This Week Health

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January 25, 2021: Today Drex and Bill talk cybersecurity strategies, vaccine distribution and Biden administration predictions for healthcare. The new final rules to Stark Law and AKS regulations include the addition of a new "cybersecurity exception". What does this mean if you’re breached? Will the government cut you some slack? What's the possibility of building your own cybersecurity program? Should you be using a partner to help? If so, which partner? What are Amazon’s plans post exiting the Haven joint venture? Bill and Drex also break down The Healthcare Innovation 2021 State of the Industry Survey. 

Key Points:

  • New cybersecurity donation safe harbor rule [00:08:25
  • Micky Tripathi tapped as Biden's National Coordinator for Health IT [00:06:20
  • Johnson and Johnson are coming out with a vaccine that may be a one-shot that could last for a year [00:20:30
  • Bundled payments is how you figure out how to get to value based care [00:30:31
  • We keep talking about bringing in more and more data sets. This is going to be a key area for us. How do we push this forward? [00:43:26

Stories:

Transcript

This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

 Welcome to this Week in Health It, it's Newsday. My name is Bill Russell, former healthcare CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping health IT staff current and engaged. Today, Drex Ford is in the house and we talk about everything. It feels like we talk about everything.

In, in this episode, we actually disagree on something. It's a lot of fun going back and forth. Hope you enjoy. Special thanks to Health Lyrics who is our Newsday show sponsor for investing in our mission to develop the next generation of health IT leaders. You know, I ran into someone and they were asking me about my show.

They are a new masters in Health administration student, and they, they, we started having a conversation and I said, you know, we've recorded about 350 of these shows, and he was shocked. And I said, well, who? He asked me who I had talked, spoken with, and I said, oh, you know, just CEOs of Providence and of Jefferson Health and CIOs from, you know, Cedar-Sinai, Mayo,

Clinic, Cleveland Clinic, and, you know, just all these phenomenal organizations, all this phenomenal content. And he was, he was just dumbfounded. He is like, I don't know how I'm gonna find time to listen to all these, all these episodes that I have so much to learn. And, uh, and, and that was such an exciting, uh, moment for me to have that conversation with somebody to realize we have built up such a great amount of content that you can learn from and your team can learn from.

And the, uh, and we did the Covid series. We did so many great things, talked to so many . Just brilliant people who are, you know, actively working in healthcare, in health. It addressing the biggest challenges that we have to face. We have all of those out on our website, obviously, and we've, we've put a search in there.

Makes it very easy to find things. All the stuff is curated really well. You can go out onto YouTube as well. Almost every episode we've done since episode six has been recorded as a video podcast, so you can watch the video as well. . You can actually pick out some episodes, share it with your team, have a conversation around those things.

We don't expect that everybody's gonna listen to every episode we record, and that's why we cover different topics and, and we are starting to organize our website around topics and. Collections as well to make it easier for you and your team to find those things which are gonna help you to, to, to really stay current and to really advance the, the knowledge of the team.

So we hope you'll take, take advantage of our website, take advantage of our YouTube channel as well. Newsday, we have co-host Drex de Ford in, uh, former CIO and founder of Drex Digital Health. Hey, Drex, how's it going? Hey, good, how are you? What's happening? Good. We decided to do a hat episode. You have your, oh, yours is cooler than mine.

Mine's Baylor. This is where I send money to. And yours is your directIO uh, consulting, which actually makes money. So this is where people send me money. Yeah, yeah. Clearly you've read Rich Dad, poor Dad, and, and understand the right side of the equation as opposed to my side of the equation. Uh, although I am a proud Baylor dad, really excited for my daughter going there.

It's a, it's great school and good. Yeah. We'll see what happens. It should be, you know, they had two basketball, the men's and women's basketball team last year. Probably both could have won the national championship, but it got up the season, got upended and you know, we'll see. We'll see what this year brings.

Yeah. Hey Drex, there's a lot of stuff going on. Like we could, we could probably do news for like three hours if we really wanted to today For sure. There's a lot happening. The inauguration yesterday. I've, I've heard there was an inauguration yesterday. Well, yeah, yesterday. I'm not sure when. Are you gonna show this Monday?

Yeah. It doesn't matter. , you, you blew the illusion. You went through the, oh, sorry, sorry. Yeah. No, we, we, we record this on, uh, Thursday, the week before it goes live on Monday, but yeah, inauguration was yesterday down without a hitch barricade. You know, a couple hours after it was all done, there was just nothing going on.

