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The other thing I don't think that we collectively do well as an industry is making sure that receiving entity is only getting the absolute bare minimum of information that they need.   📍 📍 My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health. where we are dedicated to transforming healthcare, one connection at a time. Newstay discusses the breaking news in healthcare with industry experts and 📍 we want to give a big thanks to our Newstay partners, ClearSense, HealthLink Advisors, Order, SureTest, and TauCite.

Now, let's jump right in.

(Main)   📍 all right, it is Newsday and I'm joined by the incomparable Laura O'Toole, the CEO, one of the founders of SureTest. Is with us. Laura, great to see you. Always great to see you.

Back to see you in person last week. I know, we're back from Vive, although this will air after HIMSS. And we will see each other again at HIMSS. We will. We will. Pretty exciting. And hey, what did you think of that high rise? Luxury tower with the graffiti from top to bottom. That was pretty amazing, wasn't it?

It was amazing. And when you read that recent article that came out, just the way that the artists have interacted with that building and now how the city is responding to it. It's pretty interesting to really trying to send a message and, there's a big problem in that city and it was alive and well, I'm sure you saw it too.

Yeah, you know, I don't, I don't get to go to cities as often as I once did. And so I read about it, right? I read about what's going on in the cities and whatnot. And when I was in Orange County, we had significant homeless encampments along the They call them rivers, but really they're retention areas for when it does rain in Orange County.

And they kept moving it around. So that was interesting. I actually got to meet a gentleman came to my church and was there for a while. And he was homeless for the better part of four years. And I got to ask him, what it's like to be homeless and I'm not trying to diminish, I mean, there's a lot of challenges that go along with being homeless.

But one of the reasons it was so hard for him to break out of being homeless is he said we formed a community, which is, and like the whole concept was foreign to me until I, until you see these people are, they're living near each other and I could see certain ones probably are not forming a community, but others are forming a little bit of a community of helping one another out.

And that's I'm not trying to make, it could sound better than it is, but there's a whole study of what's going on in those encampments and then obviously it's a challenge because that's not the way we really want People will be living in these cities and from a healthcare standpoint, definitely not.

Yeah, it was really interesting and I think you see a lot of these tent cities and, I think I was telling you we were driving with a client on our way to a nice restaurant and literally drove right through a tent city. And I had never seen anything like that in the middle of a city, in the middle of a road, that dramatic in my life.

But I do think a lot of these communities are in that place in between where they're working. A lot of homeless. IRIS folks are working and making, enough money, but not enough money to really afford affordable housing and too much money to be eligible for some of the programs that might be available to them whether that's through Medicaid for women and families, or some of the things like we have here in Palm Beach County, like the healthcare district for more single men, and so I think you're right.

I think it becomes somewhat of a cycle and people will do whatever they need to do to survive and certainly connecting with people that are in a like situation makes it easier to do so. Well, we're going to talk change health care. We're going to talk some other things. I think the other thing about that is When people give me a simple answer to this, oh, we just need to do this and we'll take care of the homeless problem, like, they do not understand the challenge that is faced.

I mean, there's nowhere they can live within of that encampment where they're currently at. There's nowhere they can live. for less than 2, 000 for housing. Like, and that's for like a one bedroom, shared bathroom and it's 2, 000 a month. Well, that's 24, 000 a year right there. So even if you give them a minimum wage job and it's 20 an hour minimum wage, it's still 48, 000.

Half of their income is going to go towards housing and that doesn't include insurance and a bunch of other things. So, it is a complex challenge to be faced and it seems like that's what we face, right? We face complex challenges. That's what healthcare is loaded with. There's two things, two directions I want to go with our discussion.

One is Sachin Jain, of course, he's always contributing great stuff. He has ten ways to drive change in healthcare. I think that's a good article to talk about. And we can talk about the change healthcare. You get to pick the topic, one of those two topics. Oh, gosh. Well, I think we should talk about change healthcare

I don't know about you, but this is the number one thing I heard at Vive. I mean, people were walking around and this was top of mind for them. Absolutely top of mind. And we had several clients that, we expected to be able to spend time with, and because of what was happening at their provider organizations, they literally are managing it day to day and just couldn't get away.

