Today on This Week Health.

How does the entire patient journey look like? Is it personal? Are we delivering it with empathy? Or does it feel not so great, right? We're seeing trust at an all time low for healthcare and science. So I think being able to deliver a more personalized journey and being able to understand who those folks are when they come to see us and turning it into being a lot more proactive versus reactive.

It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a 📍 channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst who are our Newsday show sponsors for investing in our mission to develop the next generation of health leaders.

It's news day. And today we are joined by Patty Hayward, VP of Strategy for Healthcare and Life sciences for Talkdesk. Patty, welcome to the show.

Thank you, Bill. It's great to be here.

I can never tell where people are calling in from or where we're connecting from because the backgrounds, I mean, every time I look at somebody I'm like, are you near a beach? Are you near? Because that's a pretty nice background you got.

Yeah, I do that to just remind myself that a vacation might be someday, but yeah, no, I'm actually in the desert.

When you say desert, is it Phoenix or is it.

I live in Scottsdale.

Scottsdale. Fantastic. I used to live down in those parts and my wife and I only lasted for one, one summer in Phoenix but lovely part of the country. I've been having some new people come on the Newsday show and you represent Talkdesk. Help me to understand what Talkdesk does. I mean, some people in healthcare may not know what Talkdesk's all about.

Great question. So we are at our core, a contact center as a service. We're the first contact center software that was born natively in the cloud.

We've got thousands of clients over many different verticals and in the past year and a half of really focused on the healthcare area. Hiring folks from that, that are really specific to that vertical. So we've got a product and R and D teams that are, that are highly skilled in the healthcare world, as well as myself who've been around in the health IT business for the last 25 years or so, helping a lot of organizations look at different things. So what we do is really focus on the patient experience. And I think thinking about things a little differently and looking at how can we elevate that and really think about the patient as a consumer.

Wow. All right. Well, we're going to talk some consumer experience and patient experience stuff today. But I want to start off with what is top of mind for everybody. So what's going on in the Ukraine. What's going on with the invasion of the Ukraine in line with our area of the world.

We're going to talk about healthcare and healthcare IT. First of all, the American hospital association issued a warning about the cyber threats that are going on in Russia and the Ukraine and they're warning was essentially, hey by the way, we're on the same battlefield. The internet is the same battlefield. It's connected across the world.

So when they unleashed cyber threats to the Ukraine, they don't generally end there. They tend to trickle out and infect other computers and those kinds of things. And so they, they talked about what to look for and how to step up your cybersecurity posture. So the AHA did that. Not a surprise and, and welcome that they are keeping an eye on that.

But it it caused me to, think about what else is going on from a technology standpoint. And there was a recent article in the New York Times. And it's a really good article and I highly recommend it to people if they get the opportunity. And the title of it is as tanks rolled into the Ukraine, so did malware, then Microsoft entered the war. And it makes the analogy of Microsoft being the Ford motor company. Ford motor company in world war II went from producing consuming devices, consumer cars and those kinds of things to actually being a significant part of the, of the war effort. So Patty, before we get going here, let me give you a little bit of a background on this story. Last Wednesday, a few hours before Russian tanks began rolling into the Ukraine alarms went off inside Microsoft. Threat intellgience center warning of a never before seen piece of wiper malware that appeared aimed at the country's government ministries and financial institutions. Within three hours, Microsoft threw itself into the middle of the ground war in Europe from 5,500 miles away. The threat center north of Seattle had been on high alert and it quickly picked apart the malware aimed at Fox played and notified Ukraine top cyber defense authority. Within three hours Microsoft's virus detection system had been updated to block the code, which erases data on computers in the network. Then Tom Burt, the senior Microsoft executive who oversees the company's efforts to counter major cyber attacks contacted Anne Neuberger, the White House Deputy National Security Advisor for cyber and emerging technologies. Ms. Neuberger asked if Microsoft would consider sharing details of the code with the Baltics, Poland and European nations out of fear that the malware would spread beyond Ukraine's borders, crippling the military Alliance or hitting west European banks before midnight in Washington.

Miss Neuberger had made introductions and Microsoft had begun playing a role as that of Ford motor company did in world war II when the company converted automobile production lines to make Sherman tanks. And they talk about the fact that after years of discussions in Washington, in the tech circles about the need for a public private partnership. I mean, I'm calling it a war. It's not technically, it's escalating to a war. In the Ukraine is stress testing the system of this public private partnership. I read that and I'm encouraged. I don't know about you, but I'm encouraged. I'm encouraged that first of all, they found it that fast. That they identified the code that they're blocking it in other systems, but I'm also encouraged that they are stepping in.

