This Week Health

News Day – National Patient ID and Amazon Personalize

Yeah, we've taken the first step for a national patient ID. Except, we really haven't... This week I explain that while the intention is correct the solution is severely flawed.

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. It's Tuesday News Day, and here's what we have on tap house votes to remove federal ban on national patient id. Amazon launches personalized, a fully managed AI powered recommendation service and CFOs plan, a more active role in healthcare digital transformation.

My name is Bill Russell, recovering 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 needs to do more with less. Start allocating more of your money to innovation and less to daily tasks.

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I pulled this story from, uh, healthcare Innovation Group, mark Haglund and Rajiv Leventhal. So on Wednesday, the US House of Representative passed the amendment that would end the current federal ban on the funding of a national patient ID strategy in an action that was hailed by leaders of Chime. So Leslie Stein.

Is, uh, chimes vice president of congressional affairs. She had this to say great news yesterday evening, the house passed an amendment that would remove a prohibition on funding for a national patient ID strategy. Our members have seen this 20 year prohibition as a barrier to interoperability and a risk to patient safety, and she, thanks everyone.

Um, pulled this, uh, Maryanne. . McGee wrote in an article, healthcare Info Security article. House approves lifting h H Ss ban on the same topic. Many healthcare and health IT industry groups have long been urging, uh, Congress to lift the ban so that the identifier could be used to help match patients and to correct health information.

Uh, from multiple sources to improve care quality and patient safety. But privacy advocates worry that the identifier could lead to an inappropriate exposure of sensitive information. She goes on to say that, uh, the bill passed 2 46 to 1 78, and she also, uh, does a rehash of, uh, schoolhouse rock. We know how a bill becomes law.

But you know, for everyone who's listening, you know, there's still a long way to go for this. The house still needs to approve its appropriation. Spill Senate needs to do something similar, and then it needs to get to President Trump's desk, and then he will sign it and make it a funded measure. Make it a law, I guess.

Uh, nevertheless, the, uh, Actually there's, there's some more in this article. Let me just summarize it. Russ Brandel talks about the national patient Id challenge in 20 $16 million crowdsourcing competition that, uh, failed, uh, according to him, uh, mostly due to, uh, complexity. And, uh, Russ is a previous guest on the show.

You can check out our, uh, uh, conversation together. Uh, there's other organizations that hail this, uh, American Health, INF Information Management Association, American Medical Informatics Association, and chime amongst others. Uh, there's one dissenting view here, and that's the A C L U. The A C L U took an opposing stance to the healthcare group stating that the amendment could be interpreted as allowing the development of a national unique health identifier without legislative approval.

The A C U'S letter wrote the dangers of having a system like this compromise or inappropriately used or access to track individuals are profound. I would guess so. And for this reason, the A C L U has historically opposed national ID systems, like a national unique health identifier because of the threat they posed to privacy rights.

The group also attested that absent strong privacy protections, use of unique health identifiers could empower H H Ss. And potentially other federal agencies, including law enforcement to gain unprecedented access to sensitive medical information. Alright, so that's the lead story for this week, an important movement.

Um, before I comment on this story, I just wanna say this is absolutely the right objective. I. to get a complete longitudinal patient record at the point of care, uh, cannot be argued as a, a worthwhile and an an important goal. And Chime is doing exactly what we've asked them to do, uh, which is to move the national patient.

Id forward in pursuit of this goal in this objective. Um, and uh, and this is something I'm very passionate about, so if this gets a little , Uh, a little more passionate than usual of comes off as a rant. Uh, I apologize, but I, I really do have three fundamental issues with this approach. and, uh, they are, you know, the first is I, I think it creates a false sense of security or a really, a false sense of accomplishment.

Uh, everyone who's approving of this feels good about themselves. They feel like they've solved a problem, but, uh, they really haven't solved anything. They've opened up a funding mechanism to solving the problem, which means we're looking at five to 10 years before anything of substance really happens in this space around the national id.

So that's the first thing. I feel like we, we, we've created this false sense of accomplishment. Uh, by getting a national patient id, I don't think it solves the problem. And why doesn't it solve the problem? Which gets to my second problem, which is I, I just think it's the wrong solution. A national patient ID is a rabbit trail.