I mean, you look at what we're reading, it's costing, what, 100 million a day for some large systems? It's crazy. Yeah, well, that's a, that's a consultant from one of our partners who said, that quote and I sort of want to reach out to that person and say, okay, this is what happens. Is that an anecdotal thing or is that an actual thing?

Because you got quoted in Becker's, and now everybody and their brother is running with that number. Is that a real number? Well, let me know, because I'm dying to know if it's real, because it was astounding when I read it. Yeah, a hundred million. Was that a day? Yeah, a day for like a large academic. And if you think about it, and the number of claims that are going out, and if you're completely halted on your claims and your remittance, I mean, this is going to have some downstream effects for our industry that I think are going to be.

Catastrophic, across the board if this doesn't get resolved. And it's affecting everywhere. I mean, even our little HSA, right? We our employees are still able to get money from their HSA if they want to use it for one of their medical procedures. But of course we contribute to their HSA and we can't make deposits.

So it's, it's affecting Every corner, I think, of those of us that work in this space, and I'm really feeling for our clients, I can go in a very unpopular direction here, one of the things we have done in healthcare is, We have followed the leader and we do it all the time.

Like, in fact, if I were coaching you as a startup, as somebody going into the industry, I would say, get two or three named clients, and then other people will follow them. It happens all the time. We see it over and over again. Well, Change Healthcare has a ridiculous amount of market share. And so they were the dominant player, they developed a solid solution and they became part of that data supply chain for the entire transaction from pharmacy all the way to claims and other things.

And so, they're dominant. By the way, we have this over and over again. I mean, in the biggest cases is Epic, they're now at 38, 39 percent market share and only growing. In the U. S. and every now and then I'll say to people, I'm like, that's not good for the industry. And then I get pummeled and I go, okay, I'll save this for another conversation.

But it's not when market share in a single organization gets to be 40, 50%. But it's not only that market share, it's the number of transactions going through it. Yep. That's dangerous, I believe. I think there's some danger to it. I really think it depends on the platform, too and what you're trying to do.

I'm all about where you can have application rationalization and it makes sense for an organization. It can save them money and you can have consistent practices and training and have a platform that makes sense. I'm all for that. I think that makes great sense and I can understand why people do it and I understand Epic's position in the market and I applaud, I applaud what they do.

But I agree with you. I think there's always fast followers and if you look now at how this is trying to get remediated, I mean, we have clients coming to us saying, can you help us with automation? Look to get some of our claims submitted. So there's Other avenues that I agree, I don't think you always want to put all your eggs in one basket, and more importantly, I think this just emphasizes the need to spend the money where we need to spend the money in health care technology.

And I think we don't spend enough money on security. That's just my opinion. So Tuesday, March 5th, I did a Today episode on business impact analysis. And I just want to reiterate how important it is to do a business impact analysis. And that is looking at all the applications and all the inputs and outputs of those applications along the way.

and identifying if that input isn't coming in anymore. What does that do for your entire workflow? And what does that do for your billing and all that other stuff? That is critical stuff. And in the finance world, we did that all the time. I did consulting for like 25 years. And when I was working at MasterCard and the banks and whatnot, they, this was a current document, an active program with committees and governance and all that stuff around it.

And I'm not sure it is as robust or even prevalent in healthcare that we think through this whole business impact analysis, this business continuity. Analysis to the point where we're standing up a program and the governance and the people and the process. So we're always looking at new inputs.

So if we bring in a new application, if we bring in a new data source, we're looking at, okay, that data source is coming from this location and we have to ensure the stability of the network to that location. We have to ensure the security to that location. We have to ensure the quality of the data from that location.

And all those, all the inputs coming into healthcare, I think need to be looked at. And this is one of those cases. Again, where I'm talking to CIOs and they're saying, well, we don't even know the impact yet. And I'm going how this is like a major, this is a tier one application. How do you not know the impact of this when we start?

