This Week Health

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April 19, 2021: It’s Newsday with Drex DeFord and Bill. We’ve got a long way to go in healthcare. We are not consumer based just yet. How do we get better? What can we adjust? The virtual CHIME conference was last week. What were the key learnings? How did big tech fit in? And what is the future of conferences? Is it too soon for in-person? Did the FBI really nuke web shells from hacked Exchange Servers without telling the owners? CMS issues new guidance to enforce price transparency rule. Moral of the story? Don't hide your pricing from search engines. Data privacy is becoming more and more acute within healthcare. Consumers want to know, what are you doing with my data? Who's using it? Plus Biden outline's health IT funding priorities for 20222.

Key Points:

  • We have a long, long way to go in healthcare before we are the experience makers that we really want to be [00:09:50
  • Kaiser Health News study says we will end up with 60-70% of the population getting vaccinated [00:17:55
  • Casino Healthcare” book by Dan Munro [00:23:18
  • The government needs to think about cybersecurity like they do national defense [00:42:20
  • Mayo Clinic launches 2 new companies [00:43:47



This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest 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 at channel dedicated to keeping Health IT staff current and engaged. Special thanks to Sirius Healthcare Health Lyrics and Worldwide Technology, who are our new state show sponsors for investing in our mission to develop the next generation of health IT leaders.

We set a goal for our show, and one of those goals for this year is to grow our YouTube followers. Uh, we have about 600 plus followers today on our YouTube channel. Why you might ask because not only do we produce this show in video format, but we also produce four short video clips from each show that we do.

If you subscribe, you'll be notified when they go live. We produce, produce those clips just for you, the busy health IT professionals. So go ahead and check that out. Uh, we also launched today in Health It a weekday daily show that is on today in health We look at one story each day and try to keep it to about 10 minutes or less.

So it's really digestible. This is a great way for you to stay current. It's a great way for your team to stay current. In fact, if I were ACIO today, uh, I would have all my staff listening to today in health it so we could discuss it, you know, agree with the content, disagree with the content. It is still a great way to get the conversation started, so check that out as well.

I ran into someone and they were asking me about my show. They are a new masters in Health Administration student, and we started having a conversation and I said, you know, we've recorded about 350 of these shows, and he was shocked. He asked me who I'd spoken with and I said, oh, you know, just CEOs of Providence and of Jefferson Health and CIOs from Cedar-Sinai Mayo.

Clinic, Cleveland Clinic, and just all these phenomenal organizations, all this phenomenal content. And 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. I, I have so much to learn. 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 we did the Covid series. We did so many great things, talked to so many . Brilliant people who are 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. All right. It's Newsday and we have. Drex to Ford in the house. Once again, Drex, welcome back to the show. Hey, thanks. Happy to be here. Always a good time. Thanks for having me. Yeah, I'm looking forward to this. We've got a lot of interesting topics. We'll talk, gosh, we'll talk a little bit about conferences because we just finished the CHIME conference.

I actually snuck out a little bit today. Went to the Health Evolution Forum, town hall that they had. I thought that was really interesting. I got to hear from some, some leaders. What they're doing in that, in that space. And that was, that was interesting as well. We have Chime coming up. Gosh. We got, we, we and we got vibe.

We got a lot of stuff to talk about with regard to conferences. Yeah. What, what works, what doesn't? We've got, uh, some CMS stuff. Uh, you actually posted something. I, I think it was you, it may have been the security guy from SEL Health, whose name I can't remember, Howard. Uh. No Uhhuh. I have, I have his name wrong.

Anyway, , I hate doing that on the show because now he knows that I got his name wrong. Well, we do follow him on LinkedIn though. We do. We do, yeah. Talking about the the FBI security thing, how. Yeah, went in and got the shell and stuff. So anyway. Yeah. Alright. We're, I did, I might have, I might've posted that too, so, yeah.

Yeah. All right. So we're gonna, we're gonna talk about that and we'll also talk about Biden outlines health IT funding priorities going into next year. So I've outlined that and we've got a lot to talk about. But let's start with where we're at. Let's, so let's talk about Chime. Yeah, you just finished two days of sitting in the dunking booth waiting for people to come in, and if people wondering what I'm talking about you, you actually manned the session as one of the Zoom people that they could talk to, right?

If they went to the CrowdStrike booth. Sweet. So you were sitting there waiting for, I mean, talk, talk about let's talk overall. I mean this is what their second virtual conference, we did the fall forum, now we did the spring virtual. What have we, what do, what do we. Uh, you know, so I mean, I think there's a part of me that is like they're getting better.

