This Week Health

News Day – EHR Vendors Respond to ONC and Transforming Medicaid

Stories Covered

Data Challenges Are Halting AI Projects, IBM Executive Says Jared Council WSJ.com

Newly merged Dignity-CHI health system offers patients home recovery care services Erin Dietsche MedCitynews

Physicians Foundation launches HIE fund for physician interoperability Benjamin Harris HealthcareITNews

Transforming Medicaid: How Andy Slavitt, AVIA and 28 Health Systems Plan to Improve Care for Underserved Patients Rajiv Leventhal Healthcare Innovation Group

EHR vendors say ONC proposed rules are too broad, would stifle innovation Mike Miliard HealthcareITNews

Banner Health launches Banner Innovation Group Alyssa Tufts AZBigMedia.com

Transcript

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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 will impact health. It. It's Tuesday Newsday. And here's what we have on tap. Our lead story for this week is the E H R vendors, say O N C. Proposed rules are too broad and would stifle innovation, and that's from healthcare IT news.

We're also gonna take a look at, uh, some work Andy Slats doing around transforming Medicaid. I think that's very exciting in a, uh, really cool story that amongst six total stories for this week is what we're gonna try to get through. 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. This podcast is brought to you by health lyrics. Every health system has one or two projects that aren't going well. We specialize in turnarounds. Let's talk visit health lyrics.com to schedule your free consultation.

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Uh, you can send me feedback, questions or, uh, guest recommendations at Bill at this week in health it.com. And uh, finally, you can subscribe to our newsletter on the website. , let's get to the news. So, e h r vendors say, O M C, proposed rules are too broad in which stifle innovation. Mike Millard Health IT News.

So let's take a look and, uh, get a flavor for this one. the, uh, the members of the HIMSS E H R Association support the rules goals, but say that as drafted, it goes beyond Congress's intent for the 21st Century Cures Act and is too loosely defined, has too tight of timelines and requires too much IP sharing.

So that's the gist of it. Lemme give you, uh, a little bit more color. The association says it pulled its members. Uh, IT member, it's member companies including allscripts, Cerner, epic, eClinicalWorks, Meditech, and many others to get a sense of the development resources that would be needed for vendors to comply with the voluminous proposed rules from the O N C.

The general consensus is that while some updated functionality or proposals may be straightforward to achieve in a short timeline, their proposed 24 month for development testing, training, and implementation across all clients is not feasible. , uh, for the more challenging proposals. So it goes on and talks about language, ambiguity, certain sections of the proposed rulemaking offer room for interpretation, such things as, uh, the words reasonable as soon as possible, near real time.

All of those things are vague and, uh, need to be clarified. Uh, there's innovation concerns as well. E H R A said it's a concern that, as written, the proposed rule would discourage innovation by imposing limitations on profit, as well as compulsory licensing terms for new intellectual property created through extensive investment in development.

The blog post points out that essentially it re, it requires e h r developers and others to share their intellectual property with anyone who asks under fair, reasonable, and non-discriminatory. Discriminatory terms. Normally companies choose when and to whom they contribute their technology, such as through the standards development process.

But a compulsory licensing model means that anyone could ask for our intellectual property and for a reasonable price capped fee, they'd be able to layer their own work over ours or otherwise repurpose it. Um, I'm gonna be honest with you here. I you normally I do a so what, so what on this story. Um, but what, what you're gonna end up with here is more observations than anything.

Not a, a potentially a rant. I'm gonna try to stay away from that, uh, on this. But, um, So my first observation is there, there's no other industry on this planet where the software vendor holds as much sway as they do in in healthcare. Uh, you know, we don't hear from e r p providers when talking about banking and manufacturing, but somehow within healthcare, anytime we talk about what we're gonna do in healthcare, the the E H R providers, Our, uh, center stage, they need to step off the stage.

It, it, it's the, the provision of healthcare, the, the providing of healthcare is something that the healthcare providers do, uh, in support with other community partners and, um, Software manufacturers should not be in the middle of this thing. So that's just one concern. Uh, and, and one observation. The second is, you know, the nature of their concern indicates that they have an architecture problem.

Uh, I, I'll agree that the way the solutions architected today, it's probably gonna take four years to implement. It'll take a couple years to program, bunch of years to test, because these are Big bang projects. It's not, it's not created on a, a new and modern . Uh, architecture stack. And because it's not, you don't have microservices, you don't have the ability to do incremental, uh, changes to the solution over time, that makes it better.