So, um, and how about Amanda Gorman? Did you see her, the, the poet laureate? Who? Uh, I did. I don't know. I don't understand people who had time to watch the inauguration. I, I, there are certain things like, it's like, did you watch all the, remember when they hearing watch. I do work

nerd. You know, I have a degree in public administration, so I spend a, you know, this is also part of something that's really interesting to me, but I also work late nights and overnight sometimes, depending on, you know, how my mood is striking me so I can take time during the day to watch stuff that other people can't.

Yeah, and it's. Yeah, I'll, I'll pick it up on podcasts. I'll pick it up on, uh, but I don't watch TV either, so people are like, oh, what News Station do you tune into? I'm like, I don't, I, I don't watch tv. We have TV because it's part of our subdivision. We have to have it sort of thing. But I think the only thing I watch on TV now is golf.

Super productive. Then, uh, take all that wasted TV time and do work well. It's not wasted T TV time, it's it's podcasts, it's audio books, it's, it's, it's that kind stuff. And I don't wanna sound smarter than I'm, because I'm not, you know, clearly I'm not, I'm not listening to books on, you know, epidemiology.

I'm listening to books on how to run a business. So we'll, we'll see what happens. All right, so we've, we've got a lot of topics. We've got, we've got some security stuff. We could start there. We've got some, you know, we're gonna hit the vaccine stuff. We could talk about maybe predictions for what we think is gonna happen in this administration.

There was an interesting USCD, I came out version two. There was a story about Amazon. I, you know, I didn't find the story. All that going back and.

I but to start the show, I think we should just note that was to be the Biden's coordinator for Health it. And last year we did a past present and of interoperability that. He's been there since the beginning. He's a great contributor, uh, wonderful gentleman and just wish him, uh, you know, all the best in that role.

And we'll keep a close eye on, keep tabs and, uh, check in with him from time to time. So looking, sure. Mickey and I worked together, uh, quite a bit when I was the CIO at Steward. And, uh, he was, you know, like running all of the interoperability stuff for Massachusetts and, uh, it's. It's good to see him. It's well deserved and it's the right person, right at the right time to do this.

Yeah. He, he, he is a, he, he is a great candidate. I mean, he really, he's so immersed in it, so it's not like there's no learning curve whatsoever. I mean, he steps in, picks up exactly where they left off Now.

But he is, he's also very adept at moving in and out of different groups of people. So if you, you know, if you want a person who's gonna be apolitical on this topic, I think Mickey's a, a great, uh, candidate for that as well. Agree, agree. Glad he is there. All right. So I will let you decide where you wanna start.

Uh, I gave, I threw out just about all the topics I wanna talk to. Uh, but where, where do you wanna start? Well, so there's, there's this weird thing that I think is going on, but I'm not really sure it's going on that I kind of want to talk about. It's tied to cybersecurity. Sure. Is that okay if we start there?

Okay. Yeah. So I will, I will send you these three articles. I don't know that you've seen them or read them necessarily, but, but I will send them to you. So that you can add them to the post game playlist for the listeners, the first one has to do with, back in December, there was a new cybersecurity donation, safe Harbor rule that was created, that created the capability of bigger organizations, bigger healthcare organizations.

It allows them now to donate cybersecurity services and technology to smaller organizations and not run afoul of the stark laws. I find that to be very interesting. And the last time that something like this in my head happened was in 2006 when we were, when there was a new rule that was a stark safe harbor rule that said that you could donate it stuff.

If you were a big organization to smaller organizations, smaller healthcare organizations and not run afoul of the Stark Law. So this, this is a weird sort of pattern. Right? Okay. I know it's been a long time ago, but I feel like I've started to see this TV show before. The second article has to do with.

The A new law, a new HIPAA cybersecurity law that promises to lower fines and give you audit relief if you're using one of the frameworks that the government has approved. So again, I. This has to do with kind of like making sure if you're, if you're doing the right things and you wind up being breached, the government will cut you some slack if you're using the right framework.

I find that to be kind of interesting. And then the newest thing is that Biden has included over $10 billion and, you know, part of the covid relief proposal, but it's, you know, the program to try to get money into the hands of people who are trying to create. Better cybersecurity programs, and I know that this is gonna send people off on a little bit of a rocket ship because I'm gonna say a couple of words that can be inflammatory, but it makes me wonder if there isn't.

Probably without calling it this, does this start to feel a little bit like maybe a meaningful use? There's the trigger words, the meaningful use program for cybersecurity, and I don't know what it's gonna look like. I don't know how they're gonna structure that money that's being spent, but just with the setup, you know, here's the donation, stark safe harbor.

Here's the framework. Here's the stuff you have to comply with for us to cut you some slack if you get breached and now here's money. I feel like I've seen this TV show before. . Meaningful use, meaningful use for cybersecurity. Um, oh, uh, you know, actually I sort of cringed there a little bit when you said that and, uh, hopefully we learned from meaningful use.