And I realized I'm not sitting in the chair and I'm railing on people that are sitting in the chair. But this is unacceptable. From my standpoint, this is unacceptable. And I'm not sure it falls on the CIO. I'm not sure who it falls on. But if I'm on the board and I'm looking at the CEO, I'm saying, this is unacceptable and it's on you.

You need to lead this. Well, I absolutely think it's about governance. And it's not just the inputs coming in, it's the outputs going out. And if you look at all the integration points that happen in a health system and the number of data that's getting exchanged, whether it be to other third parties.

through just typical interface engines, whatever the integration point is that you're doing. The other thing I don't think that we collectively do well as an industry is making sure that receiving entity is only getting the absolute bare minimum of information that they need. Amen. Absolutely. I hear, don't you hear that over and over again?

It's like, well, we collect all this information from the patient and it's like, we don't even need the information we're collecting. And then we get these third parties and they say, well, we need all that information to process claims. And we don't push back and we go, okay, here's access.

It's like, wait a minute, what are we doing? Yeah. And it's so clear, when I had that instance with my dad, when he did the inpatient hospital at home, which is one of the things that this guy from the Forbes article was talking about in terms of delivering care at the right place at the right time.

I mean, if I hadn't been there as an advocate for my dad, pushing back on some of the information, that all these people coming in and out of his house needed from him, it wasn't relevant to the specific care that he was getting. And I just think we, as an industry, not only as a patient, if you're a patient, need to take more responsibility and educate our patients on the information that they give, what they opt in for, what they opt out for.

But as organizations, we really need to think through what are the requirements. That are absolutely needed to perform the function or the job or process whatever needs to be processed. And I really think it's about governance, Bill.   📍 📍   In the ever evolving world of health IT, staying updated isn't just an option. It's essential. Welcome to This Week Health, your daily dose of news, podcasts, and expert commentary.

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  Alright, so Sachin Jain, you referred to this I'll give the intro here.

He says, almost 20 years into a career in healthcare, I remain frustrated by the slow and plodding pace of change in the industry. While there's widespread acknowledgement of the problems we face, there is there are a diversity of methods that have been applied to address them with widely varying results with precious few hours in the day.

and years of our life. How should we best work to change the industry that is most vital to our life and well being? In this post, I explore the different models of change and their associated risks, right? So he goes research and publications, financial incentives, social movements, device and pharmaceutical innovations.

So you can think about it. Which one do you want to talk about? I think changing the site of care is pretty cool as is leadership and culture. I think And when he says, we don't move fast enough, I agree, but we've proven that we can move faster. Look at what happened when COVID hit, Bill. We have seen healthcare respond in ways, in terms of being able to approach things virtually that I never thought we would see as far as even the way people work, people in IT work.

So we can move faster when we want to move faster, when we're forced to. And I think we got to get back to the basics a little bit and not try to do everything at once. You know what I miss? I miss the Sisters of St. Joseph. And here's why I miss them. Because they would look at the changing set of care.

And if we were having a conversation and we were to say, Hey, you know what, if we do this too fast, this will be bad for our bottom line. They would, they'd put us in the corner, they'd make us sit there with the DUNS cap on for a little while, and then we'd come out and they'd say, Why are we in healthcare?

It's like we're in it for the good of the community. And they would say, okay, now what is the best interest of the communities that we serve? And we would say, well, in a lot of cases, changing the site of care makes sense because coming onto this campus is expensive, it's complex, it's difficult.

Now, in some cases, it's best to get care on that campus. And so we need really good campuses. with high quality standards and those kinds of things. But they would never let us get away with that answer of well, if we move too fast, fee for service, our fees will go down and this will happen and this will happen.

And they would just look at us and go, stop it. And we would have to get, come back with an answer of, okay. This is what we're going to do. I'd like to see more health systems take that approach of saying, look, we're going to spin off a company and that company is going to deliver care through different sites of care and they're going to have a different financial model and they're going to start from scratch and they're going to prove out the model if it works or if it doesn't work and they can compete with us.