And I think the thing that, that this really drives home for me is that these companies that are in the cloud that operate in the cloud really do take cyber security seriously. And it used to be that we were shying away from the cloud because of the security concerns. And it seems to me now, that these companies in the cloud actually have better cybersecurity capabilities than we have on site. And a lot of people are looking at the cloud. Now, what I'm hearing is we're moving to the cloud because it's more secure than what we used to have. Patty, I threw an awful lot at you there.

It's amazing though, right? I mean, when you have times of stress the adoption pieces kind of accelerate. We saw a lot of things like that during the pandemic, but thinking about just the resources that these organizations who are really dealing with the cloud have. It's that centralization and being able to do take a laser focused on security and really hype it up to a level that you couldn't possibly manufacture and duplicate at each individual site.

And they do take it incredibly seriously as you saw from Microsoft. And I love the fact that they jumped right in, in order to deal with that. It's amazing to see some great partnerships coming out of very stressful times.

I mean, I'd be incredibly encouraged if I, if I was on Office 365 and my health system was utilizing Azure and whatnot, I'd be incredibly encouraged that this team know that can identify these things this quickly and update the software this quickly is protecting some of my assets. It would really encourage me.

Absolutely. Definitely. 100%. I think that the cloud has, has really proven itself over the last few years to be really a great place to house your assets and ensure that they are highly secured. Versus I think when it first started, there was a lot of skepticism based on the exact opposite. How secure is it? How easy is it to hack? But I think we're finding that it's a lot more secure than what we're seeing on the ground and being housed in house.

Yeah, it's interesting cause we used to put stuff in the cloud, we're like, how do we make sure that this client who's in that same cloud as ours, isn't going to get to that data.

It seems like we've gotten past those things. It's just architecture. Security architecture, and I think they have a handle on it. Hey before I do want to get talking about health care consumers with you before we get there, we're coming up on one of our favorite seasons which is conference season. There's the ViVE conference coming up. The HIMSS conference coming up. What do you, think's going to be the focus at those conferences? What do you think is going to be talked about?

Yeah, well, I think you're going to see obviously a lot about security and it's super timely, but I think that was already planned. And I think that's going to just amp itself up a bit. I think we're also going to see a lot about consumerism and how we deal with the patient experience. Cause I think that as we think about what's happening with the pandemic and hopefully it's winding down a little bit, but I think the advances that we made in healthcare in order to do things like telemedicine and just really evolving into very different platforms in a quick way.

There's going to be a lot of review around are these platforms, the right ones? We adopted things really, really quickly typically point solutions. How do we then look at seeing long-term strategies of what stays and what evolves. And I think that's going to be a huge aspect as well.

📍 📍 We'll get to our show in just a minute. As you've probably heard, we've launched a new show TownHall on our Community channel. This Week Health community. And it airs on Tuesdays and Thursdays. I'll be taking a back seat to some of these people who are on the front lines. TownHall is hosted by an array of talented healthcare leaders who are facing today's challenges head-on. We're going to hear from professionals and their networks on hot button issues, technical deep dives, and the tactical challenges that healthcare faces. We have some great hosts on this. We have Charles Boicey and Angelique Russell, Data Scientist, Craig richard v ille, Lee Milligan, Reid, Stephan, who are all CIOs. We have Jake Lancaster and Brett Oliver who are CMIOs and Matt Sickles, a Cybersecurity first responder. I'd love to have you listen to these episodes. You can subscribe on our Community channel. This Week Health Community, wherever you find and listen to podcasts. Now let's get to the show. 📍 📍

You know what I find interesting. I find the topics at the conferences lag by about nine months. And the reason is because they started planning nine months ago. I mean, I get why it happens. And so we are going to talk about cybersecurity. We're going to talk about a lot of the advances that have come about as a result of the pandemic. We may talk some AI and machine learning and some of the chat bots and some of the technologies that were put in place.

I wonder if we're going to talk about the labor challenges that healthcare is facing right now. Because again, this one really started to come up in December and January and start to really become top of mind. Nurse shortages and those kinds of things. I wonder if that's going to be a hot topic, or if we're going to have to another 9 months.

Good question. I didn't see as many about that as I would've thought with burnout. You're seeing a lot of webinars around burnout and around retention. I think the other areas are social determinants of health, you're going to see a lot of that as well. I think I saw a lot of access pieces come up in the conference. But yeah, I didn't, I didn't see as much on the workers piece as you would expect. And I think you're right about that.

It's interesting. Cause the safety protocols were sort of set. And they're different because it's Florida and we can do some things. And then the CDC guidelines all changed and now I'm getting different.