And not just chime, but just sort of conferences in general. I just did the American College Healthcare Executives, a college, you know, forum. Virtually too. They're all a little bit different. They're using different tools, but I think they're getting a little bit better over time and in a conversation with somebody else, either they said, or I said something to the effect of

Hopefully by the time we have this all figured out, we won't need to actually use any of it anymore. And, and I, I know that we can talk about that too, right? Yeah. It, it. It is getting better. I agree with you. They're, they're all getting better and, and it's really interesting. But they leave you wanting, don't they?

You, you're like, well, I think, I think there's like, there's a couple of different pieces of this. One is the tools have gotten better and the other part of this is we have lowered our expectations about what necessarily. You know, maybe gonna get from the conference. And we've gotten better at navigating the tools ourselves.

And so, you know, they're not perfect. They're not live conferences. A lot of the reason that I go to the Hams Annual Conference or Health or Chime, or. ACHE is for the social interaction that goes on, right? Not necessarily for the presentations, but for the actual, uh, sit down and hear people, you know, misery loves company.

You know, talk about what, what they're working on and what they're challenged with and what we're struggling with, and trading, you know, ideas and then sometimes. You know, you're, you just develop friendships over years and years and years. Sometimes. This is about trading barbs and beers and , you know, all that's good too, and all that is missing from the, from the online format.

Did you get, get a chance to take in some of the center stage stuff? The I did, yeah. There were, there were keynotes. What were they? They were, they were really round tables. I thought they were, you know, I thought they were good too. This idea, you know, of Chime, I think of moving from, you know, big expensive commercial keynote speakers who are really entertaining and can be a lot of fun to watch and, you know, at least online making that transition to more practically oriented

Folks are in the field, folks are in the trenches. How they're solving problems, the, the things that they're up against. A good, interesting transition and I think, you know, really useful. Did you all? So yeah. But bunch of really good moderators, all former guests of the show. So Kane Edwards was there and Andrew Rosenberg from Michigan was there, Daniel.

Darren dor and so all former guests of the show, so we won't say anything positive or negative about them, although they're all phenomenal. Uh, fantastic. Yeah, they're, they and they were, they did a good job of moderating. Did you learn anything? So the first, the first session was the EHR providers. It was, uh, Meditech, epic, and Cerner up on stage.

You learn anything, anything exciting. You walked away from there. Yes, but that's putting you on the spot, isn't it? But, but I mean, it is, it's hard, right? I mean, we've been doing this for so long and we keep such a close eye on those companies and what they're doing, that it's hard to have any big reveal at a, at a conference like this unless they intentionally put something in place to try to have a big reveal.

So, you know, honestly, no. I don't think I walked away with like new or special information, but it's interesting to hear them talk about. If their company's challenges as they went through the pandemic and what, you know, how they leveraged the work that they did or how they're leveraging the work that they did to prioritize and accelerate work that they're going to do in the future, that's all real good.

That, and you know, Howard Messing needs a better light. That was the other thing that I really got these kind. Dark and the dark. So, but that would be the only other thing I would say. You know, I, I, I'm, I'm actually putting a little bit more of an edge to my reporting and my posts and that kinda stuff, and I'm calling out some stuff and one of the things I'm gonna start calling out is we are a self-congratulatory lot.

I understand the work we do is hard and we've done some great things and I, I agree with all those things, but gosh, we spent an awful lot of time self congratulating ourselves for what we've accomplished. And I'd like to see, not that, I don't think we should do that. We should absolutely do that. We should have ACIO of the year.

We should applaud the, you know, most wired. We should, we should do those things. Those are accomplishments. I, I think we need to spend a little more time saying, Hey, where, where are we not making the grade? Where are we not, uh, hitting the mark? Where are we not providing our consumers what they want? It's interesting 'cause I have some people that work for me now on this week in health, it, I'm not a one man shop anymore, and they listen to every podcast.

And there are times they listen to the podcast and they get angry and they just say, I don't know how these people think that the consumer experience is any good. This was my experience and they send me over this email and I'm like, no, . So I, but the, the reality is we've all had those experiences and when we hear the self-congratulatory stuff, we're like, you do realize we have a long, long way to go here before we are the, the experience makers.

Yeah. I mean, it is, it is perspective.

Most of us who work in healthcare, when we go to get healthcare, we have special access just based on people that we know who can help us figure out how to get appointments and help us navigate. I got this bill, can you help me figure it out? The rest of the normal population don't have that kind of access.

So we kind of unfortunately start from that position. And you know, I'm with you. We have to celebrate our small wins that are incremental progress. But I think we have to do it in the context of, like you said, we have a long way to go. We are not. You know, we are not, uh, consumer based delivery healthcare systems for the most part yet.

