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 Welcome to this week in Health IT News, where we look at as many stories as we can in 20 minutes or less. That's gonna impact healthcare and health. It, it's Tuesday Newsday. And here's what we have on tap. Intermountain is tapping 500,000 patients for genetic database. One in six ER visits or hospital stays, triggers a a surprise bill and Congress is gonna take a look at that.

Uh, also in the government, F C C is uh, looking to approve a hundred million in new funding for telehealth to expand the use of telehealth. And we have a bunch of, uh, cloud computing stories. And I'm looking forward to talking about that. My name is Bill Russell, recovering healthcare, c I o, and creator of this week in Health.

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So let's get to the news. Intermountain Healthcare, seeking 500,000 patients for genetic database unmatched and scale and scope. Aaron Alberti. Uh, from, what's the source? Uh, salt Lake City Tribune. So she starts with a story, uh, Floyd Hatch. Floyd Hatch's little brother was just 23 years old and seemingly healthy when his heart abruptly stopped and he dropped dead while playing football with a friend.

10 years later, hatch said his sister 47 collapsed and died. Hatch had run 41 marathons when at age 64, his heart began to fail him. The culprit was plainly not lifestyle. Hatch had a dangerous genetic mutation that affects a protein in the walls of his heart. Further testing showed his 28 year old daughter Courtney had it as well.

I. . So, uh, this just, uh, drives home the need for, uh, genetic testing, genetic databases to be more proactive, uh, with healthcare. Uh, here's a quote from, uh, actually pretty short quote. This is the, uh, Mark Harrison, c e o of Intermountain. This has the potential to change the way we think of disease. Uh, the article goes on to say, uh, they're seeking 500,000 patients who are gonna provide.

Two vials of blood each for genome mapping to study links between people's genes and their heart on scale. Doctors say, hasn't been done before. Uh, let's see. We will take the whole genome sequence and combine it with clinical outcomes to generate a largest of its kind database that that has ever been configured to.

Physician Lincoln. Nadal Intermountain's, chief of Precision Health. Uh, there are other large genetic databases. He cites some of those. Uh, what makes this one different is the health system also is the participant's healthcare provider that enables the researchers to track patients' medical histories and outcomes in, in conjunction with genetic information they provide to identify genetics.

Uh, Uh, genetic determinants of health. Thank you. Nadel said so, uh, you know, so what's the so what of this story? First of all, uh, kudos to Intermountain. I love this, uh, exciting, uh, to end together research and the practice of medicine, uh, and more closely and, uh, to get, uh, proactive in the way that we do this.

It is just great work from Intermountain. Um, you know, this is, this is, healthcare is changing rapidly right before our eyes. From reactive to proactive. This is one of those steps. From, uh, experiential to data-driven. Um, just, you know, we used to rely on the gray hair of the physician and much more of it as being data-driven and will continue to be so.

Um, It. We will also continue to, to, uh, transition from, from episodic to more of health as a service. Uh, for those of us who want it, we're going to be able to have a lot of sensors and be connected directly to clinicians who are also, uh, giving us proactive information on, um, uh, based on our genome, based on our, uh, sensor data, based on other things.

Uh, so I think we're going to just continue to see this from an health IT perspective. Uh, This, this is knitting together an awful lot of different technologies, huge data sets by the way. Huge data sets, huge, uh, data requirements, bandwidth requirements are gonna be significant. The, um, uh, so this from a technology perspective is no small task.

Uh, the good news is, I, I don't think it represents a lot of new technologies. Just a way of knitting together a lot of technologies that are already in place. So, Uh, let's move next story. So our next story is, uh, one in six ER visits or hospital stays triggers a surprise bill. And this is Ricardo Alonzo Zaldivar.

Wow, what a great name. Uh, AP News and, uh, you know, the fact that this is AP News, the fact that it's, uh, getting that kind of coverage. Uh, I think is going to be the story that I'm gonna focus on. So the report from a nonpartisan Kaiser Family Foundation finds that millions of people with what's considered solid coverage from large employers are nonetheless exposed to out-of-network charges that can amount to thousands of dollars.

So this has, uh, caught the attention of Congress and, uh, next Wednesday, the Senate Health Education, labor and Pensions Committee. Uh, is set to vote on a bipartisan legislation that would limit what patients can be charged in their in-network deductibles and copays, uh, uh, tied it to their in-network deductibles and copays.