That doesn't solve the actual problem. The right solution, if you're wondering is, is the patient. The patient should have the data. Apple already figured this out. The unique identifier is your telephone number, and when you request the data from your health system, your health system gives it to you on your phone, and now your phone number is the unique identifier and you are the aggregator of the data.

We just need systems that allow for that to happen. Get my data delivered to my phone, I can now go to the next health system and give them temporary access to my medical records so that they can use it to care for me. And you know what? They can give it back to me when they're done because I don't really want you to have it.

I mean, at worst, you're selling my information, either, either consciously or unconsciously. And, and most times my data is just sitting there and it's not doing anything. And in the other, the other false, uh, narrative here, or the false sense that that goes on is, um, because it's in the E H r, some people might look at it and believe it's a complete medical record, and it's never the complete medical record.

I should be the aggregator. I am the aggregator. I am the constant at the point of care. Every time there is a point of care, I am the constant. The patient is the constant at the point of care, and that is who should have the data. It shouldn't be the government, it shouldn't be the h i e. Shouldn't be the health information change.

It shouldn't be the health system. It never should have been. We are horrible aggregators of data. We are horrible shares of data. So I think Cima Verma, and Secretary Azar have this, right? Any e-patient, Dave, for that matter, give me my damn data, get it into the hands of the patient. Let me be the aggregator.

You know, the other thing that's gonna happen as, uh, as, as the patient becomes the aggregator is I think you're gonna see a whole new set of data brokers that emerge. And this is gonna be ecosystem of, of data brokers as well as navigators. And, and, um, and, and this, these, these organizations are gonna have clinicians, uh, embedded in them are, that are gonna help me to organize my record.

They're gonna help me to make sense of my record and to, to help me make care decisions. There's those in the healthcare community who feel like we can't trust the patients with their health record. Um, because, uh, that's not exactly the right way to say it. The right way of saying it is, um, the, the health system because I, I really believe the motives are right and the motives are, I wanna protect the patients from themselves.

They don't know what to do with the data. I. Okay. I agree with you. I don't know what to do with my health data. I don't understand my health data. But with that being said, I think I can find a data broker that can help me. And I think that if we start giving the data to the patients, those brokers, those new organizations, that new ecosystem is going to emerge and they're gonna be, be able to help me to, to manage that data and to make sense of that data.

Um, you know, if you wanna put regulations around those brokers to make sure they have my best interests at heart, by all means do that. Um, . But what you're doing now, what health systems are doing now is to continue to propagate a model that is broken and, and, and that is not moving this thing forward.

And there's this belief that all these competitive forces are just all of a sudden gonna share data once we have a national patient Id. The problem isn't the national patient id, the problem is the competitive nature of healthcare and the inability for some health systems to share the data based on any number of factors.

Um, you know, be it, be it technical, be it, uh, Um, be it desire to, to share the data. You know, I had a situation as a C I o I sat, I, I sat down with another c I o I was asked to, uh, in our community to put together a health information exchange strategy so that for the, for the good of the community. And I sat down with this other c I o and I said, uh, you know, let's talk about our sharing strategy.

And he said, there is no sharing strategy. My organization does not wanna share data with your organization. And I'm like, Okay. That's the end of that conversation. And you know what? The national ID wouldn't have solved that. Wouldn't have solved that. Now, that might be dated, that was back in 2013, 2014.

Maybe there's enough regulations to push that organization to share data, but, um, I'm not sure that that's, that's the case. I think the answer is to get the data in the hands of the patients, um, but you know, not to be overlooked. Let's get to our third item, and that is that the a c U'S warning here about a dystopian future, uh, where two things happen.

One is . , we make it really easy for the hackers. We take all the data, we put it in in one location, and we tie it up in a little bow. Um, you know, we haven't proven we can secure our data. And then the second thing is, uh, you know, we're not really creative enough. We don't think creatively enough about what nefarious actors are gonna do with the data.

We think it's country A, B, or C is gonna do something with the data. And, and that's not my concern. And, and that's really not the a c U'S concern either. The A C L U'S concern is that h h s and other federal agencies. And what are they gonna do with the data? Think about it in light of our current political climate, um, when our political enemies essentially look at the things that you say and determine, I don't like what they say.

Let's see if I can go into their health record and see what sense sensitive information I can get from it. Um, you know, and if you don't think that's a possibility, the A C L U thinks it's a possibility. And I think a lot of other people think it's a possibility. I am really kind of shocked that we think this is the solution, first of all.

