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It's Tuesday News Day and today we discuss Lyft, Microsoft, Google UI, Mount Sinai, ONC, and more. New Top 10 Format. Let me know if it works bill@thisweekinhealthit.com.

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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. My name is Bill Russell Healthcare, CIO, coach and creator of this Week in Health. It a set of podcasts and videos dedicated to developing the next generation of health leaders.

We are going to, you know, look at a lot of stories. We have 10 stories to cover and we're gonna do something a little different. This week on these 10 stories, and I'll get to that in a minute. This is based on feedback that you have given me on how you want me to try out a show. So I figured on this Thanksgiving week, I would try something new out and see how it goes.

Uh, we wanna thank our founding channel sponsors who make this content possible, health lyrics and VMware. Uh, if you wanna be a part of our mission to develop health leaders, go to this week, health.com/sponsor for more information. , this episode is sponsored by Health Lyrics. When I became A-C-I-O-I was overwhelmed at first, and one of the things I did was I went out and hired ACIO coach.

And ACIO coach is someone who, uh, has wisdom, which is gained through years of experience. Uh, it was invaluable to my success in the role, and I now coach people through health lyrics. If you want more information, you can learn more at, uh, health lyrics.com or you can drop me a note at Bill the. Bill at this week in health it.com.

Uh, don't forget to come back, uh, every day. Uh, this actually not every day this week, 'cause this is Thanksgiving week, Monday, Tuesday, Wednesday this week we'll have shows and every day next week we'll have a show until we're done with the, uh, look back, look forward series we've done with Healthcare CIOs.

Uh, great series asked a set of CIOs, the same eight questions looking back on the year, looking forward on next year. And great feedback from you guys on the show. I really appreciate it. So we're gonna be running shows through December 6th, uh, every day. Um, shout out again to direct to Ford for his new launch.

Uh, triple X DirectX three x extract, uh, which is a tech series which has helped me to do research for this show. And, uh, hopefully we can help you as well. It's, uh, three stories texted to your inbox Monday, Wednesday, Friday. Um, from ACIO perspective, you could just, if you wanna sign up, text Drex, DREX to 4 8 4 8 4 8 and you'll start receiving, uh, some of the, uh, some of the stories from drex.

I found it to be valuable. It's the only reason I'm sharing it with you. 'cause I, uh, I, it, it's helped me to do my research. Okay. We're gonna do something a little different here. , we're gonna do a, a fast look at the top 10 stories. And as you know, what I usually do is I do the 10 stories and I do a so what?

Or I do the stories and I do a, so what what I'm gonna do is I'm gonna start the show by doing all 10 stories and the so what on all 10 stories. And then we're gonna circle back and look at some of those stories. So thanks for your feedback, which has given me the idea for, for doing this. You got tired of me just saying I have 10 stories, but I'm only gonna cover three now I'm gonna cover 10, and then we're gonna go back and do maybe two or three more in depth.

Alright, here it goes. Top 10, number one, Lyft launches two 50 cent rise to the grocery store. The so what here is, don't dismiss these announcements. Uh, 80% of health is not related to healthcare, uh, but to social determinants, we know this to be true. Uh, and this announcement may be more impactful than most of the things we are doing in healthcare.

Um, and I would say to health systems, explore ways that your health system can address that 80% social determinant gap. Uh, story number two, Mayo Clinic Partners in Abu Dhabi. I think the so what for this that I have two. So whats for this? And the first is brands matter. In healthcare, I would rather see a Mayo Doc than the doctor down the street.

Brands do matter and, uh, they're gonna continue to matter. And if I have a certain disease, I absolutely am okay flying to Rochester rather than driving down the street and going to the doctor down the street. Um, because. Again, brands matter. Brands have a certain space in your mind and they say quality, they say, uh, best in class.

And you know, when I have a certain diagnosis, that's what I want. So brands matter. That's the first. So what, uh, the second, so what is more of a, just a . You know, an observation. We're in an election cycle and it's good to be reminded. Healthcare's gonna take a beating over the next year, and it's good to be reminded from time to time that we're exporting our healthcare around the world.

And, um, you know, it's not because it's bad, it's because it's still the best in the world. And. , even as broken as it is, and we know it's broken, we know have we have issues, but, uh, we are exporting it all over. It's, you're seeing it, um, you're, you're seeing it time and again. You've seen it with Cleveland Clinic, now you're seeing it with Mayo Clinic.

