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March 3, 2020: Drex DeFord stops by to do a HIMSS pre-game. We discuss President Trump's interoperability talk and Epic's second big win in recent days. Hope you enjoy.

Transcript

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 Welcome to this week in Health IT News, where we look at as many stories as we can in 30 minutes or less that's going to impact health it. My name is Bill Russell Healthcare, CIO, coach and creator of this Week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

This episode is sponsored by Health Lyric I coach instrumental in.

Conversation. It's Tuesday Newsday and we have a special treat today. Drex de Ford, the original recovering healthcare, CIO, joins us to talk news and do a little pre-game. Uh, good morning, Drex. Welcome back. Good morning. Thank you so much for having me. It's always, uh, it's always fun. It's always a good time to sit down with you and talk about the news.

Well, I'll. Calling myself the recovering healthcare, CIO when people kept lashing back at me saying, that's Drex, uh, title. So I, I finally said, I, I give, I give, Drex has too many, too many fans. I'm not gonna, not gonna try to, oh my gosh, I can't believe that. , I can't believe it. I mean, I think there's a ton of us right now that are recovering CIOs.

Recovering CXOs. So it is what it's.

On, on the, on the show, and it's, uh, what, what's the number? Four Eight? Four eight. It's four eight. Four eight. Four eight. Just text Drex to four eight. 4 8 4 8. And I send three stories three times a week. These are the things that I think are, are hot and if you're only reading hardly anything because you're so busy at work, I'm trying to filter it out.

I'm trying to, you know, take. And give the stuff that you probably really ought to know about when you're talking to peers or talking to your staff and, and, and I know, I mean, I, I agree. I think it aligns really closely with a lot of the work that you're doing right now. We both do a lot of coaching. We both do a lot of teaching, and I think it's the beauty of being at this point in our careers where we.

And that's, that's what we do. You know what I, I, the, the thing I love is I didn't have to hire like a staff person to do research for me anymore because I get these text messages from you , and it, it gives me, you know, nine stories to look at every week. Now I'm still reading a lot of stuff that's out there, but, uh, but it is, it is really helpful to have it, have it.

Thank exchange in,

send me other little tidbits, wind showing.

A.

We'll conversation. Um, we're gonna talk President Trump on interoperability, which should

president at former president. It's not that this, uh, venue hasn't had, uh, dignitaries before, but this is the first sitting president. And then, uh, the last story I pulled was, uh, atriums really follow, following, uh, advent on this epic train. And I think that's, uh, you know, that's two major health systems in the last 30 days making this announcement.

So it's, uh. Big. And then you have three stories. What three stories do you have? Um, so I have, uh, let me look through the show notes here. I've got, um, I have a article on continued, continued consumerization in healthcare, whether or not it's good or bad for patients, or good or bad for hospitals. Um, I have a story about reinventing yourself and then, um.

You know, we talk about patients as customers, but they're still patients and they're still consumers, and there's, there's two sides to that coin and

love. Reinvent yourself or somebody else will. That's a great title. It. And good for our, our, um, so let's, let's start with Coronavirus and hims. Uh, neither of us are doctors, so we're not gonna go into details of, you know, what people should be doing around this. But are you planning to attend? Uh, as of today, I will still attend.

I'm still gonna attend. Yeah. And I feel the same way. I, it's, it's like a, uh, it's like a day-to-day decision, uh, because I, I have a lot of interviews planned, but I could easily do them the same way we're doing this. Mm-Hmm. and still get the word out and, and capture some of the thoughts. I wanna, but it is kind of a day to day thing.

I'm not, I'm not, you know, the first two cases in Florida have.

I mean, I, the thought I have in my mind is, is it responsible to go ahead with the conference? Should we, should we be even be put in this position to decide whether we should go or not? I, what, what are your thoughts on that? Yeah, I, I mean, there's, I think for hims, a huge amount of financial pressure to do this.