And if we can't do it better, if we can't do it cheaper, they should win. Yeah, I mean, I agree. I think that we're not taking full advantage of the opportunity that we have to either, work with partners or be more thoughtful about what it is that we want to do to make a difference for patients.

And it seems like we're all, following the shiny penny all the time. And if you look at what just happened with Change Healthcare, I mean, we got to get back, I think, to the basics of the organization protect, particularly in IT, are we protected? Are we taking, doing the right thing for our patients?

Do we understand where all our data and our information is going? I mean, those to me are the basics before we can leap into a lot of these other models. Yeah. And by the way changing the site of care is complex. So what we've talked to Mayo about it. I think we've talked to a couple other health systems.

I'm just at a loss right now. I know that Cedars was doing some of it. Cleveland Clinic is doing it. And I, that's the one I experienced firsthand with my dad. And it was pretty effective. I mean, there's some, there was a little few gaps, but for my dad's diagnoses, it was perfectly appropriate. I mean, certainly when you have.

A patient that has multiple diagnoses going on, probably not the best to have that care at home because you can tap into all the different specialties within the walls of the hospital. But I certainly think there's a time and a place for it. And like he says in his article, there's pros 10 drivers that are changing healthcare.

What was interesting is I was talking to the people at Artisite and, they're the computer vision people and they're putting cameras in the rooms and I started talking to them about a hospital at home and whatnot. They're like, look the physician what they do right now, the workflow is essentially.

They, they click a button and it does a virtual knock in the room and the patient lets them in and then they could have a conversation. And he said, that can go anywhere. I mean, it's a virtual, it's a telehealth visit. And so you can have specialists showing up in people's homes just by virtual knock, opening the door and saying, hey.

Yeah, I understand you're having abdominal pain. Let's talk it through and let's see if I should send somebody out there or if you need to come in. Yeah, I'm not, certainly I think it can be done. I saw it get done with my dad. I mean, that's exactly what was happening. He had an iPad, this whole separate IT entity swooped in, set up a secure server.

I mean, I've never seen anything like it happen so swiftly. And seeing it firsthand was incredibly cool. I just, all I'm saying is that if you have multiple morbidities, depending on the severity of how sick you are the home may not be the best place for you. All right. So leadership and culture.

So let's see, he says excellent leadership will always be a proven, excuse me, proven way to achieve change. And he talks about somebody who is successful. At CMS under so it was a Don Berwick, he said under his watch, CMS established the Center for Medicare and Medicaid Innovation, which seeks to improve delivery models and Berwick's pay for performance and partnership for patients initiatives were focused on health outcomes.

Don was in all ways a leader who inspired change, yet he is a rare exception in an industry with title holders who more often fail to use their positions to create good. I've long argued that true leadership means advancing a vision. And being willing to sacrifice one's own personal and institutional interests to achieve a greater good.

The list of individuals in healthcare who meet this criteria is short. Wow! Yeah, that was pretty I thought that was pretty bold. And that's really the biggest takeaway from that section to me. I think basically what he was trying to say is we don't have enough leadership. In healthcare, we're too title focused.

And, we've seen that with the chief digital officer. And, I think you and I have talked about how, the CIO and the chief digital officer to me really need to, they're the same person, right? I don't see the distinction there. But I do think we sometimes see a lot of titles in healthcare.

And, if you look at what he's saying, we're void of leadership in some instances. Large health systems, especially the large IDNs, which is what my experience was, is is interesting because it's bureaucracy. It's a huge bureaucracy. And in a bureaucracy, the people who generally float to the top are bureaucrats.

Unless you have the right culture in place, that happens over and over again. And every now and then, Somebody will say to me, isn't this health system great and blah, blah, blah, and isn't their leader great? And I will say, no, they're not. And they'll say, what do you mean? I'm like they haven't done a thing.