Uh, almost everybody who was there early on will say, you know, there were, there's some things we just didn't take into account. Let break all three is essentially.

My clinically integrated delivery network, which is right. The, the, the people that aren't necessarily a part of our system Right. But are a part of our contracting and a part of our delivery mechanism, those kinds of things. They, they may not even have a formal relationship with you. Th this could be a group practice that refers patients to, to your hospital.

Yeah. They just, you know, when patient needs inpatient services, they refer 'em to your hospital. Now, in the past, if the big system gave that small . Group practice something maybe in exchange. Now you still can't do it in exchange for admitting, you know, patients to your hospital, but, but in the past, doing anything like that could cause you to run afoul of these star ca safe harbor rules.

Yeah. And so, so, so the reason, the reason we have to love this is, you know, the, the, the network is vulnerable at its weakest point. If you're connecting in to all these, these, you know, privately owned hospitals or privately owned clinics, privately owned physician practices and those kind of things, generally speaking, there are cybersecurity practices and tools, and those kind of things are gonna be a lot weaker than the six, 7 billion.

Therefore, if you're.

You've been looking at this for, for literally a decade trying to figure out how do I make that point in my network more secure? And but you weren't able to give them anything. Right? Right. And so now, you know, sort of in this construct of, uh, services and technology you can. There's, there's a lot of capabilities that, that you could provide.

All right? And so it's, it's, it's an interesting scenario. I actually, I'm writing something with David Schoolcraft at OMW Law here in Seattle on this specific situation, and those articles will release sometime soon. All right? So the second one is if I follow, I don't know, the NIST framework for whatever, right?

My fines will be less and whatnot. I'm, I'm not a huge fan of that. I mean, I, under, I understand the positive nature of it. It gets more people to adopt the frameworks, and the frameworks are good. Uh, but here's the thing. Uh, it's like saying, bill, if you follow this recipe, everyone's gonna eat this food.

Well, you shouldn't eat anything that I bake. I mean, I can cook, but I can't bake. You shouldn't eat anything I bake. Uh, it doesn't matter what recipe. And you shouldn't gimme any leniency if I followed the recipe, but it still tastes horrible. You know, a breach is a breach is a breach. So, well, not, it's not true either, but a breach is a, you know, is a serious event.

Whether you've followed the, the recipe poorly or you know, or you had nothing in place. I'm not, I'm not jumping up and down about that one, are you? Do you like that one? Well, so I think this is where the concern comes in with the meaningful use. Kind of cross conversation, right? Part of me meaningful use was you have to do these things, and if you do them, you will have meaningful use of an electronic health record.

It was very compliance oriented. Check these boxes and we will give you money. But that didn't really help us, you know, as ACIO at a health system doing meaningful use. In many ways, it, the things that we had to check the box on weren't the things that were helping us build a good clinical program. They were things that we had to check the box on to get the money, and so we did.

And so I wonder if this isn't gonna be a, a similar challenge, right? I, I guess it moves people, . It moves people further to the left or the right, whichever way you look at it. Moves them further down the maturity models, so at least they're using a framework if they use it in a very compliance way. You know, uh, declaring that you're using a framework and using it in a compliance way is very different from having a really good solid cybersecurity program.

But it's better than somebody who hasn't declared any framework and has no cybersecurity program. So maybe it's, you know, it's better than nothing. But I think it's also, it, it can be a challenge if it's a check the box drill, and that's always been a problem in cybersecurity, you know? And then, what'd you say?

10 billion.

Yeah. And actually I think that is underfunded and my guess is that's just one, one swath of it. I, my guess is there's also military money that's being spent on cybersecurity. There's probably a, a bunch of different agencies that are spending money on cybersecurity. I, I think that budget needs to be a lot higher.

I mean, did you see the, one of the banks of country, maybe New Zealand or something like that, got hacked? I mean, you know, there's, there's an. And I, I, I, I use that term specifically. There's a lot, a lot of warfare going on. Yeah. Right now between countries, you know, it's almost like the drive by shootings of, of Chicago back in Al Capone days, uh, that's happening with these, with these, you know, organiz crime organizations, crime syndicates, those kind of things.

And they're, it is just, it's happening all over the place. And you almost need an, an Elliot ness kind of program to, to weed this out. Yeah, I, you know, and, and this is the part where I, you know, I say things and then I realize you have to be careful what you wish for. But there's a part of me that I. You know, this is not a political statement, but like, forget Space Force.

Let's take that money and that initiative and put it into a cyber defense force for the United States. Because I think creating these situations where you leave a lot of small organizations and small hospitals, especially in healthcare, small hospitals, independent practices, alternate sites of care, other things.