Surveys. Keep masks on. Or leave them off?

And to be honest with you, if we, if we do masks at the HIMSS and ViVE conference, we will be. 90% of the people in all of Florida that are wearing masks.

I agree with you. There's probably nobody. Nope. That's very similar in Arizona. You're not seeing a lot of masks being worn.

And what's interesting is I went to the Apple store yesterday. Last week, if you went to the apple store, you wore a mask when you went inside and this week the sign just said suggested. Suggested that you wear it but not required. It'll be interesting to see how those things play out. putting on a conference is a lot harder, I think, than what people think. I mean, you have things changing up until the last minute.

Yeah. Especially with all the additional variables that we have in the past couple of years. I imagine it's very difficult to coordinate everything.

All right. We're going to hit an older study cause I wanted to talk to you a little bit about healthcare consumers. I mean, some of the things that are coming up. CVS did a study back in July. July of 2021. So peak of is that Delta. It's probably towards the tail end of, of Delta, the beginning of a Omicron if I thought about. How the pandemic is boosting healthcare consumerism. Let me give you a couple of the numbers from here. I'd love to get your thoughts. The study found that patients particularly younger people are moving away from more traditional avenues of care, such as primary care routine care from primary care providers.

And it decreased from 62% in 2020 to 56%. That's an interesting number, but again, that, that younger audience I'm not sure. When we talk about healthcare consumerism, sometimes we talk about it in a big bundle, but you know, you have this younger generation, which use healthcare one way, and obviously you have the older generation which is acutely aware of health. They're just more acutely aware. I wonder if, when you're talking to your clients and when you're thinking about the things that you're doing, do you break those groups down in, in any way?

Yeah. I think that this is where it comes down to meeting the consumer where they are. And I think that having multiple channels and multiple ways to engage them is super important. Right. As you're thinking about I know my kids, they don't like to talk to people on the phone. They prefer not to go to the doctor.

They also don't want to really plan. So they want to be able to just go on the fly, which I think is why these tele,health Teladoc, if you go do Amazon care, if you go to the CVS clinics or any of these where you can sort of just run in because you have an issue, that's what they want.

They want this. They're used to this very quick resolution. I have a need, I can go on the web, I can click and I can get my issue resolved really quickly. For the most part, it's a healthy population, right? You don't have sort of, you've got some chronic disease and I'm sure you probably can break those generations down differently for those who have an issue and those who don't. But I think that you also see a very different group with the Gen X-ers. The greatest generation. The boomers are going to be a little different because we've been used to having to go to your physician. I mean, I've been with my primary care doc for 19 years.

So I continue to go to her and I, and I go typically go in person. So it's different. But at the same time, I want the ability to have a conversation once I leave, in a different way than, than just via having to call. You're probably like me. You do this all day, every day. I'm on webinars. I'm on a zoom meetings seeing folks. It's, it's hard to get a time when you can have a phone call. So there's a, there's a lot of different variability out there. So I don't think it's very easy to put things into a single

This thing goes on. It's interesting. Obviously CVS did it. So more people also visited local pharmacies for care. According to the study, 17% reported seeking out routine care at their pharmacy up from 11% in 2020. Obviously this is good news for CVS, but my anecdotal story on this is when I needed tests, that's who I went to. I went to CVS, I went to Walgreens.

And when I needed the self tests, I went to those places. When I need medications, I go to those places. And so there's a convenience factor that's associated here. That's really in their favor for the most part isn't it?

That's correct. I mean, the ability to go in and say, you have a sore throat, you want to get a strep throat test. You go in, you get it done. And if you do you walk next door, not even next door to the window next door to pick up your medications. I mean, it's pretty convenient. And I think you seeing Walmart, putting bets in telehealth. Obviously Amazon's hugely doing the telehealth piece and rolling out a bunch of different things as well. And they bought PillPack and being able to send the medications in a really quick manner. But I think there's a lot of challenges as far as what the health systems are going to deal with. I mean, it's, it's hard just to get into your physician, right. To go see them which is why a lot of these are popping up. Is just the the utilization of the care extends. The pharmacist, the nurse practitioners. It's actually needed as well. Right. So when you think about just being able to get more folks, the care that they need we're seeing a lot of this.

I mean, this study really does focus in on the gen X-ers and the gen Z, the millennials. But I going to come back to you because we're going to talk pragmatically about what, what can a health system do? How can they lay this out and create the experience that goes on? People aged 18 to 34 were least trusting of primary care providers.