And then second, I, I'm really surprised that it passed by the majority that it passed. I think people really wanna wash their hands of this and say, Hey, look, we did a good thing. Uh, I think directionally it's the right direction. Uh, You know, getting the complete medical record at the point of care is absolutely the right thing to do.

Uh, but, but gosh, I, I just want us to think it through a little bit more, understand the ramifications and, and just allow for a different way of going about this problem. Um, you know, I'm sure people are not gonna be happy with this. This little rant. Uh, but I really believe that there's a different model out there with the patient at the center and data brokers and navigators emerging.

Um, and I think to a certain extent, we just need to get outta the way and let that, let that emerge. So, um, you know, if you have a point of view on this, please email me. I'm, um, always open to be proven wrong and to discussing it on a future show. So, uh, let's keep going. So Amazon launches personalized, a fully managed AI powered recommendation service, so,

Uh, Amazon today announced the general availability of Amazon personalized and a w s service that facilitates the development of, uh, . Technology and email marketing systems that suggest products provide tailored search results and customized funnels on the fly. Uh, it's available in a couple of their data centers, most in the u, us, Tokyo, Singapore, and Ireland as well.

And, uh, let's see. One more paragraph personalized, uh, which was announced last year at Amazon's Reinvent Conference is a fully managed service that trains, tunes and deploys custom machine learning models. In the cloud by provisioning the necessary infrastructure and managing things like data processing, feature extraction, algorithm training, and optimization, and hosting.

Customers provide an activity stream from their apps and websites. E G E G, uh, clicks, page views, signups, and purchases in addition to an inventory of the items. They want to recommend such as articles, products, videos, music, et cetera, optional demographics and other stuff, and they receive results via an A P I and only pay for what they use.

One of the promises of cloud computing. Um, you know, I, I just wanted to share this story because I think it's, uh, it's, it's an important service and it's an important, uh, example of these kinds of services that are gonna continue to be available to the organizations that figure out how to get their data to the cloud in a secure fashion and start to interact with the APIs that are available, uh, in these services.

Uh, I don't think health systems are gonna develop this, nor do I think they should. I think that, uh, and I, I don't think you're gonna get some off the shelf solutions on this. I think the, uh, cloud models are gonna be the primary delivery mechanism for these kinds of services is, I think this is an exciting service.

I am hopeful that some, uh, some enterprising health IT organizations make a little magic with this service and at, at, that's one aspect. I, I think there's an opportunity for a startup to maybe get ahead of the curve on this. Think through it. I, it's not really about . You know, suggesting an article or product or video or music, although it might be within healthcare, I mean, to suggest articles that would be powerful in and of itself, suggest products that would be powerful in and of itself.

Uh, suggest classes and training and I mean, there's a whole host of ways this could go. I hope again, somebody within health IT organization has enough bandwidth to make something happen. Uh, but also I think there's an, uh, there's a startup opportunity, uh, here for . Some enterprising, smart, uh, talented, uh, machine learning kind of person.

So, uh, there it is. AI powered recommendation service, ready to go. So, uh, have at it. Hope, hope some exci, exciting things happen. I. Uh, our next story. So, intense hospital consolidation increases patient costs. This is from Atlanta Moriarty Definitive Healthcare Blog. So Definitive healthcare is really about selling a service.

So from the blog, I, I, I really pulled this, uh, pulled this out because the numbers are interesting. So I'll share a couple of the numbers with you. Um, cost reduction is arguably primary driver for mergers and acquisitions. Uh, interestingly, mergers may benefit the acquired facilities more than the buyer.

That's probably pretty obvious. A report from N C I N C C I Insights acquired hospitals reported a reduction in operating costs of between 15 and 30% through economies of scale, as you would imagine, reducing your supply chain labor. Uh, other, uh, big costs within that, uh, within that realm. So purchase and acquisitions reduce the need for out of network referrals, uh, keeping patients and payments in network.

So that's a lot of the drivers of what going on. , however, lower operating costs is, lower operating costs do not always equal lower prices for patients receiving hospital services. The same N C C I report claimed hospital mergers increased the average price of hospital services by six to 18%.