To fend for themselves when it comes to cybersecurity just isn't good for the ecosystem. It's not good for the economy at large, right? The people keep getting dragged off and beaten up in alleys. They keep getting hit by drive-by shootings. To use your analogy, and maybe it would be better if somebody sort of centrally stepped in and said, you know, here's how we're gonna do this.

Now, there's a lot of possible downside to that too, you know, don't get me wrong, but there are just some things about this that make me wonder. Do we need more? I don't know, oversight, guidance? Definitely funding and support and insight. And, you know, the, the challenge that we have right now with somebody being breached by

Ransomware or something else. And then the whole drill is to kind of keep it as quiet as we can and not tell anybody, and to have press releases that say really innocuous things so that all the other people in the neighborhood, all the other people in the ecosystem can't find out the information to figure out how to protect themselves.

That. In and of itself is a big challenge too. Yeah. So I, I wanna say this as a transition to our next topic, which is, Hmm. Uh, I, whenever somebody says, Hey, you know, let's, let's fund the government, the federal government, not the state, but the federal government to, uh, put a program together, they're gonna make it better.

And those kind of things. I always look at it through a sort of an eye of, yeah, will it make it better? Are end world's best? Yeah. And then, and so in cybersecurity, I am a thousand percent behind a federal program. I don't care if it's military funded, I don't care if it's, uh, I don't care where the money comes from and, and clearly needs to be done Well.

But it is the federal government's job to protect us from foreign actors. Period. And so, yeah, fund it, get it started. Let's get going. The reason I say that is because we're gonna, we're gonna shift gears and talk about vaccine distribution, and I see more and more people calling for, Hey, Biden's gonna do a national blah, blah, blah.

I hope. I hope, hope, hope. He does not do a national program. We are pretty close at this point. I'm, I, you know, I'm talking to my neighbors. I'm talking to my parents. People are in line, people are getting the vaccine, the, the, the distribution mechanism. We've gone through the worst part of the project to like, sort of stand it up the, the, the goofy stage where information isn't really readily available.

People don't know what they're supposed to do. Where am I supposed to go for this? Well, we, we've gotten through that. And I'm a little concerned that we're gonna step back now and say, no, we need to fix this. Well, there's things we need to fix, but not, I mean, it's not a reboot of the program that would be.

I think there are things in place today that are definitely usable and we should continue to expand on, but the logistics to deliver now, you know, this is sort of for me in the context of, and, and we know that Johnson and Johnson is coming with a vaccine that maybe is a one shot. Vaccination that could last for a year, but as it stands right now, two shot vaccine that lasts for about six months and there's 300 million people, and let's say we're just gonna vaccinate 70% of them.

You know, a hundred million shots in a hundred days. I've done, I've done some math and I actually posted something out on Twitter the other day, uh, begging someone to tell me that my math is wrong. But it turns out there's something AP approximating 3 million shots per day that you have to give forever.

Just to keep Covid away from 70% of the population, the current system logistically. Is completely incapable of handling that. Yeah. And that, and so there, there needs to be an orchestra conductor and that's, that's, that helps us figure out how we take a bunch of PAs and put 'em in Ubers or something or MAs and put 'em in Ubers or something to go out and, and give, I don't know what the logistics are, but we are way

Way under what we need to be to actually get the economy moving again. Get people back to work. Yeah. Get life back to normal. And you know what, Drex, this is what I love about having you on the show and I love about this back and forth, is because we're finally disagreeing, people are like, oh, you guys always agree?

No. So, so, so we'll disagree on this and we'll disagree from a couple different perspectives. A, the reason the, the distribution is the way it is, is because we had a limited supply of the vaccine. So as we start ramp Ed. 2020. So in fact, if you ask experts, they wouldn't even expect it to have a vaccine until late this year, let alone distributing it until next year.

So, you know, it's, it's one thing, again, I'm really apolitical on this. I wanna get shots in arms as much as anybody else. We're, we're trying to solve the wrong problem. 'cause look, if you ramp up the production, I can get it in arms. Here's how you get it in arms. You give it to CVS, you give it to Walgreens, you give it to Walmart, okay?

They are within 10 miles of 95 to almost a hundred percent of the population. So now people know, oh, all I have to do is go to Walgreens. All I have to do is go to CVS. They know where those places are. We can ramp that up. If the production's there, we can ramp that up very quickly. And you know what those organizations understand, the consumer understand how.

You know, the way we're doing it now through hospitals, hospitals don't understand how to do scheduling in this manner. They understand how to do scheduling for surgeries and those kind of things, but not this kind of stuff. They don't understand outreach in this manner, in this way. It's a muscle that they're developing, but they're not there yet.