And we're most likely to shop around for healthcare services. More than a third, 39% said they are more open to taking recommendations from pharmacists, nurse practitioners, nursing assistants, and physician assistants at a healthcare facility. The industry has an opportunity to tailor the patient experience, to meet the expectations of millennials and gen Z. But it can't forget that there are still a large population who value and expect a more traditional in-person primary care provider experience. Nearly two thirds of people, age 51 to 64, 64%. And people over 65, 65% said they have high levels of trust in their primary care provider. People age 51 to 64 were also the least likely to shop around for care with just 5% saying that they do so. Only 6% of those aged 65 and over shop around for care the study found. I'm surprised it's 6% of 65 65. Knowing my parents. My parents are so tied to their primary care physician. They absolutely love her. Thainks she walks on water.

Absolutely. I am surprised at how high that is. It probably has to do with Medicare advantage plans and tie into that, but I think you're right. I know the younger generations are much more willing to sort of go to whatever has the best experience for them that's most convenient versus I think the relationships that you see with the older populations. That's what they're all about. And they're willing to wait. And they're willing to do what they need to do in order to, to see someone that they trust.

So healthcare, traditional healthcare providers, we are turning a massive ship that was heading in one direction, which was, Hey, if I sponsored the local baseball team, everybody's going to come to my hospital because they're aware of my brand to potentially all right. So now I have to reach them where they're at. I have to create online scheduling. A way to communicate with their physician, even when they're not post appointment or between appointments, that kind of stuff. I have to become a health system that looks more like. Let's see, I'm not going to say Amazon cause it's too overused and we're going to talk about Amazon later, but who does look like a service company, a company that's really good at listening to the consumer, responding to the consumer and coming up with new ways to meet them and tailoring their services to that if they want to stay potentially relevant. Now, granted, if you need heart surgery, you're not going to go to CVS. You're not going to go to Walgreens. And that is going to funnel you back in. And the argument argument I always hear from healthcare providers is look there's a continuity of care that is required. And if you're seeing people outside the health system over and over again and then you need something big and you come into the system, your data might not be there. You may not be receiving the best care because we have the best doctors in that community, so forth and so on.

How do you turn this ship? How do you start, instead of thinking about patients who are sort of going to come to you anyway, how do you start thinking about the consumer? I mean, have we seen other industries where we've made that shift?

Yeah. I think that it's going to be really, you think about the power that these folks are going to gain as they start to develop relationships, because it's not like when you think about what some of these folks are doing with Village MD and with I'll use Amazon, but they're trying to build care teams, right? They're not just, it's a one-time visit and you never speak to the folks again. They're trying to build relationships, just also going to give them a ton of power to steer to their partner health care organizations when they do have acute episodes. So I think it's really interesting as far as how this dynamic is going to start to evolve, because there are going to be folks that really want to have that very consumer oriented feel. And in order to really deal with trying to contain that and try to keep everybody into their organization, they're going to really need to think about, first of all, think about the patient as a consumer.

There's a lot of pushback, I think from C-suite often, especially in the, in the medical side of thinking about folks as consumers versus patients. Because you've got this there's a hierarchy there, when you think about a patient doc relationship that implies certain things. And I think there's a and no one wants to feel like they're they're a retailer, right? They, they go to school. There's a lot of stuff that they, that they bring to the table and they want that to be recognized, which I completely understand. But I think there's a lot of ways that these health care organizations can really think about consumers in different ways and really allowing them to have voice. I was speaking about this with my primary care doc quite a bit. And she's now seeing she's, she reserved her entire Friday now to see televisits because she recognizes that folks want to have that, but she also wants that in-person availability because there's there's ways that you need to interact with certain diagnoses. You can't just see people remotely. So I think that blending just, we, we adopted telemedicine really quickly. It went up to like 80 something percent of visits became remote. Now it's back way down. And I think being able to think about how all of these entrances are happening and not just thinking about televisits, but thinking about your web presence, thinking about your call centers. How do you impact that and make that into a much more, we'll just use the term that retail uses delightful visit, right? Because people will actually come back if they feel like they are being heard, being seen. There's a study that I, that I read from Accenture that talked about the folks that don't have a great patient experience are less likely to actually seek care again.

Which I think has some big impacts on population health. If you think about folks that may delay coming in and then enter into the ER. So I think there's a lot of work to be done. And I think a lot of organizations are looking at things really differently. The Mayo Clinic has now moved to looking at net promoter score as opposed to just pure H Caps.

And I think thinking about things in a really different manner is, is going to be warranted. I think there's a lot of folks that are trying and that are really thinking about how do we look at this holistically and how do we deliver an experience that's going to not only just be in the acute care setting, because I think that's what H caps addresses.