To keep the conference going. Now that they've announced the president's going speak, they've almost back themselves into a can't cancel now without making you know the situation, not president. Um, I, you know, um. I sat on the HIMS National Board back in the day where the annual conference was like 95% of the revenues of the company, and we diversified specifically because of that.

We wound up buying Dorn Fest, which turned into HIMSS Analytics. Uh, we went down the media road, so there's lots of hims. Media stuff has happened. We, we did unifications and joined with several, several other, uh, organizations so that we had other conferences at other times and other events at other times, specifically knowing that this could be a thing that could happen.

We, I don't think we really thought about it being a, you know, pandemic situation, but you, you never know what's gonna happen, right. There could be, uh, you know, if you were doing this in Chicago, there could be a snow storm and everybody cancels. There were lots of different options. So specifically spent some time building out the company to be able to take one of these hits if they ever had to take it.

And I'm not sure what's going on, but we've definitely gotten to the point with HIMSS now where the show is so big and there's so much money involved. That canceling it doesn't seem to be an option. And so for a lot of us not going is also not an option. I mean, I feel like I, you know, I'm with you. I'm on the fence every day about whether or not I'll go or stay, but, um, but as of today, I'm going, yeah.

And my, you know, my film crew is my daughter, so.

But to be honest with you, it's not just that it's my daughter. I'm talking to vendors and I'm talking to people that are partners with Chime and partners with him who are, uh, seriously considering pulling out for the good of their employees. And, and a ma, one of the major vendors who I talked to this morning just canceled their national sales conference, which is a one time, once a year.

Clearly there's, there's a around this and it's probably warranted I one

and survive financially. I.

They would've to do major cuts and change things. And it would, the other thing is if you take away a major revenue source, it, it sort of showcases all the other areas where they're not making the money that they thought they were making. Mm-Hmm. . So it, it would, it would cause a major restructuring. I, I think the responsible thing would've been to, uh.

To pull out if they could and, uh, reschedule for the fall, try to do fall or some aspect of that.

Incredible to even contemplate. Yeah, no, I'm sure you're right. I'm sure there was a lot of discussions and a lot of of uh, sort of plea pre-planning to figure out what would be the options. How would they do it if they decided to cancel the conference and do something different, what would they do? Um, you know, a lot of this kind of gets down to the.

Doing these kinds of, they're not really incidents, incident response exercises, but they're that kind of thing where you are, where you always have a backup plan, especially for major things that happen with your company or with your health system. How would we do X without Y? Or what happens if we have to stop doing x, um, period?

How do.

Sometimes the wrong one, and we'll see how this works out for him. You know, I, we, we saw sars, we saw Ebola. We're now seeing, uh, coronavirus. I think this is the new norm. I think this has to be taken into consideration for these conferences and for travel and those kind of things. So. They should invite you back on the board.

I'm not volunteering you for that. I know you're busy. Um, but let's get to the next one. My job on the next one, president Trump speaking on interoperability. My job is to get you so fired up, , that, that you say the things that you normally wouldn't say on the air. Um, but, but in all.

It'll probably be somebody else's speech. I doubt President Trump has the nuance around interoperability. Say SEMA or Secretary Azar would, but clearly, uh, they're using the bully pulpit. They're gonna get this word out about interoperability, why it's important, and, uh. The, one of the things I've driven home on this show is this is a bipartisan issue.

If you had Joe Biden speaking, he would be just as passionate. In fact, I've heard about him being just as passionate, especially around the uh, Biden Cancer Initiative and how upset he was. That the, the medical record is so hard for somebody with such a complex case to follow. So this is a very much a bipartisan, uh, issue.

But I think by Trump speaking about this at hims, he's, he's almost trying to take this issue and make it, you know, a champion for the people.

Is it good to have a sitting president really championing, uh, interoperability? Yeah. Well, I mean, you and I have talked about this, um, quite a bit. Uh, we're both fans of interoperability. We both think this is a thing that probably should have been thought of and written into the original meaningful.

Rules. I think a lot of us kind of assumed it was gonna be there. And then, you know, as we've talked about before too, with all of these regulations, there's always some unintended consequences. So I think given the controversy that you and I have both wrote, written, and talked about around interoperability and the conversations this.