Uh, you're seeing it with, uh, other health systems are doing it as well. Um, so, uh. What we're doing is good. And it is still, uh, world class, uh, Microsoft, Microsoft, uh, four big ways. Microsoft wants to change healthcare. Uh, this is a story that came to us from the advisory board. The so what for this is everyone signing on for AI and ML players.

Uh, the four main ones are Amazon, Google. Uh, apple and Microsoft, but one of these players is not like the other. And that story, we'll probably go to a little bit more. Uh, the next story, doctor will monitor your health wirelessly. This is from the MIT technology review and, uh, the so what from this story?

It's, uh, I mean from the title you can Tell, doctor will monitor your health wirelessly. Home health and home monitoring will become the norm once the payment mechanisms catch up. Uh, health systems wanna start thinking about how they're going to deliver this care outside of current models. The reality is, you're not gonna be able to take these doctors that are already seeing 5, 10, 15, 20 patients a day, maybe 30, and say, all right, you're gonna see two more digitally.

Uh, what really is gonna make more sense as this side of the business grows is standing up this side of the business and having a dedicated arm for digital delivery. Uh, Intermountain has already done this. Uh, mercy Health System in St. Louis has already done this. It's gonna continue to grow. Every health system is gonna want a digital delivery component, uh, within their organization.

If you haven't already stood that up, that's the so what, uh, number six, how AI in the exam room could reduce physician burnout. Physician burnout is a real thing. The so what for? This is ambient listening and ai. Um. Which a ai, a AI in this context is just an, a fancy word for, uh, taking voice commands, making sense of them, and, uh, doing the right things with them.

Either putting 'em into the medical record or, uh, or recording them, uh, for future playback or those kind of things, but just figuring out what to do and how to appropriately use that voice. So ambient listening, ai, these are gonna be two huge buzzwords for 2020. There are already buzzwords now. . Uh, and they will continue to be at the forefront of how we think about

Reducing the burden on clinicians. Now, it's important to note that technology isn't the only thing that's burdening clinicians. There's, uh, legal, there's regulatory, and, and I, a lot of it is regulatory, to be honest with you. They're documenting things that they don't see the value of. Um, there is, uh, you know, reduced rates and the, uh, increased competition.

And, uh, you know, the burnout is not a one dimensional factor. You can't just say the EHR caused this. There are . A half dozen reasons why there's physician burnout, but this is one of the areas around technology and around the EHR that, uh, is being . Spearheaded to address this. Uh, number seven, Mount Sinai awarded $2 million to build a supercomputer for medical research.

Uh, I think the, so what for this is $2 million to build a supercomputer is a low amount of money. So that is a, uh, cool thing. And if we're standing up 3,800 intel cores to do genomics researches for only, uh, $2 million. I think the other, so what for this is every . Academic research center is going to want to have these kinds of capabilities and, uh, gonna need some sort of supercomputing, uh, capability either leased, uh, in the cloud or, uh, built out on-prem.

You're just gonna have to keep up if you build it on-prem, you're just gonna have to keep upgrading it. So that's the, that's the downside of that. So anyway, a side note, uh, number eight, eight major changes for 2020 from CMS. And, uh, I'll probably circle back on this story and go through the eight things real quick.

But here's the, so what C-M-S-O-N-C-H-H-S presidential edicts are going to continue. Uh, they're gonna continue no matter who is elected. This is just the pace at which things are moving right now. Uh, I would say create a, a team or, uh, if you're not that large, at least a person who's dedicated to these, to these changes, uh, because almost all of them have some form of it implications to them.

And we're gonna want to stay ahead of the curve. And if you can, if you could stand up a whole team. These, there's gonna be projects every year. There's gonna be a half dozen to a dozen projects every year that you're gonna have to be, uh, addressing. So just something to keep in mind. Uh, story number nine, apple Research app, solicits volunteers.

The so what for this? As we have Apple Health records now, which is linked into a lot of EHRs and pulling down that data and gives people the ability to pull down that data. And some have said, you know, if we don't allow health systems to share the data with research that we're gonna have a, uh, all of a sudden we're not gonna have enough data for research.

And I think it's the exact opposite. I think if you put. All this data in the hands of individuals, and you solicited individuals to participate in, uh, sleep studies, cancer research studies, uh, cardiovascular studies, you name it. I think they would line up in droves to share their medical data and to share their record.

In fact, I think you would have an abundance, uh. Of, of oppor opportunities to have data for your research. So Apple Research a, uh, app solicits volunteers, and, and it was a success. And I think it's, I think it's the new model. I think it's the model that we should be driving towards. And number 10, um, it's just a continuation from last week, which is, uh, uh, you know, in, in looking at the Nightingale project, the, uh, the

Agreement between Ascension and Google. Uh, a lot has come out since then. I, but I've really liked the stuff that Google has come out with. If you look at Google's blog, they've shared some stuff. You have, uh, Dr. Feinberg coming out and talking about it. You have some other of the data scientists. They've produced some videos.