Like they haven't innovated in any way. They essentially this phrase I don't use it much on the air, but it's, So true of most healthcare organizations. There are banks that operate care settings and when people say, well, what do you mean by that? I'm like, well, they make all of their money from not operational excellence or care or that kind of stuff.

They make all their money from their returns. On their investments. And every now and then I go to the JP Morgan conference and I listened to them and, better than half of them aren't making money. And better than half of them are making money from their investments. And they're up there like true innovators and that kind of stuff.

I'm like. Innovating in what way? Like, have you changed how care Clinical outcomes. Clinical outcomes. Outcomes haven't changed. We know outcomes haven't changed. We know, and so we allow people to get up on stage and restate the problem in more and more creative ways and we don't ask them for the solutions.

And we lift up the people that can say, this is the problem so creatively. Instead of people that go, Hey, you know what? There's a way to break this down and there's a way to move forward. It is, in his words, let's see, Sacrifice one's own personal and institutional interest to achieve the greater good. I don't know many institutions that are sacrificing their own interest to achieve the greater good.

And I'm a firm believer that you don't have to have a title or be in a particular role. Leading is influencing, and I'd like to see us pay closer attention to some of those folks that everybody's trying to bring up in the organization that are the ones out there working hard every day to, to solve and solution some of these problems and really empower them through influence, not necessarily through a title.

And get those people around the table. Yeah, and just so I don't get the moniker of somebody who's shouting at the moon here and, I think this is one of those cases where you can identify the leadership. It's people who lead with a story. They lead with essentially a narrative that says, this is what we want healthcare to be.

This is what we want care to be. We want it to be affordable. We want it to be transparent. All those words are buzzwords. What I want to do is describe, we want people to receive care where they're at. We want more touch points between the trusted entity, which is the health system, and the person receiving care, so that we have an ongoing dialogue with that person.

If we only talk to them three times a year, And we say, oh my gosh, our communities aren't healthy. And I hear people say this all the time. It's their fault. They're not following through on their care plan. They don't, whatever. I'm like Well, establish a better relationship. Establish an ongoing relationship with them.

Educate, train, help them get better engaged in their care. Use some of the tools that are out there now to accelerate, right, some of the research. If you look, let's talk about looking at machine learning to really make a difference in, in research and in pathology and in clinical outcomes.

And, I agree with you. I think that's the biggest opportunity for AI and machine learning in healthcare. And we're afraid and for good reason, we have to do it well, but I think we're going to be able to educate the the machine. to respond to the patient when they have questions. And by the way, patients have questions all the time.

You want them to be able to interrogate their medical record. You want them to be able to essentially ask questions of the system. Where do I park? Where do I go? You want them to be able to ask questions about their own personal health. I'm struggling with this, or I'm struggling with depression.

And have the machine, because we're not going to have enough staff, I get it, I understand, but have the machine be able to have an ongoing dialogue, which gets recorded in the medical record, and we're afraid of this risk, and for good reason, I get it, but that's, in order to increase the touch points, we need to create a dialogue.

between the health system and the patient and be that trusted entity. And by the way, the more days that go by that we don't do that, it's going to be somebody else. And it's going to be somebody that we go, Oh, you shouldn't trust them. Of course you shouldn't trust Big Tech to step into there, but they're the only ones stepping into there.

So until we do, they're filling the void. I mean, I think that the chat box, exchange with a patient has a real opportunity. And talk about customer service. Think about the patient as your customer. And think about how dissatisfied patients are. with how to navigate the health system and knowing where to go and knowing what their next step is.

I see a real opportunity there and I'm excited to see. I did watch a panel on that at VIBE, so I'm excited to see where that goes. Fantastic. Laura, always good to talk to you. I love the work that you guys are doing and I believe that automation is going to play a big role moving forward.

Hopefully not just to drive profits, but hopefully to drive better outcomes and more time for the clinicians to really focus in on the things they want to focus in on, so. Let's get everybody working at the top of their license, Bill. That's our goal. Absolutely. Laura, thanks. Until we, well, we'll see each other at HIMSS.

See you there. See each other soon. Great to see ya.

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