They did what you and I do as CIOs and that was we went to the boss. We had a conversation about what we're trying, interoperability.

We're trying to create a situation where the message comes from the top. We're gonna do interoperability. This is good for everybody. This is gonna save a lot of lives. And they'll get the kind press that they're looking for because the president saying at national, um, you know, I, I, whoever the president is, you can't blame the senior folks at HHS for saying the best way to sort of broadcast message.

I'm expecting some goofiness in the , in the auditorium. Um, just, just knowing what I know about healthcare and knowing the political bent of, you know, you take 40,000 people from, uh, from our industry and put them in a room, I don't know. There'll be people who stand up and walk out. There'll be people who stand up and turn their back.

What, whatever it ends up being. Um.

I've always been a proponent as you have been of, you know, that medical record following you wherever you go. Um, interestingly, I, I just think Epic, I think this is a precursor to the fact that the OMC rule is going through and he will probably either announce it right or it will be announced just prior to him getting on stage.

And he will drive it home and he will try to take this as an.

I.

To a major hospital that was on Epic and his records didn't follow him. And, uh, I got a lot of emails including from Epic on, you know, why it may not have worked the way that I thought it should work and whatnot. So, um, this is a, this is a, this is a, an issue that Epic didn't do a good job.

To take it and say for, I think it's a move for President Trump try issue against Biden. I, I think Biden's just gonna look at him and say. Yeah. , we're we're, we're on the same page. I is. What's gonna happen? Yeah. Wanna.

As we find with all regulations, there's always unintended consequences. And so the important part of all of this interoperability rule will be to make sure that we can adjust for effect, uh, as we start to realize the unintended consequences. And the second one is if you really wanna make interoperability work.

Make it way easier for us than it, than it ever has been before. Um, do the universal patient ID thing, stop playing around with that. Let's just get that done so that we all have some kind of a something identifier, um, that lets these records really flow because.

Duplicating records get accidentally registered where I get registered two or three times. There's as much risk associated with that as there is with records moving between health systems. So there's, there's the next couple of things that I would say need to be teed up so that we can actually make this work.

You know, what's great about that Drex? I, I disagree with that about a thousand percent, but, oh really? I might let it drop. Um, I think it's patient-centric interoperability. The problem is. Interoperability and from a patient-centric interoperability. I already have a number that's unique to me. It's called my phone number, and you just download it to my phone.

When I show up at the next hospital I go to I, you know, QR code, they scan it, they get my medical record. I say they can have it for three weeks. They can have it for two weeks. This causes healthcare professionals to just cringe. It's like, no, we need it for research. I'm like, great. Ask for for research cancer.

My. But I'm in control and I'm the one who's doing it. The reason we, I get it, I mean, we had, we had issue, uh, across our Northern California region to clean up. Um, I get where you're from. Duplication of records, hard to match records. That's serious issue, singled quickest. Challeng still think.

I don't care if we go over 30 minutes and I don't actually care if we get to the, to my stories. 'cause I actually like this conversation and I wanna tell you, I think we're on exactly the same. Uh, we're on the same path. We want the same thing. Right. I've always been a big fan of personal health records, which is essentially kind of what you're talking about.

Yep. Except that. The way that we tried to do it in the past was clunky and.

Uh, tightly linked together, and I believe this idea of like being able to have complete control of my medical record, have all the stuff that I, that I want, be able to sign up to a website to put particular data out there about myself so that I can be offered clinical trials, and then being able to actually maybe monetize part of my record for.

That is a great idea and actually makes me engaged in the reason to do. They're, they're not excited about doing that. They're not interested in doing that. People who have chronic problems, um, especially having been at a children's hospital, parents who have kids who have chronic problems will walk around with bibles, literally, we call them Bibles, giant books of medical records, tests that have been done.