The bills from Senators Lamar Alexander, Republican from Tennessee and Patty Murray, Democrat from Washington, would require insurers to pay out of network doctors and hospitals. The median or midpoint rate. Paid to in-network providers. The House Energy and Commerce Committee is working on similar legislation.

President Trump has said he wants to sign the bill, so, um, You know, this is one way to address the problem. The other way to address the problem is through, uh, setting up, uh, arbitration, which has been done in New York and some other, uh, some other locations. This is, uh, considered a less, uh, bureaucratic way of doing it, just tying it to, uh, the median or the midpoint.

Uh, that way you won't have to build this massive infrastructure that does arbitration on these kinds of bills. Um, but what I wanna really focus in on this story is . That again, I just keep coming back to election cycle election year. These stories are gonna be, uh, front and center. Um, congressional leaders and, uh, people who are running for office are gonna be going outta their way to, uh, try to address this issue.

Not, not, not a, not in a bad way, not a bad thing. But as these stories get es escalated, healthcare, um, healthcare leaders, healthcare providers are gonna be, uh, called to talk about what they're doing in this area. Uh, and, and my recommendation around this is to just get in front of it. Um, you know, be able to answer the question of what is your strategy on price transparency?

What's your strategy on helping people to navigate the financing of healthcare? And, uh, you know, you're just gonna wanna get in front of it. I mean, the best case scenario is to have, uh, a plan or strategy that the next is to have actual progress being made towards that plan. And the best case scenario would be to have, um,

You know, solutions in place with testimonials from, uh, from your patients. So I, I just think you're gonna want to get in front of this, at least have your story straight. At least have something that you are heading in this direction. Congress is gonna do what they're gonna do. You can't impact that. But, uh, it's good to have these, uh, programs in place for the communities that we serve.

Okay, let's talk cloud. There's a lot to talk about in terms of cloud. I'm gonna pull, uh, three stories out here. I'll go through 'em very rapidly. I'm not gonna hit on all of them. Uh, the first is, uh, two thirds of enterprises disappointed by cloud migration journey, uh, says Accenture. Um, the, uh, source is which?

50, which dash 50, uh, and it's their staff writers. . Uh, a couple of statistics here based on the survey of 200 senior IT professionals from large businesses worldwide, not necessarily just healthcare. The report, uh, is called Perspectives on Cloud Outcomes. Expectation versus Reality suggests that cloud migration journey is more complex than anticipated for innovation and efficiency.

While the vast majority of companies, uh, cited achieving some level of their desired outcomes, roughly 90% of those, only about one third of the companies on average, reported that they have fully achieved. Uh, they're expected outcomes across four categories, cost, speed, business enablement, and service levels.

And in those, the rough, uh, . Uh, percentage is roughly about 30 to 35% have achieved their goals in those areas. Uh, the barrier for realizing the benefits of cloud that survey respondents noted most frequently when asked to identify the top three were security and compliance risk, uh, was cited by 65% of the respondents.

complexity of the business and organizational change, 55% and, uh, legacy infrastructure and or applications for all 43% and lack of cloud skills in organization within the organization. About 42, uh, percent. Um, one other thing of note, companies employing private clouds tend to lag their counterparts, employing public cloud or hybrid cloud models when it comes to fully achieving expected outcomes.

20. Uh, 28% to 42% roughly. So, uh, you know, so what's so what on this? Um, I, I think the reason people are, are struggling is 'cause cloud is not a, a monolithic technology. It's not like I, you know, we're gonna adopt Microsoft Office Cloud is a set of technologies. So there's platforms, there's applications, there's infrastructure, there's native cloud, and each one of those has, uh, different characteristics and can be applied differently within, within healthcare.

Uh, definitely, but within business, just in general. Um, you know, your, if you're gonna do applications as a service, you're, if you're gonna do workday, that's one way of going about it. If you're gonna do infrastructure, say an a w s or, um, or even an Azure, which Azure's more of a platform, but it, uh, as is a w s I mean, they have aspects of infrastructure and platform across the board.

Um, they are different. They're very different. Uh, the other thing I would say is lift and shift to the cloud will cost you more money, period. You have to change the way you're doing things from how you're doing 'em today to realize the benefits there. There's no way of getting around it. You shouldn't need, um, like you'll only need like 15% of the people you need today.

You, you don't have a data center. You don't have a raised floor. You don't have to put, uh, servers into racks. You don't have to do, uh, you know, . Tapes and those kind of things for backups, uh, it will just radically change the way, uh, you're doing things if you don't change the way you're doing things. What organizations are finding is cloud costs more.