You have to do these, these massive projects with, with, uh, and with, uh, and with the number of variations of their code that's out in the market and, uh, things they have to consider. Uh, it's tough. It's gonna take 'em four years. There's no doubt about that. Uh, the third thing I'll say is that, um, Yeah. Yeah.

The sharing of data doesn't require a solution to a solution to share their IP stack. Uh, I'm not even sure I understand that argument. Somebody will probably have to educate me a little bit more for me to understand why they're even making that argument. Uh, there's all sorts of solutions, uh, on the, uh, on the web that share.

You can share data and, uh, you know, I don't have to know Slack's underlying IP to be able to share data, uh, in and out of Slack. I don't, and, and . And, and Slack's just the easiest example. I mean, Salesforce, workday, you name it. There's thousands of solutions, uh, newer technology stacks, uh, enable the sh inherently you build out your APIs on top of it with data sharing in mind from the get go because the hrs weren't designed with, uh, data sharing, uh, as a, uh, core fundamental, uh, design requirement from the get go.

Uh, they're architected incorrectly. And because they're architected incorrectly, they think they have to share their, uh, intellectual property in order to do that. That's just not the case. Um, . I think the fourth thing, and this, this one is a rant for me, is, um, the, the, the data doesn't belong to the E H R providers to even dictate whether it should be shared.

You know, at worst it's owned by the, uh, provider or health systems, and it really should be their, their choice, whether they're gonna share it with the patient, at best, it belongs to the patient. As, um, as many shared share, my, uh, my belief in this. Uh, including Rod Hockman, who's the c e o of Providence, who was on the the show and said that very thing that the patient should own their record.

And, uh, if the patient owns a record and they have access to the record, uh, it's gonna spawn this whole new ecosystem of, um, this data ecosystem of, of, uh, Uh, I'm, let's just call 'em, uh, surrogates people that can help us with our data. If we get messy data from the providers, we're gonna have this data ecosystem where we can go back and, uh, get trusted care providers who are going to step into that space and, uh, be able to make sense of that data for us.

So I think that that whole thing is just being slowed down by these, uh, specious arguments that are out there. And then, uh, you know, finally in terms of, uh, slowing down innovation because there's just too much work to do here. Uh, you know, I, the. Here's my recommendation to the E H R vendors. If they want to jumpstart their projects, they, they, they should just partner with a company that already has addressed this challenge.

And there's many of 'em out there. There's Innova, there's heart, there's clear sense, uh, health Catalyst, M P H R X, which is part of H c I, uh, heck, they could license, license IRIS from InterSystems. There, there's so many players that already live here and already live on top of their technology that could really, uh, catapult them forward.

Um, this having to create it all internally is, I think, slowing them down for the most part. And, uh, I think there's just some options there. So I, you know, I, I apologize if that sounded like a rant. That's probably enough on the topic. And, uh, let's, uh, let's move on to, . Uh, a, a better story, a, a more feel-good story.

So, uh, transforming Medicaid, uh, transforming Medicaid, how Andy Slatt Avia and 28 Health Systems plan to improve care for the underserved patients. I really like this story, um, mostly because it's, uh, it, it's addressing a real need within healthcare. So let me, uh, give you a little flavor for this. Um, Andy Slatt says we need to change the way we invest in communities that are underserved.

Um, slab, it says further attesting that the current healthcare system primarily focuses on and invest in commercial populations, quite frankly, white, middle and upper class populations of people that are already pretty healthy and have very few issues accessing healthcare systems. And, uh, So the group that they're bringing together is called M T P, uh, and I think it stands for Medicaid Transformation Partners.

Uh, it's part of, uh, an obvious gonna be running it for 'em. According to the project leaders Throughout the next two years, participating health systems will be implementing innovative solutions aimed at addressing several critical challenges facing vulnerable populations across the country with a focus on four core, four core target areas, behavioral health.

Women and infant care, substance use disorder, and avoidable emergency department visits. Um, let me go on here a little bit. The core goal is to share those experiences and lessons learned with other health systems. If not, uh, it's not as if we are trying to do something proprietary. Quite the contrary, these 28 systems aren't engaging in a project to create a competitive advantage, but rather to create a better model, to test a better model, and to get results from a better model and to prove that out.

And share it or prove that out and share it more broadly. Slatt says, uh, the official, uh, the initial focus of phase one of the M MTPs work centered on improving linkages from the ED and other critical parts of the delivery system, namely primary care, behavioral health, specialty care, and social services.

