause I have to give them, uh, a little bit of credit here. There it is. Healthcare innovation. Okay, so healthcare innovation. Uh, HC innovation group.com. So, interesting article, I'm not even gonna touch on this this much 'cause everybody knows this.

Uh, large hospital systems, 500 beds or more. Epic has 58% market share. Cerner coming in second, holding 27% market share. And, uh, if for those of us keeping score at home, That is, um, 85% market share of, uh, large hospitals. Um, that's interesting. And by, it talks about, you know, epic and Cerner and who's growing and where they're growing.

Talks about Meditech, Meditech as well, and some of the other players. Um, but here's what I wanna focus in on, uh, for this story and how it's relevant for health systems. Epic and Cerner will not be able to innovate. They will not be able to innovate because they're too big. Whenever a mar, we saw this in the e r P market, uh, many years ago in other industries, and we see this happen over and over again when, uh, when individual providers of certain services get too big, they have too much market share, they have too many masters, they have too many things they have to do.

They have to keep up with government regulations, they have to keep up with, uh, custom bills. They have to keep up with, uh, advancing . The various platforms that they have for different things, they don't have enough resources, they cannot possibly innovate. There is not enough resources for them to innovate once they get to a certain, uh, and I actually read an article on this a while ago.

I wish I could have found the article I couldn't. Um, but essentially says when, uh, when four players get to 80% market share, uh, in a specific space, Uh, all innovation stops ceases. It's, it wasn't even continues at a slow pace. It ceases. And so when you're sitting across from Epic and sitting across from Cerner and they say, we're gonna innovate, it's not that they don't have the intention to innovate, they just will not have the resources and wherewithal to innovate.

So why do I say that? Why do I, and, and 'cause I'm a glass is half full kind of guy. But why do I take that approach is to say you're gonna have to find innovation outside of, of those players. And there's a lot of places to find it. There's still a ton. Rock Health will tell you, there's still a ton of money being poured in.

There's a lot of big players, uh, that you could be having conversations with. But I would be looking at innovative solutions outside of these players. Uh, for too long we've been saying, well, Epic's gonna solve it. Cerner's gonna solve it. They solve a lot. They do a lot of very difficult, heavy lifting things within the health system.

Uh, but in terms of innovation, uh, it, it is a . That is a huge warning sign. 85% market share between two players. Huge warning sign. I'm, uh, willing to be proved wrong. If somebody wants to argue that point with me on the show, love to have that conversation Bill at this week in health it.com. Uh, drop me a line, we can discuss it.

Um, let's talk about five G a little bit. So five G is interesting to me. It's interesting 'cause you know, we saw rush. Uh, rush. Rush. We saw Rush, uh, really go after this and talk about their deal with at and t. Well, you know, if you're in downtown Chicago and you're one of the markets where five G's gonna go live, Yeah, you might as well sign a deal and partner with, uh, one of the largest carriers and, uh, become a spot they have to put up all these towers.

They might as well start at your hospital and work their way out from there. Um, I have no problem with the, uh, signing of that deal, and it makes perfect sense. I, on this one, I'm gonna strike a little different tone and it's, um, uh, first of all, five G is revolutionary. So five G is gonna change a lot of things.

Things we don't even . Recognize and understand yet when you can download things a hundred times faster, when you can make those . Connection is much more reliable, uh, when you can do away with last mile issues that you have with, um, IoT and patient, uh, facing things. Um, I, we did a, we actually developed some solutions that we put into patients' homes and we had all sorts of problems.

They would move, I. The, uh, they would move the iPad to a different place and it would lose its wifi connection and, you know, so then we went to, uh, three G and four G, and we had other issues with it as we moved. Five G has the ability to really drive that, uh, completely outta the market. In fact, I think you're gonna see, uh, a lot of, um, landline type things to the home.