It just flat out does. Um, if you're gonna do it the same way you're doing it today, uh, I have to say the third thing is your biggest obstacle to adoption isn't the business. The business is gonna say, Hey, I use the cloud at home. I use the cloud for email. I use the cloud for storage. I share my photos. I use the cloud all the time.

It's really kind of cool. You're not gonna get a lot of pushback from the business. You're gonna get it from the IT staff. Because it's a dramatic change for it. You have to do your change management within the IT staff first and foremost before you move out into the organization. And I think what you're gonna find within the organization is not much pushback.

So a couple stories to sort of back this up. 110, 110 healthcare migrates to Google. Cloud G Suite and saves $1.3 million. This is Bill Sowicki Healthcare IT News. You know, uh, I'm not gonna go through the story. So Huntington's, a smaller health system. Uh, they, uh, decided to do the migration department by department, not necessarily in a Big Bang approach.

Uh, again, highly recommend that. Um, You know, things like office did not go away completely. You're not gonna get, uh, Excel out of finance department. They've written too many macros. You need V B A, uh, there's a whole bunch of other things that are going on and they, they just know Excel. It's gonna stay there.

And, and there's a handful of other areas where they left, uh, office in place. Um, they engaged an outside partner. Because they did not have the, uh, skills, uh, internally and uh, and they realized those savings over three years. So you're talking about a really small health system saving $1.3 million.

That's significant. I share that story just to say it can be done. And the story's recent. It's, uh, just, I. Picked it up this, uh, past week. So, uh, it, it can be done and it is getting done. Another case where it's getting done. Uh, cloud Summit, uh, geek Wires Cloud Summit 2019 business sessions. I pulled up a video, BJ Moore talks and BJ Moore is the, uh, c i o that just came from Microsoft to Providence Health and Services, or of St.

Joseph Health in uh, In, uh, Washington, uh, state 51 hospitals across, uh, the entire west coast. One of the largest providers, if not the largest provider on the West coast. And, uh, B BJ Moore did, gave about a 30 minute talk really worth listening to. So, GeekWire search, um, cloud Summit 2019 business sessions.

Uh, great talk from him. He shares, uh, a couple of, uh, really cool stories, uh, around migrating to the cloud. and uh, and it just shares how it can be done. And, um, . , why it's, uh, not as hard as what your people are telling you. And, uh, finally I have another story. Uh, former Apple, c e o John Scully predicts how technology will change healthcare.

Uh, this is from the Mac Institute for Innovation, uh, management from Penn University, uh, where he was a couple weeks, a couple weeks ago. Uh, during the, uh, and I'm just gonna share this one quote. So, during the decade that I was c e O of Apple, I witnessed the change in the world. To how we went from computers being focused on institutions to computers being empowering, tools for individuals doing amazing things.

And I think this, and he goes on to talk a lot about cloud in this, uh, it's actually a podcast interview. He goes on to talk a lot about cloud in this and cloud's gonna enable a different focus for healthcare. It's not. Uh, it's not gonna be as much focus on business to business and business to doctors and institutions, to doctors.

We are going to start to figure out how to go directly to the consumer. So much the way that, uh, technology changed, uh, during Scully's time at Apple where we were focused, i b M was focused on selling computers to businesses and it was gonna change the way businesses was done. And during that timeframe, we, we, they started selling computers to individuals and it changed

But just changed everything. Uh, really, uh, that same thing's happening in Healthcare Cloud is one of the biggest enablers there. Cloud is possible and it works. We just need to think about it a little differently and, uh, you know, take the steps we need to, to take to, uh, get there. Uh, next story. So telehealth set for big Boost with a hundred million dollars in new funding from the F C C.

Uh, speaking in rural Laurel Fork, Virginia, uh, car announced that the new funding is meant, uh, to access, uh, uh, I'm sorry, speaking in, uh, rural Laurel Fork. Virginia Carr, who's, uh, over the F C C announced that the new funding is meant to increase access to care to patients and veterans in remote areas such as Appalachia.

Uh, with advances in telemedicine, healthcare is no longer limited to the confines of traditional brick and mortar healthcare facilities. Said Carr in a statement. I think the F C C should support this new trend towards connective care. . Which is the healthcare equivalent of moving from block blockbuster to Netflix.

That's why the F C C will vote to advance my a hundred million dollar pilot program. At our July 10th meeting, he added that the program will focus on ensuring that low income Americans and veterans can access. This technology particularly, particularly in rural communities such as Laurel Fork, uh, where the nearest hospital is in a different state, access to telehealth can make lifesaving different differences.