There's a lot of work to do to get to the point that we're, as they're, that people are as happy with us as they are with Amazon Prime. I'm pretty happy with Amazon Prime at this point. I mean, they, they do a great job, so I don't want, I don't wanna go down this path too far because I don't wanna sound like I'm being negative.

They, they did a great job with the conference. I, I just, I would've liked to pick up more, you know, how are we going to adjust? How are we going to. Get better and those kind of things. Again, I thought the questions were great. You know, Daniel really went after the, he did the big tech companies, which was interesting because I thought Darren didn't go after the EHR companies at all.

It was such a friendly little gathering and big tech came out and it felt like Daniel went after him. I'm like, that's interesting. We, we treated them like, you know, the grandparents came over and we love, thanks.

You know, like Party Crashers and Oh, I was wondering, I was like, okay, where's this going? Yeah. Who's the other grandma and grandpa and, yeah. Party Crashers. Party Crashers. I mean, it's like, Hey, you know, you guys, are you gonna help us or you not gonna help us? And if you're gonna help us, it has to look like this.

Or, or, and Dana was just right in their face of. Hey, are you gonna work together? You're not gonna work together. If you're not gonna work together, this isn't gonna work because I can't work with just one of you. I need to work with all three of you because I have a Microsoft Agreement. I need to put my stuff in in Google's cloud.

I, I, I need to use AWS for some things. And if, if the three of you can't even agree, I think the exact quote was something along the lines of, if the three of you can't even even agree on a time where you can come together and do a video call, how am I gonna get to work for. That was the point, which I was like, Ooh, boy, that was pretty sharp.

Um, anyway, yeah, yeah, that was, that was my 2 cents. Hey, so conferences, we wanna get back together. When is, when is too soon? So one of the articles out there is some healthcare associations moving full steam ahead with conferences starting this summer. Interesting. Different, different approaches here. The Federal Federation of American Hospitals is, uh.

Full steam.

Not doing their event, I think, until either late this year or early next year. But you know, the HIMS event's right around the corner. I think it's August. Yeah, it's, it's, it's August. So I mean that is that it feels like it's just right around the corner. So do you feel like, I mean, they will probably be the first large event that tries to.

Do you think they're, they're pushing it, think they're going a little too early, or think that's the right timeframe? You know, there's so many indicators that I watch all the time about this. I have my first Pfizer vaccine in, I get my next one on the 29th. Give that another 30 days. I'm in June. I'm, you know, I'm vaccinated and I have all the antibodies built up, but I realize that's not most of the country.

And so as we continue to sort of watch the, okay. 30% of the country's vaccinated and we're vaccinating. I don't know some, you know, some percent every week. The math says we ought to be at the point where we probably have everybody vaccinated who wants to be vaccinated, maybe by July, something like that.

Unless we have some kind of a problem with a vaccine. Which we see right now with Johnson and Johnson. And so now we're holding up the show. Now how many of those doses would be in arms if they weren't held up? So it's a very tenuous thing, right? And I, it concerns me a little bit about trying to walk the tightrope of.

Okay, let's do it in August when maybe July is the time when everybody is maybe finally vaccinated, but it only takes one oops. To make that, you know, two months later or a month later. So I'm, I'm skeptical. I'm kind of like a, uh, it would be better if, if maybe we waited a little bit longer, but, you know, I'm sure there's a lot of other.

Pressures around all of this that, you know, that make August a, a reasonable date. You know, my, my question is, who else is going because I, you know, the mortality rate in my age group is less than 4% since the beginning of the pandemic to now, and I'm, I'm in, I'm in an older. Actually it's, it's closer to 2% actually in my, in my age group.

And so, you know, that doesn't concern me. I have my first, uh, dose of the vaccine. I'm gonna get another one. I've seen the stories where people who have gotten the vaccine also get covid, but the numbers are so minuscule that it's within the range that they tell you is the risk that, that it could, that you could get the vaccine and still get it.

And so I think the risk is low enough that I. Going, the risk, even if I get it, is not, you know, it, it's a, an acceptable risk. I mean, have more risk driving to the airport and driving in, you know, Vegas traffic traffic than I'm really, am I gonna get to after I'm vaccinated and I'm wearing a mask, actually getting covid and then being one of the 2% that actually has a, is a fatality from it.

So why? If you're not gonna go and why go if you know the, the people I wanna see aren't gonna go. . Yeah, I, I think my concern is probably more of the larger public health concern. I'm not a public health guy, but I do worry about the variants. And I do realize, I mean, it sounds like right now that as variants continue to proliferate, they're for the most part handled by the vaccines that we have today.