And so, you know, I, I sort of step back and I go, okay, we can ramp this up as quickly as you want. That's not the problem. Everyone's worried about that problem. That's not the problem. The problem is that if I see all these different numbers, but roughly 30 to 40% of the people don't wanna get a vaccine.

Mm-Hmm. . That's the problem. And mm-Hmm, . That's problem number one. Problem number two is there is the disenfranchised.

Readily, um, has to be a whole education program, right? Well, yeah. I, I mean that's, the education is always the silver bullet. So, I mean, I read these posts of these anti-vaxxers, and I'm, and it's close enough to the truth that you're like, uh, gosh. It's, it's it, you know, it feels right, but it's not right. And it's, yeah, it's, and it reminds me what my friend to.

And when they say, well, it's not a vaccine, it's a genetic. Okay. Yeah. I mean, technically that's true, but it's also a vaccine, you know, it's a different type of vaccine. It's d different kind of vaccine we've ever had before. It's new, it's different, but it's still a vaccine. I'm sorry, I, I've, I've rambled there for a little bit.

No, no. I mean, it's, it's fine. I think, you know, the, one of the articles that I know that you're gonna include in the, in the post game feed here is, uh, an article. By Ezra Klein that you know is, it's called Biden's c Ovid 19 Plan is Maddeningly obvious and it, it is a little Trump slamming, there's no doubt about it.

But realistically, all the things that you just said are exactly right, like, like there's lots of distribution channels that we could and should be going through and. There is a lot of vaccine supply right now that is still, you know, being held back and isn't, isn't being put in arms for a lot of different reasons and all of that.

You know, the, I think operation warp speed was great, getting us to the point of having a vaccine, but the distribution part of the plan that isn't warp speed and that's where we've gotta make these shifts and, and it includes all this stuff. Education, helping people understand what it is, how it's good for them, what, how it changes the economy.

And then putting them in places where they're easy to access. Let's put some grease on this. Let's make it slippery so people can get these shots as quickly and easily as possible. And I know we've got phases, and I know some states are now starting to sort of like slip back on phases and say, okay, now everybody under 65, I mean, I'm the

I'm the last person in the line. I have, you know, I'm, I'm lucky, I have no core comorbidities. I don't have any of the issues or challenges, and I'm not 65, so I'm gonna probably be one of the last people to get it, which is why I wanted to hurry up . Yep. I, I wanna get my shot too. Alright, well let's, let's move on.

I'd love to hear what you, where you think the Biden administration, and by the way, I need to. Kudos. I, I, I sad that I, to give you kudos on this, but I mean, you called this, you said, Hey, we need to, you know, keep tabs on Trump between the election and the inauguration because he's gonna do something really stupid.

And lo andhold, he did something really stupid and I said, oh, come on, there's a lot of checks and balances and whatnot. And sure enough, you know, that, that event at the capitol, there's just no, there's just no excuse for, so, yeah. And, and, and you called it. I, I just wanna, I wanted to give you, you know, the shout out that there are times when you're right and I'm wrong.

So , it's so rare though. It's nice to hear you say that. So what, what's the, what's the Biden, what, what can we expect from the Biden administration do you think? Well, actually, let me, let me, let's it are.

You know, so I think, you know, as kind of the foundation of the program, being a believer in science and the science behind it, I hope what will happen is that. You know, the office of the National Coordinator Con continues to stay in place. It returns to a role, maybe of more prominence than it's had for the last four years, and that it's data-driven to help us figure out how to create better delivery systems.

And kind of, that's it in a nutshell. When, when it comes to how are we gonna spend money, what are we gonna spend money on that it's not driven by. I mean, it's always driven by politics, you know, to a significant degree. Right? But hopefully it's largely driven by really smart people like Mickey Tripathy, who tell the Biden administration, go senators and congressmen, here's where we need to spend money, and they listen.

I mean, that's kind of, that's kind of my hope that the culture and the environment that is created is one that supports that kind of . Smart people making smart suggestions. Yeah, it's, it's interesting. I, I, I think we will, all you have to do is really rewind to look through the Obama administration and figure out where this thing's gonna go.

It's, and to be honest with you, I don't think ONC cms, I, I don't think there should be much change there from, from the perspective of health. It, I don't think, you know, it's still interoperability is key. We're still gonna be seeing fire, we're still gonna be seeing the US CDI. A different emphasis, right?

Or the departing administration was really the emphasis on building a market. How can make healthcare into. And I think, we'll, we'll, you know, come off that a little bit, but again, it'll look very similar because the underlying infrastructure for either a market based or even a single payer base and that kind of stuff, or even Medicare Advantage for all still looks the same.

You're still trying to share the information across, uh, a large swath of the mechanism. Yep. Still trying to enable the, the innovation community to innovate on top of the data. And this one thing I Biden. The Biden Cancer Initiative, he traveled around, he understood the limitations of interoperability.