When it's important or when we figured out how to properly incentivize them for it. So, uh, I mean, I, I love this idea. We, we kind of now are getting to the point where we have good tech to be able to do a personal health record kind of thing. And whether it's the Apple stuff that's happening right now or other things, I, I think we can get there.

Allscript to, you know, give all the data to Apple and say, okay, you, you can sort of curate it for, for users. Um, I don't think there's any incentive for the health systems to do that. They sort of lose control and it actually gets back to, um, you know, HIPAA is about portability. It's, it's about security, but it's about portability and the concept was essentially that I would have my health record and be able to go anywhere and, but the health systems still, I mean, I've sat in meetings, I'm sure you have too, where people like the fact that we have their data.

Um, and there's a certain, uh, comfort in that. And, you know, so I, this is why I think the government, this is why the HHS especially though, has to push this forward because there's not an incentive for anyone else to. Yeah, I mean, I'm, I'm a fan of the free market as much as the free market will work. But, um, this is a thing that might need, like you said, might need a nudge and might need a consistent long-term nudge to get it, to get it going.

And like I say, with everything that has to do with the government, there are always unintended consequences. So we have to be able to react quickly when.

I didn't mean for that to happen. Yeah, but, and Judy's right. I mean the, the single biggest unintended consequence is security and privacy. Privacy. Right. I think people don't really understand what they're signing up for or how this data is gonna be used. And, you know, you get the, like we have with everything else.

User licensing agreement that we all sign on the dotted line, even though we have no idea what it, what it really says. And then we wind up really surprised and, and, you know, hurt later that it, they did something with our data that we gave them permission to do so. Yeah. Um, yeah, you know, Judy was right.

She did not handle it well. I think. Um, she didn't politic duck.

Academic medical centers before she sent that letter out. And, but because she didn't, they didn't, they didn't support her after the letter came out. Yeah. Um, and that was one of the biggest cases that they, that the OC made was, Hey, look, these academic medical centers didn't support Epic on this. It's not that they don't support Epic on it, it's.

It's just the way it was done. Hey, you know, let's get to one of your stories. Which, which one do you wanna start with? Well, no, let's talk about Atrium. I mean, 'cause I think that is a good story. We'll get back to our show in just a minute. Galen Healthcare is an award-winning best in class healthcare IT consulting services and technology solutions firm.

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Now back to our show that's, uh, interesting to me. So, um, I think Advent was the bigger story, to be honest with you. Advent was a long time Cerner shop from, from one end to the.

Uh, atrium though. Uh, you knowum been growing pretty aggressive leadership team.

You know, they, uh, they basically had a hodgepodge. And the reason they had a hodgepodge was because they had acquired a bunch of hospitals. Uh, Amy Crowders, now there is the CIO. Yeah, yeah. And, uh, hodgepodge. So they had Epic financials. They had, um, Cerner clinicals, and then they had acquisitions that were fully on Epic.

So my case is always the best.

A case where they were forced into a situation of we've, we've gotta, we've gotta get on something here. Yeah. I think they, you know, and some of this is also, you look at people who get hired into particular situations. So, you know, there, there's a pretty giant signal when, um, her good friend Andy Crowder gets hired.

A great job implementing Epic at two big health systems. Um, I wonder what he is gonna do when he gets to Atrium. Like, you know, there wasn't, this wasn't super, I mean, I think for people who, who had their eyes open wasn't, I don't think they were sending, he wasn't coming there to implement Cerner, so, uh.

I'm sure he will have another really successful implementation and, and he definitely has the playbook. He's seen all the hard stuff. He'll do a great job. Yeah. He'll, what does this tell you about Cerner? So Cerner just lost Advent. They just lost, uh, atrium. Does this say anything about Cerner? Cerner's leadership, Cerner's position in the market?

Turnover. Right.

You know, the, the VA just slipped their go live now from April till, I think July for Spokane. And then, you know, later for the, for the Puget Sound area, um, they're really focused on the government as the prime on the VA contract. And as the, you know, one of the.

To be involved in the.