But it probably takes, you know, one or two weird variants that aren't handled by the vaccines that we have today. And we're back at the beginning of this whole cycle again. And the way we get more variants is that . People aren't vaccinated and they're out trading around the virus, and the virus continues to adapt and generate these variants.

So in the larger sense, you know, the reason not to go might be, you know, just, uh. Hold, you know, keep your powder dry for another few months and we are able to sort of wipe out all the variants too. It, it, it may be about personal safety for a lot of people. I think it is. I certainly think that by August given my vaccine status, I'll probably feel much more safe about traveling, but I may not travel because I worry about this larger public health potential challenges out there.

I was, I was trying to pull up the, so I, I covered this on today in health it on Friday. Of course, we're doing this on Thursday, so the show will go live tomorrow morning. But it's the, uh, most recent HHS statistics and those kind of things. The numbers are actually pretty encouraging except for the, you know, ki I think it was Kaiser Health News.

There, it's, there's the report. So Kaiser Health News came out with a. Essentially this and saying, look, we're probably end up. To 70% of the population getting vaccinated. Mm-Hmm. , it looks like about 20% are just not gonna get in line. And then there's a portion that are just not going to get vaccinated, either from an access standpoint or some, some other reasons that are there.

So we're, and, and they're talking about, you know, herd somewhere in is what they're looking so.

Year and for the foreseeable future where some portion of the population is not gonna be vaccinated. And then we're gonna run into this thing of, you know, if this an every year thing and we look at vaccination rates, we've, we've got some challenges in front of us in terms of feeling a hundred percent safe.

And this is part of my concern and. I don't think we're ever gonna feel a hundred percent safe. Yeah. How are we gonna get back to, you know, how are we gonna get back to functioning? This isn't really where I wanted to, to go with the show, but I, you know, when we talk about these conferences and I'm looking at a picture of all these people milling through the HIMSS floor, and we all know what that's like.

Yeah. You're not gonna feel safe. There's no way you're gonna feel safe in that environment. So they're gonna have to redo the, the showroom floor differently. They can't possibly have. 40, 50, 60,000 people in that room. So you know, what does it look like? They've gotta really rethink, and I don't think, one of the things this article talks about is they haven't published what their safety protocols are gonna be, and I think that's gonna be a limiting factor.

HIMSS could be in trouble if they don't get ahead of this safety aspect just from the conversation you.

Look the even after everybody's vaccinated, 70, 70%, let's just say 70% of the people decide to get their vaccination. There's some other percentage beyond 70% that already had covid and have some sort of natural immunity. So maybe we can get to 80%, but when it comes to conferences like this, you know, I, the, the, the new normal to overuse a term might be.

That we're still gonna, you know, wear masks in situations where we can't social distance and, you know, we're going to spend a lot more time thinking about washing our hands and what we touch and what we don't touch, and shaking hands or bumping elbows instead of shaking hands. All the kinds of things that.

We've learned to do in the last year that probably are pretty good for public health in general anyway. Absolutely. Like, you know, if you're not washing your hands and sort of keeping your social distance from people that you don't know or aren't in your core group, uh, you probably should be doing that anyway.

I mean, it just, you're probably just generally gonna stay healthier because of that. So maybe we've developed some habits now that are gonna go on and are gonna be good for us, and we'll see. So I do, I do worry about himss. Yeah. So if anybody's listening from himss, here's the, the, the reality is if you have 50,000 people there, it means 10,000 are not gonna be vaccinated.

If people aren't vaccinated, I doubt you're gonna have 50,000 people there. So you gotta tell us. You gotta tell us the protocols, you gotta tell us what you're doing, how you're changing what we have in our head as the vendor floor and the conference rooms. How are you doing that differently? So yeah, we can feel comfortable telling our company we should go and they should pay for it.

And, and there, there are still companies that have travel bans on and I'm like, okay, so there's systems. To this, they can't afford to send their team to this event from a, from a risk standpoint. And so anyway, we'll move on from there. I hopefully somebody from him is listening. They're gonna come out with their safety protocols and we'll figure it out.

To be honest with you, I've not decided whether I'm going yet or not. So I'm going to continue to have conversations, find out who's going, if enough people. I'll probably end up going cms. So CMS issues new guidance to enforce price transparency. Did you see this one? Yeah. Yeah. Uh, it's interesting. Don't, don't hide your pricing from search engines.

Yes. So they've hidden it from us. Right? I, I've heard this from people. It's like.

But, you know, regardless if they hide it from us or not, they can't hide it from big tech. They can't hide it from the, from, you know, bang from Google, from all the, uh, search engines that are out there, which means that they're gonna pull it up. And if you know anything about Google, their strategy is that if you ask a question on the front page, in the, in the box that it gives you, it tries to give answers.