They've produced a video of what the interface looks like to the health data that they're creating. And, um, you know, transparency is a good thing. So what here is transparency is a good thing. I mean, Google's trying to be transparent. Um. And I'm gonna come back to this probably a little bit more 'cause I think there's a powerful so what in this And uh, it is a, if we allow it to be, this could be one of the most powerful HIEs in the country.

And I'm gonna come back to that in a minute after looking at their tools. So which one did I say I was gonna come back to First? Lyft. No, Microsoft. Let's go to the Microsoft story. Four big ways Microsoft wants to change healthcare. So this is a story from the advisory . Board, and this is, so the advisory board has a, um, daily briefing that goes out and it's the four big ways Microsoft wants to change healthcare.

Let's just go through 'em, not to, uh, you should download this. This is worth reading, but number one, Microsoft wants to dero an Amazon as healthcare's cloud provider of choice. So, uh, a lot of healthcare organizations for infrastructure and uh, AI tools and data tools have started to go to AWS and Microsoft has stood up with Azure and some of the other tools that they have stood up.

They now, uh, see themselves as a competing factor for that. And I agree that they probably are a strong competitor. Uh, maybe not toe to toe, uh, in terms of scale and some other things, but they will be toe to toe. Um, but the next, the next reason they give is probably the bigger reason. And by the way, and this is mostly infrastructure and the reality is Microsoft is almost easier to purchase than, uh, Amazon because all they have to do is check a box.

So, uh, check a box on their current Microsoft agreement, and now all of a sudden you can start moving things to the cloud. The problem is they don't have, a lot of health systems don't have the skills to move this quickly enough to the cloud. And, uh, so that is gonna be the thing that slows it down. . Um, a little bit.

And so a lot of, a lot of health systems are already, uh, heading down this path. Mount Sinai, Providence, Providence, signed the big deal, city of Hope. Um, and then they have a couple others. None of these are health systems. Oh, no. Cincinnati Children's, and then they have some others. , but here's the big one.

Microsoft wants to be seen as the provider's partner, not a competitive threat. When I say one of the thing things is not like the other. When you think of Amazon and Google specifically, maybe not Apple as much, but definitely Amazon and Google. You think of potential competitive threat to healthcare.

Not that they're gonna start hiring doctors, but that they can direct healthcare in certain ways with the data that they have, and start to pick the winners and losers of the market. And because they can do that . You can almost see Microsoft as the arms dealer for the health systems so that they can combat that threat so that they can have those same data capabilities and those same, uh, computing capabilities with machine learning and ai.

Now the question becomes, are they gonna have the wherewithal to, to wield the, you know, the, the tools in the same, um, in the same fashion so that that becomes one of the big . Uh, one of the big pushbacks. So, uh, but yes, so Microsoft, and I think this is a big one, Microsoft wants to be seen as a provider's partner.

Uh, there's no talk that Microsoft is, you know, gonna use your data in a certain way. There's no talk that Microsoft is, uh, is a competitor to healthcare in any way. They are really, uh, trying to position themselves as a partner. Number three, Microsoft wants to use AI to make healthcare better, don't we all?

And number four, Microsoft wants to help healthcare professionals talk to each other. And their patients. So they're, uh, they're creating team platforms to enable, uh, communication. To be honest with you, I have not found Microsoft's, uh, communication tools to be that good. I've found third parties to be a lot better, so this doesn't jazz me as much.

It is an integrated platform and hopefully they can improve. Uh, for instance, we use, we use Zoom all the time. Uh, and I just conducted a multi-city, uh, significant number of people, uh, collaboration between four health systems around security on Zoom and, uh, systems I had never used Zoom before. Brought it right up and they said, wow, this is a lot better than fill in the blank that we use or whatever.

Uh, one of the big health systems they point to is a friend of ours, St. Luke's University Health Network. . Uh, Chad ine the CI O's been on the show a couple times, doing a lot of really cool stuff with Microsoft. Uh, something to take a look at and probably something we'll have him on the show, uh, here in the future to, uh, to chat about.

I think that would be, that would be a good conversation. All right. Whichever ones that I say I would get back to, uh, doctor, we'll monitor your health, uh, wirelessly. That is, uh, home health MIT review, uh, again, and, and, um, . It's all things, you know, we, we have a lot more monitors, a lot more IoT devices, so I'm not gonna go back to that one.