So, um, you know, telehealth still remains one of the most disruptive forces going on in healthcare. Uh, we're gonna see more visits, shorter visits, no wait times. Uh, we're gonna see access to specialists, uh, from afar. I, it, it just has the, the opportunity to really transform the landscape, probably, probably the most in the near term.

Um, and I don't think it's necessarily a bad thing. I'm gonna see my doctor more 'cause I'm not going to have to take off from work. I'm not gonna have to sit in a a, in a sick room in a. Uh, waiting room with a whole bunch of sick people so that I can get sick. Um, and I'm gonna be able to do it just like I'm doing it right now on this, uh, podcast.

But I'm gonna be sitting across from my doctor. And quite frankly, as we get better at this as a society, uh, I think the, uh, consumer is gonna start to demand this from healthcare. So, uh, great move from the S sec. F C. C. Uh, in, uh, creating funding for those areas that quite frankly, don't have the business models to support taking Telehealth out there.

That is where the government belongs. That is where they help, uh, taking this to places that are not supported by business models. So, And let's do, uh, let's do one more. I, you know, I wanna point out just every now and then I see a success story and I think it's worth pointing out. Uh, this is how Advocate Aurora Health streamlined prior authorizations.

This was in rev cycle intelligence.com, Jacqueline LaPointe. Uh, so, uh, let me just share a couple things here. So . 91% of physicians in the a m A survey reported that care delays associated with prior authorizations and equal amount and an equal amount. Also said prior authorizations have a significant or somewhat negative impact on clinical outcomes.

I've heard the same thing in working with doctors. Uh, prior authorizations are pain and slow things down, frustrated with using phones and fax machines to manage the increasing burden of prior authorizations hardened turned to advocate Auroras. Uh, E H R system makes sense. Harden is the, uh, c f O for Advocate.

Aurora, uh, uh, I don't have his first name here. Uh, about three and a half, four years back we realized that prior authorizations were a problem and we wanted to see if we could try to spend, uh, speed up the process and take advantage of the E H R system. We had at the time, we thought, what functions are available, one, once our pharmacy does go live on the system.

Uh, and what do we have available to us? One of the functions we saw was electronic prior authorizations. Uh, from there, harden assessed the, uh, market of technology solutions that could work with the EHRs. Electronic prior authorization capabilities. After the solutions analysis, the health system decided, decided to implement an automated prior authorization solution from Surescripts with the solution providers, uh, trigger an automated prior authorization workflow by prescribing a medication or service that requires payer approval prior to delivery.

The solution has a lot of pharmacy benefits management information already built in. So now the typical prior authorization process happens automatically hard and elaborated. The clinic staff never need to touch about 80 to 85% of the authorizations for our patients. Uh, so what I, I just like ending the show with this, this, these are the kind of stories that it organizations,

Need to get out there. Now, I'm sure if I went to Advocate Aurora and talked to a lot of people, um, you know, we tell the best side of this story. I'm sure there's some challenges and, and whatnot, but at the end of the day, when you get 80 to 85% of the prior authorizations, uh, not requiring, uh, the clinical staff to, uh, do extra work, Giving them the ability to go home.

These are the kind of stories we need to be telling and we need to be shouting from the rooftop. So, uh, you know, great work tackling this problem with technology, reducing the burden on clinicians so that they can spend time with their family, that's a big win. So that's all for this week, uh, this Friday you're gonna wanna check it out.

We had a great time, uh, recording an episode in Philadelphia with Dr. Steven Klasko, c e o for. Um, for Jefferson Health as well as Nassar, Nazami, the c I o. Uh, great time, great conversation. Uh, you're gonna wanna check that out. Phenomenal episode. So, um, and, uh, you know, we're we it's, it's kind of funny, I've been saying we're quickly approaching our hundredth episode.

We're gonna do something special. We are planning something special, but here's a little side note. . We already did a hundred episodes. Our hundredth episode was last Friday. Uh, I'm a little behind on getting this scheduled. We're gonna do something great. I'll let you know when it's gonna be. You're gonna wanna mark your calendar once I figure out what we're gonna do there.

Uh, but, uh, it's gonna be fun and, uh, If you want to hear, uh, from someone that, uh, that we haven't talked to on the show, make sure you drop me a line at built this week in health it.com and that's all. So this show is a production of this week in Health It from work Great Content. You can check out our website at this week in health it.com or the YouTube channel at this week in health it.com/video.

Thanks for listening. That's all for now.