Additionally, an analysis of 25 metropolitan areas with high consolidation rates showed that average price of a hospital stay increased by 11 to 54%. 11. To 54%. That's a lot. Uh, according to a study commissioned by the New York Times of the 19 metropolitan areas, highlighted in the graphic from the report, only five showed a decrease in the cost of average hospital stay.

Uh, it goes on to say, according to 2015, study hospital mergers may increase the likelihood of intensive surgery without improving patient outcomes. This is a contrast to another study from 2017, which reported 30 day. Readmit rates for heart attack, heart failure, pneumonia, all dropped by about 1%. In addition, studies have shown that competition in the healthcare market actually has a positive effect for patients, particularly in areas such as care access and mortality rates.

So, uh, you know, it's, again, I, I love, I love the numbers, but, uh, . , here's the reality you really have. It's such a nuanced deal. Healthcare pricing is such a nuanced deal. I think you have to dig a little deeper. The, uh, you know, did the prices go up 11 to 54%, uh, apples to apples? Or is it the, uh, increasing costs of the specialty drugs that are coming out to combat cancer and other, um, chronic conditions?

I is, is it, is it the specialty drugs that are driving the pricing? Is it labor that's driving the cost? I mean, it, it's really hard to say whether that . How much of that 11 to 54% increase was due to the actual m and a activity. But, uh, the reality is, I mean, I, first of all, I'm kind of struck it is like, who would've thought that reducing competition increases cost?

Well, I don't know any high school student that had an economics class, I think would, uh, would know the answer to that question. Um, I think the second thing is, uh, you know, . . I, I think the thing I wanna point out to, uh, to people within healthcare right now is you guys are heroes. You're doing great work and, uh, you're gonna take a lot of shots.

Over the next year and a half, and you're gonna take shots from both parties. Anybody who's involved in an election, statewide elections, national elections, you're gonna take a shots, uh, because healthcare is gonna come under the microscope and you're gonna hear story after story. In fact, there's one story, I'm not even doing this, uh, this time about liens on homes.

Um, . And you're gonna, these stories are gonna be elevated. They're gonna talk about how evil healthcare is and how they're, uh, not doing good things. And I just, uh, I wanna bring this up now to say next year and a half is gonna be tough. Uh, you guys are still heroes. You're doing very challenging, difficult work.

It's a very complex industry. And, uh, and not all of the, the costs levers are really in your hands. So there's, there's a lot of, uh, a lot of work to do. There's some. Uh, some things need to be done around, um, obviously pharma, pricing and those kind of things. Understand the work that they're doing, understand the value of the drugs that they're bringing to market.

But at the end of the day, that has to get reigned in. If it doesn't get reigned in, every dollar you save in healthcare is just gonna be eaten up by those, uh, specialty drugs. It's just, uh, just a reality of the thing. So, um, again, very complex, multifaceted issue. Let's go onto the next story. So . Patients say physicians with mobile apps are faster, convenient, offer better communication.

Healthcare IT News, Nathan Eddy. So there's another one of those really no kidding mobile people. People like their mobile apps. They think it's faster, convenient, offer, better communication. Let me give you some of the, uh, details. The, uh, this is a chief finding of a survey, 550 US consumers commissioned by mobile device management specialist, Sodi.

I wish the n was a little higher than five 50, but, uh, it's enough, you know, it's enough. It gives us good feedback. So the survey also found, Uh, more than half of the US physicians, 57% offer their patients a mobile app to do tasks like schedule appointments, access personal healthcare information and view lab results we're revealing, uh, was the fact that three quarters of the patient surveys said Physicians who integrate mobile technology are able to provide faster, more convenient experience.

Uh, 54% of survey respondents said that they thought physicians who leveraged mobile technology cut down on physician wait times. In addition, the survey results revealed. 57% of respondents prefer communication with physicians and office staff through mobile apps as opposed to calling the doctor's office.

Wow. So the reality is, I'm not telling you anything you don't already know. We all know this. We know it's right. I. Uh, so I only point out this story to really help you to bolster your, uh, case with the laggards. There's gonna be laggards within your health system, and these kinds of numbers are helpful.

If these numbers don't work in your market, maybe you can, uh, conduct your own study. Uh, I think these numbers will bear out. It's, it's just, we know it's . True, right. We, we know that I would rather, uh, in, I, there's, in some cases I would rather text, I'd know for a fact that I would rather schedule my appointment online through a, uh, through an app than making an actual phone call.