AI in the exam room. Uh, the thing I liked about this AI in the exam room, here it is, AI in the exam room. Lemme pull up. So this is Harvard Business Review and uh, the thing I like about this article is . Again, if you are not paying attention to ambient listening and AI and how the two could merge in the exam room, you really should, uh, pull up this article how AI in the exam room could reduce physician burnout.

Has two people that have been on the show, uh, Joe Petro, who is the Executive Vice President and Chief Technology Officer for Nuance Communications. I did a, uh, interview with him at hims. You're gonna want to listen to that episode. It's, uh, it covers a lot of this. And then Shafiq Rob, who is the, uh, senior Vice President, CIO for rush, uh, system, uh, for health and Rush University Medical Center, uh, was on the show just a couple weeks ago, and we talked about this a little bit.

Uh, also contributing was, uh, Michael Ash, EDP, chief Transformation Officer for n Nebraska Medicine and Vice Chancellor, uh, worth reading. It is exactly what you think it is. It talks about ambient listening and, uh, the ability . To get the physician turned around and facing the patient instead of, uh, with their hands on a keyboard.

So, uh, an important movement, uh, to, to say the least. Uh, let's hit these CMS changes real quick. So, eight major changes. A bunch of these are medical, and so I'm gonna hit 'em quickly. Number one, uh, included a site neutral payment policy and added total knee. . Arthroplasty to the ASC payable list for 2020 Medicare hops and ASC payment system.

Final rule number two, remove six spinal procedures from the inpatient only list in the CY 2020 Medicare hops and ASC payment. Number three, decided to pay for certain angioplasty and stinting. Number four, we worked the merit-based, uh, mips. We worked MIPS to simplify reporting requirements for providers in the 2020 physician fee schedule.

Quality payment program, final rule. Number five, finalize the price for transparency policy in its outpatient perspective payment system. The mandate would apply to all hospitals in the US requiring them to publicly post standard charge information starting in January, 2020, which is getting a lot of pushback from hospital associations.

So stay tuned on that. Number six, finalize changes to the Medicare physician fee schedule that will expand payments to certified registered nurses, um, nurse anesthetists and others. Um. Number seven, updated e and m coding requirements in the Medicare physician fee schedule to align with changes adopted by the AMA and number eight, included coverage for opioid use disorder treatment under 2020 Medicare physician fee schedule.

So I, again, I gave you the so what before and the, so what just says these, these changes from the government are just gonna keep coming at about this pace, if not faster. So it, it is just the, uh, it's gonna be the new norm and not much we can do about it. Um, you know, let's go to the Google thing. So Google on their blog, blog.google.com tools for healthcare providers to deliver better care.

First, you have vid video from Dr. David Feinberg. Used to be the CEO at, uh, Geisinger Health is now the head of Google Health and, uh, I think one of the true visionaries from healthcare. It was a, a shame to lose him from a, uh, health system provider. He was doing some really cool things. He was one of the, uh, original thought leaders in, uh.

Eliminating the waiting room and everything it represents, I think is the quote that I've used from him often. And I think it is, uh, it's that kind of thinking that led him to Google to say, where's a seat that I can really impact healthcare around the world. And, uh, so a lot of questions around how they're using this data within a, this ascension data.

And so they, they're airing on the side of transparency. And they say, okay, here's, here's how we are using the data. So we develop our test system on synthetic fake data, uh, with openly available data sets. Then they test, configure, and tune to maintain the service in a clinical setting and limited number of screened and qualified Google staff, maybe exposed to real data.

These staff undergo HIPAA and medical ethics training and are individually and explicitly approved by Ascension for a limited time. So number three, we have technical controls to further enhance data. Privacy data is accessible in a strictly controlled environment with audit trails. These controls are designed to prevent the data from leaving the environment and access to patient data is monitored and auditable.

Uh, next one. We will further prioritize the development of technology that reduces the number of engineers that are needed to access the patient data. Similarly to our External redaction technology. And the last one, we also participate in external certifications like ISO 27. Oh oh one, where independent third party auditors come and check our processes, including information security controls for these tools.

And he goes on to say, I graduated from medical school in 1989. I've seen a tremendous progress in healthcare over the ensuing decades, but the progress has brought with it challenges of information overload that has taken doctors and nurses' attention away from patients they're called to serve. I believe technology has a major role in reversing this trend, while also improving how care is delivered in ways that it can save lives.