Right. Did we do certain things. But how does the entire patient journey look like, is it personal? Are we delivering it with empathy? Or does it feel not so great, right? There's a lot of trust factors. You talked about trust of primary care docs. We're seeing trust at an all time low for healthcare and science. So I think being able to deliver a more personalized journey and being able to understand who those folks are when they come to see us and turning it into being a little bit more, well, a lot more proactive versus reactive. Healthcare is hard to navigate Bill. It's really hard.

And some people would consider me an insider and it was really hard to navigate for, for my family. If I were talking to a board or administration right now, I think what I would say is look, two directions. One is a lot of solutions already exist within your health system. And it's just a matter of, of knitting those together. For example my guess is you can find a doctor or practice within your health system right now that is, is very consumer centric and they've gotten really creative and figured out ways to interact with the patients on an ongoing basis.

Adjust their schedule to be more consumer centric interact with people via text or, or some other things. And if you just went throughout your health system and looked at the scores and what feedback you're getting from your consumers and your patients, you could probably identify them fairly quickly. And if you could figure out a way to replicate that. So that's one thing I would say, look, look inside. The second, there's two approaches. One is you could try to boil the ocean, the others is you can not try to boil the ocean. To not try to boil the ocean. I think you essentially look at it and you go, all right, let's identify some workflows that the consumers would really appreciate.

And maybe that's a specific practice. Maybe it's just orthopedics. Maybe it's just labor and delivery. I don't know what it is, but you, you look at that and you look at it from end to end and you essentially put the right tools in there and the right communication, touch points and whatnot. And you really smooth that one out, you get your experience there and you start to go elsewhere.

The boil the ocean approach is to essentially say, look, we're going to become a culture that is consumer centric, and we're going to change how we're doing. And I've seen some strategies that look like this, where they essentially say, we're going to take this a hundred year old company and we're going to make it consumer centric.

And it's top-down lot of, a lot of projects each or each department's given, empowered if you will to, to look at what they're doing and to make improvements on that lines. I think that's interesting. I'm not sure it's the most effective, but I think it's interesting to engage 20,000 people as opposed to engaging small groups of people in creating areas where you can be more more responsive to the consumer.

Yeah. Yeah. I think, I think that's an interesting point. I think you put, there's two factors, righ with the big, the big look is you get a lot of different ideas. But you also have a lot of voices, so it's hard to make movement.

The more, the more voices at the table, the louder it is. I've recounted the story twice in the last week, but I remember my first IT governance meeting I went to and there's 24 people at the, at the table. And I walked in and I was looked around. I'm like, we haven't done anything yet. I know this is not going to work. There's not a chance this is going to work.

And I asked somebody what was the thought process? It's like, well everybody wanted a seat at the table. I'm like, I'm sure they all wanted to see the table. But if we have 24 people making a decision, we're not going to make any decisions. This is going to be impossible. And sure, sure enough, it was broken.

You brought it up. So I'm going to talk about it. Amazon. So Amazon care is expanding. They picked up a few more direct clients. So Silicon Labs, TrueBlue and WholeFoods. Obviously WholeFoods is part of Amazon. They're going into 20 more markets across the US for the in-person type of stuff. Obviously they can do the app and the virtual virtually, I mean, pretty much anywhere, but now they're going into 20 more states. Again a lot of this was predicated on Amazon is in all 50 states. So this was, Hey, how do we, we weren't successful with the berkshire Hathaway. That whole partnership.

And now we have to figure out a way to do better for our employees. So they they're going to do that. Oh, and by the way, this is almost identical to what they did with AWS. They're like, Hey, we need to do this for ourselves. Oh, look, we have all this extra capacity outside of black Friday and Christmas, let's start selling that capacity. And so they had to build this capacity out for the. Staff their own employees, and now they're offering it to other employees and it's it's taking off and it's mirroring what some other organizations are doing as well. How do you view this?

Well I think that Amazon has a way of making everybody get better, right. Because they, they have the ability, like you said, too, they have such scale internally that they can really put something together, interestingly, and test it and then try to bring that out to the broader market. And it definitely disrupts and makes people think differently. And I think that there's definitely going to be a lot of part. They also are really good at partnerships, even the folks that there were. So I just saw they signed a deal with Teladoc. Right. You would think, wow, wait, that doesn't make a lot of sense, but you know, they're very good at going out and partnering even with folks that are competing with.

So I think there's really an interesting tack there. And I think there's a lot of opportunity to, to partner with them around a lot of these different offerings as well, especially if we're talking about extending care that are in need. But their model is really intriguing to allow to have both a video visit, but then to send someone to your home if it's in need.