And so there could come time.

A. Pulls it up up because yeah, CMS is, is gonna go after health systems that put the, uh, no search function on there. You think this is a good thing, so I don't Yeah, I know. If you, uh, I don't know if you follow Dan Monroe on Twitter, and I don't want, I, have you ever done had Dan Monroe on as a guest? I have not.

He is, he's a great, you know, writer, uh, for, uh, Forbes and others, and he's written a book called Casino Healthcare, and it's, you know, if you talk to Dan about this, he would probably say, I don't know that it really matters. You know, do, do you care what the price is of the colonoscopy that you're going to get?

If your insurance company is paying for it and telling you that you can only go to one of these four places anyway, would you look at pricing to decide where, you know what the answer to that is? Yes. Yeah. Do you know why? I care? Why? 'cause I'm an employer. That's why I care , because I'm paying for that insurance.

I pay a hundred percent of the insurance cost for my employees. Yeah, I am paying for that. So next year when my fees go up, when my costs go up, because you know, people aren't being dis, you know, discretionary in terms of their, their healthcare spending. Yes, I do care. Yeah. I think it is a problem that there's a $20,000 colonoscopy when the average is like 3,500 bucks.

Yeah, no, I, I, look, I totally get it , but I think, uh, Dan would be able to point you to a lot of, a lot of. Sources that say that for the most part, if they knew the prices, most consumers would not change what they're doing as far as their behavior. And so this may be some kind of an okay start to trying to figure out how to influence.

Consumer behavior, but this may not be the thing that influences consumer behavior. We're, we're burning a lot of, we're creating a lot of heat and smoke around this issue. But I don't know if we're, you know, too many analogies, but is the juice worth the squeeze? Is it really gonna have the effect that we want?

So, we'll, you know, we'll see. But you know, mostly outta curiosity. I might look around and see where the lowest price colonoscopy is, but I'm probably going to the colonoscopy shop that. Is covered by my insurance. Well, here, let me point out your inconsistency, which is okay. Do you believe transparency is good in government?

Yeah. Yeah, absolutely. Do you believe transparency is good when you go to buy anything? Buy a lawnmower. Yeah. If I have a, if I have a broad range of choices, then price is definitely one of the things that influences where I go to buy. Because, yeah, because transparency communicates trust. Right. I trust you to make the right decision.

And the problem with healthcare is we are arrogant and we believe that the consumer doesn't know enough about health to make the right decision, and instead of informing them, we care for them. We care for them by keeping information from them. We care for them by not informing them. That's one of the challenges we have.

We need to change the mindset, and the mindset needs to be, you know what, we trust them to make the right decisions. And if they make the wrong decisions, there are safeguards. We're going to inform them. We're gonna say, are you sure you want to do this there? You know, there might be a better procedure here.

You may wanna stay in your own community. You know, whatever it is. It's their decision and we trust them. Therefore, we're gonna give them the pricing. We're gonna give them the quality scores down to the doctor level so that they know that the doctor they're seeing is, you know, is, is, is not as good as the doctor who's, you know, down the street and around the corner that they could just as easily, uh, have gone to.

Sure. You said something really important there and that's trust. You know, I definitely trust. The advice of a friend of mine who had their hip replaced that told me that this, you know, these guys at this organization were, you know, probably they were, they were really good. They had a really good experience there, and, and they, they thought they, they did a good job.

And then I looked up the doctor's scores, the quality scores, and I was like, okay, this is pretty good. I like this particular. Surgeon, let's see if they're in my group of people that I can be referred to. And I found out that they were, and that's who I went to. But I never looked at pricing that had nothing to do with trust for me.

I knew. I was probably gonna have a copay. I mean, I'm lucky, right? I have insurance. I knew I was, I was gonna have some kind of a copay, but the copay didn't change. If I went to doctor A or doctor B, or Doctor C or Dr. D, it really didn't. Now, what the insurance company had to pay may be wildly different pricing, and that may be the, the information that's exposed, and I may get.

Aggravated by looking at that pricing and saying, how can it be $20,000 there and $5,000 there? But I don't know that it would've changed my mind once I've sort of figured out that this doctor is the doctor that has the quality that's been recommended by a friend, and so I trust that that's probably the best place for me to go.

I wonder if it's more of a wall of shame issue than it is a. You know, influencing patients to go to a particular, to a particular doctor based on, based on price. Yeah. It's, it, you know, I keep coming back to trust. There's, there's part of it that's like, what are you hiding? What are you hiding? That I don't know what it's gonna cost me every time I go to the doctor.