And I think when someone says to him, interoperability, he's not gonna have to look at somebody else, he's gonna go, yeah, what do you mean by that? Oh, I know what the problem is. Yeah, I know what the problem is. And we, we've, we've gotta get in front of that. So I, I think that's positive. And we will probably go back to, you know, again, Obama administration probably go back to those, to those bundles.

Uh.

And, you know, again, we talked about it, we'll talk about it on, uh, tomorrow show, which will be last Friday, show bundled payments and return to that with, with, uh, Rob de mache, former CFO for UPMC. 'cause that was one of the themes that we talked about at the JP Morgan conference. So, alright, so those, those are some of the things we can think about and look at.

Let's close it out. I mean, bundle payments. Bundle payments are really kind of the, this is how you figure out how to get to value-based care. Right? I was at Stewart, we were a pioneer, ACO, and a lot of that was around, you know, how do you figure out how to get to value-based care and set sort of the, here's how it works for everybody else to be able to sort of come along for the ride and that has sort of intermittently fell apart and then come back together in different places.

I'm hoping that there's a. There's a better stream of good examples for everyone to follow. Yeah. The bundles. The bundles, for people who don't know, you know, it's like hips and knees. What they will do is they'll go into a market and they'll say, you know, on average it costs this, so CMS is gonna pay this, and by the way, they'll also structure it.

Diagnosis to complete recovery. And so the challenge for an integrated, for back when I was doing this integrated delivery network was that, you know, we, from diagnosis, we were typ typically in the room, right? So our network was in the room. But you, you come in, you have the surgery, and then you go into, you know, rehab and, and, and some pt Yeah, some, some post post-surgery.

Areas that we didn't own or control in any way, shape or form. Mm-Hmm, And you, you were still managed, first of all, the cost was for the whole thing, and second of all, you were still managed to the quality that you could deliver, not only within your four walls, but also in potentially several other entities.

So we had to, as the, as the network, we had to figure out how to manage these entities. It was not as easy as you would think. Yep, that's true, true, real challenge. So let's, let's, you know, let's, let's end this with some, some forward-leaning. Well, actually, you know what, there's, there's another story. Yeah.

Do another one, do another one. Let's, let's hit this. So, healthcare innovation group, mark, mark Haglin. They do an annual state.

So one of their findings is it budgets are seen increasing to meet needs, and they said among the survey respondents, 31% said that zero to 5% of the organizational revenues are expended on it. 34% said five to 10% of their revenues are going to it fully. 35% said that more than 10% of their revenue are being spent on it.

So as for trends, 67% of respondent said that their budget has increased. Over the past two years, while 26 said it stayed the same, only 7.5 reported that it had decreased In that time, I would be surprised. I, I'd be surprised if many decreased last year. There was an awful lot of extra costs in dealing with pandemic.

Does it surprise you those numbers in terms of, you know, 31%, zero to 5%. 5% percent and over 10%, 35%? Number being spent on it. I'm really surprised. I'm really surprised and I, I think some of this also might have to do with the way that the math is done. Yes. Realistically, back in the day, I talk way, way back in the day where you had an IT budget and you were counting, you know, that was your entire, that's what you, when people ask that question, you thought about it, budget as the spend, but because we've evolved to this world where it

Is the enabler for everything that we're doing. Very often it costs wind up being buried in other departments budgets, and that could be an informatics person. It could be the cost of a. You know, a cloud-based application that is only used by the finance team or the marketing team. And so it's in the marketing budget.

There's a bunch of ways that this, I mean it, you know, everything's connected to everything now. And so it is a part of everything. And so I think when you start thinking about how do you do the math, there's maybe some health systems now that have indicators that this is an IT thing, but it's not in the IT budget.

And that may be why the numbers go up. There's, there's a couple organizations, Scottsdale Institute, Gartner and others, that do comparisons of different health systems and.

Some IT budgets have clinical informatics. Some don't have clinical informatics. Some count the full cost of, you know, analytics as all the analysts that are out in the field. Some only count it as the central organization, and so it was a huge normalization effort. Before they could produce something that would allow you to compare yourselves to similar health systems.

And so anytime I've done this, it's been, um, you know, children's hospitals comparing each other. Integrated delivery networks comparing each other. I mean, like you said, you can kind of go through the list. Sometimes HIM is included. Sometimes HIM isn't included. Some kind. Sometimes biomed clinical engineering is included.