So, um, so on the off chance that you're still dealing with some laggards, I thought I'd throw that story in as a little help for you. Uh, let's go to the next one. Healthcare hiring continues to slide in May. This is Tara au Modern Healthcare and, uh, suffice it to say, last month's healthcare hiring 15,700 new jobs was the weakest since September of 2017.

May saw 42% fewer hires than in April, and 69% fewer than in March. According to the US Bureau of Labor Statistics, uh, majority of the new hiring was in, uh, ambulatory, as you would imagine. Um, uh, physician offices also and, uh, dentist offices and other things. The, uh, outpatient care centers added just 200 jobs and other ambulatory healthcare services lost 500 jobs.

So, um, I. Uh, you know, again, I believe I, the reason I pulled this story out, healthcare is hunkering down budgets are gonna continue to come under scrutiny. Um, the smart healthcare IT organizations are, uh, are, are really, uh, you know, getting ahead of this. They're building out sophisticated models to track and justify their, their expenses.

They're run versus grow, and, uh, You know, this is probably a tough time to be asking for more staff, uh, be, you know, you need to be considering how you are gonna do more with less. So, uh, at a minimum redirecting money from, from your daily run to the grow. So, um, and so since we're on the topic of money, the, uh, let's go to the last story and talk about CFOs.

Right? So, uh, The, uh, last story comes from, again, Nathan Eddy, healthcare IT News, CFOs plan to a more active role in healthcare digital transformation. Uh, I'll, so black BL black book survey, uh, nearly 1600 hospitals and healthcare CFOs are gonna be more active. What are they gonna be active doing? So let me just summarize this.

They're gonna be active in, uh, updating their E R P solutions. Their e r P solutions are, are, uh, woefully, um, . Behind the times, they're gonna redirect money from e H R implementations as they go to more optimization. And, uh, they're going to start to try to redirect the money to the E R P solutions. Um, nearly eight in 10 of the health systems CFOs surveyed, said that they plan to increase their investment in digital transformation by the end of 2020 with nearly 70% predicting an increase of more than 20% by the end of the first quarter.

So, um, , you know, the vast majority, 90% of the CFO surveyed, said they expect to be more active in the implementation of transformational software and services in 2020 with few pr. And they, they talk about, there's not that many proven cases. Uh, and so they're gonna, they're gonna become more heavily involved.

So, Uh, pull this out. A couple reasons. One is, uh, just to note that, that that money is moving, that money, uh, that the CFOs are starting to look at this and say, Hey, you know what? We spent a lot of money on the transactional, clinical transactional systems, but we have not spent time on the, uh, customer service and, uh, financial, uh, systems and even supply chain for that matter.

So a lot more money, they want to start directing money into those areas which have been neglected over the years. Um, You know, I think the other thing. . Uh, the other thing worth noting here is, here's a sense. CFOs indicated that until now they had been content to let the Chief Informa information officers pursue this issue.

So there's a certain sense in which the CFOs are starting to stand up and say, Hey, I want to be more involved. I. I'm not just gonna hand this over just 'cause it's a technology project to the c I o. Um, I think we should embrace that. I think that is, uh, that's a good thing. As we know more, less and less of these projects are about the technology.

More and more of these projects are about getting them operationally implemented. If the CFO's willing to step to the table and start to become a part of that, by all means you're welcome to come in because the operational changes that need to happen within the health system. Uh, can only really happen when those operational leaders are at the table and making it happen.

So, , um, you know what, that's all for this week. So this past week we had Eric I Blanca on the show to discuss architecture and healthcare. It. We're quickly approaching our hundredth episode and we are planning something special for that. So, uh, please stay tuned. Uh, in two weeks, I'm excited to do a show with, uh, Jefferson Health, C e O, Dr.

Steven Klasko, and c i o Nasser Nazami in an interview in Philadelphia. For those of you who have been following the show for a long time, I think I mentioned on show number four that I would love to have . Steven Klasko on the show, and, uh, Nasser was kind enough to, uh, make that happen. So looking forward to that.

Uh, I wanna thank everyone for your comments, news, uh, suggestions. Uh, if you want to contribute, just continue to drop me a line at hello at this week, health it.com. Uh, this show is a production of this week in Health It. For more 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.

Slash video. Thanks for listening. That's all for now.

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