What are you hiding? Oh, for sure. Now, I'll tell you, I think from a transparency perspective, absolutely pricing should be transparent. I just don't know if it's gonna have the influence that we're expecting it to have, but generally speaking, shining a light into the darkness on any of these issues is a good thing.

Yeah, it's a good thing because it makes healthcare systems also do things that they're not comfortable with, like cost accounting and really figuring out what things actually cost instead of just saying. We have a facility charge and we just put it on top of all the things that, you know, that we, that every time we treat a patient, we just chunk on this, you know, a facility charge.

And it's just a big number because we, we aren't good at cost accounting. Well, maybe we have to get better at that now, and if we do and we're, we're able to figure out pricing, then I think that's a good thing. Yeah. 'cause one of the problems in healthcare is we this in economics demand. Increased pricing, the demand goes down, and when you decrease pricing, the demand goes up.

And the reality is, in healthcare, there is no elasticity. You could raise the price forever, then we're still gonna go to that hospital. That's right. And you could lower the price and it's not gonna increase. So it doesn't respond to the normal, normal market demands. Mm-hmm. Yeah. The market dynamics. And so, you know, to a certain extent it's not gonna change behavior all that much.

It, but it does become a, a source of trust, a source of, i i, I don't know, communication and those kind of things. Let, let's, gosh, which one do we wanna talk about next? Let's talk about your security one. I think that's an interesting too, because that's a trust question. It's interesting. Yeah. So what, what was that about?

So. The FBI was responding to a threat, I guess. Right. Do you have the story in front of you? I don't. Okay. So this is dangerous territory for us. , definitely. Well, the FBI apparently went out and

without getting into the. Kind of nitty gritty technical details. The FBI got a warrant to be able to go out and go into organizations and do some. Partial cleanup of breaches that had happened, you know, to take, take particular actions in a network to, to at least partial, partially resolve some of the issues that were in these networks.

And so part of this was the, you know, sort of uncomfortable feeling of like, you know, I've been breached. And then the government actually used the information about how I've been breached to . Come in and do a partial cleanup, but they didn't fix everything. They just removed this particular piece of malware and it, it's, it's a, I don't know.

It feel, it doesn't, I'm not sure it feels right. I'm from the government. I'm here to help and, yeah. Just a little bit. That's what you said. I just, I just pulled it out. It will, it is Howard. It's Howard Haley. Who's Howard, who's the CSO for.

Which is interesting in of think that's the g.

Which was probably accurate. They probably did. But how do they know that? I mean, you know, how do they know that? And then the other thing I wonder about is if you go in and you remove that, you know, those web shells, if you go in and do that work, have you has somehow that organization now lost evidence that they would like to know as part of their investigation around the, the hack themselves?

This is a really interesting to me. Like, how, how did this happen? I would be upset if my organization were one of those organizations because, you know, I don't know how I, I'll tell you this. How do they know? I wouldn't have taken care of it from a transparency perspective. I would at least have appreciated a phone call saying that we're gonna do this.

Are you okay with it? ? I, I, I agree with you. I, I'm like, something doesn't feel right about me about this. So the department Justice press.

Still exchange servers, copy the shell shell from the. 'cause they believe that the owners of the still compromised web servers did not have the technical ability to remove them on their own, and that the shells pose a significant risk to the victim. Based on my training and experience, most of these victims are unlikely to remove the remaining web shells so forth.

That goes on to say, but I think a little later on it says, Hey, the reason they didn't tell is because they thought they might essentially interfere with this work, and it was too critical. In other words. They didn't wanna risk being told no , so they just did it. And we need, we need policy and ethics, people to be working like triple time these days.

There's so many new things coming at us. Yeah. Yeah. I, I think that in this story, there's some top secret. There's some piece of this story that we don't know and we don't understand, that might make us also now, I mean, as I say here and sort of think about it again, there might be some piece of this that makes us, if we knew that part of the story, we might go, oh man.

Okay. That totally makes sense. So I wonder if there's some. Piece of intel that we don't have that makes this feel not right. But if we knew the other piece of intel, we might say, I'm glad they did it. I just don't know. It feels uncomfortable knowing what I know. Yeah. Well, I wouldn't wanna, I wouldn't want to come home after a, a week gone and have a little note on.

I was in your house for a couple days. We, you know, just thought we'd take care of some things. I, I, I dunno, there's just part of me that, that wasn't, I dunno, I, I don't, I don't even know what I'm saying. I'm just, I, I guess there's, there's policy and there's ethics and I really, I, I, I, I, I want them weighing in on this stuff.