Go away and you're gonna have five G into the home. Uh, so five G is gonna become the backbone for all communication across the country. Your backup obviously is going to be, um, hard wires so that you can, uh, uh, I mean it's healthcare. You have to have a backup and it has to be, uh, wireless is, is, is, uh, it's gonna be fraught with problems for obvious reasons.

So, You're gonna wanna have a backup, but this is gonna, uh, create that backbone for healthcare to be delivered to the home and to extend your networks to places you hadn't before. And exciting new, uh, potential. So it is revolutionary. Three G to four G was . Uh, nifty and evolutionary four G to five G changes the game.

So I think the way to look at this again, I mean my, I'm really a C T O by trade and a C I O, uh, after being a C T O. When I look at the evolution of technologies, I look at, uh, Four G. So I'll go back and look at four G and three G. Four G is interesting. Came, uh, June, 2010, we saw four G really be introduced into the U us, uh, and let's consider it fully deployed.

Now I realize there are some really remote places that four G is not deployed today. And, uh, quite frankly, there's some places on certain carriers that if you walk around very populated areas that . Four G is not really well deployed, but at the end of the day we can see you look at the maps four G covers the United States at and t, Verizon, sprint, and T-Mobile.

Uh, completely cover with four G. Uh, just about everything except for the mountaintops. So, Um, fully deployed by 2019. That's a nine year span that you saw four G really get fully deployed. Okay, so here we are, August, 2018. Five G is really first introduced into the market. You have a handful of markets for at and t, handful of markets, uh, T-Mobile, handful of markets, uh, for Verizon.

Uh, I think Sprint has one or two as well. Um, so let's just say we're at the starting gate. Cities are starting to go live. Uh, mostly major markets where they can make some money so they can make the money and then they can, uh, expand. August 28th. So when do you anticipate this being fully deployed? If it took nine years for four G I anticipate because of the revolutionary nature of it, it's gonna go faster.

And just because we've learned stuff from 20, uh, from four G uh, it should not take nine years, but it'll probably still take about six years to get fully deployed. So you're talking about, you know, a probably a four. A four year cycle to get into all the major markets. You're talking about a, a, you know, a six year cycle to get into the secondary markets and to start to proliferate across rural markets.

So if you're worried about, oh, what are we gonna do about five G? You might be worrying a little too early about this, unless you're in Chicago, la, uh, Dallas, Charlotte, uh, you know, whatever the other markets are that are rolling it out tomorrow. Um, you know, don't get too worked up about it. You've got some time.

I think it's worth putting a plan together. I don't think I'd be rolling too many things out, uh, that if you're rolling out wireless, uh, IoT devices and those kind of things without a five G plan, that is a mistake and you're gonna want to consider what five g, uh, has in store and make sure that's on your roadmap.

Uh, okay, so let's go to this last story. Uh, just, uh, just find it fascinating for so many reasons. So, at the, oh, I gotta give credit here. Let's see, where is this from? Story is, oh, it's, uh, health Evolution. It's from the Health Evolution Summit. There was a, uh, panel discussion and, uh, health Evolution News.

Uh, put out a story on it and it's, uh, how will new entrant drive market change insiders at Google and C V S Health? Explain. I'm just gonna focus in on Google. David Feinberg was there, uh, someone who I'd love to have on the show, um, and have tried to reach out to, but, uh, have been unsuccessful at this point.

I'd love to have this conversation directly with him. So David Feinberg was, c e o at Geisinger has left, he's now vice president of Google Health. And, uh, he, uh, talked about AI and what AI can do. And anytime Google talks about this stuff, it just . It starts to blow your mind because, you know, you see those, you see those memes out on the internet where they say, uh, things like, you know, we think AI is, is, you know, machines sort of telling humans what to do, and that's where it's at.

But the real state of where AI is at is it's, it's just picking out where, where's Waldo and, uh, you know, and, and it feels good about itself. That's the meme. But the reality is Google's doing a lot more than that. They just . In typical Google fashion, haven't figured out how to take it to market yet. So, uh, let me just read some of this stuff at the leading edge of Tech Feinberg walk listeners through familiar Google search all the way to an AI algorithm that noticed undiscovered differences between male and fe female retinas.