Um, . and you know my, I have a bunch of, so what's on this? And the first is. Uh, I, I am not worried about Google having the data. I'm more worried about, I could rattle off to you 10, you know, uh, business associates that I would be worried about their data, that they're not investing enough in security that they don't have.

I. The wherewithal, uh, to train their people adequately or that they're employing people, that I'm worried about them potentially being bribed to exfiltrate data. You know, Google is paying their people top dollar. They're not gonna lose their job at Google because someone comes along and says, I'll give you, you know, $10 per medical record that you give me.

Um, . They're using controls. They have controls, they're investing in security. They understand the ramifications of that data getting out. Now, what people are worried about is the, the, um, the, the, I don't know what the, the wall, the perceived wall that there is between Google Health and go Google advertising and other Google ventures that are out there.

They think that . All that data just went to Google and it's now available to their search team, and it's now avail available to their data, their advertisement team. I can guarantee you without ever seeing a contract, I can guarantee you that that is not the case. That there's no way that Ascension signed a deal that said, Hey Google, here's the data.

Have at it, make money with it. Do what you want with it. There's not a chance that they did that. First of all, it would violate hipaa. Um. And we know that this, this deal doesn't violate hipaa. So, um, there is a wall between those organizations. Now here's the thing I think Google should be careful of, and it is if they continue down this path, this is one of the areas where the federal government could come in and say, look, we want you to separate this off if perceived or not perceived, uh, or perceived or real.

Um, there's this concern in the general public that this data is gonna be used in this way, and we wanna make sure that there's not only a logical wall between the two organizations, but there's a complete separation between the two organizations so that there is no, no perceived. And you might as well just change the name from Google Health.

To fill in the blank, whatever really cool name your marketing group comes up with, I think this is where this is gonna lead. Uh, and I'm not even sure it matters who gets elected, but I, you know, if Elizabeth Warren gets elected, I can guarantee you that you're gonna see a lot of pressure for Google to split this off, um, because she is stated that I'm not, no political affiliation here, just stating what I have heard.

So, um, here's the other interesting thing and the last thing, . Because I'm already gonna go over on this, this week's episode again. Um, uh, so I ran, so they have a video, they have a, uh, a YouTube video on the, uh, EHR interface or the interface that they put on top of the data. And I had a, a physician look at it and, you know, here's some of the things.

We went back and forth, you know, it's really easy on the eyes. You can search scan documents, which is a really nice feature. So you have that unstructured data that comes in into fax and it actually, uh, takes all that NLP data and makes it available via search, which is really powerful. Uh, predictive narratives are available, which is really nice.

Uh, and it's displays, labs in a traditional medical display, which is really nice as well. Um, the doctors who, well, specifically this one doctor I was talking to said, you know, it, it's, there are improvements here, but it's not revolutionary. , and I think that's what we put on Google. We expect Google to do revolutionary things.

Here's the thing, I, I found revolutionary. So again, not a physician, I'm a technologist. Um, I think, so this doctor was comparing it to an epic interface. What I was comparing it to was they just took data from 50 disparate EMRs. They put all that data together and they made meaning out of it with a, with a, uh, with a user experience on top of it that made sense of that data.

This could be the most powerful HIE in the country. Because Google has a way of bringing that data together and normalizing that data and making it available, making it searchable, making it, you know, think about from an epic standpoint. Epic says, here's our data model. Put everything in that data model.

Cerner does the same thing. So does Athena. So does, so does a Meditech, all of them. Start with a data model and say, put it into our data model. Google starts with a, you know, send us your, you're tired, you're weak, you're poor, you're, you know, send us your wretched data, . and we will create value from it. And I think that is, uh, again, I think it's one of the most powerful HIEs.

Uh, in the country from that perspective, uh, that, you know, that's really all for this week. Um, thanks. Oh, it let me know if you like the new format. Bill it this weekend, health it.com. Uh, I'm gonna continue to doing it in this way for a little while. See, see if I get better at it and see if you guys like it.

Uh, remember to check back every day, uh, Monday, Tuesday, Wednesday this week for a show, and every day next week for a show. And then we'll fall back to our, uh, Tuesday, Friday schedule following that. Uh, if you wanna support the fastest Growing podcast in the Health IT space, uh, you know, continue to send me feedback.

It is really helpful. And, uh, you know, let me know are there other stories you want me to cover, people you want me to talk to, um, you know, just keep sending the feedback. It's really appreciated. This show is production of this week in Health It. For more great content, you check out our website this week, health.com or the YouTube channel.

Special thanks to our sponsors, VMware and health lyrics for choosing to invest. In developing the next generation of health leaders. Thanks for listening. That's all for now.

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