And then to turn around and have a two hour delivery of the drug via PillPack to your home. If you need a prescription. That's pretty convenient. So I think, I think there's going to be definitely some pressure put on the health systems to to look at this. And I have talked to quite a few of the CIOs out there about this and, and a lot of them are also looking at the opportunity to partner, but I think there's also some pressure on the experience they're giving their providers. Right. So it's, it's not just the experience of giving the consumer, but the experience they're giving the provider and looking at how do they, how do we change that in the health care organizations and, and think about different ways that we can bring a different experience.

Sachin Jain wrote an article and I commented on it on my Today show. Sachin Jain well-respected, highly respected by me. I love what he's doing. He's at Scan Health out of a Southern California and they're expanding their offerings and doing phenomenal work.

But he wrote article where he said just stop with the press releases and buy by a hospital and see if you can figure it out. Essentially. It's what he said. And he said that to the big tech. And now I came back and said there's not a single big tech company that should give up its 20% profit margins and get into the four to 5% profit margins of healthcare and the slog that it is. I mean, from a business model standpoint, doesn't really make any sense and I'm not sure it's being entertained by any Apple, Amazon, Google. None of them are really entertaining it I would, I would doubt. Microsoft and others, but it's an interesting concept to say, could they do things better than healthcare could? If an Amazon or Google or whatever bought a health system, could they do a better job at the consumer experience? Could they do a better job at organizing our, hours of labor to address the labor shortage trying to address right now. I mean, are they that much more efficient or do they have magic sauce or is it just because their magic sauce is they don't get into the areas that have quicksand essentially.

Yeah. I think that's a really interesting question. I think that, well, my perspective would be that on the consumer experience. Absolutely. They could do better. I don't imagine you could do. I mean, in some of the places I've gone, I don't think you could do much worse. Right. It's just, it hasn't been a priority. And I think with the pandemic. It was difficult to make it a priority because we were just trying to survive through it, right. With the labor shortage and, and trying to get through what was happening. It's very difficult. Some organizations have made the bandwidth in order to do that.

I think the nice thing is for those organizations that were doing well, they're doing extremely well now financially. So there's some cash to be able to make investments. To look at things a little bit differently. But I think as you think about patient experience, the fact that we're I'll give you an example. I call into my primary care doc. I told you I've been with her for 19 years. It's like I'm brand new every time. I call you gotta fill out. You gotta fill out the forms every year. There's no personalization there, right? That's something we can definitely change. There's no productivity in, in general, right. To go and reach out or even just, just to confirm your appointment, you get a dead-end text saying yes or no. There's no okay, let me reschedule to a time that somewhat convenient for me. There's no.

You know what that what this tells me, Patty tells me you're not seeing your primary care doc enough.

Once a year.

Once a year. Actually, I've mentioned this before on the show and I get emails after I mention it, I do not have a primary care doc and haven't for probably about five years. I understand the reason for a primary care doc. I really do. I really do understand it but you know where I'm sitting. I'm looking at some different options that are available, some concierge medicine. And again, I understand that I can afford some things that maybe some other people can't, but you know, some of the concierge services that might be more tailored to me might help me around things that I need help with. Like for example, I need to lose 30 pounds. In concierge medicine, they're probably going to say, Hey, go over and see the nutritionist go over. And I'd like, all of medicine to sort look like that, where they'd look at us as a, as a complete person and say do you have access to good food? Are you eating good food? Are you exercising? Maybe the prescription is go over to LA fitness. I don't.

Well then there's followup, right? And there's care. There's sort of this ability to to look like you said that whole person. I think if you think about where healthcare has to go in order to, for us to deal with some of these lets just call them epidemics of different types of things. Especially since I think folks were a lot more focused on their health during the pandemic, but it also triggered a lot of other things like more alcohol, maybe less exercise. We closed the gyms. There's a lot of things. I sort of, kind of got escalated.

And I think if you think about looking at really true population health, you've got to look at the whole person and you've got to understand how do you connect things like the apple watch or whatever devices that we, where there's a lot of opportunity, I think out there for prevention and for holistic care that isn't necessarily just writing a prescription for having tests done.

And I think you're right. When you think about where things are going all of those things have to be incorporated and they need to be presented to whoever is on your care team so that they can see all of these things and be able to say, okay, here is where you've been going and here's, let's face it some of us need more accountability. I know I do.