Uh, currently Google users search for answers to health questions a billion times a day, 1 billion times a day. They're hitting Google for health. Uh, answers. So just sort of digest that a little bit when you're putting together your consumer plans because they are not searching the local health system website at this point, or any local health system, uh, application that you have put out there.

So, But they are searching Google, so it's something to something to consider. But with just a little bit more information, Feinberg says these, those results could easily be refined to exactly what the searcher needs. For example, if you typed in bloating and there were a couple of choices, male or female, are you talking about yourself?

Are you pregnant? Is there an elderly person or is it an elderly person or a baby? With just a few pieces of information, we could, uh, collate the results better for you. The next refinement of that approach, uh, might with proper consent, tie it to the user's health history for further customized research.

That refinement could also help clinicians understand their patient's concerns. I. Feinberg noted. I had patients come in with the whole internet, or they had searched enough to find the answer they wanted, that B pollen would cure their schizophrenia. Um, I guess we all fundamentally know this. This is not rocket science to us.

Most people start their journey for information and knowledge with Google. Alright? So if that's where they're starting, I would say every health system in the country needs to figure out how to have a relationship and a partnership with Google. I'm not sure what that looks like. But it would just strike me as it would make sense to be having those conversations.

And if you're not having those conversations, um, uh, the, the, uh, there's a chance you're gonna be left behind a billion searches a day around, uh, you know, . A billion times a day, which is just mind blowing, uh, that people are searching Google for health information. So it, and you, you almost have to look at it from a pragmatic standpoint.

Are you gonna be able to build a search engine where people go, Hey, I trust my, I trust the health system more than I trust Google, therefore I'm gonna start there for health. And I've heard a lot of health organizations say, well, that's what we're gonna do. We're gonna put this sort of thing together.

And they should. But pragmatically, To get, to get Mindshare and market share on that is gonna take a significant marketing effort. Um, you know, he goes on to say some other interesting thing. Uh, Google search, uh, has so many data sources. It also has access to more data than the C D C, uh, or your local public health department.

Feinberg says, we can tell you who has Lyme disease with accuracy that's as high as the C C D C, uh, but it. But it is two years earlier, Google can identify restaurants associated with cases of food poisoning with about 85% accuracy. Now we've got to figure out how to do those things and not be creepy.

Well, that's a good idea. Um, they have the algorithms I. They have a, a lot of data and they have a ton of data sources. I can't think of a better partner for, uh, things like social determinants of health and population health and, uh, and ai. I mean, obviously there's other partners. Microsoft's a good partner and, uh, Amazon's a good partner.

Um, heck the, I mean, the e h R vendors are decent partners, but they don't have the access to the, the kinds of data that Google has access to. And quite frankly, Um, you know, Google and Amazon are, are even not on par with each other. Amazon has a lot of, uh, consumer facing data and they have the, uh, computing resources.

I think you have to look at each cloud player that's out there and determine what they are good at. So this is, this is turning into more of a consulting session than, uh, report on the news, but, um, it's just really interesting to me as you . As you look at this to see the kind of things that Google can do with their algorithms and the reach that they have with their search, their ubiquitous search that is available to, um, to everyone who's looking for health answers across the, across the globe, really.

So, uh, really powerful story. David Feinberg. Uh, I think it's gonna be doing some great work. Who knows, Google has always struggled to commercialize anything that they do, so they'll be slow to market. And if people want to, uh, bash Google and say they'll never do anything in healthcare, that's potentially a valid uh, point because they have struggled, uh, in so many areas where people have just lapped them.

Um, but, uh, you know, from a patient standpoint, I hope that's not the case this time. So, So, uh, you know, that's, that's probably enough news for today. Um, this show is production of this week in Health It. For more great content, you could check out our website at this week in health it.com or the YouTube channel at this weekend, health it.com/video.

Thanks for listening. That's all for now.