There are a lot of dominoes following that are pushing them more and more toward. We may have a government's EHR system, which is Cerner. We may have a civilian EHR system, system or collection of systems, which Cerner will be involved in, but may not be as big a player as they have been in the past when you look 10 years down the road.

Right. I.

And there's a lot of things that can change in that you.

Yeah, it's interesting. Um, I, I read an article a while back that talked about consolidation in industries and when you get that, it's monopolistic pressure, right? So one of the things that happens when you get too much monopolistic pressure is you get organizations that have too many clients with too many distinct needs, and they're, especially in the software area, they're not so.

You know, this is the reason that Epic is driving towards foundation and a standard build across the board because they recognize that the larger they get, what they have doesn't scale and they can't, unless they get everybody to foundation, they're not gonna be able to do the innovation on top of that platform that they really wanna.

Yeah. Um.

50% market share. Uh, I don't think they'll ever, unless they come out with a new product, they'll ever get the, the rural, small hospitals. They're just, it's just too expensive still. And Community Connect requires the, I don't know about you, but my experience with Community Connect Hospitals is everyone I walk into is like, we're control whatsoever.

Yeah.

We're one, one vote out, you know, 15 community hospitals and the mother who really actually controls all that. I mean, I hear the same thing too. So it becomes a question of at what point, you know, epic gets 50% market share. Do, do they start to sort of implode on themselves?

Announced

anyone who knows program's, indications underneath. Yeah. Yeah. I mean, here's an interesting idea, right? I was talking to somebody, uh, talking with some, talking with somebody about this the other day.

Foundation of the electronic health record system in that they're the place that stores the record. Some health systems will use components of that EHR because they work really well and they like how they work. But with the interoperability rule, the capability of us going back to best of breed. Um, lots of innovators building really cool and interesting tools that work great for this tiny niche of transplant or, uh, heart transplant, an EHR that works really great for them.

That plugs into Epic and allows all that data to flow without the confusion of, you know, when you and I were kids, we had systems and everything plugged.

All the data. We may have gotten the important data back and forth between these systems, and that's why we went to Best and Suite. But I wonder if we're not like everything else, boomeranging all the way back around to inter interoperability lets us actually do the thing that we always wanted to do, which was have a bunch of niche systems that work really great.

Reduces physician burnout makes us deliver the care that we want. That all plugs back into the A mothership EHR. That is what Epic evolves into eventually. Alright. This is the last question and we're gonna come back. We need to schedule something to come back and do your three story, 'cause I really wanna talk about it, but we really are at the end.

But my question to you is, and this is an, which is.

Make the case for why they should do that, why they should develop in layers and allow someone else to own the presentation layer. Man, you know, I mean, I think it's a long, complicated business, uh, conversation. I don't know if it's the right thing for them. Uh, it may be the right. Decide that maybe they are going to be that base level layer of Maslow's hierarchy of electronic health records needs, and that then they spin up a giant innovation fund to take care and do the care and feeding of a bunch of other small companies who are actually gonna do the innovation.

Niches.

There's people doing this stuff right now. Yeah. Waiting for the interoperability. Try to get the

healthcare for this particular piece of healthcare and we can work with Epic or cer. I would love to be able to make that case to Judy and Carl because I believe there is a really strong business case to be made. But as you know, I've read their contracts, I've read theirs, everybody else's contract.

None of them allow you to do it. Yeah, if you try to it, you have to pay them. Like every transaction, everything that goes on. So, um, interesting, interesting conversation. Drex, thanks for, uh, thanks for joining us. I look forward to maybe seeing you at him next week, . I'm sure I'll see you there. I'm sure I'll see you there.

And let's, let's definitely get something on the calendar. Um, that's all for this week. Special thanks for our sponsors, VMware servers, advisors, healthcare.

This show is a production of this week in Health It. For more great content, check out our website this week, Healthcom or the YouTube channel. If you wanna support the show, best way to do it is share it with the peers, send an email, let them know that you're getting value outta the show. We'll be back again on Friday with another interview of an industry influencer, and back again next Tuesday for more news.

Thanks for listening. That's all for now.

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