Sometimes it's not included, you know, and, and every place is different. Sometimes you're running four EHRs and sometimes you're running one, sometimes you're running two ERP systems and sometimes you're running none. And so there's a, there's a lot of . You know, benchmarks are great, don't get me wrong. Uh, I, I think it's a good place for us to start with, you know, in an IS department or any department, and look at those benchmarks and say, why are we different from the benchmark, not

We are higher than the benchmark, so we must cut spending. I know, I hate that. I hate that. You have to look at those benchmarks and you have to say, why are we different from the benchmark? And if you have a legitimate reason that you're different from the benchmark because you have a much more complicated system, or because you've really spent a lot of time working hard to consolidate applications and uh, simplify the infrastructure, maybe you're below the benchmark.

You know, . CFOs don't like it when you make the argument that we need more money because we're below the benchmark, you usually get, you know, beaten in the head with a frying pan because you're, you're above the benchmark and it, and it's really just a question, why are we different from the benchmark? Can you legitimately explain why you're different from the benchmark?

And if you can, then you're right sized for your mission that is being asked for by your leadership team and board. That's where you should be. If you're not, then. That's maybe where you should get smashed with a frying pan. Yeah, and I'll, I'll tell you, rarely was it that I ever presented that number because I, I felt like, and, and, and we had it.

We always had it. 'cause every now and then, somebody would ask me. CS always have it. Yeah. They would ask me, you know, how, how do we perform against others? And I'd be like, all right, this is how we perform. And we were always in the. From a spend standpoint, one of the lower, uh, percentages, and one of the reasons for that was we were not an Epic or Cerner shop.

We were a Meditech shop. Mm-Hmm. . And we were running a six and a half to $7 billion health system on Meditech. Well, the thing about Meditech is quite frankly, it's, you know, it's flat out 50% less for. To run Meditech from an operation standpoint than it is to, to, to run Epic. And I'll, I'll challenge it.

It's not just an EHR, it has all kinds of stuff embedded in it. Right. I mean, you've got ERP and supply chain and, you know, so these are all other systems that you don't have to buy and run. Yep. The the other thing. So yeah, so we were always in that right. Right. Percentile. But my, my case was always this, what's the right thing to do?

Are we going from a strategic standpoint? What are we trying to do as a health system? Are we trying to be a consumer facing health system? I, I mean, I don't care what the strategy is. It could be that strategy or some other strategy. If we're trying to be those things, let's identify the technology components, put the right technology components in place in order to deliver that, determine what the most cost effective way to do that is, and do that and not sit back and say, oh my gosh, we spent 7% this year, or 6% or 10% of revenues.

You spend, spend the appropriate amount of revenues to execute on the strategy. That's what, yeah, that's what I always felt. Exactly. You know, we, we talked about bundles and, and value-based payments and those kind of things. And they have a little thing in here that, you know, risk contracts and those kind of things are gonna go up.

And I agree with that. And one of the thing, one of the points they make in this article is if risk-based contracts go up and value-based care goes up. We need to get really good at analytics and you know, it's, it's, it's interesting because, what did they say? A majority . It's crazy that the numbers in here, a majority, a feel like they are top of the line when it comes to, to analytics.

And I just don't, let's see. Yes, we're advanced in analytics development, 30%. We are early on in our analytics journey, 38% we have.

On any level or or scale, 12%. So maybe that was over 12%. So those are the, those are the organizations that will be bought soon? Yeah. They're, they're, they're on the, they're on the merger acquisition list. Well, 24% are on that list. We have not used data analytics until now and we have no plans to use data analytics.

Okay. 24. That 24% is clearly, uh, some sort of asset play to be purchased. I don't even understand that answer. 38%. I think there's a Go ahead. How can 38% say they're early on in their analytics journey? You know, so this is another one of those things where I think there's maybe some benchmark thinking going on that we are doing better than most places that we know of with analytics, right?

So we must be in the higher category of analytic use. But I look at this, I. The places that I think are doing really good, really well with analytics, it's not a thing that is only a coming out of an, of an analytics or knowledge management shop at that organization. And it's not just dashboards, it's actually the creation of a culture where frontline managers and directors.

Our citizen data scientists and they're, they have access to and the ability to understand data in a way that helps them run their part of the business in the most efficient way possible. And that can be clinicians, that can be clinic managers, that can be, you know, kind of across the house when you get that, where everybody's got access and everybody can actually use the data to make better decisions sometimes on their own.

It, you know, now you're doing, you're really doing something with analytics, but you know, having a bunch of dashboards and, you know, posting dashboards and sometimes just retrospective stuff, that's nice, but that's not, I don't consider that to be advanced analytics. Yeah, no, it's, it's, yeah, that, that was sort of my experience that we, we had a lot of data wranglers people.

Sense of it. Sense, or actually it doesn't even make sense of it. They would get it into a form where we could actually run reports on it. And that was a significant number of people on the staff that I had. And what we were trying to do is we were trying to change the mindset of, all right, we need to, we need to produce insights.