And finally, what M T P allows you to do is ask the question. What are the 27 other healthcare systems doing about this problem? So I, I love this story. I love this approach. Um, you know, kudos to, uh, Andy Slatt, uh, Avia and the 28 health systems that are, uh, doing this. You know, the, so what is, you know, we've got leverage, the great work that's going on, on across, uh, all these health systems.

There is not a lot of money to be made in this space, and, but there's, uh, still a ton of work to be done. and the, uh, shared collective knowledge and the shared collective work and bringing that together and sharing that, uh, is, uh, is really great. So they're gonna identify solutions, they're gonna validate those solutions.

They're going to provide a platform for sharing them and hopefully replicate the results across, uh, across many health systems. Uh, fantastic. Uh, fantastic work and, uh, really appreciate, uh, those, uh, organizations and Andy Slatt and Avia coming together. . To do that. Uh, next let's take a look at, uh, wall Street Journal article.

So data challenges are halting AI projects I B M executive says. And, uh, I'm not gonna go into too much depth here. I just, I I, I thought it was interesting. Um, I thought it was just interesting to, uh, take a look at. So I B M Corp executive. Arvind Krishna said data related challenges are a top reason I b m clients have halted and canceled artificial intelligence projects.

Uh, Mr. Krishna's, I b M, senior Vice President of Cloud and cognitive software said about 80% of the work with an AI project is collecting and preparing data. Some companies aren't prepared for the cost and work associated with that going in. He added. Uh, and so you run out of patience along the way because you spend your first year just collecting and cleansing the data.

Said Mr. Krishna, who was interviewed at the Wall Street Journal's, future of Everything Festival last week. As you say, Hey, wait a moment, where's the ai? I'm not going to, uh, I'm not getting the benefit. And you kind of bail on it. So, uh, a couple other things, uh, report this month, my Forest Research Inc.

Found that data quality is one of the biggest AI project challenges. The, uh, , you know, I just brought that story out to, uh, just to highlight that, uh, you know, good data proceeds every, every data project period. Uh, there are no shortcuts as some have found out. And, uh, . You know, and, and some are much publicized.

Uh, I b m has taken a black eye here as well. Uh, it, it starts with good data and if, uh, if you're planning an AI project, a machine learning project, or if you're just planning a straight up analytics project, it starts with good data. And, uh, you do get started on those projects, uh, today if you haven't already.

And if you, uh, have underfunded them. Uh, it may be time to fund them. 'cause data, data is the, uh, single, uh, single most important thing, I believe, to, uh, transforming healthcare. And I think we're gonna see more and more data projects lead to, uh, the transformation of healthcare. So, uh, so that's the third story, uh, real quick and worth taking a look at.

Again, that was Wall Street Journal. The, uh, let's see, let's go to, um, . Physicians Foundation launches h i e Fund for Physician Interoperability. This is from Healthcare IT News, and, uh, the, the gist of this is that a nonprofit group is joining with six state Medicaid or medical societies to incentivize practicing physicians to link their EHRs to health information exchange financial barriers, preventing buy-in.

to a health information exchange just got lower in six states. In partnership with the Physicians Foundation, the medical associations and the information networks in those states will offer funding grants for any physician with an electronic health record that wants to send and receive interoperable patient data, so they go on to say why it matters.

The program, which is starting out with about half a million dollars in funding this year, seeks to increase physician participation in h I E by covering costs. Uh, to, uh, physician practices. So, um, you know, that's interesting and, you know, you and my so what on this is you, you, you have to applaud the initiative.

Uh, anytime we're sharing data and trying to get it to the point of care, it's great. Uh, I will say that in my experience, uh, in my experiences across metro and rural, uh, kind of settings, uh, it really wasn't the money that was the issue for connecting to the h i e. Um, I think what I heard from the physicians was, uh, they, they didn't value the data that was coming across.

It was too messy, it was too hard to, uh, digest. Um, the, uh, data wasn't presented in a way that was easy for them to just, uh, bring into their workflow. Um, they didn't want the liability related to having the data. I, again, don't hear me saying that. It's not, I'm saying that my experience . That these were some of the limitations.

This is what people were, uh, telling me were the barriers to, uh, to connecting into our h i e in the multiple markets that we served. Uh, money is just one of them. Uh, it's good to get one of 'em out of the way so we can move on to the others. And so again, I applaud this initiative. This is, uh, physicians Foundation launches, h i e Fund for Physician Interoperability Healthcare IT News.

Um, check that out if you're, uh, if you're interested or looking at h i e work. Uh, let's see. Let's go to, uh, newly merged Dignity. C h i Health System offers patients home recovery care services, so, um, common Spirit Health, uh, dignity, c h i, mergers called Common Spirit. Uh, common Spirit Health is partnered with a company called Contessa to introduce a new home care option, which offers patients, virtual physician visits and remote monitoring among other features.