I want them, the cybersecurity stuff is gonna create some interesting things. Data privacy is, is becoming more and more acute. Within healthcare, what are you doing with my data? Where are you using it? Who's using it? There, there's, there's an awful lot of things that we could use. People coming out of our colleges and universities who are working on ethics and, and really focusing on the ethics aspects of it instead of the politics aspect of it.

Not coming out trained in a certain way of thinking, but coming out and looking at it. From the different perspectives that are out there. What does this mean to the individual? What does this mean to the rights of the individual? What does this mean to the rights of the, the whole, the group, right? So some of this stuff might impact more than just me and my organization might impact others.

That maybe that's why they did that work. I. Again, you might be right. There might be some piece of information we look at and go, yep, that was the right move. Yeah. I just wanna know that they're, they're following a framework of some kind. Right. And I, you know, some of this is, do you trust that whatever the reason was that the judge.

Gave them permission to do this. You know, maybe, maybe, I mean, certainly that's the role of judges in, in, in granting these kinds of actions is that, you know, they, they get a brief that if we looked at it, you know, 80% of it would be redacted. There's something else in this story that I think we don't know.

Yeah. Like I said, based on what I know, I'm with you. I would not wanna come home and and find out that the FBI had gone through my house and and done something, but they didn't ask me permission of there's something not right. But there's something absolutely right. I don't know, which it's always fun for you and I to, uh, talk about such things.

So Biden outlines health IT funding priorities. Always, always a, a good topic for us. The Biden administration. This past Friday released a letter outlining President Joe Biden's request for fiscal year 2022, discretionary funding in advance of Congress's annual appropriations and budget process, the consequences.

Anyway, they, they go on to talk about some stuff. I'll skip that and just get down to what they're, the additional funding would go towards modernizing public health data collection nationwide, in addition to supporting care. Public health territories, training new epidemiologists and other public health experts and building international

detect. Prepare and to emerging global threats according to the letter. So lemme give you some of the numbers. 53 million would go towards the C D's social determinants of health program to support the states and territories in improving health equity and data collection for vulnerable pop populations, 6.5 billion.

Advanced research projects agency ARPA for Health. Uh, a new agency ARPA for Health aimed at driving transformative innovation in health research. And speeding Implementation of health breakthroughs. In addition, the request would provide 65 million to 2021 enacted level of rural e connectivity program.

Reconnect for rural broadband makes sense, which we've talked about. The wishlist also includes 39 million for advanced communication research at a.

Which would support the development broadband technologies.

Uh, interesting sounds infrastructure to me. Million would go towards expanding scientific and technology research. Three, uh, 2.1 billion for cybersecurity and infrastructure security agency, 20 million for new cyber response and recovery fund. Three, 500 million for technology modernization fund. And let's see, 4.8 billion for va, 2.7 billion for two of, of which 2.7 billion is gonna the modernization of the electronic health record for the va.

Yeah, I think that Cerner upgrade. Yeah, I think that's a, I mean that, that covers the majority of what's in there. I mean, what are your thoughts? You're, you're a fan of, of the president, so I, I I assume that you're gonna support most of these initiatives. Right. You know, I mean, I, I have to dig into 'em too and kind of see, you know, what the story is, but I mean, a lot of these things sound very infrastructure improvement, preparing for the future, broad rural broadband.

You know, the VA EMR upgrade, I think is gonna be one of those things that we're gonna see go round and round and round. Because there's a, I mean, you know, this is a, this is a takeout, an EHR that is a legacy EHR, that's, that's working and put in Cerner and that. Project seems to be struggling. We see regularly stops and starts and and reboot change.

Projects do struggle. Or that would wither under this kind of scrutiny, especially, uh, you know, that size of a, of a deployment, right? I mean, I deployed, uh, the first two different generations of electronic health records in the Department of Defense. And, you know, it's a super com I mean, it's healthcare, it's super complicated, and it's inside the federal government, which makes it even more complicated, filled with lots of additional regulations and, and like you said, oversight and politics.

And politics around, you know. The whole procurement process and all of that too. So it is, it is very complicated. I know it's not gonna be easy to do, but yeah, I mean, I think continuing to make, you know, good investments in public health, several of the items you read off were sort of public health modernization, which we sort of figured out over the course of the pandemic, especially in the early stages.

Tons and tons of problems with public health. And the, the lack of investment at the local and state level over the past several years and, you know, maybe, maybe we'll be able to catch up. But to your point, this isn't about just catching up and, you know, and other conversations that you and I have had, this isn't about necessarily just catching up and building the things that we use today.

This is about spending that money to build the things that we want. To be in the future. And it's, it's, uh, you, we, we really have to sort of keep that in mind. 'cause if we just build stuff that we already have, then we're not, we're not spending the money. Well, yeah, I, I'll, I'll tell you this might surprise you.