No, seriously. I sorta laugh cause I, I have a, I have a WHOOP on my. I wear it and it gives me these, these messages. Like, it's funny. Cause if I, if I didn't get a good night's sleep last night, it's getting to the point now where it like 7:30 it's saying to me, Hey, you should get ready for bed. And I was like, ready for bed. You're killing me. I mean, it's like, but it's looking at, it's looking at my overall sleep patterns and history and the amount of sleep I've had over the last two or three days. And it's saying, look, you need a little more sleep. Get in bed a little earlier.

And I like these devices. The doctors do not want to see a majority of the information that comes out of these devices just yet. I I think they're, the doctors are pushing for better I don't know, just more accurate data, more relevant data and actionable stuff.

Exactly. And this is where I think care could shift a little bit. And we set up teams of people that are actually monitoring the information that we give them. I step on the scale every day it gets to my phone. It could just as easily get to get over there and get a message from my local healthcare provider, who I want to be my trusted advisor on this and have them say, Hey, bill, we'd like for you to come in and get some blood work done.

And we'd like for you to talk to nutritionists, we like, I mean, this is, this is the picture that I think we all know and we want to get to, but it's alluding us right now for whatever reason. All right. Buzzwords. What's the biggest buzz word in technology, or maybe even healthcare technology. When you think of buzzwords right now, what do you think?

AI and ML seems to be.

Yeah. And actually, I think most CIOs would agree with you. You walk through, we're going to go to HIMSS. We're going to go to VieV. We're going to walk through all these booths. And every one of them is going to talk about their AI or ML component. I don't know, maybe 50% are actually using AI and ML. Others are just writing algorithms that are just algorithms. Yeah. And at the end of the day, I'm not sure a bunch of them have it. So AI, I agree with you. That's probably the most overused, over-hyped buzzwordy kind of thing right now has to be has to be that. Overrated technology. Five tools, execs, think hospitals should skip.

This is a fun list. It's kind of funny to read this list. The last one I know I do love the last one, but people are gonna have to listen if they want to hear the last one. Number one, proprietary technology. BJ Moore CIO for Providence who's been on the show. And he just says proprietary technology leads to silos, technical debt, unnecessary complexity, and higher costs.

And yet when I look at the portfolio of most organizations, especially in healthcare, we bring in proprietary technology an awful lot. It's kind of interesting to me and we're just lining ourselves up. I wonder if it's because we don't educate the administration or the, or even the physician, some of the physicians who are making these decisions well enough to say, look, you can get out of this path.

And I know it looks really shiny and really cool right now. But at the end of the day that Ferrari that you just bought is going to have to go to the gas station an awful lot. We don't have any tires to fix it. And we don't have the parts we're going to have to wait six months to get the parts. It's a good analogy, actually. I mean.

It's a wonderful analogy, Bill I love it.

It's like we could, we could fix the Honda, the Chevy and the GM. And this is what we can fix within 24 hours of anything going wrong and you're going to buy something that we're just going to look each other and go, do you know how this thing works? I don't know how this thing works.

Then you have people that are really in charge of it, who then leave and go elsewhere. And now you're really in trouble

And the labor thing cannot be underestimated here. It's hard to get good IT talent is one of the things I'm hearing as well. And then you buy this proprietary technology. All right. Who, who could oversee this module or this thing is like, well we, we can't find anybody. Crazy. Well, number two, overrated tech execs think hospitals should skip augmented and virtual reality. Thomas Graham MD, chief innovation and transformation officer at Kettering health in Dayton, Ohio said that while he is optimistic about some of this simulated applications for AR and VR and IM as well. So I was a little skeptical when I first read this, he thought that the ball would have to be moved further on the insinuation of the technology into the clinical setting by 2022. So augmented virtual reality are interesting, especially in a time of isolation like we've just come through. But I agree with them in that we have some clinical stories because I've covered some of them. I know that Cedars-Sinai students, some really interesting things with people who are homebound or people who are really bedbound, whatnot, and, and helping them to get outside essentially through virtual reality, it's really these worlds that people are creating.

Well, the Metaverse just, it's really amazing. My daughter does a lot of, spent a lot of time in virtual reality and she put the goggles on me and I was standing on the edge of this cliff, even though I know I'm in my, I could take a step if I want to do, but there was no way it was going to. It's, it's pretty amazing what they've been able to build in these virtual realities.

In your mind really processes what you're seeing and says, don't take a step forward even though you're staying and your living room.

Absolutely. It's, it's pretty amazing. I think it's got potential. I just I agree it's not there yet, but I think there's some really cool stuff that we could build. Given what we've seen, what I've seen on the virtual reality platforms. I think there's some good opportunities. You know how slow we are in health care to adopt these things.