And, uh, talks a little bit about, so, headquartered in Nashville, Contessa. Operates risk-based home recovery care models for acute care, post-acute care and surgical procedures. As part of these models, a registered nurse conducts in-home visits and patients receive access to care coordinator who is available 24 7 patients also get medical education from nurses and access to virtual in-home visits from a physician.

Additionally, home recovery care includes remote monitoring of vitals, biometrics, and adherence. To the care plan for 30 days. Let's, uh, it goes on. Overall, the goal of home recovery care is to improve patient outcomes. For instance, at Marshall, uh, Marshfield Clinic Health System in Wisconsin, the use of home recovery care reduced readmission rates by 44% and decreased the mean length of a hospital stay by 35%.

And, uh, let me just share one quote. Let's see. Our work with Contessa will bring . Recommended intensive outpatient care into the comfort of one's home so that we can improve health outcomes and help enhance the overall health of our communities. Rich Roth, who lead strategic innovation for Common Spirits set in a statement, finding ways to improve high quality access to care in low cost settings as an essential component of how we must deliver care in the future.

Uh, couldn't, uh, agree more with, uh, rich on that? . and, uh, so, you know, so what's the so what on this? The, so what on this is that this is the new norm integrating solutions from outside of the system to provide home care. Uh, and home care itself is, uh, is the new norm. We're going back to Marcus Wellby, but we're trying to do that in a way that it's not just carrying the bag, but you're carrying a whole tool set, uh, that is giving you access to the entire patient.

Record gives you a new set of tools for monitoring on an ongoing basis. Uh, we know that when we drive care into the home setting, that it, uh, provides much better outcomes. The data is really ir irrefutable on this. Um, the so what for health. It is. Be ready to integrate these solutions into your environment.

There's just an awful lot of 'em coming down the pike. We can't build 'em all out ourselves, uh, nor would we want to. And, uh, this, uh, presents a, uh, pretty good, um, opportunity. . For, uh, improving care. Let's see. I have one last story 'cause I had six. Let's, uh, did that one, did that one. Medicaid. E h r vendors, uh, banner Health launches, banner Innovation Group.

So, uh, don't really have a lot to say about this other than, um, . I could read some of this. So, Scott Norland, chief Strategy and Growth officer of Banner Health is leading this initiative. Norlands responsibilities encompass strategic planning for merger acquisition and partnership development, marketing communications, consumer engagement for growth of four major service lines.

Uh, so that's what he's doing. He's in charge of it. Um, It's called Banner Innovation Group, big. The big has some ambitious goals, which include enabling entrepreneurs, helping champion colleague ideas and having accelerator partnerships that can commercialize great ideas and also create a new avenue for entrepreneurs as well.

I. So, um, you know, I just pulled that out mostly to the, you know, the, so what on that is that these models are becoming, um, pretty common. So this is just another one of those innovation models and, uh, it, you know, these are exciting. There's many models to choose from. The only wrong thing to do here, it's to not be associated with an innovation model if you're too small to have your own innovation model.

Then you need to, uh, find the ones that you're most comfortable in working with and create those partnerships. If you're large enough to have an innovation model and you, you haven't, uh, kicked one off yet, uh, it may be, uh, it may be time to, uh, to get that going. So, uh, that's probably enough. Six stories in 20 minutes or less.

So that's all for this week. This Friday we go deep into blockchain with Charlie Lowe, successful entrepreneur, and c e o of actual. . A company that's gonna be coming out with some solutions this fall. I'm looking forward to, uh, that conversation. Uh, you know, we're quickly approaching our hundredth episode, so we're planning something special, so we want to check that out.

It'll be in the next three weeks, so you may wanna mark your calendar. . We also have Eric Yolana for from, uh, Stanford, Jeff Johnson from Banner, Andy Crowder from Scripps. And we have a special episode coming up with, uh, Nazar, NAMI, C I o, uh, for Jefferson Health with his C E O Dr. Steven Klasko, uh, in a joint interview.

Uh, as you've heard on the show before, I've, I've wanted to have, uh, Dr. Klasko on for a while and, uh, uh, Nazar has made that happen. And, uh, I'm, I'm excited about it and I hope you're excited about it as well. Uh, if you wanna hear from someone that hasn't been on the show, just drop me a line at Bill at this week in health it.com, uh, and let's see what we can do.

This show is a production of this week in Health It. For more great content, you can check out the 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.

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