I, I have no problem with any of this. I, I really like the cybersecurity stuff. This is way past due. I, I think we need to, this one of the areas, I believe the federal government needs take role and in cybersecurity. And not that I think they should, you know, you serve what, you know, private industry is doing and the, the, the, the great security companies that we have that are, that are advancing in technology, but they need to think about it like they do national defense and this 2.1 billion and a couple hundred million here and there, probably still not even enough.

See them really invest in, in that. These really jump out at me. I, I do agree with you. We talked about this earlier. I, I, I did have a problem with the, all the money that went to health systems as, as a result of the pandemic, all the, the recovery money and, and not because I didn't think it was necessary.

I did think it was necessary. I just think it went in a lot of cases to the wrong places. It, it, it, it shored up balance sheets that didn't need to be shored up, and other balance sheets that were teetering are still teetering after the money got distributed. So I, I, I just, I'm not sure that was, that was, well, I.

Thought out, and I'm not gonna call anybody out on that in terms of who took the money, who didn't take the money. HCA did not take the money, which is interesting. But I, I agree with you. You know, we are, we need to leverage this funding to create. Healthcare we want to see, not necessarily to support the healthcare that we've had in the past.

And that's, that's, that's gonna be the key. Oh my gosh, Rex. We're almost here. How long have we been going? Well, let me ask you, let me ask you about this. So Mayo, Mayo Clinic watched two new companies and Oh, I saw that lot gonna come on the show, by the way. Do you say Halamka? Orka, Halamka. That's what I say as well, but I heard him introduced, uh, at the CHIME event.

Today is Halamka. And I thought, man, I dunno, maybe I'm saying it wrong. I've known him for years. I think I'm right, but yeah. Well, and, and yeah, he was a professor in one of the courses I took up at Harvard and he, he introduced himself as Halamka. So I, I assume, unless he is changing the pronunciation , but from Time Head of the Mayo Clinic platform, I love what they're doing by the way, essentially.

We need a platform to support healthcare moving forward, and that platform has to be meet people in their homes and where they live in motion. Not necessarily only within the four walls of the health system, and that requires a certain level of, of technologies to be stood up so that we can collect the information from these diagnostic devices.

Go at home. Yeah. And, and yeah, in motion at at work. Feed that information into. Uh, sophisticated algorithms that are AI enabled, ML enabled machine learning, enabled ai. I realize some people have gotten on my case. They're like, you realize you're being redundant. Uh, I realize that ML is a form of ai, but it's a very different form, but they're feeding it into there, which is helping them to respond to, you know, larger groups of, of the population and only put that information that is really necessary.

The insights. Of the clinic so that they don't have to wade through the mountains of information and it's, it's really interesting. So they're launching two new companies. I won't go into the details. I I did go into it in Thursday's today. Show two interesting companies, and I like to direction here.

Here's my question for you. This is, this is a tough one. I'll close you on a tough one, which is, do you see other health systems doing this level of forward thinking movement to move into the home? In, in this way. I know everybody has a, a hospital, a home initiative, but this seems to me to be sprinting towards, uh, blue ocean, as they say, sprinting towards that area that really nobody else has really taken a hold of yet.

Yeah, no, I think John's, you know. Hired John because John, and I think he even said it today, something to the effect of John is a builder, right? John is a maker of things, but only where things need to be made. What, what he's really good at and what he's good at. From my experience with him in Boston too, he is really good at putting together teams who look and understand problems and issues and challenges around the delivery of care and how that delivery of care is changing for us, moving more and more to outpatient, more and more to home, and then figuring out how to solve those problems, kind of using a criteria of.

Is there something I can buy to do that? And if there is, then we should definitely buy. And if there's not something to buy, then maybe we partner with somebody to invent something to make that work. And if nobody wants to do that, then we have to build it ourselves. And he has a platform he, and I don't mean the Mayo platform, although that is what it is.

He has a place that is willing to make investments to facilitate. What in many ways is kind of the cutting edge thinking on, on how to deliver on this. And you know, he's, I think he's the right guy. He's the right guy at the right place, at the right time to, to make some pretty cool stuff happen that could wind up being the standard that everybody else winds up following.

Yep, absolutely. Drex. I could hear your voice is already, you know, starting to go after two days of just doing nothing but talking. It's been a long, it's been a long couple days. Yeah. So I, I really appreciate you doing this. I lot and the sun's shining in Seattle as you can see, so. Wow. I know. Well we should have covered that news story.

The sun is shining in Florida as well. Not, not as much of a story as you've mentioned. Hey, thanks again. It always great talking to you. Of course. Same here. I'll talk to you soon. 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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