To be honest, I would love to be on an augmented virtual reality team thinking of what's next and that kind of stuff. I think that would be a great place to spend my mind time. That would be fun. Number three, natively written applications, hospital applications to be cloud native rather than written natively for on-prem use according to Mr. Moralis, PJ Morgan, he said the cloud is where innovation and scale are occurring. Obviously Talkdesk as a service, does that mean you're cloud-based.

Right. We are the first born in the cloud, so we are a completely cloud and cloud native which means we don't have that sort of hard infrastructure they have to maintain and sort of maintain both your on-prem and in cloud infrastructure, which allows us to innovate very rapidly. And when the pandemic hit we have tons of stories of how we were able to scale folks incredibly rapidly because folks had to go from on-prem and then they had to send all of their people in their call centers home. And being able to do that with an on-prem system is very difficult. So the scalability and the ability to deploy anywhere is is pretty amazing as well as we talked about the security aspects earlier. So there's definitely some really interesting aspects about being cloud native.

Yeah, I agree. I mean the biggest application that would be interesting to be cloud native would be the EHR. And because I think once that platform goes cloud native, then you're going to see all sorts of other other applications follow suit. Interoperability becomes easier.

That's the big thing is being able to have open APIs to be able to do real-time calls and to actually be able to have a secure connection there. All of a sudden, now we have a much different world with interoperability and ability to innovate.

Yup. Number four is niche technologies. Hospitals should carefully consider the end to end patient experience before adopting technology. That targets very specific scenarios of patient engagement. And that gets close to the conversation we had around proprietary technology. And then our last one fax machines. Christine. Christine Mercado, a vice-president of strategic innovation at Chicago based CommonSpirit health who's also been a guest on the show said she is always shocked at the ubiquity of fax machines in healthcare facilities. Better processes exist, but old habits die hard she said. It's interesting. I got into a little spat, I generally agree with the people who were commenting. But they were essentially making the case faxes play a key role in healthcare. And they're saying things like, look a fax has never been hacked, which is not true, but it's, it's mostly true. It's going across analog lines. It's not that big a deal. So it's, it's a lot harder to hack. You can spoof it. There's other things you can do, but at the end of the day, it doesn't get hacked as much as email does or digital systems. The other thing they were saying is that there's, there's a lack of alternatives for it in some health systems that don't have money to, which I sort of look at them and go, are you kidding me?

We were using fax presses back in 1992, that you could hit a print function and it sent a fax. And then and then the question is, how do you receive the fax? I'm like the same way. And by the way, by like 95 or 96, we were OCR in those faxes that were coming in and pulling key data off of them. I mean, this is nineties. I mean, we're not talking,

We're not talking millenia.

I mean, it's, so when people say to me, we need to have faxes, we need to have paper. We need to, we need to see it. I just started. I sorta shake my head and say, the only reason we haven't solved this problem is because we have chosen not to solve this problem, because this is a problem we can solve.

That's eminently solvable, but I did want to go back to your little niche niche piece. Cause I, I look at, I look at that and I, I, I think about what's just happened over the last two years where the amount of innovation, that health systems. Have undergone in a very rapid period is great. Right? I mean, we saw folks have had to adopt telemedicine. There was just a lot of different solutions that we had to adopt really quickly. But I think this is we're into that time where people are going to take a deep breath and sort of look back and say, What did we implement and how does it fit?

And did we have unintended consequences of silos of information and just different things like that? So I think there's a lot of when I talked to a lot of folks there they're looking for now, how do we go back and sort of think about platforms, right? And how do we look at things in a little bit of a different way so that we're not having so many different point solutions in our IT stack.

Yeah. I mean, every CIO I talked to talks about App Rat. Application rationalization, sorry, short. The biggest gains we've had is that when we implement the EHR, we typically turn off about I dunno 10% of the apps, right? Because if you consolidate around an app or even a Cerner or Meditech, you'll end up with a consolidated, a bunch of the ancillary applications that sit around that then the other way is when you have a, a Application, there's an application lifecycle.

And at the end of life, a lot of applications in healthcare end up running forever because you need access to that legacy data. And so the other area that people have found a lot of success in getting rid of these applications is. When they come up with the right strategy to move that data and still provide access to that data, they can then shut off those old applications.

Be surprised. Those two use cases can sometimes get up to about 20% of the sprawl of applications that happened to be across your enterprise. It's really, it's really kind of fascinating Patty. We're actually out of time.

We have such a great time.

This was wonderful. Hey, I want to thank you for stopping in. I hope to see you at one or both of the conferences. Okay. So I look forward to seeing you there. Hey, thanks again. I appreciate your time.

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