And nothing brings that home more than, you know, trying to social determinants is one or.

I, they, if I were a leader of a health system, I would go in right now and say, alright, I need, uh, detailed information on the population that lives in our markets. I need to know, you know, who lives here year round? What's the age categories? Those, I mean, that would've been when we're getting ready comorbidities.

And that's the whole outreach program, right? And then you start pounding that list, Hey, come in, you gotta get a shot. Yeah. How can we get you scheduled? You know, you're in the one B window. Yeah. So let's go. Absolutely. I mean, that should, I mean, so it's, it's insights, but think about, I mean, there's a, a lot of other areas like social determinants, areas where, uh, you can actually gain insights from the data that we have within the EHR that would allow us to do things.

Now we keep talking about getting more and more data sets and bringing more and more data sets in.

Build your own? Is it a buy capabilities? Are we going, you know, are we going to a health catalyst? Are we going to our EHR provider? You know, where are we gonna get these capabilities? Are we gonna build it ourselves? Are we going to do our own data store? Are we gonna go to Google? Mayo has going to Google for some things and uh, Ascension has for some things, you know, what's the right strategy at this point?

Yeah, I, you know, I look at this, uh, a little bit from the cybersecurity perspective, right? Analytics people, you know, the core analytics people are really smart. They're not widely available. I. You have to figure out how you're gonna hire them, attract them, and retain them at your health system. And if you're not in one of those really great places, you may about, may have a really hard time hiring and retaining those people.

So I think, you know, there's a lot of thinking that healthcare executives have to do around. What's the possibility of building my own, my own cybersecurity program, , or my own analytics program? And should I be using a partner to help me with that? And if I do, then you know who are the partners. I think you have to think through this.

You know, do I really have the capability of building my own analytics program kind of soup to nuts, or do I need help? And if you need help, you should get help. You should go out and look for that. Yep. I think there are, you know, products and capabilities that. They, they may not be perfect, but they're gonna get you a long way down that maturity model.

Yep. It's interesting. Drex as always, it, it, it was a lot of fun to, uh, seriously. Me too. Well, uh, we'll do it again in, in six weeks and look forward to seeing how much we, we never did a prediction like you and I should do, like, full on predictions. Like this is what's gonna happen.

I don't know. Some of 'em just sort of leave me flat, like, of course that's gonna happen. You know, , Amazon's gonna to improve in healthcare. It's like they're gonna make strides in healthcare. I'm like, of course that's gonna happen. Right. Tell me where, be specific. Exactly. . Yeah, I mean, that's, that's definitely the hard part of predictions.

You can make the big, broad predictions, but hitting, figuring out the ones that are actually gonna hit and stick, that's where, you know, that's where you're only gonna have about a 5% hit rate. If, if you were to tell me Amazon Pharmacy was gonna make a big hit two years ago, that was a, that was a prediction.

But saying it this year is like, well, no kidding. I mean, they have PillPack, they've announced it, they're going to market. I, I, yeah, I, I, I know where they're, I know where they're going now. If you tell me their Amazon Health employee program gets launched at a new, uh, employer, that's news That's. You know, that'll be interesting.

And actually I don't think that'll happen this year. I, Amazon is one of those companies that moves really slow until they're not moving slow. And then they're moving at like hyper speed. Yeah. It's like an earthquake. You know, there's, there's pressure between the tectonic plates and it builds and it builds.

And then once they think they really know something, there's a giant slip, there's an earthquake, and there could be an earthquake in healthcare this year. I think. Yeah. Yeah. Well, we'll see what happens. I see some of my friends, it's been hired by Amazon and I'm, I'm kind of blown away that some of those people are working over there now, and when I talk to them, what they tell me is, I can't really tell you what we're, what we're working on.

that says to me, there's a big tectonic plate about ready to slip. Well, it's, it's not one thing. Right? So. It's the Alexa stuff, and we're gonna put one of these in every hospital room and we're gonna, you know, put something in the, in the OR and whatever. So we're gonna do a bunch of stuff in voice. We're gonna do partnerships.

Supply chain. It's supply chain. Everyone's always looked at supply chains and durable goods. They sort of play in that space, but, and now it's drugs. You know, you have, you have pharmacy and whatnot. Mm-Hmm. . Yeah. I think that's only gonna increase. I mean, they're, they're world class in that, in that space.

Okay. Predictions. So we need to do predictions. Sometime in the future. Sometime in the future. I, I predict that in the future we'll do predictions. It's, but we're coming up on the end of the show, so hey, again. Thanks. Thanks for your time. Really appreciate it. Thank you. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions, please forward them a note.

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